Dexmedetomidine Mechanism of Action: an update

Dexmedetomidine (PRECEDEX) is an imidazole derivative that is a highly selective a2 receptor agonist. Activation of the a2 adrenergic receptors by dexmedetomidine leads to both sedation and analgesia; with negligible respiratory and cardiovascular side effects. The drug is likely to be increasingly used for sedation and as an anesthetic adjunct

Inadvertent Transfusion of Two Incompatible Blood Units: A Case Report

Background: An incompatible blood transfusion may lead to hemolytic transfusion reactions and severe complications such as intravascular hemolysis, multiorgan failure, and even death. Prevention, early diagnosis, and treatments have the main roles to decrease transfusion complications. Cases Report: We present a case of a 43-year-old woman with a history of mandibular malignancy and facial reconstruction surgery who needed to blood transfusion due to a hemorrhage around her tracheostomy, and inadvertently 2 units of incompatible blood were transfused. The errors conduce to this issue and consideration to prevent and manage incompatible blood transfusions are discussed. Conclusion: This case showed that an effective technique for recognizing and avoiding transfusion mistakes is staff awareness of the potential errors at the bedside and in the laboratory. Furthermore, patients’ immunological status, early detection, and recognition of blood transfusion manifestation are critical factors for early diagnosis and treatment

Investigating the Level of Troponin I and its Association With Mortality in Patients With Sepsis, Severe Sepsis, and Septic Shock

Objectives: To investigate the level of troponin I and its association with mortality in patients with sepsis, severe sepsis, and septic shock. Materials and Methods: In general, 148 patients with sepsis, severe sepsis, and septic shock admitted to Kowsar hospital of Semnan in 2017-2019 were recruited in this study. Serum troponin levels were measured during the first 24 hours of admission. The second measurement was done in the next 48 hours, which aimed at increasing the likelihood of positive troponin over time. However, if the troponin was positive just once, the patient would be in the category of positive troponin. In addition, the patient’s prognosis was recorded within 30 days. Results: Based on the results, 27.7% had troponin levels higher than normal. The mortality rate in patients with normal and abnormal levels of troponin was 5.6% and 17.1%, respectively, which was a significant difference. The age of dead patients was significantly higher than the age of the living patients and the results showed that among the variables of gender, normal or abnormal level of troponin, age, and type of underlying infection, only age had a significant relationship with patients’ vital status. Conclusions: High levels of troponin were not effective in determining the prognosis of patients with sepsis, and only age had a significant relationship with patients’ vital status while the confirmation or rejection of this hypothesis will need further studies

Efficacy of High Dose Vitamin C, Melatonin and Zinc in Iranian Patients with Acute Respiratory Syndrome due to Coronavirus Infection: A Pilot Randomized Trial

INTRODUCTION: Our aim was to investigate the efficacy of vitamin C, melatonin, and zinc in patients with severe Covid-19. METHODS:  Twenty-one adult patients were randomized 1:1 to standard care alone or standard care plus IV vitamin C (2 g, q6hr), oral melatonin (6 mg, q6hr), and oral zinc sulfate (50 mg, q6hr) for 10 days. Patients were monitored for changes in hypoxemia and inflammatory markers. RESULTS: Both treatment modalities were effective to improve PaO2/FiO2 and oxygen saturation. However, there were no significant differences between 2 groups (P > 0.05). There were reductions in CRP, ESR, and LDH levels in both study groups, although not significant. No significant difference was noted in length of ICU stay between 2 groups (P = 0.3). CONCLUSION: Our study suggests that addition of vitamin C, melatonin, and zinc to standard care is not associated with considerable improvement in patients with severe Covid-19.&nbsp

Neurologic Manifestations of COVID-19: A Case Series of Iranian Patients

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is declared a pandemic disease by the World Health Organization. Although the respiratory and cardiovascular systems are preferentially affected by SARS-CoV-2, many patients have been presented with neurologic symptoms. In this report, we describe COVID-19 patients with neurological manifestations. Case Presentation: We present 14 patients referred to Semnan Kowsar Hospital. The mean age at presentation was 54.25 ± 20.01 years with a range of 24-84 yr. At admission, they had mild symptoms of respiratory involvement. In contrast, they had a wide range of neurological conditions like impaired consciousness, seizure, stroke, ataxia, and muscle numbness. After hospitalization, they developed overt respiratory symptoms. They were positive for COVID-19 confirmed by real-time PCR. All cases received standard care of COVID-19. Conclusions: During the SARS-CoV-2 pandemic disease, patients with neurological manifestations might be affected by coronavirus. Such patients should be thoroughly evaluated and followed-up