A comparison of nasogastric tube insertion by SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) versus neck flexion lateral pressure in critically ill patients admitted to ICU: a prospective randomized clinical trial

BACKGROUND

Although many techniques have been introduced to facilitate nasogastric tube (NGT) insertion using anatomic landmarks and a group of devices, there is a lack of general consensus regarding a standard method. The current study purposed to investigate if SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) increases the success rate of NGT correct placement versus neck flexion lateral pressure (NFLP) method.

METHODS

A randomized controlled trial study was conducted in two university affiliated intensive care units (tertiary referral center). Three hundred and ninety-six critically ill patients older than 18 years of age were randomly divided into SORT (n = 200) and NFLP (n = 196) groups. The technique was classified as "failed" after the third unsuccessful attempt. Patient characteristics, success rate for the first attempt, time required for the successful first attempt and overall successful insertion time, various complications including kinking, coiling and bleeding and ease of insertion were noted as main outcomes measured.

RESULTS

Ease of insertion was significantly better in the SORT group compared to the NFLP group (P < 0.001). The number of failed attempts was significantly higher in the NFLP group (7.5%) vs the SORT group (3.0%) (P = 0.046). The pattern of complications was not different between two study groups (P = 0.242). The odds of stage II (odds ratio (OR) = 49.9; 95% confidence interval (CI) 25.2 to 98.6), stage III (OR = 67.1; 95% CI 14.9 to 302.8)) and stage IV (OR = 11.8; 95% CI 3.4 to 41.2) ease of insertion were much higher in NFLP compared to SORT group, after adjusting for age and body mass index (BMI). The odds of failure was not significantly different in NFLP group compared to SORT group (OR = 2.3; 95% CI 0.85 to 6.3), after adjusting for age and BMI.

CONCLUSIONS

SORT technique may be considered as a promising method for successful NGT insertions in critically ill patients. However, more trials are needed to confirm the results of this study. The decision must account for individual patient and clinical factors and the operator's experience and preference.

TRIAL REGISTRATION

The study was registered at government registry of clinical trials in Iran (http://www.IRCT.ir) (number: IRCT20091012002582N18, 13 March 2018).

Arterial vs venous lactate: Correlation and predictive value of mortality of patients with sepsis during early resuscitation phase

PURPOSE

To compare the lactate concentrations obtained from venous to those obtained from arterial blood in predicting hospital mortality of patients with sepsis and septic shock. To also assess lactate clearance as predictor for mortality.

METHODS

100 patients with septic shock were prospectively enrolled. Serum was sampled at baseline and after 6 h of resuscitation from arterial and venous lines. Demographic, severity indices, hemodynamic measures as well as lactate clearance levels were noted. Data were analyzed for bias and precision.

RESULTS

There was correlation between venous and arterial lactate concentrations at the baseline (R = 0.68) and at the 6-hour time point (R = 0.95). Venous concentrations were consistently higher than those obtained from an arterial access by 0.684 mg/dL. Further, arterial lactate level > 3.2 mmol/L and clearance of <20% were considered the cutoff for the mortality risk. While only 8% of the patients with no risk died, all 20 patients who had lactate level > 3.2 mmol/L and clearance of <20% died within the hospital.

CONCLUSION

Our data suggests a strong correlation between arterial and peripheral venous the lactate levels and in the initial phase of resuscitation in septic shock patients we can use venous lactate level as biomarker instead of arterial lactate level. The study also showed that combining lactate levels and its clearance is a reliable predictor of mortality in sepsis.

First Report of a Disease by Rhazes 10 Centuries Ago

Introduction:

Abu Bakr Mohammad Ibn Zakariya Al-Razi (865–925 CE), who was known as “Rhazes” in the west, was a famous scientist of medieval ages. He has more than 200 books and treatises. His masterpiece on medicine “Kitab Al-Hawi Fi Al-Tibb” contains around 900 case reports. Some of the diseases which seem to be recently reported have been stated previously, but not well described. Considering symptoms of the patient described at that time, differential diagnosis will be discussed.

