مجله دانشکده پزشکی اصفهان
پیاپی 337 (هفته اول امرداد 1394)

Laryngoscopy and endotracheal intubation may produce adverse hemodynamic effects. Magnesium directly contributes to coronary vasodilatation and inhibits the release of catecholamines، thus attenuating the hemodynamic effects during endotracheal intubation. In this study، 120 patients candidates for elective surgery were studied in four groups that received 30، 40 and 50 mg/kg magnesium sulfate، and the same volume of normal saline (control). The patient''s hemodynamic status at baseline، before laryngoscopy، and 1، 3، 5 and 10 minutes after the laryngoscopy were recorded. ST-segment changes and arrhythmias، and the time and duration of laryngoscopy and extubation were evaluated، too. 4 groups were examined for laryngoscopy effects، tachycardia، bradycardia، hypertension and hypotension. The mean heart rate in the three groups had no significant changes compared to the control group، but in systolic and diastolic blood pressure and mean arterial pressure the differences were significant. Laryngoscopy effects in the three groups had no significant differences compared to the controls. Laryngoscopy time and extubation time had no significant changes، too. Arrhythmia and ST-segment changes were not observed. The result of the present study shows that the doses lower than 50 mg/kg (30 and 40 mg/kg) of magnesium can be effective in reducing cardiac complications of laryngoscopy and tracheal intubation.

Brain death، as the loss of all brain functions including functions of the brain stem، is defined as a considerable part of mortality. Care of the patients with brain death is important as these patients are important sources for transplantation. Due to changes made in the brain and other organs، electrolyte، hemodynamic and hemostatic abnormalities have a high prevalence in patients with brain death. The recognition of these disorders is very important to have a correct view about the importance of prevention and management. The aim of this study was assessment of the prevalence of hemodynamic، acid and base، coagulation، electrolytes، and blood glucose abnormalities in patients with brain death on arrival at hospital intensive care unit (ICU). In a cross-sectional study during 2013-2014، the medical records of 119 patients with brain death who were hospitalized in ICUs of Alzahra Hospital، Isfahan، Iran، during 2010-2013 were studied. Hemodynamic، coagulation، electrolytes and glucose abnormalities، and the need for inotropic support for each patient were recorded on the data collection form. The frequency of organ donation in patients was assigned and the obtained data were analyzed using SPSS software. In 92 patients (77. 3%) organ donation was done. Impairment of pH (70. 6%)، prothrombin time (PT) (66. 4%) and international normalized ratio (INR) (58. 0%) were the most common disorders seen in the patients. Impaired glucose and sodium levels were statistically significant in organ donation and not-donation groups. Patients with brain death، due to disturbances in hemodynamic، hemostatic، and coagulation time، lose the ability of organ donation. So، the decision to do organ donation should be made in the shortest possible time.

α-thalassemia is one of the common prevente hematological disorders in the Iranian population; knowing its most common mutations can improve the prenatal diagnosis of the disease. To date of this study، no comprehensive data were available on the prevalence of the disease in Chahar Mahal va Bakhtiari Province، Iran. For the first time، this study investigated the spectrum of α-thalassemia mutations and their correlation with red blood cell (RBC) indices in this region.

128 carriers who resided in the Chahar Mahal va Bakhtiari Province were evaluated for α-thalassemia mutations using gap polymerase chain reaction (GAP-PCR)، amplification refractory mutation system-polymerase chain reaction (ARMS-PCR)، multiplex-ligation-probe-dependent polymerase assay (MLPA) and sequencing methods. The RBC indices were measured. The data were analyzed using chi-square and t tests.

The presence of 6 deletions including α3. 7 (83. 2%)، α20. 5 (5. 9%)، αMED (5%)، α4. 2 (2. 5%)، del Hbz-Hba1 (0. 8%) and HS-40 (0. 8%) as well as the point mutation of Hb-CS (1. 7%) on the α-globin gene were approved. Analysis of correlation between different mean corpuscular volume (MCV) measures and α-thalassemia indicated that 78>MCV>75 was correlated with α3. 7، α4. 2 and Hb-CS mutation and MCV of less than 75 was correlated with α3. 7، α20. 5، αMED، and del Hbz-Hba1. Among the analyzed mutations، the only mutation with 78 < MCV < 80 or low MCV (< 80) and normal (> 27) mean corpuscular hemoglobin (MCH) was α3. 7. Interestingly، mutations with low (< 27) and normal (> 80) MCV were α3. 7 and Hb-CS، respectively.

Together، the data suggested the presence of a positive relationship between α-thalassemia mutations and RBC indices، which could facilitate rapid and efficient screening for these common mutations in the population of Chahar Mahal va Bakhtiari Province.

We measured the sedation level، pain severity and patients’ and surgeon’s satisfaction in phacoemulsification cataract surgery with topical anesthesia and systemic sedation in patients with hairy normal eyebrow.

In a randomized clinical trial study، 32 hairy-eyebrow and 32 normal-eyebrow patients with the age of over 60 years and The American Society of Anesthesiologists (ASA) grade of I or II undergoing phacoemulsification under topical anesthesia (tetracaine 0. 5%) and systemic sedation (1-1. 5 μg/kg intravenous fentanyl) were studied. The intra and postoperative pain severity [based on visual analog scale (VAS)]، sedation score [based on Regional Assistance Mission to Solomon Islands (RAMSI) scale]، mean arterial pressure and pulse rate، and patients’ and surgeon’s satisfaction were evaluated. Data was analyzed using chi-square and t tests.

There was no significant difference between the two groups in age and weight. But، the mean height was significantly lower in hairy-eyebrow patients. The severity of intraoperative pain was significantly higher in hairy-eyebrow patients; the severity of postoperative pain was not significantly different. There was no statistically difference between the groups in sedation score (RAMSI) in different times، patients’ and surgeon’s satisfaction scores during operation، and the mean arterial pressure in 0، 5، 10 minutes.

Our study shows that in cataract surgery under phacoemulsification، hairy-eyebrow patients need more sedative doses of drugs in comparison to normal-eyebrow patients، regarding their higher intraoperative pain severity.

Infectious diseases are the most common diseases in the world that have huge economic losses to the society. Herbal medicines have been used among the population and the physicians for a long time for the treatment of common diseases. These days، due to the increasing resistance of bacteria and fungi to antimicrobial compounds، as well as the side effects of chemical drugs، researchers focus on herbal extracts، essential oil and natural antimicrobial compounds for the treatment of infections. The aim of this review is to introduce antifungal effects of some essential oils or herbal extracts; perhaps by taking advantages of such medications، specialists be persuaded for the use of herbal medicines for the treatment of infectious diseases.