فهرست مطالب
Journal of Research in Medical Sciences
Volume:18 Issue: 10, Oct 2013
- تاریخ انتشار: 1392/09/09
- تعداد عناوین: 22
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Page 827BackgroundThe aim of this prospective, randomized, single-blinded study was to compare the effects of a carbohydrate drink 400 mL given 2 h before the surgery with preoperative overnight fasting on the gastric pH and residual volume, postoperative nausea and vomiting (PONV) and antiemetic consumption in patients undergoing laparoscopic cholecystectomy.Materials And MethodsForty American Society of Anesthesiologists physical status I-II patients who underwent elective laparoscopic cholecystectomy. Randomized, prospective, controlled study, Gulhane Medical Faculty and Guven Hospital Department of Anesthesiology and Reanimation. Patients were randomly assigned into two groups: Pre-operative carbohydrate drink group (group C, n = 20) and preoperative fasting group (group F, n = 20). Group C was given a 400 mL carbohydrate drink 2 h before to the surgery. The patients of group F were fasted 8 h before the surgery. Both groups were operated under general anesthesia with volatile anesthetics.ResultsHemodynamic parameters, demographic data, gastric acidity and residual volumes were similar for both groups. No complications were observed. PONV and antiemetic consumption was lower in group C compared to group F (P = 0.001). Patient’s satisfaction was higher in group C (P < 0.001).ConclusionThis study showed that pre-operative carbohydrate drink may be used safely and also improves patient’s satisfaction and comfort in patients undergoing laparoscopic cholecystectomy.Keywords: Laparoscopic cholecystectomy, post, operative nausea, vomiting, pre, operative carbohydrate nutrition, pre, operative fasting
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Page 833BackgroundDeodorant products prevent the growth and activity of the degrading apocrine gland bacteria living in the armpit. Common antibacterial agents in the market like triclosan and aluminum salts, in spite of their suitable antibacterial eff ects, increase the risk of Alzheimer’s disease, breast and prostate cancers or induce contact dermatitis. Th erefore, plant extracts possessing antibacterial eff ects are of interest. Th e aim of the present study was to verify the in vitro antimicrobial eff ects of diff erent sage extracts against two major bacteria responsible for axillary odor, and to evaluate the deodorant eff ect of a silicon-based stick containing sage extracts in diff erent densities in humans.Materials And MethodsDiff erent fractions of methanolic extract of Salvia offi cinalis (sage) were evaluated on a culture of armpit skin surface of volunteers through agar microdilution antimicrobial assay. Th en, randomized, doubleblind placebo-controlled clinical trial with the best antibacterial fraction was conducted on 45 female healthy volunteers. Participants were treated with a single dose in four groups, each containing 15 individuals: Group 1 200 g/mL), 2 (400 g/mL), 3 (600 g/ mL) of dichloromethane sage extract, and placebo (without extract). A standard sensory evaluation method for the evaluation of deodorant effi cacy was used before, and two hours, four hours, and eight hours after single application of a deodorant or placebo (ASTM method E 1207-87 Standard Practice for the Sensory Evaluation of AxillaryDeodorancy).ResultsTh e data were analyzed with two factors relating to densities and time. In 45 participants with a mean [± standard deviation (SD)] age of 61.5±11.8 years, statistically signifi cant within-group diff erences were observed before and two, four, and eight hours after deodorant treatment for groups 1, 2, and 3. Groups 1, 2, and 3 had a signifi cantly smaller odor score than placebo after two, four, and eight hours (P < 0.001). In a comparison of diff erent deodorant densities, the interaction eff ect was not signifi cant between deodorant 200 and 400 g/mL, but was signifi cant between 200 and 600 and between 400 and 600 g/mL sage extract sticks (P < 0.001). Before running the sensory evaluation of the deodorant sticks on the subjects, a rabbit skin patch test was used to demonstrate that the formulation had no irritants.ConclusionA single treatment with a stick deodorant containing dichloromethane sage extract of 200, 400, or 600 g/mL concentrations was eff ective in reducing the axillary malodor level compared with the control, in healthy subjects.Keywords: Antibacterial activity, axillary deodorant, sage extract, stick