Case presentation:

Rhazes described a patient with bilious fever. He had developed bloody urine and stool on the fourth day and fatigue. Subsequently, the patient's urine and stool color turned into dark and black, respectively, and died the following day. According to Rhazes attitude, it was malignant measles. Meyerhof in his book has referred to post-measles acute glomerulonephritis, but more appropriate differential diagnoses are compatible with this patient.

Discussion:

One of the best diagnoses for this case can be Weil's syndrome. Presence of fever, icterus, hemorrhage and renal injury, all suggest Weil's syndrome without pulmonary involvement. The other probable diagnosis is thrombotic thrombocytopenic purpura (TTP). Meningococcal sepsis is the other possible diagnosis.

Conclusion:

To sum up, as three compatible diseases with the case; have been described more than a thousand years after Rhazes (Weil's syndrome 1886, TTP 1925 and meningococcemia 1805); if the case is either Weil's or TTP or meningococcal sepsis, it is the first report of the disease in the world by Rhazes.

Efficacy of carotid artery stenting on stroke prevention of octogenarians

OBJECTIVES

Octogenarians account for a third of ischemic stroke (IS) patients and applying endovascular carotid artery stenting (CAS), as a secondary prevention, in these patients is challenging. The aim of this study was to evaluate peri-procedural and long term clinical and angiographic impact of CAS on octogenarians.

PATIENTS AND METHODS

In a prospective study, 102 patients aged over 80 years old with symptomatic internal carotid artery (ICA) stenosis presenting by non-disabling IS or transient ischemic attack and having undergone CAS were evaluated prospectively from January 2012 to July 2016. All patients received standard stroke care during the study follow up period. Peri-procedural complication, cerebrovascular accidents, restenosis in target vessel and mortality rate were recorded and the collected data were analyzed to evaluate safety and durability of CAS in octogenarians.

RESULTS

48 (47.06%) males and 54 (52.9%) females with the mean age of 83.39 ± 2.53 (range, 80-88) years were followed in a mean period of 24.5 ± 14.1 months (6-50 months). Success rate of CAS was 100%; whereas, the peri-procedural complication rate was 5.8% (only one patient experienced acute ischemic stroke during the procedure). Restenosis and recurrent cerebrovascular accidents were observed in 3.9% and 9.8% of the cases, respectively. Recurrent cerebrovascular accident leading to death was seen in 2.9% of the cases. The median patient event-free survival was 20 months.

CONCLUSION

Endovascular CAS seems to be a safe and durable method for secondary prevention in ischemic stroke following symptomatic carotid artery stenosis in octogenarians.

Efficacy of Citalopram on Acute Ischemic Stroke Outcome: A Randomized Clinical Trial

BACKGROUND AND PURPOSE

Ischemic stroke (IS) is one of the main causes of death and disability in the adult population, and recovery from it is a major health concern worldwide. The aim of the present study was to evaluate the effectiveness of citalopram on 3-mounth outcome of nondepressed acute IS patients.

METHODS

In a randomized, placebo-controlled clinical trial, 144 patients with acute IS were studied for 3 months. In one group, the patients received oral citalopram 20 mg (once daily), and in the other group, they received placebo. All patients received standard care, including physiotherapy. Patients with depression were excluded throughout the study. The primary outcome of the study was set to a 50% reduction in the 3-month National Institutes of Health Stroke Scale compared with the baseline scores (Clinical Trial Registration URL: http://www.irct.ir ; Unique identifier: IRCT201203192150N2).

RESULTS

The mean age of patients was 66.4 years. Of 144 eligible patients, 15 patients died (4 in the citalopram and 11 in the placebo group), and 21 patients did not complete the study follow-up period (10 in the citalopram and 11 in the placebo group). The primary outcome of the study was achieved in 57 patients (79%) in the citalopram and 39 patients (54%) in the placebo group ( P < .001), with risk ratio and number needed to treat of 2 (CI = 1.2-3) and 4 (CI = 2.5-8.6), respectively. No major adverse events were found in either group.

CONCLUSIONS

Citalopram is a safe and tolerable medication in patients with acute IS, which could improve the outcome in these patients.

