ELECTRONIC PHYSICIAN
Year:2015 | Volume:7 | Issue:4|Papers Count:12

Background: Patients with liver cirrhosis suffer from various cardiac abnormalities, which may influence their outcome. Tissue Doppler recording of the mitral and tricuspid annular diastolic velocities can be used to assess diastolic function accurately. There has been very little published information regarding RV diastolic function in liver cirrhosis. This study is aimed at evaluating right and left ventricular systolic and diastolic functions in post hepatitis C liver cirrhosis patients using conventional echocardiography and tissue Doppler imaging.Methods: This study was conducted on 75 adults from inpatient and outpatient services of the Theodor Bilharz Research Institute (TBRI) hospital. They were divided into two groups: Group 1 included 50 patients with post hepatitis C liver cirrhosis; and Group 2 included 25 normal adults serving as a control group. All patients and normal volunteers were subjected to clinical examination, laboratory evaluation, abdominal ultrasonography and echocardiographic studies with tissue Doppler imaging for evaluation of left and right ventricular systolic and diastolic functions.Results: The mitral flow showed significant increase in A wave velocity, as well as DT and IVRT with a significant decrease in E/A ratio in Group 1 compared to Group 2 (P<0.01). The tricuspid flow also showed a significant increase in A wave velocity (P<0.01) and DT (P<0.05) in addition to a significant decrease in E wave velocity and E/A ratio (P<0.01) in Group 1 as compared to Group 2. At the mitral annulus, we found a significant increase in average Aa velocity, E/Ea ratio and average systolic wave velocity S, in addition to a statistically significant decrease in the average Ea velocity and average Ea/Aa (P<0.01) in Group 1 as compared to Group 2. At the tricuspid annulus, there were significant increases in the average Aa velocity (P<0.01), S velocity (P<0.01) and E/Ea (P<0.05) together with a statistically significant decrease in the average Ea/Aa and average Ea velocity (P<0.01) in Group 1 compared to Group 2.Conclusion: It is important to evaluate the cardiovascular function in every patient with cirrhosis, especially if the patient is a candidate for any intervention that may affect haemodynamics.

Background: Isoxsuprine (Vasodilan) is a beta-adrenergic that directly affects the vascular smooth muscle and results in peripheral vascular dilation. Isoxsuprine relaxes the uterine smooth muscles and is used for treatment of pre-term labor and dysmenorrhea. Isoxsuprine is used extensively in hospitals and private clinics in Iran; however, few studies have reported its safety and efficacy in the prevention of pre-term labor.Objective: The aim of this study was to assess the effect of maintenance therapy with oral isoxsuprine for the prevention of pre-term labor.Methods: We undertook a blinded prospective randomized trial of 70 women with singleton pregnancies who presented in pre-term labor between 26 to 34 weeks of gestation. After arresting the contractions with intravenous magnesium sulfate, the patients were randomized into two groups, with the treatment group receiving oral isoxsuprine until 34 weeks of gestation. Response to treatment was assessed by the progression of the pregnancies in both groups. The data were analyzed using SPSS software.Results: Our results showed that 14 (40%) of the patients in the case group and 12 (34.29%) of patients in the control group had pre-term births, and there was no significant difference between the two groups (P=0.621). Also four women (11.43%) in the case group and five women (14.29%) in the control group delivered before 34 weeks (P=0.721).Conclusion: Oral isoxsuprine was not effective as a maintenance treatment in preventing pre-term births or in delaying delivery until after 34 weeks. Larger studies are needed to identify the best treatment for pre-term labor. Clinical Trial Registration: The study is registered in the Iranian Clinical Trial Registry Center (IRCT201101115591N1).Funding: This study was conducted with financial support provided by the Hormozgan University of Medical Sciences.

Treatment of cancer in children often requires a combination of chemotherapy, surgery, and/or radiotherapy. Radiotherapy and chemotherapy are not painful processes, but children undergoing these procedures must be made motionless through anesthesia or sedation. There are a few reports of complications during these procedures in relation to the procedures themselves or to the anesthesia given. This report describes an unexpected pulseless radial artery which was preliminarily and unduly attributed to anesthesia. A 2.5 year-old male pediatric patient with an acute lymphoblastic leukaemia was scheduled for radiotherapy. Anesthesia with intramuscular ketamine was induced before starting radiotherapy. About 5 minutes after injection of ketamine we found the right radial pulse undetectable. There was no other manifestation of hypoxia or hypo-perfusion. Carotid pulsation was normal. Examination of the left radial pulse and other peripheral pulses showed normal pulsation. The procedure was continued uneventfully. The next follow-up after radiotherapy, showed a scar and swelling on the right antecubital area, caused by extravasation of chemotherapeutic agent in the prior period of chemotherapy. Doppler ultrasonography of the antecubital vein confirmed the diagnosis. This case study therefore demonstrates that proper intravenous cannula establishment before chemotherapy is of great importance. Furthermore, accurate history and physical examination before induction of anesthesia or sedation may be useful in preventing mismanagement in pediatric cancer procedures.

