مجله دانشکده پزشکی اصفهان
پیاپی 507 (هفته سوم بهمن 1397)

The greater the ability to accurately estimate the amount of blood loss during surgery, the greater the readiness to deal with possible risks during surgery. Therefore, in this study, we aimed to compare the visual estimation and accurate measurements of the amount of blood loss during surgery in order to make better management of the bleeding during surgery and make proper cares in proper time. 31 patients undergoing surgery who referred to Firoozgar hospital in Tehran, Iran, in 2017 were entered this clinical trial study using simple sampling method. All patients underwent posterior spinal fusion (PSF) surgery. Then, the amount of bleeding during the operation was calculated in two ways: visual estimation and also using a sensitive scale. Data were analyzed via SPSS software using descriptive statistics and Wilcoxon test. The mean age of the participants was 41.4 years old, and the mean weight was 65.2 kg. There was a significant difference between the amount of bleeding calculated as a visual bleeding amount and the bleeding calculated by sensitive scale at the first hour of operation (P < 0.0001), and also at the second hour of operation (P < 0.0001). The amount of blood on the gauzes calculated by visual estimation was significantly lower than the actual estimation. In order to reduce this error, it is recommended that, in assessing the amount of blood on gauzes, in addition to the amount of gauze to be impregnated with the blood, the amount of moisture (moisture) of the gauzes should also be taken into account.

Femoral neck fracture is a common discomfort in elderly people, often caused by osteoporosis and a trauma with low energy, such as falling. Considering that during the time, it seems that the effect of treatment with prosthesis is better than fixation, this study aimed to investigate the treatment outcomes of undisplaced femoral neck fracture treated with cannula screws in patients over 65 years of age. In this retrospective study, 50 elderly patients with undisplaced femoral neck fractures treated with cannula screws were enrolled. The postoperative complications, including avascular necrosis of the femoral head, nonunion, infection, fixation fail, and postoperative outcomes (using the questionnaire Harris) were assessed, and the patients were compared on postoperative outcomes. 20 men and 30 women with an average age of 6.63 ± 71.68 years were enrolled in this study. 46% had high blood pressure, 18% diabetes mellitus, 26% cigarette smoking, 8% avascular necrosis, 12% recurrent surgery, 26% non-union fracture, 18% postoperative infection, and 28% had fixation fail. 9 patients scored excellent and 19 patients received good score from the Harris questionnaire. Moreover, the amounts of avascular necrosis, nonunion fracture, postoperative infection, fixation fail, and mean postoperative walking time were significantly higher in patients with poor treatment results (P < 0.05). The results of the surgery were fairly good in our study according to the Harris scoring system. On the other hand, some complications were reported such as avascular necrosis.

Bullous pemphigoid is one of the most common autoimmune blistering diseases. Incidence of bullous pemphigoid has been estimated 4 new cases per 100000, but new studies show that the incidence rate is increasing. The disease typically happens in the elderly people usually after 70 years. Annual mortality rate for bullous pemphigoid is reported up to 40%. The aim of this study was to evaluate epidemiological features of bullous pemphigoid in center of Iran. This was a cross-sectional study conducted in Alzahra hospital in Isfahan City. 69 patients with bullous pemphigoid hospitalized during the years 2008-2016 were studied. 59.45% of the patients were women. The mean and standard deviation of age was 68 ± 13 and 72 ± 14 years in woman and men, respectively (P = 0.01). Mucosal involvement was seen in 55.4%., and the most common underlying disease was hypertension (23.6%). 15.4% of women and 3.7% of men used furosemide, and the most commonly prescribed drugs were antihistamine (98%), antibiotics (97%), and topical (91%) and systemic (88.4%) corticosteroids, respectively. The mean and standard deviation of the dose of prednisolone was 54 ± 12 mg per day. Rise in serum blood sugar was reported in 30% of patients, and 3.6% of men and 15% of women needed intensive care unit (ICU) admission. 42.9% of men and 44.4% of women had relapse after discharge, and 38.64% of patients died during one-year follow-up. It seems that patients with bullous pemphigoid need careful follow up, especially during treatment, and at least for one year, because of their age (> 60), underlying diseases, type of treatment (corticosteroid use), and high mortality and relapsing rates in the first year after diagnosis.

Gastroesophageal reflux disease (GERD) is a chronic and recurrence disease with increasing prevalence, and selection of the best treatment method has been considered for many years. Proton pump inhibitors (PPIs) are among the basic treatment of this disease; so this study aimed to evaluate the effects of omeprazole, pantoprazole, esomeprazole, and lansoprazole on the symptoms of GERD. This randomized clinical trial study was conducted on 120 patients with GERD. They were randomly divided into 4 groups of 30 and received 40 mg omeprazole, 40 mg pantoprazole, 40 mg esomeprazole, and 30 mg lansoprazole that administered as daily single fasting dose for 8 weeks. The severity of the symptoms of heart burn and regurgitation were signed in the form of a questionnaire (GERD-HRQL) at the time of the before study and at the 2nd, 4th, and 8th weeks of treatment. The collected data were analyzed and compared between the four groups using SPSS software. There was no significant difference in the mean of heart burn and regurgitation severity before intervention and during the 2nd, 4th, and 8th weeks of treatment between the four groups (P > 0.050). But, there were significant reductions in each group comparing these symptoms between the 0 and 8 weeks of treatment (P < 0.001). There is no significant difference between the four medications omeprazole, lansoprazole, esomeprazole, and pantoprazole in reducing GERD symptoms, and all of them could decrease the severity of general symptoms by time.

The critical-care pain observation tool (CPOT) is a standard visual method for determining the pain intensity of intubation. This study aimed to evaluate the severity of pain in patients under mechanical ventilation in the intensive care unit (ICU) of Alzahra educational hospital, Isfahan, Iran, based on CPOT criteria. In this cross-sectional study, 170 ICU-hospitalized patients under mechanical ventilation were enrolled, and their pain and CPOT scores were obtained. Then, the correlation of pain with other influential factors was evaluated. 135 patients (79.41%) had pain, and the mean CPOT score was 4.06 ± 1.46 among the patients. There was a significant relationship between the presence of pain and the cause of admission (P < 0.001). There was a significant positive correlation between the Glasgow coma scale (GCS) and CPOT (r = 0.24, P = 0.001). There was a significant relationship between the cause of hospitalization in patients and CPOT score (P < 0.001), too; so that CPOT scores were higher in postoperative, heart diseases, trauma, burn, brain damage, and respiratory diseases, respectively. The CPOT index is a good method to determine the severity of pain after intubation in patients admitted to ICU, who for any reason, have no ability to speak or express the pain.