Armaghane Danesh
Year:2005 | Volume:10 | Issue:3 (39)|Papers Count:15

Introduction & Objective: Preemptive treatment of perioperative and postoperative pain is one of the principle roles of anesthesiologists. Regional anesthesia following injection of anesthetic drug has fewer side effects than local or systemic anesthesia and induces longer analgesia with high quality. This research aimed to compare the effects of adding epinephrine, midazolam and midazolam and neostigmine mixture to lidocaine in patients undergoing transabdominal resection of prostate.Materials & Methods: This is a double blind randomized clinical trial performed in Doctor Shareeati Hospital in Fasa. Ninethy candidate patients for elective transabdominal resection of prostate who were classified in class I and II of ASA were categorized randomly in 3 groups. In group one 100 mg lidocaine 5% plus 5 ųg epinephrine, in group two 100 mg lidocaine 5% plus 2 mg midazolam and in group three 100 mg lidocaine 5% plus 2mg midazolam with 25 ųg Neostigmine was injected into subarachnoid space and then the duration of painlessness and side effects such as nausea, vomiting, respiratory and drowsiness intraoperation and 24 hour post operation were recorded. Results: The duration of analgesia was 130.2‎±‎11.59 minutes in group one, 321.6‎±30.90 minutes in group two and 1417.8‎±‎53.34 minutes in group three. The incidence of nausea and vomiting in group one was 6.5%, in group two was 6% and in group three was 19.4%. The incidence of drowsiness and respiratory depression in all groups were zero. Conclusion: With co-administration of multiple spinal drugs which act in different sites in pain pathway for reducing pain, we can co administrate 25 mg neostigmine with 2mg midazolam and spinal lidocaine in order to maintain analgesia for 24 hours in patients. The most likely side effects were nausea and vomiting which could be controlled with antiemetic drugs.

Introduction & Objective: There are several methods for relief of labor pain but not all are appropriate for every patient. In intrathecal block, administration of local anesthetic and patient management in labor process should be with supervision of an experienced physician. Agents used for this purpose consisted of: chlorprocaine, bupivacaine and lidocaine. Drug concentration and volume depend on level and degree of sensory and motor block. Recently, intrathecal epinephrine 25 microgram and even 200 microgram, has been used for prolonging labor analgesia along with opioids and local anesthetics. The aim of this study was to assess the effect of intrathecal low dose epinephrine on pain intensity and duration of labour. Materials & Methods: This clinical trial study was performed on 60 parturients. After starting the active phase of labor (cervix dilatation of 5 cm), spinal analgesia was done in all of the patients. In conventional group analgesia was achieved by 1.5 ml bupivacaine of 0.125 percent, 15 microgram fentanyl, along with 1.25 microgram epinephrine (1:800000) and the same drugs except for epinephrine were used in the control group. Pain intensity before and after block, analgesia duration, systolic and diastolic blood pressure, heart rate, frequency of nausea and vomiting in mother, and first and 5th APGAR scores in neonates were recorded. Results: Complete analgesia duration was 95.3±18.2 and 81.2±15.1 minutes in epinephrine group and in control group (without epinephrine), respectively. Mean pain intensity score in epinephrine group was less than that of the control group but the difference was not statistically significant. There was no significant difference in the frequency of nausea and vomitting, heart rates, systolic and diastolic pressure in mother and APGAR scores between two groups. Conclusion: Intrathecal low dose epinephrine with bupivacaine and fentanyl can prolong duration of analgesia and relieve pain intensity without any side-effects on mother and fetus.

