Armaghane Danesh
Year:2006 | Volume:11 | Issue:3 (43)|Papers Count:16

Introduction & Objective: Following thoracic and abdominal surgery, all patients experience a decrease in pulmonary volumes and atelectasis. Different methods such as lung physiotherapy, intermittent positive pressure breathing, positive expiratory pressure and incentive spirometry are suggested for improvement of pulmonary volumes and blood gas parameters in these patients. Due to cheap, simple and easy use of incentive spirometry, we aimed at evaluating the effects of it on pulmonary volumes and blood gases parameters (ABG) in coronary artery bypass patients.Materials & Methods: This is a randomized, clinical trial study. From February 2004 to February 2005, 150 consecutive male patients who were hospitalized for coronary artery bypass surgery in Madani heart hospital were divided into two groups at random. On the first day of operation, group I used incentive spirometry and group II was routinely followed up. Data were collected through a questionnaire including age, left ventricular function (LVEF), smoking and number of grafts. Blood gases parameters and spirometry volumes were measured in 3 phases before, in the morning of the first day of operation and after using incentive spirometry. Data were analyzed by SPSS software using paired or unpaired student’s t-test.Results: There were no significant differences between two groups as to the mean age, LVEF, number of grafts and duration of mechanical ventilation in ICU. Comparison of ABGs before anesthesia and on the first day of surgery showed a significant decrease in systemic O2 saturation and arterial Po2 in all cases (p<0.001), but no significant differences were found between the second and third phases in both groups. Spirometry parameters showed a decrease of forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) after surgery in all patients (p<0.0001), but by using incentive spirometery, no significant changes in spirometeric pulmonary volumes occurred. Conclusion: Using incentive spirometery on the first day of operation has no significant impact on pulmonary volumes and blood gases parameters.

Introduction & Objective: Post-traumatic stress disorder (PTSD) is a chronic illness which is difficult to treat; yet, it is a common disorder which is associated with significant morbidity and mortality. The hypothesis that exposure to traumatic events may sensitize or kindle limbic nuclei has led to efforts to treat PTSD with anticonvulsants based on the kindling hypothesis. This double–blind clinical trial assesses clinical response to lamotrigine as a potential treatment. Materials & Methods: Thirty patients with PTSD were randomly assigned in a double – blind design. They were treated for 3 months with lamotrigine (N=15, 150-500 mg/day) as odd-on or placebo (N=15). The patients were measured in the first visit and at the end of 3 months by clinician administration. PTSD scales (CAPS) paired t-test, and Friedman and Will Coxon were used for data analysis. Results: The mean score of frequency of PTSD criteria in Lamotrigine group in the first visit was 10.1±2.2 and in placebo group was 12.75 ±2.24. The mean score of these criteria in lamotrigin group after treatment period was 9±2.5 and for placebo group was 12.45±2.7. The analysis of these sores showed a significant difference in Lamotrigine group and a non significant difference in placebo group. The mean score of Intensity of PTSD criteria in Lamotrigine group in first visit was 9.4±1.2 and in placebo group was 9.1±1.9. The mean score of these criteria in Lamotrigine group after treatment group was 8.4±2 and for placebo group was 9.1±2. The analysis of these scores showed a significant difference in lamotrigine group and a non-significant difference in placebo group. In placebo group, the analysis of mean sores of all intensity and frequency of criteria before and after taking placebo showed a non-significant difference. In Lamotrigine group, the analysis of mean scores of intensity and frequency of criteria such as avoidance of thoughts or feelings, avoidances of activities, place, people, inability to recall important aspect of trauma and diminished interest in activities before and after taking lamotrigine showed a significant difference and in other criteria showed a non-significant difference. Comparison of mean of decline in CAPS scores before and after treatment in placebo and lamotrigine group showed a significant difference in the four symptoms in lamotrigine group.Conclusion: Results of the study suggest that lamotrigine is a safe, well tolerated and significant effective treatment for avoidance numbing of PTSD.

Introduction & Objective: Nausea and vomiting are common after general anesthesia. Nausea and vomiting are also common after tympanomastoid surgery that may endanger the results of middle ear reconstruction. Medications like dexamethasone have been used to prevent nausea and vomiting. In this study, the effect of dexamethasone on decreasing nausea and vomiting following tympanomastoid surgery has been evaluated.Materials & Methods: This study is a case control, double blinded, clinical trial that was performed in Dastgheib Hospital affiliated to the Shiraz University of Medical Sciences during 1381-1383.Eighty patients candidate for tympanomastoid surgery who were in physical status I (according to the classification of the American Anesthesiology Association) were selected randomly. These patients were divided into two control and study groups (each group consisting of 40 patients). Just before induction of anesthesia, 2 ml normal saline was given intravenously to the patients in control group and 2 ml dexamethasone (8 mg) was given to the patients in the study group. The data were collected by a special form, and SPSS software and Chi Square test were used for statistical analysis.Results: There was no significant difference between the study and control groups regarding the mean of age, male to female ratio, and length of anesthesia. Use of dexamethasone resulted in 32.5% decrease in post operative nausea (p=0.002) and 22.5% decrease in vomiting (p=0.04).Conclusion: It seems that 8 mg intravenous dexamethasone is effective in reducing nausea and vomiting following tympanomastoid surgery and can be used routinely during tympanomastoid surgery.

