Background: This research aimed to analyze the effects of sevoflurane and propofol on IFN-γ and IL-12, the study on patients with craniotomy surgery. The treatment is the anesthesia with sevoflurane or propofol for more than 2 hours. The levels of IFN-γ and IL-12 are measured just before induction of anesthesia and just after anesthesia with sevoflurane or propofol is stopped. Methods: The study design is an observational study by using pre-and-post design. The subjects are patients aged 30-55 years old who were undergoing craniotomy surgery for tumor removal at Dr. Kariadi Hospital. The differences in the means before and after the same anesthesia agent were analyzed with paired T-test if the data distribution is normal, or with the Wilcoxon rank-sum test if the data distribution is not normal. The difference in the means between the two different anesthesia agents was analyzed using an independent T-test if the data distribution is normal, or with the Mann-Whitney test if the data distribution is not normal. Results: It was observed that sevoflurane and propofol increased the level of IFN-γ and IL-12 but not significant. There were differences between IFN-γ and IL-12 before and after anesthesia with sevoflurane compared with propofol. Therefore, the hypothesis was accepted. This shows that the originality of this research has been statistically and empirically proved. Conclusion: The increase of both IFN-γ and IL-12 levels after anesthesia with propofol is significantly higher than those with sevoflurane. Propofol exerts a bigger pro-inflammatory response than sevoflurane in patients undergoing craniotomy surgery.
1 Major Stuart Mccarthy, ethics of Timor Leste Mefloquine trials, 30 Sep 15Wendy.J. Seymour
The document discusses two clinical trials conducted by the Australian Army Malaria Institute from 2000-2002 that administered the antimalarial drug mefloquine to over 1,300 military personnel deployed in Timor Leste. It argues that the trials failed to meet ethical standards and that subjects were coerced into participating and provided misleading information that understated mefloquine's neuropsychiatric side effects. Many subjects reported suffering from lasting neurological and psychiatric injuries as a result of being administered mefloquine without informed consent. The author concludes the trials were unethical according to applicable standards for human research involving military subjects.
This study investigated hematological changes, serum TNF-α and IFN-γ levels in 42 people inadvertently exposed to radium-226 in Hilla City, Iraq. The study found significantly higher levels of the pro-inflammatory cytokines TNF-α and IFN-γ in exposed individuals compared to unexposed controls. There was a negative correlation between cytokine levels and complete blood count results. The results suggest that tiny doses of radium could induce TNF-α and IFN-γ, and that these cytokines may serve as biomarkers for radium exposure. Radium exposure was found to cause changes in pro-inflammatory cytokine levels and hematological parameters.
The document discusses the history and early studies of transfer factors, which are immune system regulators found in colostrum that can transfer immunity. Early studies showed transfer factors from blood were effective against various infections and diseases but posed contamination risks. Researchers then found transfer factors in bovine colostrum that were non-species specific and more effective. Later studies showed bovine colostrum transfer factors reduced relapse in Burkitt's lymphoma, showed preliminary benefits for AIDS patients, and helped treat recurrent cystitis.
This double-blind, placebo-controlled trial explored the safety and potential efficacy of hyperimmune caprine serum (AIMSPRO) in 20 patients with established diffuse cutaneous systemic sclerosis (SSc) over 26 weeks. The trial found no safety concerns with AIMSPRO. Patients receiving AIMSPRO showed a mean decrease in modified Rodnan Skin Score compared to an increase in the placebo group. Levels of PIIINP, a biomarker of fibrosis, increased less in the AIMSPRO group. The results support the safety of AIMSPRO and suggest it may provide clinical benefit for skin disease in SSc.
Role of Corticosteroid in the Management of Covid 19pharmacypawan
This pandemic has given us so many opportunities to rethink the ideas for use of corticosteroids . one of the major help that has been achieved through the corticosteroid is the increase the efficiency of treatment.
This document summarizes research on primary immunodeficiencies that cause increased susceptibility to fungal infections. It describes how innate and adaptive immunity normally defend against fungi through pattern recognition receptors, cytokines, and T cell responses. Deficiencies in the CARD9 protein, STAT1 and STAT3 genes, and the IL-17 and IL-22 pathways are highlighted as causing chronic mucocutaneous candidiasis by impairing Th17 responses. Autoantibodies against IL-17 and IL-22 in autoimmune polyendocrine syndrome type I can also phenocopy these genetic defects. Understanding these immunodeficiencies provides insight into antifungal immunity and opportunities for new therapies.
1 Major Stuart Mccarthy, ethics of Timor Leste Mefloquine trials, 30 Sep 15Wendy.J. Seymour
The document discusses two clinical trials conducted by the Australian Army Malaria Institute from 2000-2002 that administered the antimalarial drug mefloquine to over 1,300 military personnel deployed in Timor Leste. It argues that the trials failed to meet ethical standards and that subjects were coerced into participating and provided misleading information that understated mefloquine's neuropsychiatric side effects. Many subjects reported suffering from lasting neurological and psychiatric injuries as a result of being administered mefloquine without informed consent. The author concludes the trials were unethical according to applicable standards for human research involving military subjects.
This study investigated hematological changes, serum TNF-α and IFN-γ levels in 42 people inadvertently exposed to radium-226 in Hilla City, Iraq. The study found significantly higher levels of the pro-inflammatory cytokines TNF-α and IFN-γ in exposed individuals compared to unexposed controls. There was a negative correlation between cytokine levels and complete blood count results. The results suggest that tiny doses of radium could induce TNF-α and IFN-γ, and that these cytokines may serve as biomarkers for radium exposure. Radium exposure was found to cause changes in pro-inflammatory cytokine levels and hematological parameters.
The document discusses the history and early studies of transfer factors, which are immune system regulators found in colostrum that can transfer immunity. Early studies showed transfer factors from blood were effective against various infections and diseases but posed contamination risks. Researchers then found transfer factors in bovine colostrum that were non-species specific and more effective. Later studies showed bovine colostrum transfer factors reduced relapse in Burkitt's lymphoma, showed preliminary benefits for AIDS patients, and helped treat recurrent cystitis.
This double-blind, placebo-controlled trial explored the safety and potential efficacy of hyperimmune caprine serum (AIMSPRO) in 20 patients with established diffuse cutaneous systemic sclerosis (SSc) over 26 weeks. The trial found no safety concerns with AIMSPRO. Patients receiving AIMSPRO showed a mean decrease in modified Rodnan Skin Score compared to an increase in the placebo group. Levels of PIIINP, a biomarker of fibrosis, increased less in the AIMSPRO group. The results support the safety of AIMSPRO and suggest it may provide clinical benefit for skin disease in SSc.
Role of Corticosteroid in the Management of Covid 19pharmacypawan
This pandemic has given us so many opportunities to rethink the ideas for use of corticosteroids . one of the major help that has been achieved through the corticosteroid is the increase the efficiency of treatment.
This document summarizes research on primary immunodeficiencies that cause increased susceptibility to fungal infections. It describes how innate and adaptive immunity normally defend against fungi through pattern recognition receptors, cytokines, and T cell responses. Deficiencies in the CARD9 protein, STAT1 and STAT3 genes, and the IL-17 and IL-22 pathways are highlighted as causing chronic mucocutaneous candidiasis by impairing Th17 responses. Autoantibodies against IL-17 and IL-22 in autoimmune polyendocrine syndrome type I can also phenocopy these genetic defects. Understanding these immunodeficiencies provides insight into antifungal immunity and opportunities for new therapies.
This document discusses recommendations for the management of Behcet's disease (BD) based on a systematic review of the literature. It provides 3 key recommendations:
1. Patients with BD and eye inflammation affecting the posterior segment should be treated with azathioprine, corticosteroids, and either cyclosporine A or infliximab if severe eye disease is present.
2. There is no evidence to guide management of major vessel involvement in BD, but immunosuppressants are recommended for acute deep vein thrombosis.
3. Interferon-alpha may be effective and safe for treating neuro-BD, based on case reports showing clinical and radiological improvement with its use.
vascular insulin and IGF-1 in diabetic woundsSaeed Aghdam
This document summarizes a study examining the role of vascular endothelial insulin/IGF-1 signaling in skin wound healing. The study found that deleting the insulin receptor and IGF-1 receptor specifically in endothelial cells of mice (DKOIVE mice) did not significantly impact skin vessel homeostasis under normal conditions. However, when the skin was wounded, DKOIVE mice showed strongly reduced neovascularization during wound healing compared to controls, accompanied by reduced granulation tissue formation. This indicates that endothelial insulin/IGF signaling is essential for neovascularization during wound healing and implies its reduction directly contributes to impaired healing associated with diabetes.
This case report describes a 28-year-old female patient who presented with hypersensitivity reactions after being treated with ceftriaxone (a third-generation cephalosporin antibiotic) for a bacterial infection. The patient developed urticaria (hives) after a few days of ceftriaxone therapy. Tests ruled out other potential causes, and causality assessment scales determined the reactions were probably caused by ceftriaxone. The antibiotic was stopped and the patient recovered from the hypersensitivity reactions after 10 days. The report discusses how cephalosporins can rarely cause immediate IgE-mediated allergic reactions like urticaria.
This document discusses various experimental models used to test potential anti-arthritic agents, including adjuvant arthritis in rats, terpentine oil-induced edema, and formaldehyde-induced arthritis. Adjuvant arthritis is induced in rats by injecting complete Freund's adjuvant or synthetic adjuvants and results in hind paw swelling that can be monitored over time. Terpentine oil injected into rat knee joints causes acute, non-immunological edema assessed by measuring joint diameter changes. Formaldehyde injections into rat paws induce chronic, non-immunological arthritis evaluated by paw diameter increases over 10 days. These preclinical models are used to screen anti-arthritic drugs.
NSAIDs-exacerbated respiratory disease (NERD) is characterized by chronic rhinosinusitis and/or asthma that is exacerbated by NSAID ingestion within 30-180 minutes. Symptoms include bronchial obstruction and nasal, ocular or cutaneous manifestations. Diagnosis is made through oral aspirin provocation testing, which is more sensitive than inhalation testing.
NSAIDs-exacerbated cutaneous disease (NECD) involves chronic spontaneous urticaria exacerbated by NSAIDs 0.5-6 hours after ingestion. Diagnosis is based on history of NSAID-induced urticarial symptoms in patients with chronic urticaria.
NSAIDs-
This document discusses novel treatment options for asthma, focusing on biologic-based targeted therapies. It summarizes the four approved type-2 targeted biologic therapies that target IL-5 and IgE, as well as IL-4 and IL-13. These target key pathways involved in type-2 inflammation like eosinophil recruitment and activation. Emerging therapies also target other inflammatory pathways like IL-17. Characterization of inflammatory biomarkers and phenotypes helps identify patients that may benefit most from specific targeted therapies.
