Razavi International Journal of Medicine
Volume:2 Issue: 1, Winter 2014

Background: 

Numerous scoring systems have been proposed, and there is an inaccuracy in the anatomical and physiological differences between patients. Injury severity scoring (ISS) is a process by which the complexity of traumatic patients will be reduced to a single number.

The objective of this study was to determine whether ISS scoring along with the sub-categories of the mechanism of injury, age and place where hospital traumatic deaths occurred are able to predict the clinical outcome. Patients and

The database registered accidents (DRAs) were gathered from Trauma Centre of Kamyab Hospital, Mashhad, East of Iran from March 2011 to April 2012. ISS was used to define the major trauma.

15496 traumatic patients referred to the hospital and traumatic deaths occurred in 289 patients. Blunt trauma accounted for 286 (99%) of death and penetrating trauma for only 1%. Our findings concerning the injury pattern, correlation between ISS and time of death suggest that patients who die in the first hour after admission have the highest ISS (average of 70.2); whereas those who die after 72 hours have the lowest ISS.

With regards to the predictive strength of the combination of GCS and ISS, a predictive system for analyzing the clinical outcome may be provided.

Ovarian hyper stimulation syndrome (OHSS) occurs mainly after excessive stimulation of the ovaries by exogenous gonadotropin administered in the context of ovulation induction and in vitro fertilization procedures (iatrogenic OHSS). Spontaneous OHSS is a rare event. Such cases would explain other etiologies except ovulation induction. In this case report, we have presented two cases of OHSS in spontaneously conceived pregnancies.

In this case report, we are going to present two cases of OHSS occurring in spontaneously conceived pregnancies. One of the patients mentioned the history of this syndrome in her sister, and the other one confronted with this syndrome in her second pregnancy. Both of them referred to the hospital with typical symptoms and signs of OHSS. They did not have Polycystic Ovary Syndrome (PCOS) and any other problem in pregnancy. Thrombophilia workup, Tumor markers, renin-aldosterone and thyroid function tests were normal.

The presence of OHSS in spontaneous pregnancy especially in familial pattern may lead us to evaluate some endogenous pathogenic factors.

Pain management after surgery is one the most important proceedings after emergency appendectomy but there have been no studies on this issue.

In this study, effects of intravenous acetaminophen (Apotel) are compared with intravenous pethidine (meperidine) in terms of post-operative pain management. Patients and

In this randomized clinical trial study, forty patients with ASA- class I or II who were candidates for emergency appendectomy were randomly divided into two groups. Induction and maintenance of anesthesia in the two groups were similar. The first group received 15 mg/kg intravenous acetaminophen (Apotel) and the second group received 0.5 mg/kg intravenous meperidine 30 minutes before ending surgery. The patients were asked for post-operative pain control using visual analog scale (VAS) at 1, 2, 6 hours after surgery. They were compared with regard to postoperative analgesic requirements and complications.

VAS (visual analog scale) was higher in the meperidine group than Apotel group (P = 0.006). In the meperidine group, in the first 6 hours after surgery, VAS (visual analog scale) was higher than five and analgesics were administered. VAS in the acetaminophen group was lower in the first 6 hours and the need for analgesic was very low. Analgesic requirements were much lower in the Acetaminophen group. Frequency of ileus was higher in the Apotel group (P = 0.023). The patients were similar regarding other adverse effects.

Administration of intravenous Acetaminophen before ending appendectomy might be more effective than meperidine in postoperative pain management while having fewer complications.

The excessive mobile phones use is a common problem among students, so it is necessary to identify this phenomenon’s  relevant factors in each university for appropriate planning.

The study aim was to determine the prevalence of excessive mobile phone use and its relationship with mental health status  and demographic factors on the students of Gonabad University of Medical Sciences in 2011 - 2012.Patients and

In this cross-sectional study, all 700 students in the university were surveyed and completed demographic  information form, GHQ-28, mobile phone addiction scale (MPAI). The data were analyzed in SPSS-18 software and by Chi-square test, student t-test and ANOVA were used at the significant level of P < 0.05.

The prevalence of excessive mobile phone use was 36.7% on the students. There was a significant relation between the prevalence  of excessive mobile phone use and mental health status in general (P > 0.05), and also somatization (P < 0.05), anxiety and depression specifically (P < 0.05), but no significant relation was found between the excessive mobile phone use and social dysfunction (P < 0.05), and  also sex, age, marital status, settlement, and academic achievement (P < 0.05). But there was also a significant relation between education degree (in MSc and doctoral degree students) and the prevalence of excessive mobile phone (P > 0.05).

According to rather high prevalence of excessive use of mobile phone and existence of significant relation between the prevalence of excessive mobile phone use and mental health problems, it is recommended to improve their mental health status and  acceptable social relationship instead of dependency on mobile phone use that can inreturn reduce the negative effects of excessive  mobile phone use.

Life style change is considered as a factor affecting on the increasing number of subjects with peptic ulcer disease (PUD). Helicobacter pylori (H. pylori) infection is regarded as a risk factor for the mentioned disease.

This study aims to analyze the prevalence of PUD in asymptomatic subjects referring to the check-up clinic of Razavi Hospital and the relation between PUD and H. pylori.

499 asymptomatic subjects who had referred to the Check-Up Clinic of Razavi Hospital from 2006 till 2011 included in this study. Their data including: age, sex, endoscopy report and rapid urease test (RUT) were evaluated and the results of 260 Biopsy were analyzed by SPSS.

