[ impact of educational alert cards and posters on nursing stations on preventing atorvastatin drug interactions]

Drug interactions are considered as adverse effects of drugs that alter a patient's response to an initial medication due to concurrent administration of different drugs or other substances. This study aimed to assess the role of medical education in reducing potential Atorvastatin drug interactions in a teaching hospital by distributing alert cards and putting up posters in a nursing station. Six hospital wards of Taleghani hospital were selected for the study [Gastroenterology-liver, Nephrology, Vascular Surgery, Orthopedics, Cardiology and Endocrinology Wards]. The study was conducted in three phases. In the first phase, 100 patients receiving atorvastatin were examined for presence of drug interactions. Then in the second phase, warning leaflets and informative posters about atorvastatin drug interactions and its management were provided. Leaflets were distributed among ward practitioners and posters were put up in the nursing stations. Finally, in the third phase of the study, 100 patients that were being treated with atorvastatin were examined for presence of atorvastatin drug interactions. Analysis of data was performed using SPSS version 16 and p values of less than 0.05were considered significant. Overall, results showed that in all six wards after training, reductions in atorvastatin drug interactions decreased from 43% to 24% and this was statistically significant [P = 0.004]. The comparison between internal and surgical wards showed a significant reduction in presence of atorvastatin drug interactions only in the internal wards where it decreased from 50% to 22.5% [p <0.001]. Distribution of alert cards and educational posters put up in nursing stations was successful, in that it effectively reduced atorvastatin drug interactions

Effect of oral anticoagulant therapy on coagulation activity and inflammatory markers in patients with atrial fibrillation undergoing ablation: a randomized comparison between dabigatran and warfarin

Atrial fibrillation [AF] is associated with inflammatory and hypercoagulability state. Previous studies evaluated the safety and efficacy of dabigatran and warfarin in prevention of thrombothic complications. This study was intended to assess the influence of these drugs on hemostatic and inflammatory markers among patient underwent pulmonary vein ablation. A total of 100 patients with AF who underwent catheter ablation were randomized to treatment with dabigatran [D] 110 mg twice daily or warfarin [W] adjusted to an * international normalized ratio [INR] of 2.0 to 3.0 for 3 months after ablation procedure. C - reactive protein [CRP], D-dimer, prothrombin fragment Fl + 2 [Fl +2], were measured at baseline before ablation procedures, after 30 days and after 90 days of treatment. After 3 months, the D-dimer was 164.9 +/- 48.9 in Dabigatran and 197.2 +/- 58.6 in warfarin group, Fl + 2 was 0.4 +/- 0.2 in dabigatran and 0.8 +/- 0.2 in warfarin group and CRP level was 1.8 +/- 1.6 in Dabigatran and 5.1 +/- 5 in warfarin group. [All p-values < 0.05] The results showed that treatment with dabigatran made greater changes in the serum level of CRP, D-dimer, Fl + 2. The pattern of changes in serum CRP levels D-dimer, Fl + 2 is much faster and with a greater slope in the dabigatran group

Intraoperative magnesium sulfate can reduce narcotic requirement after coronary bypass surgery

Narcotics are the most common drugs used after cardiac surgery and their side effects, including respiratory depression, hemodynamic instability, nausea and vomiting, and itching are dose dependent. Magnesium is both an N Methyl D Aspartate [NMDA]-receptor and a calcium-receptor antagonist and can modify the important mechanisms of nociception. The purpose of this study was to investigate the effect of magnesium sulfate on the pain score and reducing narcotic requirement in coronary artery bypass grafting surgery [CABG] patients. This randomized, double blinded, placebo-controlled trial recruited 185 patients [105 male and 80 female] undergoing elective CABG. Mean age was 58 +/- 11 years [range 24 to 79 years]. The patients were divided into two groups randomly: Group I received magnesium sulfate as an IV infusion [80 mg/kg] during a one-hour period post induction and Group 2 received the same volume of normal saline as a placebo. During the postoperative period, the patients' morphine requirement and pain score [visual analogue seale scaled as 0 to 10, 0=no pain and 10= worst possible pain] at 6[th], 12[th], 18[th], and 24[th] hours were recorded and documented. There were no significant differences between the two groups with respect to the baseline data. In the magnesium sulfate group, only 30 [32%] patients needed morphine sulfate, whereas 75 [83%] patients in the placebo group required some doses of morphine sulfate [p value < 0.001]. The odds ratio showed that magnesium sulfate could strongly prevent the need for opioid analgesics for pain control. The intraoperative use of magnesium sulfate can reduce the need for opioids post CABG

