مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و هفتم شماره 4 (پیاپی 128، مهر 1393)

Rapid sequence intubation is planned to protect airway from aspiration and keep patient's ventilation in critically ill cases. Intubation need a sedative drug that has the least hemodynamic instability effect and complications. This prospective-randomized study compared the hemodynamic effects of Etomidate and propofol during Rapid sequence Intubation on non surgical patients. Critically ill patients with ASA III, IV who needed rapid sequence intubation were divided into two groups of 47 patients. Patients first sedated with 2µ/kg fentanyl and ventilated with bag and mask (sellick's maneouvre). In group 1 1mg/kg propofol and in group 2 0.3 mg/kg etomidate were injected.Vital signs and oxygen saturation were recorded before and five minutes after intubation. Demographic data were similar in two groups. Systolic and diastolic blood pressure, heart rate and oxygen saturation were similar in two groups before intubation, but five minutes after intubation hemodynamic changes were less in etomidate group (p=0.000, p=0.000, p=0.047, p=0.004 respectively). Usage of etomidate for sedation in rapid sequence intubation had better hemodynamic stability effect than propofol.

Pain and hamstring muscles tightness is a common disorder among patients suffering from lumbosacral spinal stenosis. The origin of this problem may be the irritation of the spinal nerve roots or from the muscles.The purpose of this study was to determine the impact of muscle pain treatment in patients suffering from spinal stenosis. By an experimental study, during four years, all patients suffering from the lumbo sacral spinal stenosis in Ahwaz, Imam Khomeini hospital were recruited. They were sent for a ten days period of conservative therapy for their back. Their pain scale were measured before and after the treatment via visual analogue (VAS). If they did not respond to the early treatment and had suffered from hamstring tightness and pain more than 5.5 scale, they were sent for another conservative treatment for their hamstring muscles. Before and after the treatment changes of patient's pain and their ability to extent their knees were compared by paired T test. Overall 196 patients recruited. Seventy patients had suffered from a pain with the scale more than 5.5, along with the pain in extending their knees. Following receiving the conservative treatment for their hamstring muscles, their pain and ability to extent their knees improved (p=0.002). This study showed that some of the lumbosacral canal stenoic patients suffered from their hamstring muscle involvement too. The diagnosis and especial treatment of these muscles leads to a better outcome and avoiding unnecessary work ups.

Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral infection. Humans become infected through tick bites, contact with infected blood or organs or tissues of human or animals. The disease has caused nosocomial outbreaks with high mortality. Following the admission of a CCHF patient to infectious ward of Imam Reza Hospital in Mashhad a nosocomial outbreak occurred. In 1391, all steps for standard precaution in Health Personnel in the infectious ward of Imam Reza hospital observed for Crimean-Congo hemorrhagic fever. A total of 44 healthcare workers were in contact with the CCHF patients in this study. IgM and IgG antibodies against CCHF virus were studied on their sera, while Crimean-Congo fever antibody titers were negative in all 44 (100%).. There was no serologic evidence of healthcare-related CCHFV transmission in recent outbreak in Imam reza hospital.

The aim of this study was to evaluate the effects of chronic urticaria on the quality of life in patients referred to Tooba allergic clinic and Bou Ali Sina Hospital in sari.

This cross sectional study was performed on 155 Patients with chronic urticaria referred to Tooba allergic clinic and Bou Ali Sina Hospital in sari during 2013. A standard questionnaire based on the Dermatology Life Quality Index (DLQI) included demographic characteristics, criteria of the disease and various questions related to chronic urticaria was selected. Each question had five items included: always, often, sometimes, just a little and not at all. Then each item was scored between 0-4 respectively. The total score was calculated from 0 to 100. The worst score of quality of life was considered 100 and the best quality of life scored zero.

Out of total 155 cases, 132 were enrolled in which 99 (75%) were female subjects and 33 patients (25 %) were male (female to male ratio, 3 to 1). Seventy nine (60%) had degree of diploma or a bachelor of science. Most of the patients were married (87 people) and 58 of the patients were housekeepers. The numbers of lesions were often between 1 and 10 in 55 cases (42%). Daily living activities were the worst among patients under the age of 20 years, and the best daily activities belonged to the patients older than 40 years. While more severe disease was associated with worse quality of life.

This study showed that chronic urticaria in some aspects of quality of life of patients affected and the disease is more severe the situation is getting worse every day thoughts and activities.

Surgery is an option for multinodular goiter (MNG), but extension of surgery is controversial due to risk of recurrence and post operative complications. So, we decided to compare these problems between subtotal (ST) and total (TT) thyroidectomy as surgical treatment of MNG.