Introduction & Objective: Jundice is the most common problem that can occur in the newborn. Although most jaundiced infants are otherwise perfectly healthy, jundice makes us anxious because bilirubin is potentially toxic to the central nervous system. Phototherapy is a highly effective method for prevention of exchange transfusion. The evaluation of the effect of mirror room on the decrease of hyperbilirubinemia is the purpose of this study.Materials & Metods: In this clinical trial 60 term infants with the weight of more than 2500gr and the age of 72 hours who were admitted in Emam Sajad hospital (1384) for phototherapy were randiomized into two equal groups of phototherapy. The first group undertook the traditional method of phototherapy and the second group was placed in mirror room (creative method). Then the results of the 2 groups, including bilirubin on admission, after 12, 24 and 48 hours after admission, and duration of admission were analyzed using the statistical test of chi-square.Results: In term infants the first 24 hour decline rate of bilirubin for traditional and mirror incubator phototherapy was 2.1± 1.1 and 3.6± 2.2 respectively (p< 0.01). The decline rate during the second day was 2.6± 1.3 in group one versus 3.8±2.4 in the second group (p<0.01). Duration of admission in the first group was 62.3±25 hours compared to 40.5± 28.6 hours in the second group (p<0.05).Conclusion: The creative method mirror incubator had a better effect compared with traditional methods. It is comparable with double phototherapy and fibrobtic blanket methos. It could be an alternative model for double phototherapy as it produces reasonable cost effectiveness and is easy to apply.

Introduction & Objective: Hydatid cyst is located in human and some animal visceral organs such as liver and lung. The disease is considered as a medical, veterinary and economical problem in endemic area. When the hydatid cyst is ruptured, protoscolices from inside the cyst may spread out to other parts of the body and develops a new cyst named secondary hydatid cyst. In this research in an attempt to prevent secondary hydatid cyst, protective potential of protoscolices surface antigens extracted with different detergents has been investigated in animal model.Materials & Methods: In this experimental study, groups of Balb/c mice were immunized intra-peritoneally with protoscolices homogenate and three detergent (SDS, Tween and Triton x–100) extracted protoscolices surface antigens and alum as adjuvant. These mice were then boosted two times with the same antigens fortnightly.Control mice were simultaneously injected with alum alone. Two weeks following the last injection all the mice in cases and control groups were challenged with live protoscolices. Three months afterward all the mice in case and control groups were sacrificed and their peritoneal cavities were explored for hydatid cysts. Results: The mean of developed cyst number in mice injected with protoscolices homogenate was 3±2, while in control group the mean of developed cysts number was 5.8 ± 1.7 (p< 0.02). The mean of developed cyst number in mice injected with SDS, Tween and Triton x–100 extracted protoscolices surface antigens was 3, 3.6 and 3.4, respectively, while the mean of developed cyst number in control group was 5.8.Conclusion: The mean of cyst number in cases and control groups was different and this difference was statistically significant. Results of this investigation revealed that protoscolices homogenate antigens and some detergent extracted antigens are protective against secondary hydatid cyst infection.

Introduction & Objective: Endotracheal intubation during general anesthesia is necessary to control the ventilation of patients during surgery. Nevertheless, the endotracheal tube as an external object can stimulate the patient’s airway during the emergence from general anesthesia and create different reactions and complications. To prevent these reactions, a wide variety of interventions have been examined. In this study, post-extubation endotracheal tube complications are investigated in 3 different states of lidocaine 4% for filling endotracheal tube cuffs.Materials & Methods: In this quasi-experimental clinical trial study executed in one of Shiraz hospitals during 2005-2006, 200 candidates of elective surgery being in class1 and 2 ASA were randomly divided into 4 groups (N=50). The endotracheal tube cuffs of each group members were filled with (5-10 ml) distilled water, lidocaine 4%, alkalized lidocaine 4% and warmed alkalized lidocaine 4%, respectively. The patients were observed for complications such as cough (for 6 hrs), sore throat, hoarseness (for 24 hrs) and laryngospasm (immediately) after extubation. The data were analyzed by chi square and logistic regression using SPSS.Results: The findings revealed that the frequency of cough, sore throat and hoarseness was more in the control (distilled water) group as compared to the 2 groups of the study (alkalized lidocaine 4% and warmed alkalized lidocaine 4%). Distilled water and lidocaine 4% groups differed significantly in only the frequency of sore throat. The odds ratio of cough, sore throat and hoarseness was just significant for the distilled water group in comparison to warmed alkalized lidocaine 4%. Furthermore the odds ratio of the above-mentioned complications was significant for the distilled water and lidocaine 4% groups in comparison to the warmed alkalized lidocaine 4% group. Among all the considered variables, the duration of tube existence in trachea was significantly effective in the frequency of complications.Conclusion: Filling endotracheal tube cuffs with alkalized lidocaine 4% and warmed alkalized lidocaine 4% decreases the frequency of the post-extubation complications (cough, sore throat and hoarseness). The odds ratio for the observed complications is less in the warmed alkalized lidocaine 4% group as compared to other groups.

