Renal impairment and analgesia: From effectiveness to adverse effects

Effects of aminophylline on the levels of neutrophil gelatinase-associated lipocalin (NGAL) in asphyxiated term neonates

OBJECTIVE

Our study evaluates the effects of aminophylline in the reduction of NGAL levels in perinatal asphyxia.

METHODS

Term neonates with hypoxic ischaemic encephalopathy who were divided into two groups, the treatment and placebo. Urine NGAL levels were measured on day one and four of the treatment using BIOPORTO kits in both the groups.

RESULTS

Day 1 NGAL levels were not statistically different in either group irrespective of the age, gender and the mode of delivery. on 4^th day, NGAL in treatment group significantly decreased as compared to day 1 levels and placebo day-4 levels. significant differences were seen between first and fourth day NGAL levels among children with normal and caesarean birth and among female and male neonates.

CONCLUSIONS

Following the treatment with aminophylline, NGAL levels in asphyxiated neonates are likely to reduce. Further studies based on other kidney dysfunction parameters can lead to the better and accurate conclusions.

The effect of epinephrine and methylprednisolone on cardiac arrest patients

Background

Methods

Results

Conclusion

•

CPR involves organized procedures performed on patients with cardiac arrest.

•

CPR method and techniques can determine neurological outcomes of the patients.

•

Glucocorticoid, methylprednisolone does not reduce the risk of neurological complications.

Association between neutrophil gelatinase-associated lipocalin (NGAL) and iron profile in chronic renal disease

NGAL, also known as lipocalin 2, is a stress protein located on the cell surface that is known for its involvement in iron transport. This study is aimed to evaluate the correlation between the iron profile and NGAL concentration in serum among chronic kidney disease patients under dialysis in order to find its diagnostic value with regards to iron deficiency anaemia (IDA). 47 patients under chronic haemodialysis in end-stage renal disease (ESRD) and 15 healthy controls were evaluated to determine the correlation between serum NGAL concentration and IDA characteristics. Our results recorded a significant correlation between IDA (TSAT < 20%) and NGAL serum concentration with a Spearman's coefficient of 0.314. Serum NGAL was also significantly related to serum ferritin, TIBC, uric acid, creatinine and blood sugar whereas, an inverse relationship with albumin, total cholesterol and LDL. Our study reports a positive correlation between IDA and serum NGAL levels in CKD patients.

Chronic hemodialysis: Evaluation of dialysis adequacy and mortality

Objective

Dialysis efficacy is one of the important issues in patients undergoing hemodialysis. This study aimed to determine the adequacy of dialysis with mortality and hospital admissions in patients undergoing hemodialysis.

Methods

This retrospective cohort study was conducted on patients who underwent dialysis. Dialysis adequacy was measured based on the Kt/V criterion. Age, sex, disease etiology, duration of dialysis, and access dialysis were evaluated.

Results

128 patients with a mean age of 61.48 ± 13.36 years were included in the study. 8 patients had a history of kidney transplantation. The mean dialysis time in the patients was 4.30 ± 3.39 years. The mean Kt/V in the patients was 1.40 ± 1.8 years. Of the 128 patients, 53 were hospitalized for cardiac or renal reasons. The number of fatalities was 9 cases out of 128. The cause of death in all the cases was heart problems. There was a statistically significant correlation between the adequacy of dialysis in terms of Kt/V and mortality, but it was not associated with hospitalization.

Conclusion

Inadequate dialysis in terms of Kt/V is likely to increase the rate of mortality among dialysis patients.

•

Dialysis efficacy is one of the important issues in patients undergoing hemodialysis.

•

Inadequate dialysis in terms of Kt/V is likely to increase the rate of mortality among dialysis patient.

•

The findings showed that there was no significant correlation between the dialysis adequacy and hospitalization.

Complications in Patients with Cardiac Penetrating Trauma

BACKGROUND

Cardiac penetrating trauma is a medical emergency that mostly affects young people. Based on the type of injury and associated complications, it can present as a surgical challenge and can lead to mortality.

OBJECTIVE

The aim of this study is to evaluate the complications of penetrating heart trauma among patients referred to Shahid Madani Hospital.

METHODS

In this retrospective descriptive study, the data of penetrating cardiac trauma patients referred to Shahid Madani hospital, Karaj, Tehran, from 2016-2019, were investigated. Information, including age, sex, cause of trauma, traumatized area and complications, was extracted and recorded in a data collection form. The data were evaluated statistically using SPSS v18.

RESULTS

A total of 44 patients were included in the study, where the mean age of the patients was 25 years. 73.3% of these patients were men and 26.7% were women. Knife stab wounds were the most prevalent cause of the trauma, present in 93.3% of patients. 73.3% of the patients had cardiac tamponade and 20% had a pneumothorax. The right ventricle was the most common site of the injury in 46.7% of the patients. A mortality rate of 3.4% was reported in this study.

