Comparative Study on Clinical Characteristics of COVID-19 Patients with or without Digestive Symptoms in Razi Hospital, Ahvaz, Khuzestan.

BACKGROUND: Most commonly reported clinical manifestations are fever, fatigue and dry cough. Interestingly, a small percentage of patients experience GI symptoms, with the most common being anorexia, diarrhea, nausea and vomiting. We aimed to conduct a comparative study on COVID-19 patients with or without gastrointestinal patients (GI). AIMS: The pandemic of coronavirus disease 2019 (COVID-19) has emerged as a dire health problem, causing a massive crisis for global health. METHODS: Collective data of clinical manifestations and laboratory reports of patients admitted to Razi Hospital, Ahvaz, Khuzestan, Iran, for two weeks were analyzed. RESULTS: Our results showed that GI symptoms are not statistically significant criteria to be predictive or prognostic factors in COVID-19 patients, although they are probably related to the acute or non-acute phase of the disease. Moreover, non-specific GI symptoms seem to result from cytokine storm that occurred during the disease. CONCLUSION: Therefore, our results did not support GI tract involvement as a common route of COVID- 19 infection. Maybe future research will shed light on why and how the gastrointestinal system becomes infected by COVID-19.

Efficacy evaluation of budesonide nebulizer as an adjunctive medication in post-rain asthma acute phase attack.

INTRODUCTION: Bronchospasm attacks occur following syndromic rainfall and are increasing due to air pollution and need effective treatments. In this study, the effect of salbutamol nebulizer in comparison with salbutamol plus budesonide nebulizer in patients referred to the emergency department with dyspnea was investigated. MATERIAL AND METHODS: The trial study was conducted on 228 patients with dyspnea after the first rainfall in Ahvaz. Two groups of 114 patients have been randomly allocated. On the course of treatment, the first group received salbutamol plus budesonide nebulizer and the second group received salbutamol alone. In the experimental group, budesonide 0.5 mg with salbutamol was nebulized three times for 20 minutes. In all patients, 20, 40, and 60 minutes after the start of the intervention, forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR) and vital signs of size were recorded and analyzed by SPSS and t-test. RESULTS: Data revealed that there were significant differences between PEFR parameters of studied. Groups in minute 40 and 60 after intervention (p = 0.000001). There was better improvement.in PEFR values in minute 40 and 60 in budesonide plus salbutamol study group. There were no significant differences for FEV1 in minute 0, 20, 40, 60 between to studied group. Also there were no significant differences for borg dyspnea scale for minute 0 and 60 between two experimented group. Respiratory rates have significant differences in minutes 20, 40 after intervention and there was better improvement for salbutamol plus budesonide group rather than sulbutamol intervention group alone.(p = 0.001142). CONCLUSION: Experiment data revealed. that due to the significant difference between PEFR and increased FEV1 in the combination of the two drugs and due to the corticosteroid effects of budesonide in reducing and preventing inflammation and swelling of the lungs, nebulizer salbutamol + budesonide has better effects on moderate breath than in nebulizer salbutamol.

The effect of albuterol with heliox versus albuterol nebulization in acute asthma exacerbation: a randomized controlled clinical trial.

INTRODUCTION: Asthma is one of the most common chronic disorders of the respiratory tract. Thus, this study intended to evaluate the clinical effects and the peak flow metric effects of nebulized albuterol with heliox versus albuterol nebulization in acute asthma exacerbation. MATERIAL AND METHODS: In this randomized clinical trial study, 109 patients with acute asthma attacks admitted to the emergency departments (EDs) in *** were enrolled. The patients were divided randomly into two groups: the intervention and control groups. The intervention group was nebulized with heliox (helium/oxygen-70: 30) plus albuterol with a 10 mL/min dose for 20 minutes three times, which lasted 60 minutes. The control group received standard treatment (albuterol in combination with oxygen). RESULTS: The results showed that the mean scores of FEV1 and PEFR after 20 minutes were significantly different in the two groups, as FEV1 scores in the intervention group were 2.76 and 3.01 at 20 and 60 minutes, respectively, while FEV1 scores in the control group were 1.99 and 2.64, respectively (P < 0.001). In addition, PEFR scores in the intervention group at 20 and 60 minutes were 299.24 and 310.57, respectively. However, these scores in the control group were 237.98 and 274.56, respectively (P < 0.001). CONCLUSION: The results showed that the use of heliox in t eating severe asthma attacks could be regarded as a different standard treatment that can lead to significantly better control of asthma attacks in the short term.

