مجله پزشکی بالینی ابن سینا
سال بیست و یکم شماره 4 (پیاپی 74، زمستان 1393)

Introduction & By prevention of bleeding during spine surgery, we could provide suitable field for the surgeon and also reduce blood loss and the need for transfusion. The purpose of this study was to compare the effects of intravenous administration of propofol and isoflurane for anesthesia maintenance on the amount of blood loss and hemodynamic status during the surgery. In this clinical trial single blind study, 100 patients undergoing spinal surgery with ASA I were randomly assigned in two groups P and I; in group P we used intra-venous propofol (100-200? /kg/min) plus nitrous oxide 50% (50 patients) and in group I we applied isoflurane, (MAC 1.5-2) plus nitrous oxide 50% (50 patients) for maintenance of an-esthesia. For determining and comparing blood loss in each group, total volume of blood loss during surgery was determined by weighting of blood on gausses and volume of blood in suction bottle. The amount of hemoglobin, the need for blood transfusion and satisfaction of surgeon from operative field during surgery were also assessed. Mean arterial pressure and heart rate were measured every 5 minutes intra operative and were compared in the two groups. The data was analyzed by SPSS and t-test. The total volume of blood loss in propofol and isoflurane groups was 352.7± 303.5 and 450.48±321.8 ml, respectively. Total blood loss, and blood loss per min was significantly lower in the propofol group and isoflurane group (P=0.049, P=0.015). Surgeon satisfaction with bleeding of surgery field based on the Boezzart scale was higher in the propofol group. Decrease in hemoglobin concentration and hematocrit were less in the propofol group com-pared to the isoflurane group. Mean arterial pressure during surgery with the propofol group was 85.71±9.7 versus 80.25±8.04 mmHg in the isoflurane group, which was significantly lower in the isoflurane group (P=0.003). The difference between the heart rate during surgery and the need for blood transfusion in the two groups was not significant. In view of the decreased amount of blood loss and hemoglobin reduction, as well as improving surgical field, intravenous propofol is preferred to isoflurane for anesthesia maintenance during spine surgery. So, we recommend the maintenance of anesthesia with intravenous propofol during spine surgery.

Introduction & Despite all the progress in surgical sciences, controlling parenchy-mal hemorrhage especially in liver parenchyma, is still one of the challenges surgeons face in saving patients’ lives. Therefore, introducing an effective method to control liver bleeding is an important research priority. This study attempts to determine the haemostatic effect of fer-ric sulfate and zinc chloride and compare it with that of the standard method (simple suturing technique) in controlling bleeding from liver parenchymal tissue. This is an experimental study. In this animal model study 70 male Wistar rats were randomly allocated into seven groups. An incision, two centimeters (cm) long and half a cm deep, was made on each rat’s liver and the hemostasis time was measured once us-ing ferric sulfate and zinc chloride with different concentrations (15%, 25%, and 50%) and then using the control method (i.e. controlling bleeding by simple suturing). The liver tissue was examined for pathological changes. Finally, the hemostasis times were entered into SPSS software and analyzed using Kruskal- wallis test, Mann-Whitney, Kolmogorov-Smirnov test. The mean time to hemostasis in groups of ferric sulfate concentration of 50%, 25% and 15%, were, respectively, 9.50±1.17, 21.80±2.2,and 37.8±2.7 seconds, and in groups of zinc chloride concentration of 50%, 25% and 15%, were, respectively, 15.80±1.75, 30.20±2.57 and 49.00±2.21 seconds also in the control group (suture) mean time of hemosta-sis was 91.30±7.30 seconds. The haemostatic times of different concentrations of ferric sul-fate and zinc chloride were significantly less than that of the control group (P< 0.01). There was a statistically significant difference between different concentrations of ferric sulfate and zinc chloride haemostatic times (P < 0.01). The pathologic examination showed the highest frequency of low grade inflammation based on the defined pathological grading. Ferric sulfate and zinc chloride compared to the control method (i.e. controlling liver bleeding by simple suturing) needs less time to control liver bleeding. Ferric sulfate is a more effective hemostatic agent than zinc chloride in controlling liver bleeding in an animal model.

