Heart involvement in transfusion-dependent beta-thalassemia with conventional echocardiography.

BACKGROUND: The most important prognostic factor in transfusion-dependent beta-thalassemia is cardiac involvement which is usually evaluated with echocardiography. METHODS: In this cross-sectional study (April 2011 to April 2012), conventional echocardiography was used to assess myocardial performance and valvular involvement (through transvalvular Doppler study) for right and left heart abnormalities in transfusion-dependent beta-thalassemia. RESULTS: Among the 60 patients, 43 cases had heart problems, 26 (43.3%) of them had left myocardial dysfunction and 11 (18.3%) of them had right myocardial dysfunction, 3 cases had both RV and LV myocardial dysfunction, (based on LVMPI & RVMPI, respectively). In patients with right myocardial dysfunction, 4 cases had pulmonary hypertension (PH) and 3 had both sided myocardial dysfunction. LVMPI and RVMPI significantly increased in patients with cardiac involvement (p<0.001). Serum ferritin levels in patients with and without cardiac involvement were 2427±1788 ng/ml and 1573±592 ng/ml, respectively (P=0.008). All 4 patients who had PH, had been splenectomized. In splenectomized and non-splenectomized patients, LVMPI was 0.37±0.11 and 0.38±0.1 (P=0.589), RVMPI was 0.3±0.07 and 0.25±0.39 (P=0.004), and TR gradient (TRG) was 28±11.8 mmHg and 19.7±5.2 mmHg (P=0.033), respectively. Mean ferritin level in patients with a history of splenectomy (n=31), was 2525±1968 ng/ml and in patients without the history of splenectomy (n=29) was 1821±947 ng/ml (P=0.082). CONCLUSION: In addition to left-sided heart involvement, conventional echocardiography revealed right-sided heart involvement in transfusion-dependent thalassemia patients which did not correlate with serum ferritin level in splenectomized patients.

Efficacy of Simultaneous Administration of Nimodipine, Progesterone, and Magnesium Sulfate in Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial.

OBJECTIVE: To investigate the safety and efficacy of simultaneous administration of nimodipine, progesterone, magnesium sulfate in patients suffering from severe traumatic brain injury (TBI). METHODS: Overall, 90 patients with blunt head trauma who were admitted to the Besat hospital, Hamadan University of Medical Sciences, Iran through the Emergency Department in 2017 to 2018 were randomly assigned to the study or control groups each containing 45 patients. In the study group, intravenous nimodipine 60 mg every 12 hours for 5 days, intramuscular progesterone 1 mg/kg daily for 5 days, and magnesium sulfate 5 grams stat followed by 2.5 grams every 4 hours for 21 days were administered. Daily GCS and jugular venous oxygen saturation (SjvO2) of the patients were measured on admission day (day 0) through hospitalization day 4 at the intensive care unit. Then, all patients were visited at three months after discharge. RESULTS: The mean age of the patients was 31.4 ± 12.8 years including 59 (65.6%) men with no significant difference between the groups. The baseline GCS and SjvO2 of the patients were comparable in both groups, however, GCS of the patients in the study group were significantly higher in the next 4 hospitalization days compared to the controls. Whereas, the SjvO2 of the patients were not significantly different between the groups during these days. Three-month mortality rate of the patients in the study group was significantly lower than the three-month mortality rate of the patients in the control groups (22.2% vs. 42.2%, p=0.042). CONCLUSION: Administration of combined protocol of magnesium sulfide, progesterone and nimodipine may be safe and effective in patients suffering from severe TBI. CLINICAL TRIAL REGISTRY: IRCT201210229534N2.

Value of Ultrasound in the Detection of Benign and Malignant Breast Diseases: A Diagnostic Accuracy Study.

