مجله مطالعات علوم پزشکی
سال سی و یکم شماره 6 (شهریور 1399)

Postoperative shivering is one of the common complications of surgery in the recovery room, with an incidence rate of about 50-60% in various reports. Postoperative chills usually result in unwanted hypothermia during operation.

In this study, patients were divided randomly (after selecting one of 32 card containing coatings) into intervention group (n=45) and the placebo group (n=45). This was done by anesthesiologist who had no intervention in the study, and anesthesiologist and patients did not receive information about the drugs received and the examination of chills and severity of chills was performed by a person who was not aware of the way of study.

There was a significant difference in the frequency of shivering between the intervention group (fentanyl) and the placebo group (without fentanyl) (p <0.001). There was no significant difference regarding severity of shivering between the intervention group and the placebo group (p = 450.0). There was no significant difference in vomiting between the intervention group and the placebo group (p=.184). There was a significant difference between the intervention group and the placebo group (p = 0.003) with regard to nausea. Because vomiting was only recovered in the placebo group (without fentanyl), there were 2 patients and in the intervention group (fentanyl), vomiting was not recovered at all. Therefore, no significant difference was observed regarding frequency of vomiting between the intervention group and the placebo group. There was no significant difference in the vomiting time between the intervention group and the placebo group (p = 0.69). There was a significant difference between the intervention group and the placebo group regarding pruritus (p <0.001).

Most of the patients who received fentanyl had less shivering during surgery and recovery than those who did not receive fentanyl, and most of the patients who received fentanyl had less nausea during operation and recovery than those who did not receive fentanyl and those who received fentanyl have had more pruritus during operation and recovery than those who did not receive fentanyl. Also, taking fentanyl is effective in itching during surgery and recovery.

 The importance of studying Instruments is so great that some experts in the field of calligraphy; Calligraphy is considered the same as calligraphy Instruments. The field of health, especially University hospitals, is no exception to this, and given its role in promoting peoplechr('39')s health, it is doubly important. Therefore, the purpose of this study was to identify the effective Instruments in developing the outline of Iranchr('39')s University hospitals.

 This research was of applied and developmental type and its general strategy was of the type of mixed methods study. In this study, first qualitative data and then quantitative data were collected and analyzed. In the qualitative section, semi-structured interviews were used to collect data. For data analysis in this section using MAXQDA18 software and thematic analysis method was used. In small quantities; data were collected using a researcher-made questionnaire. The sample size in this section was 148 people. In this section, confirmatory factor analysis was used to validate the model using Smart PLS3 software and the results of reliability, validity, factor structure fit, model quality and alignment were reported.

in this study; the instruments of outsourcing policy formation included 53 codes which were divided into 8 conceptual categories including: organizational Instruments, cultural Instruments, human capital Instruments, structure, geographical locations, management Instruments, legal Instruments and financial instruments. Based on the findings of this study, the good fit value obtained had a favorable coefficient that indicated the overall desirability of the model.

Each type of policy will succeed when it has the right and optimal combination of available Instruments. Many high goals fail because they do not use the right tools in their policies. Therefore, considering the existence of different dimensions of effective instruments in outsourcing of Iranian university hospitals, paying attention to all dimensions can make the outsourcing policy successful and lead the organization to the desired and expected goals. Finally, if the Instruments are properly predicted and selected, the policies will be implemented, otherwise they will be ineffective.

In patients with patellofemoral pain syndrome, the presence of pain, proprioception, and neuromuscular disorders leads to posture control disorder, which causes abnormal distribution plantar pressure. The aim of the present study was to investigate the effect of twelve weeks of sensorimotor exercises on distribution plantar pressure variables and symmetry index in patients with patellofemoral pain syndrome.

This study was conducted with an experimental group (16 patients) and a control group (16 patients). The measurement plantar pressure variables were recorded using plantar pressure variables device in standing position with two legs and open eyes. The experimental group performed sensorimotor exercises for twelve weeks, three times per week and one hour per session and control group did not receive any treatment during this time. SPSS 21 software was used for data analysis and covariance statistical method was utilized.

