The Effects of Filgrastim on Complications of Patients with Cerebral Hemorrhage Due To Head Trauma.

BACKGROUND: Filgrastim, a neopogen brand, is a blood-forming agent and a natural protein in the body that plays a role in stimulating the growth of white blood cells and protecting them against infectious agents. To the best of knowledge, human and animal specimens have shown the effect of Filgrastim on treating brain injuries regarding bone marrow transfusion into the blood, neuroprotection, stimulation of neurons for forming new neural networks and reducing the risk of bacterial infections. AIM: This study aimed to investigate the effect of Filgrastim on the prognosis of a cerebral haemorrhage in patients with traumatic brain injury. METHODS: This study was conducted as a clinical trial, in which the initial diagnosis of patients with cerebral haemorrhage due to head trauma was performed with a clinical examination and CT scan. After the patient arrives at the emergency room, the patient's initial examination is performed, and blood tests are taken from the patient. Moreover, CBC values (Hb, Platelet, Hematocrit) were checked and recorded in the checklist. The intervention group received 150 mcg/day Filgrastim injected subcutaneously for 4 days. Furthermore, patients in the control group received the same amount of sterile water. At the end of the treatment period, blood tests were performed again in all patients, and their results were then recorded. All data were analysed by SPSS v.21 software package. RESULTS: Our findings revealed that the mean volume of bleeding in the intervention group based on CT scan was significantly reduced after four days as compared to the control group. Moreover, the mean score of consciousness and muscular strength of patients in the intervention group was significantly higher than the control group. Also, WBCs in the intervention group exhibited a significant increase after four days of intervention, while platelet and hematocrit levels in the intervention group decreased significantly compared to the control group. CONCLUSION: Regarding the results, the therapeutic application of filtration is considered to be effective. Given the lack of serious complications of the proposed dosages, the use of this drug can be suggested.

Therapeutic Effect of Adding Magnesium Sulfate in Treatment of Organophosphorus Poisoning.

BACKGROUND: In recent years, the prevalence of poisoning has increased dramatically due to population growth and access to drugs and toxins. Today poisoning is one of the important reasons for visiting hospitals. AIM: The present study aimed to investigate the effect of magnesium sulfate on organophosphorous toxicity. METHODS: Patients who had inclusion criteria in the study were randomly assigned to one of two groups (control group or case group) by an emergency medicine specialist. Patients' data including age, sex, ECG, vital signs, arterial oxygen saturation were recorded for patients. Patients in the case group (40 subjects) received 2 mg magnesium sulfate 50%, while the control group (40 subjects) received 100 cc normal saline (as placebo) as an intravenous infusion. RESULTS: The distribution of gender in the two groups of patients was the same. Also, the mean age, Stature and weight of patients were similar in both groups. In the group receiving magnesium sulfate, diastolic blood pressure was lower when compared with another group, at 0 and 2 hours after intervention. Moreover, the mean of systolic blood pressure in both groups was determined to be the same at all hours. Furthermore, the heart rate in the group receiving sulfate was lower as compared to the control group for 8 hours, 16 and 24 hours after intervention. CONCLUSION: The use of magnesium sulfate in organophosphate poisoning reduces therapeutic costs an average hospital length of stay and mortality compared to those who did not receive magnesium sulfate.

A Comparison of Metoclopramide and Ondansetron Efficacy for the Prevention of Nausea and Vomiting In Patients Suffered From Renal Colic.

BACKGROUND: Renal stones are the third common disease of the urinary system after infections and diseases of the prostate. One of the most common manifestations of this disease after acute pain is nausea and vomiting. AIM: To compare the efficacy of metoclopramide and ondansetron in improving nausea and vomiting in patients referred to the emergency department with a chief complaint of nausea and vomiting. METHODS: This randomised double-blind clinical trial was conducted on patients referred to the emergency department of Vali-e Asr Hospital. Mg5 intravenous morphine and ketorolac ampoule were injected to control renal colic. Then, patients were randomly divided into two groups. Group 1 consisted of 90 subjects receiving 10 mg intravenous metoclopramide and group 2 including 90 subjects receiving 4 mg intravenous ondansetron. Vital signs were also measured and recorded. RESULTS: The mean and standard deviation of nausea in 0, 15, 30, 45, 60 and 120 minutes showed no significant difference between the two groups. Mean and standard deviation of vomiting at 0 minutes showed no significant difference between the two groups, but the remaining minutes, 15, 30, 45, 60 and 120, exhibited significant difference as a comparison of two groups, indicating that vomiting in the metoclopramide group was higher than ondansetron group. CONCLUSION: Our findings indicated that ondansetron was more effective than metoclopramide in preventing and improving vomiting in patients referred to emergency renal colic, where can be used with more efficacy and more acceptable side effects to improve nausea and vomiting.