OBJECTIVES: We sought to determine the diagnostic accuracy of ultrasound for benign and malignant breast lesions. METHODS: This retrospective study was performed to evaluate the diagnostic accuracy of ultrasound in 203 patients with complete medical records who visited Mehr Medical Imaging Center for breast ultrasound between March 2014 and February 2016. The collected data comprised of demographic characteristics, ultrasound results (consisting of the anatomic area of the lesion, the involved side, and the ultrasound characteristics of the lesion), mammogram results, and pathology reports (if surgery or biopsy was performed). RESULTS: For the diagnosis of malignant and benign lesions, ultrasound had a sensitivity of 93.9% and specificity of 86.5%; its positive and negative predictive values were 86.9% and 93.8%, respectively. Lesion type was significantly associated with a family history of breast cancer and fertility status (p < 0.005), but there was no significant association between the involved side and tumor type (p > 0.050). CONCLUSIONS: Mammography is the best technique for screening and identifying patients with non-mass-like breast lesions and microcalcifications. Considering the false positive and false-negative results, ultrasound is not a perfect screening modality. Future studies are recommended to study the value of ultrasound in the detection of high-risk breast cancer patients.

Does intraperitoneal injection of propofol prior to detorsion improve testes weight and histopathological findings in a rat model?

OBJECTIVES: To determine the long-term preventive effects of intraperitoneal propofol on testicular ischemia-reperfusion injury in a rat model. MATERIALS AND METHODS: Forty adult male albino Wistar rats were divided randomly into the following four groups according to the planned treatment (n=10 per group): group I, control; group II, sham-operated; group III, torsion/detorsion (T/D); and group IV, T/D plus propofol. Testicular ischemia was achieved by twisting the left testis 720° clockwise (ie, applying torsion) for 1 h. In the T/D plus propofol group (group IV), 50 mg/kg propofol was administered intraperitoneally 30 minutes before detorsion. Ipsilateral orchiectomy was performed under general anesthesia to determine the mean testicular weight and to enable histopathological examination of the testes using Johnsen's mean testicular biopsy score 30 days after the surgical procedure in all groups. RESULTS: The testicular weights in groups I, II, III, and IV were 1.65±0.32, 1.59±0.33, 1.11±0.56, and 1.08±0.50 g (mean ± SD), respectively. Testicular weight was significantly lower in the T/D groups (III and IV) than in both the control and sham-operated groups (I and II), but there was no improvement in testicular weight as a result of propofol administration. Similarly, Johnsen's mean testicular biopsy score was lower in groups III and IV than in groups I and II, but no positive effect was conferred by the administration of propofol in group IV. CONCLUSION: The use of propofol in the treatment of testicular ischemia-reperfusion injury caused by testis torsion has no significant long-term therapeutic potential.

In patients suffering from major depressive disorders, quantitative EEG showed favorable changes in left and right prefrontal cortex.

BACKGROUND: Patients suffering from major depressive disorders (MDD) report anhedonia, low concentration and lack of goal-oriented behavior. Data from imaging and quantitative EEG (QEEG) studies show an asymmetry in the prefrontal cortex (PFC), with lower left as compared to right PFC-activity, associated with specific depression-related behavior. Cordance is a QEEG measurement, which combines absolute and relative power of EEG-spectra with strong correlations with regional perfusion. The aim of the present study was to investigate to what extent a four weeks lasting treatment with a standard SSRI had an influence on neuronal activation and MDD-related symptoms. METHOD: Twenty patients suffering from severe MDD were treated with citalopram (40mg) for four consecutive weeks. At baseline and at the end of the treatment, patients underwent QEEG. Experts rated the degree of depression with the Hamilton Depression Rating Scale (HDRS). RESULTS: Over time, theta cordance increased over right ventromedial and left dorsolateral PFC, whereas alpha cordance decreased over dorsolateral PFC. Improvement in MDD-related symptoms was higher in patients showing decreased EEG theta cordance over right dorsal PFC and increased EEG alpha cordance over left dorsolateral PFC. CONCLUSIONS: In patients suffering from MDD, treatment response was associated with favorable changes in neuronal activity.

