Intravenous Amiodarone versus Digoxin in Atrial Fibrillation Rate Control; a Clinical Trial

Introduction: Treatment of rapid ventricular response arterial fibrillation (rapid AF) varies depending on the decision of the in-charge physician, condition of the patient, availability of the drug, and the treatment protocol of the hospital. The present study was designed aiming to compare IV digoxin and amiodarone in controlling the heart rate of patients presenting to emergency department with rapid AF and relative contraindication for first line drug in this regard.Method: In the present clinical trial, patients presented to the ED with rapid AF and relative contraindication for calcium channel blockers and beta-blockers were treated with either IV amiodarone or IV digoxin and compared regarding success rate and complication using SPSS version 22. P < 0.05 was considered as statistically significant.Results: 84 patients were randomly allocated to either amiodarone or digoxin treatment groups of 42 (53.6% male). The mean age of the studied patients was 61.8 ± 11.14 years (38 - 79). No significant difference was present regarding baseline characteristics. The rate of treatment failure was 21.4% (9 cases) in amiodarone and 59.5% (25 cases) in digoxin groups (p < 0.001). The mean onset of action was 56.66 ± 39.52 minutes (10 - 180) in amiodarone receivers and 135.38 ± 110.41 minutes (25 - 540) in digoxin group (p < 0.001). None of the patients showed any adverse outcomes of hypotension, bradycardia, and rhythm control.Conclusion: Based on the findings of the present study, rapid AF patients with relative contraindication for calcium channel blockers or beta-blockers who had received amiodarone experienced both higher (about 2 times) treatment success and a more rapid (about 2.5 times) response compared to those who received IV digoxin

Early vs Late Coronary Angiography and Intervention Following Thrombolytic Therapy; a Cohort Study

Introduction: The precise time of using percutaneous coronary intervention (PCI) after fibrinolytic therapy for maximum efficiency and minimum side effects is still undetermined. Therefore, the present study was designed to compare the outcome of myocardial infarction (MI) patients who underwent surgical intervention (angiography and PCI) within 48 hours of thrombolytic therapy or after that.Methods: The present study is a prospective cohort study aiming to compare the occurrence of no-reflow phenomenon, unstable angina, bleeding during intervention, and one month major adverse cardiac outcomes (recurrent MI, need for repeating surgical intervention, and mortality) between MI patents undergoing surgical intervention within the first 48 hours of or after 48 hours of thrombolytic therapy.Results: 90 patients with the mean age of 54.97 ± 10.54 were studied (86.67% male). 50 (56%) patients underwent surgical intervention within 48 hours and 40 (44%) after that. The 2 groups were not significantly different regarding baseline characteristics. No-reflow phenomenon in the < 48 hours group was about twice the > 48 hours group (OR = 0.35; 95% confidence interval: 0.14 – 0.92; p = 0.03), other outcomes were not significantly different. No case of mortality was seen in the 1 month follow up.Conclusion: Based on the results of the present study, it seems that no-reflow phenomenon rate is significantly lower in patients undergoing surgical intervention after 48 hours of fibrinolytic therapy. The difference between the two groups regarding prevalence of major adverse cardiac outcomes was not statistically significant

Thoracic Injury Rule out Criteria in Prediction of Traumatic Intra-thoracic Injuries; a Validation Study

Introduction: Doing Chest X Ray (CXR) for all trauma patients is not efficient and cost effective due to its low diagnostic value. The present study was designed aiming to evaluate the diagnostic accuracy of thoracic injury rule out criteria (TIRC) in prediction of traumatic intra-thoracic injuries and need for CXR. Method: The present study is a prospective cross-sectional study that has been carried out to evaluate the accuracy of TIRC model in screening blunt multiple trauma patients in need of CXR for ruling out intra-thoracic injuries. Results: 1518 patients with the mean age of 33.53 ± 15.42 years were enrolled (80.4% male). The most common mechanisms of trauma were motor car accident (78.8%) and falling (13.6%). Area under the ROC curve, sensitivity, and specificity of model in detection of traumatic thoracic injuries was 0.95 (95% CI: 0.93 – 0.97), 100 (95% CI: 87.0 – 100), and 80.1 (95% CI: 78.0 – 82.1), respectively. Brier score for TIRC was 0.02 and its scaled reliability was 0.0002. Conclusion: Findings of the present study showed that TIRC has high accuracy in prediction of traumatic intra-thoracic injuries and screening patients in need of CXR.

