JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2013 | Volume:31 | Issue:262|Papers Count:6

Background: Administrating premedication for children undergoing outpatient ophthalmologic procedures to reduce costs and increase efficiency is very important. The mostly used drugs for premedication are midazolam and ketamine. In this study, we compared the effectiveness of combined oral midazolam and ketamine with oral midazolam alone in outpatient pediatric ophthalmologic surgeries.Methods: In this double-blinded randomized clinical trial study, 136 children aged 6 months to 6 years undergoing outpatient ophthalmologic procedures with class I or II in American Society of Anesthesiologists (ASA) scale and without systemic disease were enrolled. Children were randomly divided in two groups. Thirty minutes before operation, group 1 received oral midazolam 0.5 mg/kg and group 2 received oral midazolam 0.25 mg/kg with ketamine 2.5 mg/kg. Medications were mixed with strawberry-flavored juice with volume of up to 0.5 ml/kg. In both groups, children’s basic behavior, acceptance of premedication, anxiolysis (30 minutes after premedication), sedation at 10, 20, and 30 minutes after premedication, parental separation behavior (30 minutes after premedication), children’s puncture behavior, number of attempts for venipuncture, puncture duration, post-anesthetic arousal stage at the end of anesthesia and recovery duration were be compared. Any complication like nausea and vomiting were also recorded.Findings: There were significant differences between two groups in sedation score and children’ s puncture behavior score. There were no significant differences between the two groups regarding the children’s behavior type, acceptance, anxiolysis, parental separation, and arousal stage behavior scores. Numbers of attempts for venipuncture, puncture duration and recovery variables were similar in the two groups. Nausea was seen in one child in both groups. 2 children in combination group vomited.Conclusion: Oral premedication with low dose combination of midazolam and ketamine makes earlier and more effective sedation and better puncture behavior than oral midazolam alone.

Background: Seizure is accompany with neurons function disorder and abnormal electrical action. However, febrile convulsion seizure is usually benign and causes no important problem for patients; but all children with febrile convulsion are usually faced with behavior disorders. In these patients, prophylaxis and anti-convulsion drugs are used. This study aimed to survey the efficacy of zinc sulfate in prevention of febrile convulsion recurrences.Methods: In this clinical trial study, 80 children the same in age and gender, after passing inclusion and exclusion criteria were divided in two equal groups: drugs and placebo. We got blood samples of both groups and checked serum zinc level after release, prescribed zinc syrup for case and placebo for control group. After a year, we measured serum zinc level in patients and finally we analyzed the data.Findings: In case group, 27 (67.5%) and in control 24 (60%) children were boys. The mean age was 28.90±16.19 and 27.65±13.47 months in case and control groups, respectively (P=0.709). The mean zinc level was 75.36±8.12 and 73.21±7.32 mg/dl in case and control groups, respectively. In case group, 7 patients and in control group, 10 had seizure recurrences in a year (P=0.412). There was no relationship between recurrences and age or gender; but the first and the last measured level of zinc and the amount of increase of zinc level in children with recurrence were significantly less than the children without it.Conclusion: In current study, we observed that zinc sulfate syrup could not decrease the seizure recurrences related to insufficient serum zinc level, probably because of incorrect drug using or secondary decrease of serum zinc level in these children.

Background: In radiotherapy, the presence of metallic implants affects the dose distribution, depending on beam energy and type, size, material and position of the implant. In this study, the effect of spinal implants on dose distribution was evaluated by Monte Carlo simulation.Methods: Oncor accelerator and water phantom, Plexiglas phantom containing spine and Plexiglas phantom containing spine and rod implants were simulated using BEAMnrc and DOSXYZnrc user codes and were validated. The effect of the implant presence, its size material, and location on dose distribution was investigated.Findings: Comparison of dose distributions with and without implants showed an increase of 5.5% in dose up to 4 mm from metal surface, due to the back scattering of electrons. Maximum attenuation in titanium rods was 9%. When the rods were positioned closer to each other, an increase in attenuation was observed. However, dose in spine was increased, when the distance between rods and spine was reduced. Rods with smaller cross section had less effect on dose. Attenuation in vitallium and stainless steel implants were 2 times greater than titanium implants.Conclusion: Depending on the location of implant with respect to spine, dose perturbation due to implants can either increase or decrease the dose in spine. The effect of size and material of implant was more important when spine was located under the implant. Generally, the effect of spinal implant on dose distribution is a function of size, material and position of the implant. Therefore, it is recommended to evaluate the dose distribution for such patients individually.

Background: Some studies suggest that increased homocystein in blood leads to alterations in coagulation; however, the precise mechanism is not clear. The aim of this study was to compare different concentrations of homocysteine and aspirin on coagulation parameters and permeability coefficient of clot in the plasma of healthy individuals in vitro.Methods: Different concentrations of homocysteine (50, 100, 200 μM) and aspirin (1, 10, 100 mg/l) were added to the plasma citrate. They were incubated at 37°C for 24 hours. Then, coagulation parameters were analyzed by the turbidimetric procedure at 405 nm and permeability coefficient of clot was determined. The independent samples t-test was utilized to compare the results.Findings: Homocysteine at 200 mM with aspirin 100 mg/l had significant changes in the total coagulation time (820.00±1.15 s), maximum coagulation velocity (0.232±0.003), the permeability coefficient of clot [(1.108×10-6) ±0.151] compared to homocysteine at 200 mM [555.00±12.89, 0.258±0.008, (0.493×10-6)±0.038, respectively] (P<0.05). Homocysteine at 200 mM with aspirin 1 mg/l did not significantly change in either parameter (P>0.05). Homocysteine at 100 mM with aspirin 1 mg/l significantly changed only in the permeability coefficient [(0.787×10-6) ±0.071] compared to homocysteine at 100 mM [(0.636×10-6) ±0.053] (P<0.05).Conclusion: Aspirin with the dose more than 1 mg/l had more effect on higher concentrations of homocysteine and delayed forming clot by impeding the coagulation. It increased clot permeability, too.

Background: Millions of athletes participate every year in the Ramadan fasting of all around the world. However, few findings are available on the effects of Ramadan fasting on athletic performance. The aim of the present study was to investigate changes in cardiorespiratory responses, body composition, and blood lipids due to moderately and heavy aerobic exercise training during the fasting month of Ramadan in athletes.Methods: Sixty-six trained healthy men from Yazd city, Iran, were selected as purposeful and then randomly assigned into 3 groups: only fasting (F, n=22), fasting plus exercise (FE, n=22), and only exercise (E, n=22). In addition to the fasting, subjects in the FE group also participated in an aerobic exercise-training program [65-85% maximal oxygen consumption (VO2 max)] for 4 weeks during Ramadan. Body weight, body mass index, fat percentage, VO2 max, and blood glucose, total cholesterol (TC) low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG) were measured at baseline and after Ramadan.Findings: The VO2 max and HDL level of the FE group was increased compared to pre-fasting, whereas the total cholesterol and blood glucose were significantly reduced at the end of the 29-day fasting Ramadan period (P<0.05). No significant changes were observed between groups in body composition and blood lipid profile. A significant different in predicted Vo2 max was observed in the athletes group (P<0.05).Conclusion: The results of this study showed that Ramadan fasting combined with exercise training had no adverse effect on the subjects when performing aerobic exercise at submaximal level. In addition, fasting and exercise increase maximum oxygen consumption and improve total cholesterol, triglyceride and blood glucose in athletes.