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Page 840BackgroundThe aim of this study is to verify the effects of the combined and classic training of different isometric rates of force development (RFD) parameters of legs.Materials And MethodsThree groups of female athletes was tested: Experimental group (N = 12), classically trained group (N = 11), and control group (N = 20) of athletes. The isometric “standing leg extension” and “Rise on Toes” tests were conducted to evaluate the maximal force, time necessary time to reach it and the RFD analyzed at 100 ms, 180 ms, 250 ms from the onset, and 50-100% of its maximal result.ResultsThe maximal RFD of legs and calves are dominant explosive parameters. Special training enhanced the RFD of calves of GROUPSPEC at 100 ms (P = 0.05), at 18 ms (P = 0.039), at 250 ms (P = 0.039), at 50% of the Fmax (P = 0.031) and the Fmax (P = 0.05). Domination of GROUPSPEC toward GROUPCLASS and GROUPCONTROL is in case of legs at 100 ms (P = 0.04); at 180 ms (P = 0.04); at 250 ms (P = 0.00); at 50% of the Fmax (P = 0.01) and at the Fmax (P = 0.00); in case of calves at 100 ms (P = 0.07); 180 ms (P = 0.001); at 250 ms (P = 0.00); at 50% of the Fmax (P = 0.00) and at Fmax (P = 0.000).ConclusionDominant explosive factors are maximal RFD of leg extensors and calves, and legs at 250ms. Specific training enhanced explosiveness of calves of GROUPSPEC general and partial domination of GROUPSPEC by 87% over GROUPCLASS, and 35% over GROUPCONTROL.Keywords: Calf muscles, isometric rate of force development, leg extensors, plyometric training, volleyball
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Page 848BackgroundThe presence of metastatic lymph nodes is the most important prognostic factor for gastric carcinoma; however, the optimal system for the accurate staging of lymph node metastasis for patients with gastric cancer remains controversial. This study was designed to compare five systems in relation to the N classification of gastric carcinoma.Materials And MethodsThis multicentric historical cohort study was conducted on 148 patients with M0 gastric adenocarcinoma who underwent gastrectomy in, five referral hospitals in Iran. Lymph nodes were sectioned, stained with hematoxyl in and eosin. The lymph node status was classified according to the five systems which are: The number of involved lymph nodes (TNM staging), metastatic lymph node ratio (N ratio), and the largest involved lymph node size, largest metastatic nest size and largest metastatic nest to lymph node size ratio.ResultsPatients were classified into significant prognostic groups by the five N classification method including the TNM method, N ratio (0, ≤0.15, 0.15-0.4, >0.4), largest involved lymph node size (0, ≤5, 5-11, >11 mm), Largest metastatic nest size (≤1, 1-7.5, >7.5 mm) and largest metastatic nest to lymph node size ratio (≤0.3, 0.3-0.9, >0.9). All of the above systems remained as independently significant prognostic factors in terms of overall and disease free survival time.ConclusionAmong the N staging systems we recommend the metastatic lymph node ratio and largest metastatic nest to lymph node size systems, since they are reproducible, simple, have good survival applicability, have prognostic value and include less stage migration especially in patients whom fewer than 15 lymph nodes are dissected.Keywords: Gastric carcinoma, lymph node metastasis, metastatic nest, staging, TNM system
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Page 855BackgroundSulfur mustard (SM) is an incapacitating chemical warfare agent, which has been widely employed in particular regions including Iran. We investigated and reported delayed biochemical and hematological complications of SM in severely toxic Iranian veterans 23 years after exposure.Materials And MethodsForty-two Iranian veterans, residents of Khorasan Razavi, poisoned by SM, and suffering from clinical complications were investigated. A total of 30 healthy male volunteers were also selected as a control group. Biochemical and hematological variables were measured for the case and control groups. Data were analyzed using a Student’s t-test by InStat software (GraphPad Inc., San Diego, CA) to determine significant differences between the data from the two groups.ResultsThe percentages of reticulocytes were significantly higher in patients 0.82 ± 0.04, P < 0.05). Total protein and albumin levels were significantly lower in veterans (total protein: 7.58 ± 0.07 g/dL, albumin: 4.97 ± 0.04 g/dL, P < 0.01). In addition, we observed a significant increase in serum cholesterol (226.74 ± 5.23 mg/dL, P < 0.01), triglyceride (173.53 ± 17.05 mg/dL, P < 0.05),and gamma-glutamyl transferase (GTT) activity of the patients (44.04 ± 3.35 IU/L, P < 0.05).ConclusionResults showed that SM can cause long-term effects on some biochemical factors of veterans. As many of the functional tests of liver and kidney between two groups were statistically unchanged, it seems that the observed biochemical changes may be secondary to delayed respiratory complications of the patients.Keywords: Albumin, complications, Khorasan Razavi, sulfur mustard, veterans
