مجله دانشکده پزشکی اصفهان
پیاپی 423 (هفته سوم اردیبهشت 1396)

Pain and postoperative nausea/vomiting (PONV) are of the most frequent complications after major ophthalmologic surgeries, and there is no general agreement on the effective method of controlling them. We compared the effects of magnesium sulfate on pain, nausea/vomiting, and anesthetic and analgesic requirement after corneal transplantation and vitrectomy surgeries.
110 patients undergoing corneal transplantation and vitrectomy under the same manner of general anesthesia were distributed into two equal groups. In the first group, magnesium sulfate (50 mg/kg) was administered during 10 minutes just before induction of anesthesia, and then during the surgery (15 mg/kg/hour). In the placebo group, normal saline was prescribed in the same way. Information concerning the pain (visual analog scale or VAS) and nausea/vomiting, total anesthetic and additional opioid consumption, and patient's hemodynamic status was collected and compared.
Findings: The mean intensity of pain and nausea were significantly lower in magnesium sulfate group compared to placebo group in the all periods during the study (pain: 1.8 and 2.8, respectively, P = 0.020; nausea: 0.35 and 1.1, respectively, P = 0.020). But, there were no significant difference in the incidence of vomiting (P = 0.500) and total doses of ondansetrone and pethidine consumption among the two groups (P > 0.050).
Magnesium sulfate administration is more effective than placebo to reduce anesthetic consumption, pain, and nausea/vomiting after corneal transplantation and vitrectomy.

Dupuytren's disease is a soft-tissue benign disease diagnosed by progressive and irreversible fibrosis in hand's palmar fascia. The prevalence of Dupuytren's disease is 0.5-11 percent and the incidence is 3 cases per 10,000 persons in a year. Treatment options are medical and surgical. The aim of this study was to evaluate the effect of fasciectomy in flexion contracture of hand fingers in patients with Dupuytren's disease.
36 patients were selected for this study. Surgical intervention was done for all the patients with the standard protocol of fasciectomy. After the surgery and physiotherapies, patients came to clinic for follow up and the degree of flexion contracture was evaluated 3 times including 3, 6, and 12 months after the surgery.
Findings: 36 patients (83.3% was men) participated in this study. Comparing the degree of flexion contracture in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of fingers before surgery and after 3 months showed significant decrease in degree of flexion contracture. Comparing the results after 6 and 12 months of surgery showed a little difference in flexion contracture that was not statistically significant. Multivariate analysis showed that changes of flexion contracture over the time in each finger and in MCP and PIP joints were significantly different.
Surgical treatment, especially fasciectomy, has beneficial effects on patients with Dupuytren's disease and induces its effects during short time. The success rate of fasciectomy in these patients is greater than other treatments.

The aim of this study was to determine the effects of selenium on the maximum inspiratory pressure in patients under mechanical ventilation admitted to the intensive care units.
In a clinical-trial study, 50 patients under mechanical ventilation in intensive care units of Alzahra hospital, Isfahan, Iran, were selected and randomly divided in to two groups. First group of patients received selenium 1 µg daily orally with meal when were connected to the ventilator; the second group did not received the drug. The two groups were compared in terms of time separating device parameters, respiratory, hemodynamic parameters, duration of weaning from ventilation, and outcomes.
Findings: Weaning extubation was done in 17 (68%) and 16 (64%) cases of selenium and control groups, respectively, without any significant difference between the two groups (P = 0.77). The mean (± SD) maximum inspiratory pressure was -20.36 ± 2.73 and -21.04 ± 2.41 cmH2O at the beginning of ventilation (P = 0.360), -24.72 ± 2.73 and -22.16 ± 1.52 cmH2O at the pressure support ventilation (PSV) of 8 cmH2O (P Prescribed selenium led to reduced airway resistance in patients receiving mechanical ventilation, but weaning of extubation and time of separation were not difference with and without selenium. More studies are recommended to be done in this case.

