Search

Objective The objective was to compare intravenous morphine and intravenous acetaminophen (paracetamol) for pain treatment in patients presenting to the emergency department with sciatica. Methods Patients, between the ages of 21 and 65 years, suffering from pain in the sciatic nerve distribution and a positive straight leg-raise test composed the study population. Study patients were assigned to one of three intravenous interventions: morphine (0.1 mg/kg), acetaminophen (1 g), or placebo. Physicians, nurses, and patients were blinded to the study drug. Changes in pain intensity were measured at 15 and 30 minutes using a visual analog scale. Rescue drug (fentanyl) use and adverse effects were also recorded. Results Three-hundred patients were randomized. The median change in pain intensity between treatment arms at 30 minutes were as follows: morphine versus acetaminophen 25 mm (95% confidence interval [CI] = 20 to 29 mm), morphine versus placebo 41 mm (95% CI = 37 to 45 mm), and acetaminophen versus placebo 16 mm (95% CI = 12 to 20 mm). Eighty percent of the patients in the placebo group (95% CI = 63.0% to 99%), 18% of the patients in the acetaminophen group (95% CI = 10.7% to 28.5%), and 6% of those in the morphine group (95% CI = 2.0% to 13.2%) required a rescue drug. Adverse effects were similar between the morphine and acetaminophen groups. Conclusion Morphine and acetaminophen are both effective for treating sciatica at 30 minutes. However, morphine is superior to acetaminophen. © 2016 by the Society for Academic Emergency Medicine.

Energy consumption is one of the most important design constraints when building a wireless sensor and actuator network since each device in the network has a limited battery capacity, and prolonging the lifetime of the network depends on saving energy. Overcoming this challenge requires a smart and reconfigurable network energy management strategy. The Software-Defined Networking (SDN) paradigm aims at building a flexible and dynamic network structure, especially in wireless sensor networks. In this study, we propose an SDN-enabled wireless sensor and actuator network architecture that has a new routing discovery mechanism. To build a flexible and energy-efficient network structure, a new routing decision approach that uses a fuzzy-based Dijkstra's algorithm is developed in the study. The proposed architecture can change the existing path during data transmission, which is the key property of our model and is achieved through the adoption of the SDN approach. All the components and algorithms of the proposed system are modeled and simulated using the Riverbed Modeler software for more realistic performance evaluation. The results indicate that the proposed SDN-enabled structure with fuzzy-based Dijkstra's algorithm outperforms the one using the regular Dijkstra's and the ZigBee-based counterpart, in terms of the energy consumption ratio, and the proposed architecture can provide an effective cluster routing while prolonging the network lifetime.

Introduction. Ergotamine, an ergot alkaloid with partial agonist effects on ?1 receptors and serotonin receptors, is widely used in the treatment of migraine. Ergotamine may cause severe vasospasm. Case report. A 25-year-old man was admitted to the emergency department with complaints of sudden coldness, pallor, and pain in his hands and feet for 2 days. He had been using a drug containing ergotamine for his migraine headaches for 1 week. On examination, the pulses of the radial, ulnar, popliteal, and tibial arteries were bilaterally undetectable. Treatment consisted of sodium nitroprusside and heparin. On the third day of the admission, bilateral brachial and femoral artery pulses were lost and his complaints exacerbated. Angiography revealed diffuse vasospasm of the arteries in the both lower extremities (Fig. 1A and C). Because of the lack of response to the ongoing therapy, a single dose of methylprednisolone sodium succinate (1 mg/kg) was given intravenously; the nitroprusside infusion was terminated because of the development of hypotension. The pulses were palpable 2 h after the methylprednisolone dose. Angiography done 12 h after the methylprednisolone dose showed improvement of the vasospasm in the lower extremities. Recovery was uneventful and follow-up evaluation found no abnormalities. Discussion. Although vasodilator agents are first-line therapy in the treatment of ergotism, corticosteroids may be considered as an alternative therapy, especially for intractable cases. The mechanism by which corticosteroids dilate arteries is not clear. Conclusions. Ischemia in an extremity secondary to ergotamine-induced vasospasm unresponsive to sodium nitroprusside may be treated successfully with methylprednisolone. Copyright © Informa UK, Ltd.