Introduction & Objective: Cutaneous Leishmaniasis (CL) is a parasitic disease caused by Leishmania parasites. Clinical manifestation of this disease ranges from a small papule to disseminated cutaneous lesion or chronic tuberculoid ulcer and is based on the type and virulence of parasite and also immune responses of the host. This study aimed to determine the virulence of Leishmania parasite isolated from cutaneous leishmaniasis patients. Materials & Methods: Isolated parasites from CL patients were cultured. Macrophage cell line (J774) cultured in RPMI medium was used in this study to find out the virulence of isolated parasite. Cell line was infected by metacyclic form of parasite where parasite was added to the macrophage culture on a ratio of 10/1. Three days later, cell lines were checked for any infection and the rate of macrophage infectivity and mean of parasite number in each macrophage were calculated. Results: Results of this study showed that virulence of isolated parasite was different where the rate of macrophage infection was 10-63%. Results also revealed that there was a correlation between the rate of macrophage infection and type of ulcers, where more invasive isolates induced ulcerative sores. No correlation was found between the rate of macrophage infection and place of resident of CL patients. Conclusion: Isolated parasites from CL patients had different virulence and this might be the reason for various clinical signs in CL. Molecular and biochemical characterization of the most virulent isolates can be useful for vaccine development and also for drug related studies.

Introduction & Objective: Ibuprofen is one of the safest and most potent non-steroidal anti-inflammatory agents available in the market. Its oral dosage forms available in Iranian market are sugar-coated tablet, film coated tablet and suspension as well. However, the tablets suffer from potential bioinequivalance problem, the limited aqueous solubility, gastrointestinal side effects and hardening of the tablets on aging. Materials & Methods: Sugar coated and film coated tablets of ibuprofen were examined in terms of dissolution equivalency and compared with a standard brand tablet (Nurofen). The physicochemical characteristics e.g. hardness, friability, assay, disintegration time and content uniformity of coated and uncoated tablets were determined. Dissolution testing was done by rotating basket method in various dissolution media including distilled water, phosphate buffer and HCl 0.1 N. The amount of drug released during dissolution test was determined using spectrophotometer at λ=221 nm. Results: Content uniformity, hardness, friability, assay and disintegration time of both sugar coated and film coated tablets were in the acceptable pharmacopeias limits. The amount of drug released from Neurofen, sugar coated and film coated tablet in acidic media during a period of 30 min were 5%, 8% and 12%, respectively. Furthermore, both sugar and film coated tablets released 80% of their content after 20 minuites in phosphate buffer. The amount of ibuprofen released from Neurofen was completed (100%) during similar period of time. Conclusion: Although the release profiles of both sugar coated and film coated tablets are similar in phosphate buffer medium, however, sugar coated tablets release less amounts of drug in acidic medium something which indicates superiority of sugar coated relative to film coated one for ibuprofen tablets.

Introduction & Objectives: It has been reported that diabetes mellitus results in alterations in plasma level of some essential trace elements like magnesium. Magnesium is suspected to have a role in pathogenesis and progression of diabetes. Materials & Methods: In this descriptive, cross–sectional study, the plasma level of magnesium was measured in 90 diabetic patients in diabetes clinic in Gorgan city, North of Iran. After filling in a form consisted of demographic variables, plasma level of magnesium was measured using spectrophotometer. Glycated hemoglobin (HbA1c) was also measured as a glycemic control index. Collected data were analyzed, using χ2, T-test & one-way ANOVA. Results: The mean concentration of magnesium was within normal range. Hypomagnesaemia was seen in 43 cases (47.8%). Most of hypomagnesemic patients (69.8%) were 41-60 years old. Mean magnesium level revealed no significant difference between two sexes (p>0.05). In higher educated subjects mean plasma level of magnesium was lower compared with others (p>0.05). Conclusion: In respect to high rate of hypomagnesaemia in our diabetic patients, we recommend that useful information about food resources of magnesium like vegetables, seafood, seeds and nuts be given to diabetic patients.

