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Background and Objectives: Hyperthyroidism can occur with pregnancy. Thyroid storm is a life-threatening exacerbation of hyperthyroidism. The mortality rate for thyroid storm remains surprisingly high at approximately 20%.Case Report: A 21-year-old primigravida woman presented at 25 weeks, with severe pre-eclampsia and uncontrolled hyperthyroidism was scheduled for emergency cesarean section. Treatment includes rapid alleviation of thyrotoxicosis and general supportive care.Thyroid function tests may not help in differentiating thyroid storm from symptomatic hyperthyroidism. The major risk of anesthesia in the poorly controlled thyrotoxic patient is thyroid storm, which must be aggressively treated with beta-blockers, iodide, and antithyroid drugs.

Background and Objectives: Anesthesia management in myasthenia gravis is a great challenge for all anesthesiologists. In this disease, even small doses of muscle relaxants could lead to delayed recovery for respiratory muscles.Case Report: In this report we introduced our anesthetic regimen for a patient who was brought to the operation room for thymectomy. For anesthetic management of such patients, non muscle relaxant technique (NMRT) is recommended.Keywords: Myasthenia Gravis; Muscle Relaxation; Anesthetics; Thymectomy.

Post-operative sore throat is one of the most common complications and complaints of patients after general anesthesia especially in operations that need endotracheal intubations. Its causes are: size of endotracheal tube and type of its cuff, inadequate airway humidification, trauma during intubation and suctioning, high flow of inspiratory gases, surgical manipulation of airway and adjacent organs, ect. Use of instruments with less invasion to upper respiratory tract, for example, face mask and airway, LMA or CPT are methods, used for decreasing the rate of post-operative sore throat. This study was performed to compare the rate of sore throat after general anesthesia between Laryngeal Mask Airway (LMA) and Cuffed Pharyngeal Tube (CPT). From the patients, 120 ASA: PS-I cases, were selected, who were candidates for elective surgery of Orthopedics, Urology, General surgery and Gynecology in Hazrat Rasool-Akram Hospital Complex in the year 2000. Their operation were performed in supine position and did not need muscle relaxation and the patients had spontaneous breathing. Duration of surgery was less than 2 hours. The patients were randomly allocated into two groups: LMA was used for one group and CPT for others. Immediately after operation, in the recovery room and at 6, 12, 18 and 24 hours after removing the tube, the patients were asked about sore throat and the results were recorded in the related sheets. The results was 31.7 percent of patients in group LMA and 0 percent of patients in group CPT, had sore throat. There were significant difference between groups (LMA and CPT) in presentation of sore throat (P

Stress responses have been excited by the painful stimuli, after induction of anesthesia and during the operation. In order to reduce these responses, it will be useful to select the type of anesthesia. Based on this fact, two groups of patients (Every group had 50 patients) were selected randomly. All patients are older than 18 years old and were chosen according to America Society of Anesthesiologist, class I, II, and were candidated for cataract surgery. Propofol were used for induction and maintenance of anesthesia In group 1 (TIVA group). In group 2 (Balance anesthesia), Sodium Thiopental induced anesthesia and the combination of N2O and Halothane were used for maintenance of anesthesia, respectively. Blood Glucose in two groups was measured before induction of anesthesia that all were in normal range (80-120 mg/d). Then after induction, incision and 30 minutes after start of surgery, blood Glucose was measured again and deviation from basal level were classified in three categories as: 20%. The results demonstrated meaningful difference between two groups, statistically (Chi-square, P

Background: A bilateral superior laryngeal nerve block (SLNB) can provide complete anesthesia for laryngeal sampling and by providing this block we can manage the biopsy of supraglottic masses without the complications of general anesthesia., Objectives: This study aimed to compare 2 superior laryngeal nerve block (SLNB) methods using ultrasound and the traditional method for direct laryngoscopic surgery for the biopsy of supraglottic masses., Methods: In this single-blind clinical trial, 50 patients undergoing supraglottic laryngeal mass biopsy under direct laryngoscopy were divided into 2 groups. The first group was anatomical landmark bilateral SLNB (C group), and the second group was sono-guided bilateral SLNB (U group). Hemodynamic changes, pain, oxygen desaturation, surgeon satisfaction, and the complication obtained and noted., Results: There was no significant difference in the success rate of the procedure (P = 0.99), as well as the surgeon's satisfaction with the procedure (P = 0.337). Mean arterial pressure (MAP), oxygen saturation, and their changes in the studied groups were compared before the block, after the block, after the biopsy, and in the recovery room, showing no significant difference between the 2 groups (P > 0.05). Only the heart rate (HR) after the biopsy and in the recovery room showed significant differences between the 2 groups (P < 0.05). There was no significant difference between the 2 groups in the level of patient and surgeon satisfaction and pain during and after the procedure (P > 0.005)., Conclusions: SLNB for direct laryngoscopic surgery for biopsy of supraglottic masses using ultrasound was not significantly superior to the traditional method, and there was no significant difference between the 2 methods in terms of procedure success, surgeon's satisfaction, and patients' pain., Competing Interests: Conflict of Interests: No conflict of interest was declared by the authors., (Copyright © 2022, Author(s).)

