فهرست مطالب

  • Volume:6 Issue: 1, 2018
  • تاریخ انتشار: 1396/12/20
  • تعداد عناوین: 8
|
  • Samaneh Kouzegaran, Mahmood Ganjifard, Amir Sabertanha Pages 1-5
    Introduction
    Meperidine has the advantages of being widely available and inexpensive. It would be highly cost-benefit if it is used at doses that are without any side-effect. Thus, this study aimed to assess the effect of meperidine 5 mg as an additive to bupivacaine for spinal anesthesia on postoperative pain in cesarean section surgery.
    Methods
    This double-blind randomized clinical trial was performed on 40 patients aged 20-40 yr. They were in classes 1 or 2 according to the American Society of Anesthesiologists (ASA) physical status classification system and were scheduled for elective cesarean surgery under spinal anesthesia. Patients were randomly allocated into two groups according to whether meperidine or normal saline was used as an additive to bupivacaine for spinal anesthesia. All patients with pre-existing or pregnancy-induced hypertension, known fetal abnormality or allergy to bupivacaine or meperidine were excluded. Postoperative analgesia was compared between the two groups immediately and 2, 12, 24 hours after surgery. Also, the need for antiemetic was compared between the groups. The collected data was analyzed in SPSS software (version 16) using independent t-test, Mann-Whitney, and Chi-square. The significance level for all tests was considered less than 0.05.
    Results
    The severity of postoperative pain 12 and 24 hours after surgery was significantly higher in normal saline group. There was no significant difference in incidence of pruritus, nausea and vomiting between the two groups.
    Conclusions
    Addition of meperidine 5 mg to intrathecal bupivacaine is associated with increased duration and quality of postoperative analgesia but has no significant effect on severity and incidence of pruritus, nausea and vomiting.
    Keywords: Anesthesia, Spinal, Analgesia, Meperidine, Bupivacaine
  • Fateme Shakhsemampour, Elahe Allahyari, Ali Rajabpour Sanati, Amir Sabertanha Pages 6-10
    Introduction
    Inflammation is one of the probable causes of post-dural puncture headache (PDPH); logically, therefore, anti-inflammatory drugs such as dexamethasone can reduce the headache. The aim of this study was to evaluate the effect of intravenous dexamethasone 8 mg on PDPH in cesarean surgery.
    Methods
    This randomized double-blind clinical study was conducted on 104 patients aged from 15 to 45 years. They were in classes 1 or 2 according to the American Society of Anesthesiologists (ASA) physical status classification system and scheduled for elective cesarean section in Valiasr Hospital affiliated with Birjand University of Medical Sciences. The patients were allocated into one of two groups using simple randomization method. In one group, the patients received dexamethasone intravenously before anesthesia technique, while the other group received placebo. Spinal anesthesia using quince 25 needle with 0.5 percent 12-15 milligram bupivacaine was performed for patients in both groups. Forty-eight hours after the operation, the severity of headache was studied and recorded. The collected data were analyzed in SPSS-16 using independent t-test and Fisher’s exact test. The significance level was set at P
    Results
    Analysis showed that dexamethasone could not significantly decrease the incidence of PDPH and severity of headache after spinal anesthesia in recovery and within 48 hours after surgery (P >0.05).
    Conclusions
    This study showed that dexamethasone did not have any beneficial effect in prevention of PDPH in cesarean surgery.
    Keywords: Anesthesia, Spinal, Dexamethasone, Post-Dural Puncture Headache, Caesarean Section
  • Ayob Akbari, Ahmad Nasiri, Mahdi Heidari, Abdolakim Ghasemi, Alireza Amirabadizadeh, Ferydoon Keramatinia Pages 11-16
    Introduction
    Shivering after anaesthesia and surgery is a common complication. Different methods are used for control of shivering in the recovery room. The opioids such as pethidine are very common in shivering control. Pethidine can be induced apnea, respiratory depression and nausea &vomiting. The respiratory rate and spo2 can lead to more rapid diagnosis and treatment of serious hypoxemia and possibly avoid serious complication.The present study is a randomized clinical trial aimed to survey Rrespiratory Rate, SPO2, nausea and vomiting in the use of three methods(warmed intravenous fluids, combined warming and pethidine) in the abdominal surgery patients with shivering.
