Journal of Cellular & Molecular Anesthesia

Background: Hemophilia B which refers to the deficiency or functional defect of factor IX (FIX) is typically an X-linked bleeding condition that arises from heterogeneous mutations of the FIX gene (F9). The number of hemophilia cases in Iran is considerable and currently, about 1118 Iranian patients are suffering from hemophilia B, although a small number of them underwent genetic investigations. Here we assessed molecular defects and also laboratory and clinical findings of 10 Iranian cases with hemophilia B. Materials and Methods: A total of 10 cases with hemophilia B were enrolled in the study. Patients were clinically examined by a hematologist and their previous medical documents were surveyed carefully. Routine coagulation tests and FIX activity and antigen assays were performed for the studied patients. Genotyping of F9 for identifying genetic mutations was conducted by the Sanger sequencing method following PCR amplification of the promoter region and all the eight exons of the F9 gene. Results: The mean age of patients was 4 years (9 months to 16 years) and consanguinity was reported in 80% of cases. Patients were commonly manifested by hematoma (90%), epistaxis (80%), and hemarthrosis (70%) and the severity of the disorder was severe (70%) or moderate (30%). In nine out of 10 patients a genetic defect in F9 gene we detected including three missense (c.304T>C, c.1007T>A, c.191G>A) and three nonsense mutations (c.892C>T, c.880C>T, c.1113C>A). Based on the FIX variant database (http://www.factorix.org), five mutations have been reported previously, but mutation c.1007T>A (p.Ile336Asn) seems to be a novel mutation. Conclusion: Our results indicated the heterogeneous molecular defects of hemophilia B in Iran, as recorded in the FIX mutation database. Moreover, no specific genotype-phenotype association was observed in studied subjects.

Background: Nitrous oxide (N2O) has a long reputation for decades as the safest general anesthetic and has a well-known function as the laughing gas. The study aimed to know the effect of nitrous oxide with chronic exposure in operation theatre (OT) personnel of the Department of Anesthesia in Sanath Nagar, Hyderabad, India. Materials and Methods: A transversal study was conducted including 88 health workers (44 exposed and 44 non-exposed). Personal exposure to nitrous oxide for the group members was assessed indirectly by measuring the years of work experience in OT. Vitamin B12 levels are measured in both groups. Data were statistically tested for normality and also qualitative, quantitative assessment was performed. Results: From the results obtained, there is no significant difference in vitamin B12 levels between exposed and non-exposed groups. There is a multiple-fold increase in other health conditions like dizziness, nausea/vomiting, euphoria, and tachycardia. Conclusion: N2O exposure in health care personnel did not show any altered vitamin B12 levels. Chronic exposure to nitrous oxide will lead to adverse health effects and it can be reduced by using an anesthesia gas scavenging system in OT.

Background: Laparoscopic cholecystectomy may be associated with postoperative pain mandating rescue analgesics; intraoperative β-blocker (Esmolol) might improve analgesia and spare opioids. This study was performed to test this potential beneficial effect of intraoperative Esmolol in patients undergoing general anesthesia for laparoscopic cholecystectomy. Materials and Methods: A total of 100 patients of the American sociological association (ASA) physical status-1 scheduled for laparoscopic cholecystectomy under general anesthesia were included. Patients receiving Esmolol were assessed for its effect on postoperative analgesia concerning those who did not receive Esmolol. Esmolol was administered as a bolus dose (0.5mg/kg) just before induction of anesthesia followed by an infusion rate of 0.05mg/kg/min until the completion of surgery. Results: Patients in the Esmolol group and the control group were compared. A significant difference in postoperative visual analog scale (p<0.001), need for opioid analgesics (p<0.001), and the time for rescue analgesia (p<0.001) was observed, with the Esmolol group performing better. We also observed a better hemodynamic profile in patients receiving Esmolol as compared to the control group in the postoperative period. The difference in postoperative complications was not statistically significant (p=0.374). Conclusion: intraoperative Esmolol significantly reduced the postoperative opioids (analgesia) consumption and improved analgesia. The hemodynamic profile of the patients who received intraoperative Esmolol was significantly better. There was no statistically significant difference between study groups regarding intra- and postoperative complications. No major adverse event is noted with the use of Esmolol.

