فهرست مطالب

Anesthesiology and Pain Medicine
Volume:10 Issue: 5, Oct 2020

  • تاریخ انتشار: 1399/06/31
  • تعداد عناوین: 16
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  • Pooya Derakhshan, *, Seyed HamidReza Faiz, Poupak Rahimzadeh, Reza Salehi, Ghazaleh Khaef Page 1
    Background

    In previous clinical trials and a small number of studies, the fractional injection of anesthetics led to reduced physiological complications and hemodynamic stability and increased duration of anesthesia.

    Objectives

    The present study intended to compare the effect of fractionated and bolus dose injection of bupivacaine and fentanyl on spinal anesthesia for lower limb fracture surgeries.

    Methods

    In this randomized, double-blind clinical trial, 70 patients with lower limb fractures were divided into groups of bolus spinal anesthesia (Group A) and fractional spinal anesthesia (Group B). Group A received a bolus dose of 25 μg fentanyl plus 15 mg bupivacaine 0.5% intrathecally at a rate of 0.2 mL/sec and were laid down in supine position after 45 seconds. In Group B, a half dose of the mixture, i.e., 25 μg fentanyl plus 15 mg bupivacaine 0.5% mixture, was injected intrathecally, and then, the other half was injected after 45 seconds while the needle was still in place. Afterward, the patients were immediately laid down in the supine position. Hemodynamic changes in the sensory and motor blockage parameters were recorded in both groups.

    Results

    The motor blockage onset time was shorter in Group B compared to Group A (P = 0.026). Moreover, the sensory blockage duration was longer (P = 0.035), and the highest level of sensory blockage was lower (P = 0.008) in Group B compared to Group A.

    Conclusions

    Fractional spinal anesthesia led to a longer duration and more favorable levels of sensory blockage compared to the bolus method. In addition, hemodynamic changes and complications occurred less frequently following this procedure.

    Keywords: Fentanyl, Spinal Anesthesia, Bupivacaine, Hemodynamic, Motor Blockage, Sensory Blockage
  • Hassan Ali *, Ahmed Abdelaziz Ismail, Ahmed Abdalwahab Page 2
    Background

    Since the announcement of the World Health Organization of COVID-19 as a global pandemic, the probability of experiencing psychological disturbances and mental health problems among the frontline doctors who deal early with the suspected or confirmed patients is expected to increase, especially among anesthesia and ICU physicians.

    Objectives

    The objective of this study was to assess the magnitude of mental stress among anesthesia and ICU physicians in Cairo university hospitals, Egypt, treating patients exposed to COVID-19.

    Methods

    This cross-sectional, survey-based study collected the demographic and mental health data from anesthesia and ICU physicians working in Cairo university hospitals from March 15 to April 15, 2020, in Egypt. The level of stress was assessed by the perceived stress scale (PSS-10).

    Results

    A total of 193 out of 315 contacted physicians completed the survey. A significant proportion of participants (65%) experienced high levels of psychological distress during this acute situation, with the PSS-10 median score of 21 in the registrar group and 18 in the consultant group; the difference was statistically significant (P = 0.03). The most common causes of stress among the participants were the fears that they might transmit the disease to their loved people and the lack of a clear protocol on how to deal with COVID-19 cases, either suspected or confirmed.

    Conclusions

    In this survey study, anesthesia and ICU physicians responding to the spread of COVID-19 reported high rates of symptoms of mental stress.

    Keywords: Anesthesia, ICU, Mental Stress, COVID-19
  • Ali Dabbagh, *, Dariush Abtahi, Homayoun Aghamohammadi, Seyyedeh Narjes Ahmadizadeh, Seyed Hossein Ardehali, Anesthesiology Department Page 3
    Background

    “Simulated-patient scenarios and role-playing” and OSCE are among the many non-traditional education methods with variable results in different clinical settings.

    Objectives

    This cross-sectional study was performed to assess the correlation between the results of these two methods in senior anesthesiology residents, with a special focus on four of the six ACGME core competencies.