This cross-sectional retrospective study was done between 2011-2012. 104 patients with benign MNG (52 in TT and 52 in ST groups) that operated before year 2006 in Imam Reza Educational Hospital, were enrolled. Rate of recurrence and surgical complications compared between two groups. P < 0.05 considered significant.

Mean age of patients was 45.3 years. Mean duration of Follow up was 74 months. 8 patients in ST group(15.4 %) and no patient in TT group had recurrence of goiter. (p< 0.05). There was no significant differences in transient and permanent hypoparathyroidism, transient and permanent recurrent laryngeal nerve palsy, mortality, hematoma,wound infection and hospital stay duration between two groups. Conclution: Total thyroidectomy as procedure of choice for multinodular goiter is recommended in Educational Hospitals with experienced surgens.

Acute Myocardial Infarction (AMI) is one of the most common cause of mortality causes in Iran. The aim of this study was to provide a model for predicting the survival of patients with AMI in Imam Reza hospital in Mashhad. We recruited 607 patient aged>25 years, admitted to the CCU of Imam Reza hospital in Mashhad. This was a 5-year retrospective study in which patients had been followed during 2007 to 2012. The main outcome of the study was death due to AMI. The effect of independent predictors on survival was examined in a multivariate Cox regression model. Using multivariate Cox regression analysis, variables remaining in the final model including: age (HR:1.04, P=0.000), male gender (HR:0.71, P=0.03), diabetes (HR:1.93, P=0.000), history of ischemic heart disease (HR:1.35, P=0.04), acute transmural myocardial infarction of unspecified site (HR:3.23 P=0.007), and type of intervention and diagnostic procedures. By multiplying the significant variables into the regression coefficient, a risk score was calculated. Applying cut offs at percentiles of 25 and 75, three risk groups were identified. in low and high-risk groups 5-year survival rate was 91% and 20% respectively. Identification of additional risk factors and providing a new approach to high-risk group may lead to increase in survival of these patients.

leishmaniasis in Iran is a major healthcare problem. Epidemiological studies are effective in disease control and preventive measures. The aim of this study was to investigate the epidemiology of cutaneous leishmaniasis in Razavi Khorasan province in 2011. This descriptive-analytical survey was conducted on cutaneous leishmaniasis patients in 2011. Recorded demographic and epidemiological information of patients were extracted from disease surveillance department of Mashhad university of medical sciences. Data were analyzed by SPSS version 11.5. The number of cutaneous leishmaniasis patients was 3558. According to the population coverage of Mashhad university of medical sciences, disease incidence was 7.2/10000 and 52% of patients were men. Most cases were children (under 10 years old) and youth (20-30 year old). Highest disease frequency was observed in students and housewives. The disease incidence in Torghabeh _Shandiz, Sarakhs and Daregaz was 92.3, 27.6 and 16 cases per ten thousands people, respectively. The disease incidence in Razavi Khorasan was moderate compared to the other endemic areas of Iran. However, this frequency was still significant. According to high disease incidence in children and housewives, these groups needed to be trained in disease prevention and increase their level of health literacy.

Enterococci are among the most important causes of urinary tract infections. The aim of this study was to assess the frequency of erm A, B, and C genes in erythromycin-resistant Enterococci isolated from the clinical samples of inpatients of university teaching hospitals in Qazvin and Tehran. From 2012 to 2013, a total of 165 samples of enterococci were isolated from the clinical samples of inpatients. Susceptibility to erythromycin in enterococci isolates was performed by agar dilution and disk diffusion methods according to the Clinical and Laboratory Standards Institute (CLSI) guideline. Erythromycin resistance genes (ermA, B, and C) were identified by PCR. Out of 165 clinical isolates of enterococci, 142 (86%) isolates were Enterococcus faecalis and 23 (13.9%) isolates Enterococcus faecium. The results of susceptibility test showed that 158 (% 95) isolates were resistant or with intermediate sensitivity to erythromycin. There was a good correlation between the results of disk diffusion and agar dilution methods. Of total samples, 147 (89%) isolates were resistant to erythromycin (MIC≥8 µg/ml), 11 (6.6%) isolates with intermediate sensitivity (MIC 1-4 µg/ml), and 7 (4.2%) isolates with complete sensitivity to erythromycin (MIC ≤ 0.5 µg/ml). The results of this study showed high prevalence of ermA, B, and C genes in erythromycin-resistant strains with ermB asthe most common resistance gene among these isolates.

Restless leg syndrome is a common problem in chronic renal failure with adverse effects on the quality of life. Case report: In this article we presented a 5 year old boy with chronic renal failure and restless leg syndrome who did not respond to oridinary treatments. Levodopa/carbidopa caused rapid and effective result with least adverse effects. levodopa/carbidopa can be used in treatment of Restless leg syndrome which is unresponsive to oridinary treatments.