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Page 860BackgroundDiagnosis and treatment of neuropsychiatric lupus is still a major challenge in clinical practice. We investigated the association between depression and anti-ribosomal P (anti-P) antibodies in a sample of Iranian patients with systemic lupus erythematosus (SLE).Materials And MethodsTh is cross-sectional study was conducted on adult patients with SLE referring to a referral out-patient clinic of rheumatology. Demographic data and clinical data with regards to measuring disease activity with the systemic lupus erythematosus disease activity index were gathered. Anti-P antibodies were measured with the enzyme-linked immunosorbent assay method. Depression severity was measured by the Beck Depression Inventory-II.ResultsOne hundred patients (80% female and 20% male, age = 34.8 ± 10.9 years) were included. Anti-P antibodies were present more frequently in depressed than non-depressed patients (30% vs. 10%, P = 0.015). Depression severity was correlated with anti-P antibodies level only in patients with disease duration of less than 2 years (r = 0.517, P = 0.019). Th ere was no association between the depression severity and disease activity. Binary logistic regression analysis showed age (B = 0.953, CI 95%: 0.914-0.993) and positive anti-P antibodies (B = 4.30, CI 95%: 1.18-15.59) as factors that independently associated with depression.ConclusionWe found an association between depression and presence of anti P antibodies, and also strong correlation between depression severity and anti-P antibodies level in newly diagnosed SLE patients. Depression severity in newly diagnosed SLE patients may refl ect a neuropsychiatric involvement,and in later phases, it is more aff ected by the chronicity of the disease as well as other environmental factors.Keywords: Autoantibody, depression, neuropsychiatric, ribosomal proteins, systemic lupus erythematosus
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Page 865BackgroundMethanol poisoning is one of the most important poisoning due to drinking of illegal and non-standard alcoholic beverage in some countries. Relatively limited studies have been carried out to identify the prognostic factors in methanol poisoning.Materials And MethodsWe performed a retrospective study on acute methanol intoxicated patients, which were admitted on the Loghman Hakim Hospital Poison Center (Tehran, Iran) over a 24-month period. The demographic data, clinical manifestations and paraclinical findings, therapeutic interventions and outcome (survivors with or without complications and non-survivors) were extracted.ResultsWe evaluated 30 patients with methanol poisoning during 2 years. All of the patients were male; with the median age of 25.5 years. Visual disturbances, respiratory manifestations, and loss of consciousness were the most common clinical manifestations on admission time. The results of paraclinical manifestations on admission time were as following: The median of blood methanol level was 20 mg/dL. The median of pH, PaCO2and HCO3 was 7.15, 22.35 mmHg and 7.2 mEq/L, respectively. Hyperglycemia was observed in 70% of the patients and the median of blood glucose was 184.5 mg/dL. In fourteen of the patients hemodialysis was performed. Median duration of hospitalization was 48 h. Nine of the patients died. There was a significant difference between survivors and non-survivors with regard to coma, blood methanol level, and PaCO2 and blood glucose. Furthermore, we did not observe a significant difference between these two groups regarding to pH, HCO3 level, and time interval between alcohol ingestion to hospital admission and beginning of hemodialysis.ConclusionRegarding the results of this study, it can be suggested that coma, PaCO2 and hyperglycemia on admission time could be used as strong predictors of poor outcome.Keywords: Hyperglycemia, methanol, outcome, partial pressure of carbon dioxide, poisoning, prognostic factors