Astrocytic and microglial nicotinic acetylcholine receptors: an overlooked issue in Alzheimer's disease

It is increasingly recognized that astrocytes and microglia-associated dysfunction contribute to AD pathology. In addition, glial nicotinic acetylcholine receptors (nAChRs) play a role in AD-related phenomena, such as neuron survival, synaptic plasticity, and memory. From mechanistic point of view, the glial regulation of pro-inflammatory cytokines, as common contributors in AD, is modulated by nAChRs. Astrocytic and microglial nAChRs contribute to Aβ metabolism, including Aβ phagocytosis and degradation as well as Aβ-related oxidative stress and neurotoxicity. These receptors are also involved in neurotransmission and gliotransmission through indirect interaction with N-Methyl-D-aspartate (NMDA) and a-amino-3-hydroxy-5-methyl-4 isoxazolepropionic acid (AMPA) receptors as well as gamma-aminobutyric acid (GABA) and intracellular calcium regulation. In addition, glial nAChRs participate in trophic factors-induced neuroprotection. This review gathers the most recent advances along with the previous data on astrocytic and microglial nAChRs role in AD pathogenesis.

Evolutionary concept analysis of health seeking behavior in nursing: a systematic review

BACKGROUND

Although the research in health seeking behavior has been evolving, its concept remains ambiguous. Concept clarification, as a central basis of developing knowledge, plays an undeniable role in the formation of nursing sciences. As the initial step toward the development of theories and theoretical models, concept analysis is broadly used through which the goals can be used and tested. The aim of this study was to report an analysis of the concept of "health seeking behavior".

METHOD

Employing a rigorous evolutionary concept analysis approach, the concept of health seeking behavior was examined for its implications, use, and significance in the discipline of nursing between 2000 and 2012. After applying inclusion and exclusion criteria, a total of 40 articles and 3 books were selected for the final analysis.

RESULTS

The definition of attributes, antecedents, and consequences of health seeking behavior was performed through concept analysis. Core attributes (interactional, processing, intellectual, active, decision making based and measurable) were studied. The antecedents of concept were categorized as social, cultural, economic, disease pattern and issues related to health services. Health-seeking behavior resulted in health promotion and disease risk reduction. In addition, it led to predicting the future probable burden of the diseases, facilitation of the health status, early diagnosis, complete and effective treatment, and complication control.

CONCLUSION

Health-seeking behavior, as a multi-dimensional concept, relies on time and context. An awareness of health-seeking behavior attributes antecedents and consequences results in promoting the status, importance and application of this concept in the nursing profession.

Success rates and complications of awake caudal versus spinal block in preterm infants undergoing inguinal hernia repair: A prospective study

BACKGROUND

Inguinal hernia is a common disease in preterm infants necessitating surgical repair. Despite the increased risk of postoperative apnea in preterm infants, the procedure was conventionally performed under general anesthesia. Recently, regional anesthesia approaches, including spinal and caudal blocks have been proposed as safe and efficient alternative anesthesia methods in this group of patients. The current study evaluates awake caudal and spinal blocks in preterm infants undergoing inguinal hernia repair.

MATERIALS AND METHODS

In a randomized clinical trial, 66 neonates and infants (weight <5 kg) undergoing inguinal hernia repair were recruited in Tabriz Teaching Children Hospital during a 12-month period. They were randomly divided into two equal groups; receiving either caudal block by 1 ml/kg of 0.25% bupivacaine plus 20 μg adrenaline (group C) or spinal block by 1 mg/kg of 0.5% bupivacaine plus 20 μg adrenaline (group S). Vital signs and pain scores were documented during operation and thereafter up to 24 h after operation.

RESULTS

Decrease in heart rate and systolic blood pressure was significantly higher in group C throughout the study period (P < 0.05). The mean recovery time was significantly higher in group S (27.3 ± 5.5 min vs. 21.8 ± 9.3 min; P = 0.03). Postoperative need for analgesia was significantly more frequent in group S (75.8% vs. 36.4%; P = 0.001). Failure in anesthesia was significantly higher in group S (24.4% vs. 6.1%; P = 0.04).

