Safety and efficacy of phenylephrine nasal drops in bronchiolitis.

OBJECTIVE: Bronchiolitis is a common lower respiratory tract infection in the first year of life. In this disease upper respiratory tract infection is associated with nasal congestion, respiratory distress and hypoxia. We studied the effect of phenylephrine drops as a decongestant in treatment of light and moderately severe cases of acute bronchiolitis. METHODS: This is a double blind randomized trial involving 100 children aged 4 weeks to 12 months. The patients were divided into two groups, the first group received 0.1 ml phenylephrine 0.5% and the second group 0.1 ml sodium chloride (NaCl) 0.9% as placebo in both nostrils. Respiratory rate, heart rate, O2 saturation, dyspnea, retractions and wheezing were assessed before and 30 minutes after medication. FINDINGS: After medication, O2 saturation and respiratory muscles retractions in the phenylephrine group were significantly better than those of the placebo group (P=0.004 and P=0.002, respectively). In the phenylephrine group, O2 saturation, retractions and wheezing were also significantly better before than those after medication (P=0.003 and P<0.0001 respectively). In the placebo group no significant difference before and after intervention was observed. CONCLUSION: Phenylephrine as a topical decongestant is an inexpensive, easily available and suitable means in the treatment of mild to moderately severe bronchiolitis.

Clinical presentation of novel influenza a (h(1)n(1)) in hospitalized children.

OBJECTIVE: Human pandemic influenza H(1)N(1) virus as the cause of febrile respiratory infection ranging from self-limited to severe illness has spread globally during 2009. Signs and symptoms of upper and lower respiratory tract involvement, fever, sore throat, rhinitis, myalgia, malaise, headache, chills and fatigue are common. In this article we report the clinical presentation of Influenza A (H(1)N(1)) in our hospitalized children. METHODS: Between September and October 2009, all children requiring hospitalization for suspected H(1)N(1) infection were transferred to Pediatric Infectious Diseases ward. For all patients the throat swab was taken for PCR testing to confirm or exclude the diagnosis of H(1)N(1) Influenza A. Case patients consisted of H(1)N(1)-positive patients. Age, sex, symptoms, signs, laboratory data, CXR changes, details of therapy, duration of admission and patient outcome were documented. FINDINGS: Twenty patients were H(1)N(1) positive. Mean age of the patients was 65.50±9.8 months. Fever and coughs were with 55% the most commonly reported symptoms. Other presentations included vomiting (55%), abdominal pain (25%), cyanosis and dyspnea (5%), body ache (40%), rhinorrhea (80%), sore throat (35%), head stiffness (5%) and loss of conciousness (5%). The median temperature of the patients was 38.5°C. Chest X-Ray changes were noted in 13 out of 20 patients (65%). Mean leukocyte and platelet was 6475 and 169000 respectively. Seventeen (85%) patients were treated with Oseltamivir, 3 patients received adjuvant antibiotics. The mean duration of admission was 3 days. Three patients required intensive care support and all of them expired due to superinfection. CONCLUSION: Our data confirm that the presentation of influenza in children is variable and 2009 H(1)N(1) influenza may cause leucopenia and thrombocytopenia.

Assessment of clinical efficacy of intranasal desmopressin spray and diclofenac sodium suppository in treatment of renal colic versus diclofenac sodium alone.

OBJECTIVES: To determine the effect of the combination of intranasal desmopressin spray and diclofenac sodium suppository on acute renal colic and compare it with diclofenac sodium suppository alone. METHODS: A total of 150 patients aged 15-65 years referred to our hospital with acute renal colic were included in a double-blind controlled clinical trial study. Patients in group 1 received desmopressin, 40 microg intranasally plus diclofenac sodium suppository 100 mg, and patients in group 2 received diclofenac sodium suppository 100 mg plus a placebo spray consisting of normal saline 0.9%. RESULTS: Significant differences were found in the pain scores at 15 and 30 minutes between the 2 groups (P < .05). Also, significant differences were found in the mean pain scores in the first 15 and first 30 minutes after treatment between the 2 groups (P < .05). Of the patients in group 1, 37.3% had no pain relief and required pethidine. However, this rate in group 2 was 69.3%. In 17 cases, we prescribed pethidine within 20 minutes after treatment, and these patients were excluded from our study. CONCLUSIONS: According to our results, intranasal desmopressin plus diclofenac sodium suppository caused prompt pain relief with significant decreases in pain scores after 15 and 30 minutes. We suggest that intranasal desmopressin spray is a useful supplemental therapy for renal colic in combination with nonsteroidal anti-inflammatory drugs, especially to reduce the use of opioids.

