QOM UNIVERSITY OF MEDICAL SCIENCES JOURNAL
Year:2010 | Volume:4 | Issue:2|Papers Count:13

Background and Objectives: Intoxication with opiates is one of the most common causes of referring to emergency departments in Iran. Because respiratory signs are one of the most common and important signs in these patients, this study was designed to evaluate the chest x-ray changes of the patients.Methods: The present study was a cross-sectional one. The changes noted in the Chest X-Ray (CXR) of the patients having been intoxicated with opiates and referred with respiratory signs of intoxication during the one year period between July 2007 till July 2008 to Farshchian Hospital in Hamadan were studied. The data, then, were gathered and analyzed using T and chi-square statistical tests.Results: Out of 1698 patients having referred due to poisoning with drugs and chemical agents, 318(18.72%) patients were admitted due to opiates intoxication. Among them, 214 (67.29%) had respiratory signs. 84.1% were male and 15.9% were female. Their average age was 35.6. The most important substance used was opium (57.5%).Most of the cases (84.1%) were due to abuse. The most common physical signs were: miosis (83.6%), respiratory distress (74.8%), rales & wheezing (67.3%). The most common radiographic abnormality was pulmonary edema (14.5%). And the most common substance causing pulmonary edema was crack (59.4%) revealing a significant statistical difference (p=0.001). Conclusion: As expected, one of the most important complications and common causes of death in opiate-poisoned patients was respiratory problems; we suggest that physicians and staffs working in the emergency department be well-trained in management of such patients.

Background and Objectives: Treatment team perform a variety of practices in the fields of treatment and caring. The main domain of nursing practice is to prepare patients for diagnostic tests. Colonoscopy is a method of endoscopy of lower gastrointestinal system which needs proper colon preparation that allows proper assessment, diagnosis and positive treatment. Currently, there are different methods of bowel preparation. Therefore more research by a clinical nurse on this can result in better care. This study was aimed at comparing the routine method (caster oil and bisacodyl tablet) and oral sodium phosphate on the level of patients’ acceptance and bowel cleansing in patients undergoing colonoscopy.Methods: The study was a one-blind controlled randomized clinical trial done on 90 outpatient candidates for colonoscopy referring to Razi Training Center in Rasht city. Samples were randomly chosen on the visit day and divided to 2 groups of experiment and control. Data collection instrument included a demographic questionnaire and checklist to assess the level of patients’ acceptance and bowel preparation. Primarily demographic data form for each patient was filled, and then intervention was done for two groups with 45 samples. During the process the acceptance form was filled by the researcher by asking the patient and also the check list on the residual stool score and global preparation assessment left was marked by colonoscopist and the nurse.Results: The findings indicated that patients’ acceptance (p<0.000) and the level of bowel preparation (p<0.000) was better with oral sodium phosphate.Conclusion: According to the results result oral sodium phosphate has better acceptance and is more effective on colon cleansing prior to colonoscopy when compared with routine regime (caster oil and bisacodyl tablet).

Background and Objectives: In the past, women traditionally have been supported by other women during labor. Although, in recent decades the issue of continuous support during labor in all hospitals in the world has been discussed, this issue has become an exeption rather than a routine. Therefore, this study aimed at assessing the effect of supportive behaviours in comparrison with usual care on labor pain process.Methods: This quasi-experimental study was conducted on 80 primigravidas who had referred to Zanjan Valieasr hospital because of labor pain or rapture of membrane. At first, samples were selected by purposeful sampling, so they were randomly allocated into two groups; case and control. In the case group, supportive behaviors were conducted by a midwife. The control group only received usual care. For data gathering, a questionnaire and pain evaluation scale (VAS) were used. The data were analyzed by various statistical tests such as T test, Chi-Square, Mann Whitney test (p=0.05) in SPSS10 software. Results: The findings of Independent T-test showed a significant difference between case and control groups in mean pain severity in three situations (dill: 5cm, dill: 7cm, full dilatation) (P<0.001). In the case group compared with control group, duration of active phase (P=0.001) and second stage of delivery (P<0.001) significantly was low. Conclusion: This study showed thatcontinuous labor supportive behaviours makes labor progress and pain relief during labour. So it seems suitable that skill training be inserted in educational programs of midwifery students and applied by members of the hospital staff.