Background: Global cerebral ischemia (GCIR) arises in patients that are shown a variety of clinical difficulty including cardiac arrest, asphyxia, and shock. In spite of advances in understanding of the brain, ischemia and protective effects to improve ischemic injury still remain unknown. The aim of our study was to investigate the effect of ellagic acid (EA) pretreatment in the rat models of global cerebral ischemia reperfusion.Methods: This experimental study was conducted in 2014 at the Physiology Research Center of the Ahvaz Jundishapur University of Medical Sciences in Ahvaz, Iran. Adult male Wistar rats (250-300 g) were used in this study. GCIR was induced by bilateral vertebral and common carotid arteries occlusion (4-VO). 32 rats were divided randomly to four groups: 1) So (Sham) received normal saline as vehicle of EA, 2) EA, 3) normal saline + GCIR, and 4) EA + GCIR. After anesthesia (a mix of xylazine and ketamine), animal subjected to 20 minutes of ischemia followed by 30 minutes of reperfusion in related groups. EA (100 mg/kg, dissolved in normal saline) or 1.5 ml/kg normal saline was administered (gavage, 10 days) to the related groups. EEG was recorded from NTS in GCIR treated groups.Results: Present data showed that: 1) EEG in GCIR treated groups was flattened; 2) Blood pressure, voltage of QRS and P-R interval were reduced significantly in the ischemic groups compared to before ischemia, and pretreatment with EA prevented this reduction; and 3) MDA level and heart rate was increased by GCIR and pretreatment with EA reduced MDA level and restored the HR to normal level.Conclusion: Results indicate that global cerebral ischemia-reperfusion impairs certain heart functions and ellagic acid as an antioxidant can restore these parameters. The results of this study suggest the possible utility of ellagic acid in patients with brain stroke.

Background: One of the most important issues in morning report sessions is the number of patients. The aim of this study was to investigate and compare the number of cases reported in the morning report sessions in terms of case-based and conventional methods from the perspective of pediatric residents of Mashhad University of Medical Sciences.Methods: The present study was conducted on 24 pediatric residents of Mashhad University of Medical Sciences in the academic year 2014-2015. In this survey, the residents replied to a 20-question researcher-made questionnaire that had been designed to measure the views of residents regarding the number of patients in the morning report sessions using case-based and conventional methods. The validity of the questionnaire was confirmed by experts’ views and its reliability by calculating Cronbach’s alpha coefficients. Data were analyzed by t-test analysis.Results: The mean age of the residents was 30.852 ± 2.506, and 66.6% of them were female. The results showed that there was no significant relationship among the variables of academic year, gender, and residents’ perspective to choosing the number of patients in the morning report sessions (P > 0.05). T-test analysis showed a significant relationship among the average scores of residents in the selection of the case-based method in comparison to the conventional method (P < 0.001).Conclusion: From the perspective of residents, the case-based morning report was preferred compared to the conventional method. This method makes residents pay more attention to the details of patients’ issues and therefore helps them to better plan how to address patient problems and improve their differential diagnosis skills.

Background: With the growing global population, it is becoming increasingly difficult to ignore the demands for food and energy. A major portion of the food and energy is produced via agriculture and livestock activities. The objectives of this research are to gather information regarding the demographic features of farmers, previous poisoning, and the extent of farmers' knowledge in the use of pesticides and associated hazards in different counties and villages in Fasa, a city located in the Fars province of Iran.Methods: This cross-sectional study was carried out from March to July 2012 in the Nobandegan and Sheshdeh counties, and villages including Miandeh, Fedshkuyeh, Senan, Rahimabad, and other places in the Fasa suburban countryside. To collect data, an appropriate questionnaire was designed and implemented.Results: A total of 200 farmers participated in the study. We found that 55% of farmers were illiterate. Approximately 86% of used pesticides were organophosphorus compounds. Around 30% of the farmers used no protective equipment while working with pesticides, and only 22% of farmers had read and understood the instructions on the pesticide containers.Conclusion: Given the toxicity and hazards of pesticides and their adverse effects on farmers' health, effective measures should be adopted to decrease the amount of pesticides used. Conducting training programs for farmers may help to reduce pesticide exposure risks.

