Annals of Military and Health Sciences Research
Year:2005 | Volume:3 | Issue:4 (SERIAL NUMBER 12)|Papers Count:13

Background: Osteoarthritis is the most common joint disorder in human. TENS (Trans Electrical Nerve Stimulation) is used for chronic pain such as those related to osteoarthritis. Recently, APS (Action Potential Stimulation) is widely used and said to be non-stimulant of skin. Therefore, it can be a suitable therapy in controlling the pain. The aim of this study is to compare the effects of APS with TENS in reducing pain and other symptoms of knee osteoarthritis.Materials and methods: This clinical trial was done through randomizing the patients in two therapeutic groups. Thirty-two individuals having mild to moderate arthritis in regard to radiological findings and Ahlback classifications entered to the study and treated in two groups (each group=16). Group 1 received hot pad for 20 minutes, then, APS for 16 minutes and activity up to tolerance and group 2 received hot pad for 20 minutes, then TENS for 16 minutes and then activity up to tolerance. Each group was treated for 10 sessions. Data collection was performed through interview and patients examinations in four stages of the research.Results: Data was analyzed through SPSS-11. No significant differences were found in any four stages of evaluations, but in each group, most variables showed significant differences statistically in second stage from the first stage and second and four stages from third one.Conclusions: Nerve stimulation consisting of APS and TENS is useful in treatment of patients of osteoarthritis as improving of symptoms was seen with both APS and TENS after 10 days of treatment. Since the velocity of improving of pain was higher in group 1 than group 2, it seems that it is better to use APS in the beginning of the therapeutic course and to continue it with TENS.

Background: A 18 month single-blinded randomized clinical trial was undertaken to compare the potency rate, complications and outcome of Conductive arterio- venous creation, a group of techniques using mediancubital and perforating veins for elbow and brachial fistulas, with Non-Conductive (brahiocephalic/ brachiobasilic) fistulas in referred patients to SINA hospital for vascular access creation.Materials and methods: From May 2001 to Oecember2002, vascular access procedures were performed for 260 patients.144 patients were followed for patency rate, complications and outcome.Results: Mean age was 53.4 + 16.7 years and 55.5% were male, patency rate was 81% in a 3 month follow up in Conductive and Non-Conductive group. Infection and neuro-muscular complications were not significantly different between groups. 3 venous hypertension and 2 steal syndrome developed in nonconductive group. The major complications, venous hypertension and steal syndrome, were treated by conversion to conductive fistula. In 16 (43%) patients, referred for synthetic graft, conductive fistula was created.Conclusions: Conductive AV fistula is a reasonable alternative for maintenance of hemodialysis access, particularly when other types of brachial and elbow fistula has failed or in cases of major complications. In addition, performing conductive fistula in patients referred for synthetic graft would decrease costs. At the end, further multi- centeral randomized clinical trails are recommended.

Background: Melasma is a common disorder of macular hyperpigmentation, which involves mostly in sun- exposed areas of face and neck. Women are more affected. Multiple factors have been postulated to involve in the etiology and pathogenesis of melasma including pregnancy, oral contraceptives, genetics, sun exposure, cosmetics and race.Materials and methods: Fifty women completed a randomized, double blind vehicle controlled clinical trial, in which they applied 0.05%tretinoin (n=25) or vehicle cream (n=25) once daily on the face for 12weeks.Results: 2 weeks after treatment 6 out of 25(24%) tretinoin- treated patients (group 1) were clinically improved, compared with 0 out of 25(0%) in the vehicle group (group2)(p=0.022). 4 weeks after treatment 14(56%)of group1 and 5(20%) of group2 improved(p=0.006).After 12weeks, 21(84%) of group1 and 6(24%) of group2 were improved(p=0.0001) which demonstrated significant improvement in the tretinoin- treated patients compared with the vehicle group.Conclusions: This controlled study demonstrates that topical 0.05% tretinoin alone is considered to be effective in the treatment of melasma patients.