Clinical effects of topical antifungal therapy in chronic rhinosinusitis: a randomized, double-blind, placebo-controlled trial of intranasal fluconazole.

Several studies have been in favor of fungi as a possible pathogenesis of chronic rhinosinusitis (CRS); however, to date, there is no scientific consensus about the use of antifungal agents in disease management. The aim of the present study was to investigate the efficacy of intranasal fluconazole in improving disease symptoms and objective outcomes of patients with CRS. A randomized, double-blind, placebo-controlled study was conducted on 54 patients who were diagnosed with CRS and had not been responsive to routine medical treatments. They were randomly assigned to receive either fluconazole nasal drop 0.2 % or placebo in addition to the standard regimen for a duration of 8 weeks. Patients' outcomes were evaluated according to Sino-Nasal Outcome Test 20 (SNOT-20), endoscopic scores, and Computed Tomography (CT) scores. No statistically significant difference was found in SNOT-20 (p = 0.201), endoscopic (p = 0.283), and CT scores (p = 0.212) of the patients at baseline and after 8-week course of treatment between drug and placebo group. Similar to many studies, the use of topical antifungal treatment for patients with CRS was not shown to be significantly effective. However, further studies are needed to obtain high levels of consistent evidence in order to arrive at a decision whether antifungal therapy is effective in management of CRS or not.

Comparison of safety and efficacy of general and spinal anesthesia in kidney transplantation: Evaluation of the peri-operative outcome.

General anesthesia is a routine anesthetic technique for kidney transplantation. This study evaluated and compared the peri-operative hemodynamic, cardiopulmonary and general condition status in patients in whom spinal anesthesia (SA) or general anesthesia (GA) was used for kidney transplantation. A prospective study was carried out on 49 consecutive patients who underwent kidney transplantation with either GA (19 patients, mean age 37.53 ± 11.78 years) or SA (30 patients, mean age 42.17 ± 14.89 years), without any selection bias. One obese patient with a body mass index of 32.52 kg/m 2 died 22 days after transplantation in the GA group. One other patient, who developed severe nausea and vomiting, was changed from SA to GA. There were no statistical differences in gender, mean age, body mass index and hemodynamic and cardiopulmonary status between the two groups. Time to post-operative diet tolerance, defecation, ambulation and adequate urination were significantly better in the SA group. The mean operation time was 264.32 ± 18.91 and 233 ± 15.12 min in the GA and SA groups, respectively. Brisk diuresis was seen in all patients except one in the SA group. Our study suggests that kidney transplantation under SA is feasible and safe, particularly for patients who cannot receive GA.

Effects of Normobaric Hyperoxia in Severe Acute Stroke: a Randomized Controlled Clinical Trial Study.

Oxygen therapy might increase damaged tissue oxygenation, turn on the aerobic pathway, and save neurons from death and could improve clinical outcome of the patients with stroke and head trauma. Hyperbaric oxygen therapy is accompanied by some unfavorable effects. Results of normobaric oxygen therapy on clinical outcomes of patients with stroke were controversial up till now.  This study was therefore designed to evaluate effects of normobaric hyperoxia on clinical outcomes of patients with severe acute stroke. A total of 52 consecutive patients with stroke who meet the inclusion criteria of the study were entered into this randomized controlled clinical trial. The patients in the case group underwent oxygen therapy with Venturi mask for first 12 hours of admission. The patients were examined for neurologic defects at the time of discharge and after six months using both Barthel and modified Rankin Scale (mRS) neurologic disability scoring systems. There was no significant sex difference between the two groups (P=0.5). There was no statistically significant difference between ischemic-hemorrhagic stroke constitutions of two groups (P=0.2). There were no significant difference in Barthel index scores of both groups at the time of discharge as well as the follow-up examination (P=0.7) According to the mRS scoring system, there was no difference between the patients of both groups at the time of admission (P= 0.8), however after treatment there was a significant difference between mRS scores of the treated group compared to the controls (P=0.04). According to the results of this study, normobaric oxygen therapy in the first 12 hours of accident could improve long time outcome of the patients with either ischemic or hemorrhagic stroke.

