Markussenjones1758

The area under the curve (AUC), sensitivity, and specificity of Tzanakis score in the cut-off value of 8 were 0.965, 84.4%, and 100%, respectively. For Ohmann and Alvarado scores, these measures were 0.941; 71.9%, 89.9% and 0.938, 60.9%, 89.9%, respectively. Tzanakis scoring system had the best screening performance in detection of cases with AA. Conclusion Tzanakis score is more sensitive and specific than Alvarado, RIPASA, Eskelinen and Ohmann scores in identifying AA patients needing appendectomy.Introduction There is an increasing interest in the use of different biomarkers to help distinguish psychogenic non-epileptic seizure (PNES) from epileptic seizures (ES). This study aimed to evaluate the patterns of differentially expressed serum proteins in ES and PNES cases. Methods In this cross-sectional study, 4 patients with mesial temporal lobe epilepsy and 4 patients with PNES were selected from patients with history of recurrent seizures. Venous blood samples were obtained within 1 hour after seizure and serum proteomes as well as the extent of protein expression were analyzed. Results 361 proteins were identified; of these, expression of 197 proteins had altered. 110 (55.9%) proteins were down-regulated and 87 (44.1%) were up-regulated in the PNES samples compared to ES samples. The mean pI for deregulated proteins with 1.5 to 3 fold changes were 6.69 ± 1.68 in proteins with increasing expression in ES group and 5.88 ± 1.39 in proteins with increasing expression in PNES group (p = 0.008). The median and interquartile range (IQR) of molecular weight changes in proteins with 1.5 to 3 fold changes were 64 (22.0-86.0) in proteins whose expression had increased in ES group and 39.5 (26.0-61.5) in proteins whose expression had increased in PNES cases (p = 0.05). Conclusion Several spots with differential expression were observed by comparing patients with ES against the PNES groups, which could be potential biomarkers of the disease. Damage to the blood-brain barrier is the most important difference between the two groups, thus identifying total protein changes offers a key to the future of differentiating ES and PNES patients.Introduction Studies have shown that naloxone can cause behavioral changes in naïve normal volunteers. This study aimed to investigate the possible complications of naloxone in methadone-overdosed opioid-naïve patients. Methods In this pilot study, a total number of 20 opioid-naïve methadone-poisoned patients underwent naloxone challenge test to receive naltrexone. 0.2, 0.6, and 1.2 mg doses of naloxone were administered on minutes 0, 5, and 15-20. The patients were followed for 30 minutes after administration of naloxone and monitored for any upsetting signs and symptoms. Patients with clinical opiate withdrawal scale (COWS) lower than 5 were considered not addicted and the severity of patients' symptoms was calculated using subjective opiate withdrawal syndrome (SOWS). Results 20 patients with mean age of 25.5±8.09 years were evaluated (70% female). Median ingested dose of methadone was 25 mg [IQR; 10 to 50 mg] and mean time interval between ingestion of methadone and naloxone challenge test was 7.1±4.9 hours. Fourteen patients reported some discomfort after administration of a mean dose of 1.7±0.5 mg of naloxone lasting for a maximum of four hours. The most common patients' complaints were headache (45%) followed by nausea (20%), agitation (20%), abdominal pain (20%), and flushing (20%). Two (10%) mentioned severe panic attack and sensation of near-coming death. SOWS significantly correlated with female gender (p = 0.004) and time elapsed post methadone ingestion (p = 0.001). Conclusion It seems that naloxone is not a completely safe medication even in opioid-naïve patients, and administrating adjusted doses of naloxone even in opioid-naïve methadone intoxicated patients may be logical.Introduction Few studies have described their experience using esmolol, an ultra-short acting β-adrenergic antagonist, in the emergency department (ED) as a feasible adjuvant therapy for the treatment of refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) out-of-hospital cardiac arrest. However, there is currently insufficient evidence to support the widespread implementation of this therapy. The aim of this scoping review was to summarize the current available evidence on the use of esmolol as an adjuvant therapy for refractory VF/pVT out-of-hospital cardiac arrest, as well as to identify gaps within the literature that may require further research. Methods We conducted a comprehensive literature search of MEDLINE via PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) on July 5, 2019. The search was restricted to articles that were published from January 2000 to July 2019. Google Scholar was searched and reference lists of relevant papers were -of-hospital cardiac arrest based on the available evidence. The findings of this scoping review suggest that there is a paucity of research and limited evidence to support this therapy.Introduction Tramadol is an active analgesic drug that is commonly used to treat moderate to severe pain. The present study aimed to assess the arterial blood gas (ABG) analysis of patients with tramadol-induced seizure (TIS). Methods This prospective cross-sectional study was performed on 50 TIS cases that were referred to emergency department within a maximum of one hour after their last episode of seizure. The results of ABG analysis on admission were collected and their association with dosage and time interval between ingestion and admission was assessed. Results 50 cases with the mean age of 35.10 ± 9.62 years were studied (80.0% male). The mean dosage of ingestion was 1122.00 ± 613.88 (400 to 3000) mg and the mean time interval between ingestion and admission was 7.16 ± 2.18 hours. ABG analysis on admission showed that 49 (98.0%) patients had pH 45 mmHg (respiratory acidosis). There was a significant association between ingestion to admission time interval and both PaCO2 (r = -0.330, p = 0.019), and PaO2 (r = 0.303, p = 0.032). The dose of ingestion was negatively associated with respiratory rate (r = -0.556, p = 0.001), arterial pH (r = -0.676, p = 0.001), and PaO2 (r = -0.514, p = 0.001), but was positively associated with PaCO2 (r = 0.461, p = 0.001). Higher doses of tramadol led to more severe hypercapnia and need for intubation (OR = 1.12, 95% CI 0.88 - 1.26; p = 0.045). 