Mehdi Mousavi; Nasrin Razavianzadeh; Mania Armin; Maryam Fadaei Dashti
Volume 20, Issue 6 , 2018, Pages 1-8
Abstract
Background: Captopril, a short-acting antihypertensive agent, is widely used in case of emergency to control blood pressure. Al- though sublingual Captopril has a faster onset of action, it is less tolerated. Objectives: This study aimed to evaluate the efficacy, side effects, and tolerability of sublingual ...
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Background: Captopril, a short-acting antihypertensive agent, is widely used in case of emergency to control blood pressure. Al- though sublingual Captopril has a faster onset of action, it is less tolerated. Objectives: This study aimed to evaluate the efficacy, side effects, and tolerability of sublingual versus oral captopril in an emer- gency setting.Methods: Hypertensive patients, without acute target organ damage were randomly administered 25 mg Captopril sublingually or orally (35 patients in each group) using block randomization. Blood pressure was measured at 0, 10, 20, 30, 45, 60, and 120 minutes after the administration. Patient satisfaction was subjectively scored on a scale of 1 - 10, and any side effect was recorded (Iranian registered clinical trials # IRCT2015110924963N1). Results: The mean age of the study groups was 59.61 ± 9.34 years. Systolic and mean blood pressure significantly decreased after10, 20, and 30 minutes of sublingual administration (P < 0.05), but diastolic blood pressure did not decrease. This difference in the blood pressure reducing effect decreased by 60 and 90 minutes and almost equalized after 90 minutes. Headache was observed as a side effect in two patients in the sublingual group. The convenience and satisfaction scores were much lower in the sublingual group (median of 6 (25th percentile: 6, 75th percentile: 7) in sublingual group versus median of 10 (9, 10) in Captopril group, P < 0.001). Conclusions: In our study, the systolic and mean blood pressure decreased more rapidly in the sublingual Captopril group than in the oral Captopril group in the first 30 minutes after administration. Patients better tolerated the oral preparation, and the difference in the blood pressure reducing effect between the groups almost equalized after 90 minutes.
Mahnaz Yadollahi; Asieh Mahmoudi; Mohammadhadi Niakan; Maryam Fadaei Dashti
Volume 20, Issue 5 , 2018, Pages 1-7
Abstract
Background: Trauma is the main cause of death in all age groups, as well as the 7th leading cause of fatality among the elderly. Compared to the youth, the risk of mortality and length of hospital stay are higher in elderly patients experiencing similar trauma and injury severity. Objectives: The present ...
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Background: Trauma is the main cause of death in all age groups, as well as the 7th leading cause of fatality among the elderly. Compared to the youth, the risk of mortality and length of hospital stay are higher in elderly patients experiencing similar trauma and injury severity. Objectives: The present study aimed to identify the risk factors for mortality in the elderly. Methods: This was a cross-sectional study conducted on 65304 trauma patients who were referred to Shahid Rajaee (Emtiaz) Hos- pital trauma referral center, Shiraz, Iran 2011 - 2016. Information such as age, gender, injured body region, length of hospital stay, injury severity score (ISS), injury mechanism, nosocomial infection, and mortality was recorded. Injury severity scores and injured body regions were determined based on a conversion of international classification of diseases, the 10th revision (ICD-10) injury codes to Abbreviated Injury Scale (AIS-98) severity codes using a domestically developed electronic algorithm. The binary logistic regression was used to determine the partial effects of independent risk factors. Results: Patients over 60 had a mean age of 70.79 ± 8.83. Mortality rates were 4.7% (330) and 1.05% (614) among patients over and under 60, respectively. The most important risk factors for geriatric mortality included age over 75 [OR = 1.91, 95% CI (1.28 - 2.85)], nosocomial infection [OR = 10.56, 95% CI (6.52 - 17.10)], ISS (16 - 24) [OR = 12.51, 95% CI (7.28 - 21.490)], head injury [OR = 13.17, 95% CI (5.83 - 29.77)], and pedestrian accidents [OR = 1.47, 95% CI (1.47 - 1.95)]. Aging led to increased mortality due to nosocomial infection. Among the elderly patients, males had a higher mean injury severity score compared to females. Conclusions: According to our results, mortality rates increased by age in geriatric trauma patients. With similar severity of in- juries, there was a greater risk of mortality for trauma patients with very old age compared to old patients. Aging, gender (males), nosocomial infection, ISS, and head injury were the most significant predictors of mortality in the elderly.
