Armaghane Danesh
Year:2004 | Volume:9 | Issue:33|Papers Count:14

Introduction & Objective: Awareness during operation is an important complication which may produce neurosis, anxiety, irritability, and so on. The spectrum of awareness includes dreaming before complete recall.This complication occurs most often during cardiac and cesarean section surgeries. The purpose of this study was to compare the incidence of awareness when propofol or halothane-thiopantal is used during cesarean section surgeries. Material & Methods: This a douvle blind clinical trial conducted in 1382 in Shiraz city. 151 healthy pregnant women were chosen randomly and enrolled in 2 groups. Induction of anesthesia in the first group was done with Na-thiopental (5 mg/kg) and maintenance of anesthesia was done with halothane and O2 - N2O (50%) but induction in the patients of the second group was done with propofol and maintenance of anesthesia was achieved with propofol (100 mic/kg/min). Finally, the incidence of awareness was detected 24-36 hrs after operation via direct interview with the patients. Results: 1.3% of patients in both groups reported pain sensation during operation. Whereas hearing during operation occurred in %5.3 of the first group and in 2.6 percent of the second group. Dreaming also occurred in 2.7% of the patients in the first group and 2.6% of the patients in the second group. Conclusion:The incidence of awareness was equal in both groups and no significant difference was detected between the two groups.

Introduction & Objective: Common practice in induction of anesthesia for tracheal intubation is the administration of hypnotic drugs followed by a muscle relaxant. The use of muscle relaxants in short time operations is controversial due to their side effects and prolonged paralysis. Materials & Methods: We evaluated the nasotracheal intubating conditions in 76 healthy premedicated children after propofol 2.5 mg/kg combined with either a bolus of remifentanil 2µ/kg (study group) or suxamethonium 1.5 mg/kg (control group).Nasotracheal intubations were done by a blinded anesthetist and intubating conditions were graded using a four point scoring system based on mask ventilation feasibility, jaw relaxation, position of vocal cords and degree of coughing and limb movement. Also homodynamic and respiratory parameters were monitored. Results: Intubating conditions were acceptable in 36/40 (90%) and 34/36 (94.4%) of remifentanil and suxamethonium group respectively. There were no significant differences in all scores between two groups except of coughing and limb movement that was lower in control compared to remifentanil group. Also subjects who received remifentanil have lower blood pressures and heart rates after tracheal intubation in compared to another group, but these hemodynamic changes were well tolerated by the patients. Only in two patients atropine was administered for treatment of bradycardia. Conclusion: Remifentanil 2µ/kg following propofol 2.5 mg/kg provides acceptable nasotracheal intubating conditions in the most of the cases without muscle relaxants.

Introduction & Objective: Diabetes Mellitus (DM) and other endocrine disorders are frequent in thalassemic patients that need regular transfusion due to iron overload. This study aimed at determine the prevalence of diabetes mellitus in thalassemic patients that referred to coolys centers of Kohkiloyeh and Boyrahmad for blood transfusion. Materials & Methods: In this cross- sectional descriptive study fasting blood suger (FBS) of 223 patients was checked for two times (103 patients from Yasuj , 64 patients from Gachsaran- 56 patients from Dehdast). Results: Prevalence of diabetes mellitus was 3.1% (7 patients) and prevalence of impaired FBS was 4% (9 patients). These two conditions were more in patients from Dehdast than those from Yasuj and Gachsaran. No significant correlation was found between the prevalence of DM and impaired FBS and the age of blood transfusion and disferral taking. Prevalence of impaired FBS and diabetes mellitus in female patients was significantly higher than that in male patients. Conclusion: It seems that a survey of endocrine glands and an evaluation of diabetes mellitus must be done regularly in coolys centers especially for patients older than 10 years old..

Introduction & Objective : Today use of drugs with few side effects such as post operative nausea and vomiting and high recovery rate is highly important. The present study seeks to investigate the simultaneous use of alfentanil and propofol in comparison with the common use of morphine sodium thiopental in reducing the rate of nausea and vomiting after appendectomy and during recovery. Materials & Methods: This study was carried out in a setting of double blinded randomized clinical trial from 1378 to 1381. Forty two patients, candidated for emergency appendectomy in class ASA I, under general anesthesia, were chosen and randomly divided into two groups. The first group patients were injected alfentanil (10µg/kg) and propofol (2mg/kg then100 µg/kg/min) and the other group received Morphine (0.1 mg/kg) and Sodium Thiopental (5mg/kg) intravenously for the induction and maintenance of anesthesia. Then post operative nausea, vomiting and recovery time were recorded. Systolic and diastolic blood pressure and pulse rate were also measured before and after 5 minutes following induction of anesthesia and in recovery room. Results: 9.5 percent of morphine-thiopental group and all the patients in alfentanil-aropofol group had post operative nausea and vomiting (p>0.05). Systolic and diastolic blood pressure in 5 minutes after induction and pulse rate after 5 minutes after induction in morphine-thiopental group was greater than that in alfentanil group. Conclusion: The combination of propofol and alfentanil required less recovery time and homodynamic change after induction of general anesthesia and turned out to be useful for short term operations.

