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Byline: Reza. Azizkhani, Farhad. Heydari, Mohammadreza. Ghazavi, Maryam. Riahinezhad, Mohammadreza. Habibzadeh, Ali. Bigdeli, Keihan. Golshani, Saeid. Majidinejad, Abolfazl. Mohammadbeigi Background: Pediatric anxiety and restlessness may create issues and difficulties in [...]

Background: Pleural effusion (PE) is common in children with acute illness that are admitted to the intensive care unit (ICU). The present study aimed to investigate the efficacy of albumin addon therapy to furosemide in contrast to furosemide treatment only for treating transudative PE. Methods: The present randomized clinical trial was conducted on fifty 1-12-year-old children (under mechanical ventilation admitted at ICU randomly allocated to treatment with daily furosemide only (2 mg/kg) or albumin (1 gr/kg) add-on therapy to furosemide (2 mg/kg) for three days. The vital signs, venous blood gas, the pleural effusion volume, serum potassium level, potassium, and dopamine requirement were measured daily and compared between the groups. Results: Comparison of the two groups showed a significant decrease in the pleural fluid volume (P<0.001), base excess (P<0.001), diastolic blood pressure (P=0.004), heart rate (P=0.009), and potassium (P=0.005) in the intervention group than the control group. The mean of dopamine and potassium doses requirement were 2.25±0.95 and 2.60±0.89 for the intervention group, and 1.00±0.00 and 2.00±1.41 for the control group, respectively. The comparison of the two groups showed an insignificant difference between them (P=0.26 for the dopamine injection and P=0.57 for the potassium prescription). Conclusion: As the first study worldwide, considerable benefits were observed in the use of albumin and furosemide combination among PICU-admitted children under mechanical ventilation who required negative fluid balance. In addition, no hemodynamic instability or death was reported. During this short-term follow-up period, a satisfactory percentage of children were separated from the ventilator and transferred to the ward. [ABSTRACT FROM AUTHOR]

Abstract Background The combination of transfusion and chelation therapy has dramatically extended the life expectancy of thalassemic patients. The main objective of this study is to determine the prevalence of prominent thalassemia complications. Methods Two hundred twenty patients entered the study. Physicians collected demographic and anthropometric data and the history of therapies as well as menstrual histories. Patients have been examined to determine their pubertal status. Serum levels of 25(OH) D, calcium, phosphate, iPTH were measured. Thyroid function was assessed by T3, T4 and TSH. Zinc and copper in serum were determined by flame atomic absorption spectrophotometry. Bone mineral density (BMD) measurements at lumbar and femoral regions have been done using dual x-ray absorptiometry. The dietary calcium, zinc and copper intakes were estimated by food-frequency questionnaires. Results Short stature was seen in 39.3% of our patients. Hypogonadism was seen in 22.9% of boys and 12.2% of girls. Hypoparathyroidism and primary hypothyroidism was present in 7.6% and 7.7% of the patients. About 13 % of patients had more than one endocrine complication with mean serum ferritin of 1678 ± 955 micrograms/lit. Prevalence of lumbar osteoporosis and osteopenia were 50.7% and 39.4%. Femoral osteoporosis and osteopenia were present in 10.8% and 36.9% of the patients. Lumbar BMD abnormalities were associated with duration of chelation therapy. Low serum zinc and copper was observed in 79.6% and 68% of the study population respectively. Serum zinc showed significant association with lumbar but not femoral BMD. In 37.2% of patients serum levels of 25(OH) D below 23 nmol/l were detected. Conclusion High prevalence of complications among our thalassemics signifies the importance of more detailed studies along with therapeutic interventions.

Background: Laryngoscopy and endotracheal intubation are critical procedures and if the anthropometric indices of the patient leading to difficult intubation are not considered before the procedure, it can be accompanied by serious complications. One of the most practical concepts suggested about difficult intubation, is Cormack and Lehane criteria used in most medical centers. However, there is not any valuable study demonstrate the effect of anthropometric indices in difficult intubation and the immediate prediction of its complications. This study aimed to evaluate the correlation of anthropometric indices and hemodynamic changes after laryngoscopy and endotracheal intubation. Methods: This descriptive-analytic study was carried out in 2012 in Kashani hospital, Isfahan, Iran. 130 patients with fulfilling inclusion criteria were entered the study. The recorded data included age, weight, height, neck circumference, waist-to-hip ratio and body mass index. The difficulty of intubation was assessed when the patient was completely unconscious. The predictive role of obesity indices in difficult intubation and the cardiovascular changes after intubation was assessed using receiver operating characteristic (ROC) curve. Findings: The best cut-off point for body mass index (BMI) was 26.56; according to this cut-off point, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of BMI were 100, 38.84, 10.8 and 91.1 percent, respectively. The best cut-off point for neck circumference was 38; according to this cut-off point, the sensitivity, specificity, PPV and NPV of neck circumference were 7.85, 2.28, 2.45, 1.91 percent, respectively. Conclusion: BMI, neck circumference and waist-to-hip ratio are valuable in assessing difficult intubation and their value is mostly due to NPV. Therefore, we can achieve a significant NPV and sensitivity in assessment of difficult intubation by considering all these indices. [ABSTRACT FROM AUTHOR]

