Synthesis of novel tricyclic heterocycles from 2- [3-Methyl - 1,2 dihydroquinoxalin - 2 -ylidene] malononitrile

A number of pyrrolo [1.2-a]quinoxalines [3a-f], pyrimidol [1,6-a]quino-xalines [5a-c. 10.13]. pyrido[1.2-a]quinoxalines [6, 7a.b, 8a.b. 14]. [1.3] thiazino-[3,4-]quinoxalines [9, 11] and [1.3] oxazino [3,4-a]quinoxalines [12a.b] were obtained via interaction of 2-[3-methyl-1.2-dihydrquinoxalin-2-ylidene]malono-nitrile 2 with different reagents

comparative study between analgesic effect of low-dose intravenous ketamine and intrathecal fentanyl with spinal anaesthesia for caesarean section

For comparing the analgesic effects of intrathecal fentanyl and low-dose intravenous ketamine as adjuvants to intrathecal bupivacaine for Caesarean section. Forty five elective Caesarean section patients were randomized into three groups. Spinal anaesthesia was performed with 15 mg hyperbaric bupivacaine in all groups. Ketamine [0.15 mgkg -1] or an equal volume of normal saline was given intravenously immediately after initiating spinal anaesthesia in ketamine and control group respectively. Infentanyl group, 10 micro g fentanyl was added to intrathecal bupivacaine. Arterial pressures, heart rate values, adverse effects, the first request for postoperative analgesia, visual analogue pain scores, total analgesic consumptions at 24 and 48 h were recorded in all patients. The time to first request for analgesia was significantly longer in the ketamine [197 min] and fentanyl [165 mm] groups compared to the control group [144 min]. Postoperative pain scores were significantly lower in the ketamine group than in both other groups. Although the analgesic requirements during first 24h were significantly lower in the ketamine group, there was no significant differences between the groups during the following 24 h Intravenous low-dose ketamine combined with intrathecal bupivacaine for Caesarean section provides longer lower postoperative analgesia and lower postoperative analgesic consumption than bupivacaine alone suggesting a pre-emptive effect

continuous positive airway pressure [CPAP] for ventilation for patients with multiple fracture ribs

The role of non-invasive positive pressure ventilation delivered through a face mask in patients with multiple fracture ribs is uncertain. We conducted a prospective, randomized study of continuous positive airway pressure [CPAP] given via a face mask for spontaneously breathing patients compared with intermittent positive pressure ventilation [IPPV] with endotracheal intubation [ETI] in 52 patients with multiple fracture ribs who required mechanical ventilation. The 52 mechanically ventilated patients were randomly divided into two treatment groups: the ET group [n=27] received mechanical ventilation with ETI, whereas patients in the CPAP group [n=25] received CPAP via a face mask with patient controlled analgesia [PCA]. Major complications, arterial blood gas levels, length of intensive care unit [ICU] stay and ICU survival rate were recorded Nosocomial infection was diagnosed in 10 to 21 patients in the ET group, but only in 4 of 22 in the CPAP group [P=0.001]. Mean PaO 2 was significantly higher in the ET group in the first 2 days [P < 0.05]. There were no significant differences in length of ICU stay between groups. Twenty CPAP patients survived, but only 14 of 21 intubated patients who received 1PPV [P < 0.01]. Non invasive CPAP with PCA led to lower mortality and a lower nosocomial infection rate, but similar oxygenation and length of ICU stay. This study supports the application of CPAP at least as a first line of treatment for multiple fractured ribs caused by blunt thoracic trauma

comparison between effects of dopamine and dopamine analogue during the early stages of sepsis- induced renal dysfunction

Vasopressor-induced vasoconstriction may compromise renal and splanchnic blood flow in patients with septic shock, resulting in secondary organ failure. The author compared the effects of the vasodilatatory agent dopexamine against a renal-dose of dopamine and placebo in patients with early stages of sepsis-induced renal dysfunction on norepinephrine therapy, using 24-hour serum creatinine clearance [C[crea]] as a major endpoint. The primary hypothesis to be tested was that dopexamine is more effective than dopamine and that dopamine shows better effects than placebo regarding organ failure and C[crea] This is a prospective, randomized, controlled double-blinded study, done in the intensive care unit of Alain Hospital, UAE. Sixty-one patients with septic shock defined according to established criteria. Patients received either dopexamine [2 micro g-.kg[1], min1], n=20], dopamine [3 micro g.kg[1] min[-1], min[-1], n = 21], or placebo [n = 20]. The trial groups were similar in terms of baseline characteristics. The author found no significant differences among the dopexamine, dopamine, and placebo groups with regard to a comprehensive number of renal function parameters including C[crea] and organ-failure scores. There was a significant increase in heart rate after dopexamine group. In a post hoc analysis that included only patients with renal impairment at study inclusion [n=28], patients who received dopamine showed significant improvements in C[crea] when compared with placebo. Dopexamine was not effective in this subgroup. Dopexamine is no more effective than dopamine or placebo regarding renal function in patients with early stages of sepsis-induced renal dysfunction requiring norepinephrine. Both therapies do not influence organ-failure scores