Comparison of the clinical efficacy of Bovine thrombin and compression method in femoral pseudoneurysm of parients undergoing percutaneous coronary intervention

Pseudoaneurysm has been an increasingly common complication of catheterization procedures during the past two decades, with the greatest incidence being in the femoral artery. Treatment of iatrogenic femoral artery pseudoaneurysm with the injection of thrombin is reported to be an efficacious and safe procedure. In this study, we evaluated the efficacy and success rate of percutaneous ultrasonographically-guided thrombin injection and compression method for the treatment of pseudoaneurysm and for studying of the effect of thrombin injection on systemic coagulation parameters. This cohort clinical trial was conducted on patients with femoral pseudoaneurysm after percutaneous intervention [PCI] in Shaheed Rajaie Cardiovascular Medical and Research Center. The patients were divided into two randomized groups and treated with either the compression method or the percutaneous ultrasonographically-guided thrombin injection method. Pseudoaneurysm size, pseudoaneurysm neck size, thrombin dose, thrombosis time, outcome of therapy, and complications were documented prospectively. Duplex sonographic follow-up examinations were performed at 0 and 24 hours afterwards. Partial thrombin time as well as the Quick test [prothrombin time] was monitored before and after the intervention. Thirty patients between 15 and 85 years of age with femoral pseudoaneurysm following catheterization were enrolled in this study. The average length and width of the pseudoaneurysms were respectively 2.45 +/- 1.15 cm and 2.06 +/- 1.07 cm. In total, 13 thrombin injections were administered. The mean thrombin dose was 500-2000 IU. The success rate of thrombin injection was %92.30 [12 of 13 patients], which was significantly higher than that of compression 82.35% [13 of 17 patients] [p value<0.05]. No thromboembolic, infectious, or allergic complications occurred. In this study, the percutaneous ultrasonographically-guided thrombin injection method was successful and safe in the management of femoral pseudoaneurysms. Changes in coagulating factors indicated the possibility of thrombin passage into the arterial circulation.

Intravenous sufentanil and morphine for post-cardiac surgery pain relief using patient-controlled analgesia [PCA] device: a randomized double-blind clinical trial

Selection of the best analgesic technique in patients undergoing major surgeries can result in lower morbidity and satisfactory postoperative pain relief. In the present study, we tried to compare the effect of morphine and sufentanil on postoperative pain severity and hemodynamic changes by using patient-controlled analgesia [PCA] device in patients who were candidate for coronary artery bypass surgery [CABG]. It was a randomized double-blinded clinical trial in which 120 patients aged 30-65 years, ASA physical status I-Ill, candidate for CABG in Shahid Rajaee hospital in Tehran were included. Before anesthesia, patients were randomly assigned to one of three groups to receive sufentanil [n=40], morphine [n=40] or normal saline [n=40]. After tracheal extubation at intensive care unit, PCA was started by, sufentanil 4mg for the first group, morphine 2mg for the second group and normal saline, at same volume for the third group, intravenously with 10 minute lockout interval. Postoperative pain was evaluated by VAS scale, 1, 6, 12, 18 and 24 hours after extubation and systolic blood pressure, arterial oxygen saturation, PCO2 and PO2 were recorded 24 hours after extubation. VAS scores at rest revealed significantly less pain for patients in sufentanil and morphine groups than normal saline group, throughout the twenty-four hours after operation [P<0.001]. However, there were no significant differences in the means of VAS scores between sufentanil and morphine groups. Among studied hemodynamic parameters, only systolic blood pressure was reduced more in morphine than sufentanil group [P<0.001]. After CABG surgery, administration of intravenous sufentanil and morphine using PCA can lead to similar reduction of postoperative pain severity