CONCLUSION

The results of this study showed that the highest penetrating heart rate trauma occurred among young people, and the most common cause of the trauma was a knife stab. The most common area of the injury was the right ventricular, and cardiac tamponade was the most common complication.

Atrial Fibrillation and Ventricular Tachyarrhythmias: Advancements for Better Outcomes

Cardiac arrhythmias are associated with several cardiac diseases and are prevalent in people with or without structural and valvular abnormalities. Ventricular arrhythmias (VA) can be life threating and their onset require immediate medical attention. Similarly, atrial fibrillation and flutter lead to stroke, heart failure and even death. Optimal treatment of VA is variable and depends on the medical condition associated with the rhythm disorder (which includes reversible causes such as myocardial ischemia or pro-arrhythmic drugs). While an implanted cardioverter defibrillator is often indicated in secondary prevention of VA. This review highlights the newest advancements in these techniques and management of ventricular and atrial tachyarrhythmias, along with pharmacological therapy.

A cross-sectional study on the prevalence of electrolyte abnormalities in multiple trauma patients in Hamedan, Iran

INTRODUCTION

Evaluation of electrolyte status and homeostasis is one of the most important components of evaluation and treatment of critically ill patients, especially those with multiple trauma. Electrolyte imbalance can be associated with a bad prognosis and the need of specialized consultancy.

AIM

The aim of this study was to evaluate and determine the electrolyte status of patients with multiple trauma and evaluate the relationship of electrolyte disorders with patient outcome.

METHODS

In this cross-sectional study, 370 patients who were referred to the emergency department of Besat Hospital in Hamadan, Iran with multiple trauma were studied. Demographic parameters clinical characteristics such as blood pressure, heart rate, respiratory rate, consciousness score and body temperature, paraclinical characteristics including radiographic status, ultrasound, and electrocardiography and serum levels of sodium, potassium, creatinine, hemoglobin, hematocrit, and BUN and urine analysis was performed. Data regarding the discharge from emergency department or referral to other units were also complete in a questionnaire for each patient. Statistical analyses were performed using SPSSv24.

RESULTS

Three hundred seventy patients with multiple trauma were studied where 73% of patients were men and 27% were women. One hundred ninety-six patients were discharged from the emergency department, and 174 patients were referred to other units of the hospital. The most common electrolyte abnormalities were hypotension (62.7%), hypernatremia (9.5%), hypokalemia (6.8%), and hypercreatinine (4.6%). The results of independent t-test showed that heart rate and potassium level were significantly higher in patients referred to other units than in patients discharged from the emergency department and respiratory rate and hematocrit were significantly lower in patients referred to other units.

CONCLUSION

Hypotension, hypernatremia, hypokalemia, hypercreatinine, and abnormal urine analysis were more frequent in patients referred to other units than in patients discharged from the emergency department. These variables can be considered in predicting patient status for referral to other units and delayed hospital discharge.

Hypocalcemia following total and subtotal thyroidectomy and associated factors

BACKGROUND

Thyroidectomy is one of the common endocrinological surgeries for the treatment of thyroid disorders. Hypocalcemia is the potential complication after thyroidectomy, where is persistency can lead to serious systemic effects. The aim of this study is to evaluate the incidence of hypocalcemia in thyroidectomy patients.

METHODS

In this cross-sectional study, patients referred to (XXX) for thyroidectomy from 2019 to 2020 were enrolled. Preoperative serum calcium and postoperative 24- and 48-h calcium levels were evaluated in these patients. Demographic data (sex and gender), calcium levels, type of thyroidectomy and duration of surgery was recorded for all the patients. SPSS v22 was used for statistical analysis. P < 0.05 was considered as statistically significant.

RESULTS

Of 143 patients included in the study, the mean age was 49.7 ± 10.9 years and 61.5% were females and 38.5% were males. 49% patients had hypocalcemia in the first 24 hours after surgery and 63.6% following 48 hours of the surgery. The difference in calcium levels at three intervals were statistically significant, p = 0.001. The incidence of hypocalcemia was significantly more in women at 48 postoperative hours, p = 0.025. The age and duration of surgery was not significantly correlated with hypocalcemia, p > 0.05, whereas, patients who underwent total thyroidectomy had greater incidence of hypocalcemia 24 hours after the surgery, p = 0.021.

CONCLUSIONS

The incidence of hypocalcemia is greater in total thyroidectomy and female patients. Our study did not report significant correlation between duration of the surgery and age of the patients.

Evaluating memory dysfunction after spinal anesthesia among patients undergoing elective surgery: Descriptive-analytical study

BACKGROUND

Anesthesia has a number of side effects including cognitive impairment after the surgery. Postoperative cognitive impairment is commonly associated with general anesthesia.

OBJECTIVE

The aim of this study is to evaluate the effects of Marcaine (bupivacaine hydrochloride) in memory impairment among patients undergoing elective surgery.

