Airway contraction and cytokine release in isolated rat lungs induced by wear particles from the road and tire interface and road vehicle brakes.

The dominant road traffic particle sources are wear particles from the road and tire interface, and from vehicle brake pads. The aim of this work was to investigate the effect of road and brake wear particles on pulmonary function and biomarkers in isolated perfused rat lungs. Particles were sampled from the studded tire wear of three road pavements containing different rock materials in a road simulator; and from the wear of two brake pad materials using a pin-on-disk machine. Isolated rat lungs inhaled the coarse and fine fractions of the sampled particles resulting in an estimated total particle lung dose of 50 µg. The tidal volume (TV) was measured during the particle exposure and the following 50 min. Perfusate and BALF were analyzed for the cytokines TNF, CXCL1 and CCL3. The TV of lungs exposed to rock materials was significantly reduced after 25 min of exposure compared to the controls, for quartzite already after 4 min. The particles of the heavy-duty brake pads had no effect on the TV. Brake particles resulted in a significant elevation of CXCL1 in the perfusate. Brake particles showed significant elevations of all three measured cytokines, and quartzite showed a significant elevation of TNF in BALF. The study shows that the toxic effect on lungs exposed to airborne particles can be investigated using measurements of tidal volume. Furthermore, the study shows that the choice of rock material in road pavements has the potential to affect the toxicity of road wear PM10.

C-reactive protein, D-dimer, erythrocyte sedimentation rate, and troponin in intensive care unit patients with COVID-19 in Iran.

Background: The coronavirus disease 2019 (COVID-19) pandemic in Iran has led to a lack of intensive care unit (ICU) facilities. This study examines C-reactive protein (CRP), D-dimer, erythrocyte sedimentation rate (ESR), and troponin in ICU patients with COVID-19 in comparison to COVID-19 patients admitted to the wards in Iran. Materials and Methods: In a case-control study, troponin, CRP, ESR, and D-dimer were compared in the case samples of 109 COVID-19 patients admitted to the ICU, and in the control group, 140 COVID-19 patients admitted to the wards. Results: The mean of CRP (P < 0.001) and D-dimer (P < 0.001) was higher, whereas troponin (P < 0.001) was lower in patients admitted to the ICU, but no significant difference was observed between the values of ESR (P = 0.292) in the two groups. Conclusion: This study showed that the values of CRP and D-dimer were higher in patients admitted to the ICU, but no significant difference was observed between the values of ESR in the two groups.

Comparative Study of Radial and Median Nerve Blocks with Hematoma Block under Ultrasound Guide in Distal Radius Fracture Reduction: A Randomized Clinical Trial.

Background: Distal radius fractures are one of the most common upper extremity fractures, and their incidence continues to increase due to an aging population and an increase in osteoporosis. Various methods of analgesia for distal radius fractures have been described-including hematoma blocks and nerve blocks. Hematoma blocks are a simple and effective method of providing analgesia; nonetheless, their efficacy may be limited in some cases. On the other hand, nerve blocks provide more targeted analgesia and may be more effective in reducing pain during fracture reduction. This study aimed to compare the analgesic effectiveness of radial and median nerve blocks with hematoma blocks under ultrasound guidance in treating distal radius fractures. Also, this study aimed to compare the analgesia of radial and median nerve blocks with hematoma blocks under ultrasound guidance to reduce distal radius fractures. Methods: In this prospective trial, patients with distal radius fractures referring to 2 academic centers were placed into 2 randomized groups, including hematoma block, and radial median block, both of which were ultrasound-guided. The patient's pain levels were measured and recorded based on the visual analog scale before the block, 5, 10, and 15 minutes after the block, at the start of reduction, during reduction, and 5, 10, and 15 minutes after reduction. Patient satisfaction and physician satisfaction rates were assessed, and side effects were also observed for 1 week. Quantitative variables were reported as mean ± standard deviation, and number and frequency percentages were reported for qualitative variables. The Student t test and the chi-square test were used on a case-by-case basis. The significance level was set at P ˂ 0.05. Results: In this study, 120 patients were included. The groups had no significant differences in pain reduction during the procedure. Analgesic medication was needed during the procedure for 17 patients; nerve blocks were applied for 6 patients, and hematoma blocks for 11 patients, which was statistically significant (P = 0.041). Satisfaction rates for patients and physicians performing the procedure were significantly higher in the nerve block group than in the hematoma block group ( P = 0.001; P ˂ 0.001, respectively). Conclusion: The results of this study suggest that ultrasound-guided radial and median nerve blocks can be used as alternative methods of analgesia with other techniques in the reduction of distal radius fractures in emergency departments.