CONCLUSION

More appropriate success rate, duration of recovery and postoperative need of analgesics could contribute to caudal block being a superior anesthesia technique compared to spinal anesthesia in awaked preterm infants undergoing inguinal hernia repair.

Intraperitoneal Bupivacaine-Meperidine Infiltration Versus Intravenous Paracetamol: A Comparison of Analgesic Efficacy in Post-Gynecologic Diagnostic Laparoscopic Pain

BACKGROUND

Pain following laparoscopy could be due to different causes requiring effective postoperative analgesia.

OBJECTIVES

In the present study, we evaluated the combined effect of intraperitoneal infiltration of bupivacaine-meperidine versus intravenous infusion of paracetamol on pain relief after diagnostic gynecologic laparoscopy.

PATIENTS AND METHODS

In this prospective study, 90 female subjects with ASA class I or II scheduled for gynecologic diagnostic laparoscopy were studied in two groups; group B + M received intraperitoneal infiltration of 40 mL bupivacaine 0.25% with 50 mg of meperidine, group P received normal saline via abdominal trocar and ten minutes before the end of operation, group P received infusion of paracetamol 1000 mg in normal saline. Postoperative pain was evaluated using VAS score in PACU and 1, 2, 4, 8, 12 and 24 hours after the operation. The time to the first analgesic administration and total analgesic requirements were recorded.

RESULTS

Group B + M had significantly lower pain score in the first 8 postoperative hours than group P (P < 0.05). Rescue meperidine (IM) requirement was significantly less in B + M group compared to group P. Time to first request for analgesia was different between the two groups (78 versus 60 min); however, the difference was not statistically significant.

CONCLUSIONS

Intraperitoneal Infiltration of bupivacaine with meperidine following surgery provided more appropriate analgesia after gynecologic diagnostic laparoscopy than administration of IV paracetamol.

An Analytical Comparison of the Opinions of Physicians Working in Emergency and Trauma Surgery Departments at Tabriz and Vienna Medical Universities Regarding Family Presence during Resuscitation

The present study evaluated the opinions of physicians working in the emergency and trauma surgery departments of Vienna Medical University, in Austria, and Tabriz Medical University, in Iran, regarding the presence of patients' relatives during resuscitation. In a descriptive-analytical study, the data obtained from questionnaires that had been distributed randomly to 40 specialists and residents at each of the participating universities were analyzed. The questionnaire consisted of two sections aimed at capturing the participants' demographic data, the participants' opinions regarding their support for the family's presence during resuscitation, and the multiple potential factors affecting the participants' attitudes, including health beliefs, triggers that could facilitate the procedure, self-efficacy, intellectual norms, and perceived behavioral control. The questionnaire also included a direct question (Question 16) on whether the participants approved of family presence. Each question could be answered using a Likert-type scale. The results showed that the mean scores for Question 16 were 4.31 ± 0.64 and 3.57 ± 1.31 for participants at Vienna and Tabriz universities, respectively. Moreover, physicians at Vienna University disapproved of the presence of patients' families during resuscitation to a higher extent than did those at Tabriz University (P = 0.018). Of the studied prognostic factors affecting the perspectives of Vienna Medical University's physicians, health beliefs (P = 0.000; B = 1.146), triggers (P = 0.000; B = 1.050), and norms (P = 0.000; B = 0.714) were found to be significant. Moreover, of the studied prognostic factors affecting the perspectives of Tabriz Medical University's physicians, health beliefs (P = 0.000; B = 0.875), triggers (P = 0.000; B = 1.11), self-efficacy (P = 0.001; B = 0.5), and perceived behavioral control (P = 0.03; B = 0.713) were significant. Most physicians at Vienna and Tabriz Medical universities were not open towards family members' presence during resuscitation.