اورژانسهای منطقه ای، استان کرمان، شهرستان بم؛ مسمومیت با متادون

Regional emergencies, Bam, Kerman province, IranMethadone Poisoning Setareh Asgarzadeh, Mojtaba Jafari*, Bahareh Feizi Emergency Department, Pasteur Hospital, Bam University of Medical Sciences, Bam, Iran. *Corresponding Author: Mojtaba Jafari; Emergency Department, Pasteur Hospital, Baravat road, Bam, Kerman province, Iran; Tel: +989151404821; Email: [email protected]مسمومیت یکی از علل شایع مراجعه به بخش های اورژانس و دومین عامل مرگ غیرعمدی در کودکان است. مسمومیت با متادون در اطفال از مراجعات شایع به بخش اورژانس بیمارستان پاستور، شهرستان بم (جنوب شرقی ایران) می باشد. در طی سالهای اخیر استفاده از شربت متادون جهت ترک اعتیاد در این منطقه روند رو به افزایشی داشته است. عرضه و بسته بندی این دارو معمولا به شکل غیراستاندارد بوده و از بطری های نوشیدنی و یا ظرف داروهای دیگر جهت نگهداری آن استفاده می شود. این روش عرضه دارو به همراه ظاهر بی رنگ آن بارها باعث اشتباه در مصرف دارو به جای آب یا داروهای دیگر بخصوص توسط کودکان شده است. در اغلب موارد با شروع علایم، کودک توسط والدین به اورژانس آورده شده و تحت درمان قرار گرفته است؛ اما در صورت مراجعه دیرهنگام، ممکن است که درمان موثر نبوده و با مرگ و میر یا ناتوانی ناشی از هیپوکسی طولانی مدت همراه گردد. با توجه به ماهیت قابل پیشگیری مسمومیت های غیرعمدی به ویژه در کودکان، در ادامه به گزارش فراوانی این مشکل و ارائه راهکارهای جلوگیری از آن خواهیم پرداخت

ZnO/bentonite Nanocomposites Prepared with Solid-state Ion Exchange as Photocatalysts

Photocatalyst nanocomposites of ZnO/bentonite clay are synthesized by Solid-state ion exchange method. Ion exchange intercalation process of clays is used to incorporate the catalyst into the basal space of the layered structure of clays. The purpose of this study is to find a new method, which is focused on simplifying and saving time to prepare ZnO-bentonite composite with photocatalyst property. The synthesis of ZnO-doped bentonite nanocomposite is accomplished by placing bentonite in a melting bath of ZnSO4 for 10, 20, 40, 60 and 90 min. The nanocomposites are characterized by morphological (SEM), optical (UV/vis reflection) and analytical (EDX) techniques. According to SEM results, after ion exchanging, the parent structure of bentonite remains and only the distance between flakes increased significantly. EDX analysis clearly suggest the success of ion exchange of the expense of Ca2+, Na+ and Mg2+ cations with Zn2+. The calculated band gap for the composites were 3.14 eV (10 min), 2.64 eV (20 min) and 2.54 eV at longer times, respectively. All the prepared composites showed acceptable degradation performances. The greatest photocatalytic activity is detected in ZnO/bentonite composite solid-state ion exchanges which lasts 60 and 90 min. Leaching test results showed that the concentrations of Zn are less than 4 mg/l between 0 and 6 h. These results indicated that the photocatalytic property of composites would last longer

Predictive ability of galilei to distinguish subclinical keratoconus and keratoconus from normal corneas

