The Neuroprotective Effects of Administration of Methylprednisolone in Cardiopulmonary Resuscitation in Experimental Cardiac Arrest Model.

Although advances in diagnosis and treatment of cardiac arrest (CA) could improve neurological outcomes after cardiopulmonary resuscitation (CPR), survival rate and neurological outcome after CA and CPR remain poor. This study aimed to investigate the effect of epinephrine (EP) alone and EP in combination with methylprednisolone (MP) (EP + MP) on some the apoptotic and anti-apoptotic genes and proteins levels expression of the cerebral cortex as well as neuronal death in a CA rat model. Forty-five male Sprague Dawley rats were randomly divided into three groups including the hypoxic CA + EP, hypoxic CA + EP + MP, and sham groups using a simple randomization procedure. In both hypoxic CA groups, CA was induced by asphyxia and immediately after confirmation of CA, the treatment strategies including chest compression or cardiac massage simultaneously with ventilation, and administration of EP alone (20 mg/kg, every 3 min) and EP (20 mg/kg, every 3 min) + 30 (mg/kg) of MP were done. The sham group only received anesthetic drugs without CA. Some neurological outcomes were investigated using histopathological, immunohistochemical, molecular, and terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end labeling (TUNEL) assays at 5 and 48 h post-CPR. The data obtained showed the highest up-regulation of apoptotic genes and proteins expression, the lowest expression of anti-apoptotic gene and protein expression, the most DNA fragmentation and histopathological changes belonged to the EP group on 48 h post-CPR. While mild and intermediate histopathological changes, DNA fragmentation and apoptotic activity was detected in theEP alone and EP + MP groups at 5 h and 48 h post-CPR, respectively. As a novel finding, the present study showed that EP + MP protects neurons from death provoked/induced by hypoxia and reperfusion injury in an experimental model of CA through up and down-regulation of pro- (caspases 3 and 8) and anti-apoptotic (BCL2) molecules, respectively.

Sonographic Detection of Abdominal Free Fluid: Emergency Residents vs Radiology Residents.

BACKGROUND: Focused assessment with sonography for trauma (FAST) has become a part of initial examinations in trauma care at emergency departments (ED). OBJECTIVES: The goal of the present study was to evaluate the accuracy of FASTs performed by emergency residents (ER) in detection of abdominal free fluid following blunt trauma. MATERIALS AND METHODS: In this study, the reports of ERs performing FASTs on 286 admitted patients following blunt trauma were compared with those of radiology residents (RR) in relation to presence of abdominal free fluid. In addition, the reports of the two resident groups were compared with the final abdominal outcome, based on the results of abdominal computed tomography (CT) and clinical follow up. RESULTS: The ERs had reported abdominal free fluid in 20 (6.9%) patients while RRs performing FAST had positive results in 22 (7.6%) patients. The reports of FASTs revealed significant correlation between the two resident groups (P < 0.001). ERs performing FASTs had 90% sensitivity and 98.5% specificity in comparison to RRs sonography reports. Furthermore, ER-performed FASTs had 96.5% accuracy in relation to final outcome. CONCLUSIONS: Following training, ED residents can perform FAST with high accuracy and specificity, similar to RR residents, in patients with blunt abdominal trauma.

Substance Abuse among Drivers of Motor Vehicle Collisions.

BACKGROUND: Motor vehicle collisions (MVC) comprise a majority cause of referral to the emergency department (ED). A large proportion of MVC appear to be preventable, if more effective measures against driving after substance abuse can be implemented. OBJECTIVE: This study was aimed to investigate the prevalence of substance abuse among drivers of MVC, following road traffic accidents (RTA). MATERIALS AND METHODS: This case-control research was conducted from July to October 2007. One hundred MVC drivers admitted in the ED were included as the case group and 110 hospitalized patients, due to nontraumatic causes were used as controls. History of substances abused was obtained and urine samples were tested for opium in both groups. Finally the history and laboratory results of the groups were compared using SPSS 18. RESULTS: Of the 100 patients in the case group, 39 (39%) were positive for substance abuse (100% males). On the other hand, 49 (44.5%) patients in the control group had positive history or laboratory findings of substance abuse (73.9% male). Opioids were the most common agent abused in both groups. There was no significant difference between two groups regarding the prevalence of substance abuse (P = 0.92). CONCLUSIONS: The prevalence of substance abuse is high among victims of road traffic injury but in equal proportion to the control group. Health education and counseling is needed to reduce substance abuse in the general population although it was not significantly related to the cause of RTA.