INSIGHTS INTO AVICENNA'S KNOWLEDGE OF GASTROINTESTINAL MEDICINE AND HIS ACCOUNT OF AN ENEMA DEVICE

Avicenna (980-1037 AD), also known as Sheikh or-Raeis, was an Muslim philosopher, physician, surgeon, astronomer, politician, encyclopedist, and mathematician. Avicenna's writings comprise of five books, know as the Al-Qanun fi al-Tibb (The Canon of Medicine) and the canon covers a wide variety of medical issues. This canon of medicine was the main reference for medical education in Western countries up until the 16th century and in the Middle East until the 19th century. Several chapters of the 3rd book of the Canon are devoted to a detailed description of gastrointestinal diseases including bowel obstruction, hemorrhoids anal fissures, perianal fistulas and perianal itching. Additionally, that same volume contains an illustration of an enema device. The aim of this paper was to present a brief review of Avicenna's 11th century views on bowel obstruction and to present his description of an enema device that has remained relatively unnoticed until now. Finally, this article illustrates similarities between Avicenna's explanation and modern medical science that celebrate Avicenna as an important contributor to medieval knowledge on gastrointestinal diseases, the science of which has been passed on to later generations.

The medieval origins of the concept of hypertension

Despite the well-known history of hypertension research in the modern era, like many other cardiovascular concepts, main points in the medieval concept of this disease and its early management methods remain obscure. This article attempts to make a brief review on the medieval origin of the concept of this disease from the Hidayat of Al-Akhawayni (?-983 AD). This article has reviewed the chapter of “Fi al-Imtela” (About the Fullness) from the Hidβyat al-Muta’allimin fi al-Tibb (The Students' Handbook of Medicine) of Al-Akhawayni.

The definition, symptoms and treatments presented for the Imtela are compared with the current knowledge on hypertension. Akhawayni believed that Imtela could result from the excessive amount of blood within the blood vessels. It can manifest with symptoms including the presence of a pulsus magnus, sleepiness, weakness, dyspnea, facial blushing, engorgement of the vessels, thick urine, vascular rupture, and hemorrhagic stroke. He also suggested some ways to manage al-Imtela'. These include recommendations of changes in lifestyle (staying away from anger and sexual intercourse) and dietary program for patients (avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar). Al-Akhawayni's description of “Imtela,” despite of its numerous differences with current knowledge of hypertension, can be considered as medieval origin of the concept of hypertension.

Baby cuff as a reason for laryngeal mask airway cuff malfunction during airway management for anesthesia

Placement of laryngeal mask airway (LMA) is a blind procedure without requiring laryngoscopy. The reported success rate for LMA insertion at the first attempt is almost 95%; however, many functioning LMAs may not be in an ideal anatomic place. It seems that disposable LMAs have more stable cuff pressure compared to reusable LMAs; therefore, Anesthesiologists should bear in mind this fact when using reusable LMAs to achieve a proper sealing and safe airway management. In this report, we introduced a case with malfunction of LMA cuff during the airway management.

A large asymptomatic foreign body in larynx and trachea

A 41-year-old asymptomatic man was referred to emergency department complaining of severe dyspnea. He had a history of psychosis and had been taking Biperiden and Lithium carbonate since 17 years ago. Imaging studies showed multiple foreign bodies in the trachea, which were extracted.

The effect of low-level laser therapy on knee osteoarthritis: prospective, descriptive study

BACKGROUND

Osteoarthritis (OA) is one of the most common joint disorders in the elderly which could be associated with considerable physical disability.

PATIENTS AND METHODS

In a descriptive, prospective study, 33 patients enrolled in the study from which 15 people were excluded due to incomplete course of treatment, leaving the total number of 18 patients with knee osteoarthritis. Gal-Al-As diode laser device was used as a source of low-power laser. Patients were performed laser therapy with a probe of LO7 with a wavelength of 810 nm and 50 mW output power in pulse radiation mode (F = 3,000, peak power = 80 W, Δt = 200 ns, density = 0.05 W/cm(2), dose = 6 J/cm(2), area = 1 cm(2)) and also a probe of MLO1K with a power output of 30 mW and a wavelength of 890 nm in pulse radiation mode (F = 3,000 Hz, peak power = 50 W, Δt = 200 ns, density = 0.017 W/cm(2), total dose = 10 J/cm(2)), and were given low-level laser therapy (LLLT) three times a week with a total number of 12 sessions. Data were analyzed using SPSS ver. 15, and the obtained data were reported as mean ± SD and frequency (%). To analyze the data, repeated measurement and marginal homogeneity approaches were used.