Poor water solubility and low bioavailability are considered as two main factors restricting therapeutic applications of natural polyphenols in relation to various disorders including amyloid-related diseases. Among various strategies developed to overcome these limitations, nanonization has attracted considerable attention. Herein, we compared the potency of bulk and nano forms of the polyphenolic fraction of pomegranate seed (PFPS) for modulating Hen Egg White Lysozyme (HEWL) amyloid fibril formation. Prepared PFPS nanosheets using direct oxidative pyrolysis were characterized by employing a range of spectroscopic and microscopic techniques. We found that the nano form can inhibit the assembly process and disintegrate preformed fibrils of HEWL much more effective than the bulk form of PFPS. Moreover, MTT-based cell viability and hemolysis assays showed the capacity of both bulk and nano forms of PFPS in attenuating HEWL amyloid fibril-induced toxicity, where the nano form was more effective. On the basis of thioflavin T results, a delay in the initiation of amyloid fibril assembly of HEWL appears to be the mechanism of action of PFPS nanosheets. We suggest that the improved efficiency of PFPS nanosheets in modulating the HEWL fibrillation process may be attributed to their increased surface area in accord with the surface-assistance model. Our results may present polyphenol-based nanosheets as a powerful approach for drug design against amyloid-related diseases., Competing Interests: The authors declare that they have no conflict of interest., (This journal is © The Royal Society of Chemistry.)

Alpha-synuclein (α-syn) aggregation and mitochondrial dysfunction are considered as two of the main factors associated with Parkinson's disease (PD). In the present investigation, the effectiveness of the amyloid fibrils obtained from α-syn with those of hen egg white lysozyme (HEWL), as disease-related and-unrelated proteins, to damage rat brain and rat liver mitochondria have been investigated. This was extended by looking at SH-SY5Y human neuroblastoma cells and erythrocytes, thereby investigating the significance of structural characteristics of amyloid fibrils related to their interactions with biomembranes obtained from various sources. Results presented clearly demonstrate substantial differences in the response of tested biomembranes to toxicity induced by α-syn/HEWL amyloid fibrils, highlighting a structure-function relationship. We found that fibrillar aggregates of α-syn, but not HEWL, caused a significant increase in mitochondrial ROS, loss of membrane potential, and mitochondrial swelling, in a dose-dependent manner. Toxicity was found to be more pronounced in brain mitochondria, as compared to liver mitochondria. For SH-SY5Y cells and erythrocytes, however, both α-syn and HEWL amyloid fibrils showed the capacity to induce toxicity. Taken together, these results may suggest selective toxicity of α-syn amyloid fibrils to mitochondria mediated likely by their direct interaction with the outer mitochondrial membrane, indicating a correlation between specific structural characteristics of α-syn fibrils and an organelle strongly implicated in PD pathology., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background and Aims: Making a dry surgical field during functional endoscopic sinus surgery (FESS) is a challenge for anesthetists. This study was conducted to evaluate the pre-emptive hemostatic effects of a single dose of an intranasal spray of desmopressin (DDAVP) in sinus surgery., Material and Methods: Sixty consecutive patient's as first-time candidates for FESS due to chronic sinusitis were enrolled. They were randomly allocated to receive either a nasal spray of DDAVP 20 μg or sterile water before induction of anesthesia. Management of anesthesia was achieved with propofol and remifentanil infusions. Blood loss, quality of the surgical field, and surgeon's satisfaction were compared between the two groups., Results: Blood loss in the DDAVP group was 147 ± 43 mL and in the placebo group 212 ± 64 mL (mean ± SD, P < 0.01). The quality of the surgical field in the DDAVP group was better than the placebo group. (median score, 1 (1-2) vs. 2 (1-3), P = 0.017). Surgeons were more satisfied with the surgical field in the DDAVP group than in the control group (median score, 4 (2.8-5) vs. 3 (2-3), P = 0.04)., Conclusion: Premedication with nasal spray DDAVP 20 μg effectively reduces bleeding and improves the surgical field during FESS., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Anaesthesiology Clinical Pharmacology.)

