ABSTRACT
BACKGROUND@# Rapid and effective pain relief in acute traumatic limb injuries (ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous (IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI.@*METHODS@# In this double-blind randomized clinical trial, 307 patients with ATLI, who presented to the emergency department (ED) from February 2016 to April 2016, were randomly divided into two groups. One group (152 patients) received 0.1 mg/kg IV morphine. The other group (155 patients) received 1 mcg/kg IV fentanyl. Patients' demographic data, pain score at specific intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded.@*RESULTS@# Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up (P value=0.00). However, at 10, 30, and 60-minute follow-ups no significant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12 (7.7%) patients in the fentanyl group and in 48 (31.6%) patients in the morphine group (P value=0.00). No significant difference was observed regarding side effects, vital signs and patients' satisfaction between the two groups.@*CONCLUSION@# Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.
ABSTRACT
In this clinical trial, polyethylene glycol [PEG] solution was compared with lactulose in the treatment of hepatic encephalopathy in patients with cirrhosis
Methods: This randomized controlled trial was performed on 40 patients in two groups. The patients in the lactulose group received either 20-30 grams of lactulose orally or by a nasogastric tube, or 200 grams of lactulose enema by a rectal tube. The patients in the PEG-lactulose group received the same amount of oral or rectal lactulose, plus 280 grams of PEG in 4 liters of water orally as a single dose in 30-120 minutes. Serial physical examinations, hepatic encephalopathy scoring algorithm [HESA], blood level of ammonia, and serum biochemical studies were used to evaluate the severity of hepatic encephalopathy
Results: In comparison with lactulose alone, PEG-lactulose could improve HESA score in 24 hours more effectively [p =0.04]. Overall, PEG-lactulose regimen was associated with a decrease in length of hospital stay compared with lactulose treatment [p =0.03] but in subgroup analysis we found that PEG-lactulose regimen could only decrease the length of hospital stay in women significantly [p =0.01]
Conclusion: The use of PEG along with lactulose in comparison with lactulose alone is more effective in the treatment of hepatic encephalopathy in patients with cirrhosis and results in more rapid discharge from hospital
ABSTRACT
Aortic dissection occurs when a tear develops in the wall of the aorta, which is rare in the young population. This fatal disorder is hard to diagnose, especially in young patients. We present the case of aortic dissection in a 15-year-old boy referred to the Emergency Department of Yazd University of Medical Sciences in November 2015. The patient presented to our department with sudden acute chest pain. Emergent computed tomography [CT] scanning of the brain, chest, and abdomen reflected bilateral pleural effusion, biluminal aorta, arterial flap in the upper part of the abdominal aorta, and dilated small bowl loop. The patient did not have any aortic dissection risk factors such as history of connective tissue disease, congenital heart disease, coarctation of the aorta, and hypertension. The only noticeable point in the patient's history was swimming two hours before the onset of the chest pain. Aortic dissection is a rare differential diagnosis in children with acute sudden chest pain
ABSTRACT
Although demyelination along the axons is the main manifestation of Multiple sclerosis [MS], peripheral nervous system [PNS] could be affected potentially too. In some studies PNS involvement is estimated to be more than 50 percent in MS patients. Accordingly, objective tests to confirm the severity of PNS involvement might be crucial in patients' management. Modern technological advances lead to innovation of computerized electrodiagnostic [EDX] techniques in recent years. Nerve conduction studies [NCS] provide reliable data about neuropathies. Although the frequency of PNS involvement varies in different population of MS patients, recognizing clinical and subclinical PNS impairments in MS patients is important for the treatment