Avicenna Journal of Clinical Medicine
Year:2012 | Volume:19 | Issue:1 (SN 63)|Papers Count:15

Introduction & Objective: Fentanyl has been used to improve quality and increase the duration of sensory block and analgesia after surgery in spinal anesthesia, but the effects of different doses are not still correctly specified. The aim of this study was to compare the duration of sensory block and side effects of adding different doses of intrathecal fentanyl to lidocaine 5% in spinal anesthesia.Materials & Methods: 140 adult patients undergoing elective surgery under spinal anesthesia were enrolled in a double blind placebo-controlled clinical trial. For spinal anesthesia in all patients, 100 mg of 5% intrathecal lidocaine was used and based on the drug added, patients were randomly assigned to one of four groups of control (2 ml distilled water), group two (25 microgram fentanyl), three (50 microgram fentanyl) and four (100 microgram fentanyl) groups. Duration of sensory block and the occurrence of complications were evaluated.Results: The groups were similar regarding demographic variables. (P>0.05) Mean duration of analgesia in the control group was 100.28±25.05 minutes and in group two was 112.28±18.4 minutes and in the third group was 135.28±10.63 minutes, and in group four, it was 140±12.42 minutes. Except for the differences of the control group with group two and those of group three with group four, the differences between all groups were statistically significant. (P<0.001) The frequency of sedation and respiratory depression in was significantly higher in groups three and four compared to the control group and group two. (P<0.01) The frequency of itching in the control group was lower than those of groups three and four and the patients in group two experienced less itching compared to group four. (P<0.01) The frequency of nausea and vomiting and shivering in the control group was higher than those of groups two and three and four. (P<0.01)Conclusion: Adding 50 microgram of fentanyl to 100 mg intrathecal lidocaine significantly increases the duration of analgesia, but it is also associated with the risk of respiratory depression.

Introduction & Objective: Urinary tract infections (UTI) are a common cause of morbidity and its diagnosis and treatment can lead to health. In this study we evaluated the efficacy of the long- term low-dose antibiotic prophylaxis with Cotrimoxazole and Nalidixic-acid in the patients with recurrent UTI.Materials & Methods: This study is a before and after clinical trial without control group done on 100 patients with recurrent UTI who had referred to Ekbatan Hospital. These patients had no urologic findings in clinical and para-clinical evaluations. These patients were treated by Cotrimoxazole or Nalidixic-acid in long term-low dose Antibiotic prophylaxis method according to urine culture and antibiogram. These patients followed with urine cultures in the therapeutic and 6 month follow-up periods. Also, we evaluated the differences between age, gender, type of microorganism, marital status, re-infection time and number of recurrences before treatment.Results: Our study includes 100 patients (83% female and 17% male). The mean+/-SD age of the patients in the group treated with Cotrimoxazole (group A) was 15.57+/-13.03 and in the patients treated with Nalidixic-acid (group B) was 13.67+/-10.9 years. 74% of the patients who were treated with Cotrimoxazole were single and this number was 66% for the nalidixic-acid group. E.coli, kelebsiella and proteous account for 80%, 18% and 2% of infections in the Cotrimoxazole group, respectively. These microorganisms account for 62%, 34% and 4% of infections in the nalidixic-acid group respectively. The re-infection rate for the Cotrimoxazole group was 18% which 82% of them were successfully treated. The re-infection rate for nalidixic-acid was 12% which 88% of them showed a good response to nalidixic-acid. In fact, in this study Nalidixic-acid was as effective as Cotrimoxazole.Conclusion: The long term-low dose antibiotic prophylaxis is very effective in the treatment of recurrent UTI and in our study Nalidixic-acid efficacy was similar to Cotrimoxazole.

Introduction & Objective: Rubella is a disease caused by the rubella virus and is usually mild and self-limiting. Infection of a developing fetus is serious and important because the child may be born with congenital rubella syndrome. Its symptoms include mental retardation, heart defects, cataract, etc. In 2003, mass vaccination against measles and rubella in individuals 5-25 years old was done. One of the main objectives of this study was to survey congenital rubella infection status with the presence of IgM antibodies against rubella virus in cord blood samples and also the immunity assessment of maternal IgG antibodies against rubella virus in the samples.Materials & Methods: In this cross-sectional study 358 cord blood samples were collected in hospitals affiliated to Tehran University of Medical Sciences in 2008-2009. The collected samples were analyzed by two ELISA methods for detection of IgG and IgM antibodies and RT-nested PCR tests on samples of IgG-negative and IgM-positive. In this study two groups of mothers were tested, one consisted of the ones< 29 years old (at the time of vaccination) with the frequency of 70.9% and the other one was those who were>29 with the frequency of 29.1%.Results: The mean age of subjects was 22.6 years old. Out of 358 samples, 326 (91.1%) were IgG positive, and 10 (2.8%) were IgM positive against rubella virus. All of the samples with negative result for IgG antibody, and positive result for IgM antibody against rubella virus were tested for the presence of rubella genome with RT-nested PCR method. None of these samples were positive according to the presence of the virus genome.Conclusion: According to the high immunity of mothers, the probability of congenital rubella transmission is low, but because of low immunity of mothers being >29 years old, it is highly reccommended to upgrade the age of vaccination to 28.