RESULTS

In the current study, a significant reduction was observed regarding the nocturnal pain, pain on walking and ascending the steps, knee circumference, distance between the hip and heel, and knee to horizontal hip to heel distance at the end of the treatment course.

CONCLUSIONS

In brief, the current study focuses on the fact that LLLT is effective in reducing pain in knee osteoarthritis.

Percutaneous dilatational tracheostomy and surgically created thracheostomy in ICU patients

Introduction: Following advances of Intensive Care medicine and widespread administration of mechanical ventilation, tracheostomy has become one of the indispensable surgical procedures. During this research we tried to assess and compare two main strategies for doing tracheostomy: Surgically Created Tracheostomy (SCT) and Percutaneous Dilatational Tracheostomy (PDT).

Methods: In a randomized clinical trial, 60 cases of patients who were admitted in Intensive Care Unit (ICU) and needed tracheostomy during their stay were enrolled. Patients were randomly divided into two groups. SCT technique was considered for the first group and PDT for the second one. Demographic characteristics, associated and underlying diseases, type and duration of procedure, duration of receiving mechanical ventilation and ICU stay, expenses and complications of tracheostomy including bleeding, subcutaneous emphysema, pneumothorax, stomal infection and airway loss were all recorded during study and compared between both groups.

Results: There were significant differences between two groups of patients in terms of duration of receiving mechanical ventilation (P=0.04), duration of tracheostomy procedure (P=0.001) and procedure expenses (P=0.04). There was no significant difference between two groups in terms of age and gender of patients, duration of ICU stay and complications of tracheostomy including copious bleeding, stomal infection, subcutaneous emphysema and airway.

Conclusion: According to the results of our study and similar researches, it can be concluded that PDT can be considered as the preferred procedure in cautiously selected patients during their ICU stay.

Effects of ginger (Zingiber officinale) on plasma glucose level, HbA1c and insulin sensitivity in type 2 diabetic patients

The present study was aimed to evaluate the effects of Zingiber officinale on some biochemical parameters in type 2 diabetic (DM2) patients. In a randomized double-blind placebo controlled trial, 64 patients with DM2 were assigned to ginger or placebo groups (receiving 2 g/d of each). A 3 d diet record, anthropometric measurements and concentrations of fasting blood glucose (FPG), HbA1c, lipid profile (including total cholesterol, triglyceride, low density lipoprotein and high density lipoprotein) and also the homeostasis model assessment (HOMA) and quantitative insulin-sensitivity check index (QUICKI) were determined before and after 2 months of intervention. Ginger supplementation significantly lowered the levels of insulin (11.0 ± 2.3 versus 12.1 ± 3.3; p = 0.001), LDL-C (67.8 ± 27.2 versus 89.2 ± 24.9; p = 0.04), TG (127.7 ± 43.7 versus 128.2 ± 37.7; p = 0.03) and the HOMA index (3.9 ± 1.09 versus 4.5 ± 1.8; p = 0.002) and increased the QUICKI index (0.313 ± 0.012 versus 0.308 ± 0.012; p = 0.005) in comparison to the control group; while, there were no significant changes in FPG, TC, HDL-C and HbA1c (p > 0.05). In summary, ginger supplementation improved insulin sensitivity and some fractions of lipid profile in DM2 patients. Therefore it may be considered as a useful remedy to reduce the secondary complications of DM2.

Does adenotonsillectomy alter IGF-1 and ghrelin serum levels in children with adenotonsillar hypertrophy and failure to thrive? A prospective study

OBJECTIVES

Adenotonsillar hypertrophy (ATH) contributes to upper airway obstruction and recurrent tonsillitis in children. The aim of this study was to evaluate the effect of adenotonsillectomy on serum IGF-1 and ghrelin levels in children with ATH failure to thrive.