The document discusses various anti-fungal drugs, describing their mechanisms of action and clinical uses. There are 5 classes of anti-fungals: 1) lanosterol synthesis inhibitors like terbinafine, 2) cell wall synthesis inhibitors like echinocandins, 3) cell membrane integrity inhibitors like polyenes including amphotericin B and nystatin, 4) nucleic acid synthesis inhibitors like flucytosine, and 5) ergosterol synthesis inhibitors like azoles. Specific drugs are described in more detail, such as amphotericin B for serious systemic mycoses, nystatin for topical use, and flucytosine used with amphotericin B
Johannes Vogel is a senior group leader and professor at the Institute of Veterinary Physiology at the University of Zurich. He was born in 1964 in Bonn, Germany. He received his medical degree from the University of Bonn in 1992 and has since held positions at the University of Heidelberg and University of Zurich. His research focuses on the physiological and pathophysiological roles of erythropoietin. He has authored or co-authored over 25 publications in peer-reviewed journals.
This document summarizes potential dangers of COVID-19 vaccines for children aged 12-18 based on adverse event reports. It notes that:
1) Reported adverse events following vaccination are atypically high, with over 250,000 reports including 8,500 reports for children aged 12-18, of which 17% experienced cardiovascular issues.
2) The vaccines are likely causing these adverse events as over 80% of cardiovascular, neurological, and immunological issues were reported within 1 day of vaccination.
3) The vaccines may disrupt the renin-angiotensin-aldosterone system, which regulates blood pressure and electrolytes, as the spike protein binds strongly to ACE2, a key enzyme in
1) The document discusses the relationship between the immune system and brain development/function. Alterations in immune function can impact neurodevelopment and be associated with various neuropsychiatric disorders.
2) Studies show that drugs like fingolimod that modulate sphingosine-1-phosphate receptors and prevent lymphocyte egress from lymph nodes can significantly reduce relapse rates and disability progression in multiple sclerosis patients.
3) Autism disorders may involve abnormalities in certain brain areas and a complex symptomatology related to genetic and environmental factors that can disrupt normal brain growth and the immune situation. The immune status, specific time periods, microenvironment, and genetics may all provide insights into autism pathogenesis.
This document discusses iodinated contrast media which are used for imaging procedures. It provides information on the classification, properties, epidemiology and pathophysiology of reactions to contrast media.
The document classifies contrast media based on their ionization capacity, osmolality, viscosity and number of triiodobenzene rings. It discusses the prevalence of reactions which is higher for ionic contrast media. Immediate reactions are mostly mild while delayed reactions are usually self-limiting skin eruptions.
The pathophysiology of immediate reactions involves mast cell activation but the mechanism is not fully understood. Delayed reactions are believed to be T-cell mediated. Skin testing and intravenous provocation tests are used to diagnose contrast
The document discusses vaccination in patients with chronic kidney disease (CKD). It outlines the rationale and recommendations for vaccination in CKD patients, including those undergoing dialysis or renal transplantation. Specific recommendations are provided for pneumococcal vaccination in CKD patients based on guidelines. The summary discusses how CKD and end-stage renal disease can impair immune function, making vaccinations less effective, and the importance of vaccinating CKD patients to prevent infectious diseases.
1) Pneumonia is a common infection seen in nephrology practice, especially in patients with nephrotic syndrome, chronic kidney disease, end-stage renal disease on dialysis, and renal transplant recipients.
2) Patients with nephrotic syndrome have increased risk of infections like pneumonia due to urinary losses of immunoglobulins and properdin factor B. One study found 36.6% of children with nephrotic syndrome developed major infections, with nearly 1/3 having pneumonia.
3) As chronic kidney disease progresses and reaches end-stage renal disease, risk of infections including pneumonia increases. Cardiovascular disease and infections are the main causes of death in end-stage
This document discusses vaccination in patients with chronic kidney disease (CKD). It outlines how CKD affects both the innate and adaptive immune systems, leading to impaired immunity. It describes alterations in end-stage renal disease that impair response to vaccines. Guidelines recommend vaccines for hepatitis B, pneumococcus, and influenza for CKD patients, with some vaccines requiring higher doses or more doses. Methods to potentially improve vaccine efficacy include use of immunomodulators like interleukin-2 administered with vaccines.
Omalizumab is a monoclonal antibody that binds to immunoglobulin E (IgE), reducing free IgE levels. It is used to treat allergic asthma and rhinitis. Clinical trials show omalizumab significantly reduces asthma exacerbations and improves symptoms and quality of life in patients with moderate-to-severe allergic asthma. It also reduces airway inflammation and thickness. Omalizumab allows reduction of inhaled corticosteroid use without worsening asthma control. Real-world studies find omalizumab effectively improves asthma control long-term with an acceptable safety profile.
This document discusses antibiotic choice in the ICU. It provides epidemiological data from studies on infections in ICU patients. The most common infections are pneumonia, bloodstream infections, and UTIs. The pathogens vary between different ICU profiles such as medical, surgical, and pediatric ICUs. Principles of antibiotic use include targeting the likely pathogen while minimizing toxicity. Empirical antibiotic choices are discussed for common ICU infections like pneumonia, bloodstream infections, and UTIs. Antimicrobial resistance is an increasing problem addressed as well.
1. General anaesthesia can have both direct and indirect effects on the immune system by impacting the innate immune response, adaptive immune response, cytokine production, neutrophil activity, and immunoglobulin levels.
2. Surgery alone increases pro-inflammatory cytokine levels, but anaesthetic agents may increase or decrease specific cytokine production depending on the agent.
3. Perioperative interventions like mechanical ventilation, blood transfusions, chronic pain, and immunosuppressive drugs for transplant patients can further impact the immune response. Precautions are needed for patients with these factors.
This document discusses mycophenolate mofetil and its emerging role in interstitial lung diseases. It begins by providing background on interstitial lung diseases and some of the more common types. It then focuses on chronic hypersensitivity pneumonitis, noting that mycophenolate mofetil has been shown to improve lung function and allow reduction of steroid doses in patients. The document reviews evidence that mycophenolate mofetil may be better tolerated and more effective than azathioprine for chronic hypersensitivity pneumonitis. It also discusses use of mycophenolate mofetil in connective tissue disease-associated interstitial lung diseases.
This document contains summaries of several research points related to critical care. It discusses findings that propofol may limit recovery after brain injury in adults, that cardiac dysfunction is associated with mortality after traumatic brain injury, that vitamin D deficiency predicts sepsis in critically ill patients, and that neuromuscular blocking agents are associated with lower mortality in mechanically ventilated sepsis patients. It also summarizes research showing that a bundle of measures was effective at reducing ventriculitis associated with external cerebral ventricular drainage. Finally, it finds that critical illness is characterized by reduced intestinal absorption of glucose and lower expression of glucose transporters and taste receptors.
This document contains summaries of several research points related to critical care. It discusses findings that propofol may limit recovery after brain injury in adults; cardiac dysfunction occurs after traumatic brain injury and is linked to higher mortality; vitamin D deficiency predicts sepsis in critically ill patients; treating sepsis patients with neuromuscular blocking agents may reduce mortality; propofol affects patient-ventilator interactions depending on sedation level and mode of ventilation; implementing measures to reduce infections lowered the rate of ventriculitis in neurocritical patients; and critical illness reduces intestinal absorption of glucose linked to lower expression of glucose transporters and taste receptors. The document was created by Samir El Ansary and provides his contact information.
This document discusses recommendations for the management of Behcet's disease (BD) based on a systematic review of the literature. It provides 3 key recommendations:
1. Patients with BD and eye inflammation affecting the posterior segment should be treated with azathioprine, corticosteroids, and either cyclosporine A or infliximab if severe eye disease is present.
2. There is no evidence to guide management of major vessel involvement in BD, but immunosuppressants are recommended for acute deep vein thrombosis.
3. Interferon-alpha may be effective and safe for treating neuro-BD, based on case reports showing clinical and radiological improvement with its use.
vascular insulin and IGF-1 in diabetic woundsSaeed Aghdam
This document summarizes a study examining the role of vascular endothelial insulin/IGF-1 signaling in skin wound healing. The study found that deleting the insulin receptor and IGF-1 receptor specifically in endothelial cells of mice (DKOIVE mice) did not significantly impact skin vessel homeostasis under normal conditions. However, when the skin was wounded, DKOIVE mice showed strongly reduced neovascularization during wound healing compared to controls, accompanied by reduced granulation tissue formation. This indicates that endothelial insulin/IGF signaling is essential for neovascularization during wound healing and implies its reduction directly contributes to impaired healing associated with diabetes.
This case report describes a 28-year-old female patient who presented with hypersensitivity reactions after being treated with ceftriaxone (a third-generation cephalosporin antibiotic) for a bacterial infection. The patient developed urticaria (hives) after a few days of ceftriaxone therapy. Tests ruled out other potential causes, and causality assessment scales determined the reactions were probably caused by ceftriaxone. The antibiotic was stopped and the patient recovered from the hypersensitivity reactions after 10 days. The report discusses how cephalosporins can rarely cause immediate IgE-mediated allergic reactions like urticaria.
This document discusses various experimental models used to test potential anti-arthritic agents, including adjuvant arthritis in rats, terpentine oil-induced edema, and formaldehyde-induced arthritis. Adjuvant arthritis is induced in rats by injecting complete Freund's adjuvant or synthetic adjuvants and results in hind paw swelling that can be monitored over time. Terpentine oil injected into rat knee joints causes acute, non-immunological edema assessed by measuring joint diameter changes. Formaldehyde injections into rat paws induce chronic, non-immunological arthritis evaluated by paw diameter increases over 10 days. These preclinical models are used to screen anti-arthritic drugs.
NSAIDs-exacerbated respiratory disease (NERD) is characterized by chronic rhinosinusitis and/or asthma that is exacerbated by NSAID ingestion within 30-180 minutes. Symptoms include bronchial obstruction and nasal, ocular or cutaneous manifestations. Diagnosis is made through oral aspirin provocation testing, which is more sensitive than inhalation testing.
NSAIDs-exacerbated cutaneous disease (NECD) involves chronic spontaneous urticaria exacerbated by NSAIDs 0.5-6 hours after ingestion. Diagnosis is based on history of NSAID-induced urticarial symptoms in patients with chronic urticaria.
NSAIDs-
This document discusses novel treatment options for asthma, focusing on biologic-based targeted therapies. It summarizes the four approved type-2 targeted biologic therapies that target IL-5 and IgE, as well as IL-4 and IL-13. These target key pathways involved in type-2 inflammation like eosinophil recruitment and activation. Emerging therapies also target other inflammatory pathways like IL-17. Characterization of inflammatory biomarkers and phenotypes helps identify patients that may benefit most from specific targeted therapies.
The document discusses various anti-fungal drugs, describing their mechanisms of action and clinical uses. There are 5 classes of anti-fungals: 1) lanosterol synthesis inhibitors like terbinafine, 2) cell wall synthesis inhibitors like echinocandins, 3) cell membrane integrity inhibitors like polyenes including amphotericin B and nystatin, 4) nucleic acid synthesis inhibitors like flucytosine, and 5) ergosterol synthesis inhibitors like azoles. Specific drugs are described in more detail, such as amphotericin B for serious systemic mycoses, nystatin for topical use, and flucytosine used with amphotericin B
Johannes Vogel is a senior group leader and professor at the Institute of Veterinary Physiology at the University of Zurich. He was born in 1964 in Bonn, Germany. He received his medical degree from the University of Bonn in 1992 and has since held positions at the University of Heidelberg and University of Zurich. His research focuses on the physiological and pathophysiological roles of erythropoietin. He has authored or co-authored over 25 publications in peer-reviewed journals.