MATERIALS AND METHODS

In this study descriptive-analytical study, patients undergoing elective lower extremity or lower abdomen surgery requiring spinal anesthesia were included. Following 24 h of the surgery, standard Wechsler questionnaire was used to assess memory of the patients. Other demographic and clinical parameters such as age, gender and blood pressure, pulse rate were also recorded. The obtained data was analyzed using SPSSv18.

RESULTS

In this study, 105 patients where 55 (52.4%) males and 50 (47.6%) females were studied. The mean age of the subjects was 35.73 ± 10.64 years. There was a significant difference between the mean of memory scores in terms of logical memory and overall memory (P < 0.001). There was a significant relationship between the mean scores of patients' rational memory and systolic blood pressure at admission (P = 0.030). There was a significant relationship between mean associative learning scores in patients and systolic blood pressure at admission (P = 0.046) and type of surgery (P = 0.013). Furthermore, overall memory scores were significantly associated with age (P = 0.041).

CONCLUSION

Based on the results of this study, it can be concluded that spinal anesthesia had a significant effect on some areas of memory. Further studies in this area can yield more reliable results.

Human immunodeficiency: Extragonadal comorbidities of infertility in women

Introduction

Infertility is mediated by several changes system‐wide. These changes are likely to cause other systems‐related pathologies, such as changes in systemic immune response, particularly inflammatory response can lead to cardiovascular diseases and breast cancer.

Methods

These morbidities can exist immediately or years after the diagnosis of infertility. Therefore, understanding the mechanism is important to move toward therapeutic interventions.

Results

Several extragonadal pathologies are reported due to infertility, as well as, how these might also contribute to reproductive disabilities. Detailed evidence are still not present that can give stronger result.

Conclusion

This review highlights some of the most frequent comorbidities that are seen in infertile women, hence requiring a need for complete clinical screening and care, as well as diagnosis and treatment in early stages.

Risk factors and therapeutic measures for postoperative complications associated with esophagectomy

Esophageal cancer is one of the most common cancers associated with the high mortality rate. Timely diagnosis and treatment are important to manage the disease and prevent comorbidities. Surgical resection of the tumor and lymph nodes is usually practiced either with or without chemo or chemoradiotherapy. Despite advancements in surgical methods and skills, complex nature of the esophagus and invasiveness of the surgery can lead to serious complications in these patients. In order to predict postoperative outcomes, preoperative examination of the patients, in addition to risk factors, should be conducted. Conclusion: Lastly, early detection of adverse postoperative events may help faster recovery, reduce hospital stay and prevent other morbidities.

Postoperative complications associated with coronary artery bypass graft surgery and their therapeutic interventions

Coronary artery disease is one of the commonest surgery demanding cardiovascular diseases. Coronary artery bypass graft surgery is practiced all over the world for the treatment of coronary artery disease. Systemic trauma during the surgery is associated with a wide range of complications, some of which are fatal. Preoperative risk factors such as age, previous illness and obesity are common predictors of these adverse events. Advances in therapeutic medicine have allowed timely treatment of these adverse events and co-morbidities. This review summarizes some of the most occurring complications associated with coronary artery bypass graft and corresponding treatment options.

Comparison of efficacy nebulized fentanyl with intravenous ketorolac for renal colic in patients over 12 years old

OBJECTIVES

Acute renal colic is one of the common causes of referral to the hospitals. The aim of this study is to compare the efficacy of nebulized fentanyl with that of intravenous ketorolac in renal colic patients.

MATERIALS & METHODS

This double-blinded clinical study included 186 patients with acute renal colic who were referred to the emergency department of Besat Hospital, Iran.

PATIENT SELECTION

After selecting patients, according to study inclusion and exclusion criteria, they were divided into 2 groups of 93 using random block allocation method. The patients in the groups were treated with either nebulized fentanyl or intravenous ketorolac. The severity of pain was measured using the Numeric Pain Rating Scale (NPRS) of pain. The severity of pain at different times and demographic data were recorded.

RESULTS

One hundred and thirty four males and 52 females with a mean age of 42.95 ± 13.13 years were included in the study. The two groups were matched in terms of age, sex, and the severity of the pain before the treatment. Fifteen minutes following the treatment, the severity of pain was decreased in the ketorolac group but did not change in the nebulized fentanyl group. Thirty minutes after the administration of the drug, the severity of pain in the nebulized fentanyl group decreased. At any time, the severity of pain in the ketorolac group was lower than that of the nebulized fentanyl group.

CONCLUSION

Intravenous ketorolac had better analgesic effects in renal colic patients compared with nebulized fentanyl. Further studies that include complications and combinational therapy are required.

Abdominal pain in the patient with antiphospholipid antibody syndrome: A case report

Antiphospholipid antibody syndrome (APS) is known to cause hypercoagulability, affecting a wide range of vessels, systematically. A 56-year-old woman was referred to our center with severe epigastric pain, with the history of APS. She was treated with packed cells, fresh frozen plasma and anticoagulation therapies.