Journal of Archives in Military Medicine
Volume:6 Issue: 1, Mar 2018

Surgical treatment of lumbar intervertebral disc herniation is a critical procedure due to the proximity of the operation field to neural structures. Providing a bloodless field and optimizing surgeon vision is of high value in this regard. Total intravenous anesthesia with propofol and inhalation anesthesia with isoflurane are both used in spine surgeries. Both of these agents have vasodilator properties that could be benefited in inducing controlled hypotension as a blood sparing technique. We sought to compare propofol and isoflurane anesthesia in terms of intraoperative bleeding and hemodynamic changes.
After obtaining ethics approval and informed consent, 88 Iranian patients with American society of anesthesiology score 1 and 2 were randomly divided into two groups. The ISO group received isoflurane and the PRO group received propofol as the main anesthetic agent. Hemodynamic changes, intraoperative bleeding, urinary output, and surgeon satisfaction score were recorded.
The two groups were similar in demographic characteristics (for age P = 0.072; for gender P = 0.286). The ISO group had significantly lower blood pressure after 30 minutes of anesthesia (P = 0.01). Intraoperative bleeding in terms of qualitative and quantitative measures was lower in the ISO group (P = 0.001). Isoflurane anesthesia was also associated with a higher surgeon satisfaction score (P = 0.01).
Our findings showed that isoflurane as a volatile agent provides a bloodless field better than does propofol through TIVA.

The primary purpose of this study is to evaluate the use of guidelines or risk factors in patients with LBP by referring clinicians.
We randomly selected people that referred to the imaging center for lumbar spine MRI during 1 year, January to December 2016. History regarding the back pain and physical examination was taken in patients as well as asked about the parameters of indications for LBP before doing the MRI.
Total patients studied during this year were 710. Sex difference in these patients was 200 male (28.2%) and 510 female (71.8%). The mean age of referred patients was 41.2 years (18 - 90 year). Base on the history of the patients, about 135 patients had at least 1 risk factor that indicated for imaging. During physical examination about 108 patients had at least 1 indication for imaging. Patients in this study were referred from different physicians; most of them were neurosurgeons (479 - 67.5%) and orthopedics (101 - 14.2%).
This study shows that about 75% of cases referred for a MRI didn’t have any medical indication for imaging. Apart from results of any low back MRI that might be different from clinical process and cause wrong management, their cost and benefits are very important factor for decision making.

Toxoplasmosis is a parasitic infectious disease. The occurrence of this disease brings about multiple complications resulting in abortion, death, or severe fetal complications. These complications may occur as a result of increased fibrinogen levels during pregnancy and increased serum factors associated with Toxoplasmosis. This study examined the plasma level of fibrinogen in the first trimester in mothers with acute toxoplasmosis for the first time.
In this study, 205 pregnant women who were referred to various medical centers of Tehran during 2014 - 2015 were studied. The bloods were examined for the levels of IgG avidity, anti - toxoplasma IgM and IgG, and fibrinogen levels. SPSS software v. 22.0 was used to study the results. Data regarding their demographic characteristics were collected by a questionnaire.
Among a total of 205 patients, 41 cases had positive IgG titer, two had positive IgM titer (one low avidity), and five were borderline. Fibrinogen level was high in one case of positive IgM titer as well as low avidity and positive in 10 out of 41 cases with IgG titers.
The results of the present study shows that increased levels of fibrinogen in pregnant women during the first trimester of pregnancy is not significantly associated with toxoplasmosis.

Since the introduction of data envelopment analysis (DEA) in 1978, this method has become one of the best performance evaluation tools. Use of DEA has many advantages, as it can accommodate multiple inputs and outputs. However, there are some constraints concerning the number of variables. For instance, selective variables are commonly used to evaluate the performance of hospitals, based on the researcher’s personal preferences.
In application of traditional DEA models in hospital comparisons, variables are always selected based on the analyst’s opinion regarding the significance or availability of data. On the other hand, there is a need to reduce the dimensions of variables. The main goal of this study was to reduce the number of input and output variables in the evaluation of military hospitals of Iran.
In this study, the Delphi technique was applied, as well as partial least squares - structural equation modeling (PLS - SEM) method.
Acceptable goodness of fit was established for validity of the measurement model. The test of validity was accepted for the structural model in this study.
In the first step, the number of variables was reduced to 29, using the Delphi technique. In the second step, using SEM - PLS, the number of variables was reduced to half.

Desquamative gingivitis (DG) is a descriptive term, indicating inflamed and peeling gingiva. It is characterized by sloughing of the gingival epithelium as a result of formation and rupture of the vesicle. Consequently, the gingiva appears erythematous and often edematous. Desquamative gingivitis may represent an oral clinical manifestation of various systemic mucocutaneous diseases. This case report is on a 42-year-old female with chief complaint of burning sensation in the anterior maxillary gingiva. The patient did not have any other lesion at other sites of the oral cavity. The patient had been affected by asthma and her medications were salbutamol spray and tab cetirizine. Clinically, anterior gingiva appeared as the presentation of desquamative gingivitis. Therefore, an incisional biopsy of the affected area for histopathologic assessment and an incisional biopsy of clinically normal-appearing gingiva for direct immunofluorescence (DIF) study were performed. The histopathologic report was herpes simplex infection. However, this report was incompatible with the clinical view and the patient history. Therefore, a second biopsy was performed. The second histopathologic report was compatible with MMP. The treatment plan was local corticosteroid with follow-up. At the one-month examination visit, a significant improvement was observed in the clinical view of the gums.