Introduction & Objective: Post operative shivering is a prevalent complication of general and spinal anesthesia. Many drugs were used for prevention and treatment of shivering. The objective of this study was the comparison of clonidin, pethedin and fentanyl for treatment of post spinal anesthesia shivering.Materials & Methods: In this double blind randomized clinical trial, we compared the effects of 3 drug regimens to treat post operative shivering after spinal anesthesia in 60 elective caesarian sections with ASA class 1. Patients were divided into 3 groups (20 patients for each group). Each group received intravenously either pethedin 25 mg, clonidine 30 μg or fentanyl 50 μg. If a patient did not respond to the first dose, the same dose would be repeated up to a total of 3 times (with 5 minute intervals). Homodynamic changes, treatment responses and side effects were recorded. Then the resulting data were analyzed by SPSS software and chi-square test.Results: Considering control of shivering after first injection with pethedin 70%, clonidin 50% and fentanyl 30% with (p=0.04) major side effects in pethedin group were tachycardia 10%, nausea & vomiting 15%. In clonidine group the main side effects were dry mouth & drowsiness (16.7% & 3.3%) respectively. Fentanyl group had only 3.3% nausea vomiting accounting for the fewest number of side effects (p< 0.05). Homodynamic was stable in fentanyl & clonidine groups.Conclusion: We concluded that, clonidine offers better thermodynamics along with modest failure rate but pethedin was most effective with more serious side effects.

Introduction & Objective: Mental retardation is a disorder in people under 18, accompanied with restriction in mental abilities, daily activities, and social skills. These patients are at risk of malnutrition. The objective of this study is assessment of folic acid, vitamin B12 and some of the interactive factors in mentally retarded patients.Materials & Methods: This descriptive study was conducted in 40 subjects 7-15 years old, which were divided into two groups: girls (n=20) and boys (n=20). 24 hours dietary recall for two consecutive days and food frequency questionnaire (ffq) were used to evaluate intake of folate and vitamin B12. RIDA method was used for measurement of serum folate and vitamin B12 with siwul- tral- SNB-Radioassay kit. Chi square and independent T-test and Spearman and Mann- Whitney also were used to compare groups.Results: The results of this study showed that folate and vitamin B12 intakes, were lower than RDA in all subjects. Meanwhile serum folate, erythrocyte folate and serum vitamin B12 were low in 65, 62.5 and 35 percent of subjects, respectively. Mean (±SD) of serum folate, vitamin B12 and erythrocyte folate levels were 2.89 and 3.11 (ng/ml), 274.5 and 327.75 (pg/ml) and finally 98.26 and 103.27 (ng/ml) in girls and boys, respectively. Serum folate level correlated positively with vegetables consumption (p<0.05, r= 0.87). Erythrocyte folate levels correlated negatively with anticonvulsant drugs consumption (p=0.01, r=-0.66), and parasite evidence (p=0.01, r=-0.82) and correlated positively with vegetables consumption (p<0.05, r=0.22). Finally, serum vitamin B12 level correlated negatively with anticonvulsant drugs consumption (p=0.01, r=-0.46) and parasite evidence (p<0.05, r=-0.60) and correlated positively with meat consumption (p=0.01, r=0.42).Conclusion: The status of folate and vitamin B12 in these mental retarded patients was not sufficient due to both low intake and parasite evidence and finally anticonvulsant drug consumption.

