JOURNAL OF BABOL UNIVERSITY OF MEDICAL SCIENCES (JBUMS)
Year:2008 | Volume:10 | Issue:4 (45)|Papers Count:15

BACKGROUND AND OBJECTIVE: Radiotherapy treatment planning (TP) is strongly dependent to the internal organs localizations and inhomogeneity dosimetric corrections based on computerized tomographic scanning (CTS) data. The purpose of this study was to compare the dose distribution parameters between CT-based corrected and non-corrected treatment plans for inhomogeneities within the irradiated volume.METHODS: Fifty three cases of head and neck, pelvis, abdomen and breast cancer were included in this project. All of them were imaged with same CTS machine. Each case was planned twice, one before and one after inhomogeneity CT-based correction with a two dimensional TP system. Statistical analysis was done after calculation the parameters of dose uniformity (Te), average (Davg), minimum (Dmin) and maximum (Dmax) doses for target volume (TV) and organs at risk (OAR).FINDINGS: Briefly, the ratios of mean differences of dosimetric parameter between before and after correction plans to the mean of same parameter after correction were obtained. Mean differences of Te, Davg, Dmin and Dmax for pelvis were -1.59% (p=0.30), -0.993 (p=0.5), -0.890% (p=0.91), 1.29% (p=0.05), respectively. Same parameters for head and neck region were 0%(p=0.5), 0.012(p=0.05), 0%(p=0.99) and 0%(p=1.00) and for chest wall treatment were 7.13%(p<0.001), 4.65%(p=0.04), 1.79%(p=0.37) and -1.61%(p=0.10), respectively.CONCLUSION: Findings further confirm the positive effect of density correction in chest wall irradiation. Unexpectedly, minimum differences were in head and neck region which can be due to low and high density tissues compensation. Present study has shown the unique and effective application of CTS data for dosimetric error corrections rather than internal organ localizations. If not considered, the dosimetry deviations will be out of tolerance doses according to the limits defined by standard organizations (±5%) for tumors and normal tissues as well.

BACKGROUND AND OBJECTIVE: Low back pain is one of the most common and costly musculoskeletal pain syndromes, affecting up to %80 of people at some points during their lifetime. Lumbar segmental instability is one of the subgroups of non specific low back pain. Definition of these patients needs high reliable clinical examinations. The aim of this study was to determine the interrater reliability of clinical examination in patients suspected to lumbar segmental instability.METHODS: In this study, fifteen patients with chronic non specific low back pain aged between 18- 45 years were selected by non probable sampling method. They were evaluated some clinical examinations include: aberrant movement patterns, VAS (visual analogue scale), flexion and extension range of motion (modified–modified Schubert test), trunk flexor and extensor muscle endurance, side support endurance tests, modified-Oswestry index and prone instability test. Clinical examination was performed in 2 sessions with two days interval. Some statistical tests were used for data analysis contain ICC for relative reliability of quantitative variables, Standard error of measurement for absolute reliability of quantitative variable, KAPPA statistics for qualitative variables and K-S test for normalizing the distribution of variables.FINDINGS: The findings showed a high and very high reliability in modified- Oswestry (ICC=0.95), trunk flexor muscles endurance (ICC=0.91), VAS (ICC=0.92), trunk extensor muscles endurance (ICC=0.85), left side support (ICC=0.7), right side support (ICC=0.77) and flexion range of motion (ICC=0.85) and moderate reliability for extension range of motion (ICC=0.68). KAPPA for aberrant movement patterns (k=0.82) and prone instability test (k=0.85) revealed a high agreement.CONCLUSION: The existence of aberrant movement patterns together with positive prone instability test and chronic recurrent pain accompanying with functional disability are the sign of lumbar segmental instability.