    Methods

    During two years, senior anesthesiology residents were subject to “simulated patient scenario and role-playing” sessions. Two faculty members took the role of the patient and one of the relatives. An objective checklist with 15 items was prepared to be rated by other department faculty members. Meanwhile, an ordered pattern of OSCE was prepared to cover four core competencies that were more related to this academic process (from a total of six core competencies). The mean and standard deviation of the score of each of the 15 items in the checklist were calculated. The correlation between cumulative checklist scoring results and OSCE exam results was assessed. A P value of less than 0.05 was considered significant.

    Results

    A total of 40 senior anesthesiology residents, with 344 assessments by faculty members in 40 sessions, were enrolled in the study. The questionnaire’s Cronbach’s alpha reliability was 0.74. No statistically significant disparity was detected between the results of the two assessment methods, while the results of the two assessments had a significant correlation (two-tailed correlation coefficient = 0.886; P value < 0.001).

    Conclusions

    There was an objective relationship between the results of “simulated patient scenario and role-playing” strategies and the results of OSCE exams using an observer-based rating method. Thus, they could be used as surrogates in the assessment of core clinical competencies of senior anesthesiology residents.

    Keywords: OSCE, Anesthesiology, Resident, Role-Playing, Residency Program, Simulated Patient Patient Scenario
  • Ehsan Bastanhagh, Fahime Zamiri, Saghar Samimi Sadeh*, Khadijeh Adabi, Pejman Pourfakhr Page 4
    Background

    Pain is one of the most challenging issues following surgery, and it is crucial to provide adequate and appropriate pain control measures.

    Objectives

    This study assessed the efficacy of preoperative duloxetine in controlling postoperative pain in women following an abdominal hysterectomy in Yas Hospital affiliated to Tehran University of Medical Sciences between December 2019 and April 2020.

    Methods

    The study involved 80 women who were candidates for elective abdominal hysterectomy. The participants were randomly assigned to one of two groups. Group 1 received a 60 mg duloxetine capsule two hours before surgery. Group 2 received placebo following the same schedule. The amount of administrated opioids and the time from surgery to the administration of opioids were recorded, along with the frequency of nausea and vomiting experienced.

    Results

    Two patients from each group withdrew before the study ended. In total, 38 women in each group were assessed. There were no significant differences in age, duration of surgery, and the amount of administrated opioids between the two groups. However, the number of patients who had nausea and vomiting differed significantly between the two groups (65% vs. 34%; P = 0.006).

    Conclusions

    Our findings showed that duloxetine was not effective in controlling pain after abdominal hysterectomy. In addition, patients who received duloxetine had a significantly higher rate of nausea/vomiting.

    Keywords: Pain, Duloxetine, Hysterectomy, Opioid Consumption
  • Fatemeh Javaherforooshzadeh *, MohammadReza Pipelzadeh, Reza Akhondzadeh, Sara Adarvishi, Mostafa Alghozat Page 5
    Background

    The benefit of sequential compression device (SCD) for the prevention of hypotension after spinal anesthesia in cesarean sections has not been determined.

    Objectives

    In this study, an attempt was made to determine whether SCD can prevent hemodynamic changes following spinal anesthesia for cesarean sections.

    Methods

    In a prospective clinical trial, 76 parturient women undergoing elective cesarean sections under spinal anesthesia were randomly divided into SCD or control groups. The maternal hemodynamic changes within 75 min after spinal anesthesia, nausea, vomiting, and neonatal Apgar score at 1 and 5 min were compared between the groups.

    Results

    There were no significant differences between the groups in the patients’ characteristics, maximum sensory block, skin incision to delivery time, spinal anesthesia to delivery time (min), and the total duration of surgery. Concerning heart rate changes, RM ANOVA showed a significant difference in the effect of time, groups, and the interaction of the two factors (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). Tukey post hoc test showed that 3 min after spinal anesthesia, diastolic blood pressure was significantly higher in the SCD group than in the control group (P < 0.05). The SCD group had meaningfully lower rates of nausea (P = 0.005) and vomiting (P = 0.001) than the control group. The SCD group also demonstrated a significantly lower mean ephedrine dosage per patient (4.1 mg against 17.1 mg, P = 0.001). However, no significant difference was observed between the groups in terms of neonatal Apgar scores at 1 and 5 minutes.