    Methods
    87 patients in randomized clinical trial study with abdominal surgery by general anesthesia were assigned to three groups (two intervention groups in comparison with pethidine as routine) randomly. When patients meeting inclusion criteria were enrolled in the study, entered one of the three groups by simple Lottery. Patients in warmed intravenous fluids group received pre-warmed Ringer serum (38°C), patients in combined warming group received pre-warmed Ringer serum (38°C) accompanied by humid-warm oxygen, and patients in pethidine group received intravenous pethidine routinely. The Respiratory Rate and SPO2 of the participants were assessed for 20 min postoperatively in the recovery room. Then the collected data they were analyzed by chi-square, ANOVA, repeated ANOVA test, Kruskal–Wallis test, Wilcoxon test, Mann–Whitney U test, Tukey test, Friedman test, and repeated measurements through software SPSS (v. 18) with the significance level (P
    Results
    The mean of SPO2 and RR in the pethidine group was decreased, spo2 from 98% to 97% and RR from 16 to 15. But those changes werent statistically significant (p>0.05). In the combined warming groups the mean of SPO2 was clear increased from 96% to 98% and this change was statistically significant (p=0.031) but the mean of RR have no change. In the warmed intravenous serum group, the RR and SPO2 were slight decreased and werent statistically significant (P >0.05). In the pethidine group 11% of patients have nausea& vomiting.
    Conclusions
    The pethidine induce apnea and respiratory depression. despite this effects and other side effects, the combined warming can be useful for shivering treatment.
    Keywords: Meperidine, Infusions, Intravenous, Shivering, Respiratory Rate, Vomiting
  • Moslem Taheri Soodejani, Hossein Fallahzadeh, Mohammad Tabatabaei, Azimeh Ghaderi Pages 17-21
    Introduction
    Injuries are one of the most important causes of morbidity and mortality around the world. According to the World Health Organization, injuries from traffic accidents cause 5 million deaths and hurt millions of people across the world every year. In this study, we attempted to examine various injuries in different groups in Shahrekord city.
    Methods
    This is a retrospective descriptive study where data of accidents and injuries related to Shahrekord city during March 21, 2013, and March 20, 2015 (2 years in the Iranian calendar) were used. The obtained data were analyzed in SPSS software (version 16) using Fisher’s exact test at the significant level was considered 0.0.5.
    Results
    The age-standardized incidence for all accidents and injuries showed that the highest incidence, after traffic accidents (468 cases per 100,000 people), are related to falls (51 cases per 100,000 people) and violence (48 cases per 100,000 people).
    Conclusions
    Accidents and injuries occur more among younger age groups and this increases the burden of disease as well as the economic and psychological damages to society.
    Keywords: Accidents, Wounds, Injuries, Iran
  • Mostafa Hoseini, Hamzeh Mousavi Seyed, Nahid Nafissi, Khashyar Sanjary, Ali Reza Negahi Pages 22-25
    Introduction
    Abdominal radiography is an important method for acute abdomen cases and it is usually used to determine surgical approaches. This study was performed to determine the effect of abdominal radiography in the surgical approach among patients with acute abdomen attending the emergency ward of Rasool-Akram Hospital.
    Methods
    In this comparative cross-sectional study, 147 consecutive patients with acute abdomen attending the emergency ward of Rasool-Akram Hospital were enrolled. The effect of abdominal radiography on surgical approach was assessed in them.The collected data were analyzed in SPSS software (version 13) using independent t-test and Fisher’sexact test. The significance level for all tests was considered less than 0.05.
    Results
    In this study, radiography was effective on surgical approach in 63.3% of cases and it proposed peritonitis in 68% of cases. The impact was associated with lower age (P=0.0001), shorter surgery duration (P=0.003), and male sex (P=0.0001).
    Conclusions
    According to the results, it may be concluded that clinical assessment has a pivotal role for diagnosis of peritonitis, and if it is positive, no additional procedure is required whereby the operation should be carried out. Abdominal radiography should be used for cases with equivocal results in clinical assessment.