Physiological equivalent temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran.

Climate change may be associated with human morbidity and mortality through direct and indirect effects. Ahvaz is one of the hottest cities in the world. The aim of this study was to investigate the relation between physiological Equivalent Temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran. Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on death. The effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted.The results showed that in cold stress [1st percentile of PET (2.7 °C) relative to 25th percentile (11.9 °C)] the risk of total respiratory mortality, respiratory mortality in men, and mortality in people under 65 year olds, significantly decreased in the cumulative lags of 0-2, 0-6 and 0-13; but the risk of respiratory mortality increased in the elderly and in the final lags. In contrast, heat stress [99th percentile of PET (44.9 °C) relative to 75th percentile (43.4 °C)] significantly increased the risk of total cardiovascular mortality (CVD), cardiovascular mortality in men, ischemic heart disease and cerebrovascular disease mortality in lags 0 and 0-2. It seems that high PET values increase the risk of cardiovascular mortality, while low PET values increase respiratory mortality only among the elderly in Ahvaz.

Clinical Efficacy of Dexmedetomidine versus Ketamine in Shoulder Dislocation Reduction: A Randomized Clinical Trial Study.

Background :Shoulder joint dislocation and displacement is a common clinical condition. The present research aims to compare the clinical efficacy of ketamine versus dexmedetomidine during shoulder joint reduction. Methods : In this randomized clinical double-blind trial method, patients aged 18 to 65 years with shoulder dislocation referred to the Emergency Hospital of Imam Khomeini Hospital in Ahvaz, Iran, were enrolled. Patients were separated into two groups, patients in group A received 1mg/kg nebu-lized ketamine and patients in group B received 1 µg/kg nebulized dexmedetomidine. Pain score was recorded at 5 different time points: Zero (before intervention), 10 minutes, 20 minutes, 30 minutes, and 60 minutes after intervention., The pain score was evaluated using the visual analog scale (VAS) test. A linear regression test was carried out to compare the slopes. Also, ANOVA repeated measures test variables differences between groups. Then Tukey's multiple comparisons as post-hock were applied to compare the pains at different time points. Using IBM SPSS version 19.0 software, all analyzes were accomplished. Results : The pain score in both groups significantly decreased during different time points. The pain reduction slope in the group that received dexmedetomidine is meaningfully upper than that of ketamine (-0.08 vs. -0.06, p=0.012). The ketamine action onset time was 20 minutes after the in-tervention. In comparison, the effect of dexmedetomidine has an onset of 10 minutes after the in-tervention. Conclusion : Overall, the results of current research demonstrated that although nebulized dexme-detomidine and nebulized ketamine produce a significant decrease in pain score, dexmedetomidine provides a faster effect. Therefore, nebulized dexmedetomidine seems to be used as an appropriate choice to induce sedation during shoulder joint reduction in emergency departments.

Quadriparesis following a Low-Voltage Electrical Injury in a 4-Year-Old Girl.

Electricity injuries are a global health problem, especially in low-income countries. The present case report involves a 4-year-old girl with quadriparesis following a low-voltage electrical injury. She was alert and her vital signs were normal on admission. The results of her examination were normal, except for decreased muscle power of the limbs, which was significantly improved during observation in the emergency ward and the subsequent follow-up. Clinical evidence suggested the diagnosis of transient neurologic effects associated with the electrical injury. Some degrees of neurological impairment are often observed in patients after electrical damage. Given the multiorgan dysfunction observed in many electrical injury patients, it is recommended to perform neurological examinations, if possible, at the first visit and follow-ups.

Improvement of Pain Relief of Fentanyl Citrate Drug Encapsulated in Nanostructured Lipid Carrier: Drug Formulation, Parameter Optimization, in vitro and in vivo Studies.