Introduction & Gastric cancer is the forth common cancer and second cause of death. Surgery is the primary treatment of gastric cancer and chemotherapy and radiotherapy is used as supplementary treatments. The aim of this study is estimation of survival and affected fac-tor in the patients with gastric cancer after surgery in Hamadan province. All patients with postoperative gastric cancer were collected in Hamadan province as a retrospective study in 2006-2012. Survival time of the patients was deter-mined from the time of diagnosis to death or the end of the study. The effect of risk factors such as gender, age at diagnosis, tumor site, type of tumor and … on survival was assessed. The data was analyzed by Cox regression model and using SPSS16 statistical software. 67 patients with postoperative gastric cancer were assessed. 48 patients (71.6%) were male and 40 case died during the study. Median survival of patients was 26 months and 1, 3 and 5 year survival rates were 67, 40 and 36 percent, respectively. The effect of gender, di-agnosis age and stage on survival was statistically significant. Survival rate of postoperative gastric cancer in Hamadan is low similar to other regions in Iran. The most important cause is late referral of the patients. So, pervasive educa-tion via mass media about primary symptoms and risk factors of this malady is highly sug-gested.

Introduction & With increasing the information about the dangerous side effects of synthetic antibiotics, the demand for natural alternative of these drugs has increased. The purpose of this study is to investigate the antibacterial and antioxidant properties of root and flower extracts of the medicinal plant of Dendrostellera lesserti against some human pathogenic bacteria. In this experimental study, Dendrostellera lesserti was collected from Hamadan province in 2013. After identification, the extracts were prepared by maceration method. Antibacterial activities were determined by the agar well diffusion method, MIC (serial dilution method) and MBC. Antioxidant properties by DPPH method and amount of phenolic and flavonoid were measured by Folin-ciocalteu and aluminum chloride methods, respectively. The data were analyzed using sas software version 9.2 (P<0.05). The largest growth inhibition zone with diameter of 21.33±.66 mm was seen in Salmonella typhi culture against root methanolic extract. MIC and MBC of root extract was lower in comparison with flower. Methanolic extract of flower in at concentration of 0.8 mg/ml had the highest scavenging percentage of free radical. The higher amount of phenol and flavonoid was related to methanol extract of root, 111.8±2.69 mgGAE/g and 2.25±0.35 mgQ/g, respectively. According to the obtained results, the root and flower methanolic extracts of Dendrostellera lesserti contain compounds with antibacterial and antioxidant properties.

Introduction & Appropriate analgesia after cesarean section helps women feel more comfortable and increase the mobility of the mother's and also their ability to take better care of their newborns. The purpose of this study was to investigate the effects of subcutaneous infiltration of ketamine on postoperative pain reduction and hemodynamic status of patients after elective cesarean section. This study was designed as a double blinded prospective, randomized clinical trial and 60 cases of women undergoing elective cesarean section under spinal anes-thesia were randomly assigned into two groups. For 30 cases in the ketamine group, infiltra-tion of subcutaneous ketamine 0.5 mg / kg was administered after closure of surgical inci-sion. 30 patients in the placebo group received subcutaneous infiltration of saline. During the patient's recovery time and after transferring to the ward, the VAS of pain and vital signs were continuously assessed. if VAS? 3, 100 mg diclofenac suppository was administered and if there were no response, 30 mg intravenous pethidine was also administered. Prescribed number of suppositories and pethidine dosage were compared. The complications, such as hallucination, nystagmus, nausea, vomiting and drowsiness in patients were also recorded and compared. Statistical analysis was performed by SPSS16 software and? 2 and t-test. P< 0.05 was considered statistically significant in all of the cases. In the course of systolic blood pressure, heart rate and arterial blood oxygen satura-tion during the first 24 hours, no significant differences were mentioned between the two groups. At the time of arrival to the recovery room and 30 minutes later, the mean VAS was not significantly different in the groups. However, the mean VAS at 1, 2, 4, 6, 8 and 12 hours after surgery were significantly lower in the ketamine group (0.61±059)than in the sa-line group (3.37±096) (P<0.001). The mean duration of analgesia in ketamine group was 9.87 ±2.98 hrs and in saline group was 2.17±0.79 hrs (P<0.001).The first analgesic request time in the ketamine group was significantly longer than the saline (P<0.001). No significant adverse effect was observed in the ketamine group. According to the increased length of postoperative analgesia with no adverse ef-fects and also decreased need for opioids, administration of subcutaneous ketamine is rec-ommended for post operative analgesia after elective Cesarean section under spinal anesthe-sia.