    Conclusions

    This study showed that SCD could reduce extensive changes in diastolic blood pressure as an important hemodynamic parameter and the incidence of nausea and vomiting. Thus, SCD can be used in spinal anesthesia care practices for elective cesarean sections.

    Keywords: Cesarean Section, Spinal Anesthesia, Hemodynamic Changes, Sequential Compression Device
  • Gelareh Biazar, Farnoush Farzi *, Yasmin Chaibakhsh, MohammadReza Habibi, Mahsa Khosousi Sani, Ladan Mirmansouri Page 6
    Introduction

    Meperidine is known as the gold standard drug for shivering after spinal anesthesia (SA). This drug has been used widely and safely during the Cesarean Section (CS).

    Case Presentation

    This case report presents an anaphylaxis reaction to a single intravenous dose of 25 mg meperidine, aiming to control shivering during CS under SA a few minutes after surgical incision.

    Conclusions

    The condition was well managed with timely intervention. This rare fetal reaction to meperidine is worthy of reporting to make the medical team aware of the potential risks of anaphylaxis due to many routine safe drugs.

    Keywords: Anaphylaxis, Meperidine, Cesarean Delivery
  • Sanam Dolati, Faezeh Tarighat, Fariba Pashazadeh, Kavous Shahsavarinia, Saina Gholipouri, Hassan Soleimanpour * Page 7

    Chronic kidney disease (CKD) is a global public health problem. Pain is one of the most generally experienced symptoms by CKD patients. Pain management is a key clinical activity; nonetheless, insufficient pain management by health professionals keeps it up. Opioids as pain relievers are a class of naturally-derived and synthetic medications. They act through interactions with receptors in peripheral nerves. Numerous pharmacokinetic alterations happen with aging that influence drug disposition, metabolism, and quality of life. Acetaminophen alone, or combined with low-potency opioid dose is regarded as the safest pain-relieving choice for CKD. Morphine and codeine are probably eluded in renal impairment patients and used with excessive carefulness. Tramadol, oxycodone, and hydromorphone can be used by patient monitoring, while methadone, transdermal fentanyl, and buprenorphine seem to be safe to use in older non-dialysis patients with renal impairment. Consistent with the available literature, the main aim of this review was to explore the occurrence of chronic pain and its opioid treatment in CKD patients. According to this review, more and well-made randomized controlled trials are necessary to find appropriate opioid doses and explore the occurrence of side effects.

    Keywords: Pain Management, Chronic Kidney Disease, Dialysis, Opioids
  • Ariel Clare Johnson, Salih Colakoglu, Angela Reddy, Clara .Marie Kerwin, Roland A. Flores, Matthew L. Iorio, David W Mathes * Page 8

    Context:

     High rates of mortality and chemical dependence occur following the overuse of narcotic medications, and the prescription of these medications has become a central discussion in health care. Efforts to curtail opioid prescribing include Enhanced Recovery After Surgery (ERAS) guidelines, which describe local anesthesia techniques to decrease or eliminate the need for opioids when used in a comprehensive protocol. Here, we review effective perioperative blocks for the decreased use of opioid medications post-breast reconstruction surgery. 

    Evidence Acquisition:

     A comprehensive review was conducted using keywords narcotics, opioid, surgery, breast reconstruction, pain pump, nerve block, regional anesthesia, and analgesia. Papers that described a local anesthetic option for breast reconstruction for decreasing postoperative narcotic consumption, written in English, were included.

    Results

    A total of 52 papers were included in this review. Local anesthetic options included single-shot nerve blocks, nerve block catheters, and local and regional anesthesia. Most papers reported equal or even superior pain control with decreased nausea and vomiting, length of hospital stay, and other outcomes.

