Intra-abdominal pressure in critically Ill patients: it is time to pay attention

Intra-abdominal pressure [IAP] measurements can be used for the early detection and management of the abdominal compartment syndrome [ACS]. Increased intra-abdominal pressure [IAP] can lead to multi-organ dysfunction and eventually death. In this study we collected and analyzed data of the clinical cases which were prone to develop intra-abdominal hypertension [IAH] and [ACS]. A prospective study was performed in the ICU over 7 months. Patients were classified according to their IAP. The follow up of those who had high IAP was concerned with the incidence of ACS and the mortality rate. 115 patients were allocated for this study; we found prevalence of IAH in total number of patients [68.7%]. Male sex and high body mass index [BMI] predominance was noticed in the group of patients who developed IAH [62.2% with P=0.02]; and [31 +/- 6.2 with P=0.03] respectively. The incidence of ACS was 55% in the group of patients with IAH and overall mortality rate among them was 59%. IAH and ACS are significant causes for multi organ failure and increased mortality among wide variety of patients. So, we should emphasize "IAH and ACS" it is time to pay attention

Double-blind comparison of prophylactic antiemetic effect of ephedrine, metoclopramide and ondansetron on patients undergoing gynacologic laparoscopy: cost-effectiveness analysis

In a randomized, double-blind study, the prophylactic antiemetic cost-efficacy of epphedrine, metoclopramide and ondansetron in 100 patients undergoing general anaesthesia for day-case gynacological laparoscopic surgery were compared. A standard general anaesthetic technique was used for all patients. Ten min. before the end of surgery, patients were classified into 4 groups each [n=25]. Placebo, ephedrine, metoclopramide and ondansetron groups and they receive 3 ml saline i.m, 0.5 mg/kg ephedrine i.m, metoclopramide 10 mg i.v and ondansetron 4 mg i.v respectively. During the first two hours after anaesthesia [early vomiting], the incidence of postoperative nausea and vomiting [PONV] was 68%, 28%, 32% and 20% after administration of saline, ephedrine, metoclopramide and ondansetron respectively [P<0.05]. There was a significant difference between placebo and other groups. However there was no difference between ephedrine, metoclopramide and ondansetron groups in the incidence of PONV. During the time between 2 hours and 24 hours postoperatively [delayed vomiting], the incidence of PONV was 80%, 72%, 44% and 24% in saline ephedrine, metoclopramide and ondansetron group respectively. There was a significant difference between ondansetron group and other groups [P<0.05]. No difference in the incidence of once administration of rescue drug but there is a great difference in the incidence of twice or more administration of rescue drug between ondansetron and other groups [P<0.05]. No difference in the incidence of adverse events was observed between groups. There was a great difference in price between ondansetron and other drugs. This study was concluded that the prophylactic administration of I.V ondansetron was not superior to ephedrine and metoclopramide in preventing early PONV but only in preventing delayed PONV and its cost did not justify as for use in our country as a routine prophylactic antiemetic drug against PONV

Effect of radiation on the bone around healed, osseointegrated dental implants

This experimental study was designed to evaluate the bone reaction around endosteal implants after exposure to ionizing radiation, and to compare this reaction in two different types of implants; hydroxyapatite [HA] coated and titanium plasma sprayed implants. For each of twenty-four male white rabbits; the right femur was implanted with titanium plasma sprayed implant while the left side was implanted with HA-coated implant. After a period of 8 weeks during which the implant osseointegrated, the animals were divided randomly and equally [N=12] into 2 groups; control [C] and experimental [E]. In the later group, both femurs were exposed to cobalt 60 units; 200 rad per day, 5 days a week for 5 weeks. Standardized X Ray were taken for each implant, immediately postoperative as well as, 2nd, 4th, 8th and 20th week post-operative. Bone reaction was detected by measuring bone density around implants using gray scale analysis. Bone density in group C increased from 79 +/- 4.85 to 126.2 +/- 3.22 and from 77.8 +/- 3.16 to 135.6 +/- 4.24 for titanium plasma sprayed and HA- coated implants respectively, and in group E from 81.2 +/- 5.11 to 115.6 +/- 5.24 for titanium plasma sprayed implants and 78.4 +/- 3.64 to 124.9 +/- 4.93 for HA-coated implants. All differences were statistically significant [P<0.05] among each group, and statistically insignificant [P>0.29] between both groups. The results of this study suggested that, fractionated irradiation dose of 50 Gy might not induce an apparent deleterious effect on healed osseointegrated dental implants. Moreover, upon exposure to irradiation, HA-coated implants might provide a better bone reaction than titanium plasma sprayed implants