Investigating the Characteristics of Tramadol-induced Seizures: A Cross-sectional Study

Background: According to statistics, tramadol intoxication is one of the most common drug poisoning cases in Iran. Because seizure is one of the severe and dangerous side effects of tramadol, the present study aimed to investigate the characteristics of tramadol-induced seizures. Methods: In this cross-sectional descriptive study, all patients who referred to the emergency departments due to the tramadol-induced seizures were examined by the census method. The patients’ data were collected with a checklist. Then, the data were analyzed with descriptive and inferential statistical tests in SPSS v. 23 and at a significant level of P<0.05. Results: In this study, 350 patients (52.9% male, and 47.1% female) were examined. The Mean±SD dose consumed was 1171.4±802.77 mg. The minimum dose that caused the seizure was 200 mg, and the average dose consumed of tramadol was different in patients who had one, two, or three seizures outside the hospital (P=0.002). The consumed average dose of tramadol was 1144.5 mg, 2017.7 mg, and 511.1 mg for patients who had one, two, or three seizure(s), respectively. There was a significant relationship between dose consumed and the number of seizures (P=0.001). The study showed that patients who had a one-time seizure, have experienced this condition outside the hospital. There was a significant relationship between the number of seizures and the location of the seizure (outside or inside the hospital) (P=0.001). Conclusion: The results showed no significant relationship between consumed dose and location of the seizure. The number of seizures is not dependent on the consumed dose. It means that increasing the consumed dose, the number of seizures does not increase, and there is no significant relationship between the amount of dose consumed and the number of seizures

Acupressure has not an analgesic effect in patients with renal colic: a randomized controlled trial

BACKGROUND Easing renal colic (RC) pain is of the most important issues in the emergency departments. This study was conducted to investigate the analgesic effects of intravenous paracetamol in comparison to acupressure and intramuscular diclofenac in patients with RC. METHODS This randomized clinical trial was conducted on 96 eligible patients with RC, visiting the Emergency Department of Imam Reza Hospital of Mashhad, Iran. The participants were selected by consecutive non-random sampling method, and were randomized in three groups, each comprising of 32 participants. The first and second groups received 75 mg intramuscular diclofenac and lg intravenous paracetamol, respectively. In the third group, three acupressure points were manually stimulated for six minutes. The pain score was measured by Visual Analog Scale for pain at baseline and after 10, 30, and 60 minutes. Collected information analyses by SPSS version 20 and interpreted using descriptive statistics (frequency, percentage) and inferential statistics (chi-square test). RESULTS The mean age was 31.60 +/- 7.42 years (range:18-50). The two methods (diclofenac and paracetamol groups) were significantly better in pain reduction compared to acupressure after 10 minutes (p<0.001). Ninety four percent of participants in diclofenac group, 87% of paracetamol group and none of acupressure group were completely satisfied with their treatment method (p<0.001). CONCLUSION This study demonstrated that acupressure did not effectively reduces renal colic pain. It seems that contrary to acupressure, intravenous paracetamol is a safe and effective analgesic medicine for patients with RC.Mashhad University of Medical SciencesOpen access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Pain management in emergency department: intravenous morphine vs. intravenous acetaminophen

Pain is the most common complaint in emergency department and there are several methods for its control. Among them, pharmaceutical methods are the most effective. Although intravenous morphine has been the most common choice for several years, it has some adverse effects. There are many researches about intravenous acetaminophen as an analgesic agent and it appears that it has good analgesic effects for various types of pain. We searched some electronic resources for clinical trials comparing analgesic effects of intravenous acetaminophen vs. intravenous morphine for acute pain treatment in emergency setting.In two clinical trials, the analgesic effect of intravenous acetaminophen has been compared with intravenous morphine for renal colic. The results revealed no significant difference between analgesic effects of two medications. Another clinical trial revealed that intravenous acetaminophen has acceptable analgesic effects on the post-cesarean section pain when combined with other analgesic medications. One study revealed that administration of intravenous acetaminophen compared to placebo before hysterectomy decreased consumption of morphine via patient-controlled analgesia pump and decreased the side effects. Similarly, another study revealed that the infusion of intravenous acetaminophen vs. placebo after orthopedic surgery decreased the consumption of morphine after the surgery. A clinical trial revealed intravenous acetaminophen provided a level of analgesia comparable to intravenous morphine in isolated limb trauma, while causing less side effects than morphine.It appears that intravenous acetaminophen has good analgesic effects for visceral, traumatic and postoperative pains compare with intravenous morphine

Drug-induced prolonged corrected QT interval in patients with methadone and opium overdose

Abstract Background Iran is a country with the highest rate of opioid addiction in the world. The most commonly used opioid in Iran is opium, and methadone is in second place. The trend of drug use has changed from opium to methadone from 2006 to 2011. Presence of a large number of addicted people and methadone maintenance therapy clinics make methadone readily available in Iran. Therefore, evaluation of the epidemiological characteristic of methadone toxicity and its effects on the heart is essential. Methods In This cross-sectional, retrospective, descriptive, analytical study all patients with methadone or opium toxicity who had been admitted to Vasei hospital, Sabzevar, Iran, during the years 2015 and 2016 were included, and their records were evaluated. Demographic data, addiction history, underlying diseases, and the outcome of admission were recorded. Then, corrected QT interval (QTc) of the first ECG of the patients after admission was evaluated. Results The Majority of toxicities occurred in those above 30 years of age (71.4%), who lived in cities (62.8%), and were married (69.2%). A positive history of addiction was considerably higher in the opium group (72.3% versus 43.3%). There was no significant difference regarding QTc prolongation between patients with methadone and opium toxicity (p = 0.3). Conclusion QTc prolongation is one of the adverse effects of methadone or opium overdose. It seems that significant QTc prolongation is not uncommon among patients with opium overdose