Association of occupational burnout and type of personality in Iranian general practitioners.

BACKGROUND: Physicians experience high level of occupational burnout that exposes them to physical and mental exhaustion as well as job dissatisfaction. OBJECTIVE: The association between different types of personality traits and occupational burnout among a group of Iranian general practitioners is assessed. METHODS: One hundred general practitioners working in emergency wards of eight hospitals in Iran were studied. Occupational burnout was measured using the Maslach Burnout Inventory and type of personality was assessed using the Holland personality test. RESULTS: An average of 15.4% of personnel displayed high frequency in subscale of emotional exhaustion, 14.5% displayed high frequency in subscale of depersonalization, and 10.2% displayed high frequency in subscale of lack of personal accomplishment. Realistic personality was revealed in 2%, social types in 41%, investigative type in 35%, enterprising types in 6.0%, artistic type in 13% and conventional type of personality in 3.0% of them. The subjects with social personality experienced the lowest burnout. There were negative correlation between physician experiences and different subdivisions of burnout. CONCLUSION: A notable number of Iranian general practitioners suffered occupational burnout, especially emotional exhaustion. The majority of physicians had social or investigative personalities.

The main etiologies of acute kidney injury in the newborns hospitalized in the neonatal intensive care unit.

INTRODUCTION: Acute kidney injury (AKI) is one of the most common diseases among the newborns hospitalized in the neonatal intensive care units (NICUs), which is usually resulted from predisposing factors including sepsis, hypovolemia, asphyxia, respiratory distress syndrome (RDS), and heart failure. The goal of this study was to assess main etiologies, relevant risk factors, and early outcome of neonatal AKI. MATERIALS AND METHODS: In a cross- sectional study, 49 consecutive neonates hospitalized in NICU of Besat hospital with diagnosis of AKI from October 2009 to October 2011 were investigated through census sampling method. AKI was diagnosed based on urine output and serum creatinine levels. RESULTS: The prevalence of AKI was 1.54% (49 out of 3166 newborns hospitalized in NICU) with the female: male was 7:1. Thirty-nine patients (79.5%) were full-term neonates. Oliguria was observed in 38 (77.5%) patients. Sepsis was the most common predisposing factor for AKI in 77.5% of patients (n = 38) accompanied with the highest mortality rate among other factors (30.5%). Other leading causes of AKI included hypovolemia secondary to dehydration, followed by hypoxia secondary to RDS, patent ductus arteriosus, posterior urethral valve, asphyxia, and renal venous thrombosis. A positive relationship was observed between neonates' age, sex, urine output, and also between serum creatinine levels with initiation of dialysis. The mortality rate among the newborns hospitalized with AKI was 36.7%. Eighteen (36.7%) newborns were treated with peritoneal dialysis (PD) of whom 10 patients (55.6%) died, 31 patients were managed conservatively of whom five neonate died (25.9%). DISCUSSION: Prognosis of AKI in the oliguric neonates requiring PD is very poor. It is thus recommended to prevent AKI by predicting and rapid diagnosis of AKI in patients with potential risk factors and also by early and effective treatment of such factors in individuals with AKI.

Comparing the effect of prazosin and hydroxyzine on sleep quality in patients suffering from posttraumatic stress disorder.