Comparison of adaptive support ventilation and synchronized intermittent mandatory ventilation in patients with acute respiratory distress syndrome: A randomized clinical trial.

Background: Suitable mechanical ventilation strategies can reduce the incidence and severity of ventilator-associated lung injury in patients with acute respiratory distress syndrome (ARDS). In this study, the effects of adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation (SIMV) on respiratory parameters and arterial blood gases (ABGs) parameters were compared in ARDS patients. Materials and Methods: Twenty-four patients were randomly divided into two groups of ASV and SIMV. Patients were followed up for 3 days, and respiratory parameters including rapid shallow breathing index (RSBI), spontaneous breathing rate (SBR), minute volume, and peak inspiratory pressure (PIP) as the primary outcomes and ABG parameters including PaO2, FiO2, PaCO2, HCO3, and PaO2/FiO2 ratio as the secondary outcomes were measured. Results: PIP in patients in the SIMV group on the 1st day (P = 0.013), 2nd day (P = 0.001), and 3rd day (P = 0.004) was statistically significantly more compared to those in patients in the ASV group. RSBI, SBR, and minute volume between the ASV and SIMV groups during the 3 days were not statistically significantly different (P > 0.05). The mean arterial blood pressure, heart rate, PaO2, and PH between both groups were similar (P > 0.05). At the end of the 2nd and 3rd days, the level of FiO2 and PaCO2 in ASV was significantly lower than those in ASV group. HCO3 in each of the 3 days in the ASV group was statistically significantly lower than that in the SIMV group (P < 0.050). PaO2/FiO2 ratio in patients in the ASV group in the 3 days was statistically significantly higher than that in the SIMV group (P < 0.050). Conclusion: By reducing PIP and improving oxygenation and ABG parameters, ASV mode may be a safe and feasible mode during mechanical ventilation in patients with ARDS.

Curcumin for the Treatment of Prostate Diseases: A Systematic Review of Controlled Clinical Trials.

Prostate cancer is one of the significant causes of morbidity and mortality worldwide. Benign prostatic hyperplasia is another condition of the prostate which, like prostate cancer, is more common among ageing men and is linked to inflammation. In this study, a systematic review was undertaken to estimate the effect of turmeric or curcumin supplementation on prostate diseases. A comprehensive search was conducted in PubMed, Scopus, ISI Web of Science and Google Scholar up to 15 April 2020 to identify clinical trials assessing the effects of curcumin/turmeric alone or in combination with other herbs on prostate diseases. This led to the identification of 11 records comprising 745 patients who met the eligibility criteria. Eight studies were conducted on patients with prostate cancer, and three were on other diseases of the prostate. Although outcomes across the studies were heterogeneous, in some studies curcumin/turmeric supplementation had some favourable effects. This included beneficial effects on the levels of prostate-specific antigen (PSA) (2/6 studies), quality of life (1/2 studies), as well as on oxidative stress markers, feelings of incomplete bladder emptying, urination frequency, intermittency, urgency, weak stream, straining and nocturia. Curcumin/turmeric supplementation had no significant adverse effects among patients. This study demonstrated that turmeric or curcumin supplementation might have beneficial effects on some parameters related to prostate diseases, but it should be noted that some studies showed no effect. Therefore, further studies using curcumin-related compounds, particularly in highly bioavailable forms, are needed to assess the impact of curcumin on prostate conditions.