Background: No single and ideal method has been proposed so far to decrease the time of mechanical ventilation while maintaining patients' hemodynamic stability after coronary bypass surgery. This study aimed to compare the effect of Dexmedetomidine and Morphine infusion on the latter parameters in patients after coronary artery bypass graft surgery in the intensive care unit. Materials and Methods: In this clinical trial study, 60 patients undergoing coronary artery bypass graft surgery were divided into two groups (N=30): the first group receiving Morphine and the second group receiving Dexmedetomidine. At admission to the ICU in the first group, Morphine was injected at a dose of 0.25 mg/kg, and in the second group, Dexmedetomidine was injected at a dose of 1 μg/kg for 10 minutes. Hemodynamic parameters and blood gas levels at preoperative cardiac care were compared between the two groups at the time of endotracheal tube withdrawal. Results: The trend of hemodynamic changes and blood gas levels during the intensive care unit stay did not differ between the two groups. The mean duration of mechanical ventilation in the Morphine group was 10.63/2 2.31 hours and in the Dexmedetomidine group was 9.77/1 1.92 hours, and there was no significant difference between the two groups (p=0.12). Conclusion: both Morphine and Dexmedetomidine had similar effects on hemodynamic stability and blood gas levels; however, Dexmedetomidine was associated with fewer drug-related side effects; so, it seems wise to consider Dexmedetomidine superior to Morphine in the postoperative period of CABG patients.

..

Autophagy is a mechanism, which host cells can utilize it to defend against infections. Trapped cargo such as viral cargo and delivered to a lysosome for degradation. Primary immune response against some viruses can start by autophagy mechanism. In this study, we reviewed role of autophagy in viral infections.

Surgery and anesthetics may cause brain damage, and the resulting neurological defect can impair the patient's cognitive function. This disorder is one of the most common complications after surgery and causes disorders in several cognitive areas of the patient. The mechanism of this disorder is not fully understood, but Neuronal inflammation is one of the main causes of this disorder. The purpose of this systematic review study was to evaluate neuroprotective drug strategies for the treatment or prevention of surgical disorders associated with anesthesia. We searched the keywords "neuroprotective", "neuroprotection", "postoperative" and "perioperative" in the databases of web of science, Scopus, PubMed, science direct and Google Scholar with a 5-year time limit. At first, 492 articles were obtained and finally, after detailed survey based on exclusion and inclusion criteria, 31 studies were selected to extract data. Findings from studies show that medication and treatment strategies used in group of mice and rats under surgery with treatment can improve Neuronal inflammation and brain damage compared to mice and rats with surgery only and reduce the side effects of surgery and anesthetics.

Introduction: Studies reveal that viruses play important roles in the origins of cellular life and the evolution of all mammals for example. COVID-19 as a modified brutal virus has affected daily life and is slowing down the global economy.  The main purpose of the current study stems from the question that how COVID-19 was created and how it will be solved.

Method: In order to conduct the present research, 26 English articles were chosen from among 57 articles published from 2000 to 2020 based on their relation to viral diseases and the availability of the full text at the PubMed, Science Direct, ProQuest, and Google Scholar databases.

Findings: To study the new coronavirus, its genetic sequence should be accessible for us. As understood, synthetic biology takes advantage of the knowledge obtained from systems biology analysis and the conceptual tools made for such purposes. These approaches develop systems toxicology as well as stand out in predicting and evaluating the immunogenicity of vaccines as well as improving vaccine formulations through a definite immunological marker.

Conclusion and Suggestion:Dealing with viral diseases such as COVID-19 demands vast knowledge of biotechnology, cell and molecular biology expertise, and competent approaches based on bioinformatics technology that contains systems biology and synthetic biology. Therefore, such scientific fields need to be highly developed in developing countries to keep their immunity and national security under warranty encountering any biological invasion, most specifically of viral types.

Coronavirus can cause lots of viral diseases such as the common cold, Middle East respiratory Syndrome coronavirus (MERS-CoV), Severe acute respiratory syndrome coronavirus  (SARS-CoV) and Coronavirus disease 2019 (COVID-19). Coronavirus and Human immunodeficiency virus   (HIV) are considered as RNA viruses.The use of antivials in HIV-positive patients chalenges the development and the treatment of the patients with SARA, MERS and COVID-19. We reviewed the relevant studies in this regard to identify SARS, MERS and COVID-19 status in HIV-positive patients.