OBJECTIVES: In light of the high prevalence of sleep disorders in patients suffering from posttraumatic stress disorder (PTSD), this study sought to compare the effect of prazosin and hydroxyzine on sleep quality in this patient group. METHODS: A total of 100 patients suffering from PTSD were assessed (mean age = 35.51 years, SD = 6.41; 28% females). Next, they were randomly assigned to one of three treatment groups: prazosin (33 patients), hydroxyzine (34 patients) or placebo (33 patients). The trial lasted for 8 weeks. The patients' sleep quality was assessed using the Pittsburgh Sleep Quality Index. Items taken from the Mini International Neuropsychiatric Interview were used to operationalize PTSD. RESULTS: Compared to controls, patients treated with prazosin and hydroxyzine reported improved sleep and less nightmares. Improvement was greatest in patients treated with prazosin compared to hydroxyzine and placebo. Improvement in sleep was associated with an amelioration of their PTSD symptoms. CONCLUSION: Both prazosin and hydroxyzine can be used to treat psychopharmacological sleep disorders and nightmares in patients suffering from PTSD, also leading to reductions in PTSD symptoms.

Comparison of the safety and efficacy of one-shot and telescopic metal dilatation in percutaneous nephrolithotomy: a randomized controlled trial.

Minimizing X-ray exposure during percutaneous nephrolithotomy (PCNL) is challenging. Using the single semirigid dilator, also called "one-shot" or "one-stage" is a good alternative to routine telescopic metal dilators to reduce X-ray exposure. Our aim was to compare the single semirigid one-shot dilator with a telescopic metal dilator in PCNL. The intraoperative status was evaluated in 100 consecutive patients randomly assigned to two equal groups undergoing PCNL either with the one-shot (group A) or telescopic technique (group B). No significant difference in stone burden and location existed between the groups (P > 0.05). The mean age of group A and group B was 44.8 ± 15 and 45.6 ± 14 years, respectively (P = 0.78). The mean operation time was 51.14 ± 40.85 min in group A and 57.00 ± 38.85 min in group B (P = 0.46). The mean X-ray exposure time was 41.2 ± 17 and 48.4 ± 15 s in group A and group B, respectively (P = 0.03). The stone-free rate was 94 % (n = 47) in group A and 84 % (n = 42) in group B (P = 0.10). The mean hemoglobin drop was 1.26 ± 0.09 and 1.44 ± 0.11 g/dl in group A and group B, respectively (P = 0.09). The one-shot technique is feasible, safe, and well tolerated in patients undergoing PCNL. In addition to lack of complications, the method also provides less radiation exposure for urologists and nursing teams.

Complications of entry using Direct Trocar and/or Veress Needle compared with modified open approach entry in laparoscopy: six-year experience.

PURPOSE: To compare the results obtained from three routine laparoscopic entry techniques, including Direct Trocar (DT), Veress Needle (VN), and Open Approach (OA). MATERIALS AND METHODS: Safety and efficacy of three main laparoscopic entry techniques were evaluated prospectively in 453 consecutive patients who had undergone laparoscopy either with DT, VN, or modified OA technique in recent six years. RESULTS: Of 453 patients, 105 (23.2%) were operated on with the DT, 168 (37.1%) with the VN, and 180 (39.7%) with the modified OA technique. Statistical differences were seen among the groups in terms of mean age (P = .003), male-to-female ratio (P < .001), indications for the operation (P < .001), and mean trocar insertion time (P < .001). Three major complications (1 colon perforation and 2 iliac artery injuries) occurred in DT and one (iliac artery injury) in VN group, and modified OA group had no major complication (P = .04). Four major complications required laparotomy. Minor complications were seen in 6 (5.8%), 9 (5.4%), and 17 (9.4%) patients (P = .274) and gas leakage in 4 (3.8%), 16 (9.5%), and 27 (15%) patients (P = .01) in DT, VN, and modified OA groups, respectively. CONCLUSION: Although DT and VN are rapid and relatively safe, they can be associated with major complications. Therefore, modified OA seems to be safe, feasible, and most acceptable due to less major complications.

Effects of ranitidine and pantoprazole on ventilator-associated pneumonia: a randomized double-blind clinical trial.