Introduction & Objective: Retinopathy of prematurity (ROP) is a major cause of blindness in premature newborns. It accounts for 4% of childhood blindness in developed countries and up to 40% in developing countries. The aim of this study is to report the refractive and anatomical outcome of patients who had undergone laser photocoagulate on for retinopathy of prematurity (ROP).Materials & Methods: In this cross sectional study, a total of forty eyes of twenty patients who had undergone transscleral diode laser photocoagulation for ROP between 2004-2008 were studied for the following measures: grade of ROP pre- and postoperatively, birth weight, gestational age, perioperative and postoperative complications, and current refraction.Results: Mean birth weight of patients was 923±271 gr and mean gestational age was 27.3±2.6 wk. All eyes had threshold ROP and responded to laser treatment with regression of ROP. Perioperative complications included hemorrhages in 15% that resorbed spontaneously. The mean age of patients at the time of examination for this study was 4.13±1.30 yr and their anatomical status of retina was normal. Strabismus (more than 20 prism diopter) was found in 10% of patients. The spherical equivalent of refraction at the time of examination was -2.31±3.38 diopter.Conclusion: Photocoagulation for ROP in our patients resulted in regression of threshold ROP. In addition, the analyses of refractive outcome demonstrated a predominance of myopia and astigmatism.

Introduction & Objective: Diarrheal diseases are considered a major health problem, especially in children. Enteropathogenic Escherichia coli (EPEC) strains are the common cause of diarrhea in children especially in developing countries. Because of undesirable effects of diarrhea and its interference with children's growth, in some cases antibiotic treatment is recommended. In recent years, resistance toward common and effective antibiotics in the treatment of infectious diseases became one of the most important challenges in medical society, for this purpose, antibiotic sensitivity and resistance of strains in every geographical zone must be determined. So in this study, of antibiotic patterns of these bacteria were examined.Materials & Methods: This cross-sectional study was performed on 192 strains of Enteropathogen Escherichia coli isolated from children who were suffering from diarrhea in 1389-1390 in the microbiology laboratory of Hamadan University of medical sciences. To identify these strains, standard biochemical and serology tests were used. The antibiotic sensitivity test of these isolates was carried out with disc diffusion agar method according to the CLSI standards for 14 different antibiotics disc. Resistance toward 3 or more than 3 classes of antibiotics were defined as multidrug resistance.Results: The result of this study shows EPEC strains had the highest resistance to cefpodoxime (97%), trimethoprim (60.7%), tetracycline (58.4%) and ampicillin (45.8%). Multidrug resistance was 68.7 percent. These strains also showed the highest sensitivity against imipenem, ceftriaxone, and ciprofloxacin antibiotics.Conclusion: EPEC strains that were studied with resistance to ampicillin, tetracycline and convenient sensitivity against fluoroquinolones are one of the major factors in children’s diarrhea. A result of this research suggests that antimicrobial resistance in Escherichia coli strains are high and prescribing and antibiotic is not logical, because it makes the treatment of infectious diseases difficult. So with supervision on the consumption of antimicrobial agents in the treatment of multidrug resistant infections and if possible, with determining resistant strains of phenotypes and genotypes, the development of resistance in bacteria can be prevented.

Introduction & Objective: Hospitals as one of the main institutions providing health care services play an important role in the health system and allocate a high percentage of health sector's budget to them. This study aimed to answer whether social security hospitals efficiency levels are the same for all provinces in Iran? And whether any relationship exists between the human development indexes (HDI) of the provinces and technical efficiency levels of the hospitals?Materials & Methods: Data envelopment analysis model has been used to measure technical efficiency of 65 social security hospitals, including small hospitals (working with lower than one hundred active beds) and large hospitals (working with over one hundred active beds) during the years 2007 to 2009. Further, the relationship between human development index and technical efficiency of hospitals in the provinces has been analyzed.Results: Results show that the average technical efficiency of small and large hospitals working in low and medium HDI provinces (0.912 and 0.937) are more than the average technical efficiency of hospitals in higher HDI provinces (0.870 and 0.887).Conclusion: It is recommended that social security organization concentrated distribute its hospital services in provinces with lower HDI and higher density of population living under the coverage of organization’s insurance. This will eventually puts its positive effects on per capita income of people, as well as more equitable distribution of income.

