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Background Acute kidney injury (AKI) commonly occurs in critically ill patients. Estimation of renal function and antibiotics dose adjustment in patients with AKI is a challenging issue. Methods Urinary creatinine clearance was measured in a 6-hour urine collection from patients with acute kidney injuries. The correlations between different formulas including the modified Cockcroft-Gault, modification of diet in renal disease, chronic kidney disease-epidemiology collaboration, Jelliffe, kinetic-glomerular filtration rate (GFR), Brater, and Chiou formulas were considered. The pattern of the prescribed antimicrobial agents was also compared with the patterns in the available resources. Results Ninety-five patients with acute kidney injuries were included in the research. The mean age of the participants was 63.11±17.58 years old. The most patients (77.89%) were in stage 1 of AKI according to the Acute Kidney Injury Network criteria, followed by stage 2 (14.73%) and stage 3 (7.36), respectively. None of the formulations had a high or very high correlation with the measured creatinine clearance. In stage 1, Chiou (r=0.26), and in stage 2 and 3, kinetic-GFR (r=0.76 and r=0.37) had the highest correlation coefficient. Antibiotic over- and under-dosing were frequently observed in the study. Conclusions The results showed that none of the static methods can predict the measured creatinine clearance in the critically ill patients. The dynamic methods such as kinetic-GFR can be helpful for patients who do not receive diuretics and vasopressors. Further studies are needed to confirm our results.

Background and Aim: Ventilator-associated pneumonia is a common, serious and costly complication in patients of intensive care units. Oral hygiene is one of the important clinical measures to reduce the amount of pulmonary infection in these patients. Therefore, this study compares the effects of chlorhexidine and orthodontal mouthwashes on prevention of pulmonary infection in patients with endotracheal tracheal intubation under mechanical ventilation in intensive care units. Materials and Methods: This double-blind clinical trial study was performed on 60 patients undergoing mechanical ventilation in two groups of intervention (n = 30) and control (n = 30) in ICU department of Imam Reza hospital in Kermanshah. In the control group, chlorhexidine (0.2%) mouthwash and in the intervention group, Ortodontol mouthwash was used three times a day. Data on the rate of early and late pneumonia were compared based on CPIS criteria applying t-test and Chi-square. Results: The incidence of early and delay pneumonia in the intervention group was lower than that of control, but no significant difference was observed (P >0.05). The overall frequency of pulmonary infection in the intervention group was significantly lower than the control group (P = 0.03). The frequency of pneumonia causes was lower in the intervention group, but this decrease was statistically significant in Staphylococcus aureus (P = 0.03). Conclusion: According to the results of this study, orthodontol mouthwash can be effective in reducing the incidence of pulmonary infection associated with mechanical ventilation.

Background and purpose: Ventilator-associated pneumonia is a common, serious and costly disorder in intensive care units (ICUs) that rank first in hospital infections. So, appropriate interventions are needed to prevent this condition. Eucalyptus is a plant with antibiotic properties, therefore, current study aimed at investigating its effects on prevention of endotracheal tube-associated pneumonia in ICU. Materials and methods: A double-blind clinical trial was performed in 100 patients with endotracheal tube and on ventilator in ICU in Kermanshah Imam Reza Hospital, Iran. The patients were divided into two groups. In intervention group (n=50) 4 cc of 2% eucalyptus solution was mixed with 6 cc distilled water and in control group (n=50) 10 cc distilled water was given three times daily through a nebulizer kit connected to mechanical ventilation devices. Data on the rate of early and late pneumonia were compared based on CPIS criteria applying t-test and Chi-square. Results: The incidence of early and late pneumonia was lower in intervention group compared to that of the controls. The decrease was significantly more in onset of late pneumonia (P=0.01). The onset of pneumonia due to mechanical ventilation was significantly higher in intervention group than that of the control group (P=0.01). Conclusion: Eucalyptus was found to be an effective prophylaxis that could delay the development of pulmonary infection in patients on ventilation. Therefore, it is suggested in ICUs in patients with tracheal tubes. (Clinical Trials Registry Number: IRCT2017010727819N2)

Background and objective: Electrical stimulation and acupuncture points as nonpharmacological methods have been the focus of pain reduction in different patients. This study is aimed at determining the effects of transcutaneous electrical nerve stimulation (TENS) on the acupuncture points of pain in patients under mechanical ventilators. Materials and methods: This randomized double-blind clinical trial study was conducted on 50 patients undergoing mechanical ventilation in intensive care units of Imam Reza hospital in Kermanshah, Iran, in 2017. The patients were randomly allocated into intervention and placebo groups. In the intervention group, TENS electrodes were placed on points Hegu and Zusanli. Pain severity was measured using the Care Pain Observation Tool scale, and the dosages of narcotics and sedation intake were recorded. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 19. Results: The level of pain in patients decreased in the intervention group in comparison with the sham group, and this decline was significant during certain hours (p

Background and aims: Natural and technologic disasters and accidents have great influence on peoplechr('39')s lifestyle and their health. Main object of hospitals is providing fast and timely health care to reduce mortality and complications by the disaster. The aim of this study is to evaluate preparedness crisis and disasters in centers of trauma of Kermanshah University of Medical Sciences. Methods: The present descriptive, cross-sectional study was conducted in three hospitals (A,B,C) of Kermanshah university of medical sciences, Iran, 2016. Data were collected using a self-administered checklist and questioner through observation and interview. The checklist included 220 yes/no questions in 10 domains of emergency (30 questions), admission (24 questions), evacuation and transfer (30 questions), traffic (15 questions), communication (16 questions), security (17 questions), education (17 questions), support (28 questions), human workforce (21 questions), and leadership and management (22 items). Scores 0 and 1 were given to “No” and “Yes” choices, respectively. Data were analyzed using SPSS and descriptive statistics. Results: Overall, the relative mean of disaster preparedness in the study hospitals A, B and C was 99.1%, 43.4%and 84.7%, respectively. Generally, the average readiness score for all hospitals was 75%. The most and lowest preparedness was related to the management and traffic domains. Conclusion: According to the results, preparedness of hospitals was in the suitable level. Officials of medical centers have the necessary programs and educations in all areas of disaster preparedness for quick response and timely in hospitals.

Sepsis-induced leukopenia occurs in critically ill patients and associated with negative clinical outcomes. A sixty years old patients with respiratory failure, decreased level of consciousness and pneumonia transferred to the intensive care unit. During intensive care stay patients developed late ventilator-associated pneumonia and severe neutropenia. Colony stimulating factor (filgrastim) was initiated for patients. Severe leukocytosis (leukocyte counts of 94000/mm3) was seen with no source of new infection was detected. After filgrastim discontinuation serum leukocyte counts returned to the normal limits with no sequel or complication. Although Hyperleukocytosis may increase the risk of thrombosis and pulmonary edema. Most cases of iatrogenic hyperleukocytosis are well tolerated with no complication.

Levodopa is considered one of the most important medication for parkinson symptoms control, it also first line agent for elderly and patients who symptoms don’t control with other agents. However, it has several drug and nutrition interactions. A few case of levodopa enteral nutrition has been reported.