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Page 870BackgroundEtomidate and Propofol are common anesthetic agents. Previous studies say that Etomidate can be used in patients with limited hemodynamic reserve and Propofol can lead to more hemodynamic instabilities. Th is study was performed to explore the cardiovascular response during the induction of anesthesia with Etomidate or for comparison, Propofol in elective orthopedic surgeries.Materials And MethodsTh is study was a double-blinded randomized clinical trial study including patients 18-45 years of age that were admitted for elective orthopedic surgeries in 2012. 25consenting, ASA I (American Society of Anaesthesiologists), patients were evaluated randomly in two groups, and their cardiovascular responses including: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and O2 saturation (O2 sat) were measured before the laryngoscopy, during the anesthesia induction with Etomidate (0.3 mg/kg) in group A and propfol (2 2.5 mg/kg) in group B and at 1, 3, 5,10 min after the induction.ResultsTh ere were no statistical diff erences between both groups regarding gender, age, body mass index, and laryngoscopic grade of patients (P > 0.05). Changes of SBP in the group B was signifi cantly higher (P = 0.019). Furthermore, changes of the DBP was signifi cantly higher in the group B (P = 0.001). Th e changes of MAP was higher in group B (P = 0.008). Hypotension happened in 26.1% of group B and 8% of group A (P = 0.09). Th ere were no signifi cant diff erences among groups A and B in terms of HR (P = 0.47) and O2 sat (P = 0.21), tachycardia (P = 0.6), bradycardia (P = 0.66) and hypertension (P = 0.95).ConclusionSince,patients receiving Etomidate have more stable hemodynamic condition, if there would be no contraindications, it could be preferred over Propofol for general anesthesia.Keywords: Cardiovascular response, etomidate, hemodynamic changes, laryngoscopy, propofol
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Page 875BackgroundAlthough several studies have investigated the association between maternal exposure to air pollution and preterm birth, the results are inconsistent. The aim of this study was to further investigate the relation between maternal exposure to ambient air pollution during pregnancy and the risk of preterm birth and low birth weight (LBW) in an Iranian pregnant population.Materials And MethodsIn this study, we identified 4758 consecutive singleton birth records from one large referral hospital (2010-2012) in Isfahan, Iran. We identified cases of preterm birth and LBW, which were combined with meteorological and air pollution monitoring data. We estimated the effect of air pollution exposure during the entire pregnancy, each trimester, and last month, and preterm birth (gestational age)
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Page 882BackgroundCorneal collagen cross-linking with riboflavin, also known as collagen cross-linking (CXL), involves the application of riboflavin solution to the eye that is activated by illumination with ultraviolet A (UVA) light. We survey here the topographic corneal changes one year after CXL in patients with corneal keratoconus.Materials And MethodsThis prospective randomized clinical trial study comprised 66 patients with progression of keratoconus during one year who were enrolled at Feiz University Referral Eye Center in Isfahan. Before and after the operation, patients were examined with slit lamp and funduscopic examinations and measurement of uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA) was done with a logarithm of minimal angle of resolution (logMAR) scale. Corneal topographic and pachymetry values were derived from Orbscan II. The paired t-test test was used for statistical analyses with SPSS software version 20 (SPSS Inc., Chicago, IL, USA).ResultsAll 66 patients completed postoperative follow-up at 12 months. The mean age of the patients was 22.4 ± 5.4 years (range: 18-29 years). Thirty-six (54.55%) subjects were men and 30 (45.45%) were women. The mean preoperative sphere was −2.66 ± 2.14 diopter (D), the mean cylinder was −3.97 ± 2.29, and the mean spherical equivalent (SE) was −4.64 ± 2.56. Postoperatively, the mean sphere was −2.22 ± 2.57 D, the mean cylinder was −3.60 ± 2.40 D, and SE was −4.02 ± 2.93 D (P = 0.037). SE also demonstrated a mean difference of 0.62 ± 0.37 D significantly (P = 0.006).The mean diameter of preoperative posterior best-fit sphere (BFS) was 6.33 ± 0.35mm (range: 5.51-7.73 mm) before operation, and it improved to 6.28 ± 0.34mm (range: 4.36-6.13 mm) after operation; the difference was significant (P = 0.039).ConclusionOur study showed a significant improvement in topographic corneal changes and refractive results in patients with corneal ectasia after CXL.Keywords: Collagen cross, linking, progressive keratoconus, ultraviolet irradiation