What is the difference between percutaneous nephrolithotomy in patients with and without previous open renal surgery?

BACKGROUND AND PURPOSE: In this study we aimed to determine the effects of previous open renal surgery on the results and complications of subsequent percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: From October 2005 to October 2007, 104 patients underwent PCNL in our hospital. We compared the patients who undergone previous open surgery on the same kidney (group 1; n = 36) with those who had undergone no previous surgery (group 2; n = 68). We extracted requested information such as age, sex, stone number, stone burden, intraoperative and postoperative complications, hospital stay, access time, operative time, and success rate. The results of the study were analyzed using SPSS 10 software. RESULTS: Intraoperative complications were seen in 11.11% of the group 1 patients and in 11.8% of the group 2 patients. Postoperative fever was seen in 33.3% of the patients in group 1 and in 26.5% of the patients in group 2. Mean hospital stay was 85.88 +/- 17.25 hours and 80.20 +/- 17.71 hours in group 1 and group 2, respectively. Mean operating time was 75.41 +/- 17.2 minutes in group 1 and 67.42 +/- 26.25 minutes in group 2. Stone-free rate was 88.9% in the group 1 patients and 79.4% in the group 2 patients. Step 1 access time in group 1 and group 2 was 120.02 +/- 68 seconds and 117.80 +/- 80.52 seconds, respectively (p = 0.002). CONCLUSIONS: PCNL in patients who previously underwent open renal surgery is effective and safe. We found no difference in results between the two groups based on the number of stones and the number of accesses. The step 1 of dilatation was the only difference between the two groups.

One-shot versus metal telescopic dilation technique for tract creation in percutaneous nephrolithotomy: comparison of safety and efficacy.

PURPOSE: The aim of this study was to assess the feasibility and morbidity of single-step acute dilation, named "one-shot" technique, including a single dilation of the nephrostomy tract with a 28F or 30F Amplatz dilator compared with metal telescopic dilation technique. PATIENTS AND METHODS: Two hundred fourteen patients who underwent percutaneous nephrolithotomy (PNL) for stone disease from September 2005 to October 2007 were included in the study, and they were randomly divided into two groups according to the type of tract dilation technique: in group 1 (112 patients), Alken telescopic dilators were used; in group 2 (102 patients), one-shot technique was used. Access tract dilation time, X-ray exposure time, success rate, and blood loss and other complications were evaluated. RESULTS: One-shot technique was compared using Alken telescopic dilators without an increase in morbidity and with significant reduction in X-ray exposure (p = 0.003). There was no significant difference in the procedural success rate between groups 1 and 2 (100% v 96.07%, respectively) (p = 0.765). There was no any significant difference in complications. Access time was similar in both groups (p = 0.14). CONCLUSION: One-shot dilation was proved to be safe and effective like metal telescopic dilation even in patients with a history of ipsilateral open renal surgery. In this procedure, X-ray exposure is lower.

Effect of megestrol acetate on serum albumin level in malnourished dialysis patients.

