[ study of the efficacy of N-acetylcysteine for the prevention of contrast induced nephropathy in normal renal functioning patients undergoing coronary angiography]

N-Acetylcysteine [NAC] has been found to reduce the risk of Contrast Induced Nephropathy [CIN] in chronic renal insufficiency after CT imaging with contrast enhancement. The purpose of the current study was to evaluate the efficacy of NAC, for the prevention of CIN in normal renal functioning patients undergoing coronary angiography. We prospectively studied 100 patients, who were undergoing coronary angiography with meglumin compound 76% [Urografin], Patients were randomized one to two groups. Group one, IV hydration and NAC 600 mg PO were administered twice daily for 2 days [on the day prior to and on the day of coronary angiography]. Group two, was administered IV hydration alone [Control Group]. One hundred patients completed the study. There was no significant difference between the group in baseline characteristics, duration of angiography, mean volume of contrast agent infused or in mean IV hydration. Contrast nephropathy developed in 30% of subjects. 11/50 [22%] in NAC group and 19/50 [38%] in control group [P= 0.12]. In control group, the mean of Createnin Serum Level significantly increased 48 hours after administration of the contrast agent [P=0.001]. Our findings do not support routine prophylactic administration of oral NAC as an adjunct to saline hydration for prevention of contrast induced nephropathy, in patients with normal kidney, undergoing coronary angiography

[ effect of metronidazole on hemorrhoidectomy pains]

Topical metronidazole [10 percent] has been previously demonstrated to decrease post operative pain after hemorrhoidectomy. The aim of this study was to evaluate the effect of topical metronidazole [10 percent] on postoperative and after defecation pains of hemorrhoidectomy. A double-blind randomized trial was conducted to compare post- hemorrhoidectomy pain using topical metronidazole [10 percent] to. placebo carrier applied to surgical site. Forty-seven patients were randomly selected to receive metronidazole [n=25] or placebo [n=22]. Pain was assessed using a visual analog scale [VAS] preoperatively as well as on postoperative hours 6 and 12, and on days 1, 2, 7, and 14. The use of narcotic, additional analgesics and complications were recorded. [Pain scores were calculated and compared with baseline values and control group [t-test, SPSS ver.10]. Patients in the topical metronidazole group had significantly less postoperative pain than those in the placebo group by the day 14 [P

[Efficacy of oral versus intravenous vitamin c on serum oxalate level in hemodialysis patients]

Long term of high doses of vitamin C treatment might be a potential risk for the development of secondary oxalosis in end stage renal disease patients. Hyperoxalatemia may increase the risk of cardiac, vascular and bone diseases. Hemodialysis patients [HD] are at high risk for Scurvy disease due to dietary limitation and ascorbic acid losses through dialysis. Vitamin C also decreases HTN and accelerated arthrosclerosis. Thus, vitamin C supplementation is necessary for these patients. The aim of this study was to evaluate efficacy of oral versus intravenous vitamin C on serum oxalate level in hemodialysis patients. This clinical-trial study was done on hemodialysis patients referred to the three treatment centers of Mazandaran Province. 41 HD patients, who had not consumed vitamin C for two months, were randomly divided into two groups, oral and intravenous. In intravenous [IV AA] group, vitamin C 500 mg/day was administered three times a week; and oral group received vitamin C 125 mg/day for two months. Oxalate serum level was measured before and after treatment. Individual, laboratory, and treatment complication data were gathered in a questionnaire. Intra group comparison was done with t-student test and inter group comparison was done with independent- sample t-test. Data were expressed as SE +/- Mean and p-value<0.05 was considered significant. Serum oxalate level in each group increased, there was no significant differences intra group and between two groups [p= 0.3] [in oral, from 1.8 +/- 0.4mgl/L to 1.85 +/- 0.8mgl/L, P=0.4 and in IVAA from 1.8 +/- 0.7mg/L to 2.1 +/- 0.9mg/L, P=0.3]. Oral and IV AA in the used dosage did not increase serum oxalate level and were safe to use as supplementation in HD patients

[ study on lidocaine pharmacokinetic behavior following endotracheal administration in ICU]

Introduction: the endotracheal route for drug delivery is a valuable alternative in emergency conditions in which intravenous access is difficult or impossible. Liodcaine is an antiarrhythmic agent with tracheal absorbency, commonly used in cardiac emergenices

Objective: the purpose of this study was to investigate Lidocaine pharmacokinetic behavior following endotracheal administration in critically ill patients

Materials and Methods: 14 mechanically ventilated critically ill patients received 2mg/kg lidocaine 2% [diluted as necessary with 0.9% Saline up to total volume of 5-10 ml] via an endotracheal tube. Five positive pressure breaths were provided immediately after instillation of the drug into the airway and then patients connected to the ventillator again. Venous blood samples were drawn for 4 hours after lidocaine administration and plasma concentrations determined by HPLC method

Results: after 5 min, average lidocaine concentrations reached the therapeutic range [1.5-5 ?g/ml] and remained in this range for 30 minutes. Volume of distribution [Vd] was found to be 0.7 +/- 0.3 L/Kg, and clearance [Cl] 4.29 +/- 1.4 ml/min /kg. These valuse are lower than those described previously for healthy volunteers [P< 0.001], but similar to those described in ICU patients [P > 0.05]. Half life was 113.1 +/- 34.1 min and was not different from parameters published previously for healthy and ICU patients [P > 0.05]

Conclusion: in conclusion, endotracheal administration of Lidocaine can provide therapeutic levels in critically ill patients.It is not definitely clear that the technique of endotracheal drug administration or the unstable physiologic condition of the patients alters the pharmacokinetics of lidocaine