    Keywords: Abdomen, Acute, Peritonitis, Radiography, Abdominal
  • Mohammadreza Zeinadini, Seyede Fahmieh Shojaee, Mahdi Alemrajabi Pages 26-29
    Introduction
    This study aims to present the pattern of antibiotics administration in Firoozgar Hospital as an example of how antibiotics are administered in Iranian hospitals. The pattern is compared with the proposed model in the literature and relevant guidelines to determine the extent to which errors are committed in this regard.
    Methods
    In this cross-sectional study, 72 cancer patients were recruited who underwent surgical procedures in Firoozgar hospital in 2014. A survey was made the amount, type, and duration of antibiotics taken by the subjects. Data were analyzed using SPSS software version 16 (SPSS, Chicago, IL, USA). The results for quantitative variables are expressed as mean and standard deviation (mean±SD) and for the qualitative variables are expressed as percentage. The comparison between quantitative variables was performed by ANOVA. The significance level (P-value) is considered to be less than 0.05.
    Results
    In laparoscopic surgeries, patients on average received 4 days of Ceftriaxone and 3 days of Metronidazole. After Whipple procedure, patients took 8 days of Ceftriaxone and 7 days of Metronidazole and in the open gastrectomy, the mean Metronidazole and Ceftriaxone consumption was 4 days. These numbers increased about 5 days for gastrectomy and if they took esophagostomy, Ceftriaxone for 5 days and Metronidazole for 3 days. The average number of hospitalization in laparoscopic procedures was 6 days; in the Whipple procedure, it was 16 days, and in gastrectomy operations, it was 9 days.
    Conclusions
    Comparing the long duration of hospital stay with the national protocols and the different antibiotic doses for various surgical procedures, further investigations could be conducted to switch the form of national protocols.
    Keywords: Anti-Bacterial Agents, Gastrointestinal neoplasm, Surgery
  • Mohammad Hossein Davari, Toba Kazemi, Masoumeh Saberhosseini Pages 30-34
    Introduction
    Clinical education is one of most important medical education courses in Medicine. Medical education is in turn part of the higher education system that deals with human life, and thereby it is important to pay attention to its quantitative and qualitative aspects. In this study, we aimed to investigate the status of clinical education in ophthalmology ward of Vali-e-Asr Hospital in Birjand before and after an intervention.
    Methods
    This Descriptive-interventional study was conducted on students and interns in the ophthalmology department of Vali-e-Asr Hospital during one year. The number of participants was 30 (on average, 4-6 people per month). A questionnaire was first designed in 5 fields (Reviewing educational activities, studying the educational environment, reviewing patient's records, assessing the duties of trainees, and assessing the duties of interns). The questionnaires were later evaluated by 5 faculty members for validity, and after confirmation, the ophthalmology surgery ward was assessed in 3 months. Interventions were performed by the head and the deputy of the faculty of medicine. Eight months later, assessment was again carried out by the same researcher. The results were encoded and entered into SPSS 15 software and analyzed at the level of P ≤ 0.05 by independent t-test.
    Results
    After intervention in the field of educational activities, the score increased from 6 to 10 (P = 0.13). The educational environment score increased from 7 to 14 (P = 0.002). The mean score of assessments of interns before and after intervention was equal to 8. The mean scores for patient's records improved from 8.23 ± 1.98 to 8.92 ± 1.65 (P = 0.04).
    Conclusions
    The results of this study showed that physical changes in the educational spaces by the authorities can be easily accomplished and the educational environment can be improved by planning. It requires more action however to create changes in educational programs, improve the quality of clinical education, provide emergency training to students, and make plans by authorities.
    Keywords: Education, Ophthalmology, Students, Medical, Evaluation Studies
  • Mahdjoube Goldani Moghadam, Haniye Kazemi Pages 35-40
    Mechanical trauma or developmental disorders can cause an eruptive problem mostly called dilaceration. The prognosis of a dilacerated tooth depends on early diagnosis and appropriate treatment planning. The case presented in this paper is an example of severe dilacerations of a maxillary central incisor which has been treated with early orthodontic intervention.
    Keywords: Tooth, Impacted, Single upper central incisor, Space Maintenance, Orthodontic