BACKGROUND: Acid suppressive medications are used to prevent stress ulcers in critically ill patients. Few studies have been done to evaluate the effect of ranitidine and pantoprazole on stress ulcers. We aimed to compare the effects of ranitidine and pantoprazole on Ventilator Associated Pneumonia (VAP). MATERIALS AND METHODS: In this double-blind randomized controlled trial, we enrolled 120 traumatic patients with trauma admitted to the intensive care unit (ICU) of Besat Hospital in Hamadan Province located in northwest Iran. The patients were divided into two equal groups receiving either intermittent intravenous ranitidine or pantoprazole to prevent stress ulcers. The incidence of VAP, duration of tracheal intubation, length of ICU stay, duration of hospital stay, and the outcome of treatment including mortality or hospital discharge were compared in both groups. RESULTS: The incidence of VAP was 10% and 30% in patients receiving ranitidine and pantoprazole, respectively (P=0.006). There was no significant difference between the two groups with respect to the duration of tracheal intubation. However, the patients treated with pantoprazole stayed at the hospital two days longer than the other patients (P=0.027). Although patients with VAP stayed at the hospital for 12 more days, the two groups had almost equal mortality rates (P=0.572). CONCLUSION: ICU patients using pump inhibitors have a three-fold increased risk of developing VAP in comparison to H2-blocker receivers. Thus, prevention of stress ulcers should be limited to its own specific indications.

Latent and active tuberculosis: evaluation of injecting drug users.

BACKGROUND: There is a high risk of tuberculosis (TB) infection among injecting drug users (IDUs). OBJECTIVES: This study aimed to determine the frequency of latent and active TB infection among IDUs. MATERIALS AND METHODS: In a cross-sectional study between 2008 and 2009, IDUs referred to the methadone maintenance treatment (MMT) centers in Hamedan-Iran, undergone tuberculin skin test (PPD; purified protein derivative) were recruited. The participants with positive results for PPD test (> 5 mm and > 10 mm in HIV positive and negative cases), undergone other complementary procedures such as chest-X-ray and sputum smear test. RESULTS: Overall, 268 IDUs between 18 and 70 (mean: 34.5 [8.2]) years were included in the study. PPD test had positive findings in 49 cases (18.3%). There was no significant difference of PPD positivity between HIV positive and negative participants (17.7% vs. 18.5%). An active TB was found among IDUs. CONCLUSIONS: The high prevalence of latent and active TB among IDUs indicates the need for TB screening tests among this population.

Congenital anomalies in infant with congenital hypothyroidism.

OBJECTIVE: Congenital hypothyroidism is characterized by inadequate thyroid hormone production in newborn infants. Many infants with CH have co-occurring congenital malformations. This is an investigation on the frequency and types of congenital anomalies in infants with congenital hypothyroidism born from May 2006-2010 in Hamadan, west province of Iran. METHODS: The Iranian neonatal screening program for congenital hypothyroidism was initiated in May 2005. This prospective descriptive study was conducted in infants diagnosed with congenital hypothyroidism being followed up in Pediatric Endocrinology Clinic of Besat Hospital, a tertiary care centre in Hamadan. Cases included all infants with congenital hypothyroidism diagnosed through newborn screening program or detected clinically. Anomalies were identified by clinical examination, echocardiography, and X-ray of the hip during the infant's first year of life. RESULTS: A total of 150 infants with biochemically confirmed primary congenital hypothyroidism (72 females and 78 males) were recruited during the period between May 2006-2010. Overall, 30 (20%) infants had associated congenital anomalies. The most common type of anomaly was Down syndrome. Seven infants (3.1%) had congenital cardiac anomalies such as: ASD (n=3), VSD (n=2), PS (n =1), PDA (n=1). Three children (2.6%) had developmental dysplasia of the hip (n=3). CONCLUSION: The overall frequency of Down syndrome, cardiac malformation and other birth defect was high in infants with CH. This reinforces the need to examine all infants with congenital hypothyroidism for the presence of associated congenital anomalies.

Characteristics of hospitalized patients following suicide attempt in hamadan district, iran.