Introduction & Diazinon (DZN) is an organophosphate insecticide that one of the mechanisms of toxicity is the inhibition of cholinesterase. The aim of the present study was to evaluate the effects of diazinon on cholinesterase activity in blood serum and erythrocytes of male and female rats and to assess the protective role of vitamin E. In this experimental study, 60 adult wistar rats including 30 male and 30 female rats were selected and divided into 5 groups (n = 6): control group (without any intervention), sham group (received only pure olive oil daily), experimental group 1 (DZN daily, 60 mg/kg), experimental group 2 (received DZN+ vitamin E daily, with the same dose) and experimental group 3(received vitamin E daily 200 mg/kg). Diazinon and solvent were injected intraperitoneally and vitamin E was given by gavage. After 2 weeks 3 ml blood was taken from the heart tissue, and titrimetric and Ellman’s method respectively were used for serum and erythrocyte cholinesterases activity assay. In both genders, due to administration of diazinon, we observed significant reduction in serum and erythrocytes cholinesterase activity. The use of vitamin E increased serum and erythrocytes cholinesterase activity in experimental group 2 of female rats but inhibition in erythrocyte and serum cholinesterase activity was not recovered in experimental group 2 of male rats. According to a further reduction of these enzymes activity in female rats with the use of diazinon, it can be concluded that female rats are more sensitive than male rats and it seems that vitamin E as an antioxidants has a protective effect on cholinesterase activity and reduces the toxicity of DZN.

Introduction & The highest rate of non-anatomic reduction of fractures is usually seen in oblique mandibular body fractures. Thus, the aim of the present study was the as-sessment of reduction performance of TRS (Tube Reduction Screw) in comparison conven-tional method (Reduction forceps with Lag Screws). This experimental study was conducted on 30 half- mandibles of slaughtered sheep. After creation of oblique fracture in each side of mandibles, one side was reduced with TRS and the opposite side with conventional method. Then, the distance be-tween the fracture lines was determined on inferior, superior, buccal and lingual surfaces. According to the results, there were no significant differences in the distance between the fracture lines on the superior, inferior and buccal surfaces in TRS and conventional methods. But, this difference was statistically significant on the lingual surface (P<0.05). The results showed that the TRS could be a useful instrument for the reduction of oblique mandibular body fractures. But the clinical usage of this device needs more animal and clinical studies.

Introduction & The monitoring and evaluation status of diabetes control in Hamadan province helps manage diabetes control and prevention programs. This study was done to determine the achievement of quantitative and qualitative objectives of diabetes control in the rural areas of the province. This is a descriptive cross-sectional and analytical study. The sample size included 256 patients with type 2 diabetes in rural areas of the province that were se-lected by random stratified sampling method. After completing the check list, by descriptive and analytic statistics such as t-test and chi-square analysis, the data were analyzed using Stata software, version 11. 49 (19.1) of the subjects were male. 47.3% of patients had a family history of diabe-tes. and 71% of patients were overweight or obese. 4.3% of patients had diabetic foot ulcers. 79% of patients had poor glycemic status. Mean systolic blood pressure, diastolic blood pres-sure, fasting blood glucose, cholesterol, triglycerides, LDL, HDL were, 122.6 mmHg, 74.3 mmHg, 180.5 mg/dl, 193.2 mg/dl, 189 mg/dl, 104 mg/dl and 47.3 mg/dl, respectively. The results show that the level and quality of care for diabetics are far from the national standards.

Introduction & Iran is located in the dry and semi dry regions, thus almost 90% of the required fresh water is exploited from groundwater resources. Due to the increasing pol-lution of water resources, the purpose of this study was evaluation of Pb, Cd, Cu and Mg concentrations in groundwater resources of Razan Plain and preparing the zoning map using GIS. Groundwater samples were collected from 20 selected stations during two seasons in 2012. The samples were filtered (0.45? m) and maintained cool in polyethyl-ene bottles. The samples were taken for the analysis of cations, the former was acidified with HNO3 to pH lower than 2. Minor elements were determined using ICP-OES. All statistical analyses were performed using the SPSS statistical package. Also, Kriging Method was used to prepare spatial distribution maps of elements in groundwater samples. The results showed that the mean concentrations of Pb, Cd, Cu and Mg in the groundwater samples during the spring were 5.60±0.66, 0.21±0.04, 32.10±2.21 and 6990.0±302.10 ppb, respectively, and the mean concentrations of these elements in the groundwater samples in the summer were 4.86±0.46, 0.30±0.08, 25.55±3.63 and 3654.05±215.65 ppb, respectively. Comparing the mean concentrations of the evaluated metals with WHO permissible limits showed a significant difference (p<0.05). Thus, the mean concentrations of the metals were significantly lower than the permissible limits. Although the groundwater resources of Razan Plain are not currently polluted with heavy metals, long-term excessive use of agricultural inputs and establishment of pollut-ing industries, can pose a threat to groundwater resources of this area.

