Sevoflurane versus Halothane: Postoperative Maladaptive Behavioral Changes: A Randomized, Controlled Trial

Background: The authors conducted a double-blind, randomized, controlled trial to determine whether the use of sevoflurane in children undergoing anesthesia and surgery results in a higher incidence of postoperative maladaptive behavioral changes as compared with halothane.

Methods: Children and their parents (n = 102) were randomly assigned to either a halothane group (n = 50) or a sevoflurane group (n = 52). The intraoperative anesthetic protocol was strictly controlled, and the postoperative analgesic consumption and pain levels were recorded. The effect of the group assignment on emergence status and maladaptive postoperative behavioral changes was assessed both by validated psychological measures and physiologic instruments (actigraphy) on postoperative days 1-7. Anxiety of the parent and child was also assessed, as was the child's postoperative recovery (Recovery Inventory).

Results: There were no group differences in preoperative state anxiety, postoperative analgesic requirements, postoperative pain, or the incidence of emergence delirium (P = not significant). Two-way repeated-measures analysis of variance showed no group differences in the incidence of postoperative maladaptive behaviors (F4,72 = 0.60, P = 0.701) or actigraphic variables such as percent sleep, number of night awakenings, and night awakenings that lasted for more than 5 min (P = not significant).     

Optimal control problems with Atangana‐Baleanu fractional derivative

In this paper, we study fractional‐order optimal control problems (FOCPs) involving the Atangana‐Baleanu fractional derivative. A computational method based on B‐spline polynomials and their operational matrix of Atangana‐Baleanu fractional integration is proposed for the numerical solution of this class of problems. With this numerical technique, the FOCPs are reduced to a system of equations which are solved for the unknown parameters with the help of Mathematica® software. Our results show the applicability and usefulness of the numerical technique.     

Primary Sclerosing Cholangitis and Inflammatory Bowel Disease: A Review

Primary sclerosing cholangitis is a disease affecting around 0.006–0.016% of the population. Of these, around 75% have concomitant inflammatory bowel disease (IBD) according to the most recent epidemiological studies. Several theories have been proposed regarding the pathogenesis of primary sclerosing cholangitis (PSC). These include changes in the function of cholangiocytes, effects of the gut microbiome, association with specific human leukocyte antigen haplotypes and dysregulation of the immune system. However, these do not explain the observed association with IBD. Moreover, there are considerable differences in the frequency and outcomes between patients with PSC and ulcerative colitis compared with PSC and Crohn’s disease. The aim of this review is to appraise the most recent studies that have contributed to the epidemiology, advances in the pathophysiology, and characterization of important clinical aspects of the association of PSC and IBD.     

Treatment of chronic diarrhoea

The treatment of chronic diarrhoea can be challenging. While Oral Rehydration Solution is an important step in treating diarrhoeal illnesses, various medications can be used to alleviate the symptoms while the patient is undergoing diagnostic work up or to target the underlying mechanism responsible for their diarrhoea. Medications are also being prescribed in cases when there is a strong suspicious about a diagnosis or when there is no specific treatment for an underlying aetiology. This chapter discusses the treatment options for diarrhoeal disorders.     

A modified prenatal growth assessment score for the evaluation of fetal growth in the third trimester using single and composite biometric parameters

Objective: To define modified Prenatal Growth Assessment Scores (mPGAS) for single and composite biometric parameters and determine their reference ranges in normal fetuses.

Methods: Nine anatomical parameters (ap) were measured and the weight estimated (EWT_a, EWT_b) in a longitudinal study of 119 fetuses with normal neonatal growth outcomes. Expected third trimester size trajectories, obtained from second trimester Rossavik size models, were used in calculating Percent Deviations (% Dev's) and their age-specific reference ranges in each fetus. The components of individual % Dev's values outside their reference ranges, designated +iapPGAS, -iapPGAS, were averaged to give +apPGAS and ?apPGAS values for the 3rd trimester. The +iapPGAS and ?iapPGAS values for different combinations of ap (c1a (HC, AC, FDL, ThC, EWT_a), c1b (HC, AC, FDL, ThC, EWT_b), c2 (ThC, ArmC, AVol, TVol), c3 (HC, AC, FDL, EWT_a)) were then averaged to give +icPGAS and ?icPGAS values at different time points or at the end of the third trimester (+cPGAS, ?cPGAS). Values for iapPGAS, ic1bPGAS, and ic2PGAS were compared to their respective apPGAS or cPGAS reference ranges.

Results: All mPGAS values had one 95% range boundary at 0.0%. Upper boundaries of 1D +apPGAS values ranged from 0.0% (HC) to +0.49% (ThC) and were +0.06%, +2.3% and +1.8% for EWT, AVol and TVol, respectively. Comparable values for ?apPGAS were 0.0% (BPD, FDL, HDL), to ?0.58% (ArmC), ?0.13% (EWT), ?0.8% (AVol), and 0.0% (TVol). The +cPGAS, 95% reference range upper boundaries varied from +0.36% (c1b) to +0.89% (c2). Comparable values for ?cPGAS lower boundaries were ?0.17% (c1b) to ?0.43% (c2).

Conclusions: The original PGAS concept has now been extended to individual biometric parameters and their combinations. With the standards provided, mPGAS values can now be tested to see if detection of different types of third trimester growth problems is improved.