Background: Preservation of sedation is vital and of great significance to successfully carry out diagnostic-therapeutic procedures in children and researchers believe that it is indispensable to offer a safe medication with appropriate administration in this regard. Hence, the present study aimed at evaluating the efficacy of different doses of submucosal Midazolam to induce sedation in children undergoing diagnostic procedures. Methods: The present study was a clinical trial, in which 99 patients undergoing diagnostic procedures within the age range of 3 months to 5 years were selected and divided into three groups (n=33) of receiving submucosal Midazolam administration with doses of 0.3, 0.4, and 0.5 mg/kg. Then, the onset time of sedation, level of sedation, and duration of drug action were recorded and compared among the three groups. Results: In the present study, the level of sedation 30 min after the administration of Midazolam 0.3 mg/kg with the mean value of 2.42±0.83 was significantly lower than that of Midazolam 0.4 and 0.5 mg/kg with the mean values of 3.51±0.62 and 3.36±0.60, respectively (p -value <0.001). However, two doses of 0.4 and 0.5 mg/kg did not differ significantly. Conclusion: The best sub-mucosal dosage of midazolam for sedation with the least complications for pediatric diagnostic procedures is 0.4mg/kg.
Background: It seems that magnesium sulfate (MgSO 4 ) can be useful in reducing acute pain caused by stone passing through the ureter by reducing ureteral smooth muscle contractions. Aim: This study aimed to evaluate the effect of MgSO 4 plus ketorolac versus morphine plus ketorolac on pain relief in renal colic. Methods: The present double-blind randomized clinical trial was performed on 70 patients with renal colic divided into two groups. Patients in the first group received 30 mg intravenous ketorolac plus 5 mg intravenous morphine while patients in the second group received 30 mg/kg MgSO 4 plus 30 mg intravenous ketorolac. Then, patients’ hemodynamic parameters and pain scores were evaluated before and 20, 40, and 60 min after the intervention. Results: Within 60 min of administration, systolic blood pressure was significantly reduced in the morphine plus ketorolac group ( P < 0.001) while there was no significant change in the MgSO 4 plus ketorolac group in this regard ( P = 0.576). In addition, the patients’ mean pain scores were not significantly different between the two groups in any of the studied times ( P > 0.05). Conclusion: Given that the addition of MgSO 4 to ketorolac, as compared with the addition of morphine (as a drug) to ketorolac, has been associated with fewer complications and greater stability of hemodynamic parameters, it can be stated that the use of MgSO 4 as an adjunct can be a good choice for further pain relief in patients with contraindications for drug administrations.
Background and Objectives: Traumatic brain injury (TBI) is one of the major health and socioeconomic problems in the world. How clinicopathological features of TBI differ by age is unclear. The present study evaluated the epidemiology of TBI and identified any variable that differs among pediatric, middle-aged, and elderly patients. Methods: The descriptive cross-sectional study was conducted on patients with TBI from April 2019 to April 2021. The study population consisted of all patients with TBI who were admitted to the Emergency Department. The inclusion criteria were all TBI patients who were a candidate for head computed tomography (CT) scans. The patients' clinicopathological parameters were recorded. Results: Among 3513 patients with TBI who underwent CT scans, 212 patients died (6.0%). The mean age of subjects was 30.67 ± 19.42, and 69.2% of the patients (2430 cases) were male. Motor vehicle accidents (48.4%) were the most prevalent mechanisms of injury. Intracranial lesions were seen on the head CT scan in 509 (14.5%) patients. The highest mortality rate was shown in elderly patients and the lowest in children (P < 0.001). Falls were the most common mechanism of injury in the elderly subjects (65.2%), while motor vehicle accidents were the most common in the children and middle-aged groups (40.9% and 54.0%). The incidence of intracranial lesions and moderate-to-severe head injuries was significantly higher in the elderly subjects (P < 0.001). Subdural hematoma and subarachnoid hemorrhage were the most common CT findings in elderly patients (13.3% and 11.3%). Brain contusion and skull fracture were the most common findings in the children (6.0% and 4.3%). Conclusions: The present study found that the clinicopathological parameters were significantly different among children, middle-aged patients, and elderly patients.
pain unnecessarily, and adverse physiological and psychological effects occur (2).Trauma patients, report low satisfaction with their pain management (5).In addition, trauma patients who present with multiple injuries, substance abuse, delayed care, as well as psychological and emotional issues complicate the care process (5,6).Improved pain management is not only the patient right, but also it prompts early healing, reduces patient's stress response, shortens hospital length of stay, lowers costs, diminishes risk of chronic pain due to neuroplasticity, and ultimately reduces morbidity and improve long-term outcomes (5-8).
