The optimum dose of dexmedetomidine for shivering control with the least hemodynamic derangements is still under research. Objective: To compare the efficacy, hemodynamic and side effects of dexmedetomidine in 3 different doses with those of meperidine for the treatment of shivering in patients undergoing spinal anesthesia for minor elective lower abdominal surgery. Study Design: Prospective double-blind randomized clinically controlled study. Setting: University hospital. Methods: One hundred twenty patients who developed shivering under spinal anesthesia. On shivering, patients were randomly allocated to receive an intravenous 2 mL bolus dose of meperidine 0.4 mg/kg (meperidine group, n = 30), dexmedetomidine 0.5 μg/kg (DEX I group, n = 30), 0.3 μg/kg (DEX II group, n = 30), or 0.2μg/kg (DEX III group, n = 30). Control of shivering, time taken for cessation of shivering, response rate, recurrence, hemodynamic changes, sedation score, tympanic temperature, and side effects were noted and compared between groups. Results: The groups were comparable regarding demographic profile, tympanic temperature decline, and shivering onset time (P > 0.05). Lower shivering cessation time (P 0.001) and higher response rate (P 0.01) were observed in DEX I and II groups compared with DEX III and meperidine groups, with a nonsignificant difference between DEX I and II groups. Recurrence of shivering activity was higher in DEX III group (36.7%, P 0.01) compared with DEX I (10%), DEX II (6.7%) and meperidine (16.7%) groups. Lower heart rates, systolic and diastolic blood pressure mean values were recorded in DEX I group (P 0.05). Nine patients (30%) in DEX I group were in levels 3 – 5 of sedation (P 0.02) compared with 5 (16.66%), 2 (6.66%), and 4 (13.3) patients in DEX II, DEX III, and meperidine groups, respectively. Limitations: This study is limited by its small sample size. Conclusions: Among the 3 doses investigated, dexmedetomidine 0.3μg/kg effectively treated shivering associated with spinal anesthesia with modest hemodynamic and sedation effects. Trial Registration: ClinicalTrials.gov Identifier: NCT02382432.

β-Thalassemia major (BTM) is considered the most common hemoglobinopathy in Egypt and is one of the major health problems in our locality. Materials & methods: We investigated the frequency of B-regulatory cells (CD19+CD38hiCD24hi); (Bregs) among polytransfused alloimmunized and non-alloimmunized children with BTM. The study included 110 polytransfused pediatric patients with β-thalassemia major. Clinical and transfusion records of all studied patients were reviewed. Indirect antiglobulin test was performed to detect the presence of alloantibodies. We used flow cytometry for detection of CD19+CD38hiCD24hi regulatory B cells. Results: Alloimmunization was detected in 35.5% of thalassemic patients (39/110). The analysis of our data showed a significantly higher frequency of Bregs (CD19+CD38hiCD24hi) in the peripheral blood of both alloimmunized and non-alloimmunized patients as compared to healthy controls. Conclusions: Our data showed that the frequencies of CD19+CD24hiCD38hi Bregs cells were significantly increased in children with BTM. Our data suggested that Bregs cells could play a role in the clinical course of BTM. The relationship of Bregs to immune disorders in BTMchildren remains to be determined. Further longitudinal studywith a larger sample size is warranted to explore the mechanisms of Breg cells in the disease process in BTM patients.

β-Thalassemia major (BTM) is considered the most common hemoglobinopathy in Egypt and is one of the major health problems in our locality. Materials & methods: We investigated the frequency of B-regulatory cells (CD19+CD38hiCD24hi); (Bregs) among polytransfused alloimmunized and non-alloimmunized children with BTM. The study included 110 polytransfused pediatric patients with β-thalassemia major. Clinical and transfusion records of all studied patients were reviewed. Indirect antiglobulin test was performed to detect the presence of alloantibodies. We used flow cytometry for detection of CD19+CD38hiCD24hi regulatory B cells. Results: Alloimmunization was detected in 35.5% of thalassemic patients (39/110). The analysis of our data showed a significantly higher frequency of Bregs (CD19+CD38hiCD24hi) in the peripheral blood of both alloimmunized and non-alloimmunized patients as compared to healthy controls. Conclusions: Our data showed that the frequencies of CD19+CD24hiCD38hi Bregs cells were significantly increased in children with BTM. Our data suggested that Bregs cells could play a role in the clinical course of BTM. The relationship of Bregs to immune disorders in BTMchildren remains to be determined. Further longitudinal studywith a larger sample size is warranted to explore the mechanisms of Breg cells in the disease process in BTM patients.

β-Thalassemia major (BTM) is considered the most common hemoglobinopathy in Egypt and is one of the major health problems in our locality. Materials & methods: We investigated the frequency of B-regulatory cells (CD19+CD38hiCD24hi); (Bregs) among polytransfused alloimmunized and non-alloimmunized children with BTM. The study included 110 polytransfused pediatric patients with β-thalassemia major. Clinical and transfusion records of all studied patients were reviewed. Indirect antiglobulin test was performed to detect the presence of alloantibodies. We used flow cytometry for detection of CD19+CD38hiCD24hi regulatory B cells. Results: Alloimmunization was detected in 35.5% of thalassemic patients (39/110). The analysis of our data showed a significantly higher frequency of Bregs (CD19+CD38hiCD24hi) in the peripheral blood of both alloimmunized and non-alloimmunized patients as compared to healthy controls. Conclusions: Our data showed that the frequencies of CD19+CD24hiCD38hi Bregs cells were significantly increased in children with BTM. Our data suggested that Bregs cells could play a role in the clinical course of BTM. The relationship of Bregs to immune disorders in BTMchildren remains to be determined. Further longitudinal studywith a larger sample size is warranted to explore the mechanisms of Breg cells in the disease process in BTM patients.