The twelve weeks sensorimotor exercises reduced pain (p = 0.001), variables of 95% confidence eellipse including, length of minor axis (p = 0.001), length of major axis (p = 0.002), range of sway (p = 0.001), and center of pressure variables including path length (p = 0.001), average speed (p = 0.001), sway of anterior-posterior (p = 0.002), sway of medial-lateral (p = 0.001) and improvement  symmetry in distribution plantar pressure.

It seems that sensorimotor exercises reduce pain, improve proprioception, co-contracting and feed-forward activity, and feedback muscle reduce posture sway and improve symmetry distribution plantar pressure in patients with patellofemoral pain syndrome.

The chronic complications of diabetes are wide-ranging and affect almost all tissues of the body. Cardiac apoptosis is one of the most important cardiac complications of diabetics. The aim of this study was to investigate the effect of aerobic and interval training with astaxanthin supplement on cardiac tissue apoptosis in type 2 diabetic rats.

In this study, 35 Wistar male rats with a mean weight of 197.46 ± 15.55 g were used. Male rats were randomly divided into 7 groups after induction of diabetes, including diabetic control, diabetes sham, diabetes + aerobic exercise + supplement. Diabetes + Interval + Supplement, Diabetes + Interval, Diabetes + Aerobic, Diabetes + Supplement. Nicotine amide and streptozotocin injections were used to induce type 2 diabetes. Interval exercises for 8 weeks with 5 sessions per week with an intensity of 80% vo2max and aerobic exercises with an intensity of about 65 to 75% Vo2max were performed by running on the treadmill. The expression of bax and bcl2 genes was performed with Real-time-PCR technique and data analysis was performed by one-way analysis of variance.

Bcl2 and Bax gene expression in both supplemental aerobic and supplemental interval groups were significantly different from the control group (p <0.05). In addition, a significant difference was observed in Bcl2 and Bax gene expression in the aerobic+supplement group compared to the supplement group (p <0.05). However, no significant difference in bcl2 and Bax gene expression was observed in the interval+Supplement group compared with the supplement group (p <0.05).

Combining both exercise interventions with supplement, especially the combination of supplemental aerobic exercise with the double expression of bcl2 anti-apoptotic index and decreased bax apoptotic index can be used as a treatment to prevent the upward trend of apoptosis in the cardiac tissue of diabetic rats.

Infective endocarditis (IE) is an uncommon infectious disease involving both endocardium and heart valves, which is associated with a high rate of morbidity and mortality. The absence of classical signs/symptoms of IE leads to difficulties in diagnosis of this clinical entity. Being negative-culture and afebrile upon presentation have been reported in some case series.

A 69-year-old Caucasian woman presented with fatigue, tachycardia, and a mild swelling of left-sided knee. About 4 months before the index admission, she had a swelling and aching of left-sided wrist which was improved. Then, she developed a left-sided knee swelling and aching with a limited range of motion which was continued with a right-sided knee arthralgia. The limited range of motion and aching improved within 5-7 days spontaneously. All tests for the detection of brucellosis and rheumatologic diseases were negative. The transesophageal echocardiography revealed a fixed mass sizing 5 8 mm on aortic valve non-coronary cusp suspicious for vegetation in trans-gastric view. Blood cultures were negative at three times before the initiation of empirical antibiotic therapy. She was given ampicillin-sulbactam regimen and the regimen continued for 3 weeks and she discharged home on co-amoxiclave regimen. After a year, echocardiography revealed the resolution of vegetation.

The diagnosis of IE in elderly patients with unspecific signs and symptoms is of great importance in our daily practice. Timely detection and proper management of such cases can improve the outcomes of patients.

Lymphadenitis is a type of inflammatory lymphadenopathy that is caused by the infiltration of inflammatory cells that can occur with or without the formation of abscesses inside the lymph node. Infectious acute lymphadenitis causes are mostly associated with acute viral and bacterial infection. The purpose of this study was to provide a more comprehensive description of the causes and evaluations performed and the effective treatment for patients referred to Shahid Motahari Hospital with cervical infectious lymphadenitis.