Introduction & Objective: Despite advancement in technology such as coronary artery bypasses grafting (CABG) prevalence of anxiety and depression remain high after cardiac events, which have been found to influence recovery process, recurrent cardiac events and patients’ quality of life. Cardiac Rehabilitation (CR) as part of secondary prevention aims to improve patients’ physical, psychological and quality of life (QoL) status. As there is lack of study in this area in Iran, the present study aim to investigate the effects of a 12 week exercise CR on anxiety, depression and quality of life in the Iranian CABG patients.Materials & Methods: In this cross sectional study 72 consecutive CABG patients referred to and enrolled in a 12 week (3 session per week) CR program in rehabilitation center of Shahid Beheshti hospital of Hamadan(Iran). 60 patients completed and 12(17%) dropped out of the program. Patients underwent exercise testing using modified Bruce protocol before and immediately after CR. Initial exercise intensity was 45-55% of VO2 peak(peak of oxygen consumption) which was progressively increased to 0.5 MET (metabolic equivalent unit) per week to 70-85%. Patients also completed the quality of life questionnaire and hospital anxiety and depression scale (HADs) at each time point.Results: Compared with pre CR exercise capacity, MET and BMI statistically improved after the program (P<0.001). The prevalence rate of anxiety and depression preprogram were 31.6% and 25% which statistically reduced post CR(11.6% and 8.4%) . Further analysis indicated a significant improvement in all components of QoL (physical, mental and social) similarly in men and women after the program. Additionally men and women did benefit from CR program similarly as there were no significant differences between men and women in terms of improvements in anxiety, depression and quality of life after the program.Conclusion: It is concluded that the completion of a CR program has beneficial effects on physical and psychological status of CABG patients. As the findings indicate similar effects of CR program in both men and women, it is suggested to refer all CABG patients especially women to CR program regardless of sex.

Introduction & Objective: Anabolic steroids (AS) abuse is spreading increasingly among professionals and amateur athletes taking part in gym halls. Healths educators' awareness of why athletes and gym users take such substances may help them to develop appropriate intervention. In this regard, perceived behavioral control (PBC) is defined as "a person’s estimate of how easy or difficult it will be for him or her to carry out the behavior", and Self-efficacy (SE) is defined as "people’s beliefs about their capabilities to produce performances that influence events affecting their lives". Both concepts refer to people's beliefs that they are capable of performing a given behavior. The aim of this study was to determine the role of SE and PBC in predicting AS use among male body builders.Materials & Methods: In this cross-sectional study, totally three hundred male body builders in Hamadan were randomly selected. The data was gathered using a self-report questionnaire included: demographic characteristics, self-efficacy for not using AS, and PBC for not using AASs. Logistic regression analysis was applied to assess association between SE and PBC with AASs use.Results: Based on the results, 24.3% (n=73) of athletes reported that they had used AS and 38% of them reported the history of using AS in the past. Logistic regression model showed SE (OR=0.851 P=0.000) and PBC (OR= 0.711 & P=0.000) that indicate association between low PBC and Low SE to use AS.Conclusion: High self-efficacy for not using AS and high perceived behavioral control have effective potential to protect adolescents against high risk behaviors. Comprehensive preventative health education programs need to emphasize on psychological factors that mediate and predict adolescents' and youths' health-related behaviors.

