Publications by authors named "Hassan Motamed"

20 Publications

  • Page 1 of 1

Bronchodilatory effects of B-type natriuretic peptide in acute asthma attacks: a randomized controlled clinical trial.

Adv Respir Med 2020 ;88(6):531-538

Biostatistics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khouzestan, Iran.

Introduction: B-type natriuretic peptide (BNP) regulates different physiological processes such as blood pressure, cardiac growth, and neural and skeletal development. Thus, the aim of this study w as to evaluate the effect of BNP in the treatment of acute asthma attacks.

Material And Methods: In this randomized clinical trial, patients with acute asthma attacks were enrolled. The patients were divided randomly into two groups. Patients in the interventional group received BNP via intravenous infusion. Two µg/kg of BNP was injected as a bolus in 60 seconds. Then, infusion of BNP immediately began and was given in 0.01, 0.02, and 0.03 µg/kg/min doses every 30 minutes for the first 1.5 hours. The patients in the control group received nebulized salbutamol. Afterwards, peak flow meter findings, hemodynamic parameters, and estimation of the clinical severity of asthma in both groups were checked every 30 minutes.

Results: In total, 40 patients were included in this study. The values of PEFR in the 60th and 90th minutes in the control group were lower than those in the interventional group. In the 60th minute, the mean of PEFR was 377.3 in the BNP group but 335.95 in the control group (P = 0.049). Moreover, this difference remained significant in the 90th minute (P = 0.021). However, forced expiratory volume in one second (FEV1) did not differ between the groups at any time (p > 0.05).

Conclusion: Although a large experimental study is needed to verify our hypothesis, it seems that BNP might be a therapeutic option in asthma exacerbations, particularly in those with b2 agonist receptor polymorphism.
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http://dx.doi.org/10.5603/ARM.a2020.0178DOI Listing
January 2020

Characteristics of S100B and Neuron Specific Enolase in Differentiating Acute Vertigo Cases with Central Cause; a Diagnostic Accuracy Study.

Arch Acad Emerg Med 2020 28;8(1):e3. Epub 2019 Dec 28.

Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Differentiating central vertigo from peripheral ones poses a challenge to specialists. The present study aimed to examine the potential screening value of S100B and neuron-specific enolase (NSE) in this regard.

Methods: This prospective cross-sectional study recruited adult acute vertigo patients with suspected central causes visiting the emergency department (ED) in the first six hours since the onset of symptoms. The screening performance characteristics of S100B and NSE biomarkers in differentiating central vertigo cases were measured considering brain magnetic resonance imaging (MRI) as the reference test.

Results: 85 cases who met the criteria were enrolled to the study (82.3% female). The MRI of 21 (24.7%) cases had abnormal findings. The two groups were the same in terms of age, sex, and vital signs. Patients with abnormal brain MRI had significantly higher levels of S100B (p < 0.001) and NSE (p < 0.001). S100B and NSE had area under the receiver operating characteristic (ROC) curve of 90.3 (95% CI: 80.7 - 99.8) and 96.9 (95% CI: 93.7 - 100.0) in differentiating the central causes of acute vertigo, respectively. At the cut-off point of above 119.68 pg/l, S100b had sensitivity of 90.00% (95% CI: 78.83 -95.86) and specificity of 92.00% (95% CI: 72.49 - 98.60). The sensitivity and specificity of NSE at the cut-off point of above 18.12 ng/ml were 100.00% (95% CI: 93.14 - 100.00) and 89.47% (95% CI: 65.46 - 98.15), respectively.

Conclusion: The serum levels of S100B and NSE were significantly higher in patients with central vertigo, and could therefore be considered as accurate tools in screening acute vertigo cases with central causes in ED.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946037PMC
December 2019

Serum Cleaved Tau Protein and Clinical Outcome in Patients with Minor Head Trauma.

Open Access Emerg Med 2020 20;12:7-12. Epub 2020 Jan 20.

Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Minor head trauma is due to the transfer of a mechanical energy to the brain caused by a traumatic event. The present study was accomplished aiming to investigate the cleaved tau protein (CTP) as a brain injury biomarker among patients with minor head trauma.

