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Biomedical subjects

A Nashed

Publications and source records attributed to A Nashed.

8 recordsLinked to original sources
PubMed2001

Magnesium sulfate in the treatment of refractory ventricular fibrillation in the prehospital setting.

OBJECTIVE: To determine if magnesium sulfate (MgSO(4)) improves outcome in cardiac arrest patients initially in ventricular fibrillation (VF). METHODS: Randomized, prospective, double blind, placebo-controlled, multicenter prehospital trial using 2 g of MgSO(4). Eligible patients were non-traumatic cardiac arrest patients (> or =18 years of age) presenting in VF. The protocol included those patients refractory to three electroshocks. Epinephrine and either 2 g of MgSO(4) or placebo (normal saline) were then administered. The primary outcome variable was return of spontaneous circulation (ROSC) in the field and a perfusing pulse on arrival at the ED. Secondary endpoints included admission to the hospital (ADMT) and hospital discharge (DISC). IRB approval was obtained at all participating centers. RESULTS: Total 116 patients (58 MgSO(4), 58 placebo) were enrolled during the period from 4/1992 to 10/96 with 109 available. There were no significant differences between the groups in baseline characteristics and times to cardio pulmonary resuscitation (CPR), advanced life support (ALS), and first defibrillation, except for time to study drug administration. There was no significant differences in ROSC (placebo, 18.5%, and MgSO(4), 25.5%, P=0.38), ADMT (placebo rate=16.7%, MgSO(4)=16.4%, P=1.0) or DISC (placebo rate=3.7%, MgSO(4)=3.6%, P=1.0). CONCLUSIONS: We failed to demonstrate that the administration of 2 g of MgSO(4) to prehospital cardiac arrest patients presenting in VF improves short or long term survival.

Adolescent↗
PubMed1999

Prevalence of smokers and nicotine-addicted patients in a suburban emergency department.

OBJECTIVE: To define the prevalence of smokers and nicotine-addicted patients in a suburban, community ED. METHODS: This was a prospective survey of consecutive ED patients seen in a suburban ED with an annual patient census of 48,000. Medically stable patients aged 18 years or older were eligible for inclusion. Patients were excluded if they had predominantly psychiatric complaints or were critically ill. Patients were queried about their smoking habits by a closed-question survey, which included the previously validated Fagerstrom Test for Nicotine Dependence. The study was conducted during a six-week period, only at times when there were dedicated research associates available to ensure consecutive patient entry. Continuous variables were analyzed by Student's t-tests. Clinical variables were analyzed by chi-square tests. All tests were two-tailed with alpha at 0.05. RESULTS: 1,515 patients comprised the study group. The mean age (+/-SD) was 45.6 (+/-18.9) years; 52% were female, 25% were nonwhite, and 47% were college graduates. There were 317 (21%) smokers. Patients having private physicians were less likely to smoke (18% vs 29%, p = 0.001). Of all smokers, 46% were moderately to severely nicotine-dependent, 69% wanted to quit, and 30% expressed an interest in joining a smoking cessation program. CONCLUSION: A substantial percentage of ED patients smoke, many of them are nicotine-addicted, and the majority would like to quit. Randomized, controlled trials are needed to determine whether interventions by physicians in the ED can have an impact on the smoking habits of these patients.

Adult↗
PubMed1992

Effect of cardiac dysfunction upon diastolic cerebral blood flow.

The transcranial Doppler (TCD) studies performed in 54 patients with various forms of cardiac dysfunction were reviewed and the results compared with those of normal individuals. There were 4 patients with aortic insufficiency, 5 being treated by intra-aortic balloon pumps, 12 patients with atrial fibrillation, 11 with syncope, and 22 undergoing cardiopulmonary resuscitation. In all instances, significantly low or even absent diastolic cerebral perfusion was found. The importance of this parameter, in the future evaluation and management of similar patients, is discussed.