Introduction& Objective: The vaso-oculusive episode is the hallmark of sickle cell disease (SCD). Abdominal pain is also a common presenting symptom in the sickle cell population. Careful evaluation is essential in distinguishing between pain secondary to vaso-occlusion and other intra abdominal disease processes. Most cases of primary gastritis are now known to be caused by gastric infection with the organism Helicobacter pylori (H. pylori). H. pylori has been described in association with recurrent abdominal pain in children. H. pylori induced peptic ulcer disease (PUD) has not previously been reported in children with SCD, (except one case). The present study was designed to examine whether pain induced by H. pylori could imitate the recurrent abdominal pain in SCD. Materials & Methods: This is a cross sectional study, carried out in all of the patients with SCD (30 cases), who referred to Shiraz Motahari Clinic in 2004. At first 11 patients with recurrent abdominal pain (RAP) were selected and then by a questionnaire and an interview, 7 cases that had symptoms strongly suggestive of PUD were examined by upper gastroduodenoscopy with biopsy taken from gastric antrum. Six patients confirmed to be PUD induced by H. pylori were treated by quadriple therapy. All of them were followed for 9 months or more. Serum IgG titer against H. pylori was sent before and also 6 months after therapy. Results: Endoscopic finding in 6 of the 11 patients with SCD and RAP was diagnosed as PUD. In all cases (6 cases) H. pylori serology (IgG) test was positive. After treatment for H. pylori infection, all of them had complete resolution of symptoms by 1 month, and H. pylori IgG (6 month after treatment) tests were negative. Conclusion: We conclude that careful evaluation is essential in distinguishing between pain secondary to vaso-occlusion in SCD and other intra abdominal processes such as PUD. For differentiation of painful crises and H. pylori induced PUD, history and physical examination can be helpful. Episodic epigastric pain that was frequently associated with vomiting, nocturnal awakening and gastrointestinal bleeding is highly suggestive of presence of PUD. When definitive etiology of PUD is confirmed, appropriate treatment can be initiated and excess morbidity could be avoided.

Introduction & Objective: Despite the cesarean section expenses, its mortality and morbidity rate is more than that of normal delivery. The world health organization has proposed the maximum of cesarean of cesarean section & real indicators to be 15%. This is a descriptive research which defines the prevalence of cesarean section & the related causes in Yasuj city in 1382. Material & Methods: This is a cross-sectional, descriptive analytical study. Subjects were 3596 mothers & they were equal to the population size. A questionnaire was completed by each subject & the collected data were analyzed by methods of descriptive statistics. Results: The result showed that the total number of reported delivery was 3596, out of which, 73.89% had normal, 26.06% had cesarean section & 0.05% had delivery with forceps & vacuum. About 68. 19% of those who used cesarean had their first or second delivery .42% of multi para women with cesarean closed their tubes. The most common reasons for cesarean were: repeated cesarean section (23.69%), elective (13.67), CPD (13.56%), fetal distress (13.45%), no cephalic presentation (11.63%) & mothers diseases (10.35%). Conclusion: The rate of cesarean in Yasuj is higher than world standard (32.92%). In order decrease the number of unnecessary cesarean, teaching the young pregnant mothers about the disadvantages of cesarean is necessary.