Introduction & Driving under the influence of drugs is considered a social pathology that has adverse effects on a society. This study aimed to investigate the effect of substance abuse educational program among the bus drivers on the basis of the theory of planned be-havior. This quasi-experimental study was conducted on 80 suburban bus drivers working at Hamadan transportation terminal. The bus drivers were randomly divided in two equal groups (intervention and control). Intervention program design was implemented after diagnostic evaluation. The effect of educational intervention on behavior was assessed two months after the last training session. SPSS -16 was employed for data analysis. After the educational intervention, the average rates of the constructs of the theory of planned behavior in the intervention group significantly increased but these changes were not significant in the control group: attitude (t=9.53, P=0.000), subjective Norms (t=9.59, P=0.000), perceived behavioral control (t=-4.14, P =0.000). Also, behavioral intention to substance abuse avoidance and current behavior for substance abuse significantly decreased in the intervention group as compared to the control group (P<0.05). Behavioral intention and current behavior in the intervention group subsided from 15 and 12 people before the educational intervention to 3 and 0 people at the end of the educational program, respec-tively. The results showed that using the theory of planned behavior along with the train-ing skills strategies to resist drug abuse has a significant impact to create a psychiatric immu-nization and substance refusal in drivers.

Introduction & Common methods for dewatering of wastewater sludge need chemi-cals and high energy consumption and have low efficiency and environmental acceptability because of colloidal and jelly property of bacteria cells of sludge. Furthermore, their operat-ing is completely complicated. In this study electro-flotation way, as a novel method, was performed to cover these limitations and also operating parameters and energy consumptions were optimized. In order to carry out the experiments, a batch reactor with the effective volume of 450 ml was used. In this experimental- laboratorial study, the effect of pH, current density, hydraulic retention time and surface/volume changes on the amount of dewatering and the amount of total solids in both the sludge cake (dewatered sludge) and the water sepa-rated from the sludge as well as the content of TSS, TS and COD in the water were investi-gated. The amount of consumed electricity was calculated and lowered by optimizing the variables. The finding showed that the best efficiency (81.6%) of sludge dewatering was achieved at pH = 2, current density = 1.7mA/cm2, hydraulic retention time = 30 min and sur-face/volume amount = 178 cm2/L with electrical energy consumption of 0.33-0.726 kWh/m3. The electro-flotation process owing to high efficiency, convenient construction and operating and lower energy consumption and construction costs compared to common methods can effectively be applied.

Introduction & Sedentary women are at risk for problems such as obesity, diabetes, depression and cardiovascular disease. Meanwhile, due to long working hours and excessive travel time from home to work and vice versa the employees have minimal physical activity. The purpose of this study was to investigate the effective psychometric factors on physical activity of female employees, according to the Trans-theoretical Model and theory of planned behavior. In this cross-sectional study, 95 female staff of Tehran University was selected through a call. In order to collect data, a questionnaire with acceptable, reliability and validity, including demographic data, and constructs of planned behavior theory as well as Trans-theoretical Model was used. The data was analyzed using SPSS version 21 statisti-cal tests; correlation and stepwise regression were also performed. In this study, 72% of the population was in the inactive stages (pre-contemplation, contemplation and preparation) and only 28% of patients had regular physical activity. There was a significant positive correlation between the behavioral intention and attitude scores (P = 0.02), perceived behavioral control (P = 0.000), self-efficacy (P = 0.000) and stage of change (P = 0.000), but subjective norms score (P = 0.605) was irrelevant. The results of this study showed that self-efficacy and perceived behavioral con-trol can affect female employees’ intention and physical activity behaviors. So, the authori-ties should seriously consider these factors in educational planning for this stratum of society, remove barriers for the participation of more employees in sporting activities, and offer fa-cilitators at the community level.