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Page 887BackgroundOne of the methods used for standard setting is the borderline regression method (BRM). This study aims to assess the reliability of BRM when the pass-fail standard in an objective structured clinical examination (OSCE) was calculated by averaging the BRM standards obtained for each station separately.Materials And MethodsIn nine stations of the OSCE with direct observation the examiners gave each student a checklist score and a global score. Using a linear regression model for each station, we calculated the checklist score cut-off on the regression equation for the global scale cut-off set at. The OSCE pass-fail standard was defined as the average of all station’s standard. To determine the reliability, the root mean square error (RMSE) was calculated. The R2 coefficient and the inter-grade discrimination were calculated to assess the quality of OSCE.ResultsThe mean total test score was 60.78. The OSCE pass-fail standard and its RMSE were 47.37 and 0.55, respectively. The R2 coefficients ranged from 0.44 to 0.79. The inter-grade discrimination score varied greatly among stations.ConclusionThe RMSE of the standard was very small indicating that BRM is a reliable method of setting standard for OSCE, which has the advantage of providing data for quality assurance.Keywords: Borderline regression method, objective structured clinical examination, reliability, standard setting
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Page 892BackgroundFractures of distal radius are one of the most common fractures seen by physicians and account for 20% of all fractures seen in the emergency room. Various factors contribute in secondary displacement of fracture fragments after anatomic or near anatomic close reduction and cast immobilization in distal radius fractures. This study was designed to examine the correlation between radiographic outcomes in the closed treatment of unstable distal radius fractures and different risk factors.Materials And MethodsOne hundred and fifty-seven patients were included in this prospective study. There were 107 women and 50 men; with a mean age of 51 ± 16.7 years (range: 20-86 years). During the follow-up in all radiographs, the following variables were analyzed as instability factors: (1) Age, (2) gender, (3) radial shortening, (4) dorsal comminution, (5) articular step-off, (6) radial inclination, (7) associated ulna fracture, and (8) dorsal angulation.ResultsBased on the radiographic criteria for an acceptable reduction, 92 patients (58.6%) failed to maintain an acceptable reduction and classified as group I, while in 65 patients 41.4%), the postoperative radiographs were within an acceptable range and classified as group II. The mean age of patients in group I was higher than group II (P < 0.001). Radial shortening of more than 6.5 mm, loss of radial inclination of more than 6.5 degrees, and age above 52 at presentation were the most important predictive factors for instability.ConclusionAmong the variables, the most important predictors of redisplacement after an acceptable closed reduction were loss of radial height, loss of radial inclination, and age.Keywords: Distal radius fracture, instability, predictors, radiographic outcomes
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Page 897Backround: We aimed to evaluate analgesic efficacy, opioid-sparing, and opioid elated adverse effects of intravenous paracetamol and intravenous dexketoprofen rometamol in combination with iv morphine after total abdominal hysterectomy.Materials And MethodsSixty American Society of Anesthesiologist Physical tatus Classification I-II patients scheduled for total abdominal hysterectomy were nrolled to this double-blinded, randomized, placebo controlled, and prospective study. atients were divided into three groups as paracetamol, dexketoprofen trometamol, and lacebo (0.9% NaCl) due to their post-operative analgesic usage. Intravenous patient controlled analgesia morphine was used as a rescue analgesic in all roups. Pain scores,hemodynamic parameters,morphine consumption, patient atisfaction, and side-effects were evaluated.ResultsVisual Analog Scale (VAS) scores were not statistically significantly ifferent among the groups in all evaluation times, but decrease in VAS scores was tatistically significant after the evaluation at 12th h in all groups. Total morphine onsumption (morphine concentration = 0.2 mg/ml) in group paracetamol(72.3 ± 38.0 l) and dexketoprofen trometamol (69.3 ± 24.1 ml) was significantly lower than group lacebo (129.3 ± 22.6 ml) (P < 0.001). Global satisfaction scores of the patients in group placebo was significantly lower than group dexketoprofen trometamol after surgery and the increase in global satisfaction score was significant only in group placebo.ConclusionDexketoprofen trometamol and Paracetamol didn’t cause significant change on pain scores, but increased patients’ comfort. Although total morphine consumption was significantly decreased by both drugs, the incidence of nausea and vomiting were similar among the groups.According to results of the present study routine addition of dexketoprofen trometamol and paracetamol to patient controlled analgesia morphine after hysterectomies is not recommended.Keywords: Hysterectomy, multimodal treatment, NSAIDs, paracetamol
