reza bahman

Augmented renal clearance (ARC) is a common phenomenon among critically ill patients and creates sub-therapeutic concentrations of antibiotics, due to an increase in renal clearance of them. We evaluated the Pharmacokinetic and Pharmacodynamic (PK/PD) properties of recommended doses of meropenem in critically ill patients with ARC. Adult critically ill patients with confirmed ARC, based on 12-hour Creatinine Clearance (CrCl) (≥130 ml/min/1.73 m2), who received standard doses of meropenem enrolled in this study. Two blood samples were gathered from each participant, at the steady-state time, to determination of peak and trough concentrations. Serum concentrations of meropenem were measured by high-performance liquid chromatography (HPLC) with an ultra-violet (UV) detector. From eighteen paired samples (peak and trough concentrations) that were obtained from 16 critically ill patients, peak concentrations were significantly lower in group 1 (received meropenem 1g every 8 hours) than in group 2 (received meropenem 2g every 8 hours) (mean ±SD, 5.95 ±3.39 µg/mL vs. 11.93± 4.18 µg/mL, respectively, p=0.005). Trough concentrations were sub-threshold (< 2 µg/mL) in 10 patients of group 1 (83.3%) and 3 patients of group 2 (50%). ft > MIC ≥ 50% was achieved in 83.3% of patients in both groups whereas 16.6% of patients of group 1 and 33.3% of patients of group 2 had ft> MIC= 100%. Augmented renal clearance is an essential cause of sub-therapeutic concentrations of meropenem in critically ill patients, and higher than the recommended doses of meropenem administered as an intermittent infusion may be necessary to achieve the PD targets and improve efficacy.

Nasal obstruction is one of the common problems of patients. The most common structural cause of it is septal deviation. Septoplasty is the third common head and neck procedure. Splint is one of the most commonly used surgical devices for septal support, prevent adhesion and accelerate mucus healing. However, some studies have shown increased incidence of epistaxis, sleep disturbances, discomfort, PND, infection and perforation in patients using splint. This study was designed to compare the complications of septoplasty with and without nasal splint.

In this study, 48 septoplasty candidates which admitted to Imam Reza Hospital during the second half of 2015 were enrolled. They were divided into two equal groups of intervention (suture) and control (splint). The two groups were evaluated for perforation, hematoma and pain, 2 weeks after surgery. All data was collected and analyzed.

The mean age of the patients was 27.65 ± 6.7 years and the sex ratio was 1:1.4. The severity of pain was lower in the intervention group (without splint) based on VAS and VRS (P <0.01). There was no significant difference in the incidence of headache, sleep disturbances, epistaxis and epiphora after surgery in the two groups. Infection, hematoma and perforation of the nasal wall were not recorded in any of the studied groups.

The complications due to septoplasty in patients without splint are not more common and the amount of postoperative pain is significantly lower in these patients. Therefore, splint shouldn’t be used in patients who have septoplasty alone.