Renal Infarction following Asymptomatic Aortoiliac Thrombosis as a Cause of Severe Flank Pain; a Case Report

Renal infarction is rare and may be considered acute renal colic in presentation. In this report, we describe a case of renal infarction caused by thrombosis that extended from the aortoiliac to the infrapopliteal segment, along with thrombosis that occurred in the right popliteal artery and left atrium. A 48-year-old man was referred to the emergency department (ED) suffering left flank pain. The pain was significant with radiation to the left lower quadrant, and the pain did not significantly decrease despite intravenous ketorolac and morphine sulfate administration. We decided to perform a color Doppler ultrasound test of intraabdominal vessels that revealed low flow in the left iliac artery. By computed tomography angiography (CTA), it was confirmed that the left renal, iliac, and popliteal arteries were thrombosed. The patient underwent anticoagulation, thrombectomy, and Mitral valve replacement surgery during the hospitalization. After 14 days, his heart rhythm returned to normal sinus and he was discharged from the hospital with proper outpatient follow-up. Patients with severe flank pain and who do not respond to routine treatments, especially patients with significant risk factors, should be evaluated more carefully for red flag diagnosis.&nbsp

The Role of Ultrasonography in Patients Referring to the Emergency Department with Acute Abdominal Pain

Context: Acute abdominal pain is a common clinical problem in emergency and non-emergency cases accounting for 5 to 10% of all referrals to the emergency department. Studies have indicated that these widely differentiated diagnoses are common to these complaints. Considering the high prevalence of this complaint in the patients and the wide range of its differential diagnosis, this review study was designed and evaluated aiming at investigating the causes of acute abdominal pain with a focus on assessing the position of ultrasound as a diagnostic tool in the emergency department. Evidence acquisition: This article was conducted as a narrative review of 106 articles from 2005 through 2019. By comparing them, a comprehensive review of ultrasonographic status was conducted in patients with acute abdominal pain referring to the emergency department. Results: In this review study, we attempted to use the articles of the clinical approach, the required laboratory tests, the disadvantages and advantages of each imaging technique, the differential diagnosis for acute abdominal pain according to the location of the pain, and the position of ultrasound as a diagnostic aid tool. Eventually, the proposed protrusion will be considered in dealing with a patient with acute abdominal pain. Conclusion: Regarding the wide range of causes providing multiple differential diagnosis, as well as the limited time of the health team in the emergency department for diagnostic and therapeutic measures, particularly in time-sensitive clinical conditions, ultrasound offered by emergency medicine specialists as a diagnostic aid is considered to improve the overall diagnosis and treatment of patients, thereby reducing complications

The Mean Platelet Volume in children with Pyelonephritis

Introduction: The mean platelet volume (MPV) is a determinant of inflammation. The aim of the present study was to investigate the MPV levels in children with pyelonephritis and to evaluate the possible relationship between MPV and febrile UTI.Materials and Methods: In this prospective observational study, 82 patients with Pyelonephritis (group A) and 82 patients with viral gastroenteritis (group B) were enrolled from 20 Jun 2013 through 15 Jan 2014. The patients were divided into two groups according to the presence of pyelonephritis and viral gastroenteritis. The pyelonephritis group (A) included 82 patients and the acute gastroenteritis group (B) included 82 patients. Complete blood count (CBC) parameters were measured at admission. Routine biochemical tests were performed. Groups were compared according to different parameters.Results: A total of 164 patients were included from inpatients of Amir-Kabir Hospital. The mean platelet volume was lower in group (A) and it was associated with acute pyelonephritis (P =0 .003). The MPV (6.03 ± 0.26 fl vs. 9.06 ± 0.73 fl) was significantly lower in group (A), the platelet count (219.88-± 52.31vs. 184.09 ± 52.21) was significantly higher in group (A), and the WBC count (13.01± 3.43 vs. 8.30 ± 1.13) was significantly higher in group (A).Conclusions: MPV levels were significantly lower in children with pyelonephritis compared with controls. MPV can be used as a negative acute phase reactant in children with febrile UTI.Keywords: Child; Pyelonephritis; Mean Platelet Volume; Urinary tract infection

Effect of Low-dose Human Chorionic Gonadotropin on the Prevention of Ovarian Hyperstimulation Syndrome and in Vitro Fertilization Outcome

Background & aim: Ovarian hyperstimulation syndrome (OHSS) is a rare but most potentially life-threatening disorder in women under in vitro fertilization (IVF). This study aimed to determine the effect of low-dose human chorionic gonadotropin (hCG) on the prevention of OHSS and IVF outcome. Methods: This single-blind non-randomized clinical trial was performed from October 2008 to November 2012 in Motahari Hospital, Urmia, Iran. Overall, 202 infertile women undergoing IVF treatment were divided into two groups based on OHSS risk factors. Then, 87 women with serum estradiol level of 5000-8000 pg/ml received 5000 units of intramuscular hCG, and 115 women with serum estradiol level of > 8000 pg/ml, who were at high risk for OHSS, received 1600 units of hCG. Data were analyzed using independent t-test and Chi-square test in SPSS, version 16. Results: There were no significant differences in age, infertility duration, infertility factor, quality of embryo, pregnancy rate and number of abortions and OHSS rate between the groups (P>0.05). The group that received 1600 units of hCG was in a better condition regarding the mean number of ova (11.45±5.41 versus 9.24±4.24; P=0.01), mean number of good quality ova (11.10± 5.47 versus 8.68± 4.03; P=0.001), and mean number of embryos (7.38± 4.24 versus 5.53± 2.85; P=0.001). There was no significant difference in the rate of OHSS incidence and cancellation of embryo transfer between the two groups (1600 and 5000 units). Conclusion: Overall, the current study indicated that prescribing 1600 units of hCG in women who are at risk of hypersensitivity reaction may induce similar or perhaps better results regarding the quantity and quality of ova and embryos, however, OHSS risk is not completely eliminated by using a lower dose of hCG. It is therefore suggested to perform randomized clinical trials with greater sample size to verify these results