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Page 904BackgroundBenign joint hypermobility syndrome (BJHS) is a disorder due to laxity of supporting connective tissue of joints. Inguinal hernia is also proposed due to weak supporting tissue that may be a clinical presentation of a more widespread problem of connective tissue.Materials And MethodsIn a cross-sectional study, prevalence of benign hypermobility joint syndrome (BHJS) was assessed among 100 children aged 2-12 year admitted with inguinal hernia during 2010-2011.ResultsBJHS (Beighton score ≥ 4) were detected in most of children (92%) with inguinal hernias.ConclusionBHJS amongst this population was substantially greater than reported prevalence in healthy children and due to subsequent clinical significances; it is worthy to screen such patient s for BHJS.Keywords: Inguinal hernia, joint hypermobility, pediatric
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Page 906Stroke scales can be classified as clinicometric scales and functional impairment, handicap scales. All studies describing stroke scales were reviewed by internet searching engines with the final search performed on January 1, 2013. The following string of keywords was entered into search engines; stroke, scale, score and disability. Despite advantages of modified National Institute of Health Stroke Scale and Scandinavian stroke scale comparing to the NIHSS, including their simplification and less inter-rater variability; most of the stroke neurologists around the world continue using the NIHSS. The modified Rankin scale (mRS) and Barthel index (BI) are widely used functional impairment and disability scales. Distinction between grades of mRS is poorly defined. The Asian stroke disability scale is a simplified functional impairment, handicap scale which is as valid as mRS and BI. At the present time, the NIHSS,mRS and BI are routine stroke scales because physicians have used to work with these scales for more than two decades, although it could not be an acceptable reason. On the other side, results of previous stroke trials, which are the basis of stroke management guidelines are driven using these scales.Keywords: Disability, scale, score, stroke
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Page 911Duplication of inferior vena cava (IVC) is a rare fi nding in radiologic studies and its coincidence with thrombosis is even rarer. Here we described a rare case with duplicationof IVC and symptomatic venous thrombosis of her lower extrimity.Keywords: Computed tomography, double inferior vena cava, inferior vena cava, venous anomaly, venous thrombosis
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Page 914Primary choriocarcinoma of the uterine cervix is an extremely rare disease. The clinical diagnosis of cervical choriocarcinoma is difficult, because of its rarity and being non-specific abnormal vaginal bleeding the most common symptom. In the present report,the authors present a case of cervical choriocarcinoma, which was initially misdiagnosed as a cesarean section scar ectopic pregnancy. Remission of cervical choriocarcinoma was accomplished with the combination of hysterectomy and chemotherapy.Keywords: cesarean section scar, choriocarcinoma, ectopic pregnancy
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Page 918A 30-year-old African woman in Kenya succumbed to severe swollen regional lymph nodes, development of painful boils and ulcer formation and rashes at specific tick-biting sites together with an intermittent fever and headache following repeated tick bites of Rhipicephalus pulchellus. She later developed nuchal lymphadenopathy-like condition and an eschar with edematous margins at bitten sites. A sustained high fever and fatigue then followed. She became well after treatment with antibiotics and topical application of anti-histamine daily for a week. This pose dangers of emerging tick-borne pathogens such as this one as their epidemiology, biology,socio-economics and prognosis remain unknown.Keywords: Human host, inflammation, Rhipicephalus pulchellus, tick bites, tick, borne pathogens
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