Hemoperfusion in patients with severe COVID-19 respiratory failure, lifesaving or not?

BACKGROUND: The new coronavirus outbreak quickly filled hospital beds and stunned the world. Intensive care is required for 5% of patients, and the mortality rate for critically ill patients is 49%. The "cytokine storm" is considered as the main cause of pathogenesis for coronavirus disease-19 (COVID-19)-related respiratory failure, hemoperfusion may be a modality for treatment of disease. MATERIALS AND METHODS: Thirty-seven an patients with positive real-time polymerase chain reaction for SARStions2 in an upper respiratory tract sample or typical chest computed tomography lesion were eligible for this case-control study. Patients meeting the criteria for hemoperfusion including clinical and laboratory indices, were evaluated for outcomes such as hospitalization length and mortality. Patients were divided into three groups, i.e., patients who received hemoperfusion without a need for mechanical ventilation (MV), patients who received hemoperfusion before MV, and patients who received hemoperfusion after MV. RESULTS: Among 37 patients with COVID-19 respiratory failure, 32% were female with a mean age of 55.54 (standard deviation 14.1) years. There was no statistically significant difference between the three groups in terms of length of hospital stay and intensive care unit (ICU) stay (P-tayns: 0.593 and 0.243, respectively, confidence interval [CI]: 95%). Heart rate, respiratory rate, PaO2/FIO2, high-sensitivity C-reactive protein, and ferritin significantly improved after the application of hemoperfusion in all groups (P < 0.05, CI: 95%). CONCLUSION: It seems that applying hemoperfusion in the inflammatory phase of the disease, especially before the intubation, reduce the need for MV. However, hemoperfusion does not have any impacts on the duration of hospital and ICU stay.

Intranasal ketamine reduces pain of digital nerve block; a double blind randomized clinical trial.

BACKGROUND: Low dose ketamine can be used as analgesic in acute pain management in the emergency department (ED). OBJECTIVE: Efficacy of IN ketamine in acute pain management in the ED. METHOD: This is a double blind randomized clinical trial on patients older than 15 years who needed digital nerve block (DNB). Participants randomly received IN Ketamine (1 ml = 50 mg) or placebo (normal saline, 1 ml) 5 min before DNB. In both groups, patients' pain score was recorded by visual analogue score (VAS) at baseline, after DNB and 45 min after completion of DNB. Adverse effects of ketamine and changes in vital signs were also recorded and compared with placebo group. RESULTS: A total number of 100 patients were enrolled in the study with the median (IQR) age of 36.5 (26) years, including 65 men and 35 women. IN ketamine resulted in less pain compared to placebo after performing DNB and 45 min after the procedure. Median (IQR) basic VAS score was 50 (15) in ketamine group, and 49 (27) in control group. Median (IQR) block pain VAS score was 28.5 (19) in ketamine group and 47.5 (31) in control group. Median (IQR) procedural pain VAS score was 21.5 (16) in ketamine group and 43.5 (29) in control group. Only 7 patients had adverse effects in either group. CONCLUSION: The findings of this study suggest that IN ketamine can be effective in reducing pain in patients with acute pain, without adding significant side effects.

Morphological and molecular characterization of coprinoid fungi newly recorded for the mycobiota of Iran.

Twenty-five specimens of coprinoid fungi were collected during an ongoing survey of agaric fungi in Kermanshah Province, western Iran. The specimens were identified based on morphological characteristics and molecular analysis of internal transcribed spacer sequences. Five species of Coprinellus viz C. disseminates, C. flocculosus, C. micaceus, C. radians and C. xanthothrix, three species of Coprinopsis viz C. atramentaria, C. insignis and C. semitalis and two species of Coprinus viz C. pinetorum and C. sterquilinus were identified. Among the species identified in this research, three unreported species from Iran namely C. insignis, C. semitalis and C. pinetorum are reported. Detailed morphological descriptions and illustrations of this three newly-recorded species were provided here and their evolutionary relationships were presented by the constructing of a phylogenetic tree.