BACKGROUND AND OBJECTIVE: One of common complications after spinal anesthesia are nausea and vomiting that can make different problems such as spasm, hypoxia and pulmonary aspiration. This danger is more in patients with full stomach, eye injury, head trauma, cesarean and laparoscopy. The purpose of this study was to determine the effect of propofol and metoclopramide associated with dexamethasone on postoperative nausea and vomiting in patients under spinal anesthesia.METHODS: In this clinical trial study 100 patients with ASA class I and II aged 16 to 60 years who underwent orthopedic surgical operation of lower limbs divided into two groups randomly (50 patients in each). Each group received 500 cc of Ringer serum before spinal anesthesia. Spinal anesthesia with 22cc of 5% lidocaine was performed in the sitting position. The first group received metoclopramide with dexamethasone and second one received propofol with dexamethasone 5 minutes before the end of the operation. Prevalence of nausea and vomiting in both groups was surveyed for 4 hours and then data was compared with each other.FINDINGS: The occurrence rate of nausea in metoclopramide group was higher than propofol group (28% versus 22%) that this difference was statistically significant (p=0.039). Occurrence of vomiting in patients received propofol associated with dexamethasone was considerably lower than the patients received metoclopramide associated with dexamethasone (12% versus 4%) (p= 0.007).CONCLUSION: According to the results of this study, propofol associated with dexamethasone reduce nausea and vomiting in patients under spinal anesthesia.

BACKGROUND AND OBJECTIVE: Respiratory distress syndrome (RDS) and transient tachypnea of newborn (TTN) are the most frequent acute respiratory morbidity in newborns which vary according to the mode of delivery. The purpose of this study was to determine the influence of delivery mode on the frequency of RDS and TTN in newborns based on gestational age and fetus gender.METHODS: This prospective study was performed on all newborns delivered in Babol Clinic hospital, Babol, Iran during 2006. All newborns delivered by three different delivery modes: vaginally delivery (VD) (n=380), cesarean delivery without labor (elective cesarean, n=1305) and cesarean in labor (emergency cesarean, n=338) were assessed according to RDS and TTN observed in newborns. Neonates with anomaly, asphyxia and meconium staining amniotic fluid were excluded from this study. Data was analyzed using Fisher exact test and relative risk (RR) was calculated.FINDINGS: Frequency of RDS in cesarean section was more than vaginal delivery (8.5% vs 4.9%), (RR=1.7, 95% CI= 1.05-3), p=0.016. Frequency of RDS in elective cesarean was more than emergency cesarean (9.3% vs 5.7%), (RR=1.7, 95% CI= 1.04-2.7), p=0.017. Frequency of RDS in elective cesarean in neonates more than 37 weeks gestational age was more than emergency cesarean (8.6% vs 1.1%), (RR=1.8, 95% CI= 1.2-2.6), p=0.000. Frequency of TTN in cesarean section was more than vaginal delivery (9.2% vs 3.1%). (RR=3.1, 95% CI= 1.6-6.1), p=0.000. Frequency of RDS in boys was more than girls (10% vs 5.8).CONCLUSION: The results showed that the occurrence rate of RDS and TNN in newborns delivered by elective cesarean and male fetus was more. So neonatal care plan for decreasing cesarean without labor is necessary especially in male fetus.

BACKGROUND AND OBJECTIVE: Threatened abortion is defined as any bloody vaginal discharge or bleeding during the first half of pregnancy. It occurs in 30-40% of pregnant women and approximately 50% of them will abort. The aim of this study was to survey the therapeutic effects of progesterone in patients with threatened abortion.METHODS: This double blind clinical trial study was performed on 300 patients with threatened abortion who hospitalized in Ghods and Ali Ebne Abitaleb hospitals of Zahedan in 2004-2006. The patients divided into two groups randomly, we prescribed usual treatment (bed rest, hydration and analgesic drugs) in control group (150 patients) and our collaborators, gynecologists that were blind to this study, prescribed usual treatment plus progesterone (50mg/12h/im/4-6dose) in case group (150 patients) empirically.FINDINGS: In case group we have 3 cases of abortion (2%), while in control group there were 18 cases of abortion (12%) (p=0.001), while, average duration of hospitalization in case group was 1.89 days and in control group was 2.64 days and (p=0.0001). Average duration of uterine bleeding in case group was 1.78 days and in control group was 3.13 days (p=0.0001). So that the differences of two groups from these points were significant.CONCLUSION: The results of this study showed that progesterone has significant results in reducing of abortion and time of hospitalization and bleeding in threatened abortion.