Stress is an important factor in development and exacerbation of symptoms of most of the skin diseases including psoriasis. This study was designed to assess the effectiveness of mindfulness-based stress reduction program on physical symptoms in patients with psoriasis.
This study was designed as a quasi-experimental study. Experimental group received 10 sessions of mindfulness training. Psoriasis Area Severity Index (PASI) was measured before, at the end, and 45 days after treatment in all recruited patients. Data were analyzed using SPSS software.
Findings: There was a significant differences in physical symptoms of psoriasis (PASI score) between experimental and control groups both at the end of the treatment, and 45-days follow-up period (P Based on these results, mindfulness-based stress reduction program could potentially be considered as an effective method to relief physical symptoms in patients with psoriatic.

In recent years, the prevalence of Cesarean section (CS) has risen significantly worldwide, especially in Iran. The aim of this study was to determine the prevalence of Cesarean section among primipars, and identify related factors in Tehran province.
This cross-sectional study was conducted on 2120 primipars who gave singleton birth in Tehran province from 6 to 21 July 2015. Data were collected by a researcher-made questionnaire through interview with mothers and review of their medical records. To identify factor associated with Cesarean section, logistic regression model was used.
Findings: The prevalence of Cesarean section was 72.1%. In univariate analysis, higher maternal age, parents’ educational level, economic status, body mass index, fetal head circumference, preeclampsia, and use of assisted reproductive technology were associated with Cesarean section. Moreover, multivariate analysis showed a significant relationship between Cesarean section with mother’s age, economic status, and body mass index and also with fetal head circumference.
The prevalence of Cesarean section is very high in Tehran province. Factors such as mother’s age, socioeconomic status, and body mass index, and fetal head circumference were related to Cesarean section. Moreover, there is a critical need to improve the education, quality of natural delivery services, and providing psychological interventions to reduce the Cesarean section rate and its adverse outcomes.

This study aimed to compare the effect of intravenous dexamethasone, ondansetron, and ketamine in preventing postoperative shivering in patients undergoing cesarean section under general anesthesia.
A random, double-blind clinical trial was carried out on 160 patients with class I or II of American Society of Anesthesiologists (ASA) scale, undergoing cesarean with general anesthesia. They were divided into four groups of patients receiving ondansetron, dexamethasone, ketamine, and placebo. Applying the formula, the sample size consisted of 40 patients in each group. Data were analyzed using analysis of variance (ANOVA), frequency table, and chi-square test at the significant level of P less than 0.05.
Findings: There was a significant difference in the level of shivering at four times of entering recovery, and 10th, 20th, and 70th minutes in recovery between the four groups (P 0.050 for all).
Prescribing dexamethasone, ondansetron, and ketamine was equally effective in preventing postoperative shivering.

This research aimed to examine the effect of aerobic exercise and melatonin consumption on the expression of Bax and Bcl-2 markers in rat myocard after ischemia-reperfusion by isoprenaline.
30 two- to three-months-old male Wistar rats were used weighing approximately 200-250 g. They were divided into five groups of pilot (n = 14), control (n = 4), melatonin (n = 4), aerobic (n = 4), and melatonin-aerobic (n = 4). Rats in melatonin and melatonin-aerobic groups were gavaged every day for one month using a dose of 10 mg per kg body-weight. Meanwhile, rats in aerobic and melatonin-aerobic groups were familiar with running on treadmill for one week, and then, they were exposed training course with frequency of three times weekly for one month. After one month, all the rats were injected isoprenaline with dose of 150 and 125 mg per kg body-weight in two consecutive days with 24-hours interval. Finally, rats were sacrificed after confirmation of infarct. Expression of Bax and Bcl-2 gene were studied via real-time polymerase chain reaction method. Data were analyzed using 2-∆∆ct formula and one-way ANOVA and Kruskal-Wallis tests.
Findings: Separately, melatonin treatment and aerobic training had negligible effect on expression of Bax and Bcl-2 genes. But, combination of aerobic exercise and melatonin significantly decreased and increased the expression of Bax and Bcl-2 genes, respectively, compared to treatment with melatonin alone.
However, it seems that aerobic exercise with consuming melatonin in a longer term can reduce the amount of possible myocardial infarction.