This document summarizes potential dangers of COVID-19 vaccines for children aged 12-18 based on adverse event reports. It notes that:
1) Reported adverse events following vaccination are atypically high, with over 250,000 reports including 8,500 reports for children aged 12-18, of which 17% experienced cardiovascular issues.
2) The vaccines are likely causing these adverse events as over 80% of cardiovascular, neurological, and immunological issues were reported within 1 day of vaccination.
3) The vaccines may disrupt the renin-angiotensin-aldosterone system, which regulates blood pressure and electrolytes, as the spike protein binds strongly to ACE2, a key enzyme in
1) The document discusses the relationship between the immune system and brain development/function. Alterations in immune function can impact neurodevelopment and be associated with various neuropsychiatric disorders.
2) Studies show that drugs like fingolimod that modulate sphingosine-1-phosphate receptors and prevent lymphocyte egress from lymph nodes can significantly reduce relapse rates and disability progression in multiple sclerosis patients.
3) Autism disorders may involve abnormalities in certain brain areas and a complex symptomatology related to genetic and environmental factors that can disrupt normal brain growth and the immune situation. The immune status, specific time periods, microenvironment, and genetics may all provide insights into autism pathogenesis.
This document discusses iodinated contrast media which are used for imaging procedures. It provides information on the classification, properties, epidemiology and pathophysiology of reactions to contrast media.
The document classifies contrast media based on their ionization capacity, osmolality, viscosity and number of triiodobenzene rings. It discusses the prevalence of reactions which is higher for ionic contrast media. Immediate reactions are mostly mild while delayed reactions are usually self-limiting skin eruptions.
The pathophysiology of immediate reactions involves mast cell activation but the mechanism is not fully understood. Delayed reactions are believed to be T-cell mediated. Skin testing and intravenous provocation tests are used to diagnose contrast
The document discusses vaccination in patients with chronic kidney disease (CKD). It outlines the rationale and recommendations for vaccination in CKD patients, including those undergoing dialysis or renal transplantation. Specific recommendations are provided for pneumococcal vaccination in CKD patients based on guidelines. The summary discusses how CKD and end-stage renal disease can impair immune function, making vaccinations less effective, and the importance of vaccinating CKD patients to prevent infectious diseases.
1) Pneumonia is a common infection seen in nephrology practice, especially in patients with nephrotic syndrome, chronic kidney disease, end-stage renal disease on dialysis, and renal transplant recipients.
2) Patients with nephrotic syndrome have increased risk of infections like pneumonia due to urinary losses of immunoglobulins and properdin factor B. One study found 36.6% of children with nephrotic syndrome developed major infections, with nearly 1/3 having pneumonia.
3) As chronic kidney disease progresses and reaches end-stage renal disease, risk of infections including pneumonia increases. Cardiovascular disease and infections are the main causes of death in end-stage
This document discusses vaccination in patients with chronic kidney disease (CKD). It outlines how CKD affects both the innate and adaptive immune systems, leading to impaired immunity. It describes alterations in end-stage renal disease that impair response to vaccines. Guidelines recommend vaccines for hepatitis B, pneumococcus, and influenza for CKD patients, with some vaccines requiring higher doses or more doses. Methods to potentially improve vaccine efficacy include use of immunomodulators like interleukin-2 administered with vaccines.
Omalizumab is a monoclonal antibody that binds to immunoglobulin E (IgE), reducing free IgE levels. It is used to treat allergic asthma and rhinitis. Clinical trials show omalizumab significantly reduces asthma exacerbations and improves symptoms and quality of life in patients with moderate-to-severe allergic asthma. It also reduces airway inflammation and thickness. Omalizumab allows reduction of inhaled corticosteroid use without worsening asthma control. Real-world studies find omalizumab effectively improves asthma control long-term with an acceptable safety profile.
This document discusses antibiotic choice in the ICU. It provides epidemiological data from studies on infections in ICU patients. The most common infections are pneumonia, bloodstream infections, and UTIs. The pathogens vary between different ICU profiles such as medical, surgical, and pediatric ICUs. Principles of antibiotic use include targeting the likely pathogen while minimizing toxicity. Empirical antibiotic choices are discussed for common ICU infections like pneumonia, bloodstream infections, and UTIs. Antimicrobial resistance is an increasing problem addressed as well.
1. General anaesthesia can have both direct and indirect effects on the immune system by impacting the innate immune response, adaptive immune response, cytokine production, neutrophil activity, and immunoglobulin levels.
2. Surgery alone increases pro-inflammatory cytokine levels, but anaesthetic agents may increase or decrease specific cytokine production depending on the agent.
3. Perioperative interventions like mechanical ventilation, blood transfusions, chronic pain, and immunosuppressive drugs for transplant patients can further impact the immune response. Precautions are needed for patients with these factors.
This document discusses mycophenolate mofetil and its emerging role in interstitial lung diseases. It begins by providing background on interstitial lung diseases and some of the more common types. It then focuses on chronic hypersensitivity pneumonitis, noting that mycophenolate mofetil has been shown to improve lung function and allow reduction of steroid doses in patients. The document reviews evidence that mycophenolate mofetil may be better tolerated and more effective than azathioprine for chronic hypersensitivity pneumonitis. It also discusses use of mycophenolate mofetil in connective tissue disease-associated interstitial lung diseases.
This document contains summaries of several research points related to critical care. It discusses findings that propofol may limit recovery after brain injury in adults, that cardiac dysfunction is associated with mortality after traumatic brain injury, that vitamin D deficiency predicts sepsis in critically ill patients, and that neuromuscular blocking agents are associated with lower mortality in mechanically ventilated sepsis patients. It also summarizes research showing that a bundle of measures was effective at reducing ventriculitis associated with external cerebral ventricular drainage. Finally, it finds that critical illness is characterized by reduced intestinal absorption of glucose and lower expression of glucose transporters and taste receptors.
This document contains summaries of several research points related to critical care. It discusses findings that propofol may limit recovery after brain injury in adults; cardiac dysfunction occurs after traumatic brain injury and is linked to higher mortality; vitamin D deficiency predicts sepsis in critically ill patients; treating sepsis patients with neuromuscular blocking agents may reduce mortality; propofol affects patient-ventilator interactions depending on sedation level and mode of ventilation; implementing measures to reduce infections lowered the rate of ventriculitis in neurocritical patients; and critical illness reduces intestinal absorption of glucose linked to lower expression of glucose transporters and taste receptors. The document was created by Samir El Ansary and provides his contact information.
Explore the cell's role in mediating adverse reactions 7 c09Paul Thiessen
This document discusses the role of neutrophils and macrophages in mediating various physiological and pathological processes. It summarizes several scientific studies that found:
1) Neutrophils can be recruited by substances like gliadin and mediate local inflammatory responses in tissues like the intestine.
2) Neutrophils and macrophages produce reactive molecules that can damage cells and tissues, and their activation levels correlate with conditions like infertility and acute coronary syndrome.
3) Chronic activation of the innate immune system by these cells may underlie metabolic syndrome by stimulating inflammation and hormonal changes.
4) Oxidative stress can increase blood levels of modified lipids implicated in atherosclerosis, coinciding with increased neutrophil counts.
Treatment of ILDs by Dr. S.K Jindal | JIndal Chest ClinicJindal Chest Clinic
Interstitial lung disease (ILD) refers to a variety of diseases causing fibrosis in the lungs, leading to stiffness and difficulty in breathing and oxygen delivery to the bloodstream. This presentation gives an overview on "Treatment of ILD". For more information, please contact us: 9779030507.
The document discusses the relationship between the immune system and brain conditions from a toxicological perspective. It summarizes several studies that found:
1) The immune system plays an important role in brain development and any immune activation during development can affect later neural function, immune function, mood and cognition.
2) A drug called fingolimod that modulates sphingosine-1-phosphate receptors, reducing lymphocyte migration from lymph nodes, significantly reduced relapse rates and disability progression in multiple sclerosis patients compared to placebo.
3) Systemic immune status can influence local brain tissue conditions, and this effect could be considered a type of toxicological effect worth further investigation to better understand disease pathogenesis and develop new pharmacological
This study evaluated the efficacy and safety of intravenous injection of Mycobacterium w (Mw) in treating gram-negative sepsis.
The study involved 30 patients over 18 years of age with gram-negative sepsis and single organ dysfunction. Patients received intravenous Mw injections in addition to standard care. Results showed significant improvements in vital signs, organ function markers, and sepsis severity scores from day 2 onward compared to baseline. No major adverse events occurred.
The study concluded that intravenous Mw appears to be a well-tolerated and effective adjuvant treatment for gram-negative sepsis when added to standard care, as demonstrated by improved clinical outcomes. However, larger randomized controlled trials are still needed to confirm these findings.
This document summarizes research on the immunological and toxicological implications of COVID-19, focusing on the innate immune response and immune evasion. It discusses how the virus can trigger a "cytokine storm" through overactivation of the innate immune system and proinflammatory cytokines like IL-6. This storm can lead to widespread inflammation and multi-organ failure. The document also explores potential therapeutic strategies aimed at modulating the cytokine response, such as using corticosteroids or chloroquine to reduce IL-6 levels and calm the storm. Understanding the immune dysregulation and identifying key signaling pathways may help develop new clinical management approaches and prevent progression to severe illness.
IOSR Journal of Mathematics(IOSR-JM) is an open access international journal that provides rapid publication (within a month) of articles in all areas of mathemetics and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in mathematics. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Assessment of the Implementation of Ventilator-associated Pneumonia Preventiv...IOSR Journals
Background: Pneumonia associated with mechanical ventilation (VAP) is one of the important
causes of nosocomial infections in pediatric intensive care units (PICU). VAP is the leading cause of morbidity
and mortality in PICUs. Aim: To assess the compliance to ventilator bundle components: elevation of the head
of bed >30, sedation interruption, spontaneous breathing trial, peptic ulcer prophylaxis and its effect on the
prevention of VAP. Subjects and Methods: A case control study at PICU of Abo EL Reish El Moneira Hospital,
including all mechanically ventilated patients admitted over a period of one year. The study tested the effect of
implementation of this bundle as regard the rate of VAP in both group, compliance to bundle and most affecting
component of it. Results: There was decrease incidence of VAP after implementation of the bundle, from (50%)
to (14%). Development of VAP was mostly affected by being in supine position, long duration of mechanical
ventilation and presence of pump failure. (p<0.05) The compliance to bundle components was statistically
significant, p= 0.001. Conclusion: VAP rate decreased after implementation of this bundle. Elevation of the
head of bed was the most compliant component of bundle in the PICU.
