The Application of Nanotechnological Therapeutic Platforms against Gynecological Cancers.

Gynecological cancers (GCs), ovarian, cervical, and endometrial/uterine cancers, are often associated with poor outcomes. Despite the development of several therapeutic modalities against GCs, the effectiveness of the current therapeutic approaches is limited due to their side effects, low therapeutic index, short halflife, and resistance to therapy. To overcome these limitations, nano delivery-based approaches have been introduced with the potential of targeted delivery, reduced toxicity, controlled release, and improved bioavailability of various cargos. This review summarizes the application of different nanoplatforms, such as lipid-based, metal- based, and polymeric nanoparticles, to improve the chemo/radio treatments of GC. In the following work, the use of nanoformulated agents to fight GCs has been mentioned in various clinical trials. Although nanosystems have their own challenges, the knowledge highlighted in this article could provide deep insight into translations of NPs approaches to overcome GCs.

Evaluation of Palm Print Sign and Prayer Sign in Prediction of Difficult Laryngoscopy in Diabetic Patients.

Background: Laryngoscopy or endotracheal intubation in diabetic patients due to impaired mobility of the Atlanto-occipital joint owing to non-enzymatic glycosylation in connective tissue has always been a problem. A difficult laryngoscopy can disrupt the intubation process; therefore, it is valuable to predict difficult laryngoscopy using some anatomical criteria before general anesthesia. Objectives: The present study discussed the diagnostic value of two tests, palm print sign and prayer sign, in the prediction of laryngoscopy difficulty. Methods: Design: A diagnostic test and cross-sectional analytical design were used in this study. Setting: The study population included 200 patients with type 2 diabetes who were candidates for surgery under general anesthesia. Before surgery, the patients were examined regarding the airway status, Mallampati classification, head extension rate, thyromental distance, body mass index, upper lip biting test, and two palm print sign and prayer sign tests. All the diagnostic tests were compared to the Cormack test result for difficult airways regarding their sensitivity and specificity in difficult laryngoscopy. Results: The highest sensitivity was related to the Mallampati test, prayer sign test, and palm print sign test (100%). Furthermore, the mouth-opening test had the highest specificity (100%). The highest accuracy was reported for Mallampati, palm print sign, and prayer sign tests (> 86%). Conclusions: Among the tests studied to predict difficulty in laryngoscopy in diabetic patients, Mallampati and palm print sign tests have good sensitivity, specificity, and accuracy. Studies with a larger sample size are suggested to obtain more accurate results.

Comparison between the Effects of Dexmedetomidine and Midazolam on Postoperative Cognitive Impairment after Coronary Artery Bypasses Graft Surgery: A Randomized Clinical Trial.

Background: Postoperative cognitive decline is a common complication observed frequently after general anesthesia in the immediate postoperative phase. We studied the effects of dexmedetomidine versus midazolam during coronary artery bypass graft (CABG) surgery on cognitive and memory function. Methods: In this clinical trial, 42 elective on-pump CABG candidates under general anesthesia, aged between 40 and 65 years, were enrolled randomly in 2 groups. Group A received 0.05-0.1 mg/kg of midazolam and Group B received 1 µg/kg of dexmedetomidine. One day before surgery, all the participants underwent the Persian version of the Mini-Mental State Examination (MMSE) and the Persian version of the Wechsler Memory Scale (WMS) test for a comparison of cognitive impairment and memory functions. Both groups were given fentanyl and propofol for the induction of anesthesia and muscle relaxants. The MMSE and WMS tests were repeated 5 and 30 days after surgery. Results: The mean±SD of age was 55.47±7.18 y in Group A and 55.39±6.08 y in Group B. Eighty percent of the participants were men in both groups. There were no significant differences between Group A and Group B in the MMSE and WMS before surgery (89.04±14.30 vs. 97.10±18.10, respectively; P=0.059), but the WMS was significantly different 30 days after surgery (87.60±14.30 vs. 103.53±19.93, respectively; P=0.005). Group A showed high cognitive impairment and low WMS scores compared with Group B (P=0.005). Additionally, the MMSE results were not statistically different between the 2 groups postoperatively (24.80±3.18 vs. 23.55±4.18, respectively; P=0.394). Conclusion: Our results showed that dexmedetomidine might have a lower impact on cognitive function than might midazolam among patients undergoing CABG.

Unusual management of parturient patient with severe bicuspid aortic valve stenosis and congestive heart failure.

BACKGROUND: Critical aortic stenosis (AS) is an unusual cardiac pathology in pregnancy, but has significant impact on the fetal and maternal outcomes of pregnancy. Pregnant patients with aortic stenosis and heart failure represent a major challenge for the heart team and anesthesiologist who should balance the risks and benefits of different treatment strategies and their effects on the mother and fetus. CASE REPORT: We present a 26-year-old parturient who underwent cesarean section at 30 weeks of gestation under general anesthesia in the presence of cardiac surgical team followed by deferred aortic valve replacement after two weeks. CONCLUSION: This report describes the importance of multidisciplinary preoperative evaluation, and careful surgical and anesthetic planning to avoid the deterioration of perioperative cardiac condition in such patients.