Patients And Methods: This observational study was performed on patients with minor head trauma in 2017 who referred to emergency department of Imam Khomeini Hospital and Golestan Hospital of Ahvaz, Iran. The patients over the age of 16 years old with minor head trauma, who had computed tomography (CT) scan at most 10 hrs after the incident, and consented to participate in the study, were enrolled. C-tau evaluation was performed by the enzyme-linked immunosorbent assay (ELISA) method with monoclonal antibodies detecting the C-tau marker. Investigation of the injury after 3 months of minor head trauma was conducted using a post-concussion syndrome questionnaire (RPCS).

Results: In this study, 86 patients were evaluated. CTP was positive in 14% of the patients and the results revealed that there was a significant relationship between traumatic brain injury (TBI) and positive CTP (p < 0.0001). The CTP had a sensitivity and specificity of, respectively, 92% and 100% in detecting intracranial trauma. In addition, positive and negative predictive powers for this marker were 100% and 98%, respectively.

Conclusion: In general, contrary to previous studies, the findings of this study suggest that evaluation of the CTP levels can be a strong biomarker with high sensitivity and specificity in detecting TBI.
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http://dx.doi.org/10.2147/OAEM.S217424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980837PMC
January 2020

The Diagnostic Value of Neuron-Specific Enolase in Children with Mild Blunt Trauma Requiring Cranial CT Scan.

Open Access Emerg Med 2020 13;12:1-5. Epub 2020 Jan 13.

Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: The present study was conducted to investigate the relationship between serum levels of enolase and pathological findings obtained from CT scans of the brain in children with mild blunt brain trauma and help with a more accurate diagnosis of brain injuries.

Methods: The present observational study was conducted on children presenting with head traumas to the emergency department (ED) of Golestan Hospital in Ahvaz, Iran in 2016. A venous blood sample was immediately taken by the ward nurse from all the eligible patients within 6 hrs of the incident after obtaining their information, performing initial examinations and their initial stabilization. Laboratory serum levels and the corresponding interpretations of CT scans of the brain were collected, recorded and then evaluated and analyzed.

Results: A total of 62 children with mild blunt brain trauma were included in the study. A significant difference was observed between the positive CT scan group (2.7±9.74 µg/L) and the negative group (4.23±1.33 µg/L) in terms of serum levels of enolase (P<0.0001). The area under the receiver operating characteristic (ROC) curve was 0.992 for serum levels of enolase in diagnosing brain lesions caused by mild head traumas. Moreover, with a cut-off point of 6.97 µg/L, brain lesions could be detected with a sensitivity of 93.55% and a specificity of 100%.

Conclusion: Serum levels of enolase were found to be higher in patients with brain injuries. This highly accurate diagnostic biomarker can be recommended for estimating the presence of brain lesions associated with mild head traumas in infants.
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http://dx.doi.org/10.2147/OAEM.S223179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970105PMC
January 2020

Efficacy of nebulized fentanyl and low dose ketamine for pain control of patients with long bone fractures: A randomized, double-blind, clinical trial.

Afr J Emerg Med 2019 Sep 3;9(3):119-122. Epub 2019 Mar 3.

Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Fentanyl is a lipid soluble, highly potent opioid. The lipid solubility of fentanyl makes it an ideal opioid to be administrated by inhalation. The current study compared ketamine infusion and nebulized fentanyl in bone fracture pain relief.

Methods: In this double-blind, randomized clinical trial, patients aged 18 to 55 years who were admitted to the emergency department (ED) with limb fracture were recruited. A total of 127 patients were included in the study, 51.1% (65) of whom were male and 48.9% (62) of whom were female. The patients were divided equally into two groups: Group I received 100 cm IV infusion of normal saline and 4 μg/kg of 50 μg/ml nebulized fentanyl; Group II received 0.4 mg/kg ketamine in 10 min and 5 cm nebulized normal saline. Pain was assessed using a visual analog scale just before treatment and 5, 10, 15, 30, and 60 min post-treatment.

Results: Before intervention, the pain scores of both groups showed no significant difference. However, log linear analysis in both groups showed a significantly decrement during the follow up (60 min) ( < 0.0001). Multiple comparison analysis showed that pain scores were significantly higher in the patients of Group I. Moreover, patients in Group I required additional treatment.

