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

Predictive value of biochemical markers for extremity vascular trauma outcome

To evaluate the predictive value of some biochemical markers in the outcome of extremity vascular trauma. This study comprised 30 patients with traumatic arterial injury and acute limb ischemia referred to Namazi hospital affiliated with Shiraz University of Medical Sciences, over a period of 8 months, from Sep 2009 to Jul 2010. Venous blood samples were drawn from distal ischemic limb to determine pH, HCO[3][-], PCO[2], PO[2], Na[+] and K[+] before definitive surgical intervention. Comparable samples were also obtained from veins of non-ischemic upper extremities. The biochemical assays were compared after monitoring the revasculurized limbs and evaluation of viability during a period of 7 days. The mean age of the patients was 28.3 +/- 7.8 [range: 18-56] years. Two [6.6%] patients underwent amputation because of developing irreversible limb ischemia after vascular reconstruction. Both patients had blunt traumatic knee injury accompanied by nerve, vein and soft tissue damage. The statistical analysis showed correlations between parameters, except for Na[+] of local [ischemic limb] and systemic samples. In this context, the highest correlation was observed in regard to HCO[3][-]. The correlation was most pronounced with respect to HCO[3][-]. Ischemic limbs exhibited reduction in pH and PO[2] but, PCO[2] and K increased after ischemia of injured limbs. PO[2] reflects tissue perfusion and is of value in predicting the outcome. We believe that blunt trauma and associated nerve, vein and soft tissue injuries pose negative prognostic effects on limb survival postoperatively

Burden of chronic kidney disease in Iran. A screening program is of essential need

The latent nature of chronic kidney disease [CKD] in primary stages precludes early diagnosis. This necessitates plans such as screening, but we should first introduce CKD as a public health problem. This study was designed to define the burden of CKD in Iran. We calculated disability-adjusted life years [DALYs] according to the World Health Organization's practical guidelines for national burden of disease studies. The sum of years of life lost and years lived with disability were estimated for CKD stages 1 to 4 and end-stage renal disease [ESRD] based on the national registry data and the published reports about CKD in Iran in 2004. Over 700 000 people were estimated to have CKD in Iran in 2004 and 61 000 new cases of CKD were anticipated. The prevalence rate of CKD was estimated to be 1083 and its incidence rate was 173.5 per 100 000 population. Chronic kidney disease was responsible for 1 145 654 DALYs. The highest DALYs for stages 1 to 4 of CKD were due to unknown etiology, diabetes mellitus, and hypertension [382 000 years, 347 400 years, and 311 800 years, respectively]. The DALY for ESRD and CKD stages 1 to 4 were 21 490 years and 1 124 164 years, respectively. The present study provides an estimate of the burden of CKD in Iran. As CKD can be controlled by practical cost-effective plans, we strongly recommend the information given by this study be considered for future action plans