β-Thalassemia major (BTM) is considered the most common hemoglobinopathy in Egypt and is one of the major health problems in our locality. Materials & methods: We investigated the frequency of B-regulatory cells (CD19+CD38hiCD24hi); (Bregs) among polytransfused alloimmunized and non-alloimmunized children with BTM. The study included 110 polytransfused pediatric patients with β-thalassemia major. Clinical and transfusion records of all studied patients were reviewed. Indirect antiglobulin test was performed to detect the presence of alloantibodies. We used flow cytometry for detection of CD19+CD38hiCD24hi regulatory B cells. Results: Alloimmunization was detected in 35.5% of thalassemic patients (39/110). The analysis of our data showed a significantly higher frequency of Bregs (CD19+CD38hiCD24hi) in the peripheral blood of both alloimmunized and non-alloimmunized patients as compared to healthy controls. Conclusions: Our data showed that the frequencies of CD19+CD24hiCD38hi Bregs cells were significantly increased in children with BTM. Our data suggested that Bregs cells could play a role in the clinical course of BTM. The relationship of Bregs to immune disorders in BTMchildren remains to be determined. Further longitudinal studywith a larger sample size is warranted to explore the mechanisms of Breg cells in the disease process in BTM patients.

Transdermal therapeutic system fentanyl with a drug release rate of 12 mg/h should be of special value in pediatric cancer pain control. Such a fentanyl formulation allows for a stepwise dose increase, similar to that reported for sustained- release morphine. Patients and Methods. Sixty-four male and female pediatric patients with moderate to severe chronic cancer pain, ages ranging 2–14 years, were included. Patients did not receive opioids prior to enrollment. Patients were observed for pain relief using the Visual Analog Scale and the Wong-Baker FACES Pain Rating Scale, play performance score, and for side effects. Results. There was significant improvement of visual analog scale and FACES pain scores from the baseline to the second day of application (P0.001). By the 15th day, scores reached 1.18 6 0.393 and 1.13 6 0.35, respectively (P0.001). Play performance scale improved from the third day of application of the patch when compared with the baseline (P0.001), reaching 55.02 6 8.35 (P0.001) at the end of the study. The sedation score increased on the second day to 2 in 10 patients and to 3 in 54 patients. By the seventh day, 56 patients had a sedation score of 1. All patients returned to baseline by the 15th day. Itching was reported in 16 cases, and erythema occurred in 10 cases. No significant side effects were reported. Conclusion. Transdermal fentanyl was found to be an effective, safe, and well-tolerated treatment for pediatric cancer-related pain in opioid-naive patients with chronic moderate to severe pain. In this study population, evaluation of vital signs and physical examination did not suggest any safety concerns while using transdermal fentanyl

Transdermal therapeutic system fentanyl with a drug release rate of 12 mg/h should be of special value in pediatric cancer pain control. Such a fentanyl formulation allows for a stepwise dose increase, similar to that reported for sustained- release morphine. Patients and Methods. Sixty-four male and female pediatric patients with moderate to severe chronic cancer pain, ages ranging 2–14 years, were included. Patients did not receive opioids prior to enrollment. Patients were observed for pain relief using the Visual Analog Scale and the Wong-Baker FACES Pain Rating Scale, play performance score, and for side effects. Results. There was significant improvement of visual analog scale and FACES pain scores from the baseline to the second day of application (P0.001). By the 15th day, scores reached 1.18 6 0.393 and 1.13 6 0.35, respectively (P0.001). Play performance scale improved from the third day of application of the patch when compared with the baseline (P0.001), reaching 55.02 6 8.35 (P0.001) at the end of the study. The sedation score increased on the second day to 2 in 10 patients and to 3 in 54 patients. By the seventh day, 56 patients had a sedation score of 1. All patients returned to baseline by the 15th day. Itching was reported in 16 cases, and erythema occurred in 10 cases. No significant side effects were reported. Conclusion. Transdermal fentanyl was found to be an effective, safe, and well-tolerated treatment for pediatric cancer-related pain in opioid-naive patients with chronic moderate to severe pain. In this study population, evaluation of vital signs and physical examination did not suggest any safety concerns while using transdermal fentanyl

Transdermal therapeutic system fentanyl with a drug release rate of 12 mg/h should be of special value in pediatric cancer pain control. Such a fentanyl formulation allows for a stepwise dose increase, similar to that reported for sustained- release morphine. Patients and Methods. Sixty-four male and female pediatric patients with moderate to severe chronic cancer pain, ages ranging 2–14 years, were included. Patients did not receive opioids prior to enrollment. Patients were observed for pain relief using the Visual Analog Scale and the Wong-Baker FACES Pain Rating Scale, play performance score, and for side effects. Results. There was significant improvement of visual analog scale and FACES pain scores from the baseline to the second day of application (P0.001). By the 15th day, scores reached 1.18 6 0.393 and 1.13 6 0.35, respectively (P0.001). Play performance scale improved from the third day of application of the patch when compared with the baseline (P0.001), reaching 55.02 6 8.35 (P0.001) at the end of the study. The sedation score increased on the second day to 2 in 10 patients and to 3 in 54 patients. By the seventh day, 56 patients had a sedation score of 1. All patients returned to baseline by the 15th day. Itching was reported in 16 cases, and erythema occurred in 10 cases. No significant side effects were reported. Conclusion. Transdermal fentanyl was found to be an effective, safe, and well-tolerated treatment for pediatric cancer-related pain in opioid-naive patients with chronic moderate to severe pain. In this study population, evaluation of vital signs and physical examination did not suggest any safety concerns while using transdermal fentanyl

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