Conclusion: Ketamine can be used as an alternative non-invasive treatment to successfully relieve pain in patients with limb fractures.
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http://dx.doi.org/10.1016/j.afjem.2019.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6742599PMC
September 2019

Comparison of the Analgesic Effect of Intravenous Ketamine versus Intravenous Morphine in Reducing Pain of Renal Colic Patients: Double-Blind Clinical Trial Study.

Rev Recent Clin Trials 2019 ;14(4):280-285

Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: The effective relief of renal colic patients with low complications is one of the important concerns of emergency physicians. The aim of this study was to investigate the use of injectable ketamine as an alternative to routine drugs in the relief of pain in patients with renal colic.

Methods: This double-blind clinical trial was conducted on patients who had suffered kidney pain due to kidney stones in 2017, referred to Ahvaz Imam Khomeini Hospital. Patients were divided into 2 groups: the first group received intravenous ketamine (0.3 mg/kg) and the second group received intravenous morphine (0.1 mg/kg) in a double-blind form. Finally, the mean pain was evaluated before injection, after 10, 20, 30, and 60 minutes as the initial result while the side effects were considered as secondary results.

Results: In this study, 135 patients with renal colic participate in this study. The mean pain at the time of referral to the hospital in the group receiving morphine and ketamine was 9.2 and 9.2, respectively, which did not show any significant difference. Based on these findings, there was no significant difference between the factors evaluated during the study of the two groups. Only in the ketamine group, there were 3 cases of nausea and 1 of vomiting. However, there was a significant increase in the need for additional doses of fentanyl in the morphine recipient group (p = 0.02).

Conclusion: The findings suggest that the use of ketamine can produce a more rapid relief effect, and decrease the use of opioids which create various complications, including nausea and vomiting in patients, especially patients with renal colic.
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http://dx.doi.org/10.2174/1574887114666190705122727DOI Listing
May 2020

Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial.

Am J Emerg Med 2020 03 26;38(3):549-553. Epub 2019 May 26.

Assistant professor of Emergency Medicine, Department of Emergency Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Kidney stones are a fairly common problem that manifests itself as symptoms of acute abdominal and flank pains in patients presenting to emergency departments.

Objective: The present study was conducted to compare the analgesic effect of intravenous fentanyl with that of intranasal ketamine in renal colic patients.

Methods: One mg/kg of intranasal ketamine was administered in the first group, and one μg/kg of intravenous fentanyl in the second group. The pain severity was measured in the patients in terms of a visual analogue scale (VAS) score at the beginning of the study and at minutes 5, 15 and 30, and the medication side-effects were evaluated and recorded.

Results: A total of 130 patients were ultimately assessed in two groups of 65. In the ketamine group, the mean severity of pain was 8.72 ± 1.52 at the beginning of the study (P < 0.001), 5.5 ± 2.97 at minute 5 (P < 0.001), 3.38 ± 3.35 at minute 15 (P = 0.004) and 2.53 ± 3.41 at minute 30 (P = 0.449). In the fentanyl group, this severity was 9.66 ± 88.8 in the beginning of the study (P < 0.001), 7.27 ± 1.37 at minute 5 (P < 0.001), 4.61 ± 1.5 at minute 15 (P = 0.004) and 1.24 ± 1.25 at minute 30 (P = 0.449). The general prevalence of the medication side-effects was 10 (15.4%) in the ketamine group and 1 (1.5%) in the fentanyl group (P = 0.009).

Conclusions: Ketamine was found to be less effective than fentanyl in controlling renal colic-induced pain, and to be associated with a higher prevalence of side-effects; nevertheless, ketamine can be effective in controlling this pain in conjunction with other medications.
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http://dx.doi.org/10.1016/j.ajem.2019.05.049DOI Listing
March 2020

Comparison the analgesic effect of magnesium sulphate and Ketorolac in the treatment of renal colic patients: Double-blind clinical trial study.

Am J Emerg Med 2019 06 24;37(6):1033-1036. Epub 2018 Aug 24.

Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Ureter muscles contraction movements caused pain in renal colic. Magnesium sulphate could influence the pain by reducing acetylcholine in the nerve terminals. We have aimed to evaluate the analgesic effects of magnesium sulphate on acute renal colic pain.

Method: In this double-blind clinical trial study, the patients with renal colic pain were randomly divided into 2 groups; Group I received an intravenous infusion of 30 mg of Ketorolac and normal saline as placebo, Group II 50 mg/kg magnesium sulphate 50%/100 ml normal plus 30 mg of Ketorolac. The pain severity of patients was assessed using the visual analog scale (VAS) at baseline, and 15 and 30 min after intervention.

Results: Baseline pain score and demographic characteristics did not significantly different between the groups. After 30 min the pain score significantly reduced in both groups. While, at 15 and 30 min, mean pain score did not show statistically significant differences.

Conclusion: Our findings indicated that Magnesium sulphate did not influence renal colic pain relief.
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http://dx.doi.org/10.1016/j.ajem.2018.08.040DOI Listing
June 2019

Rectus Muscle Hematoma as a Rare Differential Diagnosis of Acute Abdomen; a Case Report.

Emerg (Tehran) 2018 1;6(1):e28. Epub 2018 May 1.

Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Rectus sheath hematoma is a rare but well-known problem. Exercise, pregnancy, subcutaneous injection of insulin, abdominal surgery and severe coughs can be predisposing factors of hemorrhage in the mentioned muscle sheath. Here, we will discuss a case of rectus sheath hematoma in a 28 year-old female patient who presented to emergency department with complaint of abdominal pain and improved in 1 week with palliative care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036518PMC
May 2018

Intravenous Lidocaine Compared to Fentanyl in Renal Colic Pain Management; a Randomized Clinical Trial.

Emerg (Tehran) 2017 23;5(1):e82. Epub 2017 Oct 23.

Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Using alpha blockers such as intravenous (IV) lidocaine has been deemed effective in controlling acute pain. Therefore, the current study was designed with the aim of evaluating the efficiency of IV lidocaine in comparison to IV fentanyl in pain management of patients with renal colic in emergency department (ED).

Methods: In this double blind clinical trial, 18-65 year old patients that presented to ED with colicky flank pain and met the inclusion criteria of the study were allocated to either lidocaine or fentanyl group using block randomization and compared regarding pain severity 5, 10, 15, and 30 minutes after drug administration.

Results: 90 patients with the mean age of 35.75±8.87 years were divided into 2 groups of 45 (90% male). The 2 groups were not significantly different regarding the studied baseline variables. Pain severity was not significantly different between the 2 groups at various times after injection. Treatment failure rate 15 minutes after injection was 44.4% (20 cases) in IV lidocaine and 17.8% (8 cases) in IV fentanyl group (p = 0.006). These rates were 26.6% (12 patients) versus 22.2% 30 minutes after injection (p = 0.624). Absolute risk increase of treatment failure in case of using lidocaine was 26.7 (95% CI: 8.3-44.9) in the 15 minute and 4.4 (95% CI: 13.3-22.2) 30 minutes after injection. Number needed to harm (NNH) in treatment with lidocaine 15 and 30 minutes after injection were 4 (95% CI: 2.2-12.0) and 23, respectively.

Conclusion: Although mean pain severity was not significantly different between IV fentanyl and lidocaine at various times after injection, treatment failure rate was significantly higher in the IV lidocaine group 15 minutes after injection.
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http://dx.doi.org/10.22037/emergency.v5i1.18894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703759PMC
October 2017

Intranasal Lidocaine for Primary Headache Management in Emergency Department; a Clinical Trial.

Emerg (Tehran) 2017 16;5(1):e79. Epub 2017 Sep 16.

Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Most of the headache cases only require pain management in emergency department (ED). The present study aimed to evaluate the efficacy of intranasal lidocaine in this regard.

Method: In this clinical trial, adult patients with primary headache were randomly treated with 7.5 mg intravenous (IV) chlorpromazine and 1 ml intranasal lidocaine 2% (treatment) or normal saline 0.9% (placebo), and were compared 5, 15, and 30 minutes later regarding success rate using SPSS 21.

