effects of intravenous acetaminophen on pain and clinical findings of patients with acute appendicitis; a randomized clinical trial

Objective: To determine the effects of intravenous Acetaminophen [Apotel[registered sign]] on pain severity and clinical findings of peritonitis in patients with acute appendicitis

Methods: This randomized cross-over clinical trial was carried out duringa 6-month period from August 2012 to February 2013 and comprised 107 patients diagnosed with acute appendicitis. Patients were randomly assigned to received placebo [n=] or Apotel[registered sign] [n=]. Patients were evaluated before, 30 minutes, 1 hour and 4 hours after administration of Apotel[registered sign] or placebo,and were told to fill in two forms. The first form required patientsto measure their painintensityaccording to visual analogue scale [VAS]. The second form was filled by a surgeon who examined the patients and recorded his or her findings using Alvarado score criteria for diagnosis of acute appendicitis at foregoing time points

Results: Of 72 patients, 37 [51.4%] were men and 35 [48.6%] were women. The mean age of the patients was 34.1 +/- 13.5 years. The mean pain score in 107 patients included in this study was 7.96 +/- 2.3. Those who received Apotel[registered sign] had significantly lower pain scores when compared to placebo at 30 minutes [p<0.001], 1 hour [p<0.001] and 4 hours of administration. There was no significant difference between two study groups regarding the frequency of Alvarado score; however the frequency of fever was significantly lower in those who received Apotel[registered sign] [p<0.001]. We found that Apotel[registered sign] was not associated with resolved physical findings of acute appendicitis in different time intervals

Conclusion: Apotel[registered sign] does not affect the clinical findings of acute appendicitis and dos not interfere with the accurate diagnosis. Therefore, it could safely be used as a reliable pain relieving agent, in patients with acute appendicitis

Modified perihepatic packing; a creative and beneficial method for management of high grade liver injury

To evaluate the efficacy of modified perihepatic packing [MPHP] in reducing the rate of re-bleeding rate after packing removal. This was an experimental study being performed in Shiraz animal laboratory. High grade liver parenchymal injury was induced in 30 transgenic Australian rabbits which were then divided into two groups. Group A [control] included 14 and group B [experimental] comprised 16 rabbits. The animals in group A underwent standard perihepatic packing [SPHP] and those in group B were subjected to MPHP. Re-bleeding was assessed and compared between the two groups, after removal of perihepatic packings. There was no significant difference between two study groups regarding baseline and perioperative characteristics. Rabbits in group A had significantly lower rate of postoperative re-bleeding compared to those in group A [57.1% vs. 12.5%; p=0.019]. The mean bleeding volume was also significantly lower in group B compared to group A [76.88 +/- 22.12 vs. 98.93 +/- 33.8 mL; p<001]. Although the survival rate was higher in group A compared to group B [93.8% vs. 78.6%] but the difference was not statistically significant [p=0.315]. MPHP is a simple and safe procedure for surgical management of high grade liver parenchymal injury concomitant with severe loss of glisson's capsule. This procedure significantly decreases re-bleeding after packing removal in comparison with SPHP

Asymptomatic tuberculosis-induced heal perforation in an HIV-infected individual; a case report

The co-existence of acquired immune deficiency syndrome [AIDS] and tuberculosis is a major cause of morbidity and mortality because of a widespread organ involvement. The gastrointestinal tract is a common site for localization of opportunistic microorganisms in AIDS. However, surgical abdominal emergencies such as intestinal perforation resulted from tuberculosis are uncommon in these patients. The asymptomatic occurrence of such intestinal perforation has not been reported our knowledge. We represent an HIV and piCV co-infected man with miliary tuberculosis and an incidentally detected free air under diaphragm in the chest X-ray eventually resulting in exploratory laparotomy which then revealed two tubercular-induced intestinal perforations. It seems that as the tuberculosis is increasing in incidence, mostly due to reactivation in HIV-infected patients especially in developing countries, we should not underestimate its acute abdominal emergencies such as bowel perforation

Short-term outcome of early tracheostomy in the trauma patients admitted to intensive care unit: a comparative study

Objectives: To compare the results of early versus late tracheostomy in trauma patients admitted to intensive care unit [ICU]

Methods: This was case control study being performed at a major trauma centre in Shiraz, Iran including 120 trauma patients admitted to ICU during a 2-year period and underwent tracheostomy during their ICU stay. The patients were categorized into two groups of the early tracheostomy who underwent tracheostomy within the first 7 days of initiation of mechanical ventilation [n=60], and the late tracheostomy group, in which tracheostomy was performed after 7 days [n=60]. The duration of mechanical ventilation, ICU stay and hospital stay as well as mortality rates in ICU and hospital were recorded and compared between two study groups

Results: The baseline characteristics such as age [p=0.325], sex [p=0.071] Glasgow coma scale [GCS] [p=0.431] and the mechanism of injury [p=0.822] were comparable between two study groups. Early tracheostomy was associated with a significantly shorter duration of mechanical ventilation [p=0.008] and shorter ICU stay [p=0.003]. Hospital stay [p=0.165], ICU mortality [p=0.243], and hospital mortality [p=0.311] were not different between the two study groups

Conclusion: Early tracheostomy is associated with reduced ICU stay and shorter duration of mechanical ventilation. Adopting a standardized strategy may improve resource utilization

comparison of case-control and case-only designs to investigate gene-environment interactions using breast cancer data

The traditional methods of studying the gene-environment interactions need a control group. However, the selection of an appropriate control group has been associated with problems. Therefore, new methods, such as case-only design, have been created to study such interactions. The objective of this study was to compare the case-only and case-control designs using data from patients with breast cancer. The interaction of genetic and environmental factor as well as the ratio of control to population odds ratio was calculated for case-only [300 patients with breast cancer] and case-control [300 cases of breast cancer and 300 matched controls] designs. The confidence intervals and -2log likelihood in all variables in case-only design was smaller than those in the matched case-control design. In case-only design, the standard errors of some variables such as age at menarche, the first delivery at the age of 35 yrs and more or no delivery, the history of having live birth, use of oral contraception pills, breastfeeding history were less than those in the matched case-control design. The findings indicate that the case-only design is an efficient method to investigate the interaction of genetic and environmental factors