Background: Efficient pain management is one of the most important components of care in the field of emergency medicine.Objectives: This study was conducted to compare intravenous paracetamol and intravenous morphine sulfate for acute pain reduction in patients with limb trauma.Patients and Methods: In a randomized double-blinded clinical trial, all patients (aged 18 years and older) with acute limb trauma and a pain score of greater than 3/10 in the emergency department were recruited; they received either 1 g intravenous paracetamol or 0.1 mg/kg intravenous morphine sulfate over 15 minutes. The primary outcome was the pain score measured on a numerical rating scale at 0, 15 and 30 minutes after commencing drug administration. The requirement for rescue analgesia and the frequency of adverse reactions were also recorded.Results: Sixty patients randomly received either IV paracetamol (n = 30) or IV morphine (n = 30). The mean reduction in numerical rating scale pain intensity scores at 30 minutes was 3.86 (± 1.61) for paracetamol, and 2.16 (± 1.39) for morphine. However, pain relief was significantly higher in the paracetamol group compared to the morphine group (P < 0.001). Four patients in the paracetamol group and 15 patients in the morphine group needed rescue analgesia and the difference was significant (P = 0.05).Conclusions: Intravenous paracetamol appears to provide better analgesia than intravenous morphine in acute limb trauma. Further larger studies are required.

Definitions:Anesthesia: Loss of consciousness, analgesia, immobility, and muscle relaxation Tranquilizer: any of a group of compounds that calm or quiet an anxious patient. There are two types: the major tranquilizers called also neuroleptics1 or antipsychotic agents, such as acepromazine, and the minor tranquilizers called also antianxiety agents, such as diazepam (Valium).Dissociative Anesthesia: A form of general anesthesia characterized by catalepsy, catatonia, and amnesia, but not necessarily involving complete unconsciousness, as that produced by ketamine.Catalepsy: A condition that occurs in a variety of physical and psychological disorders and is characterized by lack of response to external stimuli and by muscular rigidity, so that the limbs remain in whatever position they are placed….

Adjuvant high dose IVIgs are being used increasingly in a range of immune-mediated and autoimmune diseases. Although numerous immunomodulatory mechanisms have been suggested, the exact mechanisms of action are poorly understood. The efficacy of IVIg in certain diseases has been proven in clinical trials, in so far as IVIg is approved as the therapy of choice for Kawasaki syndrome and idiopathic thrombocytopenic purpura. IVIg treatment has been shown to be safe, without many drug-related adverse effects, including systemic immunosuppression, that are related to corticosteroids and other immunosuppressive agents. Current dermatologic uses of IVIg are increasing, which calls for adequately controlled clinical trials. This review evaluates the current published data on the use of IVIg therapy in the treatment of autoimmune diseases and discusses current opinion concerning its potential immunomodulating mechanisms, the industrial preparation and safety features'of this biologic agent.    

The use of narcotics is a worldwide health problem. Systemic lethal viral infections (AIDS and Hepatitis) and bacterial infections of soft and hard tissues are serious complications in the users. It plays an important role in mortality and morbidity. Incidence of hard tissue infection among IV narcotic users is rare. This review while introducing narcotic users with osteomyelitis, summarizes recent information on hard tissues associated with heroin drug user.

Myocarditis is an inflammatory disease of the myocardium with lymphocyte infiltration and myocyte necrosis leading to a wide range of clinical presentations including heart failure, arrhythmia, and cardiogenic shock. Infectious and noninfectious agents may trigger the disease. The fact that immunosuppressive drugs are useful in several kinds of autoimmune myocarditis is proof of the autoimmune mechanisms involved in the development of myocarditis. Pathogenic mechanisms in myocardial inflammation are including inflammasome activation followed by myocyte destruction, myocarditis, and pericarditis. Intravenous immunoglobulin (IVIG) is a serum product made up of immunoglobulins, widely used in a variety of diseases. This product is effective in several immune-mediated pathologies. As well as the determined usage of IVIG in Kawasaki disease, IVIG may be useful in several kinds of heart failure including fulminant myocarditis, acute inflammatory cardiomyopathy, Giant Cell Myocarditis, and peripartum cardiomyopathy. Generally, IVIG is used in two different doses of low dose (200 to 400 mg/kg) and high dose (2 g/kg) regimen. The exact therapeutic effects of IVIG are not clear, however over the last decades, our knowledge about its mechanism of function has greatly enhanced. IVIG administration should be based on the accepted protocols of its transfusion. In this review article, we try to provide an overview of the different kinds of myocarditis, pathologic mechanisms and their common treatments and evaluation of the administration of IVIG in these diseases. Furthermore, we will review current protocols using IVIG in each disease individually.

Background: Based on beneficial reports of pamidronate use for reflex sympathetic dystrophy in reduction of pain and swelling, this drug can be studied as a novel treatment for refractory lymphedema. This study aims to determine the effectiveness of pamidronate on lymphedema and its possible side effects.Methods: Twelve cases of lower limb refractory lymphedema were enrolled. They received intravenous pamidronate monthly for 3 consecutive months and were followed by measuring any discomfort with visual analog scale (VAS) and physician global assessment, based on objective signs of limb volume and circumference.Results: The limb volume, circumference, and satisfaction of the patients improved significantly.Conclusion: Pamidronate when is added to conservative treatments may reduce lymphedema and improve the patient’s comfort.

Numerous clinical studies have shown bisphoshonates (BPs) to be useful and cost-effective options for the fractures prevention and postmenopausal bone loss. The use of oral bisphoshonates is an established option for management of osteoporosis in postmenopausal women, but many of them complaint from gastrointestinal side effect or frequently dosed oral regimens. To improve upon the suboptimal therapeutic compliance in postmenopausal women, newer, longer-acting intravenous formulations of BPs has been approved for intermittent administration in postmenopausal women. These preparations would become an option for patients who can not tolerate oral BPs or it was ineffective in increasing their bone density.This article proposed to review effectiveness and tolerability of intravenous BPs in postmenopausal women with osteoporosis.