INTRODUCTION: In this study, the encapsulation of fentanyl citrate as an opioid drug with hydrophobic nature in the nanostructured lipid carrier (NLC) is performed. METHODS: For encapsulation of fentanyl citrate drug, hot homogenization method is used. The pharmacokinetics of encapsulated fentanyl citrate for pain relief of rats are investigated. The influence of important variables such as the ratio of liquid lipid to the total amount of lipids, surfactant type and concentration on the particle size is investigated using response surface method. RESULTS: Results show that the optimal NLC size is about 90 nm with PDI value around 0.2 and zeta potential of -25±4.01 mV. Characterization analysis of optimal nanostructure shows successful encapsulation of the drug in nanostructure with a spherical morphology of the NLC structure. Results of drug release from commercial fentanyl citrate ampoule and NLC form indicate a control drug release from the NLC within 72 hours in comparison to the commercial ampoule. In vivo studies show that fentanyl citrate-loaded NLC not only has the potential to relieve pain in doses equal to commercial drug but also it can reduce the dose of the drug about 50%. CONCLUSION: In conclusion, NLC form of fentanyl citrate can increase the efficacy of the drug by appropriate drug distribution in the body and can reduce the risks of overdose.

Acute Effects of Air Pollution on Hospital Admissions for Asthma, COPD, and Bronchiectasis in Ahvaz, Iran.

Background and Aim: Although air pollution is a serious problem in Ahvaz, the association between air pollution and respiratory diseases has not been studied enough in this area. The aim of this study was to determine the relation between short-term exposure to air pollutants and the risk of hospital admissions due to asthma, COPD, and bronchiectasis in Ahvaz. Methods: Hospital admissions data and air pollutants including O3, NO, NO2, SO2, CO, PM10, and PM2.5 were obtained from 2008 to 2018. Adjusted Quasi-Poisson regression with a distributed lag model, controlled for trend, seasonality, weather, weekdays, and holidays was used for data analysis. Results: The results showed a significant increase in hospital admissions for asthma (RR=1.004, 95% CI: 1.002-1.007) and COPD (RR=1.003, 95% CI: 1.001-1.005) associated with PM2.5. PM10 was associated with increased hospital admissions due to bronchiectasis in both genders (Men: RR=1.003, 95% CI: 1.001-1.006) (Female: RR=1.003, 95% CI: 1.000-1.006). NO2 was also associated with an increased risk of hospital admissions for asthma (RR=1.040, 95% CI: 1.008-1.074) and COPD (RR=1.049, 95% CI: 1.010-1.090). SO2 was associated with the risk of hospital admissions of asthma (RR=1.069, 95% CI: 1.017-1.124) and bronchiectasis (RR=1.030, 95% CI: 1.005-1.056). Finally, CO was associated with COPD (RR=1.643, 95% CI: 1.233-2.191) and bronchiectasis (RR=1.542, 95% CI: 1.035-2.298) hospital admissions. Conclusion: Short-term exposure to air pollutants significantly increases the risk of hospital admissions for asthma, COPD, and bronchiectasis in the adult and elderly population.

Characteristics of S100B and Neuron Specific Enolase in Differentiating Acute Vertigo Cases with Central Cause; a Diagnostic Accuracy Study.

INTRODUCTION: Differentiating central vertigo from peripheral ones poses a challenge to specialists. The present study aimed to examine the potential screening value of S100B and neuron-specific enolase (NSE) in this regard. METHODS: This prospective cross-sectional study recruited adult acute vertigo patients with suspected central causes visiting the emergency department (ED) in the first six hours since the onset of symptoms. The screening performance characteristics of S100B and NSE biomarkers in differentiating central vertigo cases were measured considering brain magnetic resonance imaging (MRI) as the reference test. RESULTS: 85 cases who met the criteria were enrolled to the study (82.3% female). The MRI of 21 (24.7%) cases had abnormal findings. The two groups were the same in terms of age, sex, and vital signs. Patients with abnormal brain MRI had significantly higher levels of S100B (p < 0.001) and NSE (p < 0.001). S100B and NSE had area under the receiver operating characteristic (ROC) curve of 90.3 (95% CI: 80.7 - 99.8) and 96.9 (95% CI: 93.7 - 100.0) in differentiating the central causes of acute vertigo, respectively. At the cut-off point of above 119.68 pg/l, S100b had sensitivity of 90.00% (95% CI: 78.83 -95.86) and specificity of 92.00% (95% CI: 72.49 - 98.60). The sensitivity and specificity of NSE at the cut-off point of above 18.12 ng/ml were 100.00% (95% CI: 93.14 - 100.00) and 89.47% (95% CI: 65.46 - 98.15), respectively. CONCLUSION: The serum levels of S100B and NSE were significantly higher in patients with central vertigo, and could therefore be considered as accurate tools in screening acute vertigo cases with central causes in ED.