Introduction & Objectives: Chronic illnesses affect people’s life span. Nowadays it involves not only elderly, but also the middle aged and the young. Because they result in disabilities, many of these diseases have significant effects on the quality of life of the affected persons. One of these chronic and disabling diseases is multiple sclerosis. It is seen mostly in young adult. This illness is characterized with inflammation in white matter, demyelization and geliosis of cerebllar cells that causes multiple neurological disorder and long term disability. The goal of this research was to determine the effect of rehabilitation process on the quality of life in multiple sclerosis patient referred to neurological clinics of Shiraz university of medical sciences in 2005. Materials & Methods: For the assessment of the quality of life, a standard questionnaire which included 12 aspects of quality of life was used. Also the degree of disability was determined with the use of Expanded Disability Status Scale (EDSS). A total sample of 75 patients affected by multiple sclerosis was randomly divided into two groups, case (35) and control (45). At first the patients completed the quality of life questionnaire and their EDSS scores were determined. The rehabilitation intervention was performed on the patients based on their individual needs which included 10 sessions of physiotherapy, 5 sessions of education and 2 sessions of grouptherapy. The control group received only conventional treatment (medical therapy). The quality of life and EDSS score in an interval of one month, three months and of one to three months were determined and compared in both groups. Results: Results showed that the patients in the case group showed statistically significant increase, one month after intervention, in 7 aspects of quality of life and no statistical significant difference was observed in other aspects. Besides, during three months after intervention, significant difference was observed in all quality of life aspects. Although in the control group there was a statistically significant decrease in 5 aspects of quality of life one month after the intervention, there was no such a decrease in other aspects. Moreover, a statistically significant decrease was observed in 5 aspects of the quality of life in control group three months after intervention. Noticeably, the case group maintained an increase in 11 aspects one to three months after intervention. The patients' ESDD score in the case group before one month and three months after the intervention, did not show any significant difference with the pre-intervention stage. No significant difference was observed one month after intervention while a significant decrease was observed after three months and in the interval of one to three months of intervention (p=.03 ,p=.009 ). Conclusion: In general, the results of this research showed the process of rehabilitation would increase the quality of life and life satisfaction in multiple sclerosis patients. Furthermore, this process improves patients’ abilities in doing their daily living activities, although the process dose not affect patients’ EDSS score. Therefore, we recommend that the process of rehabilitation be considered as a part of the treatment program of multiple sclerosis patients.

Introduction & Objective: Social relationships have a positive effect on physical health and psychological well-being. Social relationships are thought to be supportive of the extent that they provide individuals with transition as well as general sense of self-worth psychological well-being, and control over their environment. Support may also motivate mother to engage in positive health behaviors and to make lifestyle changes that can improve her physical health. Thus, there are multiple pathways through which social support may be linked to improved maternal and fetal health and consequently better birth outcomes. Pregnant women need the support of caring family members, friends and professionals. The purpose of this study was to identify physical and social status of pregnant women and their association with demographic factors. Materials & Methods: 290 pregnant women referred to Iran- Shiraz prenatal clinic in 2004 were included in this randomized analytic descriptive study. Physical, familiar, occupational, personal and social status of pregnant women and association of these indicators with demographic factors were evaluated. To collect data, we used Holmes and Cooper’s life change questionnaires. To identify reliability of questionnaire, we used pilot study with 40 cases and the reliability was estimated to be 95%. For data analysis, chi square, non parametric spearman and Mann- Whitney U were used. Results: Most of pregnant women had low education (64.4%) and were housekeepers (94.1%). The frequency of pregnancy interval> 2 years and intended pregnancy were reported 57.9% and 72.4% respectively. Physical status of pregnant women showed that the most physical problems were changes of sleeping habit (64.2%), eating habit disorders (51.6%), vacation changes (82.1%) and changes in personal habits (93.8%).The results also showed that gravida has negative effect on physical status, it means higher gravida is related to low physical health (p=0.004) but education level and pregnancy interval aren’t related to physical status. Regarding family-relative status, the most negative events were: husband work problems (30.8%), family members’ conflicts of pregnant women (27.4%), and conflict with husband’s family members (25.7%), conflict with husband (31%), sexual desire decrease (48.7%), husband's sexual desire decrease (27.6%) and change in residence (32.8%). High education (p<0.001) and low gravida (p=0.02) had positive effects on social-familiar support but pregnancy interval was not related to it (p>0.05). The results also showed that education, gravida and pregnancy interval did not have any relationships with financial, occupational, personal and social status, but personal and social status of pregnant women had positive effect on occupational status (p=0.001). Physical and financial statuses were not connected to occupational status. Conclusion: Lower gravida improves physical status of pregnant women. High level of education increases familiar-social support but these factors have no effect on financial, occupational, personal and social status. Good personal and social status makes better occupational status.

