BackgroundAcute poisoning is a common chief complaint leading to emergency department visits and hospital admissions in developing countries such as Iran. Data describing the epidemiology of different poisonings, characteristics of the clinical presentations, and the predictors of outcome are lacking. Such data can help develop more efficient preventative and management strategies to decrease morbidity and mortality related to these poisonings. This manuscript describes the epidemiology of acute poisoning among patients admitted to the intensive care unit (ICU) in Birjand, Iran.MethodsThis retrospective, cross-sectional study was conducted to characterize acute poisonings managed in the ICU during a 7-year period from March 2010 to March 2017 in a single center in Birjand, Iran. Patient characteristics, suspected exposure, the route of exposure, and outcome data were collected from hospital medical records.ResultsDuring the study period, 267 (64% male and 36% female) patients met inclusion criteria. Pharmaceutical medication (36.6%), opioids (26.2%) followed by pesticides (13.9%) were the most common exposures 38.2% of these cases were identified as suicide attempts. There were different frequencies in terms of xenobiotic exposure in relation to gender (p = 0.04) and the survival (p = 0.001). There was a significant difference between various xenobiotics identified as the cause of poisoning (p = 0.001). Mortality rate in our study was 19.5%. The incidence of outcomes was significantly higher in patients poisoned with opioids, pesticides, benzodiazepines, and tricyclic antidepressants (p < 0.05). The median length of hospital stay was higher in pesticide-poisoned patients (p = 0.04).ConclusionOpioids and pesticides were the most common exposures. The mortality rate of the poisoned patients in the ICU was proportionately high. The mortality rate due to opioid poisoning is a major concern and the most significant cause death due to poisoning in the region. Further monitoring and characterization of acute poisoning in Birjand, Iran is needed. These data can help develop educational and preventative programs to reduce these exposures and improve management of exposures in the prehospital and hospital settings.

Objective. The present study uses simulated data to find what the optimal number of response categories is to achieve adequate power in ordinal logistic regression (OLR) model for differential item functioning (DIF) analysis in psychometric research. Methods. A hypothetical ten-item quality of life scale with three, four, and five response categories was simulated. The power and type I error rates of OLR model for detecting uniform DIF were investigated under different combinations of ability distribution (θ), sample size, sample size ratio, and the magnitude of uniform DIF across reference and focal groups. Results. When θ was distributed identically in the reference and focal groups, increasing the number of response categories from 3 to 5 resulted in an increase of approximately 8% in power of OLR model for detecting uniform DIF. The power of OLR was less than 0.36 when ability distribution in the reference and focal groups was highly skewed to the left and right, respectively. Conclusions. The clearest conclusion from this research is that the minimum number of response categories for DIF analysis using OLR is five. However, the impact of the number of response categories in detecting DIF was lower than might be expected.

Background: Some studies have reported the effects of anesthesia induction using a single propofol dose and low ketamine doses in short-term outpatient operations. Objectives: In this study, we aimed to evaluate the intra and post-operative hemodynamic effects of ketamine-propofol mixture (Ketofol) infusion in comparison with propofol infusion. Methods: This study was performed on 54 class I and II of the American Society of Anesthesia patients aged 15 to 45 years who were candidates for leg fracture surgery. The patients were randomly assigned to propofol and ketofol groups. In the propofol and ketofol groups, propofol infusion (100 µg/kg/min) and propofol-ketamine infusion (50 µg/kg/min propofol + 25 µg/kg/min ketamine) were used for the maintenance of anesthesia, respectively. Heart rate and systolic, diastolic and mean blood pressure before, immediately after the induction of anesthesia and at 10-minute intervals were measured and recorded. Pain, nausea, and vomiting were recorded immediately after surgery and each 2 hours until 6 hours. Results: Systolic, diastolic and mean blood pressure were significantly higher in the ketofol group than in the propofol group at 10 -60 min intervals (P < 0.05). There was no significant difference, however, between the two groups in terms of the severity of nausea and pain and vomiting frequency. Conclusions: Infusion of hypnotic doses of ketofol leads to increase in diastolic and systolic blood pressure and improves blood pressure stability in addition to inducing more as compared with propofol infusion, but it leads to higher risk of nausea and vomiting.

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