Journal of Isfahan Medical School
Year:2017 | Volume:35 | Issue:442|Papers Count:8

Background: Postoperative pain is one of the most prevalent complications after the surgery and several studies have been performed for prevention of it. This study aimed to compare the preemptive effect of intravenous paracetamol and ketorolac on prevention of postoperative pain in patients undergoing abdominal surgeries.Methods: In a clinical trial study, 80 patients undergoing abdominal surgery were selected and randomly divided into two groups of 40. The first and second groups received 30 mg intravenous paracetamol and 1 g intravenous ketorolac, respectively, one hour before the beginning of surgery. Incidence and intensity of postoperative pain were compared between the two groups.Findings: The mean score of postoperative pain in paracetamol and ketorolac groups in recovery were 7.4±0.9 and 5.9±2.0, respectively and the difference between the groups was statistically significant (P<0.001). In addition, postoperative pain intensity in 2, 6, and 18 hours after the surgery was lower in ketorolac group. The mean change of postoperative pain intensity was different in the two groups (P=0.034). But, the incidence of nausea and vomiting was higher in ketorolac group.Conclusion: Injection of paracetamol led to more decrease in postoperative pain; but the incidence of postoperative nausea and vomiting was higher with ketorolac. As using non-steroidal anti-inflammatory drugs in some of patients is limited, probably paracetamol is a suitable drug for prevention of postoperative pain. Although, more studies is recommended.

Background: Iron deficiency anemia (IDA) is a public health problem and the most common cause of anemia worldwide. The prevalence of iron deficiency anemia is 17-75 percent in preschool children in the Middle East. Early diagnosis and proper treatment of disease in initial stages can result in normal physical and mental growth of the children. The aim of this study was to evaluate the prevalence of iron deficiency anemia in 2-6-year-old Iranian children based on their serum ferritin level.Methods: This cross-sectional study evaluated 257 children with age of 2-6 years. Data about age, gender, weight, and height of participants were recorded; the serum levels of hemoglobin and ferritin were evaluated; and the prevalence of iron deficiency anemia was calculated.Findings: 257 children with mean age of 3.90±1.47 years were assessed that 49.8% were boy. There was not significant relationship between iron deficiency anemia and gender. Ferritin level had inverse association with weight (P=0.007) and 2-5-year-old children had less level of ferritin (P=0.002). Iron deficiency anemia was more prevalent in children with higher body mass index (BMI) (P=0.010).Conclusion: Iron deficiency anemia is prevalent in children and increases by ages. More researches to investigate the optimal intervention for treating and preventing this type of anemia are needed.

Background: Burnout is viewed as an affective and passive reaction to chronic occupational stress that occurs as emotional exhaustion, physical fatigue, and cognitive weariness.The medical residency is one of the most challenging periods in the professional life of physicians and requires high psychological and physical energy. The aim of this study was to determine the prevalence of burnout among medical residents.Methods: This cross-sectional study conducted on 104 emergency medicine, internal medicine, and obstetrics and gynecology residents in Isfahan University of Medical Sciences, Isfahan, Iran, using the Maslach Burnout Inventory. Data were analyzed using MANOVA, Cramer's V, and Pearson correlation coefficient tests.Findings: 71.15% of residents were burned out. The frequency percentage of burnout among obstetrics and gynecology residents was higher than in the other two groups (non-significant) and among the second- and third-year residents was higher than others (significant). In addition, the frequency percentage of burnout among women was higher than men (non-significant), and among the married residents was more than singles (significant). The mean burnout was not significantly different in various levels of demographic variables namely type of specialty, year of study, gender, and marital status. There was no significant correlation between age and burnout.Conclusion: Majority of residents were burned out. Given the importance of the consequences of burnout, periodic evaluation of residents' burnout is necessary and psychological interventions should be prepared for them.

Background: Some of previous studies showed that risk of mortality in patients who need hemodialysis and hospitalized in intensive care unit is higher but and biomarker is not detected for prediction of mortality in these patients. So, this study aimed to evaluate the diagnostic values of troponin I and T for prediction of mortality in patients hospitalized in intensive care unit and need hemodialysis.Methods: In a cross-sectional study in Alzahra hospital, Isfahan, Iran, during 2015-16, 70 patients hospitalized in intensive care unit were selected and serum levels of troponin I and T were measured and its relation with mortality was studied. In addition, the diagnostic values of troponin I and T for prediction of mortality was evaluated.Findings: The best cut-off point of troponin I and T for prediction of mortality were 1.5 and 1.2 mg/ml, respectively. In addition, sensitivity, specificity, false positive, false negative, positive predictive values, negative predictive value and accuracy were 26.7%, 81.8%, 18.2%, 73.3%, 28.6%, 80.4%, and 67.1% for troponin I, respectively, and 26.7%, 78.2%, 21.8%, 73.3%, 25.0%, 79.6%, and 70% for troponin T, respectively.Conclusion: Troponin I and T are not suitable markers for prediction of mortality in patients hospitalized in intensive care units and need hemodialysis.