Background: Functional renal failure and cardiovascular dysfunction are common complications of liver cirrhosis. This study aimed to evaluate cardiac performance, systemic vascular resistance (SVR) and fluid status in patients with decompensated liver cirrhosis either with or without functional renal failure.Methods: Sixty patients diagnosed as having decompensated liver cirrhosis were divided into two groups. Group 1 included 30 patients with decompensated liver cirrhosis with ascites and with creatinine values ≤ 1.5 mg/dl. Group 2 included 30 azotemic decompensated cirrhotic patients with diagnostic criteria of hepatorenal syndrome (HRS). Also, 20 healthy subjects, of matched age and sex to the Group 1 and Group 2 patients, were included in the study as the control group. All patients and normal controls were subjected to clinical examination, laboratory evaluation, ECG, abdominal ultrasonography and echocardiographic studies.Results: The echocardiographic and ECG data showed significant increase in LAD (P<0.01, P<0.01), AoD (P<0.05, P<0.01), interventricular septum thickness (IVST) (P<0.01, P<0.01), posterior wall thickness (PWT) (P<0.01, P<0.01), EDD (P<0.01, P<0.01), ESD (P<0.05, P<0.01), left ventricular (LV) mass (P<0.01, P<0.01), and Corrected QT (QTc) (P<0.01, P<0.01) interval with significant decrease in SVR (P<0.01, P<0.01). Additionally, there was significant decrease in IVC diameter in both patients groups compared to the control group (P<0.01, P<0.01).Conclusion: Patients with decompensated liver cirrhosis have low SVR, and Doppler echocardiography provides an easy noninvasive tool to assess this finding. Also, these patients demonstrate small inferior vena cava (IVC) diameter with normal collapsibility, which indicates low effective plasma volume. Measuring IVC diameter and collapsibility are of value in the prediction of intravascular fluid status in liver cirrhosis. This is especially true with renal dysfunction. Early addition of oral vasoconstrictors in decompensated patients may correct the SVR and circulatory dysfunction and hinder HRS occurrence.

Background: Direct out-of-pocket (OOP) payment is the most inequitable way to pay for healthcare services, and this trend exposes patients and their families to backbreaking financial risks. The aim of this study was to estimate the out-of-pocket expenditures for outpatient imaging services in Imam-Khomeini Hospital in Tehran.Methods: This cross-sectional study was conducted in 2014 on 100 users of outpatient imaging services (radiology, ultrasonography, CT-scan, and MRI) in Imam-Khomeini Hospital in Tehran. Structured interviews and the analysis of related documents were used to acquire the pertinent data. The percentage of out-of-pocket expenditures was obtained by dividing the out-of-pocket expenditures by the total expenditures paid to the service provider, i.e., the sum of out-of-pocket expenditures and insurance payments. To analyze the data, we used descriptive-analytic statistics, distribution indices, the t-test, and the Pearson product-moment correlation coefficient.Results: Health insurance covered 84% of costs incurred by users of outpatient imaging services. There was no significant relationship between the user’s age and the amount of out-of-pocket expense (p = 0.01). The relationship between the user’s gender and out-of-pocket expense was significant (p = 0.05). The average payment for males was greater than the average payment for females. The highest percentage of the total payment the users incurred was 41% for a CT-scan, and the lowest percentage the users incurred was 30% for radiology services.Conclusion: It is suggested that expensive diagnostic tests, such as CT-scans, be prescribed according to the actual needs of patients to make the financial burden of diagnostic services reasonable for all patients.

Background: Early diagnosis of neonatal sepsis followed by appropriate treatment decreases mortality and morbidity in infants. The aim of this study is to assess the role of procalcitonin (PCT) as a marker in the early diagnosis of neonatal sepsis.Methods: We present a cross sectional study where 35 neonates with early onset sepsis (admitted to the Neonatal Intensive Care Units at El-Minia Children University Hospital from August 2012 to August 2013) were included in the study. Another 35 healthy neonates with no clinical or biological data of infection were included as a control group. Subjects were subjected to a thorough history taking and routine laboratory investigations. Serum PCT and C-reactive protein (CRP) levels were determined by enzyme-linked immunosorbent assay (ELISA).Results: Mean levels of PCT and CRP in neonates with sepsis were significantly higher than in the control group (p=0.0001). There was a moderate, but significant, positive correlation between PCT and C-reactive protein (p=0.001, r=0.55) and an insignificant correlation between procalcitonin and total leukocytic count among the neonates with sepsis (p=0.2, r=0.2). In addition, procalcitonin had high sensitivity, specificity, a high positive predictive value, and a high negative predictive value (80%, 85.7%, 84.8%, and 81.1% respectively). Procalcitonin showed higher sensitivity when compared to CRP.Conclusion: Procalcitonin is a sensitive, independent, and useful biomarker in comparison to CRP in early diagnosis of neonatal sepsis.