Purpose: To determine the predictive ability of different data measured by the Galilei dual Scheimpflug analyzer in differentiating subclinical keratoconus and keratoconus from normal corneas. Methods: This prospective comparative study included 136 normal eyes, 23 eyes with subclinical keratoconus, and 51 keratoconic eyes. In each eye, keratometric values, pachymetry, elevation parameters and surface indices were evaluated. Receiver operating characteristic (ROC) curves were calculated and quantified by using the area under the curve (AUC) to compare the sensitivity and specificity of the measured parameters and to identify optimal cutoff points for differenciating subclinical keratoconus and keratoconus from normal corneas. Several model structures including keratometric, pachymetric, elevation parameters and surface indices were analyzed to find the best model for distinguishing subclinical and clinical keratoconus. The data sets were also examined using the non-parametric #8220;classification and regression tree#8221; (CRT) technique for the three diagnostic groups. Results: Nearly all measured parameters were strong enough to distinguish keratoconus. However, only the radius of best fit sphere and keratometry readings had an acceptable predictive accuracy to differentiate subclinical keratoconus. Elevation parameters and surface indices were able to differentiate keratoconus from normal corneas in 100% of eyes. Meanwhile, none of the parameter sets could effectively discriminate subclinical keratoconus; a 3-factor model including keratometric variables, elevation data and surface indices provided the highest predictive ability for this purpose. Conclusion: Surface indices measured by the Galilei analyzer can effectively differentiate keratoconus from normal corneas. However, a combination of different data is required to distinguish subclinical keratoconus

Design of 2D nanomaterials (photo-)electrocatalysts for biomass valorization coupled with H2 production

Electrocatalytic water splitting driven by renewable energy is a promising strategy for sustainable hydrogen production. However, the slow oxygen evolution reaction (OER) kinetics severely limit the rate of the hydrogen evolution reaction (HER) and the overall energy conversion efficiency of the water electrolyzer. To overcome this challenge, hybrid water electrolysis systems have been developed which replace the sluggish OER with thermodynamically and kinetically favorable biomass (photo-)electro-oxidation. In addition, these system allow for the simultaneous production of value-added chemical products. This review highlights the design strategies related to the host structure remodeling and structure assembly design of two-dimensional (2D) nanomaterial-based (photo)electrocatalysts, as well as their wide application in hybrid water electrolysis. Moreover, the current challenges and emerging strategies for the development of advanced (photo-)electrocatalysts and industrial-scale systems are emphasized

Improving Wettability: Deposition of TiO2 Nanoparticles on the O2 Plasma Activated Polypropylene Membrane

Radio frequency plasma is one of the means to modify the polymer surface namely in the activation of polypropylene membranes (PPM) with O2 plasma. Activated membranes were deposited with TiO2 nanoparticles by the dip coating method and the bare sample and modified sample (PPM5-TiO2) were irradiated by UV lamps for 20–120 min. Characterization techniques such as X-ray diffraction (XRD), Attenuated total reflection technique- Fourier transform infrared spectroscopy (ATR-FTIR), Thermogravimetric analysis (TGA), X-ray photoelectron spectroscopy (XPS), Scanning electron microscope (SEM) and water contact angle (WCA) measurements were applied to study the alteration of ensuing membrane surface properties which shows the nanoparticles on the sample surface including the presence of Ti on PPM. The WCA decreased from 135° (PPM) to 90° (PPM5-TiO2) and after UV irradiation, the WCA of PPM5-TiO2 diminished from 90° to 40°

A promising nanocatalyst: Upgraded Kraft lignin by titania and palladium nanoparticles for organic dyes reduction

*Baran, Talat ( Aksaray, Yazar )The evaluation of dye degradation was adorned a great interest due to scarcity of water, courtesy of industrialization. Here, Kraft lignin was upgraded by immobilization of TiO2 nanoparticles (NPs) by the reflux method (KL-T). Palladium (Pd) NPs were produced in a promising way by laser ablation in liquid (LAL) and loaded on KL-T to prepare an efficient nanocatalyst (KL-T/Pd). The synthesized KL-T/Pd is characterized by X-ray diffraction (XRD), Fourier transforms infrared (FT-IR), Scanning electron microscopy (SEM), Energy-dispersive X-ray spectrometry (EDX), and Transmission electron microscope (TEM) analyses. The KL-T/Pd nanocomposite was applied as an efficient and novel nanocatalyst for the reduction of methylene blue (MB) and methyl orange (MO) by NaBH4 as a reducing agent in aqueous media at ambient temperature. Our experimental results displayed that the 1 mg of KL-T/Pd catalyst can be reduced MB and MO organic dyes within 23 and 8 s, respectively at room temperature. The KL-T/Pd nanocatalyst can be recycled and reused four times with no considerable loss of performance. Having different advantages such as high catalytic performance, safe synthesis method, and high stability, lignin was suggested as a natural substrate