OBJECTIVES: Limited research has been undertaken on suicide in developing countries. This paper aims to investigate characteristics of suicide attempts in Hamadan district of Iran. METHODS: A prospective study was conducted in all university hospitals in the Hamadan district of Iran and patients admitted for attempted suicides were included. All cases were assessed by psychiatrists and visited by two trained interns of Medicine. RESULTS: The incidence rate per 100,000 persons of attempted suicides was 228.6 for males and 263.1 for females; moreover, 344.9 for rural areas and 222.7 for urban areas. The suicide attempt was the highest in the 15 to 24 age category for both sexes and regions. CONCLUSIONS: Suicide is a complex, long-term outcome that requires multifaceted theoretical constructs for the appropriate study of its antecedents. Findings of this study along with other studies in Iran revealed that unemployed men, housewives, and rural women, high-school students, and those with a low level of education were at higher risk of suicidal behaviors.

Therapeutic effect of Vitex agnus castus in patients with premenstrual syndrome.

Medical therapies have been widely used for premenstrual syndrome (PMS), but in all of them side effects are predominant. Herbal remedies rarely have side effects and people have more tendencies toward them than chemical therapies. In this study the therapeutic effect of Vitex agnus castus on women who had the PMS, in comparison with placebo, were investigated. In this randomized, placebo-controlled, double-blind study, from 134 selected patients 128 women suffered from PMS were evaluated (active 62, placebo 66). All patients answered to a self assessment questionnaire about their headache, anger, irritability, depression, breast fullness and bloating and tympani during the premenstrual period before the study. Forty drops of Vitex agnus extract or matching placebo, administrated for 6 days before menses for 6 consecutive cycles. Patients answered the self-assessment questionnaires after 6 menstrual cycles, again. Each item rated using a visual analogue scale (VAS). The mean age was 30.77 (SD=4.37) years in the active group and 30.89 (SD=4.02) years in the placebo group.Rank of variables had significantly difference in active and placebo group before and after the study (P<0.0001) also we noticed significant differences on the use of Vitex agnus in comparison with placebo (P<0.0001). Vitex agnus can be considered as an effective and well tolerated treatment for the relief of symptoms of mild and moderate PMS.

Comparison of allergic adverse effects and contrast enhancement between iodixanol and iopromide.

BACKGROUND: Iodinated X-ray contrast media are the most commonly used contrast agents in the world with an annual application of 40-50 million. New non-ionic contrast agents are subdivided into low osmolar agents such as iopromide and iso-osmolar agents such as iodixanol. Regarding different biochemical characteristics, these agents are different in the allergic reactions and contrast enhancement and final lesion conspicuity. OBJECTIVES: This study was carried out to compare allergic adverse effects and contrast enhancement between iodixanol and iopromide. PATIENTS AND METHODS: One-hundred and twenty patients who were referred for abdominal CT scan to Besat Hospital were included in this study. Patients were randomly divided into two groups (A and B). Group A received 100 cc iodixanol (300 mgI/mL) and group B received 100 cc iopromide (300 mgI/ml) by power injector. CT examination was performed using Helical CT Scanner (Somatom, Siemens, Germany). Sixty seconds after injection, images were obtained and enhancement of port, liver and aorta were determined. Allergic adverse effects were recorded one hour and up to one week after injection. RESULTS: Iodixanol produced a significantly greater enhancement of the hepatic, aorta and portal vein than iopromide (P < 0.01). Sixty seconds after injection, associated pain and heat sensation were less frequent in iodixanol in comparison with iopromide (P = 0.03). Immediate reactions such as nausea and vomiting were less frequent in iodixanol (P = 0.01). Late skin reactions such as rash was more frequent in iodixanol (P < 0.01). CONCLUSIONS: Iodixanol is safe and is better tolerated in the early phase of injection with better contrast enhancement and lesion conspicuity. Mild late skin rash is its disadvantage.