Background: There has been an increasing demand for cesarean section delivery (C/S) by pregnant women in recent years. This increase in demand, not only adversely affects the rate of delivery complications, but also imposes a great amount of extra expenses on families, government and insurance companies. It was assumed that by training programs for pregnant women during their prenatal care visits, they can play an active role in the process of decision-making regarding their type of delivery. The goal of the present study is to determine the effect of such training programs on pregnant women in selecting the type of the delivery and to specify if the current rate of C/S can be change by such training programs.Material and methods: In this single-blind randomized control trial, 200 primi- par pregnant women (age 18-30 years old) with gestational ages of less than 30 weeks, referring to the Ob-Gyn clinic of Be'sat general Hospital (IRIAF central hospital) for prenatal care were included. These pregnant women were randomly divided into two groups: Group A which received planned training program during their pregnancy and group B with no training program. None of the assessors knew about the women's status in the mentioned groups.Distribution of women in both groups were equal considering factors like age, education, profession and selected method of delivery at their first interview. In group A, films and pamphlets were used for training.Pamphlets were explained by professional midwives. Patients visited the Ob- Gyn department and delivery ward and spoke to women in their post-delivery phase. At their 36th week of gestational age, all patients in both groups were interviewed again and data were collected and analyzed by proper software using chi square test.Results: In group A, the level of patient's awareness regarding Normal Vaginal Delivery (NVD) and cesarean section (C/S) was markedly increased, expectedly (78%vs.4%) and (71% vs. 4%), while in group B the level of patient's awareness did not changed on their second interview. The rate of selecting C/S in group A (test) was markedly reduced, (25%vs. 39%), (p<0.05), while there were no changes in this rate among patients in group B (40% vs. 41%).Conclusions: It can be concluded that basic trainings for pregnant women can effectively reduce the rate of demand for C/S delivery. It is therefore, recommended that this kind of training to be available for all patient (regardless of their level of education) referring to prenatal care clinics.

Background: Infection has always been one of the major complications of surgical procedures and drains have been used to reduce the rate of post operative infections in spite of the fact that their efficacy is under question.In this study, we tried to investigate the role of a loose tightened drain to reduce the infection rate in comparison with an ordinary used drain and no use of drain.Materials and methods: In this experimental study, the role of loose tightening of drain on infection was investigated trough usage of blood agar plates, prospectively. Firstly, blood agar plates were prepared according to strict methods to guaranty sterility. Then, the plates were randomized into three groups in operating room and the drains were inserted into the plates while another surgical operation was being performed in the same place.The plates then were incubated for 3-5 days and the subsequent results were gathered and being analyzed using SPSS-10.Results: Among total of 585 cases being investigated, 4 positive cultures were -out of 197-in tightened drain group and 4 positive ones- out of 194-cases in ordinary placed drain group, while 10 positive ones in no-drain group were found. There was no significant difference between both two control groups (P=0.102). Also, no significant difference was found between drain groups and no-drain group (P=0.122). Among cases tested after 72 hour incubation, the rate of infection was zero but this ratio was 2 out of 88, and 4 out of 88 in ordinary drain group and in tightened drain group respectively. There were no significant differences among groups of 72 hour incubation.Among cases incubated for 5 days, in tightened drain group (109 cases) no growth was found and in ordinary drain group (106 cases) 2 positive cultures were reported, while no growth was found in no-drain group. There was significant difference among all 3 groups (P=0.001), while no significant difference was found among ordinary drain group and tightened drain group (P=0.242).Conclusions: According to increased rate of infection in no-drain group incubated for 5 days, the role of incubation time in occurrence of clony growth is clearly proven. It also seems that statistically significant reduction in the growth of microorganisms in the groups with drain recommends the usage of drains in the surgical sites that hematoma formation is probable. According to researchers' idea, the reduction in the rate of infection to zero in tightened drains incubated for 5 days although not significant, it can state the role of tightening of drains in decreasing the rate of infection.

Background: Many studies about nursing managers' behaviors & job satisfaction show that managers with effective behaviors & use of participative management can empower the nurses & thus causes the enhancement of job satisfaction. This article was conducted to evaluate the effect of participative management based on quality circles on nurses' job satisfaction.Materials and methods: This quasi experimental study with before - after was conducted to evaluate the effect of participative management based on quality circles on nurses job satisfaction in CCU of army, hosp. ital in 1383(2004). Samples of research consisted of all CCU nurses (17 individual) data gathering tools included a demographic questionnaire and questionnaire for determining nurses job satisfaction that designed based on Fredric Hertzberg theory that consisted of 34 items which 17 items were due to hygiene factors and 17 items were due to motivation factors. Before intervention job satisfaction was determined, participative management program based on quality circles performed. After intervention job satisfaction was determined again. Then before and after mean average score of nurses job satisfaction was compared the results are assessed through SPSS software.Results: Findings indicate that mean average score of nurses job satisfaction (total average score of hygienic factors and motivation factors) improved from 71% to 97/35%. Also, findings showed significant difference between mean average score of job satisfaction before and after intervention with T test (p<0/001). Findings showed that there isn't any relationship between demographic characteristics and job satisfaction. Therefore hypothesis of research as; participative management based on quality circles causes the enhancement of nurses' job satisfaction was verified.Conclusions: Participative management based on quality circles lead to some changes in the physical work environment and supportive methods of managers especially head nurses. That causes enhancement of nurse's job satisfaction.