Result: 100 patients were assigned to either treatment or placebo group. Number needed to treat of intranasal lidocaine at 5, 15, and 30 minutes were 4 (95% CI: 2.2 - 6.6), 3 (95% CI: 1.7 - 3.5), and 4 (95% CI: 2.3 - 15.9), respectively. These measures for absolute risk reduction were 30 (95% CI: 15.2 - 44.8), 44 (95% CI: 28.7 - 59.3), and 26 percent (95% CI: 6.3 - 44.3), respectively. Pain relapse occurred in 16% of treatment and 11% of control group within 1 hour of treatment (p = 0.402).

Conclusion: It seems that, intranasal lidocaine along with IV chlorpromazine could result in more successful and faster management of primary headaches in ED.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703756PMC
September 2017

A Comparison of the Effects and Side Effects of Oral Betahistine with Injectable Promethazine in the Treatment of Acute Peripheral Vertigo in Emergency.

J Clin Med Res 2017 Dec 6;9(12):994-997. Epub 2017 Nov 6.

Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Vertigo is an illusion of rotation that is caused by the asymmetry of neurological function of the right and left vestibular nuclei. The aim of this study was to compare the efficacy and side effects of oral betahistine with injectable promethazine in treatment of acute peripheral vertigo.

Methods: In this double-blind clinical trial study, the patients with acute peripheral vertigo were assigned in the two groups: receiving promethazine intramuscularly at a dose of 25 mg (group A) and receiving 8 mg betahistine tablets (group B) and the severity of their vertigo was evaluated on the visual analog scale (VAS) scoring system. In addition, adverse events in both groups of patients were compared and evaluated.

Results: A total of 162 patients (82 subjects in group A) participated in this study. The mean age, gender distribution, intensity and symptoms of vertigo were similar in both groups before the intervention. At 2 and 3 h after the intervention, the score of VAS in patients taking betahistine was significantly higher than promethazine. In addition, the clinical symptoms after taking betahistine were significantly less. Side effects seen in patients taking the promethazine include mainly drowsiness. After taking betahistine, the most common complication was abdominal problems (nausea and vomiting).

Conclusion: The results of this study show that betahistine is a safe and effective drug in controlling patients with acute vertigo and its impact is more than promethazine.
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http://dx.doi.org/10.14740/jocmr3093wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687903PMC
December 2017

Sublingual Buprenorphine Efficacy in Renal Colic Pain Relief: A Randomized Placebo-Controlled Clinical Trial.

Pain Ther 2017 Dec 20;6(2):227-234. Epub 2017 Oct 20.

Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: This study was designed to compare the analgesic efficacy of sublingual (SL) buprenorphine and intravenous (IV) ketorolac for renal colic pain relief.

Methods: The present study was carried out as a double-blind, double-dummy randomized clinical trial in patients diagnosed with acute renal colic attending the emergency department. The study subjects were 63 patients with confirmed renal stones. The subjects were randomly divided into two groups. One group, which included 32 patients, received SL buprenorphine tablets (2 mg) with an IV placebo, and another group, including 31 patients, received ketorolac tromethamine (30 mg) with a SL placebo. After medication, the pain of subjects was measured by a standard visual pain analogous scale (VPAS) in minutes 0, 20, 40, and 60 of study. Also, probable adverse effects were recorded.

Results: In 28.1% of patients in the buprenorphine group, the mean pain score decreased from 9.2 to 5.9, 2.8, and 1.5 after 20, 40, and 60 min, respectively, as determined by VPAS. Also, in 38.7% of patients in the ketorolac group, the mean pain score decreased from 9.1 to 5.5, 3.0, and 1.6 after 20, 40, and 60 min, respectively, as determined by VPAS. The two groups did not significantly differ for pain reduction at 20, 40, and 60 min (P value = 0.16, 0.34, and 0.3, respectively). No adverse effects were seen in the ketorolac group, but vomiting (18.8%), nausea (18.8%), and dizziness (21.9%) were detected in the buprenorphine group.

Conclusions: We found no difference between SL buprenorphine and intravenous ketorolac in renal colic pain relief but more adverse effects in the buprenorphine group. Trial Registration Iranian Registry of Clinical trials identifier, IRCT2015041421773N1.
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http://dx.doi.org/10.1007/s40122-017-0082-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693813PMC
December 2017

Intravenous Lidocaine versus Morphine Sulfate in Pain Management for Extremity Fractures; a Clinical Trial.