Background and Objectives: Cisplatin, Platinum co-ordinate complex is a widely used antineaplastic agent for treatment of metastatic tumors. Taurine is an organic acid and an endogenous antioxidant. In this study we investigated the protective effect of taurine as an endogenous antioxidant against cisplatin induced nephrotoxicity and hepatotexicity.Methods: 24 male albino rats (180-220 grams) were divided into 4 groups (n=6): (1): saline-treated group (2): cisplatin-treated group (10mg/kg, ip) (3): group that received taurine (400mg/kg, ip) 1hr before cisplatin (10mg/kg, ip) administration (4): taurine (400mg/kg, ip). The animals were killed 7days after treatment and then blood samples were collected.Results: The results of this study indicated that cisplatin significantly increased CRATININ, URE, ALT, AST levels as compared to control group. Moreover, taurine significantly decreased CRATININ, URE, ALT and AST levels compared to cisplatin group.Conclusion: According to this study taurine prevents the incease of Creatinin, BUN, ALT and AST levels assisted by cisplatin, which may be due to its antioxidant properties.

Background and Objectives: Type, intensity and duration of exercises exert pivotal effects on athletes’ immune system and probably athletes’ susceptibility to upper respiratory tract infections. In this study we examined the effects of one session of moderate-intensity exercise on male judoists’ circulating blood neutrophil counts (BNC) and respiratory burst, and self-reported upper respiratory clinical infections 24 hours after the exercise and during the sport seasons.Methods: Ten male judoists after obtaining informed consent were included in the study. The athletes took part in a session of moderate-intensity exercise (60 minutes running on a treadmill) at 60% of maximum heart rate. Blood samples were drawn at rest immediately after the exercise. Blood neutrophil count and percentage of Phorbol Myristate Acetate (PMA) stimulated neutrophils in whole blood were assessed [as a marker of oxidative burst (OB) quality]. Athletes were asked about any signs of upper respiratory infections 24 hours after the exercise and during sport seasons. Paired-t test was used for statistical analysis and statistical significance was set at p<0.05.Results: BNC were in normal range at rest, and meaningfully increased immediately after the exercise (p<0.05). At rest, the OB activity was in normal range, and increased immediately after the exercise (not significant). During 24 hours after the exercise, athletes showed no signs of upper respiratory system infections. Also they mentioned no history of increased susceptibility of upper respiratory infections during sport seasons.Conclusion: Continuous judo exercises have no negative effects on BNC and OB activity. This finding is in accordance with the absence of self-reported upper respiratory infections in judoists during sport seasons. Significant increase in BNC after a session of exercise was a predictable event as a normal response of immune system to exercise stress. Normal OB activity after the exercise was in accordance with the absence of any signs of upper respiratory infections in athletes during 24 hours after the exercise.

Background and Objectives: The use of neuraxial opioids has gained popularity over the last few years; they may cause analgesia by the local anesthetic through direct binding with the specific spinal receptors. The purpose of this study was to compare the effect of intrathecal alfentanil in patients undergoing cesarean section on spinal anesthesia during the operation, and after the operation on spinal anesthesia and side effects.Methods: The study was a randomized prospective and double blind study. 60 young adult females, with ASA physical status I and II with singleton pregnancy undergoing elective cesarean section under spinal anesthesia were randomly allocated to receive spinal elective anesthesia either by using 0.5% hyperbaric bupivacaine 2.5 ml with 0.5 ml normal saline (saline group) or with 0.5ml alfentanil (alfentanil group). Blood pressure, heart rate, respiratory rate, oxygen saturation and side effects were observed before spinal anesthesia and every 5 minutes interval during the surgery, therefore at 30 minute interval until the patient complained of pain. Intraoprative quality of analgesia during spinal anesthesia, time of first feeling of pain (complete analgesia), time of first request of analgesics postoperatively (effective analgesia), side effects (nausea, vomiting, shivering, Purities) and fetal outcomes were evaluated and analyzed.Results: It was shown that 90% of patients in alfentanil group had excellent analgesia Intraopratively, while only 16.7% of patients in the saline group had an analgesia which was qualified as excellent (p<0.001). Complete analgesia also lasted longer in alfentanil group (178±41.8min) compared with saline group (97±28.9min) (p<0.01). The duration of effective analgesia was significantly shorter in the saline group (132±0.32min) compared with the alfentanil group (223.5±0.40.9min) (p<0.01). Hemodynamic variables were similar in both groups (p>0.05). Purities were the most common side effect in the alfentanil group (76.7% of patients). Nausea was less present in alfentanil group than in saline group (50% versus 85%). The incidence of shivering and vomiting did not differ between two groups (p>0.05). APGAR scores were similar in both groups (p>0.05).Conclusion: The addition of alfentanil 250 micrograms to hyperbaric bupivacaine 12.5mg for spinal anesthesia increased the quality of surgical analgesia and duration of postoperative analgesia in patients undergoing cesarean section without increased any side effects. Purities were the most common side effects but they were mild.