The mean age of the subjects was 52 which included 73.1% males and 26.9% females. Positive H. Pylori were reported in 75.2% of males and 24.8% of females. Endoscopy results revealed 57.2% subjects with PUD from which 23% were seen with erosion, 11.6% with gastritis, 11.4% with ulcer, 8% with erythema, 1.6% with sub epithelial hemorrhage, 0.8% with deodenitis and 0.8% with gastroduodenitis. In 72% of  subjects that their endoscopy showed PUD and in 38% of the subjects with normal endoscopy, positive RUT was reported. There was a significant relation between PUD observed in endoscopy and RUT (P = 0.001). In 89.6% of subjects who had PUD in biopsy, 57.7% subjects  had gastritis with positive H. pylori and 13.8% subjects had gastritis without H. Pylori. There was a significant relation between gastritis incidence based on biopsy and RUT (P = 0.001).

The prevalence of PUD is more common in asymptomatic males than females. Regarding the high prevalence of PUD and H. pylori in the population under study and according to other studies, life style change and healthy nutrition are considered as effective factors in PUD prevention. According to the results of this study, the patients with upper GI symptoms should be suspect to PUD and positive H. pylori infection.

Cerebral haemorrhage could complicate post operative course after cardiac surgery, especially after multiple mechanical  valves replacement needing for anticoagulation. The interruption of vitamin K antagonists in this cases, to avoid the enhancement of the cerebral haemorrhage, can be performed with reasonable safety.

We report the case of a patient who underwent mitro-aortic valve replacement with mechanical valves. Postoperative  course was uneventful until the 6th day when he developed paresthesias on the left side and left arm paresis; CT scan showed a sub-cortical cerebral haemorrhage. in the right temporo-parietal area. At that time, he was receiving Enoxaparin (4000 IU/day) and Acenocoumarol (1 mg/day) which were started on the 2nd postoperative day without a loading dose. The patient was then transferred to another hospital where neurosurgery intensive care unit was available; he was conservatively treated without surgery. During his stay at this hospital he  did not receive vitamin K antagonists until February, 7th for a total of 117 days receiving only 4000 IU Enoxaparin daily. He was then reevaluated at our hospital on April 2nd 2008 with transthoracic echocardiography and fluoroscopy: both valves were well functioning with  no major problems.

Withholding anticoagulant therapy after mechanical heart valve replacement due to the severe haemorrhage is a complex  problem that can occur after heart valve surgery. Although it has been shown that interruption of vitamin K antagonists can be performed in patients with mechanical valves with reasonable safety for a short-term period. As the patient transferred to another hospital after the  occurrence of cerebral haemorrhage, he was treated only with low doses of enoxaparin for 117 days. In less than two months after the coumarols resumption, the subsequent reassessment of the valves performed using echocardiography and fluoroscopy confirmed the normal performance of both mitral and aortic valves. In this case, a very long suspension of standard anticoagulant therapy did not affect the performance of mechanical bi-leaflet mitral-aortic prostheses.

Spinal anesthesia is a common procedure in the anesthesia. In some studies it has been shown that chronic use of opioids  is associated with shorter duration of spinal anesthesia when local anesthetics are applied.

This trial was conducted in order to determine effect of fentanyl on the duration of spinal block by bupivacaine in chronic  opium abusers who undergo spinal anesthesia and have lower thresholds for pain.Patients and

This study was a randomized clinical trial in which 50 opium abusers (25 patients in each group) undergoing  lower extremity orthopedic surgeries with spinal anesthesia were selected. The patients were randomly divided into two groups. The study  group received 15 mg hyperbaric bupivacaine 0.5% plus 25 µg fentanyl, while the control group received 15mg hyperbaric bupivacaine 0.5% plus 0.25 mL normal saline.

All randomly selected cases were male (44.7 ± 13.6 year). The mean duration of sensory block was much longer in the study  group (87.8 ± 7.22 minutes) in comparison with the control group (70.47 ± 5.45 minutes) (P < 0.001). There was no statistically significant difference between the two groups regarding their age and duration of surgery.

Bupivacaine administration in spinal anesthesia for spinal block has a shortened duration in comparison to the combination  of bupivacaine and fentanyl in chronic opium abusers.

Rheumatismal mitral stenosis is less common today than it was several decades ago, but it is a common cause of mitral  stenosis (MS) in the developing world. Mitral valve stenosis symptoms include fatigue, palpitations, and Shortness of breath especially  with exertion.

The purpose of this prospective study was to determine the incidence of left atrial (LA) thrombus and the predisposing  factors predicting its developments in patients with symptomatic rheumatismal mitral stenosis who underwent transesophageal  echocardiography (TEE) planed for percutaneous transvenous mitral commissurotomy (PTMC).Patients and

Patients who were referred to perform TEE before mitral balloon valvuloplasty enrolled the study. Data were analyzed by SPSS.

Out of 92 patients, females were 68 (73.91%). Mean age was 43.35 ± 13.94. They were classified into two groups based on the presence  or absence of LA thrombus. Group A consisted of 21 patients (seven men and 14 women) with LA thrombus (mean age of 53.00 ± 15.70 years). Group B consisted of 71 patients (17 men and 54 women) without LA thrombus. There were no statistically significant differences  between the two groups regarding age, sex, LA diameter, LA area, LA smoke, Trans-mitral mean pressure gradient, systolic pulmonary artery pressure, left ventricular ejection fraction and right ventricular function, but patients with LA clot had more LA appendage dysfunction,  more frequent atrial fibrillation rhythm, and smaller mitral valve area (P = 0.020, 0.005 and 0.020 respectively) and the prevalence of MR  was also lower in this group (P = 0.049). In our evaluation there was no statistically significant difference regarding the LA diameter or LA  area in patients with or without LA smoke.

The frequency of left atrial clots increased with the presence of LAA dysfunction, atrial fibrillation rhythm, and smaller  mitral valve area. Presence of MR had protective effects against LA clots.