METHODS

Forty pre-pubertal children with more than 5 years of age (6.57 ± 1.284 years) suffering from ATH, sleep disorder breathing, snoring, open mouth breathing and growth retardation were studied. Blood samples were taken eight hours after fasting and weight and height were measured by SECA instrument. Blood samples were centrifuged immediately and the extracted sera were stored at -70 °C in Eppendorf vials. IGF-1 and ghrelin were measured by ELISA kit. Patients with adenotonsillectomy indication underwent adenotonsillectomy and serum levels of IGF-1 and ghrelin were measured 12 months after operation.

RESULTS

Weight, height and BMI were increased significantly after operation (P < 0.001). Serum IGF-1 and ghrelin levels increased significantly after operation compared to before operation (P < 0.001).

CONCLUSION

Growth retardation in children with adenotonsillar hypertrophy is related to lower serum IGF-1 levels. Ghrelin levels increase before the meals and ghrelin increases hunger and food intake. The results obtained from our study confirmed that weight, height and BMI increase significantly following adenotonsillectomy; this could in turns prevent undesirable and irreversible physiological changes that occur due to adenotonsillar hypertrophy. Adenotonsillectomy in children with adenotonsillar hypertrophy and failure to thrive increases IGF-1 and Ghrelin serum levels which might contribute to the improvement in the growth pattern of the children.

Iran's Bushehr Earthquake at a Glance

On 9 April 2013, an earthquake of 6.1 magnitude hit southwestern Iran near the city of Khvormuj and the towns of Kaki and Shonbeh in Bushehr province. The official disaster mitigation committee took immediate actions to coordinate rescue teams equipped with 24-hour medical air assistance. Overall, 160 victims were transferred to and treated in the Khvormuj hospital, while 139 survivors were transferred to the hospitals in Bushehr for specialized care. The survivors have been settled in temporary shelters with adequate primary supplies. Considering the hot climate of the area, immediate measures should be taken in order to avoid any further casualties particularly heatstroke, dehydration, diarrheal and vector-borne diseases.

Do pediatric patients undergoing cardiac surgeries require larger-size cuffed endotracheal tubes? A prospective study

BACKGROUND

There is a controversy over using either smaller- or larger-size endotracheal tubes (ETT) in children undergoing cardiac surgery, and some anesthesiologists prefer to use ETT sizes different from the formula-based sizes. The aim of the present study was to compare proper-size cuffed ETT in children undergoing cardiac vs noncardiac surgeries.

METHODS

In an observational prospective study, 80 children planned to undergo noncardiac elective surgeries (NCS group) and 80 children scheduled for cardiac surgeries (CS group) were recruited. For intubation, initial cuffed ETT size was calculated based on the following formula: Tube size (mm ID) = age (year)/4 + 3.5. The estimated ETT size for each age group and the size of final utilized tubes for each age range were recorded.

RESULTS

Patients of tube sizes 4.5, 5, and 5.5 in the CS group were of lower age, weight, height, and body surface area compared with the patients of the same tube sizes in the NCS group (P < 0.05). The compatibility of the predicted vs actual required tube sizes was more in the NCS group compared to the CS group (72.5% vs. 56.2%; P = 0.02). Additionally, the cases with underestimated tube sizes were significantly more in the CS group compared with the NCS group (38.8% vs. 18.8%, P = 0.01).

CONCLUSION

Children undergoing cardiac surgeries in relation to their age and body size do require larger-size ETTs compared with the children scheduled for noncardiac surgeries.

Dexamethasone added to bupivacaine prolongs duration of epidural analgesia

BACKGROUND

Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind, controlled clinical trial to evaluate the effect of dexamethasone added to bupivacaine-fentanyl on the duration of postoperative analgesia via epidural catheterization.

METHODS

Seventy two adult patients scheduled for elective abdominal or thoracic surgery under epidural anesthesia were randomly allocated into two groups to receive either bupivacaine (0.5%) - fentanyl (50 microg) and dexamethasone (8 mg) in lumbar or thoracic epidural anesthesia (Dexa group, n=36), or bupivacaine-fentanyl and saline normal (control group, n=36) via epidural catheter. Duration of analgesia, postoperative pain score and IV analgesic use at first 24 hours were recorded and compared.

