فهرست مطالب علیرضا پیمان

To improve the quality of sedation in procedures, different medications are used alone or in combination with each other, but so far, no administration method that is agreed upon by anesthesiologists has been presented. This study aimed to investigate the effectiveness and safety of intranasal ketamine in comparison with intravenous ketamine in cataract surgery.

This clinical trial was performed from December 2016 to March 2017 in Feyz Hospital, Isfahan. Ninety patients over the age of 18 who were candidates for cataracts surgery were randomly assigned to receive 1 mg/kg ketamine through the nasal route (INk) or intravenously (IVK). Ten minutes before the surgery, ketamine was administered in the INK group and intranasal saline in the IVK group. Two minutes before the start of surgery, normal saline was administered in the INK group and ketamine was administered intravenously in the IVK group. Patients received intravenous midazolam 0.04 mg/kg during prep and drape. The quality of sedation and analgesia, vital signs, patient and doctor satisfaction, and side effects were recorded during the study period. Data were analyzed using of SPSS software, version 23 (IBM SPSS, Armonk, NY, USA).

In this study, 90 people were included in the study, 53 of whom (58.9%) were men. The mean age of the patients was 61.5±10.6. Two groups had a significant difference in terms of gender (P=0.696), age (P=0.960), weight (P=0.212), height (P=0.632), underlying disease (P=0.094), and type of disease (P=0.090). Two groups were not significantly different in terms of mean heart rate (P=0.77), mean arterial blood pressure (P=0.13), mean blood oxygen saturation (P=0.58), patient satisfaction (P=0.470) and surgeon satisfaction (P=0.115), pain intensity (P=0.506), level of sedation level (P=0.477) and side effects (P=0.221).

Intranasal administration of ketamine provides similar sedation and cardiovascular response compared to intravenous administration of ketamine. Administering ketamine intranasally is a non-invasive, safe and effective method with easy application and can be a suitable alternative to intravenous administration.

The weekly story system is the fourth work of Hakim Nezami Ganjavi, a talented poet of the sixth century AH. The main subject of this work is the life story of Bahram Gore, from his birth to his disappearance, along with the various stories that are included in it, and among these stories are seven legends that are told in the language of the seven princesses. In this research, with the aim of showing military skills in storytelling, the issue of "narrative speed" in this collection of poetic stories has been investigated.

This research has been done in a descriptive-analytical manner.

The study of the speed of narration is to show how long the events and actions of the story occur in a literary work and how much of the story is assigned to them according to each time period.

The speed of narration is moderate in the whole system and the components of increasing and decreasing the speed of narration are used in a balanced way. Although a number of slowing factors are more in some stories and less in others, due to the artistic aspects and poetic language of this lyrical system, the artistic pleasure of reducing and increasing the speed of narration has helped to balance and moderate the story.

The risk of anesthesia increases with age, so it is necessary to choose a safe and effective method. In this study, we compared the effectiveness of intranasal fentanyl with intravenous fentanyl in patients undergoing cataract surgery.

This study was a triple-blind prospective randomized clinical trial (The patient, physician, and data analyzer were unaware of the patient grouping). The study was performed from April 2017 to March 2019 in Feyz Hospital, Isfahan, Iran. 90 patients over 18 years of age who were candidates for cataract surgery were included in the study and were divided in two groups receiving intravenous fentanyl (IVF) or intranasal fentanyl (INF). The dose of fentanyl in both groups was 1.5 μg/kg with a maximum of 100 μg. In the IVF group, 1 ml of normal saline was dripped into each nasal passage 10 minutes before surgery and intravenously fentanyl was injected 2 minutes before surgery. In the INF group, 1 ml of fentanyl was administered into each nostril 10 minutes before surgery and 2 ml of saline was administered intravenously two minutes before surgery.

In this study, there was no significant difference between the two groups in terms of mean heart rate (P=0.762), mean arterial blood oxygen saturation (P=0.262), mean systolic blood pressure (P=0.264), mean arterial blood pressure (0.462), satisfaction rate Patient (P=0.231), duration of surgery (P=0.612) and pain intensity (P=0.87). But in the intravenous fentanyl group (IVF), the level of sedation (P=0.002) and the level of surgeon satisfaction (P<0.001) were higher than intranasal fentanyl group (INF). There was no significant difference between the two groups in terms of side effects (P=0.171) and surgery time (P=0.612). The mean VAS was not significantly different between the two groups.

