Frequency of polypharmacy and drug interactions in inpatients in the emergency department, Southwest of Iran

This study aimed to evaluate the polypharmacy extent and the frequency and severity of drug interactions by evaluating inpatients in the emergency department. In this epidemiologicaldescriptive study, data were collected retrospectively by reviewing medical records of 92 hospitalized patients in the emergency department with a stay over 48 hours. Out of the study population, 54.3% and 45.7% were respectively male and female, with a mean age of 59.09. In terms of hospitalization, 27.2% and 16.3% were hospitalized due to heart problems and trauma, respectively and the mean length of hospitalization was 3.91 with a standard deviation of 2.57 days. The mean drug received was 8.48, with a standard deviation of 4.48. Of the patients, 81.5% received more than 5 drugs; in addition, the observed amounts of drug interactions of A, B, C, D, and X were 2.5%, 17%, 59.3%, 19.5%, and 1.9%, respectively. The drug interaction prevalence in inpatients in the emergency department was high. The presence of a pharmacist is necessary to identify drug interactions and reduce drug-therapy problems to provide quality services.

Montelukast Efficacy for Improvement of Adult Acute Phase Mild-Moderate Asthma Attack: A Clinical Trial Study

Background:

Asthma, an inflammatory disease of the respiratory tract, is one of the most frequent causes of referral to emergency departments. The aim of this study is to evaluate the efficacy of montelukast as a member of LTRAs for the improvement of pulmonary function and clinical symptoms of patients with asthma.

Methods:

The study was conducted on 80 patients with acute mild- moderate asthma, divided randomly into two groups of 40 subjects. A double-blind clinical trial was conducted on asthmatic patients who encounter an acute phase asthma attack. The experimental group received two montelukast 5 mg chewable tablets at arrival, accompanied by standard mild-moderate asthma treatment consisting of oxygen and nebulization with albuterol 2.5 mg and ipratropium bromide 0.5 mg in 3 doses for 60 minutes. The control group received standard mild-moderate asthma treatment plus placebo chewable tablets at the beginning without any leukotriene inhibitors. Pulmonary function tests, hemodynamic variables and Borg Dyspnea Scale were evaluated and analyzed at 0, 30, 60, 90 and 150 minutes in both case and control groups.

Results:

No significant differences were observed between the case and the control group in terms of PEFR and FEV1 measurements during the study at different time points [P > 0.05]. There were no significant differences in terms of hemodynamic variables [blood pressure, pulse and respiration rate, pressure of oxygen in arterial blood] and Borg Dyspnea Scale in both groups as well.

Conclusion:

The study findings showed that the montelukast administration in mild-moderate acute asthma attack setting had no significant impact on pulmonary function tests and clinical symptoms of the studied patients rather than standard asthma treatment.

Intravenous Lidocaine versus Morphine Sulfate in Pain Management for Extremity Fractures; a Clinical Trial

INTRODUCTION

Considering the existing contradictions regarding effectiveness of intravenous (IV) lidocaine, especially in emergency department (ED), the present study was designed to compare the analgesic effect of IV lidocaine and morphine sulfate in pain management for extremity bone fractures.

METHOD

In this triple blind clinical trial, 15 to 65 year-old patients with extremity fractures and in need of pain management were randomly allocated to either IV lidocaine or morphine sulfate group and were compared regarding severity of pain 5, 10, 15, 20, 25, and 30 minutes after infusion via intention to treat analysis. The absolute risk reduction, number needed to treat and relative risk of IV lidocaine after 30 minutes were 0.40 (95%CI: 0.25 - 0.64), 7 (95%CI: 3.7 - 23.1), and 20.71 (95%CI: 10.91 - 30.51), respectively.

RESULTS

280 patients with the mean age of 32.50 ± 12.77 years were randomly divided into 2 equal groups of 140 (73.9% male). The 2 groups had similar baseline characteristics. 15 minutes after injection success rate was 49.28% in lidocaine and 33.57% in morphine sulfate group (p = 0.011), and after 30 minutes it reached 85.71% and 65.00%, respectively (p < 0.001).

CONCLUSION

Based on the results of the present study, IV lidocaine could be considered as a reasonable alternative choice for pain management in ED.

Comparing Two Different Doses of Intravenous Midazolam in Pediatric Sedation and Analgesia

INTRODUCTION

Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard.

METHODS

The present clinical trial was performed to compare 0.1 and 0.3 mg/kg doses of IV midazolam in induction of sedation for head trauma infant patients in need of brain computed tomography (CT) scan. Conscious infants under 2 years old, with stable hemodynamics were included. Onset and duration of action as well as probable side effects were compared between the two groups using SPSS version 22.

RESULTS

110 infants with the mean age of 14.0 ± 5.9 months (range: 4 - 24) and mean weight of 9.7 ± 2 kg (range: 5 - 15) were randomly allocated to one of the 2 study groups (54.6% female). Success rate in 0.1 and 0.3 mg/kg groups were 38.2% (21 patients) and 60% (33 patients), respectively (p = 0.018). Overall, 56 (50.9%) patients did not reach proper sedation and were sedated receiving ketamine (22 patients) or another dose of midazolam (34 patients, mean additional dose needed was 2.1 ± 1.1 mg).