Dexmedetomidine versus Midazolam-Fentanyl in Procedural Analgesia Sedation for Reduction of Anterior Shoulder Dislocation: A Randomized Clinical Trial.

BACKGROUND: Shoulder joint dislocation is the most common dislocation of joints in the body. To reduce the anterior shoulder dislocation, it is necessary to have analgesia and sedation. METHODS: In this randomized clinical trial, patients were divided into two equal groups. Group I received midazolam-fentanyl (0.05 mg/kg fentanyl at a dose of 1 µg/kg) for 10 minutes and group II received dexmedetomidine (1 µg/kg in the initial dose and then 0.2 µg/kg/h) for 10 minutes. The levels of analgesia according to VAS criteria and the time to reach desired sedation were compared between the two groups. RESULTS: A total of 60 patients participated in this study. The time to reach the desired sedation was 8.60 ± 2.3 minutes in the dexmedetomidine group and 11.27 ± 3.57 minutes in the midazolamfentanyl group (p= 0.001). Also, the VAS score in both midazolam-fentanyl and dexmedetomidine groups was 3.3 ± 1.24 and 2.57 ± 0.9, respectively. The differences were statistically significant (p=0.015). There was significant relationship between the time to reach desired sedation and the level of analgesia. Moreover, there was no significant difference between patient age and the time to reach the desired level of analgesia. During this study, no side effect was observed. CONCLUSION: The findings of this study show that dexmedetomidine provides a higher level of analgesia than midazolam-fentanyl. Moreover, it was also shown that dexmedetomidine causes quicker procedural sedation than midazolam-fentanyl.

Comparison of the Analgesic Effect of Intravenous Ketamine versus Intravenous Morphine in Reducing Pain of Renal Colic Patients: Double-Blind Clinical Trial Study.

BACKGROUND: The effective relief of renal colic patients with low complications is one of the important concerns of emergency physicians. The aim of this study was to investigate the use of injectable ketamine as an alternative to routine drugs in the relief of pain in patients with renal colic. METHODS: This double-blind clinical trial was conducted on patients who had suffered kidney pain due to kidney stones in 2017, referred to Ahvaz Imam Khomeini Hospital. Patients were divided into 2 groups: the first group received intravenous ketamine (0.3 mg/kg) and the second group received intravenous morphine (0.1 mg/kg) in a double-blind form. Finally, the mean pain was evaluated before injection, after 10, 20, 30, and 60 minutes as the initial result while the side effects were considered as secondary results. RESULTS: In this study, 135 patients with renal colic participate in this study. The mean pain at the time of referral to the hospital in the group receiving morphine and ketamine was 9.2 and 9.2, respectively, which did not show any significant difference. Based on these findings, there was no significant difference between the factors evaluated during the study of the two groups. Only in the ketamine group, there were 3 cases of nausea and 1 of vomiting. However, there was a significant increase in the need for additional doses of fentanyl in the morphine recipient group (p = 0.02). CONCLUSION: The findings suggest that the use of ketamine can produce a more rapid relief effect, and decrease the use of opioids which create various complications, including nausea and vomiting in patients, especially patients with renal colic.

Comparison of the analgesic effects of haloperidol with or without morphine in patients with acute renal colic: A randomized double-blind clinical trial study.