Cardiovascular Diseases↗
PubMed1978

Laparoscopy for the confirmation and prognostic evaluation of pelvic inflammatory disease.

A presumptive diagnosis of pelvic inflammatory disease (PID) is usually made in our gynecologic clinics when obscure, acute lower abdominal pain is accompained by fever and abnormal vaginal discharge, urinary and rectal discomfort, marked tenderness of the pelvic organs to palpation, or pelvic masses. In the present study, during a 2-year period, 223 women underwent laparoscopy to confirm this diagnosis. PID was confirmed in 103 (46.2%) of the cases; other serious conditions were diagnosed in 69 (30.9%) of the cases; and no evidence of disease was found in 51 (22.9%) of the cases. The authors conclude that laparoscopy is a valuable tool in the diagnosis of PID.

Diagnosis, Differential↗
PubMedDate not supplied

Performance of two clinical decision rules for knee radiography.

We designed a prospective observational study to attempt to validate two recently described clinical decision rules for knee radiography. Consecutive patients aged > or = 15 yr with acute knee injuries occurring less than 1 wk prior to presentation were included for study. Patients with distracting conditions, open knee injuries, or previous surgery were excluded. Each patient was assessed for 7 historical and 15 physical examination criteria that were recorded on a standardized data collection instrument. Radiographs were ordered at the discretion of the attending physician and were read by two board-certified radiologists. When radiographs were not ordered, structured telephone follow-up was performed after 3 wk. The main outcome parameter was the presence or absence of a clinically significant fracture. There were 351 patients in the study; 26 (7%) had knee fractures. Fractures were significantly associated with an increased prevalence for two of the three criteria in the rule derived by Bauer: inability to weight bear immediately or in the emergency department (ED; 76.9% of patients with a fracture vs. 29.8% of patients without a fracture) and effusion (53.8% vs. 28.9%, respectively). Ecchymosis was not significantly associated with fracture (19.2% with fracture vs. 9% with no fracture). Use of the Bauer rule would have led to a radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 48.9%). Fractures were associated with a significantly increased prevalence for three of the five criteria in the decision rule proposed by Stiell: isolated patella tenderness (30.8% with fracture vs. 14.5% with no fracture), inability to flex the knee to 90 degrees (42.3% vs. 19.7%, respectively), and inability to weight bear immediately and in the ED (57.7% vs. 18.8%, respectively). Age > or = 55 yr (23.1% vs. 12.0%, respectively) and fibula head tenderness (11.5% vs. 5.5%, respectively) were not significantly associated with fracture. Use of the Stiell rule would have led to radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 49.8%). We conclude that neither clinical decision rule is 100% sensitive. Further refinement will be necessary to identify all patients with knee fractures.

Adolescent↗
PubMedDate not supplied

Automated differential leukocyte counts.

Automated differential counts have the advantage of precision, efficiency, safety, and economy. They could potentially serve effectively in 90 percent of patients with normal counts or in 75 percent of patients with anemia only (64 percent of the total in this study). Even patients with increased white blood cell counts and major population shifts (toward granulocytes or lymphocytes) could be followed with automated differential counts. Such a tactic would decrease turnaround time for results, be less expensive, and reduce exposure of technologists to direct contact with patients' blood. However, presently available instruments fail to detect patients' blood samples with small numbers of abnormal cells, e.g., blasts in early relapse of acute leukemia, atypical lymphocytes in viral diseases such as infectious mononucleosis, eosinophils in allergic or parasitic disease, and band forms in early infectious diseases. Clinical judgment should be used in selectively ordering manual differential counts for these patients. While automated differential counts can be very useful in screening general medical and surgical patients in the ambulatory setting, in referral centers where hematologic abnormalities are more prevalent, the manual differential count and further examination of a smear is particularly necessary at least on initial presentation. Selective manual differential counts may improve efficiency, economy, and safety while not compromising patient care. Further studies of the correlation of clinical disease with automated differential counts are necessary.

Autoanalysis↗