Editorial

Although sedatives such as midazolam or nitrous oxide  (N₂O) are administered to dental patients, the effects of these drugs on intra?-cerebral oxygenation are not well?-known. Aims: We investigated the effects of intravenous midazolam or inhalational N₂O on intra?-cerebral oxygenation using near?-infrared spectroscopy. Setting and Design:   University hospital, prospective. Materials and Methods: During intravenous sedation, volunteers received supplemental oxygen through nasal cannula at 3  L/min for 10  min  (control group). Midazolam  (0.05  mg/kg) was then injected intravenously with flumazenil  (20  mg) injected 30  min later. In the inhalational sedation study, volunteers lay quietly for 10  min receiving 100% oxygen, then received N₂O via nasal mask at concentrations of 10%, 20%, and 25% for 5  min; 30% for 20  min; and supplemental oxygen at 100% for 15  min after N₂O was discontinued. Statistical Analysis: Intra?-group comparisons were made using one?-way analysis of variance for repeated measures followed by Dunnett’s test for multiple comparisons. Differences were considered statistically significant at P  < 0.05. Results: During intravenous sedation, oxyhemoglobin increased 10  min after midazolam administration, and total hemoglobin increased slightly until 20  min after flumazenil administration, followed by a decrease. During inhalational sedation, oxyhemoglobin increased until 5  min after starting N2O, and total hemoglobin increased until 5  min after starting N₂O, followed by a decrease. Conclusions: Midazolam and N₂O influenced intra?-cerebral oxygenation during intravenous or inhalational sedation. Cerebral blood flow increased with intravenous sedation when midazolam was administered once at a dose of 0.05  mg/kg and with inhalational sedation when N₂O was supplied at a concentration of 25?-30%.

Incidence of deep vein thrombosis (DVT) is 2-10  times more in human immunodeficiency virus (HIV)-infected persons than non-HIV cohort. Risk factors involved with DVT in HIV-infected patients are age older than 45  years, use of protease inhibitor in highly active antiretroviral therapy (ART), most common indinavir, hospitalization and presence of AIDS-defining opportunistic infections such as cytomegalovirus, Pneumocystis jiroveci (is a yeast-like fungus particularly in immune-compromised host), and Mycobacterium-intracellular. Others well known thrombogenic risk factors include are such as immobility, cigarette smoking, advanced age, pregnancy, pelvic surgery, and personal or family history of DVT may be absent in HIV-infected patients presenting with DVT. Inflammation and venous thrombosis are related to each other, and the associations between them are strong when the inflammation or the infection has occurred recently, or the inflammation is active. A 29-year-old HIV-positive soldier on first-line ART with poor adherence presented with fever pain abdomen and diarrhea and was diagnosed to have an enteric fever with immunological and clinical failure. He was treated for enteric fever but during treatment of enteric fever he complains of painful left lower limb swelling after 4  weeks and was suspect to have DVT of left lower limb based on Doppler studies. After confirmation of DVT by Doppler images, thrombolytic therapy was started, and gradually improvement was seen in the condition. Recent Infection or inflammation has a strong association with the development of thrombosis in HIV-positive patients, absent with classical predisposing factors of DVT. Physicians involved in the care of HIV-positive patients should be aware of this condition and the associated aggravating risk factors in them so as to provide timely management.