Intravenous versus Subcutaneous Midazolam Using Jet-injector in Pediatric Sedation; a Randomized Clinical Trial

Introduction: The quality of interventions in children is largely dependent on their control. Hence, this study compared the sedative effects of subcutaneous (SC) and intravenous (IV) Midazolam in pediatric sedation induction. Methods: This randomized clinical trial was conducted on children aged 1-6 years presenting to emergency departments of Shahid Sadoughi and Shahid Rahnemoon Hospitals, Yazd, Iran. Participants were randomly assigned to IV or SC midazolam using a jet injector and success rate, degree of sedation, and satisfaction of parents and physician were compared between groups.Results: 60 cases with the mean age of 3.15±1.43 (1-6) years were randomly assigned to the SC (30 cases) or IV (30 cases) groups (56.7% female). SC and IV groups were similar regarding the mean age (p = 0.165) and sex (p = 0.121).Depth of sedation (p=0.900), control of child (p=0.711), in-charge physician’s satisfaction (p=0.467), successful sedation and need for rescue dose (p=0.519) were not different between groups. IV midazolam group had a significantly shorter recovery time (about 10 minutes; p=0.040) and SC midazolam group had a significantly higher level of parent satisfaction (p=0.001).Conclusion: The findings indicate no significant difference in depth of sedation, control of child, in-charge physician’s satisfaction, successful sedation (reaching stage 1 of sedation or higher), and need for rescue dose of SC and IV midazolam. Parents’ satisfaction was significantly greater with SC administration and IV injection had shorter recovery time

Intravenous Haloperidol versus Midazolam in Management of Conversion Disorder; a Randomized Clinical Trial

Introduction: Conversion disorder is a condition in which the patient shows psychological stress in physical ways. This study aimed to compare the effects of haloperidol versus midazolam in patients with conversion disorder.Methods: This double-blind randomized clinical trial was conducted on patients with conversion disorder who had presented to the emergency department, throughout 2015. Patients were randomly divided into two groups and were either treated with 2.5 mg of intravenous (IV) haloperidol or 2.5 mg of IV midazolam. Recovery rate, time to recovery, and side effects of both drugs 1 hour, 24 hours, and 1 week after treatment were compared using SPSS19.Results: 140 patients were divided into two groups of 70. There were no significant differences between the groups regarding the baseline characteristics. 12 (17.1%) patients who were treated with IV haloperidol experienced drug side effects within 1 hour and 12 (17.1%) within 24 hours, while only 3 (4.3%) patients in IV midazolam experienced side-effects within 1 hour after drug administration (p = 0.026).  The symptoms of the disease subsided in 45 (success rate: 64.3%) patients in midazolam and in 64 (success rate: 91.5%) participants in haloperidol group (P<0.001). Mean recovery time was 31.24 ± 7.03 minutes in IV midazolam and 30.53 ± 7.11 minutes in IV haloperidol group (p = 0.592). Absolute risk reduction (ARR) of treating patients with haloperidol compared to midazolam is about 27%.Conclusion: The response of patients to treatment with haloperidol is clearly better than midazolam. Although more transient and minor side-effects were observed in the group treated with haloperidol compared to midazolam group, serious side-effects were rare for both treatments

A case report of a biologic foreign body in the knee region

Introduction: Biologic foreign body had been rarely reported. Reported cases are mainly due to the explosion but there are few cases in the traffic road accidents. Methods: Our report is due to a case of motorcycle to motorcycle road accident. The victim was 18 years old man with femoral shaft open fracture and Pease of diaphyseal bone in the knee region. The bone segment was biologic foreign body that was transmitted from the counterpart of the accident that had open femoral shaft fracture and was died at the scene. Conclusion:  Biological foreign bodies beside the physical damages to the body had the risk of transmitting blood borne diseases that should be managed perfectly

The Relationship between the Distribution of General Practitioners and the Mortality Rate of Children Based on the Gini Coefficient and Lorenz Curve

Background: Equity is one of the most important issues in the distribution of resources and access to health services. Although it is very challenging to address health equity issues, it deeply affects policy making, resource allocation, and generally the legal principles of government and society. This study aimed to determine the inequality of distribution of general practitioner in Tehran province. Methods: This was an applied study that by ecological descriptive method investigated the relationship between the distribution of general practitioners and the mortality rate of children in the cities of Tehran province in 2012-2015. The data collection tool was a researcher-made form including the name of the city, the number of general practitioners, the mortality rate for children under five years old, and the population of each city. The STATA software with the DASP21 version 2.1 was used to draw the Lorenz curve. The SPSS19 software and Pearson correlation coefficient (P-value < 0.05) were utilized for analyzing data. Results: Based on the results the Gini coefficient for general practitioners was not significantly changed and was in a relatively equitable position, the Gini coefficient varied from 0.269 to 0.299. The results of the study did not show a significant relationship between the distribution of general practitioners and the mortality rate of children, although, with an increase in the ratio of general practitioners, the mortality rate of children decreased (P-value ≤ 0.05). Conclusion: The results of the study indicate that the distribution of general practitioners was relatively inequitable. Therefore, it is essential for the Ministry of Health to establish the balance in the distribution of the human resource