This retrospective study was performed on 191 children aged 3 months to 14 years admitted to Urmia Shahid Motahari Hospital who were diagnosed with cervical lymphadenitis between 2013 and 2018. Disease records, biological information, type of antibiotic treatment, aggressive procedure, contrast-enhanced CT scan information, treatment duration, and clinical symptoms were collected and a checklist was filled out.

107 patients (56%) were male and 84 patients (44%) were female. The mean age of patients was 46.65±35.05 months (range 3–168 months). Mean hospitalization duration was 5.54±3.19 days (range 1–22). The most common clinical symptom of the patients referred to the hospital was fever, which was present in 151 patients (79.1%). In 135 patients (70.7%) no aggressive procedure was taken. Abscess drainage was performed in 40 patients (20.9%), mass biopsy in 14 patients (7.3%), and surgery in 2 patients (1%). Thirty-nine patients (20.4%) had cultures that reported negative results in all cases.

The most common diagnosis in children is acute inflammatory lymphadenitis and occurs usually in spring and urban children. It is common in boys under 5 years of age. The most commonly used antibiotic is clindamycin. In cases of abscess, surgical drainage is performed for treatment.

Recent studies have demonstrated an important role for Th-17 lymphocytes and other cytokines in pathogenesis of multiple sclerosis. Although previous studies have demonstrated the anti-inflammatory potential of troxerutin,  the effects of troxerutin on multiple sclerosis have not been studied so far. The present study was carried out to investigate the therapeutic effects of troxerutin on experimental autoimmune encephalomyelitis (EAE) by reducing the production of pro-inflammatory cytokines IL-17, IL-1, TNF-α, and reducing nitric oxide levels and reducing immune cell proliferation.

EAE was induced by MOG35-55 peptide and complete Freundchr('39')s adjuvant in female C57BL/6 mice. The mice were placed in four therapeutic groups of 5. Treatment with troxerutin (135 mg/kg daily) was started in the treatment group when they developed a disability score. Signs of disease were recorded daily until the day 21 when mice were sacrificed. Then, Immune cells were tested to assess proliferation rate, cytokine, and nitric oxide by the 3-(4,5 dimethylthiozol-2-yl)-2,5- diphenyl-tetrazolium bromide (MTT) assay, enzyme-linked immunosorbent assay (ELISA), and Greiss, respectively.

The troxerutin significantly decreased the clinical signs of established EAE. Troxerutin significantly decreased the production of pro-inflammatory cytokines IL-17, IL-1 TNF-α and decreased levels of nitric oxide, while reduced the proliferation of immune cells (p<0.05).

Parallel with decreasing proliferation of Immune cells and cytokine production, troxerutin ameliorated established EAE.

Seizure is a common neurological disease with many therapies, especially antiepileptic drugs being used to treat it. Any adverse effects caused by taking antiepileptic drugs are called antiepileptic side effects. The purpose of this study was to evaluate the side effects of antiepileptic drugs in patients admitted to Shahid Motahari Hospital of Urmia from 2010 until the end of 2016.

This descriptive study was conducted after the approval of the Ethics Committee of Urmia University of Medical Sciences. In this study, 100 epileptic children with complications of antiepileptic drugs admitted to Motahari Pediatric Hospital of Urmia from 2010 to 2016 were studied. The sampling method was census using the keyword drug reaction in patient files. The information was collected through a checklist, which was completed by the project manager based on the information in the patientchr('39')s file. The checklist consisted of 3 sections. The first part included demographic information of patients including age and sex; the second part included targeted information including the number of seizures, type of anticonvulsant drug used; and the third part included targeted information including drug side effects in these patients.

The mean weight SD of the studied patients was 40.09 /1 1.94 kg with a median of 41.50 kg. Most of the adverse events observed in the studied patients were related to skin complications with the frequency of 52 patients (52%). The most common adverse events observed were within the age range of 9 to 10 years with a frequency of 16 patients (16%). Also, there was no significant relationship between the side effects of epileptic drugs and the age of the patients (p = 0.844).

The renal side effects of antiepileptic drugs in males were higher than females, and the skin and liver complications were higher in females, and the most common side effects were observed within the age range of 9 to 10 years. It also has a direct relationship with the duration of drug side effects. Compared to sodium valproate, Phenobarbital has more side effects in children.