Background and Objectives: Nowadays the use of enlightened experiences in research domain can lead us to understand the reality of human behavior which is of paramount importance in clinical fields.The first years of marriage are important due to acquiring new experiences (for example parenthood, making use of contraceptive methods and family planning programs). Exploitation of these experiences might elucidate the complexity of beliefs surrounding fertility behavior.The aim of this study was to examine young women’s motivation for pregnancy prevention in the first years of marriage.Methods: This study used a qualitative and phenomenological design. Women surveyed by purposeful sampling were in the first years of marriage. Depth and non-structured interview were used for data collection. 11 women took part in this study. Data were gathered using unstructured interview and analyzed with colaizzi method. Reliability and validity of data were confirmed by conformity of results through participants and team analysis. Results: The findings of research were classified in 61 codes, 7 subcategories and 2 categories that formed our main concept.Conclusion: This study indicated that pregnancy-preventing motivations in the first years of marriage depend on cognitive, economic, cultural and medical factors.

Background and Objectives: Painting workshops are part of the woodwork (carpentry) industry in which despite advances in technology, the work force fulfills most of the roles in the production process. Since such manual activities are often performed with awkward postures due to lack of workers’ awareness and inappropriate design of tools and working conditions, ergonomic assessment of work environment and working condition improvement seems essential. Designing evaluation checklist and calculating ergonomics indexes can be useful in this assessment. This study was conducted on workers of painting workshops of furniture industry with the objectives of a) evaluation of level of exposure to musculoskeletal disorders (MSDs) risk factors and b) determination of action category levels in the workshops.Methods: After conducting task analysis in the painting workshops, 47 workers were assessed by the designed ergonomic checklist and ergonomic indexes were calculated. Finally, the risk factors were determined. Ergonomics indexes were considered as the criteria to demonstrate the workshops ergonomic conditions and to determine action category for working condition improvement. Nordic musculoskeletal disorders questionnaire was also applied to determine prevalence rate of MSDs among workers. Data were analyzed using statistical tests including t-test and test of proportion.Results: Mean of age was 28.78 (range=17-58). The highest prevalence was reported in lower back (38.3%). Statistical analysis revealed that there were significant associations between occurrence of MSDs and calculated ergonomics indexes (P<0.05). The higher the means of ergonomics indexes (showing ergonomically better working conditions), the lower MSDs prevalence rate would be. Totally, 85.11% of the workers studied were in the first priority of action category (i.e., ergonomic measures should be done as quickly as possible). Inappropriate hand tools, awkward postures and unsuitable organization were determined as risk factors in the workshops studied.Conclusion: The designed checklist was found to be an appropriate, rapid and low cost tool for ergonomic evaluation of working conditions and determining measures for ergonomic improvement. In the painting workshops most problems were originated from inappropriate hand tools, awkward working postures and unsuitable work organization.

Background and Objectives: Anesthesia management in myasthenia gravis is a great challenge for all anesthesiologists. In this disease, even small doses of muscle relaxants could lead to delayed recovery for respiratory muscles.Case Report: In this report we introduced our anesthetic regimen for a patient who was brought to the operation room for thymectomy. For anesthetic management of such patients, non muscle relaxant technique (NMRT) is recommended.

Background and Objectives: Irritable bowel syndrome is one of the most common functional gastrointestinal disorders striking 10-20% of the world population. Although most patients do not take medical assistance, this disease enforces significant cost on the patient and health systems and has negative effects on quality of life of the individual. After diagnosis, treatment of this disease is the next step. Many pathways of treatment has been introduced and the efficacy of each other has been established in one way or another. The first step in the path of treatment is education and confidence of patients that might also be the most important step. Fiber diet, probiotic, anti-cholinergic and anti antispasmodics, laxatives, anti-diarrhea, the drugs affecting serotonin receptors, antidepressants and anti-anxiety, the chloride channel activator and non-drug methods such as cognitive-behavior therapy, hypnotherapy, acupuncture and herbal medicine each of which has been tested on irritable bowel syndrome and efficacy of each one has been indicated in one way or another. This paper tried to outline new treatments available in addition to categorization and discussion of various treatments for irritable bowel syndrome.