مجله دانشکده پزشکی اصفهان
پیاپی 528 (هفته چهارم تیر 1398)

Cardiopulmonary arrest is one of the most important priorities of medical emergencies. The number of successful cases is one of the important indicators of the quality of emergencies, and identifies the barriers to successful of cardiopulmonary resuscitation (CPR). Therefore, identifying the barriers and causes of failure of CPR team is very important. The aim of this research was to study the barriers to the success of CPR team from the perspective of physicians and nurses in selected hospitals of Isfahan City, Iran, in years 2017 and 2018. This cross-sectional study was conducted during the years 2017 and 2018 in Shariati and Gharazi hospitals of Isfahan. The sample size included 126 physicians and nurses. All subjects with complete satisfaction and knowledge were studied based on the criteria for entering the study. Samples were collected using simple random sampling method. The data-gathering tool was a researcher-made questionnaire which validity and reliability were previously reported between 0.87 and 0.90. The data were analyzed using Mann-Whitney and Friedman tests via SPSS software. The significance level was considered at P < 0.050. In this study, the most prevalent age group was 35-45 years old (76.0%), and 78.4% were men. 68.3% of the personnel surveyed were from the emergency departments of both hospitals. Among the domains considered, the dimension of patient-dependent factors had the highest mean (1.95 ± 1.42), and the dimension of program and educational facilities had the lowest mean (0.68 ± 0.80). Only, there was a significant difference between the physicians’ and the nurses' view in terms of equipment and material (P = 0.002). According to the results, we can conclude that by reviewing the characteristics of patients, as well as supplying educated and enough personnel, proper evaluation, and ready and safe equipment, and providing appropriate feedback to the recovery team, the success rate can be improved.</div>

 Sever pain due to various reasons is one of the most important complaints of patients in the emergency department; so, management of pain is one of the main challenges there. The present study aimed to evaluate the effect of ketorolac in comparison to morphine on pain reduction in patients with spinal trauma in emergency department.  This randomized controlled clinical trial study was done on 100 patients with spinal trauma who were randomly assigned in two groups of ketorolac (30 mg) and morphine (0.1 mg/kg). Drugs were infused in both groups in 100 cc normal saline solution during 15 minutes. Pain was assessed based on visual analog scale (from 0 means no pain to 10 means the worst pain possible), and adverse effects, as the main outcomes, were measured and compared between the groups at baseline, and minutes 5, 15, 30, 45, and 60 after drugs injection. Pain scores were compared using independent t test, and adverse effects using chi-square test.  Pain score at minutes 45 and 60 after injection was significantly lower in ketorolac group than morphine group (P < 0.050). In morphine group, 34.8% of patients and in ketorolac group, only 2.1% of patients reported nausea during the study (P < 0.001). The trend of change in pain score was not significantly different between studied groups during study period (P = 0.106).  Due to better effects of ketorolac on pain reduction in studied patients, with lower side effects in comparison to morphine, it seems that ketorolac can be considered as a good alternative of morphine for pain management in patients with spinal trauma referred emergency department.

 The aim of this study was to isolate, characterize, and investigate the efficacy of specific phages against multidrug resistant (MDR) Acinetobacter baumannii to use them as an appropriate and effective method to replace antibiotic treatment, or be used as an antiseptic for the hospital surfaces.  In a cross-sectional study in a period of two years (2017-2019), 48 suspected Acinetobacter baumannii strains were isolated from patients admitted to the intensive care unit (ICU) in Alzahra hospital, Isfahan, Iran. First, the isolates were identified by phenotypic method, and confirmed with blaOXA-51 gene amplification. Then, the antibiotic sensitivity of isolates was assessed using disk diffusion method, and the isolation of phage from water sources was carried out. Finally, the sensitivity of Acinetobacter baumannii isolates, and different hosts to phage were investigated, and One-Step Growth Curve was detected.  All Acinetobacter baumannii isolates were confirmed, and the pattern of antibiotic resistance percentage was 99% to ciprofloxacin, 96% to ceftazidime, 97% to cefipime, 82% to amikacin, and 100% to imipenem. The specific phage was isolated from the sewage, 27 isolates of Acinetobacter bumannii were sensitive to phage, and other different hosts were not affected by the phages. Finally, after 30 minutes in the latent phase, phage was exploded during a period of 40 minutes.  According to the results of the effectiveness of phage in disturbing Acinetobacter baumanni, and considering the increasing rate of the resistance of it to most of the antibiotics and the difficulty of treating its infections, phage therapy can be used as a therapeutic approach for this infection.

Hemodynamic changes are common complications of different surgeries. Today, laparoscopic surgeries are more exploited due to the lower level of complications, compared to open surgeries. This study aimed to evaluate the effect of two doses of magnesium sulfate on cardiovascular changes during general anesthesia in laparoscopic surgeries of women. This double-blind clinical trial study was conducted on 106 women aged 18-65 years, who were candidates for laparoscopic gynecologic surgeries. Subjects were randomly divided into three groups of placebo, and 30 and 50 mg/kg magnesium sulfate. Medication was infused during 10-15 minutes from the onset of anesthesia induction to before the pneumoperitoneum. At the end of the infusion process, carbon dioxide gas blow was used by the surgeon. Parameters of systolic and diastolic blood pressure, arterial oxygen saturation, and heart rate before the induction of anesthesia as a base and after the anesthesia were measured and recorded after the finishing of the infused medication. These parameters were measured and recorded immediately before the pneumoperitoneum and 5, 10, 20, 30, 40 minutes after it. The injection of magnesium sulfate caused significant changes as decrease in systolic blood pressure and heart rate (P < 0.001), and increase in arterial oxygen saturation (P = 0.040) and serum level of magnesium (P < 0.001). Moreover, complications of chills and vomiting significantly was lower in the medication-receiving groups. The 30 mg/kg dose of magnesium sulfate can be safely used for sustainable anesthesia in laparoscopic surgeries of women.

 The incidence of cases with acute myocardial infarction (AMI) and patients suffering from chest pain (CP) referred to emergency departments are increasing. Therefore, finding a marker that can help faster diagnose of the disease can have beneficial effects for patients. This study compared troponin, high-sensitivity troponin, and copeptin markers at different times in patients with high-risk chest pain.  This study was performed on 90 emergency care patients with high-risk chest pain, as the first symptom of myocardial infarction (MI), in educational hospitals in Isfahan City, Iran. Demographic and clinical data including the levels of troponin, high-Sensitivity troponin, and copeptin markers were collected and evaluated at the time of arrival, and 2 and 6 hours later.  The mean age of patients with high-risk chest pain was 60.73 ± 1.23 years, of which 57 (63.3%) were men. There were significant differences between the frequency of three markers at arrival (P = 0.0004) and 2 hours (P = 0.0009) later. Nevertheless, after 6 hours, the results did not show any significant difference (P > 0.0010).  Repeated measurement of copeptin leads to a more successful AMI prevention compared to troponin and high-sensitivity troponin markers.