Downward Trend in Maternal Mortality Ratio in Khorasan Razavi Province, Iran

Background & aim: Maternal mortality is defined as the death during pregnancy or up to 42 days postpartum. This study sought to determine the trend of maternal mortality ratio (MMR) and its associated factors in Khorasan Razavi province, Iran. Methods: This retrospective cross-sectional study was conducted in Khorasan Razavi Province, North East of Iran, during 2010 to 2014. Data was collected from the reports of Maternal Mortality Committee of Mashhad University of Medical Sciences, Mashhad, Iran. The MMR was calculated for each period, and its trend was estimated. Chi-square test was used to find the relationship between mode of delivery and direct or indirect causes of maternal death. Results: According to the results, 94 maternal deaths occurred during 2010 to 2014. The total MMR was 17.68 (95%CI: 13.59-21.77) per 100,000 live births. The mean maternal age was 30.7±6.1 years old. Most of the deaths (75.6%) occurred during postpartum period, from which 81% happened following a high-risk pregnancy. In addition, 50% of the mothers had proper numbers of visits during pregnancy. The most direct and indirect causes of maternal death were maternal hemorrhage (24.5%) and cardiovascular diseases (12.8%), respectively. The relative risk of maternal mortality associated with cesarean section was 1.3 in comparison to normal vaginal delivery. Conclusion: The estimation of MMR is essential for decision-making and resource allocation. To reach this goal, a good registration system is needed to register all deaths and their exact causes

میزان رضایتمندی بیماران از خدمات بخش اورژانس؛ یک مرور سیستماتیک: میزان رضایتمندی بیماران از خدمات بخش اورژانس

Introduction: Recently, patients' satisfaction with the delivery of medical services in the emergency departments of hospitals has received much attention. Therefore, this systematic review study was conducted to evaluate patients' satisfaction with services provided in the emergency department. Methods: The present study is a systematic review. Studies on the level of satisfaction of patients with the services provided in the emergency department published in Persian were searched for, using Persian keywords meaning "satisfaction", "emergency department", and "services provided in emergency department". Searches were performed in Google scholar, Sid, and Magiran databases to find studies published from 2001 to 2020 and retrieved studie were examined using the Prisma checklist. Results: After searching for, screening, and qualitatively evaluating the studies for the systematic review, in the end, the final synthesis was performed on 24 articles. Among the studied articles, the level of satisfaction with the services provided in the emergency department was desirable in 20, unfavorable in 2, and not mentioned in two. The highest level of satisfaction with the services provided in the emergency department was mostly related to the services provided by doctors and nurses and the way the doctor treated them. Additionally, the lowest level of satisfaction was related to welfare facilities and the physical environment of the emergency department and the security not treating the patients properly. Conclusion: The results of the present study showed that patient satisfaction was at a desirable level in most studies. Assessing the level of patient satisfaction can increase the awareness of the relevant authorities about the current situation in hospital emergency departments. It also reveals the weaknesses in providing services to patients and helps the relevant authorities to eliminate the shortcomings and improve the quality and quantity of services.مقدمه: امروزه رضایتمندی بیماران از نحوه ی ارائه ی خدمات درمانی در بخش اورژانس بیمارستان ها، بسیار مورد توجه قرار گرفته است. لذا این مطالعه با هدف بررسی میزان رضایتمندی بیماران از خدمات بخش اورژانس به صورت یک مطالعه مرور سیستماتیک انجام شد. روش کار: مطالعه حاضر یک مرور نظام مند می باشد. مطالعاتی که به زبان فارسی در مورد میزان رضایتمندی از خدمات بخش اورژانس منتشر شده است با کلمات کلیدی "رضایتمندی"، "بخش اورژانس"، "خدمات بخش اورژانس" &nbsp;جستجو و با استفاده از چک لیست پریسما مورد بررسی قرار گرفت. مرور مطالعات در محدوده زمانی سال 1380 تا سال 1399 در پایگاه داده های . یافته ها: پس از جستجو، غربالگري و ارزيابي كيفي مطالعات در طي مرور سيستماتيك، در پايان سنتزنهايي بر روي 24 مقاله انجام گرفت. از میان مطالعات مورد بررسی؛ میزان رضایتمندی از خدمات بخش اورژانس، 20 مورد مطلوب، 2 مورد نامطلوب و دو مورد ذکر نشده بود. بالاترین میزان رضایتمندی از خدمات بخش اورژانس بیشتر مربوط به خدمات ارائه شده توسط پزشکان و پرستاران و نحوه برخورد پزشک می باشد. همچنین کمترین میزان رضایتمندی مربوط به امکانات رفاهی و محیط فیزیکی بخش اورژانس و عدم برخورد مناسب نگهبانان با بیماران می باشد. نتیجه گیری: نتایج مطالعه حاضر نشان داد که میزان رضایتمندی در اکثر مطالعات مورد بررسی در سطح مطلوب قرار دارد. بررسي میزان رضایتمندی بیماران ميتواند آگاهي مسئولین مربوطه را نسبت به وضعیت موجود در اورژانس بیمارستانها افزایش دهد. همچنین نقاط ضعف در ارائه خدمات به بیماران را آشكار ساخته و به مسئولین مربوطه در برطرف کردن کاستي ها کمک نموده و موجب ارتقا سطح کمي و کیفي خدمات شود