The study showed that intranasal administration of fentanyl compared with intravenous administration of fentanyl provided similar sedation and cardiovascular response. Intranasal administration of fentanyl is a non-invasive, safe and effective method, that is easy to use and can be a viable alternative to intravenous administration.

To determine the outcomes of visual correction with femto-LASIK following PK.

In this prospective study, 34 eyes of 31 patient who had undergone thin – flap lasik due to high refractive error after corneal grafting were evaluated. After complete ocular examination and assessment of uncorrected and corrected distant visual acuity (UCVA and BCVA), the patients underwent femto-lasik using the Ziemer femto-LDV with 100 micron flap thickness.

After 3 to 19 (10.14±4.81) months of follow-up, mean UCVA increased from 1.5 Log MAR preoperatively (5/100) to 0.3 LogMAR (5/10) postoperatively (P<0.05). Mean BCVA also increased from 0.3 LogMAR (5/10) to 0.1 LogMAR (8/10) (P<0.05). Mean spherical equivalent changed from -6.98±3.87 to -2.18±2.69and mean of defocus equivalent also decreased from 10.32±3.74 preoperatively to 4.13±2.93 postoperatively (P<0.05 for both). No significant intraoperative and postoperative complications occurred.

Femto-LASIK surgery after penetrating keratoplasty is a successful procedure for correction of moderate to high refractive errors. It seems to be clinically safe, effective and predictable.

To evaluate refractive, visual, topographic, and wavefront outcome of photorefractive keratectomy (PRK) for treatment of myopia and myopic astigmatism with two different excimer laser systems: Technolas 217z and Lasersight LSX excimer lasers.

183 eyes of 95 patients enrolled in this clinical trial. Patients underwent PRK in a Sadra refractive surgery center with Technolas or Lasersight system by a single surgeon between 2007 and 2011. For PRK we used Technolas 217z in one group and Lasersight LSX excimer laser in another group. Subjects examined before and 24 months after surgery evaluating vision, refraction, Orbscan topography, and Wavefront analysis. Data collected, analyzed with SPSS 16. We used Student t-test for statistical data analysis.

83 eyes were in the Lasersight group and 100 eyes in the Technolas group. Pre-op spherical equivalent refraction was not different in two groops. After surgery it was -0.93 ± 0.73 in Technolas and -0.19 ± 0.40 in Lasersight group, the difference was statistically significant (P < 0.001). Post-op difference vector of astigmatic correction was 0.44 ± 0.58 in Technolas and 0.41 ± 0.26 diopters in Lasersight group (P = 0.04). Post-op LogMAR Acuity was 0.015 ± 0.027 in Technolas and 0.0005 ± 0.005 in Lasersight group (P < 0.001). Post-op Q value of asphericity was 0.24 ± 0.33 in Technolas and 0.46 ± 0.37 in Lasersight group (P < 0.001).

Post-op spherical equivalent refractive outcome, best corrected distance visual acuity and satisfaction were better in Lasersight group. We did not find any difference regarding post-op wavefront analysis between groups.

To determine whether angiotensin II levels in aqueous humor is related to diabetes mellitus and to evaluate the effect of captopril.

In a case-control study, aqueous humor samples were obtained during cataract surgery from 58 eyes of 58 patients, of which 37 were diabetic. From these latter subjects, 16 had taken captopril (captopril group) and 21 had not taken any angiotensin converting enzyme (ACE) inhibitor (non-captopril group). Angiotensin level was assessed by radioimmunoassay. Severity of macular edema was evaluated by clinical examination after surgery. Mann Whitney U test was used to assess the statistical difference of mean angiotensin II and Hb A1C levels between the groups and Spearman's rank-order correlation coefficient was used to evaluate the correlation between aqueous levels of angiotensin II and severity of macular edema.

The aqueous level of angiotensin II was significantly higher in diabetic patients (31.07.3 pg/ml) compared to non-diabetics (6.282.8 pg/ml). (P<0.0001) Aqueous concentration of angiotensin II in the captopril group (16.36.5 g/ml) was significantly lower than in the non-captopril group (75.739.36). (P<0.0003) Severity of macular edema was significantly lower in the captopril group as compared to the non-captopril group such that 68.75% of the captopril group vs 33.3% of the non-captopril group had no macular edema (P<0.005).

These findings suggest that the aqueous level of angiotensin II is significantly correlated with the severity of macular edema and may have a role in pathogenesis of macular edema in diabetic patients. It seems that modulation of the renin-angiotensin system may become a very important target for medical treatment in patients with diabetic macular edema.