BACKGROUND AND OBJECTIVE: There are so many factors affecting the posts retention, such as length, diameter, surface, etc. Moreover, another influencing factor is canal irrigators, which are used before cementation. The purpose of this study was to evaluate the efficacy of different root canal irrigators in the retention of casting post.METHODS: In this study, 80 recently extracted central teeth with the same size and shape were selected, and after root canal treatment (RCT), the canals were prepared with the same length and diameter. Post’s length was the same with the mean size of 12mm. After canal preparation, acrylic post & cores were constructed. Then spruing, investing and casting were done. Before cementation, samples were classified into 4 groups (20 cases in each group) and each group were irrigated by different root canal irrigators: group A: by normal saline, group B: hypochlorite sodium 2%, group C: citric acid 10%, group D: EDTA+ hypochlorite sodium 2%. Then the canals were dried and posts were cemented by Glass Inomer GC Fuji I. The evaluation of maximum force to push the posts out was done by Zwick machine and the diagram was traced by computer. For data analyzing, Kruskal wallis and one way ANOVA and tuckey tests were used and confidence interval was set at 95% (a= 0.05).FINDINGS: The average and standard deviation in 4 groups were: group A: 47.7±8.6 kg, group B: 46.8±9.3 kg, group C: 45.7±6.9 kg, group D: 43.9±6.8 kg. There was no significant difference between the four groups.CONCLUSION: The root canal irrigators had no influence on the retention of the casting posts which were cemented by Glass Inomer.

BACKGROUND AND OBJECTIVE: Bruising is the most common complications that resulting from subcutaneous heparin injection. It causes the limitation of injection area, anxiety, disruption of body image, refusing treatment in patients and the reduction in patient's trust in nurse. Although different methods were suggested to lessen these unwanted complications, unfortunately none of them could decrease these complications effectively. The aim of this study was to compare the effect of injection duration on the bruising size of subcutaneous heparin injection.METHODS: This quasi-experimental study was performed on 50 patients who were administered by subcutaneous heparin. They were hospitalized in the internal-surgical ward of Shahid Beheshti hospital in Babol, Iran. For each patient two methods of subcutaneous injection, 10 second injection (control method) and 30 second injection (experimental method) were tried on right and left deltoid muscle accidentally. The interval between two injections was 12 hours. Dimension of hand's bruising and indurations were measured and compared using flexible, plastic ruler, 48and 60 hours after each injection.FINDINGS: The size of bruising caused by 30 second injection, was significantly less than 10 second injection (p=0.00). Mean of bruising size in 10 second injection at 48 and 60 hours after injection was14±19.7 and 12.26±14.38, respectively and in 30 second injection at 48 and 60 hours after injection was 9.78±17.55 and 8.02±12.98, respectively. Also, 48 and 60 hours after 30 second injection, absence of bruising, were significantly less than 10 second injection (p=0.03 and p=0.001, respectively). Comparison of bruising size based on sex, females significantly had more bruising than males (p=0.001). Furthermore, patients in internal wards compared to surgical wards had significantly bigger size of bruising (p=0.001). There wasn't any significant relationship between age and bruising size.CONCLUSION: The results of this study showed that the increase in injection duration significantly reduced the bruising size. So in order to improve the quality of care and lessen the uncomfortable and stressful experiences of patients it is suggested to increase the duration of subcutaneous heparin injection to 30 seconds.

BACKGROUND AND OBJECTIVE: Vertigo is a common cause of consultation with a doctor and there is no specific cause in most of cases. There is some evidence that in some cases of benign positional vertigo there is hyperlipidemia coincident. The objective of this study was to determine the rate of hyperlipidemia in benign positional vertigo cases with symptoms of true vertigo.METHODS: In a case-control study, frequency of hyperlipidemia in 136 cases of benign positional vertigo compared with a control group. Hyperlipidemia defined as triglyceride or cholesterol more than 200 mg per deciliter of serum. Data was analyzed by chi-square test and ttest. Odds ratio was calculated and p<0.05 was considered significant.FINDINGS: From 136 patients with benign positional vertigo, 87 cases (64%) were female and 49 cases (36%) were male, respectively. Mean age of cases was 48.1 years and for control group was 49.4 years. Most of cases were between 41-60 years. There was hyperlipidemia in 70 cases (51.5%) with benign positional vertigo and in 22(16.2%) in the control group (OR=5.5, CI=3.1-9.7, p< 0.0001).CONCLUSION: In this study, the accompaniment of hyperlipidemia and benign positional vertigo has been agreed. According to their high rate, the assessment of serum lipids in every unknown case of vertigo is recommended. Treatment of hyperlipidemia will probably be effective in decreasing the frequency and severity of vertigo attacks.