Can low-dose of ketamine reduce the need for morphine in renal colic? A double-blind randomized clinical trial.

BACKGROUND: The combination of morphine with low doses of ketamine (MK) has been utilized in the Emergency Department (ED) compared with morphine and placebo (MP) for the treatment of acute pain in few studies. The purpose of this study was to compare the effect of MP with MK for the treatment of severe pain with renal colic of patients who had been referred to the ED. METHODS: This study is a double blind randomized clinical trial on patients with severe renal colic pain who were referred to the ED. Patients were enrolled with pain severity of at least 6 of the 10 visual analogue scales (VAS). Patients were divided into two groups: Morphine 0.1mg/kg and placebo (MP group) and morphine 0.1mg/kg and ketamine 0.15mg/kg (MK group). Pain of patients was studied in 10, 30, 60, 90, and 120min after injection. RESULTS: Totally, 106 patients were enrolled in study groups. Assessment of the average pain during 120min at 10 and 30min after the start in the drug, MK group was significantly lower than the MP group (p=0.019 and p=0.003 respectively). CONCLUSION: Given that combinations of morphine with low doses of ketamine in patients with renal colic pain causes more pain and morphine consumption reduction then this combination is suggested as an alternative treatment that could be utilized in patients with renal colic.

Barriers to intensive care unit nurses' autonomy in Iran: A qualitative study.

BACKGROUND: The acute nature of the intensive care unit (ICU) environment necessitates that urgent clinical decisions are frequently made by the health care team. Therefore, it is important that critical care nurses have the authority to make decisions about their patient care. PURPOSE: The purpose of this study was to explore perceived barriers to the practice of professional autonomy from the perspectives of ICU nurses in Iran. METHODS: In this qualitative study, 28 critical care nurses were interviewed using a semistructured in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. DISCUSSION: Data analysis led to identification of two main themes and five subthemes: (a) the profession-related barriers with two associated subthemes of "lack of capacity to exercise autonomy" and "lack of strong professional bodies"; (b) organizational barriers with the associated subthemes of "role ambiguity," "a directive rather than supportive workplace," and "lack of motivation." CONCLUSION: ICU nurses in Iran may face many challenges in gaining professional autonomy. The identified inter- and intraprofessional barriers to the exercise of autonomy need to be addressed to promote critical thinking, job satisfaction, and motivation of ICU nurses, which can in turn lead to improved patient outcomes.

Can intravenous acetaminophen reduce the needs to more opioids to control pain in intubated patients?

AIMS: To evaluate the effect of intravenous (IV) acetaminophen on reducing the need for morphine sulfate in intubated patients admitted to the Intensive Care Unit (ICU). SETTINGS AND DESIGN: Current study was done as a clinical trial on the patients supported by mechanical ventilator. SUBJECTS AND METHODS: Behavioral pain scale (BPS) scoring system was used to measure pain in the patients. All of the patients received 1 g, IV acetaminophen, every 6 h during the 1(st) and 3(rd) days of admission and placebo during the 2(nd) and 4(th) days. Total dose of morphine sulfate needed, its complications, and the BPS scores at the end of every 6 h interval were compared. RESULTS: Totally forty patients were enrolled. The mean pain scores were significantly lower in the 2(nd) and 4(th) days (4.33 and 3.66, respectively; mean: 4.0) in which the patients had received just morphine sulfate compared to the 1(st) and 3(rd) days (7.36 and 3.93, respectively; mean: 5.65) in which the patients had received acetaminophen in addition to morphine sulfate too (P < 0.001). Cumulative dose of morphine sulfate used, was significantly higher in the 1(st) and 3(rd) days (8.92 and 3.15 mg, respectively; 12.07 mg in total) compared to the 2(nd) and 4(th) days (6.47 mg and 3.22 mg, respectively; 9.7 mg in total) (P = 0.035). CONCLUSION: In our study, IV acetaminophen had no effect on decreasing the BPSs and need of morphine sulfate in intubated patients admitted to ICU.

