JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2012 | Volume:29 | Issue:163|Papers Count:6

Background: Pharmacological strategies with rapid antidepressant effects lasting for hours or even a few days would have an enormous impact on public health. The objective of this study was to compare intravenous ketamine therapy and electroconvulsive therapy in depressive patients.Methods: A total number of 32 depressive patients aged 18 and over, who were candidates for electroconvulsive therapy, were assessed in two groups of 16. The first group received intravenous ketamine therapy (0.5 mg/kg) while the second underwent electroconvulsive therapy (ECT). Six sessions of treatment were performed during 3 weeks. The Hamilton depression rating scale (HDRS) was used before treatment, at therapy sessions, and one week, as well as 1, 2, and 3 months after the treatment.In addition, Wechsler adult intelligence scale (WAIS) was employed before and 1 and 3 months after treatment.Findings: Although the HDRS scores improved in both groups after treatment, the reductions were insignificantly more in the ECT group. Three months after the treatment, the WAIS scores increased in the ketamine group but decreased in the ECT group. However, the deference was not significant.Conclusion: The results of this study showed that intravenous ketamine therapy improved the WAIS scores after treatment. However, long term effects of ECT on reducing HDRS scores were more than ketamine therapy.

Background: Neonates with lower hemoglobin and hematocrit are more at risk of iron deficiency anemia. This rate is influenced by several factors. Children's health can be improved by identifying these factors and taking appropriate actions. This study determined the relationship between type of delivery and umbilical cord blood hemoglobin and hematocrit.Methods: This descriptive correlational study was performed on full-term neonates born in 22-Bahaman hospitals in Gonabad, Iran, during 2011. The sample size was determined based on previous studies and means comparison. Purposeful sampling was used to select 90 cases of normal delivery and 90 cases of caesarean section. Cord closure time was similar in both groups. Umbilical vein blood samples were sent to the specific laboratory for hemoglobin and hematocrit to be measured. The data was analyzed by t-test, Fisher's exact test, Pearson's correlation and analysis of variance (ANOVA) at a significance level of 5% in SPSS16.Findings: Our results showed that the mean of hemoglobin in normal delivery and caesarean section cases were 15.11±1.38 and 13.88±1.52, respectively. The difference between the two values was statistically significant (P<0.001). There was a significant difference between the mean of hematocrit in normal delivery (43.64±4.58) and caesarean section (40.73±4.53) groups (P<0.001). The results showed a significant difference between hemoglobin and hematocrit levels in both sexes, i.e. the levels were higher in boys (P=0.01(.Conclusion: Umbilical cord blood hemoglobin and hematocrit in neonates of caesarean section were less than those with normal delivery. Therefore, the first group is more at risk of iron deficiency anemia.Development and promotion of safe vaginal delivery are recommended to avoid unnecessary complications of cesarean section. Moreover, iron deficiency anemia should be followed and treated in cesarean section cases.

Background: Snoring is breathing with a hoarse sound during sleep caused by the vibration of membrane structures in the upper airway. Snoring can manifest as a primary snoring to obstructive sleep apnea with an apparent decrease in quality of life. The purpose of the current survey was to evaluate the clinical manifestations and polysomnographic (PSG) findings of snorers.Methods: This descriptive-analytical study included 98 snorers who referred to a sleep clinic from September 2009 to June 2010. All subjects filled a questionnaire containing demographics, clinical symptoms, the epworth sleepiness scale (ESS), comorbid diseases and medications. Full PSGs have been performed for each patient. Records were scored manually according to the guidelines of American association of sleep medicine (AASM). Finally, all data was analyzed by chi-square test and t-test.Findings: Mean weight of patients was 86 ± 18 kg and 80 individuals were overweight or obese.Moreover, 74 patients were male. According to PSG findings, 90 subjects had obstructive sleep apneahypopnea syndrome (OSAHS), 2 had upper airway resistance syndrome (UARS) and 6 suffered from primary snoring. ESS scores more than 8 were observed in 65 persons. There were significant correlations between body mass index (BMI) and OSAHS (P<0.01) and arousal index (AI) (P<0.01(.Moreover, the correlations between excessive daytime sleepiness, feeling unrefreshed during days and apnea hypopnea index (AHI) (P<0.01) and AI (P<0.01) were significant. The breath pauses reported by the patient's spouse was also significantly correlated with AHI (P<0.04). The prevalence of patients with mild, moderate and severe sleep apnea was 16.3%, 21.4% and 58.2%, respectively.Conclusion: The sensitive signs for evaluation of OSAHS are snoring, tiredness and excessive daytime sleepiness. It seems to be necessary to screen snorers for the quantity and quality of sleep in order to refer patients for PSG.

Background: Poisoning is an important medical emergency. The purpose of this study was to portray the pattern of poisoning in Isfahan, Iran.Methods: This cross-sectional study included all patients (n=402) with acute poisoning who attended the Emergency Department of Noor and Ali-Asghar hospitals in Isfahan, Iran, during 2008. The variables such as age, sex, residential location, educational level, type and cause of poisoning were reviewed and analyzed.Findings: The mean age of the cases was 26.5±11.6 years and 54.7% of the patients were male. The majority of cases (92.8%) lived in urban areas. The main agent of poisoning was drugs and the most frequently involved drug groups were psychological drugs (33.8%). The most overall common route of exposure was ingestion (93.3%). The mortality rate was 2% while 91.3% were admitted due to suicidal attempts. No significant differences were observed in age, sex distribution, poisoning outcome or types between suicidal patients and others. However, the history of psychiatric diseases (P<0.0001) and addiction (P=0.02) were significantly more prevalent among suicidal patients.Conclusion: Attempted suicide was the most common route of poisoning which necessitates attention to the risk factors and prognostic factors of poisoning.

Background: The use of temporary or permanent venous catheters in patients with renal failure has been increased recently. Therefore, familiarity with their clinical applications and complications is essential. This study aimed to evaluate the complications and effectiveness of temporary and permanent venous catheters.Methods: This was a prospective study conducted in Alzahra Hospital during 2006-2008. Patients with renal failure candidate for placement of either permanent or temporary central venous catheter were evaluated for early and delayed complications immediately after placement, as well as one and four weeks afterward. Data was analyzed using chi-square test in SPSS16. P values less than 0.05 were considered as significant.Findings: Overall, 114 patients with temporary and 129 patients with permanent catheters participated in this study. The majority of complications among the temporary catheter group were infection (15.3%) and bleeding (5.4%). In the permanent catheter group, the most frequent complications were infection (13.6%) and venous thrombosis (13.6%). Venous thrombosis rate in the temporary catheter group was significantly lower than the permanent catheter group (P<0.01). The frequency of catheter malfunctions in the temporary and permanent catheter groups were 23.4 % and 6.4%, respectively.Therefore, there was a significant difference between the two groups (P<0.001(.Conclusion: Since permanent catheters have prolonged and better function than temporary catheters, they are the first and best method of central venous catheterizing for hemodialysis. However, due to the lower venous thrombosis rates of temporary catheters, they are preferred in patients with proper indications for arteriovenous fistula (AVF) until the maturation of AVF.