Background: This study aimed to evaluate the safety and efficacy of 2 forms of vitamin D supplementation on oxidative stress and weaning from the ventilator in patients with traumatic injury and vitamin D deficiency. Methods: Seventy-two patients were randomly divided into 3 groups: receiving 50,000 IU pearl cholecalciferol daily for 6 days, 1 intramuscular injection of 300,000 IU of cholecalciferol, or a control group that did not receive any supplement. Duration of mechanical ventilation, body composition, and biochemical biomarkers were measured before and after the intervention. Result: At the end of the study, the mean serum 25(OH)D increased in the intervention groups compared with the control group (P < .05). The interleukin 6, erythrocyte sedimentation rate, C-reactive protein levels, Sequential Organ Failure Assessment score, duration of mechanical ventilation, and length of intensive care unit admission significantly decreased; however, total antioxidant capacity concentration did not differ significantly between the 2 intervention groups. Among the body composition variables, extracellular water ratio changes were statically different in oral vitamin D group compared with the control group (P = .001). No side effects were reported with the supplements. Conclusions: Vitamin D administration improved clinical signs and biochemical biomarkers in a small group of patients with traumatic injury. Well-designed multicenter clinical studies with longer intervention duration are necessary for this field.

Patient safety is an increasingly recognized challenge and opportunity for stakeholders in improving health care delivery. Because of extensive use of medicines, life expectancy is increasing and elderly as well as comorbidities need polypharmacy, and therefore the risk of drug-drug interactions (DDIs) increases.We searched PubMed and ScienseDirect for epidemiology of articles describing the frequency of potential DDIs published up to 2011 in title, abstract, keywords and text.Studies show that the rate of DDIs both in outpatients and hospitalized patients is high. The elderly, <5 year-old children and women are at higher risks for it. Also, the rate of DDIs in patients who suffer from chronic kidney disease (CKD), cardiovascular disease (CVD) such as heart failure (HF) and hypertension (HTN) and cancers is significant.Physicians, for lowering the risk of DDIs, should take precise drug history, prescribe appropriate and lowest drugs and ultimately counsel with clinical pharmacologist as a key strategy in order to insure the patient safety. This article reviews the existing data concerning this problem to provide an aid for choosing the appropriate drugs and prescribe the most effective with the lowest DDIs for providing patient safety.

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Traumatic brain injury is a major cause of death and disability in adults. This study investigated the effect of oral administration of amantadine on the neurological outcomes of patients with diffuse axonal injury (DAI) in the intensive care unit (ICU). This double-blind clinical trial was conducted in the ICU of Imam Hospital in Urmia. Patients with DAI were intubated and received mechanical ventilation in the ICU. They were divided into 2 groups: patients receiving amantadine (A) and placebo (P). The acquired data were analyzed using SPSS, P < .05 significant level. Findings showed no significant difference between the 2 groups in age and sex. There was no significant difference between the mean Glasgow Coma Scale (GCS) at the time of admission and discharge, and the mean Glasgow Outcome Scale (GOS) of the patients in 2 groups. No significant difference was observed in the duration of mechanical ventilation, hospitalization, and mortality in both groups (P > .05) in ICU. However, there was a significant difference between the mean GCS at the time of admission and discharge and death. Also, significant differences existed between the mean GOS in discharged and deceased patients (P = .001). This study showed no significant difference between the mean GCS at the time of admission and discharge and the mean GOS of the discharged patients and the mortality rate in the 2 groups. However, there were clear statistical differences between these variables in discharged and deceased patients. It is recommended that further studies are conducted with a larger sample size.

BackgroundLaryngeal mask airway (LMA) is frequently used as a replacement method for endotracheal intubation. Few studies have investigated placement of laryngeal mask airway in pediatric surgical patients. In the present study, we aimed at comparing the success rate of 2 techniques, classic versus rotational, in the correct placement of laryngeal mask airway in pediatric patients.MethodsAfter obtaining approval from the research committee of Faculty of Medicine, and receiving clearance from the ethics board of the University, this randomized controlled clinical trial (RCT) was administered on children of 2 months to 8 years with ASA class I & II undergoing lower abdominal surgical procedures in Motahari hospital in Urmia. General anesthesia using muscle relaxant was the preferred anesthesia technique for all the patients. Demographic data were recorded. Success rate, number of trials for correct placement, cuff leak pressure, and blood stain on the cuff of the laryngeal mask airway after its removal were all recorded.ResultsIn the present study, 116 children were evaluated and placed into 2 groups. According to the results of the t test, no significant effect of age, weight, or average number of trials in mask placement was observed between the 2 groups (P > 0.05). According to the results of the Fisher’s exact test, no significant difference was detected between the 2 groups in blood staining on the cuff (P > 0.05); no leak was recorded in any of the LMA placement methods (classic or rotational).ConclusionsBoth insertion techniques work well in pediatric surgical patients. Success rate and complications were comparable between the 2 groups.

BACKGROUND: Traumatic brain injury is one of the major concerns of global public health, because it is the main cause of morbidity and mortality between young people. This study aimed to investigate the possible association between the parameters of arterial blood gas (ABG) and outcome of patients with severe head trauma.

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Introduction: Pain self-report is the gold standard of pain assessment. Mechanically ventilated patients cannot self-report the pain due to the presence of a tracheal tube and changes in the level of consciousness caused by sedation, exposing them to the risk of inadequate pain management that leads to psychological and physiological consequences. This study aimed to present a review of the published evidence and studies concerning the scales used in pain assessment in mechanically ventilated patients according to their psychometric characteristics and application in the nursing practice. Methods: We conducted a systematic review following PRISMA guidelines. National and international journals in such databases as Science Direct, PubMed, EMBASE, Pro Quest Central, Web of Science, SID, and Magiran were searched using Persian and English keywords, and retrieved articles were included in this review based on the inclusion and exclusion criteria. Results: 22 articles were included in this review based on the inclusion and exclusion criteria. According to the research objectives, findings were extracted from selected articles and reviewed in two sections: 1] validity and reliability, and 2] clinical application. Conclusion: Scales of CPOT and BPS are superior to NVPS, and a combination of BPS and CPOT improves the pain detection accuracy, and vital symptoms should be used cautiously for pain assessment along with objective measures due to poor evidence. Moreover, rapid and effective pain relief plays an important role in the improvement of psychological and physiological consequences.