Ultrasound-guided hematoma block in distal radial fracture reduction: a randomised clinical trial.

OBJECTIVE: We compared the efficacy and safety of ultrasound-guided haematoma block with that of procedural sedation and analgesia in patients with acute distal radial fracture reduction pain control. METHODS: This was a randomised clinical trial on adult patients conducted in two teaching hospitals. Patients received intravenous midazolam plus fentanyl in the procedural sedation and analgesia group, and fracture site injection of lidocaine 10% in the ultrasound guided haematoma block group. We measured pain scores before reduction, during reduction and 5, 10 and 15 min after reduction by a numeric rating scale, and patient and physician satisfaction by a four-level Likert scale. Time to discharge, early adverse effects and late complications were also compared. RESULTS: We enrolled 160 patients with distal radial fracture and randomised 143 patients into two groups (after excluding 17 patients). Pain was effectively controlled in both groups. Pain scores had no statistically significant difference before and during reduction and 5 and 15 min after reduction in the procedural sedation and analgesia and ultrasound guided haematoma block groups. Patient and physician overall satisfaction were similar in the two groups. Time to discharge was significantly lower in the ultrasound guided haematoma block group. Four patients (5.5%) in the procedural sedation and analgesia group showed early adverse effects. No patient in either group showed any late complications. CONCLUSIONS: Ultrasound guided haematoma block may be a safe and effective alternative to procedural sedation and analgesia. TRIAL REGISTRATION NUMBER: 201112308104N5.

Assess the clinical applicability of transthoracic echocardiography in laparotomy patients in a general intensive care unit.

BACKGROUND: Echocardiography is one of the diagnostic tools that can be applied at the bedside, along with avoiding transporting critically ill patients. This prospective observational study was designed to assess the clinical applicability of the transthoracic echocardiography (TTE) device by noncardiologist intensivists. MATERIALS AND METHODS: Intensivists performed a limited TTE examination on critically ill patients admitted to the surgical intensive care unit (ICU). After initial cardiac clinical assessment in 85 critically ill adult patients, a limited TTE was performed by an intensivist to assess left ventricular (LV) function and LV volume status as well as valvular function and qualitative factors. Data were analyzed and presented in proportions using descriptive statistics. The setting was in surgical ICU of an academic medical center. RESULTS: Valvular abnormalities (44.8%) as well as qualitative indices (68.3%) were the most frequently detected abnormalities. The ejection fraction was the only alteration, which was affected by the risk factors (P = 0.05, mean = 55.57). CONCLUSION: Transthoracic approach can provide useful information on cardiac anatomy and function in most ICU patients along with detecting severe previously unknown conditions in some patients.

Role of plasma ammonia level in detecting intra-abdominal hemorrhage following blunt abdominal trauma.

BACKGROUND: Blunt abdominal injury is a leading cause of death in trauma patients. A reliable test predicting intra-abdominal hemorrhage would be a novel method. The study objective was to assess the diagnostic accuracy of plasma ammonia in detection of intra-abdominal bleeding in patients with blunt abdominal trauma (BAT). MATERIALS AND METHODS: In this observational study, all patients suffering from BAT, referred to our university teaching hospital included. The levels of ammonia were measured at the time of emergency department admission and 1 h after initial treatment. Demographic data, vital signs, and venous blood gas reports were recorded. Findings of contrast-enhanced abdominopelvic computed tomography scan and laparotomy were assumed as a gold standard for abdominal injuries. RESULTS: A total of 104 patients was enrolled in the study. 15 patients (14.4%) had intra-abdominal hemorrhage and the mean plasma ammonia level in this group was significantly higher than the other patients on admission time (101.73 ± 5.41 µg/dL vs. 47.36 ± 26.31 µg/dL, P < 0.001). On receiver-operator characteristic curve analysis, in cutoff point of 89 µg/dL, the sensitivity, specificity, positive and negative likelihood ratios were 100% (95% confidence interval [CI], 79.6-100), 93.26% (95% CI, 86-96.8), 14.83 (95% CI, 6.84-32.12), and 0, respectively. CONCLUSION: The study findings suggest the measurement of ammonia level at the time of admission in the patients with BAT would be a useful test predicting intra-abdominal hemorrhage. Furthermore, decrease in the ammonia level could be a useful marker for monitoring response to treatment in these patients.