5 (10.0%) cases needed mechanical ventilation. All patients improved after supportive care with no in-hospital death. Conclusion Based on the findings, 98% of TIS cases had respiratory acidosis. Higher doses of ingested drug and longer time interval between ingestion and admission were associated with severity of ABG disturbances.Introduction Much attention has been paid to the association between valproic acid treatment and bone health. The objective of this study is to compare the serum vitamin D3 level in the epileptic children under valproic acid treatment with the healthy control group. Methods A case-control study has been carried out to compare vitamin D3 levels in 50 epileptic children who were treated with valproic acid with 50 healthy children selected from children visiting the hospital for routine checkup as control group. Results 100 cases with the mean age of 7.57± 3.62 years (range 2 - 15 years) were studied (44% boys). Among the 50 epileptic cases; 41 (82%) had generalized and 9 (18%) had partial seizure (56% well controlled and 44% poorly controlled). 15 (30%) of epileptic cases were using anti-epileptic drugs for 6-12 months, 36% for 12-24 months, and 34% for more than 24 months. The case and control groups were similar regarding gender (p =0.99), age (p = 0.24), and BMI (p = 0.64). 49 (49%) patients had some grade of vitamin D3 deficiency. There was a significant difference between case and control groups regarding vitamin D3 levels (p = 0.001). None of the controls had severe vitamin D3 deficiency, while 14% of cases did. 36 (72%) individuals in control group had sufficient or optimal vitamin D3 levels; while only 15 (30%) case patients had such levels. Generally, the control group had higher vitamin D3 levels in comparison to case group (p = 0.001). Conclusions The study revealed that there was a higher prevalence of vitamin D3 insufficiency in epileptic children receiving valproate monotherapy compared with healthy children. Vitamin D3 supplementation should be given to all epileptic children even before initiation of anti-epileptic drugs.Introduction External hemorrhage is a leading cause of preventable death due to trauma and Emergency Medical Services (EMS) staff members play a vital role in the frontline of trauma management. This study aimed to assess the knowledge, attitude and practice of EMS staff in bleeding control. Methods This knowledge, attitude and practice (KAP) study was conducted to assess the educational needs of EMS staff of Hormozgan province, Iran, regarding the bleeding control of trauma patients, during 2019. The participants were randomly selected and then their knowledge, attitude, and practice in management of hemorrhage and hemorrhagic shock were assessed using two researcher-made scenario-based questionnaires and one checklist. Results The scores for knowledge of the EMS staff regarding actions during complete amputation, status of injured patients, and medical measures during transfer of injured patients were 3.22 ± 0.68, 2.28 ± 0.83, and 2.29 ± 0.62, respectively. The average participants' attitude scores regarding the fear of bleeding, the importance of bleeding control, and confidence in bleeding control were 2.09±0.56, 2.4±0.58, and 1.76±0.55, respectively. The findings indicated that mean practice score was 1.72 ± 0.46 in capillary hemorrhage control, 1.41 ± 0.25 in venous bleeding control, 1.47 ± 0.25 in arterial bleeding control, and 1.56±0.27 in control of bleeding in the amputee limb. Conclusion The knowledge, attitude, and practice of EMS staff regarding bleeding control were moderate, positive and appropriate, and incomplete, respectively. Since bleeding is a life threatening status and EMS staff skills are critical in this issue, it seems that we need to provide continuous education in this regard.We investigated the added predictive value of lactate and lactate clearance to the Acute Physiology and Chronic Health Evaluation IV model for predicting in-hospital mortality in critically ill patients with sepsis. Design Retrospective observational cohort study. Setting Mixed ICU of Leiden University Medical Center, The Netherlands. Patients Critically ill patients adult patients with sepsis who have been admitted to the ICU of Leiden University Medical Center, The Netherlands, from 2006 to January 2018. Interventions None. Measurements and Main Results We fitted a baseline model with the Acute Physiology and Chronic Health Evaluation IV predictors and added 13 prespecified combinations of lactate and lactate clearance at 0, 6 and 24 hours after admission to create a set of extended models to compare with the baseline Acute Physiology and Chronic Health Evaluation IV model. Among 603 ICU admissions, 451 patients met the inclusion criteria. A total of 160 patients died in-hospital, of which 106 died in the ICU.