مجله دانشکده پزشکی اصفهان
پیاپی 446 (هفته دوم آبان 1396)

Erythromycin is a medicine that can affect motilin receptors and thereby cause wrinkling of the gall bladder and, theoretically, is able to help in not rupturing the gallbladder while holding it on the grasper and/or in not dissecting the liver. Therefore, this research intended to study the effects of this drug on reducing the volume of the gallbladder, on the consequent reduction in the extent of perforation, and on reduction in complications resulting from perforation including infections and postsurgery pain.
There were 130 women with cholecystitis in this clinical trial. They were randomly divided into the control group (63 patients) and the case group (67 patients). The case group received 250 mg of intravenous erythromycin 30 minutes before surgery, and a surgeon used laparoscopic instruments to measure gallbladder distention. Complications during surgery were recorded and, 24 hours after the surgery and one week later, patients were evaluated to study postsurgery pain and infections.
Findings: The extent of distension in the case group was significantly reduced (P 0.05). Postsurgery pain decreased in the case group (P It can be concluded that erythromycin was effective in reducing distension of the gallbladder, and this effect was observed in the surgeries that were performed. It had no statistically significant effect on the extent of perforation, but decreased postsurgery pain through reducing surgery duration and distention. Therefore, it is recommended that erythromycin be used for this purpose.

One of the most successful advances in bacteria is transmission of antibiotic resistance genes by integrons, which leads to the emergence of multiple drug resistant (MDR) species. The aim of this study was to determine the prevalence of class 1 and 2 integron among Escherichia coli (E. coli) isolated from children with urinary tract infection (UTI) in Imam Reza hospital, Kermanshah City, Iran, in 2016.
In this cross-sectional study, 89 Escherichia coli isolates were collected. After identification by biochemical tests, and evaluating antibiotic susceptibility tests using disk diffusion method, the frequency of class 1 and 2 integron were determined using specific primers and polymerase chain reaction (PCR) methods.
Findings: Of total of 89 studied samples, 53 (59.03%) isolates were multiple-drug resistant. The highest antibiotic resistance of isolates was to ampicillin (85.4%), and co-trimoxazole (68.5%), and the lowest was to imipenem (12.4%) and nitrofurantoin (16.8%). Frequency of class 1 and class 2 integron were 71.9% and 3.5%, respectively. There was significant relationship between the frequency of integrons and resistance to tetracycline and gentamicin (P The results showed that, in addition to the high prevalence of multiple-drug resistant isolates, the frequency of class I integron was also high in Escherichia coli species. Therefore, identifying frequency of integrons and their relationship with drug resistance patterns in bacterial isolates seems to be necessary.

The number of patients with end-stage renal disease (ESRD) and the need for hemodialysis (HD) has increased and they needed repeated intervention to maintain access patency. Care of hemodialysis patients has considerable economic burden on health care system. The effects of antihypertensive medications on arteriovenous fistula (AVF) thrombosis are not clearly explained. This study aimed to evaluate the effects of continuing and discontinuing use of antihypertensive medications in peri-operative time on arteriovenous fistula thrombosis.
This was a clinical trial study on 60 patients with ESRD and hypertension, candidates for hemodialysis that divided into two groups. The case group received their antihypertensive drug before surgery and the control group did not receive. Systolic, diastolic, and mean arterial blood pressure and heart rate were evaluated before and during surgery; the incidence of thrombosis immediately, 24 hours, and one week after surgery was evaluated as well.
Findings: Patients with mean age of 58.85 ± 14.95 years were participated that 78.4% of them were men. The mean systolic blood pressure was higher in control group but this difference was just statistically significant before surgery and at the start of administering local anesthesia. Just before surgery, the mean diastolic blood pressure and mean arterial blood pressure were higher in control group significantly. The number of thrombosis in case group was higher significantly than control group immediately (P = 0.03), 24 hours (P = 0.04), and one week (P =0.02) after the surgery.
Using antihypertensive medications in patients, candidates for arteriovenous fistula, increased the risk of arteriovenous fistula thrombosis.