CONCLUSION

The results of the present study demonstrated the higher success rate and longer duration of action for 0.3 mg/kg midazolam compared to 0.1 mg/kg. The groups were equal regarding onset of action, effect on vital signs and probable side effects.

Effective Factors in Severity of Traffic Accident-Related Traumas; an Epidemiologic Study Based on the Haddon Matrix

INTRODUCTION

Traffic accidents are the 8(th) cause of mortality in different countries and are expected to rise to the 3(rd) rank by 2020. Based on the Haddon matrix numerous factors such as environment, host, and agent can affect the severity of traffic-related traumas. Therefore, the present study aimed to evaluate the effective factors in severity of these traumas based on Haddon matrix.

METHODS

In the present 1-month cross-sectional study, all the patients injured in traffic accidents, who were referred to the ED of Imam Khomeini and Golestan Hospitals, Ahvaz, Iran, during March 2013 were evaluated. Based on the Haddon matrix, effective factors in accident occurrence were defined in 3 groups of host, agent, and environment. Demographic data of the patients and data regarding Haddon risk factors were extracted and analyzed using SPSS version 20.

RESULTS

700 injured people with the mean age of 29.66 ± 12.64 years (3-82) were evaluated (92.4% male). Trauma mechanism was car-pedestrian in 308 (44%) of the cases and car-motorcycle in 175 (25%). 610 (87.1%) cases were traffic accidents and 371 (53%) occurred in the time between 2 pm and 8 pm. Violation of speed limit was the most common violation with 570 (81.4%) cases, followed by violation of right-of-way in 57 (8.1%) patients. 59.9% of the severe and critical injuries had occurred on road accidents, while 61.3% of the injuries caused by traffic accidents were mild to moderate (p < 0.001). The most common mechanisms of trauma for critical injuries were rollover (72.5%), motorcycle-pedestrian (23.8%), and car-motorcycle (13.14%) accidents (p < 0.001).

CONCLUSION

Based on the results of the present study, the most important effective factors in severity of traffic accident-related traumas were age over 50, not using safety tools, and undertaking among host-related factors; insufficient environment safety, road accidents and time between 2 pm and 8 pm among environmental factors; and finally, rollover, car-pedestrian, and motorcycle-pedestrian accidents among the agent factors.

Proper Angle of Sono-guided Central Venous Line Insertion

INTRODUCTION

Determining the proper angle for inserting central venous catheter (CV line) is of great importance for decreasing the complications and increasing success rate. The present study was designed to determine the proper angle of needle insertion for internal jugular vein catheterization.

METHODS

In the present case series study, candidate patients for catheterization of the right internal jugular vein under guidance of ultrasonography were studied. At the time of proper placing of the catheter, photograph was taken and Auto Cad 2014 software was used to measure the angles of the needle in the sagittal and axial planes, as well as patient's head rotation.

RESULT

114 patients with the mean age of 56.96 ± 14.71 years were evaluated (68.4% male). The most common indications of catheterization were hemodialysis (55.3%) and shock state (24.6%). The mean angles of needle insertion were 102.15 ± 6.80 for axial plane, 36.21 ± 3.12 for sagittal plane and the mean head rotation angle was 40.49 ± 5.09.

CONCLUSION

Based on the results of the present study it seems that CV line insertion under the angles 102.15 ± 6.80 degrees in the axial plane, 36.21 ± 3.12 in the sagittal plane and 40.49 ± 5.09 head rotation yield satisfactory results.

Comparison of Oral Midazolam and Promethazine with Oral Midazolam alone for Sedating Children during Computed Tomography

INTRODUCTION

Both midazolam and promethazine are recommended to be used as sedatives in many studies but each have some side effects that limits their use. Combination therapy as an alternative method, may decreases these limitations. Therefore, this study aimed to compare midazolam with midazolam-promethazine regarding induction, maintenance, and recovery characteristics following pediatric procedural sedation and analgesia.

METHODS

Children under 7 years old who needed sedation for being CT scanned were included in this double-blind randomized clinical trial. The patients were randomly divided into 2 groups: one only received midazolam (0.5 mg/kg), while the other group received a combination of midazolam (0.5 mg/kg) and promethazine (1.25 mg/kg). University of Michigan Sedation Scale (UMSS) was used to assess sedation induction. In addition to demographic data, the child's vital signs were evaluated before prescribing the drugs and after inducing sedation (reaching UMSS level 2). The primary outcomes in the present study were onset of action after administration and duration of the drugs' effect.

RESULTS

107 patients were included in the study. Mean onset of action was 55.4±20.3 minutes for midazolam and 32.5±11.1 minutes for midazolam-promethazine combination (p<0.001). But duration of effect was not different between the 2 groups (p=0.36). 8 (7.5%) patients were unresponsive to the medication, all 8 of which were in the midazolam treated group (p=0.006). Also in 18 (16.8%) cases a rescue dose was prescribed, 14 (25.9%) were in the midazolam group and 4 (7.5%) were in the midazolam-promethazine group (p=0.02). Comparing systolic (p=0.20) and diastolic (p=0.34) blood pressure, heart rate (p=0.16), respiratory rate (p=0.17) and arterial oxygen saturation level (p=0.91) showed no significant difference between the 2 groups after intervention.

CONCLUSION

Based on the findings of this study, it seems that using a combination of midazolam and promethazine not only speeds up the sedation induction, but also decreases unresponsiveness to the treatment and the need for a rescue dose.