Shiraz Emedical Journal
Volume:16 Issue: 9, Sep 2015

Postoperative pain in addicted patients is important because they are opioid tolerant, they have abnormal pain sensitivity and psychological disorders. Many modalities and combination of medications have been used to reduce the suffering of addicted patients’ postoperative pain. There has been some evidence for the use of antipsychotics for such pain control.. The aim of this study was to compare the effect of morphine versus morphine/haloperidol on postoperative pain management in opioid-addicted patients undergoing orthopedic surgery..Patients and In this randomized double-blinded placebo-controlled trial, 101 addicted patients were divided randomly into two groups. For pain intensity, the categorical scale was marked by asking the patient at time zero in the recovery unit. The patients received 0.1 mg/kg morphine with either 20 mg haloperidol or 4 mL normal saline in the first episode of pain, according to the study groups. Pain ratings were obtained at 30-minute intervals till two hours. Pain scores were measured by the summation of numbers equal to pain severity in the categorical scale. The total morphine dosage was also assessed in the study.. The trend of decrease in the pain scores between the placebo and haloperidol groups was significant (P < 0.001) with higher slope in the haloperidol group. The trend of decrease in morphine consumption between the groups was significant (P < 0.001) with higher slope in the haloperidol group. In the placebo group, at hour two, 45 patients (90%) were pain-free, whereas in the haloperidol group, 51 patients (100%) were pain-free (P = 0.027). The total morphine dosages used in the two groups had a statistically significant difference (P < 0.001).. Haloperidol together with morphine is beneficial in postoperative pain management in opium-addicted patients..

Context: The general message of the world kidney day is a concerted knowledge against the illnesses that lead to end-stage kidney failure, through better education, improved economic opportunity, increasing community outreach and access to protective medicine for individuals at the highest risk. These might end the unacceptable relationship between chronic renal failure and disadvantages in these societies..Evidence Acquisition: Annually, world kidney day reminds us that renal disease is a common harmful complication and in many cases treatable. The task of the world kidney day is to develop consciousness so that everybody cares for their kidneys and, if suitable, check and assess if they are at risk of renal disease. Prevention of renal disease, prompt recognition, and following renal protection protocols are serious goals for the world kidney day.. As an annual global alertness and education event, the 2013 World Kidney Day focused on increased awareness of acute renal failure among hospital staff and physicians and the necessity for a public awareness campaign to clarify this hazardous situation and make ‘kidney attack’ recognizable for the community, similar to that conducted by stroke and heart attack campaigns. Currently, acute renal failure is inefficiently directed in clinical education and training, and mainly ignored by people.. Prevention of renal disease, prompt recognition, and following renal protection are serious goals of the world kidney day..

Laryngospasm and postoperative vomiting are serious complications after surgery involving pediatric anesthesia, and these complications may cause morbidity.. The objective of this study was to compare the incidences of laryngospasm and vomiting between two groups of children treated with anesthesia. The patients were managed by either controlled ventilation or spontaneous respiration..Patients and This prospective clinical study was conducted with 200 children who had underwent elective infraumbilical surgery. The patients were divided to two groups of one-hundred cases, including the control ventilation (CV) and spontaneous respiration (SR) groups. Anesthesia induction and maintenance were the same in all patients. However, in the CV group, atracurium was used as a muscle relaxant to facilitate intubation and surgery.. The incidences of postoperative vomiting, laryngospasm, and excessive secretions were significantly higher in the CV group than the SR group (P = 0.001, 0.02 and 0.001, respectively).. This study demonstrated that the incidences of postoperative vomiting and laryngospasm are significantly higher in patients receiving anesthesia with muscle relaxants and controlled ventilation..

Epilepsy is a group of disorders characterized by recurrent unprovoked seizures. It is recognized as one of the most common neurological diseases affecting different age groups.. This study aimed to determine the causes of secondary epilepsy in patients with epilepsy at Mashhad hospitals in 2011 - 2012..Patients and In this cross-sectional, descriptive study, 300 participants were selected via available sampling from patients with epilepsy referred to hospitals affiliated to Islamic Azad University of Mashhad. Diagnosis of epilepsy was based on the criteria of the International League Against Epilepsy. Patients’ demographic and medical profile questionnaires were completed, using clinical examinations, electroencephalography (EEG) and brain imaging.. In this study, 54% and 46% of participants were male and female, respectively (mean age = 31.5 ± 15.3 years). Head trauma was the most common cause of secondary epilepsy, observed in 26% of patients. Brain tumor (9.7%), stroke (9.3%), brain infection (8.3%), metabolic disease (3.3%) and birth trauma or congenital anomalies (2.3%) were other causes. Findings of the last performed EEG were normal and abnormal in 49% and 51% of participants, respectively. Moreover, results of brain imaging were normal in 85.3% and abnormal in 14.7% of subjects.. This study evaluated the causes of secondary epilepsy. Our findings showed that 45.3% of the subjects had secondary epilepsy. Some patients presented with multiple conditions and there was more than one cause of secondary epilepsy in these cases. This study showed that the average age of patients with previous history of stroke was higher than that of other participants. However, previous history of stroke and head trauma mostly observed in males..

Coagulopathy is common after severe trauma or massive bleeding, and many studies have shown the benefits of co-administration of blood and plasma. Efforts are being made to improve the treatment of patients injured by blunt trauma using plasma infusion. This study focused on blood fibrinogen levels in patients with severe trauma and bleeding.Patients and Twenty-eight patients who were admitted to the Rajaee (Emtiaz) Trauma Hospital were studied in this cross-sectional survey, which was conducted in August and September of 2013. The patients were male and over 16 years old, with an injury severity score greater than or equal to 16, diastolic blood pressure under 90 mmHg, a minimum 1500 cc of estimated blood loss, and a minimum of 2000 cc crystalloid fluid intake, and patients were not receiving blood or blood products at the time of the traumatic event. Upon patient arrival, blood samples were obtained to measure fibrinogen concentration before starting resuscitation for the patient. Administration of blood and blood products was then performed according to hospital protocol. Over three months, twenty eight patients were admitted with the above criteria. Among these patients, the fibrinogen levels of eight cases (28.57%) were reported as non-measurable. Fibrinogen levels in 10% of the patients were below the acceptable standard of admission to the center, which means that blood fibrinogen levels were lower than normal in a significant number of patients. Severe tissue damage and bleeding significantly reduce fibrinogen levels, and the positive effects of administering plasma to severe trauma patients may be due to the fibrinogen that plasma provides. It is therefore important to discover safer ways to administer fibrinogen. We recommend that the amount of administered fibrinogen be controlled, and that a thromboelastography be conducted for all patients on arrival.