Emerg (Tehran) 2017 28;5(1):e68. Epub 2017 May 28.

Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Considering the existing contradictions regarding effectiveness of intravenous (IV) lidocaine, especially in emergency department (ED), the present study was designed to compare the analgesic effect of IV lidocaine and morphine sulfate in pain management for extremity bone fractures.

Method: In this triple blind clinical trial, 15 to 65 year-old patients with extremity fractures and in need of pain management were randomly allocated to either IV lidocaine or morphine sulfate group and were compared regarding severity of pain 5, 10, 15, 20, 25, and 30 minutes after infusion via intention to treat analysis. The absolute risk reduction, number needed to treat and relative risk of IV lidocaine after 30 minutes were 0.40 (95%CI: 0.25 - 0.64), 7 (95%CI: 3.7 - 23.1), and 20.71 (95%CI: 10.91 - 30.51), respectively.

Results: 280 patients with the mean age of 32.50 ± 12.77 years were randomly divided into 2 equal groups of 140 (73.9% male). The 2 groups had similar baseline characteristics. 15 minutes after injection success rate was 49.28% in lidocaine and 33.57% in morphine sulfate group (p = 0.011), and after 30 minutes it reached 85.71% and 65.00%, respectively (p < 0.001).

Conclusion: Based on the results of the present study, IV lidocaine could be considered as a reasonable alternative choice for pain management in ED.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585838PMC
May 2017

Comparing Two Different Doses of Intravenous Midazolam in Pediatric Sedation and Analgesia.

Emerg (Tehran) 2016 Nov;4(4):192-195

Department of EmergencyMedicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran.

Introduction: Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard.

Methods: The present clinical trial was performed to compare 0.1 and 0.3 mg/kg doses of IV midazolam in induction of sedation for head trauma infant patients in need of brain computed tomography (CT) scan. Conscious infants under 2 years old, with stable hemodynamics were included. Onset and duration of action as well as probable side effects were compared between the two groups using SPSS version 22.

Results: 110 infants with the mean age of 14.0 ± 5.9 months (range: 4 - 24) and mean weight of 9.7 ± 2 kg (range: 5 - 15) were randomly allocated to one of the 2 study groups (54.6% female). Success rate in 0.1 and 0.3 mg/kg groups were 38.2% (21 patients) and 60% (33 patients), respectively (p = 0.018). Overall, 56 (50.9%) patients did not reach proper sedation and were sedated receiving ketamine (22 patients) or another dose of midazolam (34 patients, mean additional dose needed was 2.1 ± 1.1 mg).

Conclusion: The results of the present study demonstrated the higher success rate and longer duration of action for 0.3 mg/kg midazolam compared to 0.1 mg/kg. The groups were equal regarding onset of action, effect on vital signs and probable side effects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007910PMC
November 2016

Erythrocyte Sedimentation Rate Measurement Using as a Rapid Alternative to the Westergren Method.

Emerg (Tehran) 2015 ;3(2):50-3

Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Erythrocyte sedimentation rate (ESR) remains as one of the most reliable tests in clinical practices. Yet its use is time consuming and requires a large blood sample. The aim of this study was assessing a faster and reliable method of ESR estimation.

Methods: An ESR estimation method was described and performed on 108 patients using capillary tube (micro ESR) and capillary peripheral blood. Micro ESR results at different intervals were measured and compared with Westergren ESR (conventional ESR) estimation by Pearson and Spearman's coefficients. A regression equation was derived to predict conventional ESR values based on micro ESR results. The agreement of two measurements was demonstrated using the Bland-Altman plot.

Results: Micro ESR results at 20 minutes showed the earliest close correlation with conventional ESR results at one hour (r = 0.987). The presented regression equation was able to closely predict ESR values (r(2) = 0.974) and the Bland-Altman plot showed an acceptable agreement between converted and conventional ESR measurements.

Conclusion: Using capillary tube and capillary blood sample (micro ESR) appears to be a faster, cheaper, more reliable, and precise tool for ESR measurement in the ED. The results have acceptable correlation with conventional ESR, especially at 20 minutes of measurement.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614602PMC
October 2015

Lateral lower face and neck contouring following burn injury.