BACKGROUND: Given the increasing number of patients with acute renal colic, the present study examined the analgesic effects of haloperidol with or without morphine in order to find an effective method with fewer side effects for pain reduction in these patients. METHOD: In the present randomized double-blind clinical trial study, patients with a pain severity score of above 3 were randomly divided into 2 equal groups: Group A received intravenous morphine and haloperidol, and Group B received intravenous morphine with normal saline. Pain severity was recorded at Times 0, 20, 40, and 60 min following the injections based on a visual pain analog scale (VPAS) from 0 to 10. RESULTS: A total of 140 patients were included in this study. A comparison of the recorded pain severity scores did not show a significant difference between the 2 study groups (P = 0.38). The mean heart rate, the mean systolic and diastolic blood pressures, and the mean incidence rate of nausea and vomiting were not significantly different between Group A and Group B. The frequency of extrapyramidal side effects was 4.3% in the haloperidol group, which was not significantly different from that of the other group. The frequency of extra analgesic requirement was not significantly different between the 2 groups (P = 0.05). CONCLUSION: In our patients with acute renal colic, haloperidol failed to reduce pain and the incidence of nausea or vomiting, while it caused extrapyramidal side effects. Therefore, the prescription of this medication for acute pains, especially in renal colic, is not recommended.

Air pollution and hospital admissions for cardiovascular diseases in Ahvaz, Iran.

Cardiovascular disease is one of the main causes of death in Iran. The aim of this study was to determine the relation between air pollution and cardiovascular hospital admissions in Ahwaz, Iran. Daily information about cardiovascular hospital admissions (based on the ICD-10) and data on air pollutants during 2008-2018 were inquired. A quasi-Poisson regression combined with linear distributed lag models; adjusted for trend, seasonality, temperature, relative humidity, weekdays and holidays was used to assess the relation between hospital admission for cardiovascular diseases and the average daily air pollution. The results of this study showed a significant increase in cardiovascular hospital admissions in the total population and women's population in relation to O3. There was a significant increase in hospital admissions for cardiovascular diseases in the whole population as well as gender and age groups associated with NO2 and NO. A significant increase was found in hospital admissions for cardiovascular diseases in relation to CO in the 65-74-year-old population. Finally, the results of this study showed that there was a significant increase in hospital admissions for cardiovascular disease associated with SO2. The main results of the present study confirm the deleterious short term impact of air pollution on cardiovascular morbidity in Ahvaz city. This evidence empasizes the need to implement policies for reducing air pollution.

Diagnostic Accuracy of Serum and Urine S100A8/A9 and Serum Amyloid A in Probable Acute Abdominal Pain at Emergency Department.

STUDY DESIGN: This study was performed to investigate the diagnostic values of some inflammatory biomarkers in abdominal pain. METHODS: Patients over 18 years of age with acute recent abdominal pain who presented to the Emergency Department were evaluated. Serum and urinary samples were taken and evaluated for serum and urine S100A8/A9 and serum amyloid A. All patients were referred to a surgeon and were followed up until the final diagnosis. In the end, the final diagnosis was compared with the levels of biomarkers. RESULTS: Of a total of 181 patients, 71 underwent surgery and 110 patients did not need surgery after they were clinically diagnosed. Mean levels of serum and urine S100A8/A9 had a significant difference between two groups, but serum amyloid A did not show. The diagnostic accuracy of serum S100A8/A9, urine S100A8/A9, and serum amyloid A was 86%, 79%, and 50%, respectively, in anticipation of the need or no need for surgery in acute abdominal pain. CONCLUSIONS: Our study showed that in acute abdominal pain, serum and urine S100A8/A9 can be useful indicators of the need for surgery, but serum amyloid A had a low and nonsignificant diagnostic accuracy.

Rainfall-Associated Bronchospasm Epidemics: The Epidemiological Effects of Air Pollutants and Weather Variables.

BACKGROUND: This study compares different risk factors in patients visiting a hospital during five rainfall-associated bronchospasm epidemics in Ahvaz and those visiting on other occasions. METHODS: This case-control study was conducted on 5307 patients with bronchospasm admitted to the Emergency Department of Imam Khomeini Hospital in Ahvaz (Iran) from late October to December (as the epidemic) and 916 patients admitted from late January to March (as the nonepidemic) in 2011 to 2015. RESULTS: A total of the 41.7% of the cases and 48.8% of the controls had episodes of bronchospasm, suggesting a significant difference between the two groups (P < 0.001). The mean concentrations of PM10, NO, NO2, and NO x pollutants (except O3) were significantly higher in the nonepidemic periods (P < 0.05). The adjusted analysis showed a direct significant relationship between emergency respiratory admissions and each unit of increase in NO and SO2 concentration during the epidemic periods and NO2 concentration during the nonepidemic periods. During the epidemic periods, a direct and significant relationship was also observed between respiratory admissions and each unit of increase in relative humidity and evaporation. CONCLUSION: The results suggest that certain pollutants and weather variables are associated with the risk of emergency respiratory admissions during epidemic periods.

