Evaluation of hemodynamic changes due to protamine administration by calcium gluconate after coronary artery bypass grafting surgery

Administration of Protamine sulfate for heparin neutralization after cardiopulmonary bypass may be associated with adverse reactions such as transient hypotension to cardiovascular collapse. Although catastrophic events are rare and occur only in 2.6% of cardiac surgeries, it is associated with adverse postoperative outcome. The aim of this study is to investigate whether bolus administration of calcium gluconate can minimize the adverse hemodynamic effects of protamine. This randomized clinical trial [RCT] prospective study was conducted between Feb. 2006 to Dec. 2008. The patients were randomly allocated into three groups including group A [42 patients] who received only protamine after weaning from cardiopulmonary, group B [44 patients] concomitantly treated with protamine sulfate and calcium gluconate, and group C [40 patients] receiving calcium gluconate 5 minutes before administration of protamine. Hemodynamic variables such as systolic and diastolic blood pressures, mean of arterial pressure, central venous pressure and heart rate were obtained 0, 2, 4, 6, 8 and 10 minutes after protamine administration from each group. Systolic blood pressure in groups A [control] and C [calcium administration before protamine] 0,2,4,6,8 and 10 minutes after protamine administration initially decreased and increased subsequently [P=0.228]. Also no statistically significant difference was found in diastolic blood pressure [DBP], mean arterial pressure [MAP], central venous pressure [CVP], and heart rate [HR] in 0,2,4,6,8, and 10 minutes in any of the three groups. In our study, hemodynamic changes in 10 minutes after protamine administration for heparin neutralization in patients with good left ventricular systolic function after coronary artery bypass grafting surgery were mild, and prophylactic calcium gluconate administration concurrent with or before protamine injection was not recommended

Comparison of the effects of ceftriaxone and cefazolin regimes in the treatment of adult acute pyelonephritis

Background and Purpose: There have been variations on the response rate of microorganisms causing pyelonephritis to antibiotics in different studies. The present study was conducted to compare the drug resistance against Ceftriaxone and Cefazolin in adult acute pyelonephritis

Methods and Materials: In this phase-3 single blind clinical trial, 86 patients suffering from pyelonephritis were selected through successive sampling, and were randomly assigned into one of the two groups after they signed an informed consent: Ceftriaxone 1g every 12 hours and IV Cefazolin 1g every 8 hours. Seventy two hours after the onset of treatment, patients were examined for their clinical and laboratory resistance. The obtained data were analyzed in SPSS using chi-square test, independent sample t-test, and Kappa coefficient

Results: Mean fever alleviation time were 2.63 +/- 0.95 and 2.77 +/- 0.81 days in the ceftriaxone and cefazolin groups respectively [p=0.2]. Urinary culture 72 hours after treatment was positive in 7% of patients in both groups. In the ceftriaxone group, 51.2% of the patients were sensitive clinically and in the laboratory results. In total, 9.3% were sensitive in laboratory and clinically resistant; and 39.5% were sensitive in laboratory despite being clinically resistant. With the cefazolin group, 51.2% were both clinically and laboratory sensitive; and 7% were clinically and laboratory resistant; also, 11.6% were sensitive in laboratory but clinically resistant; but 30.2% were clinically sensitive despite being resistant in the laboratory results

Conclusion: In the treatment of non-complicated upper urinary infections, the therapeutic effect of cefazolin is not different from that of ceftriaxone, which is broad spectrum and more expensive

study on reliability and validity of the depression-happiness scale in justice's staff of Isfahan city

The purpose of this study was to assess the reliability and validity of the Depression-Happiness Scale [H-PS] in staff of Isfahan justice. 200 subjects [134 male, 66 female] with a mean age of 33/7 [ranged from 21to 56] and standard deviation 10/6 were chosen among 900 staff of Isfahan's court. Their literacy level ranged from diploma to MS. All subjects completed the Depression-Happiness Scale [D-HS], Beck Depression Inventory [BDI] and Oxford Happiness Inventory [OHI] in one session. The study of internal consistency of D-HS showed that all items have high correlation with total scores, the Cronbach alpha was 0/93 and test-retest reliability after two months was 0/72. D-HS was highly correlated with OHI and BDI. The factor analysis revealed 5 factors with an eigenvalue greater than 1, which could explain 57/1% of the total variance. But because first factor with an eigenvalue 10/72 accounted for most [42/91%] of the variance, a one-factor model was specified. Depression-Happiness Scale is a reliable and valid test for measuring happiness in Iranian population