Background: Driver fatigue as a leading cause of death in the transportation industry can impair the driving performance in long-distance driving task. Studies on the links of driver subjective fatigue and the bus lateral position are still an exploratory issue that requires further investigation. This study aimed to determine the correlation between the driver subjective fatigue and the bus lateral position in a driving simulator.Methods: This descriptive-analytical research was conducted on 30 professional male bus drivers participated in a two-hour driving session. The driver subjective fatigue was assessed by the Fatigue Visual Analogue Scale (FVAS) at 10-min intervals. Simultaneously, the performance measures of lane drifting as the mean and standard deviation of the bus lateral position (SDLP) were calculated during the simulated driving task. Descriptive statistics and the Spearman correlation coefficient were used to describe and analyze the data.Results: Fatigue levels had an increasing trend as the time-on-task of driving increased. Time-on-task of driving had the greatest effect on the fatigue self-evaluation (r = 0.605, p < 0.0001). The results showed a significant correlation between fatigue self-evaluation and bus lateral position (r = 0.567, p < 0.0001).Conclusion: As the time of driving increased, driving performance was affected adversely, as shown by the increase in the SDLP. Even so, the effect of individual differences on driving performance should not be overlooked. This work concludes that predicting the state of a driver fatigue based on the group mean data has some complications for any application.

Background: Bedside teaching is a patient-based teaching method in medical education. The present study has been conducted with the aim of investigating the quality of bedside teaching in the internal wards of Qaem and Imam Reza Educational Hospitals.Methods: This study follows a mixed qualitative-quantitative approach using checklists on educational clinical rounds in Imam Reza and Qaem Hospitals in Mashhad. In the first stage consisting of qualitative study, the parts related to the quality of bedside teaching were recognized and a checklist was designed in three domains of patient comfort (8 questions), targeted teaching (14 questions) and group dynamics (8 questions), and its reliability and validity were verified. In the next step, data were collected and then analyzed using SPSS 16 software through statistical techniques of independent t-test, one-way ANOVA and variance analysis.Results: In total, 113 educational rounds were investigated in this study. Among them, 59 (52.2%) and 54 (47.8%) educational rounds have been investigated in Imam Reza and Qaem Hospitals, respectively. The average total score of bedside teaching was 180.8 out of 300 in the internal wards of both Imam Reza and Qaem Hospitals.Conclusion: The results of this study showed that generally the quality of bedside teaching in Imam Reza and Qaem Hospitals of Mashhad is low according to the qualitative standards considered in this study. Holding educational workshops along with more familiarity of the professors with effective bedside teaching strategies could be effective in improving the quality of educational rounds.

Background: Health-related quality of life (HRQOL) is a concept that relates to an individual's perception of health status in relation to the culture and value systems in which they live, in addition to their expectations, goals, concerns, and living standards. Considering the size of the population affected by Chronic Liver Diseases (CLDs) and the severity and chronic nature of the symptoms, there is an emerging need to evaluate the quality of life of patients using a standard protocol. The aim of this study is to assess the HRQOL in children with CLD based on child self-report and parent proxy-report forms.Methods: A total of 164 children, 55 CLD and 109 healthy children (aged 6-17 years), upon referral from the Pediatric Department at Ghaem Hospital in Mashhad from 2010 to 2014 were enrolled in this case-control study. We used the PedsQLTM 4.0 generic score scale to assess the HRQOL in children with CLD compared to the control group based on child self- and parent proxy reports.Results: According to the child self-reports, the total HRQOL in the case group (89.93±9.63) was significantly lower than control group (93.05±9.28) (p=0.006). We found significant differences in emotional functioning based on the CLD child self-reports (p=0.001) and their parent proxy-reports (p=0.002). Furthermore, there was a statistically significant correlation between the severity and physical functioning as reported by the Child-Pugh score (p=0.03, r= -0.31) and the MELD/PELD scores (p=0.01, r= -0.35), based on child self-reports. Gender, age of onset, CLD types, duration of the disease, and treatment showed no significant differences with total HRQOL.Conclusion: HRQOL is significantly lower in children with CLD in comparison to the normal population. We strongly recommend considering different aspects of quality of life, especially emotional functioning concomitant to the therapy programs.