ABSTRACT
Sickle-cell disease [SCD] is an inherited hemoglobin childhood disorder, frequently complicated by pulmonary hypertension and cardiac involvement. Cardiovascular events and complications are the leading cause of mortality and morbidity in patients with SCD. Tissue Doppler imaging and the myocardial performance index [Tei index], are simple indices for the assessment of the cardiac function. The purpose of this study was to assess the left ventricular function in children with SCD. Sixty-four patients with SCD [mean age = 11.7 +/- 5.5 years] were compared with 50 age matched healthy controls [mean age = 11.2 +/- 5.20 years]. Myocardial wall motion velocities at the lateral mitral annulus and the junction between the medial mitral annulus and the interventricular septum were assessed during systole [Sa], early diastole [Ea], and late diastole [Aa] through a four-chamber view using pulsed Doppler echocardiography. The ejection fraction and shortening fraction were estimated. The Tei index was estimated via tissue Doppler echocardiography. The results showed that Ea and Aa velocity in the mitral annulus and interventricular septum had no difference between the patients and controls [p value > 0.05], and nor was there any difference between the two groups as regards the Tei index, Ea/Aa, ejection fraction, and shortening fraction [p value > 0.05]. Sam wave velocity, however, had a significant difference between the two groups [p value < 0.038]. The Tei index is a sensitive indicator for the cardiac function in chronic diseases and the right ventricular function in some disorders such as SCD
ABSTRACT
Postoperative nausea and vomiting [PONV] are among the most common complications following surgery and anesthesia. Preoperative intravenous fluid therapy is one of the prophylactic methods against PONV. Preoperative administration of hypertonic solutions has already been used for controlling intraoperative hypotension. This study was conducted to assess their efficacy to reduce PONV. Ninety patients were enrolled in the study. The patients were allocated randomly, according to a random number table, to three groups. Group A received intravenous saline [15 cc/kg] thirty minutes before induction of anesthesia. Group B received intravenous ringer [15cc/kg] thirty minutes before induction of anesthesia. Group C received hypertonic saline 5% [2cc/kg] half an hour before the induction of anesthesia. Patients were assessed as to the presence of nausea, vomiting and VAS scores in the recovery room, six, twelve and 24 hours after the surgery. Serum sodium level was checked when leaving the recovery room. Data were recorded through questionnaires in data sheets. The analysis indicates that nausea severity in group C [hypertonic saline 5%] was significantly less than other groups. Vomiting frequency distribution was not significantly different among the three groups in the recovery room. The distribution frequency of vomiting six and twelve hours following the surgery was remarkably less in group C. When leaving the recovery room, serum sodium level in group C was significantly higher than other groups. However this level was still within the normal range and none of the patients manifested the signs or symptoms of hypernatremia. This study suggests that hypertonic saline can reduce PONV more significantly than ringer's solution and normal saline
ABSTRACT
Postoperative nausea and vomiting [PONV] are known to be among the most common and undesirable postoperative complications. The aim of this study was to compare the effect of midazolam [IV], metoclopramide [IV] and a combination of both as a treatment for established PONV. One hundred and thirty two males and females who experienced PONV following general anesthesia for cholecystectomy were enrolled in the study. Patients were allocated randomly into three groups of 44 individuals using a random number table. The first group received midazolam [30 micro g/kg, Max 2mg, IV], intravenous metoclopramide [0.15 mg/kg, Max 10 mg] was administered to the second group, and the third group was treated with a combination of midazolam and metoclopramide with mentioned doses. The frequency of vomiting and nausea [with Visual Analog Scale [VAS] >/= 3] were measured and registered at two, six and 24 hours after drug administration. Drug side effects were also recorded and compared. The frequency of nausea [VAS >/= 3] recorded six hours after the administration of injection has been significantly higher in the second group. No other significant differences were detected through the comparison between other values. There were no significant differences among the drug side effects in the three groups. Administration of intravenous midazolam or midazolam-metoclopramide combination is more effective than metoclopramide alone in the treatment of postoperative nausea. The incidence of adverse effects is not significantly in the three groups
ABSTRACT
Peripartum cardiomyopathy [PPCM] is an uncommon disease that affects women in the last month of pregnancy or within the first five months postpartum, occurring in about 1 in 3500 live births. The disease bears potentially devastating effects both on mother and the fetus if not treated early in its course. The case was a 34-year old woman with a triple pregnancy who presented to the ward immediately after cesarean section with signs of dyspnea, cyanosis and pulmonary edema. She was diagnosed with PPCM upon echocardiography. The patient improved remarkably despite the PPCM's devastating complications. This case report aims to describe a female patient who developed PPCM after a triple delivery. Regarding the high risks of developing PPCM in subsequent pregnancies and avoiding multiparty, especially in older age, a reliable contraception in childbearing women would be helpful. The best prevention of PPCM is to avoid subsequent pregnancies
Subject(s)
Humans , Female , Postpartum Period , Echocardiography , Hypertension, Pregnancy-Induced , Myocarditis , Pre-Eclampsia , Pregnancy , Critical Care , Cesarean SectionABSTRACT
Palmar hyperhidrosis is a fairly common disease with an unknown etiology. Some treatment modalities have shown benefits, the most recent of which is the injection of botulinum toxin A [BTX-A]. We tried to test the beneficial effects of BTX [Dysport] in Iranian patients. Fifteen volunteers with severe palmar hyperhidrosis, diagnosed by iodine starch test, were enrolled in the study. Employing a standardized scheme, Dysport was injected intradermally into the palmar aspect of patients' dominant hands. The distal parts of the non-dominant hands were injected by normal saline as control. Follow-up was performed using iodine starch test. Wilcoxon signed rank test was used for comparison between the cases and controls. Satisfactory response to treatment was achieved in 13 out of 15 patients. Comparing the cases with the controls, Dysport showed a significant beneficial effect [p<0.001]. Weakness of handgrip was seen in 13 patients. We suggest using Dysport in the treatment of selected cases of severe palmar hyperhidrosis