1) The study evaluated changes in the expression of hypoxia-associated genes in mouse lung tissue at various time points after radiation exposure. A microarray analysis found that 44 genes related to metabolism, growth, apoptosis, inflammation, oxidative stress, and fibrosis were upregulated after radiation.
2) Treatment with the antioxidant AEOL10150 after radiation exposure attenuated the elevated expression of 31 of these hypoxia-associated genes. This suggests that expression of many hypoxia genes is regulated by early oxidative stress following radiation.
3) The hypoxia-associated genes identified provide insight into how hypoxic signaling may contribute to radiation-induced lung injury. The study also provides clues about how AEOL10150's antioxidant properties confer radi
Role of Breast-Feeding in Early Development of Immune System in InfantsAriyanto Harsono
Breastfeeding plays an important role in the development of an infant's immune system. The document discusses how an infant's immune system is still maturing in the first years of life, leaving them more susceptible to infections. Breastmilk supports immune maturation by providing antibodies and modulating the infant's immune response. Impaired immune development in infancy can increase the risk of allergies and autoimmune diseases later in life. The interplay between genes, nutrition from breastfeeding, and the infant's environment all influence how their immune system develops.
Nano patches can be used to deliver vaccines through the skin for epicutaneous immunization. They have micro-projections containing the vaccine that deliver it into the epidermis, which is rich in immune cells called Langerhans cells. These cells then carry the antigen to lymph nodes where it stimulates antibody production. Nano patch vaccines could help reduce costs by providing needle-free delivery, making vaccination easier and safer especially in developing countries by eliminating needle stick injuries and reuse. Further research is still needed but nano patch vaccination shows potential for improved vaccine delivery and uptake.
This document discusses host modulation as a promising direction in periodontal therapy. It reviews various pharmacological agents that can be used as host modulators to inhibit the destructive inflammatory response and promote resolution of inflammation in periodontitis. These include non-steroidal anti-inflammatory drugs, cytokines inhibitors such as IL-1 receptor antagonists, bone sparing bisphosphonates, pro-resolving lipid mediators like lipoxins and resolvins, and MMP inhibitors like sub-antimicrobial dose doxycycline. Host modulation aims to reduce tissue destruction by modulating the host response in addition to conventional antibacterial therapy.
Long acting pe gylated interferon application of pegDoriaFang
Interferons (IFNs) are a group of signaling proteins secreted by host cells in response to the virus infection. The IFNs can be subdivided into three types (types I, II, and III) based on their different receptors.
Development of anti tnf therapy for rheumatoid arthritis碩彥 徐
This document summarizes the development of anti-TNF therapy for rheumatoid arthritis (RA). It discusses how TNF was identified as a key cytokine in RA, leading researchers to hypothesize that blocking TNF may help treat the disease. Early clinical trials of the anti-TNF antibody infliximab showed promising results, with many patients experiencing reduced joint swelling and tenderness. Further studies demonstrated the safety and efficacy of long-term anti-TNF therapy for RA and other chronic inflammatory diseases where TNF is involved, such as Crohn's disease. However, anti-TNF treatment is not effective for all diseases and some patients still do not adequately respond.
The document summarizes several studies on new treatments for chronic urticaria and atopic dermatitis. It discusses how omalizumab is currently the primary treatment for antihistamine-resistant chronic urticaria. Newer monoclonal antibodies like ligelizumab and UB-221 show promise. Other potential treatments discussed include interleukin inhibitors and kinase inhibitors. The document also reviews trials of JAK inhibitors, TSLP antagonists, and other targeted treatments for atopic dermatitis subtypes.
This document provides an overview of ciprofloxacin, a broad-spectrum antibiotic. It discusses the drug's pharmacokinetics including absorption, metabolism, distribution and elimination. The pharmacodynamics section covers its mechanism of action and therapeutic uses. Potential interactions, resistance development, side effects and dosage forms are also reviewed. Ciprofloxacin is administered orally or intravenously to treat bacterial infections, with a standard daily dosage of 500-1500mg depending on the infection severity. Common side effects include nausea, diarrhea and eye irritation.
By Dr. Usama Ragab Youssif
Definitions & Nomenclatures
Structure of immunoglobulins
Immunoglobulins in our bodies
Physiologic actions of immunoglobulins
The Idea behind use of immunoglobulins
Uses: indications, mechanisms, preparation, posology, administration
Adverse effects
Safe practice
Final bottom-line
Similar to The effects of Sevoflurane and Propofol on IFN-γ And IL-12 Study On Patients With Craniotomy Surgery (20)
The Statutory Interpretation of Renewable Energy Based on Syllogism of Britis...AI Publications
The current production for energy consumption generates harmful impacts of carbon dioxide to the environment causing instability to sustainable development goals. The constitutional reforms of British Government serve to be an important means of resolving any encountered incompatibilities to political environment. This study aims to evaluate green economy using developed equation for renewable energy towards political polarization of corporate governance. The Kano Model Assessment is used to measure the equivalency of 1970 Patents Act to UK Intellectual Property tabulating the criteria for the fulfillment of sustainable development goals in respect to the environment, artificial intelligence, and dynamic dichotomy of administrative agencies and presidential restriction, as statutory interpretation development to renewable energy. The constitutional forms of British government satisfy the sustainable development goals needed to fight climate change, advocate healthy ecosystem, promote leadership of magnates, and delegate responsibilities towards green economy. The presidential partisanship must be observed to delineate parties of concerns and execute the government prescriptions in equivalence to the dichotomous relationship of technology and the environment in fulfilling the rights and privileges of all citizens. Hence, the political elites can execute corporate governance towards sustainable development of renewable energy promoting environmental parks and zero emission target of carbon dioxide discharges. The economic theory developed in statutory interpretation for renewable energy serves as a tool to reduce detrimental impacts of carbon dioxide to the environment, mitigate climate change, and produce artefacts of bioenergy and artificial intelligence promoting sustainable development. It is suggested to explore other vulnerabilities of artificial intelligence to prosper economic success.
Enhancement of Aqueous Solubility of Piroxicam Using Solvent Deposition SystemAI Publications
Piroxicam is a non-steroidal anti-inflammatory drug that is characterized by low solubility-high permeability. The present study was designed to improve the dissolution rate of piroxicam at the physiological pH's through its increased solubility by using solvent deposition system.
Analysis of Value Chain of Cow Milk: The Case of Itang Special Woreda, Gambel...AI Publications
Ethiopia has a long and rich history of dairy farming, which was mostly carried out by small and marginal farmers who raised cattle, camels, goats, and sheep, among other species, for milk. Finding the Itang Special Woreda cow milk value chain is the study's main goal. In order to gather primary data, 204 smallholder dairy farmer households were randomly selected, and the market concentration ratio was calculated using 20 traders. Descriptive statistics, econometric models, and rank analysis were used to achieve the above specified goals. Out of all the participants in the milk value chain, producers, cafés, hotels, and dairy cooperatives had the largest gross marketing margins, accounting for 100% of the consumer price in channels I and II, 55% in channels III and V, and 25.5% in channels V. The number of children under five, the number of milking cows owned, the amount of money from non-dairy sources, the frequency of extension service contacts, the amount of milk produced each day, and the availability of market information were found to have an impact on smallholders' involvement in the milk market. Numerous obstacles also limited the amount of milk produced and marketed. The poll claims that general health issues, sickness, predators, and a lack of veterinary care are plaguing farmers. In order to address the issue of milk perishability, the researchers recommended the host community and organization to construct an agro milk processor, renovate the dairy cooperative in the study region, and restructure the current conventional marketing to lower the transaction and cost of milk marketing.
Minds and Machines: Impact of Emotional Intelligence on Investment Decisions ...AI Publications
In the evolving landscape of financial decision-making, this study delves into the intricate relationships among Emotional Intelligence (EI), Artificial Intelligence (AI), and Investment Decisions (ID). By scrutinizing the direct influence of human emotional intelligence on investment choices and elucidating the mediating role of AI in this process, our research seeks to unravel the complex interplay between minds and machines. Through empirical analysis, we reveal that EI not only directly impacts ID but also exerts its influence indirectly through AI-mediated pathways. The findings underscore the pivotal role of emotional awareness in investor decision-making, augmented by the technological capabilities of AI. It suggests that most investors are influenced by the identified emotional intelligence when making investment decisions. Furthermore, AI substantially impacts investors' decision-making process when it comes to investing; nevertheless, AI partially mediates the relationship between emotional intelligence and investment decisions. This nuanced understanding provides valuable insights for financial practitioners, policymakers, and researchers, emphasizing the need for holistic strategies that integrate emotional and technological dimensions in navigating the intricacies of modern investment landscapes. As the synergy between human intuition and artificial intelligence becomes increasingly integral to financial decision-making, this study contributes to the ongoing discourse on the symbiotic relationship between minds and machines in investments.0
Bronchopulmonary cancers are common cancers with a poor prognosis. It is the leading cause of death by cancer in Algeria and in the world. Behind this unfavorable prognosis hides numerous disparities according to age, sex, and exposure to risk factors, ranking 4th among incident cancers and developing countries including Algeria, all sexes combined. It ranks 2nd cancers in men and 3rd among women. Whatever the age observed, the incidence of this cancer is higher in men than in women, however the gap is narrowing to the detriment of the latter. The results of scientific research agree to relate trends in incidence and mortality rates to tobacco consumption, including passive smoking. Furthermore, other risk factors are mentioned such as exposure to asbestos in the workplace or to radon for the general population, or even genetic predisposition. However, the weight of these etiological and/or predisposing factors is in no way comparable to that of tobacco in the genesis of lung cancer and the resulting mortality. We provide a literature review in our article on the descriptive and analytical epidemiology of lung cancer.
Further analysis on Organic agriculture and organic farming in case of Thaila...AI Publications
The objective of this paper is to present Further analysis on Organic agriculture and organic farming in case of Thailand agriculture and enhancing farmer productivity. In view of the demand for organic fertilizers, efforts should also be made to enhance and to develop more effective of compost, bio-fertilizer, and bio-pesticides currently used by farmers. Likewise, emphasis should also be laid on the cultivation of legumes and other crops that can enhance the fertility of the soil, as practiced by farmers in many developing countries to fertilize their lands. On the other hand, most of the farmers who practice this farm system found that they are adopting a number of SLMs and interested in joining the meeting or training to gain more and more knowledge.
Current Changes in the Role of Agriculture and Agri-Farming Structures in Tha...AI Publications
The objective os this study is to present Current Changes in the Role of Agriculture and Agri-Farming Structures in Thailand and Vietnam with SLM practices. Farmer’s adoption and investment in SLM is a key for controlling land degradation, enhancing the well-being of society, and ensuring the optimal use of land resources for the benefit of present and future generations (World Bank, 2006; FAO, 2018). And agriculture remains an essential element of lives of many farmers in term of the strong cultural and symbolic values that attach current working generation to do and to spend time for it but not intern of income generating.
