Bacterial safety of commercial and handmade enteral feeds in an Iranian teaching hospital

This study aimed to investigate and compare the bacterial safety of handmade and commercial ready-to-use enteral feeding formulas used in an Iranian teaching hospital. In this experimental study, a total number of 70 samples [21 handmade formulas sampled at two sampling times, i.e. the time of preparation and 18 h after preparation, and 28 commercial ready-to-use formulas] were studied. Total count of viable microorganisms, coliform count and Staphylococcus aureuscount for all samples were conducted. Out of 42 handmade samples, 16 samples [76%] had total viable counts greater than 103 CFU/g in the first sampling time and 17 samples [81%] had total viable counts greater than 103 CFU/g in the second sampling time. Also, 11 [52%] had coliform contamination in the first sampling time which reached 76% [16 samples] in the second sampling time. Regarding contamination with S. aureus, 5 samples [24%] were contaminated in the first-and 13 samples [62%] were contaminated in the second-sampling time. Out of 28 commercial formulas, 27 samples [96%] had total viable counts greater than 103 CFU/g. Also, 24 samples [86%] were contaminated with S. aureus and 27 samples [96%] were contaminated with coliforms. In order to compare these two formulas, the results of Mann-Whitney test showed that contamination of ready to use formulas in all three microbiological samples was significantly more than that for handmade samples. The results of the present study indicate that the microbial safety of enteral feeding solutions in this hospital is much lower than standard values, demonstrating that the development of protocols for clean techniques in the preparation, handling and storage of both commercial and handmade enteral feeds is necessary

Does naloxone prevent seizure in tramadol intoxicated patients?

Tramadol poisoning has increased in recent years. Seizure is one of the side-effects of tramadol toxicity. There is a controversy about possible preventive effect of naloxone in tramadol poisoning induced seizure. Therefore, this study was performed to compare seizure incidence in tramadol poisoning patients who received and did not receive naloxone, as an opioid antagonist. This study involved prospective data collection followed by retrospective analysis on 104 tramadol poisoning patients who were admitted in a referral poisoning center. The incidences of seizure were compared between patients received naloxone and those did not. Outcome was considered as survived without or with complications and death. Logistic Regression analysis was used to determine the effects of different variables on seizure incidence. 70 [67.3%] of the patients were men. The mean age of the patients was 26.3 +/- 9 years old. 18.3% of the patients received naloxone in their treatment period. Seizure incidence was significantly higher among tramadol poisoning patients who did not receive naloxone compare with those received naloxone [14.1% vs. 5.1%]. Among different variable studied, age had a significant effect on predicting of seizure [odds ratio = 2.09; 95% of confidence interval: 1.82-2.26; P value, 0.004]. Although the seizure incidence was lower in patients with tramadol poisoning who received naloxone, the logistic regression did not support the preventive effect of naloxone on seizure in tramadol poisoning cases

Role of Benzodiazepines in the management of agitation due to inappropriate use of naltrexone

Agitation is an early symptom of the acute opioid withdrawal syndrome in addicts that may start by inappropriate use of naltrexone. The current drug interventions are not efficient or need critical care as well. This study compares the clinical role of midazolam and diazepam for the management of agitation due to inappropriate use of naltrexone. In this double-blind randomized controlled clinical trial, 44 agitated addicts, who did not use any type of benzodiazepine, not on systematic central nervous system depressant drugs, without any known hypersensitivity to diazepam, midazolam, or any other component of their formulation and had no evidence for the need of critical care, were enrolled. An i.v. stat dose of 0.1 mg/kg diazepam and 0.1 mg/kg stat dose of midazolam and a 0.1 mg/kg/h infusion of these drugs were administered for different groups of patients, respectively. Agitation scores were recorded at 30, 60, 120 min after the start of drug administration using Richmond Agitation Sedation Scale score. A significant difference between the mean onset of agitation control in midazolam group [at 67 min] and diazepam group [at 81 min] was recorded. The difference of mean agitation score in the midazolam and diazepam group was only significant at 120 min. There was a negative correlation between agitation score and time elapsed from naltrexone administration to admission. Midazolam and diazepam may not be considered suitable and perfect pharmacologic agents for the initial controlling of agitation induced by naltrexone.

General health status in a cohort of Iranian patients with intentional self poisoning: a preventive approach

Prevention of suicide is one of the most important issues of community medicine in the world. Because of high accessibility of people to different drugs in our society, one of the easiest ways of suicide is intentional self poisoning. In this study, demographic factors and health status of the patients with intentional self poisoning were evaluated. A cross sectional study was conducted in the poisoning referral center on 384 patients aged 15-40 years who committed intentional self poisoning. Information was gathered using two questionnaires about demographic characteristics and the general health status of the patients. 70.5% of the patients had easy accessibility to drugs. Most of the patients were women [62.5%] and single [51%]. History of psychological disease was demonstrated in 82.5% of patients. In terms of general health status, the most common problems were social dysfunction [97.57%] and depression [88.9%]. Easy accessibility to drugs and psychological problems may increase the risk of intentional self poisoning. Being religious and the consequent hopefulness may have a positive protecting effect for the prevention of intentional self-poisoning

Pharmacokinetic behavior of amikacin in 31 Iranian critically ill septic patients

The pharmacokinetic behavior of amikacin and predictive performance of Sawchuk-Zaske dosing method, have been prospectively evaluated in 31 [16 male, 15 female] critically ill septic patients of mean [ +/- SD] age of 58 +/- 23 years, mean ideal body weight of 59.6 +/- 6.4 kg, mean creatinine clearance of 52 +/- 21.5 ml/min, mean serum albumin of 3.1 +/- 0.5 mg/dl and median APACHE [acute physiology and chronic health evaluation] II score of 26 [with a range of 18 to 33]. In this cross-sectional study, critically ill patients who met the Bone criteria for spesis but had stable creatinine clearance [serum creatinine change <0.5 mg/dl of the baseline] received the ordered dose of amikacin in one hour infusions. Blood sample were collected 30 minute after the third dose, half an hour before the fourth dose which was 1.5 times of the predicted half life of amikacin after the third dose. Cirrhotic patients and patients with renal failure requiring any mode of dialysis were excluded. Vital signs were recorded at each time of blood sampling; serum Mg+, serum albumin and APACHE score were recorded at the time of the first blood sampling. Mean [ +/- SD] of the pharmacokinetic key parameters of amikacin in this population was as follow: Vd=0.390.045 l/kg; Ke=0.141 +/- 0.057 /h; half-life=5.7 +/- 2.06 h; Clearance=54.2 +/- 25.2 ml/min. There was a good correlation between Vd and serum albumin and also APACHE score II [r2=0.83, P=0.033;r2=0.82, P<0.001 respectively]. Mean measured peak and trough amikacin concentrations were 20.9 and 3.2 micro g/ml respectively which were significanthy different [P<0.05 paired t test] from levels, predicted by Sawchuk-Zaske method [33.5 and 4.6 micro g/ml respectively]. Ke, t0.5 and cledrane did not show any statistically significant changes [P>0.05 repeated measure test] amongst three times of blood sampling, but Vd was significanly different [P<0.05]. The overall predictive performance of Sawchuk-Zaske method was poor; in spite of good correlation between predicted and measured parameters when using pooled data