Dexmedetomidine in Neurocritical Care

Early and appropriate management of brain insults has significantly reduced patient morbidity and mortality. Neuromonitoring, neuroprotection and secondary brain injury prevention are the essential principals of brain injury management. In this literature review we have elaborated the neuroprotective role of dexmedetomidine (DEX), predominantly in different animal models of brain insults and reports in patients cared in a neurocritical care setting.  We undertook an electronic literature search of articles published in English prior to July 2019. This search resulted in inclusion of 59 studies from medical databanks such as PubMed, Scopus, EMBSCO, CINAHL, ISC and the Cochrane Library. The keywords used were brain, α2 agonist, neurocritical care and dexmedetomidine. DEX may have a neuroprotective effect in a broad spectrum of brain pathologies such as traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), ischemic stroke, intracerebral hemorrhage (ICH), and cerebral hypoxia. However, its neuroprotective role in status epilepticus (SE) is less clear. Further animal and human studies are needed before we could consider DEX as a neuroprotective agent in this patient population. Due to its favorable properties outlined in this review, DEX could be considered a favorable sedative agent in the neurocritical care settings

Concomitant COVID-19 and acute ischemic stroke in patients transferred by emergency medical service during first wave of pandemic in Tehran, Iran; a cross-sectional study

Objective: We conducted this study to evaluate the prevalence of concomitant COVID-19 in acute ischemic stroke (AIS) patients admitted to stroke centers of Tehran, Iran. Methods: We conducted a retrospective cross-sectional study in a 45-day period. AIS patients transferred by emergency medical service (EMS) to all medical centers of the city were included. Information was recorded and compared in two groups: patients who tested positive for COVID-19 and those who were negative. Result: Emergency medical technicians (EMTs) screened 348 patients as AIS cases, of whom, AIS was ultimately confirmed in 311 (89.4%) patients; and 58 (18.6%) of the 311 AIS patients were diagnosed with concomitant COVID-19 infection. The National Institutes of Health Stroke Scale (NIHSS) scores of COVID-19 positive AIS patients were significantly higher than non-COVID-19 AIS patients (16.3±3.7 vs. 11.8±4.3; p<0.001). There was also a significant difference in length of hospital stay between the two groups (11.1±1.8 vs. 8.8±4.3 days; p<0.001). However, data showed no significant difference regarding prevalence of in-hospital mortality between the two groups (1.6% vs. 3.5%; p=0.320). Conclusion: Our study results showed that AIS patients with concomitant COVID-19 infection had higher NIHSS scores and longer length of hospital stay compared to patients without concomitant COVID-19 infection

Predictor factors for sepsis diagnosis, length of ICU stay and mortality in ICU

Introduction: In a prospective study, we aimed to assess the value of enhanced RDW to predict sepsis and evaluate factors affecting length of ICU stay and in-hospital mortality among sepsis patients. Material and Method: After exclusion of 27 patients, we included 160 adult patients with suspicious sepsis admitted at university affiliated Hospital with 33 ICU-beds from 2010 to 2012. Nighty patients were diagnosed with sepsis and the source of infection was defdined. Receiver–operating characteristic (ROC) curves were used to examine the sepsis predictions from RDW, APACHE II scores, and combination of them. The primary endpoint of this analysis was ICU mortality. The secondary endpoints were length of stay at ICU and hospital.A linear regression analysis was used to study risk factors for longer ICU stay and we used Logistic regression analysis to predict factors affecting in-hospital mortality. Results: The addition of elevated RDW value to APACHEII score in critically illness states enhanced the AUC for predicting sepsis and its differentiation from SIRS.Female patients and those with numerous co-morbidities or AKI and those on mechanical ventilation significantly stayed longer at ICU. Moreover, the patients with higher APACHE II score died significantly more than others. Conclusion: The addition of elevated RDW value to APACHEII score in critically illness helps to differentiate sepsis from SIRS. Key words: Red blood cells distribution width, Intensive Care Unit, Facto

Population-based epidemiology of non-fatal injuries in Tehran, Iran

Background: Our aim in this survey was to explore descriptive epidemiology of injuries in Tehran in 2012 and to report the recalled estimates of injury incidence rates. Methods: A population survey was conducted in Tehran during 2012, within which a total of 8626 participants were enrolled. The cluster sampling was used to draw samples in 100 clusters with a pre-specified cluster size of 25 households per cluster. Data were collected on demographic features, accident and injury characteristics based on the International Classification of Diseases (ICD10). Results: A total of 618 injuries per 3 months were reported, within which 597 cases (96.6%)were unintentional injuries. More than 82% of all injuries were those caused by exposure to inanimate mechanical forces, traffic accidents, falls and burns. Above 80% of the traffic injuries happened among men (P<0.001). About 43% of the unintentional injuries were mild injuries.After the age of 40, women, unlike men, had higher risks for being injured. The estimated annual incidence rate for all types of injuries was 284.8 per 1000 (95% CI: 275.4-294.4) and for unintentional injuries was 275.2 per 1000. Conclusion: Injuries are major health problems in Tehran with a highly reported incidence. The status is not substantially improved over the recent years which urges the need to be adequately and emergently addressed. As the incidence rate was estimated based on participant recalls, the real incidence rate may even be higher than those reported in the current study

Evaluating Suppression of PGE2, PAF, and Histamine Synthesis and Histopathological Changes of Bones in the Membrane Surrounding Particulate Polymethylmethacrylate in The Rat Tibia

Introduction:Inflammation and wear debris may be responsible for bone lysis and subsequent lost in aseptic arthroplasty.Prostaglandin E2, platelet activating factor,and histamine are important mediators of inflammatory cells.We studied histopathological changes of cement-bone interface after using specific antagonists of these mediators.Methods:Left and right tibiae of 120 rats in ten groups were drilled.The left side was filled with polymethylmethacrylate and the right side was used as control.The first three groups respectively received 1mg/kg, 10mg/kg, and 25mg/kg of terfenadine,   the second three groups respectively received 0.08mg/kg, 0.32mg/kg, and 0.64mg/kg of alprazolam, and the third three groups respectively received 1mg/kg,5mg/kg,and 25mg/kg of naproxen. The tenth group received no drug and served as the control group. The animals were killed after 16 weeks and studied by one pathologist.   Results:Cellular reaction in the left side was significantly more than the right side in all cases.Medium and high doses of terfenadine and naproxen and high doses of alprazolam could also significantly decrease giant cells and histiocytes.Conclusion: Increased cellular reaction in the cement-bone interface was suppressed by administration of PGE2,PAF,and histamine specific inhibitors. The use of these agents may induce retardation of the bone loss associated with early prosthetic loosening.