Comparative evaluation of the effects of hydroxyethyl starch on coagulation state of patients during brain tumor surgeries in comparison to crystalloids by thromboelastography.

BACKGROUND: Hypercoagulability has been reported in primary brain tumors which can lead to thrombotic complications. Hydroxyethyl starch (hetastarch) is a synthetic colloid solution with adverse effects on blood coagulation. The aim of this study was to evaluate the protective effect of hetastarch in reducing thromboembolic events in these patients. MATERIALS AND METHODS: In a double-blinded clinical trial, 60 brain tumor surgery patients were randomly divided into two groups and given 10 mL/kg hetastarch or normal saline during surgery. Blood coagulation was compared before and after infusion of these fluids within and between groups by thromboelastography (TEG). RESULTS: There were no significant differences in bleeding (P = 0.126), duration of surgery (P = 0.504), and fluid intake (0.09L) between the two groups. Percentage of changes in R (R: Time to initiate fibrin formation), K (K: Measure of the speed taken to reach a specific level of clot strength), and Ly30 (Ly30: Percent of fibrin distraction after 30 minutes of clot formation) in the crystalloid group were -20.61 ± 26.46, -30.02 ± 49.10, and 1.27 ± 22.63, and that in the colloid group were 22.10 ± 26.11, 41.79 ± 37.15, and 59.09 ± 37.12, respectively. Deterioration in hemostasis during and after surgery was not observed. CONCLUSION: There was a reduction in the speed of clot formation and increase in clot lysis in the hetastarch group. Coagulability was decreased in the colloid group. Infusion of 10 mL/kg hetastarch in brain tumor resection surgeries can probably decrease susceptibility of these patients to deep vein thrombosis (DVT) and thromboembolic events.

Oral oxycodone plus intravenous acetaminophen versus intravenous morphine sulfate in acute bone fracture pain control: a double-blind placebo-controlled randomized clinical trial.

OBJECTIVES: Bone fracture is a common cause of acute pain in emergency and orthopedics departments. Targeting the multifaceted mechanisms of pain with combinations of multiple analgesics (multimodal analgesia) can increase the pain control efforts efficacy and decrease the adverse effects of each medication. METHODS: One hundred and fifty-three patients with acute bone fracture were randomly allocated to two groups receiving intravenous morphine sulfate (74 patients) or oral oxycodone plus intravenous acetaminophen (79 patients). Pain scores and drugs' adverse effects were assessed 10, 30 and 60 min after treatment. RESULTS: Pain scores were similar between groups before, 30 and 60 min after medication but patients in morphine sulfate group experienced less pain 10 min after medication. Eight (10.8%) patients in morphine sulfate group and 26 (32.9%) patients in acetaminophen/oxycodone group experienced nausea that was statistically significant higher (P value = 0.001). Itching was seen in 12 (15.1%) patients of acetaminophen/oxycodone group and three (4.0%) patients of patients in morphine sulfate group (P value = 0.02). CONCLUSION: Intravenous acetaminophen plus oral oxycodone is as effective as intravenous morphine sulfate in acute pain control in emergency department but with a less desirable safety profile.