Electroconvulsive therapy (ECT) was first experienced in 1938 and had been conducting without anesthesia for 30 years. In this study, the most common indication for ECT was mood disorder (major depressive disorder and bipolar I disorder). We introduce a patient with a history of COVID-19 and suicide who required emergency ECT. Electroconvulsive therapy can be life-saving in patients with suicide history or catatonic schizophrenia. Health workers are at the front line of the COVID-19 outbreak control and must follow health instructions. Aerosol-producing procedures such as suction in anesthesia for ECT may facilitate the transmission of infectious diseases such as COVID-19. When performing aerosol-producing procedures during the pandemic of novel coronavirus, every patient should be considered suspicious., Competing Interests: Conflict of Interests: There is no conflict of interest., (Copyright © 2020, Author(s).)

Coronavirus disease 2019, known as COVID-19, was first identified in Wuhan, China, in December 2019 and became a pandemic on Mar 11, according to the World Health Organization report. In the epidemic of COVID-19, many patients admitted to hospitals for other reasons may be silent carriers of COVID-19 and have the risk of infecting medical personnel. Thus, meticulous personal protection measures should be considered in suspicious patients, especially when close contact with the patient's airway is anticipated. We introduce two airway trauma patients suspected of COVID-19 who required emergency tracheostomy. Patient one was a 29-year-old man who suffered facial trauma following a car accident. A chest CT scan showed peripheral ground-glass opacities suggestive for COVID-19. The second patient was a young elevator mechanic who experienced maxillofacial trauma after an elevator crash. The methods of anesthesia and airway protection and safety precautions are described., Competing Interests: Conflict of Interests: There is no conflict of interest., (Copyright © 2020, Author(s).)

Introduction: Congenital hearing loss is associated with cardiac rhythm disturbances namely long Q-T syndrome. This study was designed to investigate the effect of anti-emetic doses of ondansetron and dexamethasone on ECG recordings in children undergoing cochlear implant surgery., Methods: Sixty-three pediatric patients scheduled for elective cochlear implantation were enrolled in the study. Two patients were excluded as their baseline ECG showed long QT syndrome. Anesthesia was induced with fentanyl, propofol and atracurium and maintained with propofol. Dexamethasone 0.1 mg.kg -1 or ondansetron 0.2 mg.kg -1 was randomly administered for the participants approximately 30 min before the end of surgery. ECG recording was performed 15 min after induction of anesthesia and 15 min after dexamethasone/ondansetron administration. RR interval, QRS duration, QT interval, and Tp-e interval were measured by a blinded cardiologist., Results: Ondansetron resulted in no significant changes in RR, JTc and QTc intervals; while prolongedTp-e interval. Multivariable logistic regression analysis showed that use of ondansetron was an independent predictor of QTc prolongation after adjustment for age, gender and baseline QTc (OR = 17.94, CI 95% 1.97-168.70, p = 0.011). The incidence of postoperative retching/vomiting in ondansetron group was significantly lower than dexamethasone group. (3.2% vs. 26.7%, p = 0.011)., Conclusion: The risk of arrhythmias with the use of ondansetron in otherwise healthy candidates of cochlear implant is very low. However, the drug may induce significant changes in ECG parameters. The clinical significance of these changes in patients with cardiac conduction abnormalities should be investigated in further studies., Competing Interests: Declaration of competing interest None to disclose., (Copyright © 2020 Elsevier B.V. All rights reserved.)

An issue in engineered wood products, like oriented strand lumber (OSL), is the low thermal conductivity coefficient of raw material, preventing the fast transfer of heat into the core of composite mats. The aim of this paper is to investigate the effect of sepiolite at nanoscale with aspect ratio of 1:15, in mixture with urea-formaldehyde resin (UF), and its effect on thermal conductivity coefficient of the final panel. Sepiolite was mixed with UF resin for 20 min prior to being sprayed onto wood strips in a rotary drum. Ten percent of sepiolite was mixed with the resin, based on the dry weight of UF resin. OSL panels with two resin contents, namely 8% and 10%, were manufactured. Temperature was measured at the core section of the mat at 5-second intervals, using a digital thermometer. The thermal conductivity coefficient of OSL specimens was calculated based on Fourier's Law for heat conduction. With regard to the fact that an improved thermal conductivity would ultimately be translated into a more effective polymerization of the resin, hardness of the panel was measured, at different depths of penetration of the Janka ball, to find out how the improved conductivity affected the hardness of the produced composite panels. The measurement of core temperature in OSL panels revealed that sepiolite-treated panels with 10% resin content had a higher core temperature in comparison to the ones containing 8% resin. Furthermore, it was revealed that the addition of sepiolite increased thermal conductivity in OSL panels made with 8% and 10% resin contents, by 36% and 40%, respectively. The addition of sepiolite significantly increased hardness values in all penetration depths. Hardness increased as sepiolite content increased. Considering the fact that the amount of sepiolite content was very low, and therefore it could not physically impact hardness increase, the significant increase in hardness values was attributed to the improvement in the thermal conductivity of panels and subsequent, more complete, curing of resin., Competing Interests: The authors declare no conflict of interest.