Introduction & Objective: Critical thinking is simply defined as ability for analysis and evaluation of information. Today, this skill is considered as an undeniable necessity for social life. So fostering critical thinking ability is one of the basic goals of different levels of education from primary school to higher education. Each conscious behavior is related to the theoretical and intellectual foundation and origin. Therefore, the quality and types of thought play an important role in human mental health. This research studies the relationship between female pre-university students' critical thinking skills and their mental health in the academic year 2009-2010 in Hamadan city.Materials & Methods: This study is a cross sectional research and our method is based on correlation. Using random multiple stages clustering method, we selected 331 students as statistical sample. The data gathering instruments are two standard questionnaires: California form b critical thinking questionnaire and 28-question Goldberg and Hilier general health questionnaire. The data were analyzed using descriptive statistic indexes such as frequency, percent, mean and standard deviation and inferential tests such as Pearson correlation coefficient and multiple regressions.Results: Research findings show that  the average point of students' critical thinking skills is (6.51 out of 34) and their average point of mental health is (31.52 ).About  61 persons(18.4) percent have not  any psychological disorder, about 270 person (81.6 percent) seemed to have psychological disorder symptoms. There are negative and significant differences between critical thinking skills and disorder in mental health. Multiple regression analysis show that: there is negative and significant differences between critical analysis and deductive rational skills with psychological disorder symptoms, that is when students' critical thinking skills increases, the psychological disorder symptoms decrease. Therefore the mental health status can be predicted according to students' critical analysis and deductive rational skills.Conclusion: Research findings show that students' critical skills are weak and the majority of students are at risk of mental health: and when the level of critical thinking decreases, depression, anxiety, physical and social disorder symptoms increase. Therefore are educational and health managers recommended paying serious attention to these issues.

Introduction & Objective: Communication skills are the most important characteristics for healthcare providers. The aim of this study was to assess communication skills level and its related factors among healthcare practitioners in Bahar-Hamadan.Materials & Methods: This descriptive-analytical study was carried out on 309 employees in Bahar health care system. Data-gathering tools consisted of a 3-part questionnaire: communication skills level measuring feedback, listening, and verbal communication. Subjects’ demographic variables such as age, gender, education level and job were also recorded. The obtained data was analyzed by means of the statistical software SPSS-13 using coefficient correlation, liner regression, t-test, and One-way Anova.Results: The subjects reported 62.2, 57.1, and 60.2% of receivable scores of verbal, listening, and feedback communication, respectively. Overall communication skills of 27.8% of the participants were evaluated at the desired level. Significant differences were observed in average score of communication skills related to age, gender, education degree, employment status, workhouse, and experience (P<0.05). In liner regression, factors influencing communication skills were age, gender, and education degree (P< 0.05).Conclusion: The results reveal that the communication skills of more than half of the medical practitioners are weak and moderate. It is recommended to design some program to improve medical practitioners' communication skills.

Introduction: Pneumonia is one of the most common infections during childhood. In children with recurrent bacterial pneumonia complete evaluation for underlying factors is necessary. The most common underlying diseases include: antibody deficiencies, cystic fibrosis, tracheoesophageal fistula and increased pulmonary blood flow. Vascular ring and its pressure effect is a less common cause of stridor and recurrent pneumonia. Congenital abnormalities in aortic arch and main branches which form vascular ring around esophagus and trachea with variable pressure effect cause respiratory symptoms such as stridor , wheezing and recurrent pneumonia.Case Report: A 2 year old boy was admitted in our hospital with respiratory distress and cough. Chest x-Ray demonstrated right lobar pneumonia. He had history of stridor and wheezing from neonatal period and hospitalization due to pneumonia for four times. The patient received appropriate antibiotics. Despite fever and respiratory distress improvement, wheezing continued. Review of his medical documents showed fixed pressure effect on posterior aspect of esophagus in barium swallow. In CT angiography we confirmed double aortic arch.Conclusion: Double aortic arch is one of the causes of persistant respiratory symptom and recurrent pneumonia in children for which fluoroscopic barium swallow is the first non-invasive diagnostic method.

Introduction: Wegener's Granolomatosis (WG) is a systemic, necrotizing, small-vessel vasculitis. Vascular inflammation and occlusion leading to tissue ischemia is a hallmark of WG. WG has a clinical predilection for the upper airways, lungs, and kidneys. Thromboembolic events do not usually occur and arterial thrombosis is extremely rare.Case Report: Here we reported 2 rare cases of arterial thrombosis that caused lower limb ischemia. There were not any risk factors such as deficiency of protein C, protein S or anti-thrombin 3, Factor V Leiden mutation, and anti-phospholipids syndrome. Limb perfusion returned as a result of emergency treatment and ischemia did not occur. High doses of prednisolone and endoxan were administrated for them.Conclusion: The thrombosis seemed to happen due to the inflammation process of the disease itself. Because of possible morbidity of limb gangrene we suggest special notice to limb pain, evaluation by paraclinics such as color doppler sonography or angiography to rule out or rule in thromboembolism, determining whether there are risk factors for thrombosis such as (deficiency of protein C and protein S or anti-thrombin III, Leiden 5 factor mutation and anti-phospholipid antibody syndrome), and treatment or removal of them. If no risk factor is found, high doses of immunosuppressive therapy like steroid and cytotoxic agents like Endoxan will be the choice.