Background: The ratio of partial pressure of oxygen in arterial blood (PaO2) to the fraction of inspiratory oxygen concentration (FiO2) is an indicator of pulmonary shunt fraction. PaO2/FiO2 (P/F) ratio is used to classify severity of acute respiratory distress syndrome (ARDS). With the same shunt fraction, P/F ratio decreases with increases in FiO2 which may lead to errors in classifying severity of ARDS. The effect of FiO2 on P/F ratio has not been investigated in COVID-19 pneumonia. In this study, we estimated the best FiO2 for the calculation of P/F ratio in a sample of patients with ARDS due to COVID-19 pneumonia. Materials and Methods: Blood gas and ventilatory data of 108 COVID-19 ARDS patients were analyzed in a cross-sectional observational study. Using Oxygen Status Algorithm the calculated shunt fraction served a basis for calculating P/F ratio for different FiO2. The severity of ARDS determined by P/F ratios at each FiO2s was compared with the shunt-based severity to find the optimum FiO2 for calculation of P/F ratio so the resulting classification has the best match with the reference classification. Results: A FiO2 of 1.0 for calculation of P/F ratio and ARDS classification showed the best match with shunt-based ARDS classification. A regression model was obtained with the PaO2, patient's original FiO2, Hemoglobin concentration, and SaO2 as the independent predictors of the P/F ratio for the FiO2 of 1.0. Conclusion: This study shows a FiO2 of 1.0 as the best value for correct calculation of P/F ratio and proper classification of ARDS. [ABSTRACT FROM AUTHOR]

Background: Electroconvulsive therapy (ECT) is a medical treatment used in serious mental illnesses, in which a small amount of electricity passed the brain. The hemodynamic side effects include an initial parasympathetic response causing transient bradycardia, followed by a sympathetic discharge resulting in tachycardia, hypertension and a risk of arrhythmias. The aim of this study was to determine the effect of different doses of magnesium sulfate on cardiovascular response after electroconvulsive therapy. Methods: This clinical-trial, double-blind, randomized study was held cross over on 35 patients in electroconvulsive therapy (ECT) center of Noor hospital in Isfahan, Iran, in 2011. Each patient was randomly assigned to be allocated twice into each of the four test groups which received placebo (control) or 10 (first), 20 (second), or 30 (third) mg/kg of MgSo4. Systolic and diastolic arterial blood pressures, heart rate and oxygen saturation values were recorded on arrival for the ECT and then at 0, 1, 3 and 10 minutes after the end of the ECT-induced seizure. Findings: Mean systolic blood pressure at 0, 1 and 3 minutes after the end of the ECT-induced seizure of the second (126.140 ± 20.937, 122.710, ± 18.524, and 115.710 ± 17.504 mmHg, respectively) and third (123.000 ± 18.077, 123.710 ± 14.770, and 116.290 ± 14.201 mmHg, respectively) groups were statistically different compared to controls. Besides, mean diastolic blood pressure at 0, 1 and 3 minutes after the end of the ECT-induced seizure of the second group (76.000 ± 10.304, 74.430 ± 9.669, and 76.140 ± 9.082 mmHg, respectively) were statistically different compared to control group. Mean arterial blood pressure (MAP) at 0, 1 and 3 minutes after the end of the ECT of the second (92.140 ± 12.237, 90.710 ± 12.328, and 89.330 ± 12.425 mmHg, respectively) and third (91.670 ± 11.602, 90.860 ± 10.905, 89.520 ± 9.873 mmHg, respectively) groups compared with the control group were statistically different, too. Heart rate and arterial oxygen saturation at different times in the four groups were not statistically different. Conclusion: Based on the results of this study, magnesium sulfate with doses of 20 and 30 mg/kg attenuated the systolic and diastolic blood pressure and mean arterial blood pressure (MAP) response of electroconvulsive therapy without reducing the duration of seizure activity. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori is the most common microorganism which colonizes in gastrointestinal system. There are different methods for diagnosis of infection such as rapid stool antigen, urea breath and serology tests. The purpose of this study was comparing the cost and effectiveness of these methods. Methods: 94 dyspeptic patients with mean age of 46 ± 14 years, were evaluated. The patients were considered infected when the results of 2 tests (rapid stool antigen test, urea breath test, rapid urease test and histology) was positive. Findings: Accuracy of rapid stool antigen test was 91%, urea breath test was 82% and serology was 52%. Conclusion: As the cost of stool antigen test was minimum, it is concluded that rapid stool antigen test is more cost-benefit, accurate and reliable test for diagnosis of helicobacter pylori compared with urea breath test and serology. [ABSTRACT FROM AUTHOR]