    Conclusions

    Though opioid medications are currently the gold standard medication for pain management following surgery, strategies to decrease the dose or number of opioids prescribed may lead to better patient outcomes. The use of a local anesthetic technique has been shown to reduce narcotic use and improve patients’ pain scores after breast reconstruction surgery.

    Keywords: Breast Reconstruction, Opioid, Regional Anesthesia, Blocks, Non-narcotic
  • HamidReza Amiri, Solmaz Ohadian Moghadam, Seyed Ali Momeni, Majid Amini * Page 9
    Background

     Postoperative pain management can improve patients’ quality of life and decrease hospitalization rates. Preemptive analgesia may provide an effective approach for both pain control and opioid consumption decrease. A common approach for pain management after surgery is to relieve the pain that has already occurred.

    Objectives

     The aim of this clinical trial was to compare the preemptive analgesic effect of single-dose versus two-dose administration of pregabalin, acetaminophen, naproxen, and dextromethorphan (PAND) combination.

    Methods

     This study involved 60 patients who had undergone one surgery (including nephrectomy, cystectomy, prostatectomy, colectomy, Whipple, and RPLND). They were randomly divided into two groups: The first group received a single dose of PAND, while the other group received a second dose within 6 hours after discharge from recovery. Pain intensity was assessed by the Universal Pain Assessment Tool (UPAT) in both groups 2, 4, 6, 8, 12, 24, and 48 hours postoperatively. The postoperative morphine dose in both groups was also recorded. Data were analyzed using SPSS version 25.

    Results

     Mean pain scores were significantly different between the two groups at 2, 12, 24, and 48 hours after surgery (P < 0.05). There was a statistically significant difference between the two groups in terms of opioid consumption (P < 0.001). The total opioid consumption in the second group (with the second administration of PAND) was lower than the first group.

    Conclusions

     Preemptive analgesia with a second dose of PAND is an effective method for reducing pain and morphine consumption after surgery.

    Keywords: Postoperative Pain, Preemptive Analgesia, Major Surgeries
  • Mahzad Alimian, Masood Mohseni *, Omid Moradi Moghadam, Seyed Alireza Seyed Siamdoust, Javad Moazzami Page 10
    Background

    Earlier studies have suggested the liberal administration of fluids in favor of reducing the risk of rhabdomyolysis in obese patients, but the results are conflicting.

    Objectives

    The present study aimed at comparing the effects of liberal and restrictive fluid therapy on renal indices in laparoscopic gastric bypass surgery.

    Methods

    In a double-blinded randomized clinical trial, 72 candidates of bariatric surgery were randomly assigned into two groups of restrictive and liberal fluid therapy. Indices, including BUN, creatinine, creatine kinase, GFR, and urine output were measured before and 24 hours after the surgery. The clinical trial was registered at IRCT.ir under code IRCT20170109031852N3.

    Results

    There was no significant difference in BUN, creatinine, creatinine kinase, and GFR indices between the two groups of liberal and restrictive fluid therapy both before and 24 hours after surgery (P > 0.05). Intragroup comparisons before and after surgery revealed that BUN decreased in both groups after the surgery (P < 0.05). Also, creatinine and GFR values improved in patients who received a liberal fluid regimen, whereas these indices remained statistically unchanged in the restrictive group before and 24 hours after the surgery (P > 0.05).

    Conclusions

    Two methods of liberal and restrictive fluid therapy have comparable effects on traditional renal functional indices in laparoscopic bariatric surgery. The clinical significance of observed differences in outcomes should be investigated in further studies. The use of early biomarkers of acute kidney injury is warranted.

    Keywords: Surgery, Renal Function, Creatinine, Fluid Therapy, Gastric Bypass
  • Shahram Sayyadi, Masoomeh Raouf, Ali Arhami Dolatabadi, Marzieh Rostami, Elham Memary* Page 11
    Background

    Aspiration is one of the important complications of general anesthesia, although infrequent as well as accompanying high morbidity and mortality. The volume of gastric content is considered as a risk factor in this regard. Therefore, it is normally mostly recommend to consider proper fasting time before induction of general anesthesia.