Prematurity is accompanied with various complications including sepsis, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and apnea. In current study, we assessed the effects of oral vitamin E on incidence of prematurity complications in premature neonates.
This was a clinical trial study on 76 neonates in Alzahra hospital, Isfahan, Iran, during 2015-2017. Neonates were randomly divided in two age- and sex-matched group. 38 neonates of case group were treated with 10 units of vitamin E through orogastric tube for three days. Control group were treated with distilled water through orogastric tube. Patients in two groups were evaluated in terms of sepsis, NEC and IVH.
Findings: In this study, 48.7% of patients were boys. Mean neonate's age and weight was 28.49 ± 1.46 weeks and 1183.02 ± 167.97 g, respectively. Incidence of sepsis (P = 0.77), NEC (P = 0.53), hypotension (P = 0.31), death (P = 0.45), and IVH in 4th (P = 0.30) and 7th (P = 0.20) day of birth was not significantly different between the two groups.
Using oral vitamin E did not have statistically significant effect on prevention of sepsis, necrotizing enterocolitis, and intraventricular hemorrhage. Due to more controllable bioavailability of oral vitamin E in comparison to intramuscular and intravenous use of it, and increased risk of sepsis and necrotizing enterocolitis by using high doses of vitamin E in other reports, further studies with different doses of oral vitamin E are recommended.

Sleep disorders are common in patients with kidney disease and on dialysis. The aim of this study was to assess the association between vitamin D deficiency and sleep quality in these patients.
This cross-sectional study was done on patients under peritoneal dialysis. Demographic data, dialysis information, and sleep quality were assessed using questionnaires and serum level of vitamin D was measured.
Findings: Out of 81 patients, 55.6% had poor sleep quality. Frequency of vitamin D deficiency was 75.6% in patients with poor sleep quality and 61.1% in those with good sleep quality (P = 0.226). There was significant correlation between vitamin D level and sleep quality score (correlation efficient = -0.273, P = 0.014).
Serum level of vitamin D is associated with sleep quality in patients under peritoneal dialysis. Evaluating the influence of treatment with vitamin D on sleep quality in these patients is recommended.

Scoliosis is lateral curvature of the spine and postoperative complications are common in these patients. This study aimed to evaluate these complications in adult patients with idiopathic scoliosis.
In this cross-sectional study, postoperative complications of posterior fusion with instrumentation were evaluated in the 93 adult patients. Convenience sampling method was used and patients were allocated into 4 groups of scoliosis deformity types (Long c, thoracic, thoracolumbar/lumbar, and double curve). Complications were compared between the 4 groups.
Findings: There was a significant difference between the 4 groups regarding postoperative respiratory complications (P = 0.009). There were 35 cases with postoperative complications of them, 20 cases had respiratory complications.
Postoperative complications are common in the adult patients with idiopathic scoliosis undergoing posterior fusion with instrumentation. Postoperative respiratory complications are the most common one in these patients.

Laryngoscopy is a common procedure in general anesthesia; but some problems such as laryngospasm and tachycardia may occur during laryngoscopy. This study aimed to determine the effect of using topical lidocaine on blade and cuff of laryngoscope tube, and tracheal mucosa on changes of heart rate and blood pressure during laryngoscopy and intubation.
In a clinical trial study, 275 patients, candidates for laryngoscopy, were selected and randomly divided in 5 groups of 55. 4 groups received lidocaine spray 10% on laryngoscope blade, intratracheal, on the cuff of laryngoscope tube, on blade plus cuff and plus intratracheal, respectively, and the fifth group did not receive lidocaine. Heart rate and blood pressure were measured in base, before laryngoscopy, and 1, 3, 5, and 10 minutes after laryngoscopy and compared between the five groups.
Findings: Spraying lidocaine on endotracheal cuff and laryngoscope blade led to decrease of complications such as tachycardia, bradycardia, hypotension, and hypertension. So, heart rate and blood pressure were the highest in the control group and mean changes of heart rate and blood pressure were significantly different between the five groups (P Spraying lidocaine 10% of the blade and cuff of laryngoscope, and intratracheal led to decrease of heart rate and blood pressure and probably, these methods can be used for decrease of complications due to laryngoscopy.