Background: Ophthalmic disorders are more prevalent in children with hearing loss. This study aimed to investigate the types and frequencies of ophthalmic disorders in children with congenital sensorineural hearing loss and cochlear implant.Methods: This descriptive cross-sectional study was conducted among 51 children aged 3-18 years in Isfahan City, Iran, in 2017. Patients were selected via simple random sampling method. Visual acuity and strabismus were examined and direct ophthalmoscopy, dry and cycloplegic refraction tests, and slit lamp examination with a hand-held lens were done. Results were analyzed using descriptive statistics and chi square tests.Findings: Mean age (SD) of children was 8.0 (3.4) years.26 (51%) were boys and 25 (49%) were girls. 24 patients (47.1%) had at least one ophthalmic disorder. There were 8 patients (15.7%) with decreased visual acuity, 13 (25.5%) with refractive errors, 4 (7.8%) with amblyopia, 4 (7.8%) with strabismus, and 9 (17.6%) with retinal abnormality. Diagnosis of 3 patients was consistent with Usher syndrome and one with Goldenhar syndrome. Decreased visual acuity was more frequent in boys than in girls (P=0.02).Conclusion: According to remarkable frequencies of ophthalmic disorders among our study sample, early screening of visual disorders is suggested to be done in children with definite diagnosis of hearing loss.

Background: This study aimed to investigate the correlation of ictal onset patterns in scalp electroencephalography (EEG) in patients with refractory extratemporal lobe epilepsy with postsurgical outcome.Methods: This was a retrospective cohort study conducted between 2011 and 2015 in Kashani Epilepsy Center, Isfahan, Iran, enrolling patients with refractory extratemporal epilepsy who underwent presurgical evaluation. Demographic, clinical, and imaging data, and also ictal findings during video-EEG monitoring were reviewed. The correlation between preoperative findings and 1-year postsurgical outcome was analyzed.Findings: We reviewed 91 seizures of 27 patients.49.5% of seizures were sleep-related. Secondary generalization occurred during 15.4% of seizures. The most common EEG pattern at ictal onset and the most frequent late pattern were rhythmic theta and rhythmic spike/sharp, respectively. Favorable 1-year outcome was observed in 74.1% of patients. Age of less than 35 years, lower number of antiepileptic drugs, and occurrence of EEG changes before clinical signs of seizure were more common in patients with favorable outcome. Secondary generalization and sleep-related seizures frequently associated with unfavorable postsurgical outcome.Conclusion: Clinical and EEG findings during video-EEG monitoring can provide valuable information regarding postsurgical prognosis in patients with extratemporal lobe epilepsy. However, in order to reach a more accurate conclusion, intracranial monitoring and larger studies are required.

Background: Kidney transplantation is the preferred treatment for most patients with end-stage renal disease (ESRD) and therefore, kidney transplantation survival analysis is important. The aim of this study was to determine the cumulative survival rate of renal transplantation and the factors affecting it.Methods: This was a historic cohort study including information of 381 patients with end-stage renal disease who underwent kidney transplantation surgery from December 2007 to March 2016 in Noor hospital, Isfahan, Iran. The Kaplan-Meier method, Log Rank test and Cox regression model were used for statistical analysis. Data analysis was carried out with R software, Version 3.1.0, at the significance level of P<0.05.Findings: According to Kaplan-Mayer method, 1-, 3-, 5- and 8-year survival rates of transplanted kidney were estimated as 98.7, 93.3, 86.9, and 83.9 percent, respectively. The results of Cox regression model indicated that the time duration of dialysis before transplantation (P<0.05), and the level of creatinine at the time of discharge from hospital (P<0.05) had significant relationship with survival of transplanted kidney.Conclusion: The survival rate of the transplanted kidney calculated for this center was suitable in comparison with other transplant centers. The level of creatinine at the time of discharge from hospital and the time duration of dialysis prior to transplantation were the factors influencing survival of the graft.