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.

Background: Trauma in the head is one of the most common childhood injuries. Children with minor head trauma are at higher risk of intracranial injury (ICI). Vomiting is one of the most common signs after minor head trauma in children, and different treatments are suggested for managing it. Objective: To determine the antiemetic effects of dexamethasone in children with minor head trauma. Methods: This single blind randomized clinical trial study was carried out during the period from September 2015 to August 2016 in Imam Khomeini and Golestan Hospitals in Ahvaz, Iran, on 64 children (2-8 years old) with minor head trauma (Minor head trauma was considered as GCS 14-15) who were admitted to the hospitals' emergency departments. In the intervention group, metoclopramide (0.15 mg/kg) and dexamethasone (0.15 mg/kg) were injected. In the placebo group, patients received metoclopramide (0.15 mg/kg) and placebo. Nausea severity was measured using Rhodes Index of Nausea and Vomiting. The data were analyzed using SPSS version 19. We used descriptive statistics, Chi-squared, t-test, and ANOVA for the analyses of the data. P-value of less than 0.05 was defined as the level of significance. Results: Finally, 62 patients (mean age of 56.4 and 62% male gender) attended the study and were equally divided into intervention and placebo groups. The Rhodes Index of Nausea and Vomiting on the intervention and placebo groups was 4.9±3.73 and 7.19±3.79, respectively (p=0.021). Conclusion: Collectively, our results indicated that dexamethasone can be used as an effective medication along with metoclopramide to control vomiting in children with minor head trauma. Trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016081128944N1.

Background: Shoulder joint dislocation is the most common dislocation of joints in the body. To reduce the anterior shoulder dislocation, it is necessary to have analgesia and sedation. Methods: In this randomized clinical trial, patients were divided into two equal groups. Group I received midazolam-fentanyl (0.05 mg/kg fentanyl at a dose of 1 µg/kg) for 10 minutes and group II received dexmedetomidine (1 µg/kg in the initial dose and then 0.2 µg/kg/h) for 10 minutes. The levels of analgesia according to VAS criteria and the time to reach desired sedation were compared between the two groups. Results: A total of 60 patients participated in this study. The time to reach the desired sedation was 8.60 ± 2.3 minutes in the dexmedetomidine group and 11.27 ± 3.57 minutes in the midazolamfentanyl group (p= 0.001). Also, the VAS score in both midazolam-fentanyl and dexmedetomidine groups was 3.3 ± 1.24 and 2.57 ± 0.9, respectively. The differences were statistically significant (p=0.015). There was significant relationship between the time to reach desired sedation and the level of analgesia. Moreover, there was no significant difference between patient age and the time to reach the desired level of analgesia. During this study, no side effect was observed. Conclusion: The findings of this study show that dexmedetomidine provides a higher level of analgesia than midazolam-fentanyl. Moreover, it was also shown that dexmedetomidine causes quicker procedural sedation than midazolam-fentanyl.

Objective: The present meta-analysis was conducted to determine the diagnostic accuracy of the bipolarity index (BI) and Rapid Mode Screener (RMS) as compared with the Bipolar Spectrum Diagnostic Scale (BSDS), the Hypomania Checklist (HCL-32), and the Mood Disorder Questionnaire (MDQ) in people with bipolar disorder (BD). Methods: We systematically searched five databases using standard search terms, and relevant articles published between May 1990 and November 30, 2021 were collected and reviewed. Results: Ninety-three original studies were included (n=62,291). At the recommended cutoffs for the BI, HCL-32, BSDS, MDQ, and RMS, the pooled sensitivities were 0.82, 0.75, 0.71, 0.71, and 0.78, respectively, while the corresponding pooled specificities were 0.73, 0.63, 0.73, 0.77, and 0.72, respectively. However, there was evidence that the accuracy of the BI was superior to that of the other tests, with a relative diagnostic odds ratio (RDOR) of 1.22 (0.98-1.52, p < 0.0001). The RMS was significantly more accurate than the other tests, with an RDOR (95%CI) of 0.79 (0.67-0.92, p < 0.0001) for the detection of BD type I (BD-I). However, there was evidence that the accuracy of the MDQ was superior to that of the other tests, with an RDOR of 1.93 (0.89-2.79, p = 0.0019), for the detection of BD type II (BD-II). Conclusion: The psychometric properties of two new instruments, the BI and RMS, in people with BD were consistent with considerably higher diagnostic accuracy than the HCL-32, BSDS, and MDQ. However, a positive screening should be confirmed by a clinical diagnostic evaluation for BD.

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.

No abstract

Background: COVID-19, which began in December 2019 in China, can have a broader impact on individuals' mental dimensions. Meanwhile, the medical staff battling this epidemic are more at risk of mental and emotional problems.  This study aimed to examine the level of stress, anxiety, and depression and their relationship with the level of knowledge of medical staff battling in COVID-19 pandemic treatment. Methods: This descriptive-analytical study was conducted on 641 medical staff using an online platform to design the questionnaire, and its link was placed in different groups of social networks all over the country  in which the medical staff battling COVID 19 were members. Statistical analysis was performed by SPSS 25 and Kolmogorov-Smirnov test, independent samples t-test, independent one-way analysis of variance, and chi-square. Results: Higher knowledge about COVID-19 was associated with younger age, clinicians, and nurses. Moreover, females were more knowledgeable in terms of support; while males were more reliable in washing hands and disinfecting wet places. Based on the categorical version of psychological factors, the majority of cases had severe stress ( 39.80 % ), normal depression ( 48.50 % ), and normal anxiety ( 57.30 % ). Finally, it was found that married participants had more knowledge about COVID-19, but knew less about its fatality. Conclusion: Studies have shown negative psychological experiences caused by COVID-19 in nurses, including negative emotions, such as fatigue, discomfort, helplessness due to high-intensity work, anxiety, and worry about family members.

No abstract