Intravenous Drug Sedation for MRI in Children; A Randomized Controlled Trial

Introduction; Performing MRI in children is a matter of concern and needs adequate sedation because patients should be completely motionless to provide a good quality of imaging.  The aim of this study was to compare the effects of Nesdonal and Propofol + Lidocaine to provide sedation in children undergoing brain MRI.Methods; This was a randomized, blinded trial including 250 patients aged 3 months to 13 years who were candidate for elective brain MRI. Participants were divided into two groups. Group 1 received Nesdonal and group 2 received Propofol + Lidocaine. Demographic characteristics were recorded. Unconsciousness time, scan time and discharge time were compared between the two groups. Data was analyzed using SPSS version 16 by Chi-square, ANOVA, Man-Whitney and T-test (p value < 0.05).Results; Totally 250 patients were assigned randomly to two groups of Propofol + Lidocaine and Nesdonal, each including 125 patients. There was no meaningful difference regarding demographic factors of age, gender or ASA class between the two groups. There was no meaningful statistically difference regarding unconsciousness time (P value=0.655), scan time (P value=0.324) and discharge time (P value=0.436) between the Propofol + Lidocaine and Nesdonal group. Some minor adverse effects occurred in the Propofol + Lidocaine group. No major complication occurred.Discussion; Nesdonal was superior to Propofol + Lidocaine regarding lower adverse effects, lower costs, no need for an infusion pump and not lowering seizure threshold.it can be considered safe for sedation in children undergoing brain MRI, especially those with a history of seizure

Porównanie wpływu leczenia metforminą i insuliną na kontrolę glikemii u krytycznie chorych pacjentów

Introduction: It is accepted that preventing hyperglycaemia during critical illness while assuring adequate caloric intake can reduce mortality and morbidity. The aim of this study was to compare the metabolic effects of metformin and insulin on hyperglycaemia in ICU patients. Methods: This double-blind randomised clinical trial was performed on 24 patients who were admitted to the intensive care unit (ICU) from 20 March to 20 September 2007. All patients with serious injuries or with major non-abdominal surgeries were included if they met the inclusion criteria, and were assigned randomly to one of the study groups. Patients in Group 1 received intensive insulin therapy, and patients in Group 2 were treated with metformin. Moreover, the Acute Physiology And Chronic Health Evaluation (APACHE) II scoring system was used to grade disease severity. Results: Both glycaemic management protocols led to significantly improved glucose levels without any report of hypoglycaemia. The mean initial glucose levels for the insulin group decreased significantly after the intravenous infusion of insulin (p < 0.001). Additionally, the blood glucose concentration was significantly lower after two weeks of metformin administration compared to baseline measurements (p < 0.001). Moreover, the blood glucose concentration decrease during these two weeks was significantly higher in the insulin group (p = 0.01). Besides, APACHE II score was lower than baseline at the end of the study for both therapeutic groups (score of 10 vs. 15 [insulin] and 16 [metformin]). Finally, new renal dysfunction (maximum serum creatinine level at least double the initial value) was observed in three of the patients (two patients from the metformin group and one from the insulin group) in the last days of the protocol, although none of the patients showed lactic acidosis after ICU admission. Conclusions: Both metformin and intensive insulin therapy significantly decreased hyperglycaemia in ICU patients. Insulin caused a greater reduction in blood glucose concentration but required more attention and trained personnel.Wstęp: Dowody naukowe wskazują, że zapobieganie hiperglikemii u osób w stanie krytycznym przy zapewnieniu odpowiedniego poboru kalorii może zmniejszyć śmiertelność i chorobowość. Celem niniejszego badania było porównanie wpływu metforminy i insuliny na występowanie hiperglikemii u pacjentów leczonych na oddziale intensywnej opieki medycznej (OIOM). Materiał i metody: Badanie z randomizacją przeprowadzone metodą podwójnie ślepej próby obejmowało 24 chorych przyjętych na OIOM w okresie od 20 marca do 20 października 2007 roku. Wszystkich pacjentów z ciężkimi obrażeniami lub po poważnych zabiegach chirurgicznych niedotyczących jamy brzusznej, którzy spełniali kryteria włączenia, przydzielono losowo do jednej z grup terapeutycznych. U chorych przydzielonych do grupy 1. stosowano intensywną insulinoterapię, natomiast chorym z grupy 2. podawano metforminę. Do oceny ciężkości stanu chorych wykorzystano skalę APACHE (Acute Physiologic Assessment and Chronic Health Evaluation) II. Wyniki: Oba protokoły leczenia hipoglikemizującego spowodowały istotną poprawę wyrównania glikemii, przy czym nie odnotowano żadnego przypadku hipoglikemii. W grupie stosującej insulinoterapię średnie stężenie glukozy obniżyło się istotnie w stosunku do wartości wyjściowych po dożylnym wlewie insuliny (p < 0, 001). U osób leczonych metforminą po 2 tygodniach przyjmowania leku stężenie glukozy we krwi było istotnie niższe od poziomu wyjściowego (p < 0,001). Redukcja stężenia glukozy w ciągu tych 2 tygodni była istotnie większa w grupie przyjmującej insulinę (p = 0,01). W obu grupach terapeutycznych punktacja w skali APACHE II w momencie zakończenia badania była niższa od wartości wyjściowych (10 punktów v. 15 [insulina] i 16 [metformina]). U 3 chorych (2 osoby przydzielone do leczenia metforminą i 1 osoba przydzielona do insulinoterapii) zaobserwowano rozwój niewydolności nerek de novo (maksymalne stężenie kreatyniny w surowicy co najmniej 2-krotnie większe od wartości wyjściowych) w ostatnich dniach stosowania protokołu leczenia hipoglikemizującego, chociaż u żadnego z pacjentów nie stwierdzono kwasicy mleczanowej po przyjęciu na OIOM. Wnioski: Zarówno leczenie metforminą, jak i intensywna insulinoterapia istotne zmniejszają hiperglikemię u pacjentów na OIOM. Insulina powoduje większą redukcję stężenia glukozy, jednak jej stosowanie wymaga większej uwagi, a personel medyczny musi być odpowiednio przeszkolony