Growth, Yield and Economic Advantage of Onion (Allium cepa L.) Varieties in R...AI Publications
Haphazard and low soil fertility, low yielding verities and poor agronomic practices are among the major factors constraining onion production in the central rift valley of Ethiopia. Therefore, a field experiment was conducted in East Showa Zone of Adami Tulu Jido Combolcha district in central rift valley areas at ziway from October 2021 to April 2022 to identify appropriate rate of NPSB fertilizer and planting pattern of onion varieties. The experiment was laid out in split plot design of factorial arrangement in three replications. The main effect of NPSB blended fertilizer rates and varieties (red coach and red king) significantly (p<0.01) influenced plant height, leaf length, leaf diameter, leaf number and fresh leaf weight, shoot dry matter per plant, and harvest index. Total dry biomass, bulb diameter, neck diameter, average fresh bulb weight, bulb dry matter, marketable bulb yield, and total bulb yield were significantly (p<0.01) influenced only by the main effect of NPSB blended fertilizer rates. In addition, unmarketable bulb yield was statistically significantly affected (p≥0.05) by the blended fertilizer rates and planting pattern. Moreover, days to 90% maturity of onion was affected by the main factor of NPSB fertilizer rate, variety and planting pattern. The non-fertilized plants in the control treatment were inferior in all parameters except unmarketable bulb yield and harvest index. Significantly higher marketable bulb yield (41 t ha-1) and total bulb yield (41.33 t ha-1) was recorded from 300 kg ha-1 NPSB blended fertilizer rate applied. Double row planting method and hybrid red coach onion variety had also gave higher growth and yields. The study revealed that the highest net benefit of Birr, 878,894 with lest cost of Birr 148,006 by the combinations of 150 kg blended NPSB ha-1 with double row planting method (40cm*20cm*7cm) and red coach variety which can be recommendable for higher marketable bulb yield and economic return of hybrid onion for small scale farmers in the study area. Also, for resource full producers (investors), highest net benefit of Birr 1,205,372 with higher cost (159,628 Birr) by application of 300 kg NPSB ha-1 is recommended as a second option. However, the research should be replicated both in season and areas to more verify the recommendations.
Evaluation of In-vitro neuroprotective effect of Ethanolic extract of Canariu...AI Publications
The ethanolic extract of canarium solomonense leaves (ecsl) was studied for its neuroprotective activity. The neuroprotective activity of ECSL was found to have a significant impact on neuronal cell death triggered by hydrogen peroxide (MTT assay) in human SH-SY5Y neuroblastoma cells. Scopolamine, a muscarinic receptor blocker, is frequently used to induce cognitive impairment in laboratory animals. Injections of scopolamine influence multiple cognitive functions, including motor function, short-term memory, and attention. Using the Morris water maze, the Y maze, and the passive avoidance paradigm, memory enhancing activity in scopolamine-induced amnesic rats was evaluated. Using the Morris water maze, the Y maze, and the passive avoidance paradigm, ECSL was found to have a substantial effect on the memory of scopolamine- induced amnesic rats. Our experimental data indicated that ECSL can reverse scopolamine induced amnesia and assist with memory issues.
The goal of neuroprotection is to shield neurons against damage, whether that damage is caused by environmental factors, pathogens, or neurodegenerative illnesses. Inhibiting protein-based deposit buildup, oxidative stress, and neuroinflammation, as well as rectifying abnormalities of neurotransmitters like dopamine and acetylcholine, are some of the ways in which medicinal herbs have neuroprotective effects [1-3]. This review will focus on the ways in which medicinal herbs may protect neurons.
A phytochemical and pharmacological review on canarium solomonenseAI Publications
The genus Canarium L. consists of 75 species of aromatic trees which are found in the rainforests of tropical Asia, Africa and the Pacific. The medicinal uses, botany, chemical constituents and pharmacological activities are now reviewed. Various compounds are tabulated according to their classes their structures are given. Traditionally canarium solomonense have been used to treat a broad array of illnesses. Pharmacological actions for canarium solomonense as discussed in this review include antibacterial, antimicrobial, antioxidant, anti-inflammatory, hepatoprotective and antitumor activity.
Influences of Digital Marketing in the Buying Decisions of College Students i...AI Publications
This research investigates the influence of digital marketing channels on purchasing decisions among college students in Ramanathapuram District. The study highlights that social media marketing, online advertising, and mobile marketing exhibit substantial positive effects on purchase decisions. However, email marketing's impact appears to be more complex. Moreover, the study explores how demographic variables like gender and academic level shape these effects. Notably, freshman students display varying susceptibility to specific digital marketing messages compared to their junior, senior, or graduate counterparts. These findings offer crucial insights for marketers aiming to tailor their strategies effectively to the preferences and behaviors of college students. By understanding the differential impacts of various digital marketing channels and considering demographic nuances, marketers can refine their approaches, optimize engagement, and ultimately enhance the effectiveness of their campaigns in targeting this demographic.
A Study on Performance of the Karnataka State Cooperative Agriculture & Rural...AI Publications
The Karnataka State Co-operative Agriculture and Rural Development Bank Limited is the apex bank of all the primary co-operative agriculture and rural development banks in the state. All the PCARD Banks in the state are affiliated to it. The KSCARD Bank provides financial accommodation to the PCARD Banks for their lending operations. In order to quick sanction and disbursement of loans and supervision over the PCARD Banks the KSCARD Bank has opened district level branches. Bank has established Women Development Cell to promote entrepreneurship among women in 2005. The Bank is identifying women borrowers in the rural areas by assigning suitable projects to motivate their self-confidence to lead independent life. Progress made in financing women entrepreneurs women.
Breast hamartoma is a rare, well-circumscribed, benign lesion made up of a variable quantity of glandular, adipose and fibrous tissue. This is a lesion that can affect women at any age from puberty. With the increasingly frequent use of imaging methods such as mammography and ultrasound as well as breast biopsy, cases of hamartoma diagnosed are increasing. The diagnosis of these lesions is made by mammography. The histological and radiological aspects are variable and depend on its adipose tissue content. The identification of these lesions is important in order to avoid surgical excisions. We report radio-clinical and pathological records of breast hamartoma.
A retrospective study on ovarian cancer with a median follow-up of 36 months ...AI Publications
Ovarian cancer is relatively common but serious and has a poor prognosis. The aim of this study is to highlight the epidemiological, diagnostic, therapeutic and evolutionary aspects of this malignant pathology managed at the Bejaia university hospital center. This is a retrospective and descriptive study over a period of 3 years (2019 - 2022) carried out on 20 patients who developed ovarian cancer. The average age of the patients was 50 years old, 53.23% of whom were over 45 years old. The CA-125 blood test was positive in 18 out of 20 patients. The tumors were discovered on ultrasound in 87.10% of cases and at laparotomy in 12.90%. Total hysterectomy with bilateral adnexectomy was the most performed procedure (64.52%). The early postoperative course was simple. 15 patients underwent second look surgery (16.13%) for locoregional recurrences. Epithelial tumors were the most frequent histological type (93.55%), including 79% in the advanced stage ( IIIc -IV) and 21% in the early stage (Ia- Ib ). Adjuvant chemotherapy was administered in 80% of patients. With a median follow-up of 36 months, 2 patients were lost to follow-up. The evolution was favorable in 27.42% and in 25.81% deaths occurred late postoperatively. Ovarian cancer is not common but serious given the advanced stages and the high rate of late postoperative deaths which were largely observed in patients deprived of adequate neoadjuvant or adjuvant chemotherapy.
More analysis on environment protection and sustainable agriculture - A case ...AI Publications
This study presents a case of tea and coffee crops , esp. environment protection and sustainable agriculture in Son La and Thai Nguyen of Vietnam. Research results show us that The process of having an agricultural product goes through many steps such as planting, planning, harvesting, packing, transporting, storing and distributing. - The State adopts policies to encourage innovation of agricultural production models and methods towards sustainability, adapting to climate change, saving water, and limiting the use of inorganic fertilizers and pesticides. chemicals and products for environmental treatment in agriculture; develop environmentally friendly agricultural models. Our research limitation is that we can expand for other crops, industries and markets as well.
Assessment of Growth and Yield Performance of Twelve Different Rice Varieties...AI Publications
The present investigation entitled “Assessment of growth and yield performance of twelve different rice varieties under north Konkan coastal zone of Maharashtra” was carried out during the kharif season of the year 2021 and 2022 on the field of ASPEE, Agricultural Research and Development Foundation, Tansa Farm, At Nare, Taluka Wada, District Palghar, Maharashtra, India. The experiment was laid out in Randomized Block Design (RBD). The twelve varieties namely Zini, Jaya, Dandi, Rahghudya, Govindbhog, Dangi, Gurjari, VNR-7, VNR-8, VNR-9, Karjat-3, and Karjat-5 were replicated thrice. The plant height (cm), number of tillers per plant, number of panicles per plant, number of panicles (m²), and length of panicle (cm) were noted to the maximum with cv. “VNR-7”. The highest number of seeds per panicle, test weight (gm), grain yield (q/ha), and straw yield (q/ha) were recorded with the cv. “VNR-7”. While the lowest number of days to 50% flowering was also recorded with cv. “VNR-7” during the year 2021 and 2022.
Cultivating Proactive Cybersecurity Culture among IT Professional to Combat E...AI Publications
In the current digital landscape, cybercriminals continually evolve their techniques to execute successful attacks on businesses, thus posing a great challenge to information technology (IT) professionals. While traditional cybersecurity approaches like layered defense and reactive security have helped IT professionals cope with traditional threats, they are ineffective in dealing with evolving cyberattacks. This paper focuses on the need for a proactive cybersecurity culture among IT professionals to enable them combat evolving threats. The paper emphasis that building a proactive security approach and culture can help among IT professionals anticipate, identify, and mitigate latent threats prior to them exploiting existing vulnerabilities. This paper also points out that as IT professionals use reactive security when dealing with traditional attacks, they can use it collaboratively with proactive security to effectively protect their networks, data, and systems and avoid heavy costs of dealing with cyberattack’s aftermaths and business recovery.
