ABSTRACT: Acute seizure attack is a stressful experience both for health care personnel and parents. These attacks might cause morbidity and mortality among patients, so reliable methods to control the seizure preferably at home should be developed. This study was performed to measure the time needed to control seizure attacks using intranasal midazolam compared to the common treatment (intravenous diazepam) and to evaluate its probable side effects.
This study was conducted as a not blind randomized clinical trial among 60 patients coming to Imam Ali Hospital, Zahedan, Iran. The patients were 2 months to 15 years old children coming to our emergency department suffering from an acute seizure episode. Intranasal midazolam was administered 0.2 mg/kg equally dropped in both nostrils for case group and intravenous diazepam was administered 0.3mg/kg via IV line for control group. After both treatments the time needed to control the seizure was registered by the practitioner. Pulse rate and O2 saturation were recorded at patients' entrance and in minutes 5 and 10 after drug administration.
The time needed to control seizure using intranasal midazolam (3.16±1.24) was statistically shorter than intravenous diazepam (6.42±2.59) if the time needed to establish IV line in patients treated by intravenous diazepam is taken into account (P<0.001). The readings for O2 saturation or heart rate did not indicate a statistically significant difference between two groups of patients either at entrance or 5 and 10 minutes after drug administration.
Considering the shorter time needed to control acute seizure episodes compared to intravenous diazepam and its safety record, intranasal midazolam seems to be a good candidate to replace diazepam, as the drug of choice, in controlling this condition.
Iranian journal of pediatrics. 03/2012; 22(1):1-8.
ABSTRACT: To investigate the efficiency of partial radiofrequency ablation of the spleen in patients with thalassemia major and intermedia.
Partial radiofrequency ablation of the spleen was performed in 19 thalassemic patients (10 females, nine males) with a mean age of 12.7 years (age range, 7-30 years). This group of patients consisted of 11 patients with thalassemia major and nine with thalassemia intermedia. The procedure was performed under intravenous sedation and was complete in 29-35 min.
The ratio of the ablated volume to the whole spleen ranged from 5.3% to 23% (mean, 9.83 ± 5.56%). A significant increase was found in the platelet count after radiofrequency ablation of the spleen (P = 0.002). No statistically significant difference was found in hemoglobin levels (P = 0.171) or transfusion intervals (P = 0.054) before and after radiofrequency ablation. Additionally, no statistically significant relationship was observed between the ablation ratio and hemoglobin levels (P = 0.233) and between the ablation ratio and transfusion interval (P = 0.822). No major complication occurred due to this interventional procedure.
A single percutaneous radiofrequency ablation of the spleen reduces thrombocytopenia in thalassemic patients with splenomegaly but does not change the hemoglobin levels or transfusion intervals.
Diagnostic and interventional radiology (Ankara, Turkey) 02/2012; 18(4):397-402. · 1.10 Impact Factor
ABSTRACT: Improved survival in thalassemic patients has lead to the manifestation of morbidities such as renal dysfunction. This involvement suggests the need for a reliable and non-invasive method to assess the degree of kidney iron overload. We conducted the present study to evaluate the relationship between serum ferritin levels, liver, heart, and kidney MRI gradient echo (T2*) relaxation times in thalassemic patients, as a step to evaluate the feasibility of using MRI T2* to assess the degree of kidney iron overload.
This was a prospective study of 120 (60 males, 60 females) regularly transfused thalassemic patients (mean age: 25.9 ± 9 years) who suffered from major and intermediate thalassemia. Patients attended an adult thalassemia clinic located in Tehran, Iran. Cardiac, hepatic and renal MRI T2* were performed. Serum ferritin levels were measured.
Our results indicated a moderate correlation between kidney MRI T2* relaxation time and serum ferritin (r = -0.446, P < 0.001). Kidney MRI T2* relaxation time weakly correlated with liver MRI T2* relaxation time (r = 0.388, P < 0.001) and cardiac MRI T2* relaxation time (r = 0.338, P = 0.023).
The moderate correlation between kidney MRI T2* relaxation time and serum ferritin, and its weak correlation with liver and heart T2* relaxation times indicate that relying on liver and heart MRI T2*, as well as serum ferritin levels to predict the exact condition of kidney iron overload might not be a reliable approach. Our findings suggest the use of kidney MRI T2* as a noninvasive method for evaluating renal iron overload in thalassemic patients. Further studies to investigate the relation between kidney MRI T2* relaxation times and renal function, as well as the cost benefit of using this method, are suggested.
Archives of Iranian medicine 02/2012; 15(2):91-4. · 0.97 Impact Factor