Introduction & Objective: Azoospermia means no sperm in semen. It may be due to hormonal imbalance, any disorder in production of sperm, or might be due to obstruction in sperm pathway from testis till ejaculatory ducts. This study was performed to determine the causes of azoospermia in infertile male, referred to Yasuj clinic of urology.Material & Methods: This study was done during more than 2 years beginning from May 2004. Patients with at least two consecutive azoospermic semen analyses were included in this study after a complete history taking, physical examination, hormonal study (FSH, LH, prolactine, testosterone), vasography, testis biopsy and genetic evaluation.Results: Among 842 infertile men, 172 patients (20.4%) were azoospermic. 28 patients (16.3%) with obstructive azoospermia and 144 patients (83.7%) with non obstructive azoospermia were detected. Common causes of non obstructive azoospermia were as follow: idiopathic 68 patients (39.53%), atrophied testes 40 patients (23.25%), sertoli cell only 34 (19.76%) patient, undescended testes 28 (16.27%) patients and post chemotherapy in 2 (1.16%) patients. Causes of obstructive azoospermia were obstruction of epididymis or vasa deferens in 24 patients (86%) and congenital bilateral agenesis of vasa deferens in 4 patients (14%).Conclusion: Results of this study showed that about 20% of infertile men are azoospermic and the most common type of azoospermia is non obstructive type.

Introduction & Objective: Stress is a collection of reactions against incompatible and unexpected internal and external factors. Since the manager of any organization is exposed to stress more than other personnel. The present study was performed to determine the rate of stress in senior managers and their assistants in Kohgilouyeh and Boyrahmad province.Materials & Methods: In this descriptive, cross-sectional study, all the 134 senior managers and their assistants were recruited through a stress questionnaire. The questionnaire included six physical, individual, cultural, occupational, familial domains, and physical conditions of job environment.Results: It was revealed that the average rate of stress was 54.88, and 34.3% of the subjects appeared to experience high stress. Occupational stress (58.73) appeared to be the most stressful domain and physical stress (41.43) was the least stressful one, respectively. Violation from regulations, success of the opportunists, and showing discrimination toward the referrals turned out to be the most stressful options.Conclusion: Since in this study the occupational dimension had created the highest degree of stress in the managers, it appears that the greatest and most effective step in decreasing the managers’ stress is perhaps accurate supervision, appropriate encouragement and finally due punishment proportionate the managers' performance.

ntroduction & Objective: Sexually transmitted infections (STIs) and AIDS are the most common diseases worldwide. Women are more affected by STIs and AIDS due to gender-related factors such as biological, cultural and so on. This study was conducted to investigate knowledge about AIDS and STIs among married women in Kohgilouyeh & Boyer Ahmad Province/Iran. Materials & Methods: This cross-sectional study was conducted in the urban areas of Kohgilouyeh and Boyerahmad province.Using stratified cluster sampling, a valid questionnaire covering demographic variables and items related to knowledge about AIDS and STIs was administered to 1379 women covered by the urban PHC clinics.Results: The mean age of the respondents was 33.3 (SD=±9.3).Most were household (%85) and the mean level of their formal education was 7.2 years (SD=±4.8). The results also showed that women had the most knowledge with the statements that "using condom protects against AIDS" (%63.9) and "asymptomatic persons would be as AIDS vectors" (%65.1). There was a significant relation between education and recognizing AIDS as a sexually transmitted infection (p=0.004). Albeit, women were poorly familiar with the STIs, the most knowledge was found with gonorrhea (%40.5) and the least with chlamydia (%12.2). The most knowledge was observed with the statements that "STIs would induce PID in women" and "using condom protects against all the venereal diseases" (both %61.1). A significant correlation was found between education and job and familiarity with STIs (p<0.001).Conclusion: Findings showed limited knowledge on sexually transmitted infections and fairly good knowledge on AIDS. There is need for the promotion of women's knowledge in sexual health field.

Introduction & Objective: About 12% of complications of cholecystitis are reported to be the fistula between the gall bladder and the gastrointestinal tract. In this article, a case of inflammatory adhesion between the gall bladder and the transverse colon is reported. Due to the importance of this phenomenon, the literature has been reviewed in order to highlight anatomical relation between these two viscera. Case: A case of inflammatory adhesion between the gall bladder and the adjacent part of transverse colon was observed during routine dissection of abdominal cavity of a male middle age cadaver. The adhesion fold contained multiple fistulae between the fundus of gall bladder and the adjacent part of transverse colon. Through the round openings of these fistulae, the green bile material appeared to have been passed from the gall bladder to the colon. Conclusion: In cases of untreated chronic cholecystitis, this kind of inflammatory adhesion between the gall bladder and the adjacent part of transverse colon and subsequent fistulae used to be a usual complication. Because of low level of hygiene and medical services, the frequency of these complications, was not uncommon in the past, but their occurrence has decreased in recent decades. Meanwhile, due to the possibility of occurrence, the emphasis on anatomical relation of these two viscera, and drafting an integrated discussion of anatomy, developmental and clinical aspects of heptorenal pouch is mandatory in the educational areas.