Introduction & Objective: Plastination is a unique technique(was developed by gunthea hagens in 1984) involves substituting the tissue water in a specimen with polymer. The aim of this study is plastination of 3.5-5 months human aborted fetuses. Materials and Methods: This is a experimental applied study. 12 human aborted were plastinated after fixation in formalin solution, clearing in hydrogen peroxides, dehydration by acetone and forced imperegnation was carried. In the last step curing shrinkages was removed by positive pressure anatomical spaces. The data was analysed by T & Mann whitney. Results: Samples were obtained in this study compared with the samples. Two sampels have the same durablity but flexibility resin sampel are more than silicones , probably besause of insertion glycerin to resin polyester. Also matching of aboartion steps of forensic medicin was done in this collection . Conclusion: A collection of 12 plastinated aboarted human fetuses were prepared and matchs the samples with the definition of forensic medicine. Silicone substituted by cheap resin polyester asseptable samples were obtained. Plastinated fetuses are usefull for teaching of embryology and forensic medicine for the medical students.

Introduction & Objective: Visceral Leishmaniasis (kala-azar) is endemic in some areas of Iran, including: Ardebil, Fars, East Azerbaijan and Bushehr provinces and its sporadic in other regions. The causative agent of kala-azar in Iran is Leishmania infantum and its main reservoirs are canine. Materials and Methods: In this survey, blood samples were collected from all children of ≤ 10 years old and 10% of the adult population of Qahan district villages drawn by systematic sampling. Besides, blood samples were collected from all owner dogs of Anjile and some randomized samples of Nevis plus Qahan villages. The specimens were subjected to direct agglutination test (DAT).Results: Of the 416 human samples, 315 samples belonged to children ≤ 10 years old and 101 samples to adults. 226 (54.3%) out of 416 samples were prepared from males and 190 (45.7%) from females. Totally, 7 cases (1.7%) of human samples showed specific Leishmania antibodies with titers 1:3200 and above by DAT. Of the 32 dog samples, 8 cases (25%) showed specific Leishmania antibodies with titers 1: 320 or above. Two cases of seropositive dogs were necropsied and examined by parasitological procedures, and found to be highly infected by Leishmania.Conclusion: Results of this study showed that dogs are the main sources of infection for human visceral leishmaniasis in these regions.Likewise, kala-azar is endemic in Qahan district villages, especially in Anjile and Nevis villages, and visceral leishmaniasis is more prevalent in canine and children and also in males. These regions identified as new endemic focus of VL in Iran.

Introduction & Objective: Accurate treatment of T.B is the only way for prevention of the disease. Incomplete therapy results in disease recurrence and development of drug resistance. The most important problem in the control of T.B is lack of compliance to therapy one reason of which is side effects of drugs. This study aims at studying the prevalence of the adverse effects of anti-TB drugs in tubercular patients in Shiraz, 2001-2002. Materials & Methods: In this descriptive study, from April 2001 to April 2002, all new T.B patient records registered in our public T.B center(325 cases) were studied. All the patients were trained for the symptoms of drugs side effects. LFT test was done for those who developed drugs adverse effects. Pertinent demographic and lab data were gathered and analyzed. Results: 325 new patients (182 male, 56%, 143 female, 44%) were registered. Among these 113 patients (52 male, 44%, 61 female, 56%) developed drugs side effects. 107 (29.5%) had minor and 16 (5.2%) had major side effects. The incidence of all major adverse effects was 0.4 person-day during this study. There was significant statistical difference between female sex and drugs adverse effect (P<0.05), but no significant difference was found between nation, age and weight of the patients and the adverse effects of drugs. Conclusion: Of 113 patients experiencing side effects, 109 (96.5%) received complete treatment (3 died & 1discontiued). Anti-TB drugs adverse effect isnt a major reason for discontinuation of therapy. Appropriate treatment of side effects leads to cure of illness.