Molecular detection of Candida spp. and Aspergillus fumigatus in bronchoalveolar lavage fluid of patients with ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common nosocomial infection in critically ill patients with high morbidity and mortality rates. The etiology of VAP is usually bacterial. Opportunistic fungi such as Candida and Aspergillus species (spp.) are found frequently in the respiratory track secretions of immunocompetent critically ill patients known as colonization. Contribution of fungi colonization to severe bacterial VAP and poor prognosis of these patients has been documented in several studies. The aim of this study was to detect Candida spp. and Aspergillus fumigatus colonization in patients with a clinical diagnosis of VAP as a marker of high risk pneumonia. MATERIALS AND METHODS: Bronchoscopic alveolar lavage (BAL) fluids from patients with VAP in central intensive care unit (ICU) of a tertiary university hospital in Isfahan were examined by real time polymerase chain reaction (PCR) to detect Candida spp. or A. fumigatus. Rate of fungi colonization and its association with clinical criteria of the patients was determined. RESULTS: BAL fluids from 38 patients were tested from which six samples (15.8%) were positive for Candida spp. and five (13.2%) for A. fumigatus. Fungi colonization was not associated with age, sex, or mortality rate of patients. Rate of A. fumigatus colonization was significantly more in traumatic patients (P = 0.036), and higher in patients ventilated more than 4 weeks (P = 0.022). CONCLUSION: High rate of A. fumigatus colonization in our ICU patients indicates that underlying causes such as unfavorable ICU conditions and other patient related factors such as unnecessary antibiotic therapy should be further evaluated.

Diagnostic accuracy of ultrasonographic examination in the management of shoulder dislocation in the emergency department.

STUDY OBJECTIVE: Emergency physicians frequently encounter shoulder dislocation in their practice. The objective of this study is to assess the diagnostic accuracy of ultrasonography in detecting shoulder dislocation and confirming proper reduction in patients presenting to the emergency department (ED) with possible shoulder dislocation. We hypothesize that ultrasonography could be a reliable alternative for pre- and postradiographic evaluation of shoulder dislocation. METHODS: This was a prospective observational study. A convenience sample of patients suspected of having shoulder dislocation was enrolled in the study. Ultrasonography was performed before and after reduction procedure with a 7.5- to 10-MHz linear transducer. Shoulder dislocation was confirmed by taking radiographs in 3 routine views as a criterion standard. The operating characteristics of ultrasonography to detect dislocation in patients with possible shoulder dislocation and to confirm reduction in patients with definitive dislocation were calculated as the primary endpoints. RESULTS: Seventy-three patients were enrolled. The ultrasonography did not miss any dislocation. The results of ultrasonography and radiography were identical and the sensitivity of ultrasonography in detection of shoulder dislocation was 100% (95% confidence interval 93.4% to 100%). The sensitivity of ultrasonography for assessment of complete reduction of the shoulder joint reached 100% (95% confidence interval 93.2% to 100%) in our study as well. CONCLUSION: We suggest that ultrasonography be performed in all patients who present to the ED with a clinical impression of shoulder dislocation on admission time. The results of this study provide promising preliminary support for the ability of ultrasonography to detect shoulder dislocation. However, further investigation is necessary to validate the results and assess the ability of ultrasonography in detecting fractures associated with dislocation.

Evaluation of intravenous neostigmine infusion on tolerance of enteral nutrition in Intensive Care Unit patients.

BACKGROUND: Based on the dramatic response of acute colonic pseudo-obstruction to neostigmine, we designed this study to evaluate the effect of neostigmine on the tolerance of enteral feeding in Intensive Care Unit (ICU) patients. MATERIALS AND METHODS: A total of 60 patients hospitalized in the ICU of Alzahra Hospital, Isfahan, Iran entered the study. They were randomly assigned to one of the two groups of case (who received intravenous neostigmine infusion) and control (normal saline). They were compared with respect to incidence of constipation, diarrhea, and vomiting. Arrhythmia, bronchospasm, mean arterial blood pressure (MAP), and heart rate (HR) were also evaluated at 0, 4, 8, 12, 16, 20, and 24 h. RESULTS: The frequency distribution of constipation, diarrhea, vomiting, and increase in gastric lavage volume in the intervention group was 20%, 33.3%, 46.7% and 43.3%, while these indices in the control group were 40%, 30%, 43.3%, and 63.3%, respectively (P > 0.05). Arrhythmia was observed in 3% and 6% in the case and control groups, respectively. Bronchospasm was not detected in any of patients. CONCLUSION: There was no significance difference between neostigmine and normal saline with respect to tolerance of enteral nutrition in ICU patients.