مجله دانشکده پزشکی اصفهان
پیاپی 399 (هفته سوم آبان 1395)

This study aimed to determine the effect of intravenous infusion of magnesium sulfate in three doses before the end of the surgery for prevention of shivering after abdominal surgeries under general anesthesia.
In a clinical-trial study, 100 patients under abdominal surgeries were randomly divided in four groups. Before the reverse of anesthesia, one of the solutions included normal saline, and 30, 40 or 50 mg/kg magnesium sulfate were injected during 10 minutes for each group. The incidence of postoperative shivering mas measured and compared between the four groups.
Findings: The incidence of shivering at the entrance to recovery room was 9, 3, 8 and 3 patients in normal saline, and 50, 40 and 30 mg/kg magnesium sulfate groups, respectively (P = 0.07). 15 minutes later, the incidence of shivering was 8, 1, 1 and 6 patients in mentioned groups, respectively (P = 0.01). 30 minutes after the entrance, the incidence of shivering was 4, 0, 1 and 4 patients in mentioned groups, respectively (P = 0.10).
Using 40 or 50 mg/kg of magnesium sulfate is benefit for decreasing postoperative shivering and using these doses is recommended for prevention of postoperative shivering in patients under abdominal surgeries.

Ventilator-associated pneumonia (VAP) is the most common infection in intensive care units (ICUs) which in most of cases is resistant to regular antibiotics. This study aimed to identify the antibiotic-resistance pattern of common pathogens in ventilator-associated pneumonia and risk factors of multi-drug resistance (MDR) in ICUs of Alzahra Hospital, Isfahan University of Medical Sciences, Iran.
In this cross-sectional study, files of 196 patients with ventilator-associated pneumonia, which were hospitalized in ICUs of Alzahra teaching hospital from March 2014 to March 2015, were reviewed. To identify the common pathogens and related antibiotic-resistance pattern, reports of bronchoalveolar fluid culture were used. Pathogens were divided to multi-drug and non-multi-drug resistance groups and the groups were compared for some demographic and resistance risk factors.
Findings: From 196 cases, 63 were early pneumonia and 133 were delayed. Number of multi-drug resistance pathogens showed no significant differences between the early and delayed pneumonia. Multi-drug and non-multi-drug resistance groups were compared for age, sex, immune deficiency, duration of hospitalization, and previous antibiotic therapy; and there were no significant differences. The most common pathogens for both early and delayed pneumonia were Acinetobacter baumannii (40.4%) and Klebsiella pneumoniae (31.8%) and minimum resistance among these bacteria was against colistin and amikacin.
Resistance to antibiotics is most affected by situational conditions. Considering this point and increasing prevalence of antibiotic resistance, it is necessary to do some actions such as preparing culture sample before antibiotic therapy, empirical treatment based on common pathogens and their resistance rate, and avoiding antibiotic therapy without indication.

The linkage between consumption of fried foods and constipation was less studied. We aimed to assess the relationship between fried foods intake with constipation and functional constipation and its components in a large group of Iranian adults.
In this cross-sectional study on 4517 adults, fried foods intake was assessed using an eating-behavior questionnaire. Subjects were classified into four categories based on their fried foods intake: "never", "1-3 times per week", "4-6 times per week" and "every day". The prevalence of functional constipation and its components was defined according to Rome III criteria.
Findings: The prevalence of functional constipation and constipation among study population was 15.3% and 33.5%, respectively. After adjustment for potential confounding factors, individuals who ate 4 to 6 meals of fried foods per week had lower odds ratios for functional constipation (OR: 0.67; 95% CI: 0.45-0.99), in comparison to those in the lowest category of fried food intake; more adjustment for dietary fiber intake disappeared this association. However, fried foods intake raised the risk of "sensation of incomplete evacuation" and "fewer than three defecations per week" by 36% (OR: 1.36; 95% CI: 1.02-1.79) and 159% (OR: 2.59; 95% CI: 1.00-6.71) in females as well as frequency and severity of these symptoms in whole population.
There was no significant association between fried foods intake and odds ratios for functional constipation. However, fried foods intake raised frequency and severity of some components of functional constipation.

Shivering after spinal anaesthesia is an unpleasant feeling that causes discomfort for patient and interferes with monitoring systems. The goal of this study was comparing the prophylactic use of magnesium sulfate infusion and midazolam plus ketamine for prevention of shivering in spinal anaesthesia.
In this double-blinded study, 90 patients with status 1 or 2 of American Society of Anesthesiologists (ASA) classification, undergoing orthopedic surgery under spinal anaesthesia (with 15 mg of bupivacaine), were included. All the patients were randomly allocated to one of three equal groups: 1) Group MK received 0.25 mg ketamine 37.5 μg/kg midazolam. 2) Group Mg received intravenous (IV) bolus dose of 80 mg/kg MgSO4 over 30 minute period followed by infusion of 2 g/hour. Group S received saline without any prophylactic drug. Shivering score was recorded at 10-minutes intervals. Peripheral and core body temperature were recorded at 10-minutes intervals.
Findings: Shivering frequency and intensity were significantly higher in group S compared to groups MK (P = 0.001) and Mg (P 0.999).
There was no difference between the use of ketamine plus midazolam and magnesium sulfate in preventing shivering during spinal anaesthesia.

Pancreaticouodenectomy (Whipple surgery) is the chosen treatment in patients with malignant or benign tumors of the pancreatic head. Pancreatic anastomosis is the most important part of Whipple surgery. Pancreatic fistula is the most common postoperative complication.
This prospective study was conducted on patients with pancreatic tumor who went under pancreaticodoudenectomy and pancreaticojujenosotmy during the years 2011-2016 in Isfahancity, Iran. The incidence of postoperative pancreatic fistula was evaluated based on the criteria of International Study Group of Pancreatic Fistula (ISGPF). Data were analyzed using chi-square test via SPSS22 software. P-value Findings: 82 patients participated in this survey. The rate of pancreatic fistula was 26 (31.7%) and 14 cases (17%) based on the right and left drainage, respectively. Although, there was meaningful relationship between the pancreatic fistula and pancreatic duct size, age, gender, pancreatic texture, and tumor histology had no effect on its incidence.
Based on our analysis, a pancreatic duct less than 3 mm was considered a risk factor regarding the incidence of pancreatic fistula. In addition, the rate of pancreatic fistula was different based on the drainage location.