Effect of dexmedetomidine on postoperative pain in knee arthroscopic surgery; a randomized controlled clinical trial.

BACKGROUND: Various drugs are administered intra-articularly to provide postoperative analgesia after arthroscopic knee surgery. The purpose of this study was to assess the analgesic effects of intra-articular injection of a dexmedetomidine following knee arthroscopy. METHODS: Forty six patients scheduled for arthroscopic knee surgery under general anaesthesia, were randomly devided into two groups. Intervention group received 1µg/kg dexmedetomidine (D) and isotonic saline. Control group received 25ml isotonic saline (P). Analgesic effects were evaluated by measuring pain intensity (VAS scores) and duration of analgesia. RESULTS: There was no significant difference between the two groups in terms of age, sex and weight. The mean of post-operation pain severity in 1, 3, 6,12, and 24 h was significantly lower in the intervention group (D) in comparison with the control group (P). the mean of the total dose of tramadol consumption was significantly lower in the intervention group in comparison with the control group (P<0.001). CONCLUSIONS: Intra-articular injection of dexmedetomidine at the end of arthroscopic knee surgery, alleviates the patients' pain, reducing the postoperative need for narcotics as analgesics, and increase the first analgesic request after operation.

Paracetamol, ondansetron, granisetron, magnesium sulfate and lidocaine and reduced propofol injection pain.

BACKGROUND: Propofol is a most widely used intravenous anesthetic drug. One of its most common complications is the pain upon injection; therefore, different methods, with various effects, have been proposed in order to alleviate the pain. OBJECTIVES: This study investigates the effects of paracetamol, ondansetron, granisetron, magnesium sulfate and lidocaine drugs on reducing the pain of propofol injection during anesthetic induction. Also, the hemodynamic changes will be analyzed. PATIENTS AND METHODS: This is an interventional study containing 336 patients underwent elective orthopedic surgeries in Educational Hospitals of Mashhad University, using systematic sampling, the patients were divided into six groups. A 20-gauge needle was inserted into a venous vessel in the back of the hand and 100 cc of Ringer serum was injected into the vein, which was applied proximal to the injection site. Afterwards, paracetamol 2 mg/kg (group p), magnesium sulfate 2 mmol (group M), ondansetron 4 mg (group O), granisetron 2 mg (group G), lidocaine 40 mg (group L) and 5 cc saline (group S) were injected into the vessel, after 60 seconds, the tourniquet was opened. One quarter of the total dose of propofol (2.5 mg/kg) was injected with a flow rate of 4 mg/sec and then the injection pain was measured. Finally, the fentanyl (2 µg/kg), atracurium 0.5 mg/kg, and the remaining dose of propofol were injected and the vital signs were recorded before the administration of propofol and 1, 3, 5 and 10 minutes after the propofol injection. RESULTS: The six groups did not significantly differ, regarding their gender, weight or age. Propofol injection pain was less in L and G groups, in comparison with the others (P ≤ 0.001). By analyzing the hemodynamic changes, it was observed that the least amount of change in mean arterial pressure was observed in the paracetamol group. CONCLUSIONS: The reduction of propofol injection pain was observed by using medications (in comparison with normal saline), but it was more significant in groups G and L. Moreover, Hypotension was higher in groups S and G and it was lessened in group P.

A comparison of effects of propofol and isoflurane on arterial oxygenation pressure, mean arterial pressure and heart rate variations following one-lung ventilation in thoracic surgeries.