Effects of Intravenous and Inhaled Nebulized Lignocaine on the Hemodynamic Response of Endotracheal Intubation Patients: A Randomized Clinical Trial.

BACKGROUND: Endotracheal intubation is one of the most common measures in the Intensive Care Unit (ICU) which plays an important role in airway management of the critically ill patients. AIMS: The study aimed to evaluate the effects of lignocaine spray on hemodynamic response of endotracheal intubation patients. SETTINGS AND DESIGN: This study is a randomized clinical trial on a study population comprising patients admitted to the ICU. SUBJECTS AND METHODS: The patients were divided into three groups using a permuted block randomization. In Group 1, inhaled nebulized lignocaine 4% (75.0 mg/kg) was sprayed around the patients' epiglottis and larynx. In Group 2, intravenous (IV) lignocaine 2% (75.0/mg/kg) was injected. No lignocaine was prescribed for or administered to the control group. One and four minutes after intubation, the patients' hemodynamic and vital signs were measured. STATISTICAL ANALYSIS USED: Data analysis was run using Stata 13 software through repeated measure ANOVA tests. RESULTS: Although the mean arterial blood pressure (MAP) of Group 1 (inhaled nebulized lignocaine) was smaller than that of Group 2 (IV lignocaine), there was no significant difference between the two groups. Both groups' MAPs were significantly different from that of the control group. As for the average number of pulses, a significant difference was observed between the inhaled and IV lignocaine groups; hence, the average number of pulses in Group 1 (inhalation) was lower than that of Group 2 (IV injection). CONCLUSION: As blood pressure is considered to be normal under 140/90 and may not entail any hemodynamic complications, it can be concluded that inhaled nebulized lignocaine can control the hemodynamic changes of intubation more effectively than IV lignocaine.

The Effects of Injected Vitamin D on Prognosis of Patients with Urosepsis.

The aim of this study was to evaluate the effect of prescribing vitamin D on improving the symptoms of patients diagnosed with urosepsis. The participants were randomly divided into two equal groups (each consisting of 50 patients). The patients in the first group received standard treatment with 300 000 units of injected vitamin with a volume of 1 cc. As for the patients in the second group, they received standard treatment along with 1 cc normal saline injected to them as placebo. Vital signs of the patients were checked every 6 h, while their CBC, EXR, CRP, creatinine, urea, and uric acid were checked 0, 24, 48, and 72 h following the interventions. Calcium, phosphorus, and vitamin D levels were measured 72 h following injection of the medicine. A significant difference was observed between the two groups in terms of the number of WBC's in 24th, 48th, and 72nd hours. A similarly significant difference was reported between the case and control group in terms of the average BUN within 24th, 48th, and 72nd hours. The difference observed between the two groups in terms of average Cr within the 0th, 24th, 48th, and 72nd hours and in terms of days of hospitalization was also significant. Considering these results and keeping in mind the fact that no particular side effects were reported as a result of utilizing muscular injections of vitamin D and the easy and cheap use of this medicine, it can be used in auxiliary treatment of patients with urosepsis.

Use of Fentanyl Patch and Intravenous Morphine for Treatment of Leg Bone Fracture: Treatment Profile, and Clinical Effectiveness.

BACKGROUND: Severe pain is one of the major problems in patients with leg bone fracture. Various methods have been proposed to relieve pain. Opioids are one of the most important available medications to control these types of pain. Among the opioids available, fentanyl can be applied for its unique properties as transdermal patches. AIM: Therefore, the current study aimed to investigate the effect of intravenous morphine and fentanyl skin patch in patients with a lower leg fracture. METHODS: We entered 60 patients in this randomised, one-blind randomised clinical trial among patients referring to the emergency department of Vali-e-Asr Hospital in Arak with a fracture of the leg. Demographic and clinical data were recorded for patients. The case group (n = 30) received the fentanyl patch in the same area. Patients in the control group (30) received 0.1mcg/kg of morphine intravenously. In both groups, the severity of pain was measured every 20 minutes within two hours after onset of treatment based on VAS criteria and subsequently recorded in the checklist. Data were analysed by SPSS v.22 software package. RESULTS: The results of the present study demonstrated that the mean visual analogue scale (VAS) pain score at minutes 20, 40, 60 and 80 were statistically lower in intervention group when compared with the control group (p = 0.000). CONCLUSION: Our results indicated a considerable risk-benefit profile for the treatment of pain in patients suffering from dysphagia, nausea and vomiting, or resistance to other opioids. The use of fentanyl patch is also suitable for patients who are not able to take their medication at their scheduled time.

