The effect of intravenous metoclopramide on pain, nausea, discomfort, and ease of insertion of nasogastric tube in emergency department: a double-blind randomized clinical trial

Background: Placement of nasogastric tube (NGT) is a routine procedure in the emergencydepartments, which can be uncomfortable, painful, and cause nausea. The aim of this study was to investigate the effect of intravenous metoclopramide on the ease of NGT insertion, as well as reduction of patients’ pain, nausea, and discomfort during NGT insertion in the emergency department.Methods: In this randomized, double-blind, placebo-controlled trial, 80 patients referred to Imam Khomeini Hospital, Mazandaran Province, Iran were enrolled. Data were collected from December 2015 to March 2016. Participants were selected via convenience sampling and randomly divided into two equal groups (placebo and intervention groups). In metoclopramide and placebo groups, 10 mg of metoclopramide and 10 mg of normal saline solution were administered, respectively. All of the NGT was inserted 15–20 mins after the intravenous infusion. Patient-reported pain, discomfort, and nausea were evaluated using visual analogue scale (VAS), at four time points including before (T0), immediately (T1), 30 min after (T2), and 1hr after the NGT placement (T3). The ease of NGT insertion was evaluated as easy, moderate, and difficult to pass.Results: None of the patients had pain, nausea, and discomfort in T0. Additionally, for those who received intravenous metoclopramide, pain intensity significantly decreased compared with the placebo group in T1 (37.7 vs 55.0), T2 (26.2 vs 41.7), and T3 (20.5 vs 33.7), respectively (P < 0.001). Nausea intensity decreased significantly over time among patients in the interventiongroup compared with the placebo group in T1 (32.7 vs 43.2), T2 (19.5 vs 31.2), and T3 (9.0 vs 21.7), respectively (P < 0.001). The intensity of patients’ discomfort decreased significantlyamong patients in the intervention group compared with the placebo group in T1 (39.5 vs 54.0), T2 (28.7 vs 40.2), and T3 (26.2 vs 39.6), respectively (P < 0.001). Patients in the intervention group had easier placement of NGT compared with the placebo group (Easy: 40.0% vs 0.0%, Moderate: 45.0% vs 62.5%, and Difficult: 15.0% vs 37.5%; P < 0.001).Conclusion: Based on the results of the present study, it seems that intravenous metoclopramide can be used as a promising modality for improving the ease of NGT placement and reducing patients’ pain, nausea, and discomfort during NGT insertion in the emergency department

The Effect of Intravenous Metoclopramide on Pain, Nausea, Discomfort, and Ease of Insertion of Nasogastric Tube in Emergency Department: A Double-blind Randomized Clinical Trial

Background: Placement of nasogastric tube (NGT) is a routine procedure in the emergency departments, which can be uncomfortable, painful, and cause nausea. The aim of this study was to investigate the effect of intravenous metoclopramide on the ease of NGT insertion, as well as reduction of patients’ pain, nausea, and discomfort during NGT insertion in the emergency department. Methods: In this randomized, double-blind, placebo-controlled trial, 80 patients referred to Imam Khomeini Hospital, Mazandaran Province, Iran were enrolled. Data were collected from December 2015 to March 2016. Participants were selected via convenience sampling and randomly divided into two equal groups (placebo and intervention groups). In metoclopramide and placebo groups, 10 mg of metoclopramide and 10 mg of normal saline solution were administered, respectively. All of the NGT was inserted 15–20 mins after the intravenous infusion. Patient-reported pain, discomfort, and nausea were evaluated using visual analogue scale (VAS), at four time points including before (T0), immediately (T1), 30 min after (T2), and 1 hr after the NGT placement (T3). The ease of NGT insertion was evaluated as easy, moderate, and difficult to pass. Results: None of the patients had pain, nausea, and discomfort in T0. Additionally, for those who received intravenous metoclopramide, pain intensity significantly decreased compared with the placebo group in T1 (37.7 vs 55.0), T2 (26.2 vs 41.7), and T3 (20.5 vs 33.7), respectively (P < 0.001). Nausea intensity decreased significantly over time among patients in the intervention group compared with the placebo group in T1 (32.7 vs 43.2), T2 (19.5 vs 31.2), and T3 (9.0 vs 21.7), respectively (P < 0.001). The intensity of patients’ discomfort decreased significantly among patients in the intervention group compared with the placebo group in T1 (39.5 vs 54.0), T2 (28.7 vs 40.2), and T3 (26.2 vs 39.6), respectively (P < 0.001). Patients in the intervention group had easier placement of NGT compared with the placebo group (Easy: 40.0% vs 0.0%, Moderate: 45.0% vs 62.5%, and Difficult: 15.0% vs 37.5%; P < 0.001). Conclusion: Based on the results of the present study, it seems that intravenous metoclopramide can be used as a promising modality for improving the ease of NGT placement and reducing patients’ pain, nausea, and discomfort during NGT insertion in the emergency department