Effect of Nebulized 3% Hypertonic Saline with Salbutamol on Management of Acute Asthma in Outpatient Adults: A Double-blind, Randomized Clinical Trial in Emergency Department.

Asthma is one of the most common disorders of respiratory tract, management of which still remains as a serious health problem. This study aimed to compare the efficacy of 3% hypertonic saline (HS) plus salbutamol with solely salbutamol on management of acute adults' asthma based on peak flow meter findings. In this double-blind randomized clinical trial, 340 adult patients with acute asthma attacks admitted to emergency department of Ahvaz Golestan and Emam hospitals were enrolled during 2014-2015. The patients were allocated randomly to intervention group (nebulized 2.5 mg of salbutamol and 2.5 mL of 3% HS solution for three consecutive 20-min periods) and control group (nebulized only salbutamol in the same dose and time of the intervention group). The principal outcome measures were forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR), which were assessed at baseline, and 20, 40 and 60 minutes after treatment in both groups. HS plus salbutamol resulted in a significant increase compared with solely salbutamol in both PEFR and FEV1 in 40th min (0.11±1.36; p=0.036 and 0.05±1.16; p=0.033, respectively) and 60th min (0.15±1.12; p<0.001 and 0.11±1.22; p=0.011, respectively), while no significant difference was observed in baseline and 20th min. Also, PEFR and FEV1 in both groups significantly increased as the treatment processed and the time passed. The results showed the beneficial effects of 3% HS in management of adults with acute asthma in the short term.

Sublingual Buprenorphine Efficacy in Renal Colic Pain Relief: A Randomized Placebo-Controlled Clinical Trial.

INTRODUCTION: This study was designed to compare the analgesic efficacy of sublingual (SL) buprenorphine and intravenous (IV) ketorolac for renal colic pain relief. METHODS: The present study was carried out as a double-blind, double-dummy randomized clinical trial in patients diagnosed with acute renal colic attending the emergency department. The study subjects were 63 patients with confirmed renal stones. The subjects were randomly divided into two groups. One group, which included 32 patients, received SL buprenorphine tablets (2 mg) with an IV placebo, and another group, including 31 patients, received ketorolac tromethamine (30 mg) with a SL placebo. After medication, the pain of subjects was measured by a standard visual pain analogous scale (VPAS) in minutes 0, 20, 40, and 60 of study. Also, probable adverse effects were recorded. RESULTS: In 28.1% of patients in the buprenorphine group, the mean pain score decreased from 9.2 to 5.9, 2.8, and 1.5 after 20, 40, and 60 min, respectively, as determined by VPAS. Also, in 38.7% of patients in the ketorolac group, the mean pain score decreased from 9.1 to 5.5, 3.0, and 1.6 after 20, 40, and 60 min, respectively, as determined by VPAS. The two groups did not significantly differ for pain reduction at 20, 40, and 60 min (P value = 0.16, 0.34, and 0.3, respectively). No adverse effects were seen in the ketorolac group, but vomiting (18.8%), nausea (18.8%), and dizziness (21.9%) were detected in the buprenorphine group. CONCLUSIONS: We found no difference between SL buprenorphine and intravenous ketorolac in renal colic pain relief but more adverse effects in the buprenorphine group. Trial Registration Iranian Registry of Clinical trials identifier, IRCT2015041421773N1.

Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients.