    Objectives

    This study was conducted to assess the effect of metoclopramide on reducing gastric contents in patients with incomplete fasting before induction of general anesthesia.

    Methods

    This quasi-experimental study was conducted on patients with urgent surgical indications with incomplete NPO time. Every other patient received metoclopramide or placebo. Patients in the intervention group received 10 mg (2 ml) of intravenous metoclopramide, and patients in the control group received 2 ml of distilled water as a placebo. Patients in both groups underwent ultrasonography before starting surgery by an expert radiologist to calculate gastric antral grade (GAG) and cross-sectional antral area (CSA). These measurements were then taken for the second time 30 minutes after intervention, before starting the surgery. The values were compared statistically.

    Results

    The data of 60 patients were analyzed, of which 30 were in each group. The mean age, body mass index, type of the last consumed food (solid or fluid), NPO time in the two groups were not significantly different (P value > 0.05). The number of patients in the metoclopramide group with higher GAG (P value = 0.001) and the mean CSA (P value = 0.004) before the intervention was more than the control group. The GAG and mean CSA after intervention were not significantly different between the two groups; but the mean difference of decrease in CSA in the metoclopramide group was more than the control group (4.3 vs. 0.99; P value = 0.001), and changes of GAG after intervention to lower levels in the metoclopramide group was more than the control group (P value < 0.05).

    Conclusions

    In the current study in which ultrasonographic indexes, including GAG and CSA, were assessed as a suboptimal gastric emptying test method, it was found that metoclopramide could accelerate gastric emptying compared to placebo in patients with incomplete fasting before induction of general anesthesia.

    Keywords: Ultrasound, Respiratory Aspiration, Metoclopramide, Gastric Emptying, Gastrointestinal Contents
  • Mehdi Rajabi, MohammadReza Razavizade *, Maryam Hamidi Shad, Zohreh Tabasi, Hossein Akbari, Abbas Hajian Page 12
    Background

    Making stable hemodynamic and also durable unawareness is a daily challenge in the setting of general anesthesia in women who undergo surgical delivery of neonate and have limitations to receive opioids derivatives.

    Objectives

    We aimed to evaluate the effects of magnesium sulfate and clonidine on hemodynamic changes and depth of anesthesia and in mentioned mothers and also in neonatal APGAR index.

    Methods

    Current randomized, double-blind controlled trial study was conducted among a total of 360 pregnant females (38 - 41 weeks of gestation) who underwent elective cesarean section. Participants were randomly divided into three drug-receiving groups (equal 120 members): magnesium sulfate (30 mg/kg), clonidine (3 µg/kg), and placebo (0.9% NaCl). Patients’ blood pressure, heart rate, cerebral state index (CSI) in specific time zones, and also late 24-hour recall were recorded. The CSI is an electroencephalographic monitoring method helping to assess the depth of anesthesia. Neonatal parameters, including APGAR score and umbilical venous blood sampling, were measured.

    Results

    Mean patients’ age was 28 ± 4.5. A significant decreasing and stabilizing effect of magnesium sulfate and clonidine on hemodynamic parameters (blood pressure and heart rate) was revealed (P < 0.001). Evidence implied on deeper anesthesia (lower CSI) among drug receivers comparing to placebo (P < 0.001). None of the participants experienced a late 24-hour recall postoperatively. All neonates were healthy, and no decrease was reported in APGAR score at minutes 1 and 5. Umbilical blood gas analysis showed no signs of acidosis and/or hypoxemia.

    Conclusions

    Adjuvant administration of either magnesium sulfate or clonidine is associated with hemodynamic stability and favorable unawareness in the setting of elective surgical delivery.