BACKGROUND AND OBJECTIVE: Blood borne diseases are still one of the major sources of nosocomial infections and are large concern of health personnel because of extension of HIV infection. The aim of this study was to determine the occurrence and risk factors of needle stick and sharps injuries among personnel of hospitals and health centers in Astara, Iran.METHODS: In this cross sectional study, a total of 90 nurses, midwives, physicians, laboratory technicians, operation technicians, nurse aids, and anesthesia personnel, involve in the direct management and care of patients answered a questionnaire that had questions about occurrence of needle stick and sharps injuries and some potential risk factors.FINDINGS: The rate of needle stick injury was 1.9 per person in a year. A 67% of personnel had at least one needle stick injury in the last year. Only 20% of these hadn’t any injury from needle stick duration entire work career. Multiple logistic regression analysis showed that the most important risk factor for needle stick injuries was working night shifts, (OR: 2.5, 95% CI; 1.5-4.8). Other important risk factor including lack of training on such injuries (OR: 1.89, 95% CI;1.1-3.4), number of patients attended daily or nightly (OR: 1.81, 95% CI; 1.1-2.8) and recapping needles (OR: 1.67, 95% CI; 1.1-2.3).CONCLUSION: The rate of needle stick injury is fairly high among health care personnel of Astara and is a cause of the spread of blood borne diseases including HIV, hepatitis B, hepatitis C and the most important risk factor was the number of night shifts and lack of training. So trainin program especially for personnel who work the night shift is recommended to prevent needle stick injury.

BACKGROUND AND OBJECTIVE: The period of studying at the university, with its specific characteristics, is of a great importance in regard to the preventive measures of cigarette smoking. The aim of this study was to determine the prevalence rate of cigarette smoking in Iranian University students and its related factors.METHODS: This cross-sectional study was done on 1677 university students of Kerman, Iran in 2006. Data gathering was done by using a questionnaire included questions about demographic features and cigarette smoking. The relationship between the rate of cigarette smoking and a number of factors were analyzed statistically.FINDINGS: Mean age of students was 21.2±2.1 years. From all, 52% were women and 92% were single. In whole, 184 students (11%) were current smokers (21.5% of men and 2.4% of women). Mean age of smoking onset was 15.9±4.5 years. Among the affecting factors on cigarette smoking, smoking by close friends (OR=4.3), alchohol consumption (OR=3.0) and male sex (OR=2.8) showed the highest relationships with cigarette smoking. The rate of cigarette smoking was lower in students who were saying their regular daily prayer (OR=0.52) and those who had higher academic marks (OR=0.68).CONCLUSION: Considering the high prevalence rate of cigarette smoking among university students and its related factors, gender-based preventive measures are highly recommended.

BACKGROUND AND OBJECTIVE: Abdominal pregnancy is a rare event but is associated with significant morbidity and mortality. The clinical presentation of abdominal pregnancy varies, and the diagnosis depends on a high index of suspicion. Clinical history, physical examination and ultrasonographic features are all non-specific.CASE: A 29-years-old woman, G1, presented with a history of 4 days of vaginal bleeding and treated as missed abortion. After medical treatment failure, we decided to do D&C (Dilation and Curettage) for termination of pregnancy. After evaluation of cervix under anesthesia, with suspicious of abnormal pregnancy, laparotomy was done. In laparotomy abdominal pregnancy was diagnosed. Fetus and placenta was removed from the cul-de-sac, and the patient remained well after the operation.CONCLUSION: There are many pitfalls in diagnosing abdominal pregnancy by examination and ultrasound. Laparoscopy or laparotomy is required to make a definitive diagnosis of abdominal pregnancy. For abdominal pregnancy, surgical interventions are recommended.