مجله دانشکده پزشکی اصفهان
پیاپی 585 (هفته اول مهر 1399)

The present study aimed to evaluate the sensory-motor changes in patients undergoing lower limb orthopedic surgery with spinal anesthesia by two drug combinations of ropivacaine plus dexmedetomidine and ropivacaine plus fentanyl.

In a clinical trial study, 90 patients underwent lower extremity orthopedic surgery with spinal anesthesia were selected and randomly allocated in three groups of 30. In the first group, 4.5 ml of ropivacaine 0.5% isobaric plus 5 micrograms of dexmedetomidine in 0.5 cc of distilled water, in the second group, 4.5 cc of isobaric ropivacaine plus 25 micrograms of fentanyl in 0.5 cc distillated water, and in the third group, 4.5 ml ropivacaine 0.5% isobaric in 0.5 cc distillated water was injected. The severity of pain and sensory and motor characteristics of patients were determined and compared between the three groups.

The mean time of onset of sensory motor block in the three groups of ropivacaine-dexmedetomidine, ropivacaine-fentanyl and ropivacaine alone was 9.1 ± 3.0, 11.2 ± 3.2, and 12.5 ± 4.3 minutes, respectively (P = 0.001). The mean time of motor block in the three groups was 10.9 ± 3.3, 14.7 ± 5.1, and 15.8 ± 4.8 minutes, and this time was shorter in the groups of ropivacaine-dexmedetomidine (P < 0.001).

The onset of sensory and motor block was shorter in the ropivacaine-dexmedetomidine group.

Isfahan province is one of the major foci of cutaneous leishmaniasis in Iran, and Ardestan City with 93 foci is one of the infected areas. This study aimed to examine the disease trend in the last seven years considering the environmental and ecological changes in Ardestan.

The present study was a retrospective and census type. 1278 cases enrolled in the study who were diagnosed with the acute form of leishmaniasis in Ardestan during the years 2012-2019, and also had a file in Ardestan health care centers. Patients information about age, sex, residency, occupation, place of work, the month of incidence of illness, duration of illness, number of wounds, nationality and date of incidence were entered in the related checklists.

The highest prevalence of leishmaniasis was observed among young Ardestanian with 20-29 years old and with a rate of 38.4%, and the lowest prevalence rate was observed in Zavareh villages with the rate of 5.0%. Moreover, the incidence of disease was significantly higher in men, natives infected compared to immigrants, and patients who live in urban areas compared to rural areas. In terms of occupation, "housewife/unemployed" had the highest prevalence. Besides, children, adolescents, and young people have the highest frequency. The incidence rate in Ardestan was also estimated 1.2 per thousand people

Although, the rate of incidence has been decreasing during 2012-2018 due to reasons such as carrying out programs to control vectors and reservoirs, but increasing rate of incidence of disease in 2019 in the area shows the importance of public health problem of this endemic disease.

In recent years, human papillomavirus (HPV) test has been approved in triage of women with Atypical Squamous Cells of Undetermined Significance (ASCUS). However, due to the low prevalence of cervical cancer, high costs and limited access to test, the effectiveness of this test in our country is ambiguous.

In a diagnostic accuracy study, 245 women who were diagnosed as ASCUS in cervical cytology based on Bethesda 2001 criteria, were then assessed with colposcopy. Cervical biopsy was taken when needed. They were classified according to the results to high risk [Cervical Intraepithelial Neoplasia (CIN) > 2] or normal. Cobas® HPV Test was conducted for participants. Considering the colposcopy-biopsy as the golden standard, the performance of the HPV test was determined for detecting precancerous lesions.

24 patients had CIN1, 10 patients CIN of 2, and 4 patients had CIN ≥ 3. The sensitivity and specificity of the HPV test was 80% and 77%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) was 12.9% and 98.9%, respectively.

Considering the low prevalence of high-risk lesions in this series of women with ASCUS cytology, and the high NPV of the HPV test, it seems that its application can be helpful in the initial triage of patients with this pathology. In other words, the negative result of this test provides sufficient assurance that there are no precancerous or cancerous lesions.