مجله دانشکده پزشکی اصفهان
پیاپی 255 (هفته اول آذر 1392)

Electroconvulsive therapy (ECT) is a medical treatment used in serious mental illnesses، in which a small amount of electricity passed the brain. The hemodynamic side effects include an initial parasympathetic response causing transient bradycardia، followed by a sympathetic discharge resulting in tachycardia، hypertension and a risk of arrhythmias. The aim of this study was to determine the effect of different doses of magnesium sulfate on cardiovascular response after electroconvulsive therapy. This clinical-trial، double-blind، randomized study was held cross over on 35 patients in electroconvulsive therapy (ECT) center of Noor hospital in Isfahan، Iran، in 2011. Each patient was randomly assigned to be allocated twice into each of the four test groups which received placebo (control) or 10 (second)، 20 (third)، or 30 (forth) mg/kg of MgSo4. Systolic and diastolic arterial blood pressures، heart rate and oxygen saturation values were recorded on arrival for the ECT and then at 0، 1، 3 and 10 minutes after the end of the ECT-induced seizure. Mean systolic blood pressure at 0، 1 and 3 minutes after the end of the ECT-induced seizure of the second (126. 140 ± 20. 937، 122. 710، ± 18. 524، and 115. 710 ± 17. 504 mmHg، respectively) and third (123. 000 ± 18. 077، 123. 710 ± 14. 770، and 116. 290 ± 14. 201 mmHg، respectively) groups were statistically different compared to controls. Besides، mean diastolic blood pressure at 0، 1 and 3 minutes after the end of the ECT-induced seizure of the second group (76. 000 ± 10. 304، 74. 430 ± 9. 669، and 76. 140 ± 9. 082 mmHg، respectively) were statistically different compared to control group. Mean arterial blood pressure (MAP) at 0، 1 and 3 minutes after the end of the ECT of the second (92. 140 ± 12. 237، 90. 710 ± 12. 328، and 89. 330 ± 12. 425 mmHg، respectively) and third (91. 670 ± 11. 602، 90. 860 ± 10. 905، 89. 520 ± 9. 873 mmHg، respectively) groups compared with the control group were statistically different، too. Heart rate and arterial oxygen saturation at different times in the four groups were not statistically different. Based on the results of this study، magnesium sulfate with doses of 20 and 30 mg/kg attenuated the systolic and diastolic blood pressure and mean arterial blood pressure (MAP) response of electroconvulsive therapy without reducing the duration of seizure activity.

The purpose of this study was investigating the relationship of obstructive sleep apnea (OSA) and erectile dysfunction (ED) in patients referred to specialized sleep clinic. 77 patients with chief complain of erectile dysfunction referred to one specialized sleep clinic by urologists or legal authorities were investigated if they had obstructive sleep apnea. They were monitored for 8 hours in view of erection، apnea، electrocardiogram، pulse oximetry and polysomnography. Tests confirmed that erectile dysfunction and obstructive sleep apnea had no meaningful relationship (P > 0. 05). In our study، the relationship between erectile dysfunction and obstructive sleep apnea was not meaningful but we understood that some psychological factors are effective for erectile dysfunction. It is suggested to study organic factors responsible for erectile dysfunction.

Etomidate has been used to induce anesthesia with minimum changes in hemodynamic profile in many surgeries. Nevertheless، its infusion for sedation during cataract surgery has been less evaluated. In a double-blind clinical trial study، 64 patients candidate for cataract surgery under sedation were randomly assigned to receive eitheretomidate-fentanyl (E/F) or ketamine-midazolam-fentanyl (K/M/F) combinations. Systolic and diastolic blood pressures، heart rate، oxygen saturation (SaO2)، nausea and vomiting، movement frequency، sedation score، recovery duration، and patients'' and surgeon''s satisfaction were recorded during the surgeries. No statistically significant differences were observed in basic systolic and diastolic blood pressures and heart rate between the groups. But، mean systolic and diastolic blood pressures were significantly higher in K/M/F group during and after the surgery (P < 0. 050). Systolic and diastolic blood pressures and heart rate did not have significant difference in E/F group (P > 0. 050) during surgery but there was significant difference in K/M/F group (P < 0. 050). SaO2 in recovery was significantly higher in E/F group (P < 0. 001). Incidence of nausea، vomiting and movement episodes، sedation score، and patients'' and surgeon''s satisfaction were the same in both groups. Recovery duration was significantly less in E/F group (P < 0. 001). Combination of etomidate and fentanyl for sedation could be as efficient and safe as ketamine، midazolam، and fentanyl combination in cataract surgery، with less hemodynamic profile changes and recovery time.

Optical coherence tomography (OCT) is a progressively important modality for the noninvasive management of retinal diseases، including age-related macular degeneration (AMD)، glaucoma، and diabetic macular edema. Spectral domain OCT (SD-OCT) generates 3-dimensional (3-D) volumes، which have proven to be useful in clinical practice. In this regards، forming projection images limited to each layer of retina not only represents information of each layer but also، it would individually display the amount of vulnerability in the each layer caused by a specific disease.

In the first step، a projection image associated with 11 retinal layers was formed with merging the levels and voxels between each pair of boundaries by using different statistical indicators including average، mean، maximum and minimum. Then، retinal layers with more information through statistical indicators were fused with each other to gain an image without any noise and other deficiencies to possess a better clarify and contrast of specific information in X-Y axis.

Using different statistical methods such as average، mean، maximum، minimum and variance، projection images associated with each layer of retina were gotten. Each of these methods made better images in the specific layers than other methods used in the next steps. Fusing of layers with each other was also provided appropriate information from retinal depth in different parts. Contrast enhancement of images related with layers of fused images and creating more complete coordinate of vessels presence were important characteristics of final image.

Resulting projection image would be used more effectively in the extraction of important characteristics of retina including vessels extraction as well as determination of confinement and the center of macular region. Moreover، newer multi-resolution transforms such as curvelet transform would be used to obtain better final fused image.

Midkine (MK) is a heparin-binding growth factor with various effects in induction of neurodegenerative diseases and promotes inflammatory responses by enhancing the migration of inflammatory leukocytes. This study aimed to determine the relationship of Midkine protein and clinical course of multiple sclerosis (MS). In 32 patients with MS and 32 Age- and sex-matched healthy people، the serum level of Midkine and other cytokines (IL10، IL17، IL23 and TGF-β) were determined by enzyme-linked immunosorbent assay (ELISA) method and compared. Midkine level in patients with MS was significantly lower than healthy control. In addition، there were significant differences between IL10، IL23 and TGF-β levels in patients with MS and the healthy people. It seems that the significant lower level of Midkine in patients with MS is because of IFN-β treatment for them during this research.