Introduction & Objective: Depression is known as a disorder that results in physical disorders, increases different diseases or mortality. Group psychotherapy is used to treat and reduce depression and physical function in depressive patients effectively. Group psychotherapy requires structured and organized group process and defined goal. The purpose of this study was to determine the effect of group psychotherapy on physical function of major depressive patients admitted in psychiatric wards in Hafez and Ibn-Sina hospitals. Materials & Methods : In this quasi-experimental study, group psychotherapy effect on three aspects of physical function, limited role playing resulting from physical problems and physical pain in 65 depressed patients admitted in psychiatric wards in Hafez and Ibn-sina hospitals, affiliated to Shiraz university of medical sciences (1382) with available sampling was carried out. 35 patients were included in case group and 35 patients in control group. A 36-item life quality questionnaire and a questionnaire of demographic characteristics with 13 items were used for data collection. The researchers completed related questionnaires for case group before group psychotherapy units about 1-1.5 hours. One month after group psychotherapy termination the above questionnaires were completed for 30 patients again (5 patients excluded). For control group, the first pretest was done, then without intervention one month after discharge, post test was completed. The data were analyzed by SPSS soft ware and statistical tests. Results: Results of this study showed that group psychotherapy was more effective on the three aspects of physical function, limited role playing resulting from physical problems and physical pain in case group than in control group and the difference was statistically meaningful (p<0.001). Conclusion: Group psychotherapy is recommended as one of the treatments of depression for improvement of physical function, physical pain relief, which lead to reduction of depression in major depressive patients.

Introduction & Objective: Trichomoniasis is a disease which caused by Trichomonas vaginalis and is the most common reason for non viral sexually transmitted disease and is the third cause of vaginitis which brings millions of people to women clinics.The main problem with this protozoa is the diagnoss of symptomatic cases and treatment of patients and also their sexual partner to avoid chronic infection and dissementation of parasite. The common way for diagnosis of Trichomoniasis is microscopical study of vaginal sample. Considering the diagnosis symptomatic cases just based on clinical observations, this study aimed to compare the clinical and microscopical diagnosis of trichomoniasis in women who referred to the Yasuj women clinics. Materials & Methods: In this study a vaginal sample was taken from women who had clinical symptoms of vaginitis and refered to Yasuj clinic (63 cases) by the use of swap. Samples in were transferred to the laboratory in dextrose saline solution. Results of microscopic diagnosis was compared with clinical diagnosis cansidering personal characteristics such as age, using contraceptive, clinical symptoms and type and color of discharge. Results: Out of 63 patients which their vaginal discharge was studied, 12 cases (19.04%) in clinical examination and 27 cases (42.9%) by the use of direct microscopic observation were positive with Trichomoniasis. Of the 27 positive cases, 10 cases were considered to have trichomoniasis by clinical observation and others (17 cases) had been diagnosed as other vaginitis. Conclusion: There was a significant difference between clinical diagnosis and microscopical diagnosis of trichomoniasis . No significant difference was found between clinical symptoms and diagnosis of trichomoniasis. So we can not use just clinical symptoms for diagnosis of trichomoniasis. By considering just the clinical symptoms we can not diagnos positive cases of trichomoniasis in more than 60% of cases and as a result they undergo unnecessary treatment.

Introduction & Objective: Ovarian hyperstimulation syndrome has been described after treatment with exogenous gonadotropins, clomiphen citrate and GuRh,s, but spontaneous form of this syndrome is very rare. This is a case report of spontaneous ovarian hyperstimulation syndrome associated with a case of spontaneous pregnancy and ovarian torsion. Case: The patient was a 30-year -old woman who was admitted due to abdominal pain from 1 week ago at 11 weeks gestation .In physical examination her abdomen was severely distended and diffusely tender and both ovaries were enlarged about 15 cm each and were tender. Ultrasonography revealed a single alive intrauterine fetus, 10 weeks gestation, with bilateral multilocular ovarian cysts with smooth surfaces and clear contents. Laboratory results showed low albumin and elevated CA125 (295 U/ml). She received 100g albumin and due to dyspnea a paracentesis was done. After 2 weeks she was readmitted with a complaint of right lower quadrant pain and tenderness and underwent laparotomy with diagnosis of right ovarian torsion. The ovary untwisted and several large cysts were aspirated. She had a normal vaginal delivery of a normal healthy female infant weighing 3100g at 40 weeks gestation. Conclusion: Ovarian torsion and rupture should be considered in these patients. If surgery needed , untwisting of ovarian even if it is chemic and contron of bleeding seems to be enough.