Background: Understand more about histopathological events of COVID-19 helps to choose more proper management strategies and treatments. There are several ways to histopathologic evaluations; including, tissue sampling of different organs in living people as biopsies or search for these data in tissues of dead people as autopsies or necropsies, that in this comprehensive review we tried to evaluate histopathologic concordance between findings of various tissue samplings of different sites which may work as a mirror of each other especially mucocutaneous findings may indicative of similar events of other parts.

Method: Based on main key words, we searched databases of PubMed, Scopus, Google Scholar, Medscape and CEBD coronavirus dermatology resource of Nottingham University and included the most relevant and well-designed studies with higher level of evidences and higher sample size.

Result: In this study, selected pathological samples from different tissues including skin and mucosa, lungs, gastrointestinal tract and kidneys were studied and summarized in patients with COVID-19. Pathological findings in these patients were included by organ and listed in order of prevalence.

Conclusion: Tissue sampling in patients with COVID-19 may be helpful in understanding the pathophysiology of the disease as much as possible. Although most of these samples are taken after patients die, sampling before the more advanced stages of the disease could also show signs of tissue involvement before full systemic symptoms appear.

Background: The purpose of this study was to analyze the effects and results of dimethyl sulfoxide (DMSO) usage on viability and perfusion of local and regional flaps in rabbits, via this study we are going to conclude whether DMSO could be effective after flap operations in human or not. Materials and Methods: Local and regional DMSO spray was used on rabbit’s dorsum flaps immediately after the operation and once per day up to 7 days post-op in 14 rabbits, divided equally to control group (saline solution spray) or experiment group (DMSO spray). The results were compared 3 and 7 days after operations. Results: There were improved results attributed to the DMSO effects regarding flap survival Conclusion: We concluded that topical application of DMSO reduces skin flap ischemia in rabbits and we highly advise the use of it after operations in which skin flaps are created.

Background:Spontaneous Pneumomediastinum (SP) is a rare complication that has not been reported in patients with coronavirus (COVID-19). In this report, we introduce a patient with coronavirus (COVID-19) with spontaneous Pneumomediastinum unrelated to aggressive ventilation.

Case presentation : A 39-year-old woman with coronavirus (COVID-19) with ARDS sign was admitted to the ICU of Babol Rouhani Hospital. She died four days after hospitalization with Pneumomediastinum with subcutaneous emphysema. According to chest x-ray and CT scan, the patient had spontaneous Pneumomediastinum prior to admission and aggressive ventilation.

Results: Spontaneous Pneumomediastinum can be a complication of acute respiratory syndrome in patients with coronavirus (COVID-19) with unclear pathogenesis.

Keywords: Spontaneous Pneumomediastinum, COVID-19

It is important to diagnose coronavirus disease 2019 (COVID-19) by the clinical symptoms, although they are not specific. Clinical symptoms of COVID-19 in pediatrics are less severe and milder than in adults, which can be threatening to the health staff. In this case study, we report a 23-year old female pediatric nurse who developed COVID-19 with the rare symptom of gastrointestinal bleeding (GIB). The case of interest was affected by two children who had a positive reverse transcription-polymerase chain reaction (RT-PCR). The patient had no respiratory symptoms. Despite the use of an N95 mask and face shield, the nurse was infected because the gastrointestinal symptoms were predominant. Medical staff should pay attention to silent symptoms in pediatrics. Neglecting the use of personal protective equipment in dealing with pediatric patients can be hazardous.

 Most COVID-19 severe cases are presented with uncontrolled elevated level of proinflammatory cytokines such as IL-6, IL-1β, IL-2   IL-8, IL-17, G- CSF, GM- CSF, IP10, MCP1, CCL3, and TNF which is called cytokine storm. Previous studies showed that proinflammatory cytokine overexpression such as TNF and IL-6 exacerbates TB. In COVID-19 patients, we are facing immune system imbalance due to cytokine storm. Thus, COVID-19 may be a predisposing factor to turn latent TB to active TB.