Assessment of postural response after sudden perturbation in subjects with genu valgum

زمینه و هدف: بد شکلی های وضعیتی اندام تحتانی به عنوان عاملی که در ترتیب قرار گیری بخش های مختلف بدن نسبت به یکدیگر تغییراتی ایجاد می کند، مورد توجه می باشد. حفظ تعادل بدن، می تواند از این تغییرات که راستای طبیعی وضعیت بدنی را بر هم می زند، متاثر گردد. هدف این تحقیق ارزیابی پاسخ وضعیتی و فعالیت الکترومایوگرافی سطحی منتخبی از عضلات اندام تحتانی افراد دارای زانوی والگوس یا ضربدری برای بازیابی تعادل بدن، هنگام مواجهه با اغتشاش ناگهانی بیرونی می‌باشد. روش بررسی: در این مطالعه مورد-شاهدی، شانزده فرد مبتلا به زانوی ضربدری به روش در دسترس و شانزده فرد با ساختار قامتی نرمال در اندام تحتانی و زانو با توجه به همتا سازی دو گروه، انتخاب شدند. جابجایی مرکز فشار پاها (COP) و فعالیت الکترومایوگرافی منتخبی از عضلات اندام تحتانی پس از اعمال اغتشاش ناگهانی اندازه گیری و ثبت شد. برای تجزیه و تحلیل داده ها از t مستقل استفاده شد. یافته ها: جابجایی مرکز فشار پاها به طور معنی داری در گروه آزمون با زانوی ضربدری نسبت به گروه کنترل بیشتر بود (05/0

Diagnostic Accuracy of Ascites Fluid Gross Appearance in Detection of Spontaneous Bacterial Peritonitis

Introduction: Spontaneous bacterial peritonitis (SBP) as a monomicrobial infection of ascites fluid is one of the most important causes of morbidity and mortality in cirrhotic patients. This study was aimed to determine the diagnostic accuracy of ascites fluid color in detection of SBP in cirrhotic cases referred to the emergency department. Methods: Cirrhotic patients referred to the ED for the paracentesis of ascites fluid were enrolled. For all studied patients, the results of laboratory analysis and gross appearance of ascites fluid registered and reviewed by two emergency medicine specialists. The sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ration of the ascites fluid gross appearance in detection of SBP were measured with 95% confidence interval. Results: The present project was performed in 80 cirrhotic patients with ascites (52.5 female). The mean of the subjects’ age was 56.25±12.21 years (35-81). Laboratory findings revealed SBP in 23 (29%) cases. Fifty nine (73%) cases had transparent ascites fluid appearance of whom 17 (29%) ones suffered from SBP. From 21 (26%) cases with opaque ascites appearance, 15 (71%) had SBP. The sensitivity and specificity of the ascites fluid appearance in detection of SBP were 46.88% (Cl: 30.87-63.55) and 87.50% (95% Cl: 75.3-94.14), respectively. Conclusion: It seems that the gross appearance of ascites fluid had poor diagnostic accuracy in detection of SBP and considering its low sensitivity, it could not be used as a good screening tool for this propose