Epidemiology of trauma in Markazi (Center) province of Iran; eliminate the hazard is first priority

Objective: To investigate the epidemiology of traumatic patients, referred to the Vali-asr trauma center, Arak, Iran in the summer of 2016. Methods: In a cross-sectional study, all patients with trauma, entered the study considering inclusion and exclusion criteria. Data were then analyzed by the SPSSv.19. Mean, SD, percentage and frequency were used for data analysis. Results: A total of 1 049 patients were released after examination due to normal vital signs. A total of 483 patients were transferred to be under observation in hospital’s wards. All patients were chest X-rayed, among whom, 17 unusual cases were found. Conclusions: It is recommended that comprehensive investigations should be made to identify road and non-road hazardous factors, and that a great step and first priority in safety and removal of hazards is effectively taken by accurate planning in addition to higher public educations

Intranasal ketamine as an analgesic agent for acute pain management in emergency department: A literature review

Ketamine is a well-known dissociative anesthetic agent, and has been used over 50 years. Intranasal pathway is a mucosal way for absorbing agents to directly affect in brain via olfactory sheets, bypassing first pass metabolism and the blood brain barrier. The current uses of intranasal ketamine as an analgesic agent for acute pain management in emergency department are discussed in this review article. Using "ketamine", "pain or analgesia", and "intranasal" as keywords, a search of google scholar, Pubmed, web of science, and Medline database from 1970 until 2017 was performed. Finally, from 1 204 papers extracted via primary search, 1 088 papers were omitted and finally 10 studies were considered for further assessment. There were four observational studies, one case series and report and 5 clinical trials. Ketamine was used for acute pain control due to musculoskeletal trauma, burns, and painful procedures. A total of 390 cases were included in these studies. The studies used ketamine with doses ranging 0.45-1.25 mg/kg via intranasal pathway. Intranasal ketamine provides relatively rapid, well tolerated, and clinically significant analgesia for emergency department patients. Considering the lack of adequate studies and undetermined intranasal dose, it is better to conduct further high quality investigation in both adults and pediatrics

Comparing the analgesic effect of intranasal with intravenous ketamine in isolated orthopedic trauma: A randomized clinical trial

Objectives: Ketamine is commonly used in anesthetic and sedation before surgical procedures and acts as an analgesic in smaller doses. The aim of this study was to assess the effects of intranasal (IN) ketamine in patients with moderate to severe limb trauma (visual analog scale (VAS) > 60 mm). Methods: In a triple-blind randomized controlled clinical trial; 154 patients with isolated orthopedic trauma and visual analog scale (VAS) ≥60 mm were included on the basis of inclusion and exclusion criteria. Patients were divided into two groups of ketamine-IN (0.4 mg/kg IN ketamine and an equal volume of placebo saline intravenously (IV)) and ketamine-IV (0.2 mg/kg ketamine IV with 0.5 ml saline IN) on the basis of balanced block randomization method. At 5, 10, 20, and 30 min, patients were assessed for VAS measurement and adverse events. Repeated measure ANOVA, independent t-test and chi square test were employed. The level of statistical significance was considered to be less than 0.05. Results: Mean VAS in IN ketamine and IV group at minute 30 was 31.50 ± 13.40 and 29.35 ± 11.73, respectively. At minute 30, 31 patients (20.39%) required a low-dose of morphine as rescue analgesia (P = 0.427). The results showed that mean change score of VAS (difference of time 0 and time 30) in IN ketamine and IV ketamine VAS were 43.8 (95% confidence interval: 41.1–46.5) and 46.4 (95% confidence interval: 42.8–50.1) and there is no difference between two groups in case of score change of VAS (P = 0.245). Adverse events in nasal and intravenous ketamine in both groups were mild and transient. Conclusion: IN ketamine is associated with few side effects and appropriate analgesic effects in isolated orthopedic trauma patients, and it may be used in cases where there is no need for venipuncture of peripheral vessels, especially in crowded EDs. Keywords: Ketamine, Intranasal, Pain, Emergenc

Relationship between progesterone level on the day of human chorionic gonadotropin administration with outcomes of intra-cytoplasmic sperm injection in infertile couples

Background: Gonadotropin-releasing hormone agonists or antagonists are used in assisted reproductive technique cycles as premature luteinizing hormone secretion inhibition. Studies have been reported different and contradictory results on the serum progesterone effect on intra-cytoplasmic sperm injection. Objective: The purpose of this study was to evaluate the effect of serum progesterone level on the day of Human chorionic gonadotropin (HCG) administration on the intra-cytoplasmic sperm injection (ICSI) outcome in infertile women. Materials and Methods: 249 infertile couples candidated for ICSI were enrolled in the study. Their serum progesterone level on the day of HCG administration was measured and according to serum level, patients were divided into four groups of less than 0.9, 0.9-1.4, 1.5-1.9, and ≥2 ng/mL. The four groups were compared with each other regarding fertility outcomes. Results: Pregnancy rate was not significantly different among the four groups (p>0.05). Also, there was no significant difference among the groups regarding frequency of abortion and ectopic pregnancy. Conclusion: Serum progesterone level on the day of HCG administration does not have any significant effect on pregnancy outcomes, including abortion, ectopic pregnancy, and pregnancy rate in patients undergoing ICSI treatment