Aortic Dissection of Unknown Origin in a Young Patient: A Case Report

Aortic dissection occurs when a tear develops in the wall of the aorta, which is rare in the young population. This fatal disorder is hard to diagnose, especially in young patients. We present the case of aortic dissection in a 15-year-old boy referred to the Emergency Department of Yazd University of Medical Sciences in November 2015. The patient presented to our department with sudden acute chest pain. Emergent computed tomography (CT) scanning of the brain, chest, and abdomen reflected bilateral pleural effusion, biluminal aorta, arterial flap in the upper part of the abdominal aorta, and dilated small bowl loop. The patient did not have any aortic dissection risk factors such as history of connective tissue disease, congenital heart disease, coarctation of the aorta, and hypertension. The only noticeable point in the patient’s history was swimming two hours before the onset of the chest pain. Aortic dissection is a rare differential diagnosis in children with acute sudden chest pain

Lidocaine induced seizure during rapid sequence intubation, a case report

به دلیل تاثیر مناسب و شروع اثر سریع، لیدوکائین به طور معمول برای ساپرس تغییرات همودینامیک ناشی از لوله گذاری داخل تراشه مورد استفاده قرار می گیرد. از جمله عوارض جانبی این دارو تشنج می باشد که متعاقب تجویز موضعی و وریدی آن به صورت موردی گزارش شده است. در این مقاله به معرفی بیماری می پردازیم که با شکایت از تنگی نفس شدید و پیشرونده به بخش اورژانس ارجاع گردید و در حین انجام لوله گذاری داخل تراشه با توالی سریع و به دنبال تجویز لیدوکائین وریدی دچار تشنج تونیک کلونیک جنرالیزه شد.The best choice for Patients who need intubation in the emergency ward is rapid sequence intubation in order to reduce laryngoscopic adverse effect and to have better condition for intubation. Lidocaine is one of the drugs used in premedication before induction and paralysis to attenuate laryngoscopic sympathetic reflex. We present a patient that had an episode of seizure immediately after administering lidocaine intravenously during rapid sequence intubation, not reported before

Seizure Following Lidocaine Administration during Rapid Sequence Intubation; a Case Report

Lidocaine is commonly used for suppressing hemodynamic instabilities resulting from endotracheal intubation due to its good effect and rapid onset of action. Seizure is one of the side effects of this drug, which has been reported following its topical and intravenous administration in some cases. In this article, we present a patient referred to the emergency department with complaint of severe and progressive shortness of breath who had a generalized tonic-clonic seizure following lidocaine administration during rapid sequence intubation

Acute necrotizing pancreatitis following coronary artery angiography: A case report

BACKGROUND: Acute pancreatitis has different etiologies from biliary stone to metabolic disturbances. Coronary angiography is one of the newly understood etiologies. CASE REPORT: This paper is about a women suffering from acute pancreatitis after coronary angiography. CONCLUSION: Embolization of cholesterol crystals due to vessel wall trauma during coronary angiography as well as contrast medium are responsible for such side effect.&nbsp;&nbsp;</p

Investigating the Use of Pantoprazole in Yazd Shahid Rahnemoon Hospital, 2019

Background and purpose: Proton pump inhibitors (PPIs) are one of the main therapeutic agents for acid-related diseases. Pantoprazole, with minimal drug interaction, is one of the well-known PPIs. According to various studies, 25-75% of pantoprazole injections have no indications and cause a high burden on health systems. The aim of this study was to investigate the indication and rate of pantoprazole injections in Yazd Rahnemoon Hospital, Iran. Materials and methods: This cross-sectional study was performed in 72 hospitalized patients in invasive care units, and internal and emergency wards between March and December 2019. Demographic and clinical data, risk factors, PPI indication, and doses of utilized pantoprazole were recorded. The rationality of pantoprazole prescription was confirmed by comparing the drug information from up-to-date database under the supervision of a clinical pharmacist in the hospital. Results: In total, out of 60 patients who received IV pantoprazole, 52.8% could have received the oral form and in 69.4% there was no indication to use IV pantoprazole. Conclusion: In this study, parenteral form of pantoprazole was not indicated in majority of the patients. Guidelines should be approved to prevent irrational administration of parental PPIs in hospitals

Moral Hazards in Providing Health Services: A Review of Studies

Background: Moral hazard is the increased likelihood of loss driven by insured behavior, which is a major the challenges faced by the insurance system. Therefore, the purpose of this study is to review the concept of moral hazard and its types, causes, consequences and control measures. Methods: This study was conducted through review, utilizing articles related to the subject in Springer's published texts, valid sites and databases such as: Google Scholar, Magiran, Medline, Springer, SID, Scopus and PubMed. The information utilized was collected from 1960-2016. Databases were searched using keywords of moral hazard in health services, causes of hazards, types of hazards in health systems, the consequences of hazards, the ways of controlling hazards, health insurance, moral hazards and health insurance. Results: The results showed that the third party (insurer) in health insurance contracts, paying a high share of treatment costs, mitigates the motivation for the behaviors of disease prevention, and prevents harm or disease, i.e.&nbsp; Because the patient pays only a fraction of the cost, it has devastating consequences such as increasing insurer costs and the health system, reducing welfare, wasting resources, reducing insurance coverage, and so forth. Conclusions: Identifying various types of moral hazards, their causes and consequences in determining control strategies and reducing moral hazard and preventing undesirable outcomes are effective