    Keywords: Blood Pressure, Cesarean Section, Clonidine, General Anesthesia, Magnesium Sulfate, Hemodynamic
  • Dawood Agha Mohammadi, Eissa Bilehjani, Haleh Farzin, Solmaz Fakhari *, Masoud Naderpour Page 13
    Background

    Postoperative pain is a common problem after middle ear surgery. Several analgesic agents are available for pain relief, but they cause numerous side effects. Therefore, complementary analgesic methods are developed to reduce patient’s postoperative pain and discomfort.

    Objectives

    The current study aimed to investigate the effect of the acupressure on post middle ear surgery pain, applying pressure on the Yinmen acupoint of the sciatic nerve.

    Methods

    In this randomized clinical trial, 100 adult patients who were candidate for elective middle ear surgery were selected and divided into two groups of Yinmen and placebo, each with 50 subjects. After admission to the ward, patients’ postoperative pain score was measured using the visual analog score (VAS) tool. Then, patients were placed in the prone position. In the Yinmen group, using a fist, we applied a continuous pressure (11 - 20 kg) to the posterior aspect of the thighs at the Yinmen acupoint for 2 minutes. In the placebo group, only soft contact was kept between the fist and Yinmen point for the same period. The maneuver repeated every two hours for four times. The pain intensity surveyed 10 minutes after the first maneuver, then every hour for 8 hours. For those with a VAS score ≥ 4, intravenous paracetamol and/or meperidine was administered. Any nausea and vomiting was managed using ondansetron 2 mg, IV. The pain score, paracetamol, and meperidine consumption were recorded and compared between the two groups. The chi-square and student t-tests were used to compare the two groups.

    Results

    No significant difference was found between patients’ characteristics and the first pain score. For all measurements, pain intensity was lower in the Yinmen group (P value < 0.01). The pain after the first maneuver was relieved exactly when the acupressure was true. The intervention could reduce patients’ need to take paracetamol (6.68 ± 2.58 vs. 10.42 ± 3.87 mg/kg) and meperidine (0.21 ± 0.17 vs. 0.39 ± 0.23 mg/kg) in the Yinmen group. The two groups were not significantly different concerning the need to take ondansetron to manage postoperative nausea and vomiting.

    Conclusions

    Applying 2 minutes pressure (11 - 20 kg) on the Yinmen acupoint of the sciatic nerves can reduce post middle ear surgery pain and analgesic consumption.

    Keywords: Acupressure, Postoperative Pain Management, Yinmen Acupoint, Middle Ear Surgery
  • Saghar Samimi Sadeh, Elham Hashemi, Reza Aminnejad, Ehsan Bastanhagh* Page 14
    Background

    Following surgery, patients frequently suffer from shivering, and this can lead to postoperative complications and discomfort.

    Objectives

    This study aimed to compare the effect of ketamine on patients’ shivering following an elective abdominal hysterectomy. Patients were given either Ketamine (0.25 mg or 0.5 mg/kg) or a placebo. The study and surgery took place in a subspecialty University Hospital for Gynecology and Obstetrics.

    Methods

    This study was an interventional, randomized, controlled clinical trial. Ninety-six women who underwent elective abdominal hysterectomy were randomly assigned to three groups. Ketamine was administered to all participants 20 min prior to the end of surgery. The first group received 0.25 mg/kg of intravenous ketamine. The second group received 0.5 mg/kg intravenous ketamine. The third group received a placebo of intravenous saline. Postoperative shivering, sedation grade, hallucination, nausea, vomiting, and nystagmus were measured for each patient up to 30 minutes.

    Results

    The study showed that patients suffered from less shivering in the two groups that received ketamine. The reduced shivering was seen 5, 10, and 20 min following surgery in the two groups that were given two doses of 0.25 and 0.5 mg/kg ketamine compared to the control group (P value < 0.05). There was a significant difference between patients receiving normal saline and those having 0.25 and 0.5 mg/kg of ketamine in the rate of sedation grade, nausea, vomiting, and nystagmus (P value < 0.05). The main differences in patients receiving ketamine were the sedation grade at zero time and postoperative hallucination experienced by those patients who received 0.5 mg/kg of ketamine.