The Effect of Magnesium Sulfate on Renal Colic Pain Relief; a Randomized Clinical Trial.

INTRODUCTION: Renal colic can be managed by preventing the contraction movements of ureter muscles. By reducing acetylcholine in the nerve terminals, magnesium sulfate could be effective in this regard. The aim of this study is to investigate the effect of magnesium sulfate on acute renal colic pain relief. METHOD: The present study was a double-blind clinical trial in which the patients suffering from acute renal colic were randomly divided into 2 groups of who either received standard protocol (intravenous infusion of 0.1 mg/Kg morphine sulfate, 30 mg of Ketorolac, and 100 ml normal saline as placebo/15 minutes) or standard protocol plus 15 mg/Kg of intravenous magnesium sulfate 50%/100 ml normal saline/15 minutes. Severity of patients' pain was measured by visual analogue scale (VAS) at baseline, and 30 and 60 minutes after infusion. The collected data were analyzed using STATA statistical software. RESULTS: 100 cases were randomly allocated to intervention or control group. The two groups were similar in baseline pain score and demographic characteristics. At 30 and 60 minutes, mean pain score was less in the intervention group compared to the control group. Moreover, the difference between the two groups was statistically significant regarding the additional amount of morphine, suggesting that the intervention group needed less additional morphine than the control group. CONCLUSION: The results of this study showed that Magnesium sulfate can be used as an adjunct drug in treatment of patients suffering from renal colic. It not only alleviates the pain in the patients, but also diminishes the need for pain medications.

The effect of tranexamic acid in traumatic brain injury: A randomized controlled trial.

PURPOSE: Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage (ICH) secondary to TBI is associated with a high risk of coagulopathy which leads to increasing risk of hemorrhage growth and higher mortality rate. Therefore, antifibrinolytic agents such as tranexamic acid (TA) might reduce traumatic ICH. The aim of the present study was to investigate the extent of ICH growth after TA administration in TBI patients. METHODS: This single-blind randomized controlled trial was conducted on patients with traumatic ICH (with less than 30 ml) referring to the emergency department of Vali-Asr Hospital, Arak, Iran in 2014. Patients, based on the inclusion and exclusion criteria, were divided into intervention and control groups (40 patients each). All patients received a conservative treatment for ICH, as well as either intravenous TA or placebo. The extent of ICH growth as the primary outcome was measured by brain CT scan after 48 h. RESULTS: Although brain CT scan showed a significant increase in hemorrhage volume in both groups after 48 h, it was significantly less in the TA group than in the control group (p = 0.04). The mean total hemorrhage expansion was (1.7 ± 9.7) ml and (4.3 ± 12.9) ml in TA and placebo groups, respectively (p < 0.001). CONCLUSION: It has been established that TA, as an effective hospital-based treatment for acute TBI, could reduce ICH growth. Larger studies are needed to compare the effectiveness of different doses.

How do Iranian emergency doctors decide? Clinical decision making processes in practice.

INTRODUCTION: Emergency doctors must make decisions for many patients in a limited time. Various emergency cases are not compatible with routine conditions as described in textbooks, so doctors use clinical decision making (CDM) processes to act in the best possible way. In the present work, these processes and some of the related factors were assessed. METHODS: Decisions made by doctors were studied via patient medical records, doctors' notes and interviews with decision-making doctors from the Emergency Department of Rasul-Akram Hospital, Tehran, Iran. All doctors were unaware of this research, and they had previously studied CDM processes as part of their training curriculum. A total of 10 day and 10 night shifts (240 h) between 1 March 2010 and 30 May 2010 were considered for the study. RESULTS: Rule-based, event-driven, knowledge-based and skill-based decisions, respectively, were the most frequent processes used by doctors in 726 first visits. It was also found that 7% of decisions were not made on a known CDM basis, that all of them were for non-urgent and 'standard' patients, and that most patients who were non-urgent were referred to first-year postgraduates. Skill-based decisions were not applied in very urgent cases; 107 out of 726 decisions on first visits had shifted to knowledge-based process by the time of final treatment decisions. For final treatment decisions, rule-based and knowledge-based processes were more frequently used than other CDM processes. CONCLUSIONS: The rule-based process is the most common CDM process used by emergency doctors, perhaps because of the minimisation of human error in this process. CDM choice may be influenced by triage level, treatment room and doctors' educational levels. Revealing and studying these factors may help shift decisions to the best possible decision making levels, defining a model in future research.