مجله دانشکده پزشکی اصفهان
پیاپی 120 (هفته چهارم بهمن 1389)

This study aimed to compare the results and complications of photorefractive keratectomy with alcohol versus mechanical corneal epithelial debridement in myopia and myopic astigmatism.

This prospective comparative interventional study was done on 1250 eyes of 625 patients who were candidate for photorefractive keratectomy. Each patient was randomly assigned to the group of mechanically or alcohol assisted epithelial removal. The epithelium was removed mechanically in one group and with 20% ethylic alcohol in the other group.

658 eyes were in alcohol group and 592 eyes were in non alcohol group. Mean spherical equivalent was -3.8 ± 1.3 D in non alcohol and -4.37 ± 2.3 D in the alcohol group (P = 0.78). There was no significant difference in postoperative pain between two groups (P = 0.22). Uncorrected visual acuity of ≥ 20/20 and ≥ 20/40 were achieved in 90.9% and 98.9% of alcohol group and 93.4% and 99.5% of non alcohol group respectively (P = 0.36 and 0.21). Refraction of ± 1.00 D was achieved in 90% of alcohol and in 92.2% of non alcohol group respectively.

Epithelial removal with diluted ethanol provides a safe, simple and fast technique.

General health is affected by personality factors such as pessimism and self esteem. The present study was concerned with relationship between general health, pessimism, and self esteem in college students with father and martyr father in Shiraz University of Medical Sciences. 94 college students with martyr father (51 men and 43 women) and 97 with father (35 men and 62 women) were randomly selected. Students completed Beck Hopelessness scale (20-items), Cooper Smith self esteem (58-items), and Goldberg general health questionnaire (28-items). To analyze the data, independent t-test, two-factor analysis of variance and multiple regression analysis were used. There was significant relationship between general health, pessimism and self esteem. There was no significant difference between college students with father and martyr father, in general health. Pessimism in college students with martyr father was more than those with father. College students with martyr father have less self esteem than those with father. Gender has moderator role in effectiveness of martyr father on general health and self esteem. Social support and particular advantage for college students with martyr father in our culture promotes increased health. Father absence negative effectiveness in men with martyr father is more than women with martyr father, because of identification source missing in men.

Nontrumatic intracerebral hemorrhage (ICH) is one of the results of hypertension. The treatment is surgery for some patients; but the best type of surgery is controversial. This study aimed to compare an endoscopy-guided method with open craniotomy removal of nontrumatic intracerebral hemorrhage. In this clinical trial study, patients with nontrumatic intracerebral hemorrhage referred to Kashani Hospital in Isfahan from June 2009 till June 2010 were assessed. One group (15 patients) underwent open craniotomy surgery and the other (15 patients) underwent endoscopy-guided surgery. The mean length of stay in hospital (9.2 ± 9.4 vs. 20.5 ± 14.6 days), the mean length of surgery (1.6 ± 51.6 vs. 2.2 ± 36.5 hours), and incidence of systemic infection (6.6% vs. 60%) was statistically lower in endoscopy-guided surgery group. Also, hematoma was deranged better in this group (after surgery intracerebral hemorrhage volume of 4.7 ± 3.9 vs. 10.8 ± 10.5 cc) and after surgery GCS (11.8 ± 7.5 vs. 8.2 ± 3.2) was higher in them compared to open craniotomy surgery group. Endoscopy-guided method removal of nontrumatic intracerebral hemorrhage is a more effective surgery method compare to open craniotomy surgery.