BACKGROUND: Hypoxia occurs during one-lung ventilation (OLV) due to the arteriovenous shunt of unsaturated pulmonary venous blood. Hypoxic pulmonary vasoconstriction (HPV) acts as a defense mechanism against shunting. In thoracic surgery, anesthetics with minimal inhibitory effect on HPV and minimal hemodynamic changes are preferred. OBJECTIVES: The present study aimed to evaluate the effects of propofol and isoflurane on patients' arterial oxygen pressure following one-lung ventilation during thoracic surgeries. MATERIALS AND METHODS: In this randomized clinical trial study which was conducted in Iran, sixty patients with ASA (The American Society of Anesthesiologists) class I & II who were candidates for right elective thoracotomy were divided in two groups. Induction of anesthesia in the two groups was conducted using the same method, and left double-lumen endotracheal tube was inserted. In the first group propofol was used for the maintenance of anesthesia, and isoflurane for the second group. During two-lung ventilation and at minutes 5 and 10 after OLV, ABG (arterial blood gas) (for detecting the mean pressure of arterial oxygen), mean arterial pressure and heart rate were recorded. RESULTS: Sixty patients (mean age = 4124.18 ± 18.63 years) were divided into two groups. The age and gender of the subjects were not statistically different between the two groups. In the propofol group, the arterial oxygen pressure during two-lung ventilation and at 5th and 10th minutes after OLV was 263.14 ± 136.19, 217.40 ± 133.99 and 182.34 ± 122.39; in the isoflurane group, it was reported as 206.29 ± 135.59, 164.78 ± 118.90 and 155.35 ± 109.21 mmHg, respectively. In the propofol group, mean arterial pressure during two-lung ventilation, and 5th and 10th minutes after OLV, was 84.01 ± 20.67, 88.15 ± 20.23 and 86.10 ± 19.13, respectively; regarding the isoflurane group, it was reported as 79.66 ± 17.04, 84.78 ± 20.19 and 86.50 ± 17.07 mmHg, respectively. In the propofol group, heart rate during two-lung ventilation, and 5th and 10th minutes after OLV was 92.77 ± 17.20, 94.0 ± 18.34 and 94.33 ± 21.03, respectively; In the isoflurane group, it was reported as 92.87 ± 16.96, 91.8 ± 18.75 and 91.05 ± 17.20 min, respectively. These values were statistically similar in the two study groups. CONCLUSIONS: The effects of propofol on hemodynamics and arterial oxygen pressure during one- or two-lung ventilation were not different from those of isoflurane.

Effectiveness of oral Tranexamic acid administration on blood loss after knee artroplasty: a randomized clinical trial.

INTRODUCTION: Some studies have proved that Tranexamic acid infusion is associated with a decrease in blood loss during and after surgery. Due to the availability of an oral form of the drug, the rapid and complete absorption of it and ease of administration without need for specific instruments, we evaluated the effectiveness of the oral form in decreasing blood loss after total knee arthroplasty. MATERIALS AND METHODS: In this double-blind, randomized, parallel clinical trial study, we evaluated 53 patients undergoing knee arthroplasty admitted to Ghaem hospital, Mashhad in 2012. Patients with any history of severe ischemic heart diseases, renal failure, cirrhosis, history of bleeding disorders or thromboembolic events, were excluded from the study. The patients were randomly allocated into 27 patients with and 26 patients without Tranexamic acid. Blood loss (mL) at 12 and at 24h and hematocrit at 24h were measured postoperatively. The results were analyzed with SPSS software (11.5 version) using independent and paired sample t-tests. A p-value ≤ 0.05 was considered to be significant. RESULTS: The average blood loss after 12h of surgery in the control and Tranexamic acid groups were 462.9 (± 147.4) and 274.6 (± 139)mL, respectively (p<0.001) and after 24h of surgery they were 588.8 (± 193)and 364 (± 165.1)mL, respectively (p<0.001). The mean decrease in the hematocrit after surgery was 4.7% in the Tranexamic acid group and 6.8% in the control group (p=0.016). CONCLUSION: Prescription of oral Tranexamic acid before knee arthroplasty can cause remarkable decrease in blood loss after surgery and also less decrease in hematocrit. The advantages of the oral route of the drug versus the intravenous form is that it can be used routinely as a safe and effective way to decrease bleeding after surgery.

Evaluation of Oral Tiazinidine Effects on [intraoperative] Hemodynamic Responses During Direct Laryngoscopy Under General Anesthesia.

BACKGROUND: Direct laryngoscopy and tracheal intubation can result in blood pressure and heart rate increase which in turn may lead to myocardial ischemia, cerebral hemorrhage, and even death in susceptible patients. Tizanidine is α2-receptor agonists that suppresses central sympathetic system. OBJECTIVES: This study evaluates the effects of oral Tizanidine on hemodynamic responses during operations and aims to determine the appropriate Propofol dosage to maintain anesthesia under BIS monitoring. MATERIALS AND METHODS: A double-blind clinical trial has been performed on 70 candidates for elective abdominal surgery undergoing general anesthesia in Educational Hospital of Ghaem, Mashhad, Iran. 35 randomly selected patients (the case group) were given 4 mg of oral Tizanidine 90 minutes before the induction of anesthesia whereas the remaining subjects (the control group) were given placebo. Blood pressure and heart rate before and after induction of anesthesia, and after intubation and extubation, existence of postoperative shivering, and the needed Propofol dosage were measured and recorded. Data analysis was done with T-test and Chi-squared test, using SPSS software version 16. RESULTS: Variations of blood pressure and heart rate after anesthesia induction, intubation and extubation were less in Tizanidine group generally. Postoperative shivering was reported in 28.6% and 11.4% of patients in control and case group respectively. Average propofol needed dose for anesthesia maintenance in case group was 25% less than the needed amount in the control group. CONCLUSIONS: Using oral Tizanidine as a premedication, yielded stability in blood pressure and heart rate during surgery and decreased required Propofol. Considering its short duration of action, Tizanidine use as a premedication is recommended for sedation and stabilization of hemodynamic responses during the operations.