Background: Pseudomonas aeroginosa is one of the most important oppourtunistic bacteria which produce biofilm. It has been reported that biofilm forming bacteria are more resistant to antibiotic treatment and immunologic response. Biofilms, communities of cells adhering to a surface enclosed in a self-producing polymeric matrix. Biofilms might be responsible for 65%of bacterial infections.Materials and methods: In this study we investigated the role of the barrier formed by alginate against antibiotic penetration. Mucoid isolates of P. aeruginosa were collected from 2 hospitals and identified by biochemical tests. Strain M214 P. aeruginosa produces more biofilm compared with other strains. Alginate was extracted from mucoid- type P. aeruginosa (M214) with method described by Goven. We evaluated the penetration of antibiotics macrolides (azithromycin, erythromycin), aminoglycosides (amikacin, gentamicin) lactames (imipenem, ceftazidem), fluoruqinolones (ciprofloxacin,ofloxacin) through P. aeruginosa (M214) alginate with a sandwich cup method described by Hiromi Kumon.Results: The results indicated that macrolides demonstrated penetration rate 100%, fluroquinolones and lactames demonstrated relatively high penetration rate>85%, whereas aminoglycosides showed low penetration (amikacin=59%, gentamicin= 73%).Conclusions: In this study, the role of alginate as a barrier against antibiotics penetration was proven.

Background: Regarding to the importance of the portal vein diameter and inadequate knowledge of it in our county and due to determining its normal values, this survey was performed in patient visiting Loghman Hakim medical center within 1383.Materials and methods: The portal vein diameter was measured using ultrasonography (Aloka Japan½) which has a phased array convex 3.5 MHz, and was compared according to sex standard values in main text books and articles.Results: The portal diameter vein was 9.56±1.71, major right brach was 6.44± 0.89 and major left branch was 5.61±0.87. The obtained values for all three variables were more in males than females (P<0.0001).Conclusions: It seems that normal values obtained for males were different with standard values, whereas obtained values and standard values were cmpatible in females.

Background: Some basic laboratory examinations have been suggested as being helpful in the diagnosis of acute appendicitis, including white blood cell count.Materials and methods: In this cross sectional study on adult patients, we decided to assess the accuracy of leukocytosis for prediction of acute appendicitis, in Loghman- Hakim hospital, 2002- 2004.Results: From 736 patients, 456 were male (62%),and 280(38%)were female. 96 patients were observed. The frequency of acute appendicits was 79%. Negative appendectomyrate was 8%. Sensitivity for Leukocytosis with history and physical examination was 84%. The range of specifity was 44-71%. By combining history, physical examination and leukocytosis, sensitivity and specifity increased to 94% and 74%, respectively.Conclusions: Accuracy of history, physical examination and paraclinic combination in diagnosis of acute appendicitis is higher than using one or two of these criteria. However, clinical judgment has the main role in diagnosis of acute appendicitis.

Background: Macrosomia, which is defined as birth weight more than 90 percentile of the population, has multiple side effects on mother and the newborn. The most important side effect is the shoulder dystocia which can increase injuries during birth. Multiple factors are involved in inducing macrosomia. This study was designed to determine rate and risk factors of macrosomia in a training hospital in Tehran.Materials and methods: This was a cross-sectional study to evaluate the rate of macrosomia (birth weights equal to or more than 4 kilograms) and its risk factors in newborns of Baharloo hospital in years 1380 and 1381.206 out of 3377 born infants had macrosomia (6.1%).These macrosomic infants were compared with 575 control infants who had weights less than 4 kilograms.Results: Analysis of data by "SPSS" showed that macrosomia is increased in situations as: mother's old age (P=0.000, r= 0.183), mother's diabetes (P=0.001), mother's high weight (P=0.000, r= 0.002), prolonged gestational age (P=0.000, r= 0.29), mother's multiparity (P=0.000). Macrosomia was more in male infants (P=0.012).Conclusions: Our results indicate that macrosomia is relatively common in Tehran. Mother's old age, mother's diabetes, mother's high weight, prolonged gestational age, and mother's multiparityare risk factors which can induce macrosomia. Predicting or prevention of some of these factors can decrease macrosomia or its side effects.

Background: Malignant hyperthermia is amongst the most life-threatening complications of surgery. The most classical type occurs following to the administration of agents used for induction of anesthesia.Case report: The patient was 56 years old male being scheduled for Tympanomastoidectomy due to chronic otitis media. Induction of anesthesia was performed via Thiopental sodium, Fentanyl, Succinyl choline and lidociane.After75 minutes of induction of anesthesia, the patient experienced increase in blood pressure, heart rate, body temperature, acid-base and electrolyte impairment being suggestive of malignant hyperthermia.Conclusions: Regarding to its life-threatening feature, the occurrence of malignant hyperthermia is probable during surgery even in patients with previous non-complicated surgeries. Therefore, continuous monitoring, and appropriate history, early diagnosis and reduction of side effects are necessary.