Phlegmasia cerulea dolens is a severe form of deep venous thrombosis (DVT) characterized by severe venous outflow obstruction, marked limb swelling, pain, bluish discoloration, and even venous gangrene if the condition is untreated. In our case, 75-year-old woman, with general abdominal pain, which increases with eating and anorexia and 5 days of coldness and swelling of the left leg, was accepted. The patient had a history of Type II diabetes, ischemic heart disease, congestive heart failure, hyperlipidemic (HLP), hypertension, metastatic ovarian cancer, and previous DVT. She has undergone chemotherapy for the past 3 weeks due to ovarian cancers. Anticoagulation with intravenous administration of heparin and fluid resuscitation started immediately. The evidence of color Doppler sonography approved acute DVT in common femoral vein extending to the left external iliac. The patient did not consent for continuing the procedure in the hospital and succumbed to her illness on the 7th day after discharge.
Large-volume paracentesis is one of the usual treatments for cirrhotic patients with tense ascites, which may cause different complications including decreased cardiac preload, suppressed renin angiotensin system, inactivation of sympathetic nervous system, electrolyte imbalances, etc.The aim of this study was to compare the effects of administrating hydroxyethyl starch (HES) and albumin in cirrhotic patients with tense ascites in order to reduce the paracentesis complications.In the present randomized clinical trial, 108 cirrhotic patients with tense ascites were enrolled. The patients were randomly divided into 3 groups. In group A, albumin 20% with 5 g/L dose of paracentesis fluid, in group B, HES 6% dissolved in saline were administered, and in group C, a combination of albumin 20% and HES 6% with half the dosage administrated to two other groups were prescribed. Then biochemical panel, and liver function tests and renal and electrolyte complications were compared between the groups.The results obtained after intervention did not show significant differences between the groups regarding weight (p=0.102), heart rate and platelet count (both p=0.094), hematocrit (p=0.09), creatinine (p=0.421), serum sodium (p=0.743) and potassium (p=0.147), total bilirubin (p=0.375) and urine volume (p=0.421). Additionally, we concluded that mean arterial pressure of patients who had received albumin was higher than the other 2 groups (p < 0.001).The results of the present study showed the similar effects of HES and albumin in cirrhotic patients with tense ascites undergoing large-volume paracentesis.
Pulmonary thromboembolism (PTE) is a serious and life-threatening condition. Diagnosis of PTE can be challenging in emergency departments, as there is no absolutely reliable biomarker for the diagnosis of PTE. Copeptin (COP) is a new biomarker, which may be valuable in the diagnosis of PTE; however, its role has not been well studied. In this study, we aimed to investigate the diagnostic value of COP in the diagnosis of PTE.This study was carried out on 102 patients suspected of PTE. The serum levels of D-dimer and COP were measured, and diagnosis of PTE was confirmed by CT angiography. Next, the prognostic value of D-dimer and COP was examined.The area under the curve (AUC) of D-dimer was 0.581 with a standard error (SE) of 0.07 (P=0.34). Estimation of the validity of D-dimer showed that it is a highly sensitive (100%), but poorly specific (15.8%) test. Evaluation of the predictive value of this test showed that it has a positive predictive value of 20% and a negative predictive value of 100%. The AUC of COP was 0.423 with SE of 0.1 (P=0.44). Measurement of the validity of COP test showed that it is a poorly sensitive (50%) and specific (22.9%) test.COP is a new cardiovascular biomarker. However, the present findings did not confirm the prognostic value of this biomarker for the diagnosis of PTE.
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