BACKGROUND: Long bone fractures are common injuries caused by trauma. Some studies have demonstrated that ultrasound has a high sensitivity and specificity in the diagnosis of upper and lower extremity long bone fractures. OBJECTIVE: The aim of this study was to determine the accuracy of ultrasound compared with plain radiography in diagnosis of upper and lower extremity long bone fractures in traumatic patients. METHODS: This cross-sectional study assessed 100 patients admitted to the emergency department of Imam Khomeini Hospital, Ahvaz, Iran with trauma to the upper and lower extremities, from September 2014 through October 2015. In all patients, first ultrasound and then standard plain radiography for the upper and lower limb was performed. Data were analyzed by SPSS version 21 to determine the specificity and sensitivity. RESULTS: The mean age of patients with upper and lower limb trauma were 31.43±12.32 years and 29.63±5.89 years, respectively. Radius fracture was the most frequent compared to other fractures (27%). Sensitivity, specificity, positive predicted value, and negative predicted value of ultrasound compared with plain radiography in the diagnosis of upper extremity long bones were 95.3%, 87.7%, 87.2% and 96.2%, respectively, and the highest accuracy was observed in left arm fractures (100%). Tibia and fibula fractures were the most frequent types compared to other fractures (89.2%). Sensitivity, specificity, PPV and NPV of ultrasound compared with plain radiography in the diagnosis of upper extremity long bone fractures were 98.6%, 83%, 65.4% and 87.1%, respectively, and the highest accuracy was observed in men, lower ages and femoral fractures. CONCLUSION: The results of this study showed that ultrasound compared with plain radiography has a high accuracy in the diagnosis of upper and lower extremity long bone fractures.

Nerve Stimulator versus Ultrasound-Guided Femoral Nerve Block; a Randomized Clinical Trial.

INTRODUCTION: Pain control is the most important issue in emergency department management of patients with femoral bone fractures. The present study aimed to compare the procedural features of ultrasonography and nerve stimulator guided femoral nerve block in this regard. METHOD: In this randomized clinical trial, patients with proximal femoral fractures presenting to emergency department were randomly divided into two groups of ultrasonography or nerve stimulator guided femoral block and compared regarding success rate, procedural time, block time, and need for rescue doses of morphine sulfate, using SPSS 20. RESULTS: 50 patients were randomly divided into two groups of 25 (60% male). The mean age of studied patients was 35.14 ± 12.95 years (19 - 69). The two groups were similar regarding age (p= 0.788), sex (p = 0.564), and initial pain severity (p = 0.513). In 2 cases of nerve stimulator guided block, loss of pinprick sensation did not happen within 30 minutes of injection (success rate: 92%; p = 0.490). Ultrasonography guided nerve block cases had significantly lower procedural time (8.06 ± 1.92 vs 13.60 ± 4.56 minutes; p < 0.001) and lower need for rescue doses of opioid (2.68 ± 0.74 vs 5.28 ± 1.88 minutes; p < 0.001). CONCLUSION: Ultrasonography and nerve stimulator guided femoral block had the same success rate and block duration. However, the ultrasonography guided group had lower procedure time and lower need for rescue doses of morphine sulfate. Therefore, ultrasonography guided femoral block could be considered as an available, safe, rapid, and efficient method for pain management of femoral fracture in emergency department.

Comparing Two Different Doses of Intravenous Midazolam in Pediatric Sedation and Analgesia.

INTRODUCTION: Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard. METHODS: The present clinical trial was performed to compare 0.1 and 0.3 mg/kg doses of IV midazolam in induction of sedation for head trauma infant patients in need of brain computed tomography (CT) scan. Conscious infants under 2 years old, with stable hemodynamics were included. Onset and duration of action as well as probable side effects were compared between the two groups using SPSS version 22. RESULTS: 110 infants with the mean age of 14.0 ± 5.9 months (range: 4 - 24) and mean weight of 9.7 ± 2 kg (range: 5 - 15) were randomly allocated to one of the 2 study groups (54.6% female). Success rate in 0.1 and 0.3 mg/kg groups were 38.2% (21 patients) and 60% (33 patients), respectively (p = 0.018). Overall, 56 (50.9%) patients did not reach proper sedation and were sedated receiving ketamine (22 patients) or another dose of midazolam (34 patients, mean additional dose needed was 2.1 ± 1.1 mg). CONCLUSION: The results of the present study demonstrated the higher success rate and longer duration of action for 0.3 mg/kg midazolam compared to 0.1 mg/kg. The groups were equal regarding onset of action, effect on vital signs and probable side effects.