Acta Med Iran 2015 ;53(4):225-30

Department of Emergency Medicine, Ahvaz University of Medical Sciences, Ahvaz, Iran.

The neck is normally a concave and highly mobile structure. Facial and cervical skin is prone to burn scar contracture because of its thin nature. The goal of treatment is to reconstruct this region to achieve a good aesthetic outcome and also normal neck and chin mobilization. This study was conducted to compare the effect of one row of suture and three rows of suture in critical points of the neck to recreate cervicomandibular angle for better contouring of the neck. A cross-sectional study was performed from July 2006 until August 2010. A total of 65 patients underwent lower lateral face and neck burn scar contracture reconstruction. The mean age of participants was 25.5 years old. After designing a local flap, in 31 patients we applied one row of suture. In 34 patients, we used three rows of suture on each side of the neck incorporation with  the recipient bed and the flap dermis or capsule to recreate a natural lower lateral face and neck contour (P<0.001). The standard deviation in hospitalization was 7 ± 2 days for group A and 6 ± 1 days for group B. In a two years follow-up, no blunting of cervicomandibular angle occurred and three rows of suture were superior according to present findings.
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October 2015

Comparison of morphine-midazolam versus morphine injection for pain relief in patients with limb fractures - a clinical trial.

Ulus Travma Acil Cerrahi Derg 2015 Jan;21(1):22-6

Department of Emergency Medicine, Shahid Beheshti Medical University, Tehran, Iran.

Background: Pain relief, using opiates as a primary choice, is an important part of treating limb fractures. Yet, in order to reduce opiate consumption, other combinations have been introduced. This study aimed to compare pain reduction by a combination of morphine-midazolam with morphine injection in patients with limb fractures.

Methods: A randomized double-blind study of patients with upper or lower extremity fractures was conducted. Patients' response to treatment with either morphine-midazolam solution or morphine at 15, 30, 45, 60, 120, and 180 minutes were assessed. The Kaplan-Meier curves and generalized estimating equations were examined to evaluate the success of treatment.

Results: A total of seventy-two patients aged 18-60 (80.6% male; mean age: 35±17.9 years) were included. At 15, 30, 45, and 60 minutes, successful pain control was seen in 8.83 22.2%, 33.3% and 63.9% of the patients in the morphine group, and 11.1%, 27.7%, 44.4% and 63.8% in the midazolam-morphine group. By the third hour, pain-control was achieved in all patients receiving morphine while pain persisted in one patient receiving morphine-midazolam. Log-rank test showed no significant difference between the two groups (p=0.55).

Conclusion: Our findings revealed that adding midazolam to morphine did not improve its pain-relief profile.
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http://dx.doi.org/10.5505/tjtes.2015.64494DOI Listing
January 2015

Development of an Easy-to-Use Tool for the Assessment of Emergency Department Physical Design.

Emerg (Tehran) 2014 ;2(2):59-65

Department of emergency medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Physical design of the emergency department (ED) has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study, we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed. Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a "Yes or No" question for ease of analysis, meaning that the criterion is either met or not.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614581PMC
October 2015

An isolated bee sting involving multiple cranial nerves.

Case Rep Emerg Med 2013 18;2013:920928. Epub 2013 Jul 18.

Emergency Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Hymenoptera stings are self-limiting events or due to allergic reactions. Sometimes envenomation with Hymenoptera can cause rare complications such as acute encephalopathy, peripheral neuritis, acute renal failure, nephrotic syndrome, silent myocardial infarction, rhabdomyolysis, conjunctivitis, corneal infiltration, lens subluxation, and optic neuropathy. The mechanism of peripheral nervous system damage is not clearly known. In our studied case after bee sting on face between the eyebrows with little erythema and 1 × 1 cm in size, bilateral blindness developed and gradually improved. Lateral movement of eyes was restricted with no pain. Involvement of cranial nerves including II, V, and VI was found. With conservative therapy after a year significant improvement has been achieved.
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http://dx.doi.org/10.1155/2013/920928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732619PMC
August 2013