The Impacts of Viral Hepatitis on Liver Enzymes and BilrubinAI Publications
Viral hepatitis is an infection that causes liver inflammation and damage. Several different viruses cause hepatitis, including hepatitis A, B, C, D, and E. The hepatitis A and E viruses typically cause acute infections. The hepatitis B, C, and D viruses can cause acute and chronic infections. Hepatitis A causes only acute infection and typically gets better without treatment after a few weeks. The hepatitis A virus spreads through contact with an infected person’s stool. Protection by getting the hepatitis A vaccine. Hepatitis E is typically an acute infection that gets better without treatment after several weeks. Some types of hepatitis E virus are spread by drinking water contaminated by an infected person’s stool. Other types are spread by eating undercooked pork or wild game. Hepatitis B can cause acute or chronic infection. Recommendation for screening for hepatitis B in pregnant women or in those with a high chance of being infected. Protection from hepatitis B by getting the hepatitis B vaccine. Hepatitis C can cause acute or chronic infection. Doctors usually recommend one-time screening of all adults ages 18 to 79 for hepatitis C. Early diagnosis and treatment can prevent liver damage. The hepatitis D virus is unusual because it can only infect those who have a hepatitis B virus infection. A coinfection occurs when both hepatitis D and hepatitis B infections at the same time. A superinfection occurs already have chronic hepatitis B and then become infected with hepatitis D. The aim of this study is to find the effect of each type of viral hepatitis on the bilirubin (TB , DSB) , and liver enzymes; AST, ALT, ALP,GGT among viral hepatitis patients. 200 patients were selected from the viral hepatitis units in the central public health laboratory in Baghdad city, all the chosen cases were confirmed as a positive samples , they are classified into four equal group each with fifty individual and with a single serological viral hepatitis type either; anti-HAV( IgM ) , HBs Ag , anti-HCV ,or anti-HEV(IgM ). All patients were tested for; serum bilirubin ( TB ,D.SB ) , AST , ALT , ALP , GGT. Another fifty quite healthy and normal person was selected as a control group for comparison. . Liver enzymes and bilirubin changes are more pronounced in HAV, HEV than HCV and HBVAST and ALT lack some sensitivity in detecting HCV ,HBV and mild elevations of ALT or AST in asymptomatic patients can be evaluated efficiently by considering ,hepatitis B, hepatitis C. ALT is generally a more sensitive indicator of acute liver cell damage than AST, It is relatively specific for hepatocyte necrosis with a marked elevations in viral hepatitis. Liver enzymes and bilirubin changes are more pronounced in HAV, HEV than HCV and HBV.AST and ALT lack some sensitivity in detecting HCV ,HBV and mild elevations of ALT or AST in asymptomatic patients can be evaluated efficiently by considering ,hepatitis B, hepatitis C. ALT is generally a more sensitive indicator of acute liver
Determinants of Women Empowerment in Bishoftu Town; Oromia Regional State of ...AI Publications
The purpose of this study was to determine the status of women's empowerment and its determinants using women's asset endowment and decision-making potential as indicators. To determine representative sample size, this study used a two-stage sampling technique, and 122 sample respondents were selected at random. To analyze the data in this study, descriptive statistics and a probit model were used. The average women's empowerment index was 0.41, indicating a relatively lower status of women's empowerment in the study area. According to the study's findings, only 40.9% of women were empowered, while the remaining 59.1% were not. The probit model results show that women's access to the media, women's income, and their husbands' education status have a significant and positive impact on the status of women's empowerment, while the family size of households has a negative impact. As a result, it is important to enhance women's access to the media and income, promote family planning and contraception, and improve men's educational status in order to improve the status of women's empowerment.
Immersive Learning That Works: Research Grounding and Paths ForwardLeonel Morgado
We will metaverse into the essence of immersive learning, into its three dimensions and conceptual models. This approach encompasses elements from teaching methodologies to social involvement, through organizational concerns and technologies. Challenging the perception of learning as knowledge transfer, we introduce a 'Uses, Practices & Strategies' model operationalized by the 'Immersive Learning Brain' and ‘Immersion Cube’ frameworks. This approach offers a comprehensive guide through the intricacies of immersive educational experiences and spotlighting research frontiers, along the immersion dimensions of system, narrative, and agency. Our discourse extends to stakeholders beyond the academic sphere, addressing the interests of technologists, instructional designers, and policymakers. We span various contexts, from formal education to organizational transformation to the new horizon of an AI-pervasive society. This keynote aims to unite the iLRN community in a collaborative journey towards a future where immersive learning research and practice coalesce, paving the way for innovative educational research and practice landscapes.
Discovery of An Apparent Red, High-Velocity Type Ia Supernova at 𝐳 = 2.9 wi...Sérgio Sacani
We present the JWST discovery of SN 2023adsy, a transient object located in a host galaxy JADES-GS
+
53.13485
−
27.82088
with a host spectroscopic redshift of
2.903
±
0.007
. The transient was identified in deep James Webb Space Telescope (JWST)/NIRCam imaging from the JWST Advanced Deep Extragalactic Survey (JADES) program. Photometric and spectroscopic followup with NIRCam and NIRSpec, respectively, confirm the redshift and yield UV-NIR light-curve, NIR color, and spectroscopic information all consistent with a Type Ia classification. Despite its classification as a likely SN Ia, SN 2023adsy is both fairly red (
�
(
�
−
�
)
∼
0.9
) despite a host galaxy with low-extinction and has a high Ca II velocity (
19
,
000
±
2
,
000
km/s) compared to the general population of SNe Ia. While these characteristics are consistent with some Ca-rich SNe Ia, particularly SN 2016hnk, SN 2023adsy is intrinsically brighter than the low-
�
Ca-rich population. Although such an object is too red for any low-
�
cosmological sample, we apply a fiducial standardization approach to SN 2023adsy and find that the SN 2023adsy luminosity distance measurement is in excellent agreement (
≲
1
�
) with
Λ
CDM. Therefore unlike low-
�
Ca-rich SNe Ia, SN 2023adsy is standardizable and gives no indication that SN Ia standardized luminosities change significantly with redshift. A larger sample of distant SNe Ia is required to determine if SN Ia population characteristics at high-
�
truly diverge from their low-
�
counterparts, and to confirm that standardized luminosities nevertheless remain constant with redshift.
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfSelcen Ozturkcan
Ozturkcan, S., Berndt, A., & Angelakis, A. (2024). Mending clothing to support sustainable fashion. Presented at the 31st Annual Conference by the Consortium for International Marketing Research (CIMaR), 10-13 Jun 2024, University of Gävle, Sweden.
PPT on Alternate Wetting and Drying presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...Sérgio Sacani
Context. The observation of several L-band emission sources in the S cluster has led to a rich discussion of their nature. However, a definitive answer to the classification of the dusty objects requires an explanation for the detection of compact Doppler-shifted Brγ emission. The ionized hydrogen in combination with the observation of mid-infrared L-band continuum emission suggests that most of these sources are embedded in a dusty envelope. These embedded sources are part of the S-cluster, and their relationship to the S-stars is still under debate. To date, the question of the origin of these two populations has been vague, although all explanations favor migration processes for the individual cluster members. Aims. This work revisits the S-cluster and its dusty members orbiting the supermassive black hole SgrA* on bound Keplerian orbits from a kinematic perspective. The aim is to explore the Keplerian parameters for patterns that might imply a nonrandom distribution of the sample. Additionally, various analytical aspects are considered to address the nature of the dusty sources. Methods. Based on the photometric analysis, we estimated the individual H−K and K−L colors for the source sample and compared the results to known cluster members. The classification revealed a noticeable contrast between the S-stars and the dusty sources. To fit the flux-density distribution, we utilized the radiative transfer code HYPERION and implemented a young stellar object Class I model. We obtained the position angle from the Keplerian fit results; additionally, we analyzed the distribution of the inclinations and the longitudes of the ascending node. Results. The colors of the dusty sources suggest a stellar nature consistent with the spectral energy distribution in the near and midinfrared domains. Furthermore, the evaporation timescales of dusty and gaseous clumps in the vicinity of SgrA* are much shorter ( 2yr) than the epochs covered by the observations (≈15yr). In addition to the strong evidence for the stellar classification of the D-sources, we also find a clear disk-like pattern following the arrangements of S-stars proposed in the literature. Furthermore, we find a global intrinsic inclination for all dusty sources of 60 ± 20◦, implying a common formation process. Conclusions. The pattern of the dusty sources manifested in the distribution of the position angles, inclinations, and longitudes of the ascending node strongly suggests two different scenarios: the main-sequence stars and the dusty stellar S-cluster sources share a common formation history or migrated with a similar formation channel in the vicinity of SgrA*. Alternatively, the gravitational influence of SgrA* in combination with a massive perturber, such as a putative intermediate mass black hole in the IRS 13 cluster, forces the dusty objects and S-stars to follow a particular orbital arrangement. Key words. stars: black holes– stars: formation– Galaxy: center– galaxies: star formation
The cost of acquiring information by natural selectionCarl Bergstrom
This is a short talk that I gave at the Banff International Research Station workshop on Modeling and Theory in Population Biology. The idea is to try to understand how the burden of natural selection relates to the amount of information that selection puts into the genome.
It's based on the first part of this research paper:
The cost of information acquisition by natural selection
Ryan Seamus McGee, Olivia Kosterlitz, Artem Kaznatcheev, Benjamin Kerr, Carl T. Bergstrom
bioRxiv 2022.07.02.498577; doi: https://doi.org/10.1101/2022.07.02.498577
Anti-Universe And Emergent Gravity and the Dark UniverseSérgio Sacani
Recent theoretical progress indicates that spacetime and gravity emerge together from the entanglement structure of an underlying microscopic theory. These ideas are best understood in Anti-de Sitter space, where they rely on the area law for entanglement entropy. The extension to de Sitter space requires taking into account the entropy and temperature associated with the cosmological horizon. Using insights from string theory, black hole physics and quantum information theory we argue that the positive dark energy leads to a thermal volume law contribution to the entropy that overtakes the area law precisely at the cosmological horizon. Due to the competition between area and volume law entanglement the microscopic de Sitter states do not thermalise at sub-Hubble scales: they exhibit memory effects in the form of an entropy displacement caused by matter. The emergent laws of gravity contain an additional ‘dark’ gravitational force describing the ‘elastic’ response due to the entropy displacement. We derive an estimate of the strength of this extra force in terms of the baryonic mass, Newton’s constant and the Hubble acceleration scale a0 = cH0, and provide evidence for the fact that this additional ‘dark gravity force’ explains the observed phenomena in galaxies and clusters currently attributed to dark matter.
Evidence of Jet Activity from the Secondary Black Hole in the OJ 287 Binary S...Sérgio Sacani
Wereport the study of a huge optical intraday flare on 2021 November 12 at 2 a.m. UT in the blazar OJ287. In the binary black hole model, it is associated with an impact of the secondary black hole on the accretion disk of the primary. Our multifrequency observing campaign was set up to search for such a signature of the impact based on a prediction made 8 yr earlier. The first I-band results of the flare have already been reported by Kishore et al. (2024). Here we combine these data with our monitoring in the R-band. There is a big change in the R–I spectral index by 1.0 ±0.1 between the normal background and the flare, suggesting a new component of radiation. The polarization variation during the rise of the flare suggests the same. The limits on the source size place it most reasonably in the jet of the secondary BH. We then ask why we have not seen this phenomenon before. We show that OJ287 was never before observed with sufficient sensitivity on the night when the flare should have happened according to the binary model. We also study the probability that this flare is just an oversized example of intraday variability using the Krakow data set of intense monitoring between 2015 and 2023. We find that the occurrence of a flare of this size and rapidity is unlikely. In machine-readable Tables 1 and 2, we give the full orbit-linked historical light curve of OJ287 as well as the dense monitoring sample of Krakow.
CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)eitps1506
Description:
Dive into the fascinating realm of solid-state physics with our meticulously crafted online PowerPoint presentation. This immersive educational resource offers a comprehensive exploration of the fundamental concepts, theories, and applications within the realm of solid-state physics.