The maternal and neonatal outcomes of pregnant women with definite COVID-19

Background: This study aimed to assess the symptoms and clinical laboratory data of pregnant women with COVID-19 in their second or third trimester of pregnancy as well as their maternal and neonatal outcomes. Methods: This retrospective observational study was conducted on 177 pregnant women with COVID-19 who were admitted to Yas hospital (affiliated with Tehran University of Medical Sciences), and Ali-ibn-Abi-Talib hospital (affiliated with Zahedan University of Medical Sciences). Results: There was significant higher complaints including fever (p-value=0.015), cough (p-value=0.028), fatigue (p-value=0.002), dyspnea (p-value=0.022), and lower hemoglobin level (p-value=0.009) in patients who were in their third trimester compared to those who were in their second trimester. 9.6% (n=17) of the patients had severe disease and needed ICU admission. There was a significant variation regarding gestational age (p-value=0.022) in pregnant women admitted to ICU compared to the other ones. During the study, delivery happened in 108 (61%) pregnant women. Fetal distress following meconium deification (p-value=0.041), need to MGSO4 (p-value=0.001), IUFD (p-value=0.006), need for blood transfusion (p-value=0.004), and neonatal death (p-value<0.001) were significantly higher in patients who needed ICU admission. Conclusion: Higher gestational weeks are the main risk factor for severe COVID-19 disease. Although vertical transmission is rare; due to the higher risk of perinatal outcomes, the delivery should be done in a center with a NICU department

Mechanisms of action of ginger in nuclear factor-kappaB signaling pathways in diabetes

Diabetes mellitus is considered a metabolic disorder characterized by high blood sugar. Active disease is associated with low grade chronic inflammation resulting from the enhanced release of inflammatory mediators such as interleukin (IL)-1 β, IL-6, induced nitric oxide synthase, and cyclooxygenase-2 enzymes that lead to insulin resistance and disease progression. Nuclear factor kappa-B (NF-κB) is a key mediator involved in the inflammatory process which plays an important role in the inflammatory pathogenesis of diabetes. Based on recent evidence, ginger—which contains many phytochemicals—is believed to exert anti-inflammatory properties through multiple mechanisms, such as probably inhibiting the activation of NF-κB signaling pathway. It can thus be a target agent in the treatment and control of diabetes. It appears that ginger may be a complementary agent in diabetes treatment by targeting the NF-κB cascade pathway and exerting antioxidant or anti-inflammatory actions. In this context, this review aims to present the recent evidence regarding the mechanisms of action of ginger in NF-κB signaling pathways in diabetes mellitus

Translation, cross-cultural adaptation and validation of the Persian version of selected PROMIS measures for use in lumbar canal stenosis patients

BACKGROUND: The National Institutes of Health (NIH) developed a new measurement system called the Patient-Reported Outcomes Measurement Information System (PROMIS) which can be used for multiple health conditions. The 29-item short form (PROMIS-29) with seven domains was more often used by clinical researchers to measure the physical function, mood and sleeping status of patients with low back pain (LBP). Translation of the PROMIS into multiple languages and adaptation of its application in different cultural diversities can help to further standardize clinical research studies and make them comparable to each other. This study aimed to cross-culturally adapt the PROMIS-29 into Persian (P-PROMIS-29) and evaluate the construct validity and reliability of the translated questionnaire among patients with lumbar canal stenosis. MATERIALS AND METHODS: The translation was conducted by using the multilingual translation methodology guideline. Construct validity, internal consistency, and test–retest reliability at a two-week interval for the P-PROMIS-29 were calculated. Construct validity was assessed by calculating correlations between the P-PROMIS-29 with Oswestry Disability Index (ODI) and Roland–Morris results. RESULTS: The study sample included 70 participants with lumbar canal stenosis. Internal consistencies were moderate to good with Cronbach's alpha ranging from 0.2 to 0.94. The test–retest reliability evaluation was excellent with intraclass correlation coefficients (ICCs) ranging from 0.885 to 0.986. Construct validity of different domains of P-PROMIS-29 were moderate to good, with Pearson's correlation coefficient results ranging from 0.223 to 0.749. CONCLUSION: Our results showed that P-PROMIS-29 is a valid and reliable measurement tool for evaluation of patients with lumbar canal stenosis