Sever dental fear and mental disorders are indications for dental treatment under general anesthesia, which usually is performed as outpatient anesthesia for dentistry; so decreased recovery time and complications are important. This study aimed to compare the recovery time and complications after Anesthesia with Propofol between mental retard and healthy patients. In this clinical trial study, 34 mental retarded and 34 healthy patients were prescribed for general anesthesia. In both groups, anesthesia was performed with propofol. After the end of anesthesia, recovery time and complications in both groups were recorded and the data were analyzed with independent samples t and Mann-Whitney tests. Recovery time in retarded group was significantly higher than the healthy group (P < 0.05); but the side effects had no significant difference between in the two groups (P > 0.05). There was direct relation between anesthesia time and recovery time (P < 0.05). Recovery time was prolonged in mental retard patients; it might be because of their need to prolonged treatment. Recovery side effects were similar in both groups. In both groups, increasing the anesthesia time made longer recovery time like the previous studies.

The aim of this study was to evaluate the association between clinical symptoms and endoscopic findings among patients with duodenal ulcer.

This cross-sectional study was performed in endoscopic center of Al-Zahra Hospital in Isfahan. We selected 200 patients older than 18 year who had Dyspepsia by simple nonrandom sampling. Finally Endoscopic findings and clinical symptoms data were collected and analyzed for 114 patients with active peptic duodenal ulcer.

The mean age of the study sample was 46.5 ± 10.4 years. There were 44 females (38.6%) and 70 males (61.4%). The average of BMI was 27.2 ± 4.3. There was a significant association between endoscopic findings (site, size and quantity of ulcer) with clinical symptoms (weight loss and heartburn) and there was no association between other endoscopic findings and clinical symptoms.

The results of present study showed that weight loss and heartburn can use as marker to determine site, size and quantity of duodenal ulcer. But these findings can not be enough and more study need to be done to determine the association between endoscopic findings and clinical symptoms.

Driving is a usual job with many occupational complications. Occupational hearing loss in track driver is not an unusual occupational problem. We studied the relation of occupational hearing loss and long term noise exposure in track drivers. This descriptive study was done among track driver population in Kashani and Al-Zahra hospitals in Isfahan. Taking medical history and physical examination were done by an expert otolarygologist and then, eudiometry was done. The data were analyzed by paired-t and variance regression tests via SPSS11.5 software. In 384 track drivers, hearing threshold in left ear was more than hearing threshold in right ear (P < 0.001). In this study, such as the other studies, a relation between persistent noise and hearing loss was observed. In track drivers, persistent noise can cause occupational hearing loss and their left ears are more susceptible than the rights in risk.

Cervical cancer is the second most common cancer of women and one of the most important factors in theirmortality. The role of human Papillomavirus (Hpv) in cervical carcinogenesis has been confirmed, but the high risk subtypes are different in different areas. The purpose of this study was to determine high-risk sub-types of HIV in Isfahan. This study was a case-control, retrospective and analytical study. We collected the data from 12 paraffin blocks of normal cervical tissue and 36 paraffin blocks of cervical tissue of women with pre-malignant and malignant lesions (SCC). After DNA extraction from paraffin blocks existence of HPV, DNA was investigated by Polymerase Chain Reaction (PCR) with the primer HPV General. HPV positive cases were tested with Real-Time PCR to determine the virus subtype. The prevalence of HPV in patient samples was higher than control cases. 50 percent of patients had HPV type 16. The frequency of HPV type 59 HPV types in SCC cases was significantly greater than others. There was not a significant correlation between other sub-types and cervical tissue lesion. This study showed that HPV was present in all samples with cervical lesions. Although the high frequency of HPV type 16 in cervical samples, due to low sample size of this study further studies with larger sample size is needed.