From crystalline structures to semiconductor devices, this presentation delves into the intricate principles governing the behavior of solids, providing clear explanations and illustrative examples to enhance understanding. Whether you're a student delving into the subject for the first time or a seasoned researcher seeking to deepen your knowledge, our presentation offers valuable insights and in-depth analyses to cater to various levels of expertise.
Key topics covered include:
Crystal Structures: Unravel the mysteries of crystalline arrangements and their significance in determining material properties.
Band Theory: Explore the electronic band structure of solids and understand how it influences their conductive properties.
Semiconductor Physics: Delve into the behavior of semiconductors, including doping, carrier transport, and device applications.
Magnetic Properties: Investigate the magnetic behavior of solids, including ferromagnetism, antiferromagnetism, and ferrimagnetism.
Optical Properties: Examine the interaction of light with solids, including absorption, reflection, and transmission phenomena.
With visually engaging slides, informative content, and interactive elements, our online PowerPoint presentation serves as a valuable resource for students, educators, and enthusiasts alike, facilitating a deeper understanding of the captivating world of solid-state physics. Explore the intricacies of solid-state materials and unlock the secrets behind their remarkable properties with our comprehensive presentation.
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
The effects of Sevoflurane and Propofol on IFN-γ And IL-12 Study On Patients With Craniotomy Surgery
1. International Journal of Medical, Pharmacy and Drug Research (IJMPD) [Vol-4, Issue-3, May-Jun, 2020]
https://dx.doi.org/10.22161/ijmpd.4.3.1 ISSN: 2456-8015
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The effects of Sevoflurane and Propofol on
IFN-γ And IL-12 Study On Patients With
Craniotomy Surgery
Mohammed Husyan Mohammed Jaabh1
, Sofyan M. Harahap2
, Helmia
Farida3
1
Student Master Program of Biomedical Science Diponegoro University, Indonesia
2,3
Department of Biomedical Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
Corresponding author: mohammed Jabh1989@gmail.com
Abstract— Background: This research aimed to analyze the effects of sevoflurane and propofol on
IFN-γ and IL-12, the study on patients with craniotomy surgery. The treatment is the anesthesia with
sevoflurane or propofol for more than 2 hours. The levels of IFN-γ and IL-12 are measured just before
induction of anesthesia and just after anesthesia with sevoflurane or propofol is stopped.
Methods: The study design is an observational study by using pre-and-post design. The subjects are
patients aged 30-55 years old who were undergoing craniotomy surgery for tumor removal at Dr.
Kariadi Hospital. The differences in the means before and after the same anesthesia agent were
analyzed with paired T-test if the data distribution is normal, or with the Wilcoxon rank-sum test if the
data distribution is not normal. The difference in the means between the two different anesthesia
agents was analyzed using an independent T-test if the data distribution is normal, or with the Mann-
Whitney test if the data distribution is not normal.
Results: It was observed that sevoflurane and propofol increased the level of IFN-γ and IL-12 but not
significant. There were differences between IFN-γ and IL-12 before and after anesthesia with
sevoflurane compared with propofol. Therefore, the hypothesis was accepted. This shows that the
originality of this research has been statistically and empirically proved.
Conclusion: The increase of both IFN-γ and IL-12 levels after anesthesia with propofol is significantly
higher than those with sevoflurane. Propofol exerts a bigger pro-inflammatory response than
sevoflurane in patients undergoing craniotomy surgery.
Keywords— Effects Of Sevoflurane, Propofol, IFN-γ, IL-12, Craniotomy Surgery.
I. INTRODUCTION
The immune system is important to live because there are
a lot of hazardous pathogens in the environment. The
immune system will protect us from those pathogens and
diseases. The immune system identifies and eliminates
pathogens by inducing innate immune responses and then
adaptive response. Immunity innate, often known as
normal or initial immunity, it is the first line of defense
and refers to the system of protection that occurs long
before infection.”The key component of innate immunity
is the epithelial membrane that prevents the entry of
bacteria, phagocytic cells (neutrophils and macrophages),
dendritic cells, natural killer cells (NK), and other plasma
proteins, including the complementary network. Innate
immunity's critical cellular reaction is inflammation, the
mechanism by which phagocytic cells are recruited and
stimulated to remove microbes and viral elimination,
mediated by dendritic cells and NK. Adaptive immunity
also is known as acquired or specific immunity consists of
a microbial mediated mechanism and is capable of
identifying microbial and non-microbial molecules
precisely called antigens.”
“The adaptive immune system such as
lymphocytes comprising antibodies and cytokines and
their constituents. The lymphocyte receptors in the innate
immune system are far more complex and may identify
2. International Journal of Medical, Pharmacy and Drug Research (IJMPD) [Vol-4, Issue-3, May-Jun, 2020]
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large numbers of foreign substances. There are two forms
of adaptive immunity: humoral immunity, mediated by B
lymphocytes and secreted antibodies that defend against
extracellular microbes and their toxins; and cellular or
bacterial immunity, mediated by T lymphocytes that
primarily defend against intracellular microbes.”The two
types of immunity obtained are related by a broad family
of proteins known as cytokines, which play an important
role in the activation, control, and communication of
immune cells.1
For the study of the effects of anesthetic drugs on
the immune system, various for vitro studies with human
immune cells,10
or animal models were used. Such studies
have shown a range of effects, such as improvements in
the number and role of immune cells, and effects on
patterns of varying immune mediator secretions, Impact
of the inflammatory response by releasing cytokines
during the postoperative period.2
Such results can be
clinically important as the balance between cytokine
secretions pro and anti-inflammation also tissue injury.
Several studies have shown the effect of anesthetics on
immune responses even in few days after
administration.12,13,14
Impaired immunity in vivo is frequently found
following major surgery and is multifactorial. Procopio
et.al performed a randomized clinical trial to assess the
independent impact on human immune function between
general anesthesia (GA) and lumbar epidural anesthesia
(LEA) in the absence of surgical trauma. To the
pulmonary clinician, this heralds the dawn of innovative
treatments in different fields such as diseases, allergies,
and cancer.3
The immune system mediates many adverse
drug reactions. It may be because the drug's therapeutic
role affects the immune system.4
Mechanical ventilation
can lead to ventilator-induced lung injury in animals and
can contribute to acute lung injury or acute respiratory
distress syndrome in humans, both high-strength
mechanical ventilation and hyperoxia.5
In the anesthesia
community, the immunopathological effects of prolonged
exposure to inhalation anesthesia have reduced
neutrophils, leukocytes, B lymphocyte cells and natural
killer cells (NK), which are the main features of the
immune system.6
A recent research examining the effects
of immunity from first-inhalation anesthesia, halothane,
showed that CD4, CD8 cells and B lymphocytes
significantly decreased with repeated doses of halothane.7
Sevoflurane is a modern form of inhalation
anesthesia widely used in the practice of anesthesia
today.8
“Sevoflurane is a highly fluorinated methyl-
isopropyl ether typically used in the induction and
maintenance of general anesthetics. In addition to the
anesthetic function it was also proven to be involved in
the protective cycle under hypoxia or endotoxemia
conditions, often studied in neurons and myocardial
tissue.9
Research conducted by “Kidani et al. examined
the effect of sevoflurane pretreatment on mortality and
inflammation during endotoxin-induced mice shock.
Researchers reported that this pretreatment significantly
increased the blood pressure, acid-base balance, and
decreased the mortality and plasma rates of TNF-α and
IL-6, suggesting a weakening of the inflammatory
response.”10
Sevoflurane induces postconditioning symptoms
following exposure to hypoxia, or lipopolysaccharides
(LPS). In this regard, the postconditioning of sevoflurane
has been shown to reduce oxidative blood and brain
damage and increase the immunity index in mice with
ischemic reperfusion of the brain.11
Importantly, data
from Yue et al. evaluating sevoflurane postconditioning
in an acute lung injury model in vitro showed that
inflammatory mediators, chemotaxis and neutrophil
adherence were significantly reduced.12
IL-12 is also known as a stimulant factor for T-
cells, since it contributes to the differentiation of CD4 T
cells into TH1 cells. IL-12 family cytokines had important
therapeutic targets or agents in a number of inflammatory
diseases and induced surgical stress.13
Surgical stress
activates the aid's dominant T-cell type 2 (Th2) status and
disturbs the cytokine balance between Th1 and Th2.
Anesthesia can suppress the stress response to surgery, so
it can reduce the imbalance in the Th1/Th2 ratio.14
In this
study, the researcher will investigate the immune system
effects of sevoflurane by measuring IFN-π and IL-12.
A craniotomy is a skull opening procedure
(cranium) with the purpose of detecting and restoring
damage to the brain. The aim of the surgery is to open the
skull so it can locate and restore brain damage.
Intracranial procedure or also called craniotomy is an
intracranial problem-related intervention. How do the
effects of sevoflurane and propofol on IFN-γ and IL-12
study on patients with craniotomy surgery ?
II. HYPOTHESIS
1. There are differences of IFN-γ and IL-12 level after
anaesthesia using sevoflurane compared the level
before anesthesia
2. There are differences of IFN-γ and IL-12 after
anaesthesia using propofol compared to the level
before anesthesia
3. International Journal of Medical, Pharmacy and Drug Research (IJMPD) [Vol-4, Issue-3, May-Jun, 2020]
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3. There is differences of increase in IFN-γ and IL-12
level after anesthesia with sevoflurane compared to
with propofol.
III. METHODS
The population of this study is patients aged
between 30-55 years old undergoing craniotomy surgery
at Dr. Kariadi hospital. Subjects are patients aged 30-55
years old who undergo craniotomy surgery for tumor
removal at Dr. Kariadi Hospital who fulfill the inclusion
and exclusion criteria as follows: The total number of
subjects in each group is minimum 14 for every group. IN
this research will be used 16 patients for every group.
Differences in the means before and after the
same anesthesia agent will be analyzed with paired T-test
if the data distribution is normal, or with the Wilcoxon
rank sum test if the data distribution is not normal. The
difference in the means between the two different
anesthesia agents will be analyzed using an independent
T-test if the data distribution is normal, or with the Mann-
Whitney test if the data distribution is not normal.
IV. RESULTS AND DISCUSSION
Characteristics of the Subjects
Table 1. Demographic Data
No Descriptive Propofol Group
n (%)
Sevoflurane Group
n (%)
p
1 Sex
- Male
- Female
6 (37.5)
10 (62.5)
3 (18.7)
13 (81.3)
0.217
2 Age,average (SD) ± 45 (5.3) years ± 44.4 (5.8) years 0.7
3 ASA
- I
- II
12 (75)
4 (25)
11 (68.7)
5 (32.3)
0.361
4 Kind of surgery Intracerebral tumor Intracerebral tumor Not tested
The p-value showed that there were no differences between males and females for both groups and also the ASA. The
type and duration of surgery were comparable among both groups. Age of the patients between propofol and sevoflurance
group was similar and not different significantly.
