Efficacy of intravenous dexamethasone for the prevention of vomiting associated with intrathecal chemotherapy and ketamine sedation in children: a randomized, double-blinded, crossover, placebocontrolled trial.

Background: Chemotherapy-induced nausea and vomiting remains a significant problem for children with leukemia. There is limited evidence to support using prophylactic antiemetic prior to the administration of intrathecal chemotherapy. Objective: Determine whether vomiting and nausea associated with intravenous ketamine and intrathecal chemotherapy may be reduced by the addition of prophylactic dexamethasone in children. Method: A randomized, double-blinded, crossover, placebo-controlled trial was completed in 33 children receiving intrathecal chemotherapy with methotrexate and ketamine sedation at Pharmongkutklao Hospital. Patients were randomly assigned in a double-blinded fashion to receive one of two interventions during the first period, either an infusion of normal saline or intravenous dexamethasone at 0.25 mg/kg/dose. Each patient acted as his or her own control, and each patient was studied at two time-points. Results: Period effect, sequence effect, and carry over effect were not demonstrated. The absolute risk reduction of vomiting was significantly greater after infusion of dexamethasone than after placebo at 33.3 % (p=0.02). The number needed to treat was three to prevent one episode of vomiting. Fifteen patients in the treatment group reported nausea versus 26 patients in the placebo group (p= 0.007). In the group of patients treated with dexamethasone, five required antiemetic vs. 16 of those receiving placebo (p=0.02). There was no complication from dexamethasone. Conclusion: Intravenous dexamethasone reduced vomiting associated with intrathecal chemotherapy and ketamine sedation, without significant side-effects. It may be recommended a reasonable option before intrathecal chemotherapy.

Prospective, randomized comparison of castor oil and sodium phosphate preparation for barium enema.

OBJECTIVE: To compare castor oil and sodium phosphate preparation (Swiff) in patients' satisfaction, efficacy for colon cleanness, side effects, and prices. MATERIAL AND METHOD: One hundred patients referred for barium enema were randomized to receive castor oil (n = 50) and sodium phosphate preparation (n = 50). They graded their satisfaction using a 5-point scale (easy, acceptable, slightly difficult, extremely difficult, and unacceptable). The efficacy for colon cleanness was graded by two radiologists using a 5-point scale (excellent, easy for evaluation, acceptable, difficult for evaluation, and unacceptable). Side effects were evaluated by patients' vital signs, total number of bowel frequency, and 10 associated symptoms. RESULTS: Both preparations revealed no difference in patients' satisfaction (p = 0.882) and efficacy of colon cleanness (p = 0.130). Sodium phosphate preparation was more expensive (79 vs. 10 Baht) and caused higher number of bowel frequency (p < 0.001). CONCLUSION: With a cheaper price, castor oil was comparable with sodium phosphate preparation in patients' satisfaction and efficacy of colon cleanness.

A method in field measurement of urinary iodine.

The objective of this study is to determine a very cheap, reliable, relatively rapid portable field unit for quantitative urinary iodine measurements. As Individual Urine Excretion (IUE) approximate those of Daily Iodine Intake (DII), iodine deficiency can be measured in casual urine samples of individual. Using the criteria, the frying pot method has been introduced and modified from the long and tedious Zak’s method after Pino et al, and Robbins and Dunn et al. This modified method has many advantages. Such the assay takes 84 tubes of urine per pot in100o C paraffin oil bath and changes into water. It has been shortened from one hour to 25 minutes. Change of color to intermediate violet is observed by adding ferroine as the indicator, resulting in a standard curve reading the concentration of iodine being, in micrograms per liter. The results of 255 subjects from Mukdaharn Province indicated the reliability of the method as the results of which are the same as those using in the heating block and spectrophotometespectrophotomete. This has been confirmed by the results of 1,007 samples. This new technique provides good results; between oil and water, the results on using water are even better. This saves much money modification reduces significantly by lowering the cost of equipment. It is rapid, simple and reliable. The method is portable and valuable for measuring and monitoring iodine deficiency studies and for epidemiological studies of iodine deficiency its control in developing countries.