In last decades, the technology was outside the education but these days all the universities are eager to use new technologies for improving the quality of education. Isfahan University of Medical Sciences as one of the top universities in Iran, with 6000 students, will encounter problems with improving the quality of education and need to use new methods for education. Having knowledge about new technologies will help us to deal with these problems. In the other hand regarding the special feathers of our country, many researches should be done to choose the best methods. In this study we were to deliver the content of pathology laboratory via the internet and evaluate the knowledge and attitude of the students. This was a quasi experimental study which was done in the summer of 2008 at Isfahan University of medical sciences. All the volunteers were registered. They were 34 students who divided into two groups based on their means. The control group (14 students) was first told to take part the traditional course and the study group (20 students) takes part in the web based pathology laboratory and then they have gone to the laboratory and practiced their knowledge. The knowledge and attitude of the students were evaluated in both groups using t-test via SPSS15 software. Finally 34 students were registered, twenty students in the internet group and 14 students in the traditional group. The mean of knowledge questioner was 5.4 greater in the internet group than in traditional group (t = 4.593, P < 0.001). The findings of the study were shown that the students of internet group could better use their knowledge and had greater scores than the traditional. Finally, regarding the above it seems that use of such web based courses can promote students in learning. Also they are more eager to take part such courses. It is recommended to use this method to deliver other basic science courses.

Determination whether spectral Doppler ultrasound parameters, including resistance index (RI) and pulsatility index (PI), or vascular pattern can be used to distinguish malignant from benign thyroid nodules. This study was done in 2009-2010. 120 patients with thyroid nodules were selected from our patients attending Al-zahra hospital, in Isfahan. We prospectively examined 120 thyroid nodules in patients undergoing surgery. The flow pattern seen via power Doppler examination was ranked for each nodule on a scale of 0 to 4 as follows: absent, perinodular alone, mixed with perinodularprominency, mixed with intranodularprominency, and exclusively intranodular, respectively. For each nodule, the RI and PI values were recorded as the average of the recordings obtained. Pathological examination were used as a proof of final diagnosis to categorize all nodules as benign or malignant. The data collected in check list then the data analyzed by chi-square with SPSS software. The mean age in patients was 45.44 ± 14.3 years. The malignant nodules had a mean RI of 61 ± 0.05 percent. These values were significantly higher than those associated with benign nodules (P = 0.000). Shifting to intranodular vascularization had a significant correlation with malignancy (P = 0.001). Spectral parameter and vascular pattern are useful to distinguish malignant from benign thyroid nodules, especially for those with suspicious or undetermined fine-needle aspiration biopsy.

Antibiotics help many patients to treat. But misadministration and wrong methods of taking them cause many side effects including drug resistance and treatment failure. This study was designed to assess antibiotic prescribing in hospitalized children in comparison with standard methods. In this study, 196 children admitted in surgical and internal wards in Alzahra hospitals in Isfahan received antibiotic, were studied. The collected data included age, sex, cause of hospitalization, indication, dosage, and duration of antibiotic. All information was extracted from patient records and their relative abundance ratio was measured by standard methods. Indication of drug usage and drug administration methods were adjusted completely to standards; the dosage and duration of therapy had less adjustment to standards. Mismatch in drug dosage in the studied wards could be due to lack of record weight of patients in their files. In addition, early discharge of patients due to their personal satisfaction or because of their family caused incomplete treatment period. It seems that educating nurses, patients, and their families can help to correct these problems.

Glucose-insulin-potassium (GIK) could be protect myocardium from hypoxia by improvement myocites function with providing normal carbohydrate and metabolism of fatty acids. This study reviews the effect of GIK on cardiac function in coronary artery bypass graft(CABG) surgery with cardiopulmonary bypass. This clinical trial was carried out on 60 patients undergoing elective CABG with ejection fraction lower than 40 percent and age 40-70 years old. Patients were divided in two groups(30 person in each groop): GIK group and control group. Ejection fraction changes after surgery, the frequency of arrhythmia, the frequency of consumption of inotropes, need to shock, need to temporary pacemaker after surgery and mean duration of staying in ICU were compared in the two study groups by student's t-test and χ2. This study showed that arrhythmia, inotrope use and staying in ICU in case group was lower than the control group (05 / 0> P). According to the results of this study we can be say clearly that the effects of GIK in reducing the incidence of arrhythmia and postoperative inotrope consumption and reduced the duration of satying in ICU is remarkable.