    Conclusions

    Ketamine reduced shivering in all patients following elective abdominal hysterectomy. This was regardless of dose. Patients were less likely to suffer from hallucinations and sedation grade with a lower dose of ketamine (0.25 mg/kg compared to 0.50 mg/kg).

    Keywords: Ketamine, Hallucination, Abdominal Hysterectomy, Postoperative Shivering
  • Poupak Rahimzadeh, Saied Amniati, Reza Farahmandrad, Seyed HamidReza Faiz*, Setareh Hedayati Emami, Azadeh Habibi Page 15
    Background

    Knowledge about clinical features of critically ill patients with COVID-19 still lacks adequate information up to now.

    Objectives

    We aimed to describe and compare the epidemiological and clinical characteristics of critically ill patients with COVID-19 in Rasoul Akram Hospital.

    Methods

    In this case series, 70 critically ill patients with COVID-19 admitted in ICU wards of Rasoul Akram Hospital, Tehran, Iran, from 29 February to 25 April 2020 were enrolled. Demographic and clinical characteristics, laboratory data, and outcomes of the patients were all collected and compared between deceased and recovered patients.

    Results

    Fifty-six cases had died of COVID-19, and 14 patients had fully recovered and discharged. The median age of the patients was 68 years old, ranging from 22 to 91 years, 66% were men, 80% had one or more comorbidities, and hypertension was the most common comorbidities (45% of deceased cases). The most common signs and symptoms at the onset of illness were SPO2 depression (92%) and dyspnea (90%). Dyspnea was significantly more common in deceased patients (95%) than recovered patients (70%) (P = 0.048). Most patients had lymphopenia (80%). The number of patients who needed mechanical ventilation in the deceased patients was 53 (95%), which was significantly more than the recovered patients (10 [70%]) (P = 0.048).

    Conclusions

    The mortality rate of critically ill patients with COVID-19 is very high, and the patients with dyspnea and required mechanical ventilation are at higher risk for death.

    Keywords: Mortality, ICU, Critically Ill, Pandemic, COVID-19
  • Farnad Imani, Kokab Hejazian, MohammadReza Kazemi, Mahnaz Narimani Zamanabadi*, Khalid M Malik Page 16
    Background

    Prolotherapy, as an alternative therapy, has emerged as an effective treatment for chronic musculoskeletal injury, including knee osteoarthritis (OA). Several studies have mention ozone as a potential treatment for these diseases, which is based on analgesic, anti-inflammatory, and anti-oxidant.

    Objectives

    The current study aimed to investigate the effect of adding ozone gas to hypertonic dextrose and somatropin for knee prolotherapy in patients with knee OA. For this purpose, pain, knee stiffness, and physical activity are measured.

    Methods

    Sixty patients with chronic knee OA were randomly assigned into two groups of DS and DSO. The DS group received intra-articular hypertonic dextrose (10 ml) plus 4 IU somatropin (4 IU), and the DSO group received 10 ml ozone 25 mcg plus intervention in the DS group. This procedure was performed three times (first, third, and fifth weeks). WOMAC score was examined during the third, fifth, and sixteenth weeks.

    Results

    The mean WOMAC score of the DS group was decreased significantly (P < 0.001) sixteen weeks after providing the intervention (before 64.9 ± 10.6, vs. after 49.2 ± 9.0). A similar decrease (P < 0.001) was observed in the DSO group (before 64.1 ± 11.3, vs. after 41.3 ± 8.0). The decrease of the WOMAC score in the third and sixteenth weeks after providing the intervention was significant in the DSO group compared to the DS group (P < 0.005).

    Conclusions

    For patients with knee OA, prolotherapy with ozone plus hypertonic dextrose and somatropin was more effective in sedating the pain and improving the stiffness and function of the knee than dextrose and somatropin alone.

    Keywords: Knee, Osteoarthritis, Dextrose, Prolotherapy, Ozone, Somatropin