MAC-Oriented Programmable Terahertz PHY via Graphene-based Yagi-Uda Antennas

Graphene is enabling a plethora of applications in a wide range of fields due to its unique electrical, mechanical, and optical properties. In the realm of wireless communications, graphene shows great promise for the implementation of miniaturized and tunable antennas in the terahertz band. These unique advantages open the door to new reconfigurable antenna structures which, in turn, enable novel communication protocols at different levels of the stack. This paper explores both aspects by, first, presenting a terahertz Yagi-Uda-like antenna concept that achieves reconfiguration both in frequency and beam direction simultaneously. Then, a programmable antenna controller design is proposed to expose the reconfigurability to the PHY and MAC layers, and several examples of its applicability are given. The performance and cost of the proposed scheme is evaluated through full-wave simulations and comparative analysis, demonstrating reconfigurability at nanosecond granularity with overheads below 0.02 mm$^{2}$ and 0.2 mW.Comment: Accepted for presentation in IEEE WCNC '1

Reprogrammable graphene-based metasurface mirror with adaptive focal point for THz imaging

Recent emergence of metasurfaces has enabled the development of ultra-thin flat optical components through different wavefront shaping techniques at various wavelengths. However, due to the non-adaptive nature of conventional metasurfaces, the focal point of the resulting optics needs to be fixed at the design stage, thus severely limiting its reconfigurability and applicability. In this paper, we aim to overcome such constraint by presenting a flat reflective component that can be reprogrammed to focus terahertz waves at a desired point in the near-field region. To this end, we first propose a graphene-based unit cell with phase reconfigurability, and then employ the coding metasurface approach to draw the phase profile required to set the focus on the target point. Our results show that the proposed component can operate close to the diffraction limit with high focusing range and low focusing error. We also demonstrate that, through appropriate automation, the reprogrammability of the metamirror could be leveraged to develop compact terahertz scanning and imaging systems, as well as novel reconfigurable components for terahertz wireless communications.Peer ReviewedPostprint (published version

Terahertz Dielectric Resonator Antenna Coupled to Graphene Plasmonic Dipole

This paper presents an efficient approach for exciting a dielectric resonator antenna (DRA) in the terahertz frequencies by means of a graphene plasmonic dipole. Design and analysis are performed in two steps. First, the propagation properties of hybrid plasmonic onedimensional and two-dimensional structures are obtained by using transfer matrix theory and the finite-element method. The coupling amount between the plasmonic graphene mode and the dielectric wave mode is explored based on different parameters. These results, together with DRA and plasmonic antenna theory, are then used to design a DRA antenna that supports the $TE_{y}^{112}$ mode at 2.4 THz and achieves a gain (IEEE) of up to 7 dBi and a radiation efficiency of up 70%. This gain is 6.5 dB higher than that of the graphene dipole alone and achieved with a moderate area overhead, demonstrating the value of the proposed structure.Comment: Accepted for presentation at EuCAP 201

Investigation of Frequency of the Lethal Triad and Its 24 Hours Prognostic Value among Patients with Multiple Traumas

BACKGROUND: Death in multiple trauma (MT) patients is one of the serious concerns of the medical service provider. Any prediction of the likelihood of death on the assessment of the patient's condition is performed using different variables, one of the tools in the triage of patients to determine their condition. AIM: We aimed to investigate the frequency and the predictive value of death in 24 hours triad of death in patients qualified with multiple traumas admitted to Imam Khomeini hospital. METHODS: This was a prospective cross-sectional study to determine the prevalence and predictive value of 24-hour triad of death among patients with MT referred to an emergency department. Three factors including acidosis, hypothermia and coagulopathy and predictive value of 24-hour death were evaluated. Arterial blood gas, oral temperature and blood samples for coagulation factors were analysed. Data were analysed using SPSS version 19. Multivariate analysis (logistic regression) was used to determine the predictive value of the triad of death. RESULTS: A group of 199 MT patients referring to Imam Khomeini hospital during the first 6 months of 2015 were evaluated for the first 24 hours of admission. Logistic regression analysis showed that using the following formula based on the triad of death can predict death in 96% of cases can be based on the triad of a death foretold death upon admission to the emergency room. It should be noted that this prediction tool as 173 people left alive after 24 hours as live predicts (100% correct). CONCLUSION: The triad of death is one of the tools in the triage of patients to determine their condition and care plan to be used, provided valuable information to predict the prognosis of patients with a medical team