Imperforated anus is a congenital disease in which infant cannot deficate. About 25% of infants with imperforated anus have some other congenital diseases. This study aimed to investigate the attendant diseases and also the surgery complications in patients with imperforated anus underwent surgery treatment. This cross-sectional study was performed in Alzahra Hospital in Isfahan. 128 patients with imperforated anus underwent surgery during a decade were studied. Patients’ data were extracted from their files. To analyse data, descriptive tests were investigated. 25 patients had died after surgery. From the remaining 103 patients, 63 patients had no complications. The most common early complication was wound dehiscence and the most common late complication was stenosis. Incidence of associated anomalies was 40 percent and the most common associated abnormality was renal anomalies were seen in 16.4 percent of patients. Given the high prevalence of associated anomalies, and examinations of children for proper diagnosis of imperforated anus and treatment of associated anomalies is essential. In addition, carefully selection of and perform the correct surgical technique can reduce surgical complications. Parental education about the complications and follow-up in the recommended deadline is recommended.

Frozen section is widely used in gynecological oncology. However, the accuracy of frozen section procedure in intraoperative diagnosis of endometrial hyperplasia and endometrial adenocarcinoma in endometrial curettings has not been studied. The aim of this study was determining the accuracy of frozen section in evaluation of histopathologic findings of endometrial curettings from peri- and postmenopausal women with abnormal uterine bleeding (AUB). 71 women having 45 years or more with the complaint of AUB entered the study. In pathology lab, part of fresh diagnostic sample was prepared for frozen section and the remainder was fixed and further processed for permanent pathology. Permanent pathology was considered as the gold standard for evaluation of histopathologic findings. χ2 and Fisher’s exact tests were used for statistical analysis. The findings of frozen section were exactly the same as permanent pathology in 70 persent of patients. Despite high specificity of frozen section in detecting various histopathologic findings, significant statistical difference was seen between frozen section and permanent pathology in all of these findings. Our results are in favor of the superiority of permanent pathology over frozen section in evaluation of endometrial curettings. However, according to high specificity of frozen section examination in detecting endometrial hyperplasia and adenocarcinoma, it may be acceptable to rely on the results of frozen section in these conditions to make an intraoperative decision for the type and extent of surgery.

The most important in hospital environment relationship is the relationship between doctors and nurses. This kind of connection is the most important relationship of the doctor-patient interaction involves creating collaborative relationships and provides information to achieve a common goal of treatment. Few studies in Iran about the current level of communication between doctor and nurse was done, so assessment of barriers of communication between these two groups was essential. This descriptive-analytical study was performed at the second half of 2009 in Al-Zahra hospital in Isfahan. The target population was 80 nurses and 80 physicians. Sampling for both groups was convenient; all of them completed a researcher-made questionnaire. Content validity of questionnaire was approved by leader professors. After a pilot study with 30 questionnaires, reliability was performed by split half method. Questions were in likert span and interpreted by Mann-Whitney and chi-square tests. All 160 people participated in the project were completed the questionnaire, 50% of physicians were disagreed with the failure of the communication of nurses in prescribing drugs and in total opposition to have opposing views than nurses and more there is quite the opposite, most opposition has been communication barrier in differences religious belief almost for other physicians agree with the obstacles mentioned. Both nurses and physicians completely agree and agree with communication situations and oppose almost completely absent. Relatively both groups agree and agree completely about ways to deal with the obstacles mentioned above. There were Significant differences between the attitudes of doctors and nurses, but significant relationship does not exist between the type of attitude of doctors and their gender, also significant relationship does not exist between the attitude of nurses and their gender. The highest mean score of the answers of physicians and nurses was about the third part of the questionnaire, namely methods to deal with obstacles and the majority have consensus on this issue. Considering that communication skills are also having extensive background and great value in improving health systems, it seems that communication skills, both through the inclusion of the important subjects of communication skills in nursing and medical education system or by creating understanding and conducting workshops for practical communication skills in the health system can increase.