The Effects of Sevoflurane and Propofol on IFN-γ and IL-12 Levels
-
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
median propofol median sevflurane
71.32
77.8377.00
88.58
IFN-y (pg/ml)
IFN-y (pg/ml) pre IFN-y (pg/ml) post
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Graph 4.2. plasma IL-12 concentration (pg/ml)
The table 2 showed the level of IFN-γ and IL-12 in sevoflurane group.
Table 2. Level of IFN-γ and IL-12 in Sevoflurane Group
Anestetic agent IFN-γ level
Median(IQR)
(pg/ml)
IL-12 level
Median(IQR)
(pg/ml)
Before anesthesia with Sevoflurane 71.3 (66.3-81.8) 2.3 (2.1-3.7)
After anesthesia with sevoflurane 77.0 (72.7-90.4) 3.4 (2.9-4.3)
Differences 2.3 (-5.1-18.0) 0.6 (-01-1.0)
p* 0.211 0.049
* Wilcoxon rank sum test
Table 2. showed that the level of IFN-γ increased after anesthesia in sevoflurane group; however the difference
was not statistically significant. therefore hypothesis number 1 for IFN-γ is rejected. Table 4.2. also showed that the level
of IL-12 significantly increased after anaesthesia using sevoflurane (p = 0.049). Therefeore, the hypothesis number 1
for IL-12 is accepted.
Table 3. Level of IFN-γ and IL-12 in Propofol Group
Anestetic agent IFN-γ level
Median(IQR)
(pg/ml)
IL-12 level
Median(IQR)
(pg/ml)
Before anesthesia with propofol 77.8 (73.1 - 112.2) 3.2 (1.5 - 16.4)
After anesthesia with propofol 88.6 (80.6 - 121.9) 4.2 (3.1 - 11.6)
Differences 7.4 (1.5 – 16.4) 0.8 (0.2 – 1.6)
p* 0.006 0.007
* Wilcoxon rank sum test
Table 3. also showed that the level of IFN-γ and IL-12 significantly increased after anesthesia using propofol.
Therefore, the hypothesis number 2 is accepted for both IFN-γ and IL-12.
-
1.00
2.00
3.00
4.00
5.00
median propofol median sevflurane
2.47
3.223.39
4.22
IL- 12 (pg/ml)
IL- 12 (pg/ml) pre IL- 12 (pg/ml) post
5. International Journal of Medical, Pharmacy and Drug Research (IJMPD) [Vol-4, Issue-3, May-Jun, 2020]
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Table 4. Difference in Level IFN-γ and IL-12 between Groups
Variables Groups p*
Sevoflurane
Median(IQR)
Propofol
Median (IQR)
IFN-γ (pg/ml) 2.3 (-5.1 – 18.0) 7.3 (1.5 – 16.4) 0.006
IL-12 (pg/ml) 0.6 (-0.1 -1.0) 0.8 (0.3-1.6) 0.001
* Wilcoxon rank sum test
Table 4. showed that the level of both IFN-γ
and IL-12 were significantly higher in propofol group
rather than in sevoflurane group; Therefore, the
hypothesis number 3 is accepted for both IFN-γ and IL-
12.
Discussion
In this study, the effects of general anesthesia on
pro-inflammatory cytokines INF-γ and IL12 were
assessed in pre-and post-anesthesia on patients with
craniotomy surgery. This study result showed that the
level of both IFN-γ and IL-12 were significantly higher in
the propofol group rather than in the sevoflurane group.
IFN-γ is known as a pro-inflammatory cytokine that plays
a central role in infections and autoimmune diseases. It is
synthesized by human macrophages in a single cell of
human macrophages, in addition to lymphocytes that
contribute to the IFN-γ response, and provide another
correlation between the innate and acquired immune
response. Interferon is also available as a drug. Interferon
in the form of drugs works by increasing the body's
immune response and inhibiting the growth of viruses,
bacteria, or cancer, and also have a role in the immune
system.
IL-12 and interferon-gamma, actually represent
the inflammation conditions, not directly the immune
condition, but they can be considered to represent immune
condition because IL-12 and interferon-gamma are pro-
inflammation. Inflammation is a response to various kinds
of trauma. This matter is the most important part of innate
immunity, too is an initiator and also a regulator important
in adaptive immune responses. Inflammation involves
tissue micro vascularization affected, especially the
postcapillary venules. System Immune patients
undergoing surgery influenced by anesthetic actions as
well as the act of surgery itself. Hypothalamic-pituitary-
adrenal axis the sympathetic nervous system will be active
along with stress surgery, blood transfusion, hypothermia,
hyperglycemia, and pain. Anesthetic action causing direct
emphasis on activity cellular and neuro-hormonal
immune system so that it influences cell function
immunocompetent and expression and secretion
inflammatory mediator. Immunosuppression by
anesthesia especially occurs in patients of intracerebral
tumors, such as natural killer (NK) dysfunction and
lymphocytes which accelerate growth and metastasis of
malignant cells so it will worsen the prognosis.
Leukocytes are part of innate immunity. The cellular
component of immunity innate consists of several types
of cells and many found at the entry point of the pathogen.
Examples of these cells are natural killer cells (NK),
polymorphonuclear cells (PMN), macrophages, and
dendritic cells Neutrophil/lymphocyte ratio (NLR) is a
simple marker of the inflammatory response. NLR value
peripheral blood is used as a parameter that provides
information on the relationship between the inflammatory
environment and stress physiology. Postoperative Value
of NLR in surgery patients undergoing spinal anesthesia
lower compared to patients who undergo general
anesthesia. If IL12 level increase, mean inflammation
increase, this is mean that immune become increase
(good condition). It has been shown that IL-12 cytokine
has an effect on both immune and hematological
functions. It has been shown to be necessary for the
independent induction of IFN-γ T cells. Therefore, IL-12
thus function to stimulates and binds innate and acquired
immune responses. When the patients undergo the
surgery, therefore the surgical trauma and anesthesia
influence the immunological and inflammatory responses.
Anesthetic agents like sevoflurane and propofol modulate
the inflammatory reactions in this sense. The stress of
surgery will result in an increase of level IFN-γ and IL-12
as a response to the inflammatory reaction.
After surgery and give anesthesia, the result
showed that the level of IFN-γ increased after anesthesia
with sevoflurane; however, the difference was not
statistically significant. therefore hypothesis number 1 is
rejected. Meanwhile, the level of IL-12 increased after
anesthesia using sevoflurane; however, the increase was
significant. Therefeore, hypothesis number 1 is accepted.
This is because the patients’ age also gives an effect on
the increase of level IFN-γ and IL-12. Sevoflurane not
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give too significant effect to the patients between before
and after surgery and given anesthesia. This indicates that
sevoflurane can reduce patients’ stress and good pro-
inflammatory.
Another result of this study showed that the
level of IFN-γ increased after anesthesia with propofol;
however the difference was statistically significant,
therefore hypothesis number 2 is accepted. The level of
IL-12 increased after anesthesia using propofol, however,
the increase was significant. Therefeore, the hypothesis
number 2 is accepted. Thus the hypothesis 3 accepted
because there are differences effect between propofol and
sevoflurane as anesthesia agents. There are different
effects of sevoflurane and propofol on pro-inflammatory
cytokines. This research also supported by previous
research done by Dang et al. (2018) that concluded
“general anesthesia combined with regional anesthesia is
better than single-use general anesthesia. Most inhaled
anesthetics, opioids, local anesthetics, and other
intravenous anesthetics can reduce immunity to a certain
extent, which sometimes leads to an increased recurrence
of malignant tumors. However, tramadol, selective
nonsteroidal anti-inflammatory analgesics, and propofol
have protective effects on the immune function of the
body and can reduce the recurrence and metastasis of the
tumor. Therefore, it is important to make a careful
anesthesia plan and to select appropriate narcotic drugs
for patients with malignant tumors, since these decisions
will have a crucial impact on the therapeutic effect and
prognosis.”
Also supported the result of a previous study
done by Ji et al. (2011) that stated “immune response in
the process of tumor development is not just a single
factor, but it plays a multifaceted role affecting tumor
initiation, growth, progression, and other processes. The
immune system regulates and promotes cancer programs,
a process known as immunoediting. There are three
phases to this process: elimination, balance, and escape.
Although experimental evidence shows that inflammation
can also promote the occurrence and development of
tumors, the immune inflammatory response in colon
carcinogenesis requires further study and is still under
debate. Some clinical data show that the immune response
inhibits the tumor. However, other investigators have
concluded that the opposite is true. IL-12 is an early
promoter of T-cell-induced inflammatory responses and
can amplify the inflammatory response by promoting the
release of proinflammatory cytokines. Intravenous
anesthesia can maintain a safe, constant concentration of
drug treatment during surgery and can reduce the
stimulation of surgical trauma. Intravenous anesthesia can
also reduce the intraoperative inflammatory response
albeit affecting the patient’s immune system function.
Immune system disorders or inhibition during the
perioperative period can cause postoperative
complications, especially in cancer patients.
Immunosuppression after surgery can accelerate the
spread of residual cancer cells and promote a new
transfer.”
In this study, the patient characteristics,
preoperative values in the laboratory, and surgical data
were comparable in craniotomy surgery between two
groups and ASA I /II. The advantage of this study is to
test the different effects between anesthetic agents of
propofol and sevoflurane. thus it shows that propofol
increases the pro-inflammatory cytokines significantly,
while sevoflurane does not significantly increase these
cytokines. The weakness of this study is the limited
samples and not include the BIS (Bispectral Index), as
confounding variables. The BIS is derived from a non-
invasive technology, which provides a composite value of
cortical activity between 0 (no cortical activity) and 100
(completely wake) represents a general anesthesia
condition. A longer observation period would still be
necessary to clarify the possible effects of anesthetics on
pro-inflammation cytokines after tumor craniotomy.
The implication of this study was that propofol
increases the level of IFN-γ and IL-12, therefore in the
anaesthesiologists and surgeons must be more careful
during the post-operation, particularly on the
manifestations of an inflammatory reaction, such as fever,
hemodynamic and respiratory instability. Our findings
should incite future studies to prove a potential medically
important anesthesia agent’s role with pro-inflammatory
other cytokines.
V. CONCLUSION
According to the analysis data, the conclusion in this
reserach as follows:
1. When sevoflurane was used as an anesthesia
agent, the level of IFN-γ dose not significantly
increase while the level of IL-12 significantly
increases.
2. When propofol was used as an anesthesia agent,
the level of both IFN-γ and IL-12 increase
significantly.
3. The increase of both IFN-γ and IL-12 level after
anesthesia with propofol is significantly higher
than those with sevoflurane.
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4. Propofol exerts a bigger pro-inflammatory
response then sevoflurane in patients undergo
craniotomy surgery.
Recommendation for the future research based
on this research result as follows:
1. BIS (Bispectral Index) can be considering as
confounding variables, also a longer observation
period would still be necessary to clarify the
possible effects of anaesthetics on pro-
inflammation cytokines after tumor craniotomy.
2. Future studies to prove other anesthesia agents’
role on pro-inflammatory other variables would
still be important to do.
3. Adding more components of the immune system
in future studies or analyzes, and evaluating
exposure to anesthesia after more than two hours.
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