OBJECTIVE: Malnutrition is a common problem in dialysis patients, and may affect up to one third of patients. It is associated with high mortality and morbidity. Although a number of studies were performed to determine effective treatment, there is no proven medication for this condition. This study aimed to evaluate the effect of megestrol acetate (MA) on serum albumin levels in malnourished dialysis patients. DESIGN: This was a randomized, controlled clinical trial. SETTING: The setting, a dialysis center at Razi Hospital, Rasht, Iran, provides services to dialysis patients. PATIENTS: Twenty-two malnourished dialysis patients with persistent hypoalbuminemia (albumin, <3.5 g/dL for 2 months) participated, and were randomly assigned to either an experimental group or a control group. INTERVENTION: The experimental group was treated with MA, 40 mg twice daily, over 2 months, and was compared with the control group. The collected data were analyzed using SPSS (version 10; Chicago, IL). RESULTS: After 2 months, the mean (+/-SD) serum albumin level in the experimental group rose from 3.31 +/- 0.31 g/dL to 4.41 +/- 0.31 g/dL, but in the control group, it declined, from 3.35 +/- 0.21 to 3.02 +/- 0.48 g/dL. The difference between the two groups was significant (P = .002). CONCLUSION: At a dose of 40 mg twice a day, MA safely increased serum albumin in malnourished dialysis patients.

Tubeless percutaneous nephrolithotomy for staghorn stones.

PURPOSE: To assess the outcome and safety of tubeless percutaneous nephrolithotomy (PCNL) to treat patients with staghorn stones. PATIENTS AND METHODS: Between March 2006 and March 2007, 75 patients underwent 82 PCNLs at our hospital. Of that total, 42 procedures were done without a nephrostomy tube (tubeless group) and 40 procedures were done with insertion of a nephrostomy tube at the end of the procedure (standard group). RESULTS: The mean age was 41.55 +/- 15.15 years and 50.29 +/- 9.42 years in the tubeless group and the standard group, respectively. Seven patients had bilateral stones. None of our patients had organ trauma or any other significant complication. The average operative time was shorter in the tubeless group than in the standard group (93.76 v 109.98 minutes, respectively; P = 0.03). The mean analgesic doses given postoperatively were 79.17 +/- 62.2 and 93.75 +/- 40.7 mg of meperidine in the tubeless group and the standard group, respectively, with no statistically significant difference. The mean postoperative hospital stay was 1.7 +/- 0.6 days in the tubeless group and 4 +/- 1.6 days in the standard group (P < 0.0001). The stone-free rate was 37 units (88.09%) and 35 units (87.5%) units in the tubeless and standard groups, respectively. CONCLUSIONS: Complications, operative time, and the length of hospitalization in selected patients undergoing tubeless PCNL were all lower than those seen in the standard group. Tubeless PCNL was thus found to be safe and effective, even in patients with staghorn stones.

Vasal irrigation with sterile water and saline solution for acceleration of postvasectomy azoospermia.

INTRODUCTION: Vasectomy is the safest and most reliable method of all the contraception methods, but azoospermia is not achieved immediately by this method. We decided to determine whether irrigation of the vas deferens with sterile water or hypertonic saline solution irrigation during vasectomy would reduce the time needed to obtain azoospermia. MATERIALS AND METHODS: A total of 126 fertile men presented for vasectomy were divided in 3 groups. No-scalpel vasectomy was done for all of the participants and irrigation of the vas deferens was carried out during the procedure in 2 groups with either sterile water or hypertonic saline solution (9 g/L sodium chloride solution). Forty-two participants underwent vasectomy without irrigation. Semen analysis was performed at 4, 8, 12, and 16 weeks after vasectomy. RESULTS: Azoospermia was achieved in all of the men with sterile water after 12 weeks, while at the end of the study (16 weeks) it was achieved in 37 (88.1%) of those with saline solution and in 11 (26.2%) of those without irrigation. There were significant differences in the rates of azoospermia between the participant with sterile water and saline solution at 8 weeks (38.1% versus zero; P < .001), 12 weeks (100% versus 30.9%; P < .001), and 16 weeks (100% versus 88.1%; P = .02). No pregnancy developed during the follow-up and no complication was reported. CONCLUSION: Vasal irrigation with sterile water and hypertonic saline solution during vasectomy were effective in removing sperm from the distal vas and increasing the rate at which men achieved azoospermia. Sterile water was a promising option with no complications.