Introduction & Objective: Nowadays the Health services Unit have limitation in resources in many countries. Thus managers of Health Unit have to attend to limitation resources. According to economic science making use of facilities, equipments and maximum productivity of them is one of principals Health & Medication management system. So managers for doing this issue must use cost – benefit, cost – effectiveness and cost – analysis as the best way for receiving to the goals of organization. This study was done in order to Cost – Analysis in Health& Medication services in Health sector of Kogiluyeh & Boyrahmad Province. Materials & Methods: This was a descriptive, cross-sectional and prospective study which was performed in 2003. The cases study include: 3 District Health Centers 25 Urban & Rural Health Centers and 131 Health Houses were selected by random selection procedure. The way to gather data was use of the report forms of Health and Cure system, Data resulted from the present study were analyzed by SPSS soft ware.Results: Based on the results of this study: In Health houses, public participation and mass education had a maximum cost and first aids had a minimum cost. In Rural and Urban Health Centers dental scaling had maximum cost drug and family planning had minimum cost. Among Urban Health centers the maximum cost was related to Gachsaran district and minimum cost was related to Bourahmad district. Among Rural Health centers and Districts Centers the maximum cost belonged Kogilouyeh district and Bourahmad had the minimum cost. But the cost of Health House, Bourahmad had maximum cost and Kohgilouyeh had the minimum cost. Conclusion: The study say that the services, which have more frequency and time less their cost - price will be less. Thus managers and experts of Health Unit in the line and staff in short and long planning change their methods to give services. But they mustn’t eliminate every service even expensive services.

Introduction & Objective: Job stress is a harmful physical and mental response which is due to the interaction between the individual and his environment and lack of agreement between job requirements and the individual's abilities and desires. In addition to damaging the individual, job stress imposes overwhelming expenses on the related organizations. Nursing is one of the occupations in which people are exposed to stress and thus it adversely affects the quality of the services which they offer. So recognition of stress – making factors among nurses can serve as an effective step in determining and reducing stress. The present study was carried out in order to determine the stress- making factors and their degrees of stressfulness from the viewpoint of the nurses working in the hospitals of the University of Medical Sciences in the province. Materials & Methods: This cross sectional, descriptive, analytical study included 142 nurses who were at work when the study was carried out. A questionnaire was designed for data collection. After coding, the data were analyzed using SPSS software. Results: The most severe stressful factors in nurses proved to be lack of consent with the rate of income (72%), high work- load (61.3), working on holidays (25.9), unacceptability of the profession in the society (51.4), and disturbance of sleep and relaxation (14.1). Presence of new unfamiliar equipment in the environment and the nurses' lack of skill in working with the equipment (2.4) and lack of skill in the field (14.1) turned out to be the least stress making factors. A comparison between the mean score of stress making factors and the township and the hospital in which they work proved to be statistically significant (p<.004 and p<0.0001). Spearman correlation coefficient indicated a significant relationship between the number of children and stress (p.01) and between age and stress (p< 0.007). This study, however, showed no significant relationship between stress and factors such as sex, ward, record of service, type of employment, status of marriage, income, and being local to the area where they work. Conclusion: Since stress among nurses is potentially harmful and influences their physical and mental abilities and reduces the effectiveness of the service they offer, officials should manage to reduce stress– making factors such as lack of consent with income, work load, etc.

Introduction & Objective: Ectyma Conaginosum (ORF) is a viral infection with benign presentation in human and transmission occurs after direct contact with animals (domestic) or indirect contact due to infected meat or knife. The lesion usually is in hands as single, but other parts of the body can also be involved. This case report is the first record with skin lesions in hand and leg. Case: The patient was a thirty years old man with history of skin trauma about 31 days ago (second finger of left hand was injured by infected knife during cutting meet) and coinfection occurred when he itched the leg. Skin lesion appeared in the area of skin trauma and the site of itched leg in less than one week because of disease duration, ORF diagnosis was made by sample resection of skin lesions and histopathological study, then the patient was treated by daily skin lesion disinfection with betadin. Conclusion: The most common site of ORF was in hand as single eruption but multiple eruptions and other sites of body could not rule out ORF, so history of contact with domestic animals (direct or indirect) was a good guide to the diagnosis and prevention of unnecessary treatment.