RESULTS

Two patients were excluded (one in each group) due to unsuccessful blockade. Age, gender and duration of surgery were similar in the two groups (p>0.05). The duration of analgesia (372< or = 58.1 vs. 234.6+/- 24.3 min) was significantly longer and pain score and pentazocine use were less in the Dexa than the control group (37.1+/- 19.7 mg v.s. 73.1 +/- 17.6 mg, respectively; p=0.001).

CONCLUSIONS

This study revealed that dexamethasone added to bupivacaine-fentanyl solution in epidural analgesia prolongs the duration of analgesia in abdominal or thoracic surgery.

Determination of safe margin in the surgical pathologic specimens of non-small cell carcinoma of the lung

BACKGROUND AND AIM

Local recurrences of the tumor at the surgical margin are serious problems in pulmonary resections for lung cancer. The aim of this study is to determine the involved margins and safe distances of the resection sites from tumor for prevention of local recurrences.

MATERIAL AND METHODS

In this prospective study, 66 patients operated for non-small cell lung carcinoma (NSCLC) from Jan 2006 to Sep 2008 were evaluated. After performing pulmonary resections, multiple biopsies were taken up from 5 mm (A), 10 mm (B), 15 mm (C), and 20 mm (D) distance from tumor. The specimens were studied histopathologically.

RESULTS

From a total of66 patients with NSCLC admitted to our referral hospital, 25 (38%) had adenocarcinoma, 18 (27.3%) squamous cell carcinoma, 5 (7.5%) large cell carcinoma, 4 (6%) bronchoalveolar cell carcinoma, 4 (6%) adenoid cystic carcinoma, 3 (4.6%) malignant carcinoid tumor and 7 (10.6%) had metastasis. The most common symptoms were dyspnea and cough. Histopathologically tumor positive margins were found in 84.8% (A), 10.6% (B), 4.5% (C), and 0% (D). There was a significant statistically difference between tumor involvement at distances 5 mm (A) versus 10-20 mm (B-D) (P <0.001).

CONCLUSION

A 20 mm distance from the gross tumor is considered as a safe surgical margin in any type of malignant pulmonary resections for prevention of local surgical recurrences if there was no pathologic examination before surgery.

Effectiveness of intravenous dexamethasone versus propofol for pain relief in the migraine headache: a prospective double blind randomized clinical trial

BACKGROUND

There are many drugs recommended for pain relief in patients with migraine headache.

METHODS

In a prospective double blind randomized clinical trial, 90 patients (age ≥ 18) presenting to Emergency medicine Department with Migraine headache were enrolled in two equal groups. We used intravenous propofol (10 mg every 5-10 minutes to a maximum of 80 mg, slowly) and intravenous dexamethasone (0.15 mg/kg to a maximum of 16 mg, slowly), in group I and II, respectively. Pain explained by patients, based on VAS (Visual Analogue Scale) was recorded at the time of entrance to ED, and after injection. Data were analyzed by paired samples t test, using SPSS 16. P < 0.05 was considered to be statistically significant.

RESULTS

The mean of reported pain (VAS) was 8 ± 1.52 in propofol group and 8.11 ± 1.31 in dexamethasone group at presenting time (P > 0.05). The VAS in propofol group was obviously decreased to 3.08 ± 1.7, 1.87 ± 1.28 and 1.44 ± 1.63 after 10, 20 and 30 minutes of drug injection, respectively. The VAS in dexamethasone group was 5.13 ± 1.47, 3.73 ± 1.81 and 3.06 ± 2 after 10, 20 and 30 minutes of drug injection, respectively. The mean of reported VAS in propofol group was less than dexamethasone group at the above mentioned times (P < 0.05). The reduction of headache in propofol group, also, was very faster than dexamethasone group (P < 0.05). There were no adverse side effects due to administration of both drugs.

CONCLUSIONS

Intravenous propofol is an efficacious and safe treatment for patients presenting with Migraine headache to the emergency department.

TRIAL REGISTRATION

Clinical Trials IRCT201008122496N4.