negar yeganeh khorasani

Neonatal jaundice is a very important problem that occurs in 80% of premature infants. Treatments for jaundice include phototherapy and blood transfusions. But phototherapy is expensive and covering the eyes disrupts the relationship between mother and child. Also, in bilirubin above 20, the power of reducing bilirubin due to phototherapy is not so high Samples will be selected by the probabilistic method. The infants were admitted to the study at the NICU of Imam Reza and Samen Al-A'meh Hospitals in Mashhad. Random allocation is given in one of the two phenobarbital or case and the placebo groups. Routine laboratory tests for jaundice are performed for all infants. Then phototherapy and medicine are prescribed. Bilirubin levels are checked every 6, 12, 24, and 48 hours after medication and until discharge. After collecting information, the data is analyzed with SPSS software version 16. According to these results, there were no significant differences between sex, gestational age, infant weight and age in two groups. The mean and standard deviation of bilirubin levels before the intervention and after intervention were not significantly different between the two groups after 6 , 12, 24,48 hours, and discharge time. Phototherapy with 20 mg/kg phenobarbital was prescribed for the study group and only phototherapy was performed for the control group. In neonates with jaundice, phototherapy with phenobarbital 20 mg single dose did not reduce bilirubin levels and length of hospital stay.

A narrow margin between the therapeutic and toxic doses of digoxin can result in an increased incidence of toxicity.  Since digoxin has an enterohepatic cycle, multiple oral doses of absorbents like montmorillonite may be useful in the treatment of digoxin toxicity.

In this study, 4 groups of 6 rats received intraperitoneal digoxin (1 mg/kg), and half an hour later, distilled water (DW) or oral adsorbents, including montmorillonite (1 g/kg), activated charcoal (1 g/kg) (AC) alone or in combination in the ratio of 70:30. Half of the mentioned doses were also gavaged at 3 and 5.5 hr after digoxin injection. The serum level of digoxin, biochemical factors, and activity score were assessed during the experiment. Three control groups only received DW, montmorillonite, or AC.

All adsorbents were able to significantly decrease the serum level of digoxin compared to the digoxin+DW group (P<0.01). Only montmorillonite reversed the digoxin-induced hyperkalemia (P<0.05). Multiple dose administration of adsorbents also significantly reduced the digoxin area under the curve and half-life and increased digoxin clearance (P<0.05). However, there was no significant difference in the kinetic parameters between groups that received digoxin plus adsorbents.

Multiple-dose of montmorillonite reversed digoxin toxicity and reduced serum digoxin levels by increasing the excretion and reducing the half-life. Montmorillonite has also corrected digoxin-induced hyperkalemia.  Based on the findings, a multiple-dose regimen of oral montmorillonite could be a suitable candidate for reducing the toxicity issue associated with drugs like digoxin that undergo some degree of enterohepatic circulation.

Personal protective equipment (PPE) is one of the protective equipment that health workers can use to protect themselves against coronavirus disease 2019(COVID-19); however, it is accompanied by some problems for medical staff. Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not transmitted through healthy skin, the hypothesis was examined as to whether the cotton gown could be used instead of PPE.

The medical staff of the Neonatal Care Unit took care of 51 patients with 1180 shifts. During the first and a half months, the medical personnel used a special PPE package for providing care of  patients, which included an air-impermeable plastic gown with a head-to-toe cover, an N95 mask, gloves, and a face shield. However, from the beginning of the epidemic, doctors used cotton surgical gowns instead of the ones in the package. Following that, the nursing team gradually replaced the air-impermeable plastic gowns with cotton surgical gowns, and finally, all the staff used the cotton gowns. 

After three months, all medical staff was evaluated for clinical signs of COVID-19, such as fever, cough, nausea, and headache. During these three months, no symptoms or absence due to illness were observed in the staff. It should be mentioned that the antibody titer was not evaluated at the end of the study.

A retrospective review of the staff showed that the cotton surgical gown protected the staff against COVID-19. Accordingly, the cotton surgical gown can be used in medical centers to replace PPE sets containing an air-impermeable plastic gown with a head-to-toe cover. The result of this study can improve some of the problems of the medical staff.