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Soudeh Ghafouri-Fard , Mehdi Dianatpour , Seyed Mohammad Bagher Tabei, Mohammad Miryounesi ,
Volume 74, Issue 11 (2-2017)
Volume 74, Issue 11 (2-2017)
Abstract
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Background: Mental retardation is defined as impaired mental capacity and ability to comply with environmental and social conditions. Chromosomal abnormalities are the most important causes of mental retardation. Carriers of balanced chromosomal translocation are phenotypically normal, although they may be at risk of infertility, recurrent miscarriage or giving birth to mentally retarded children. These abnormalities are caused because chromosomes participated in the reciprocal translocations produce quadrivalents at meiosis. These quadrivalents segregate and lead to several different meiotic outcomes, just two of which are normal or balanced. Case Presentation: A consanguineous family with three mentally retarded daughters at the ages of 24, 18 and 10 years was referred to Comprehensive Medical Genetics Centre, Shiraz, Iran in 2015. Family history showed a case of unexplained infant death as well as a spontaneous abortion. Three survived siblings had hypotonia and severe developmental delay during infantile period. In addition, they suffer from primary amenorrhea. Two siblings have vesicoureteral reflux (VUR). Cytogenetic analysis of two patients showed 46,XX,t(6;12)(q23;q22),der(9)t(8;9)(q24;p24) with partial monosomy of chromosome 9 and partial trisomy of 8q24 segment, while the other patient had 46,XX,der(12)t(6;12)(q23;q22) with partial monosomy of 12q22qter and partial trisomy of 6q23qter segment. Their mother had two balanced chromosomal translocations (46, XX, t(6,12)(q21;q22), t(8,9)(q24;p24)). Conclusion: The above presented case is another example for the rare occurrence of double balanced chromosomal translocations in a phenotypically normal person. Although the most important causes of mental retardation in consanguineous marriages are autosomal recessive disorders, the role of chromosomal aberrations in mental retardation in these families must not be neglected. In other words, cytogenetic studies should be performed as a first line test in either situation. |
Zahra Raeisi , Pantea Ramezannezad , Marzieh Ahmadzade , Shahram Tarahomi ,
Volume 75, Issue 1 (4-2017)
Volume 75, Issue 1 (4-2017)
Abstract
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Background: One of the today most common and incurable diseases that is associated with central neural system is ‘MS’ disease. Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. In this disease become apparent a wide spectrum of symptoms such as lose muscles control and their coordination and vision derangement. The goal of this research is to consider to two problems: 1- Recognition of effective clinical symptoms on MS disease and 2- Considering levels of effectiveness of age, sex and education levels factors on MS disease and association between these factors according to verity of categories of this disease. Methods: Data mining science in medicine is worthy of attention with main application in diagnosis, therapy and prognosis, respectively high volume of collected datum. The data that were used in this article are about patients of Chaharmahal and Bakhtiari Province and collected by cure assistance. In this paper classification and association methods in software engineering field are used. Classification is a general process related to categorization, the process in which ideas and objects are recognized, differentiated, and understood. Association rules are created by analyzing data for frequent if/then patterns and using the criteria support and confidence to identify the most important relationships. Results: In consideration of first problem in this paper, concluded vision-clinical symptoms are the most effective symptoms and in consideration of second problem, concluded that from 584 records, women affected four times more than men. In other word 70% of MS patients with high graduate are in relapsing-remitting category and 62.5% of MS patients are 20-40 years old. Conclusion: Some of symptoms are quite temporary and transitory and are ignored by people. Awareness of clinical-symptoms prevalence manner can be warning for people before starting critical cycle of illness. This would cause early diagnosis, effective therapy and even prevention of disease progress, respectively to MS chronicity. |
Alireza Mahoori , Ebrahim Hassani , Nazli Karami , Mehrdad Azizpoure ,
Volume 75, Issue 5 (8-2017)
Volume 75, Issue 5 (8-2017)
Abstract
Background: Tracheal intubation and direct laryngoscopy are powerful noxious stimuli that can elicit sever hemodynamic responses. These hemodynamic responses should be attenuated by appropriate use of premedication, smooth induction of anesthesia and rapid tracheal intubation. Gabapentin and pregabalin have been suggested in several studies to be efficient. Gabapentin is an antiepileptic drug and a structural analogue of gamma-Aminobutyric acid (GABA) but it does not act through GABA receptors and pregabalin, is also an antiepileptic agent. The aim of this study was to compare the effect of gabapentin and pregabalin as premedication for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation.
Methods: In a prospective double blinded randomized clinical trial, during April 2015 to March 2016 in Urmia Imam Khomeini Hospital, a total of ninety normotensive adult consented patients, candidate to elective abdominal surgery aged 20-50 years, American Society of Anesthesiologist (ASA) class I, of both gender were randomized into three groups. Patients in group I received oral placebo, group II received oral gabapentin 900 mg and group III patients received oral pregabalin 150 mg two hours prior to induction of anesthesia. Anesthetic technique was same in three groups and all groups were assessed for hemodynamic changes such as heart rate, systolic blood pressure and diastolic blood pressure, after the premedication, before and after induction of anesthesia, and 1, 3 and 5 minutes. after laryngoscopy and tracheal intubation.
Results: Significant increase in heart rate and systolic blood pressure and diastolic arterial pressure was observed in placebo group after tracheal intubation, while statistically significant attenuation of hemodynamic changes was seen in gabapentin and pregabalin groups. (P=0.001) No adverse outcome was reported in the study groups.
Conclusion: Oral gabapentin premedication is effective for control of hemodynamic pressor response of laryngoscopy and tracheal intubation. The study data showed that the pregabalin have the same effect. Pregabalin and gabapentin are both useful and safe for control of hemodynamic pressor response as premedication.
Methods: In a prospective double blinded randomized clinical trial, during April 2015 to March 2016 in Urmia Imam Khomeini Hospital, a total of ninety normotensive adult consented patients, candidate to elective abdominal surgery aged 20-50 years, American Society of Anesthesiologist (ASA) class I, of both gender were randomized into three groups. Patients in group I received oral placebo, group II received oral gabapentin 900 mg and group III patients received oral pregabalin 150 mg two hours prior to induction of anesthesia. Anesthetic technique was same in three groups and all groups were assessed for hemodynamic changes such as heart rate, systolic blood pressure and diastolic blood pressure, after the premedication, before and after induction of anesthesia, and 1, 3 and 5 minutes. after laryngoscopy and tracheal intubation.
Results: Significant increase in heart rate and systolic blood pressure and diastolic arterial pressure was observed in placebo group after tracheal intubation, while statistically significant attenuation of hemodynamic changes was seen in gabapentin and pregabalin groups. (P=0.001) No adverse outcome was reported in the study groups.
Conclusion: Oral gabapentin premedication is effective for control of hemodynamic pressor response of laryngoscopy and tracheal intubation. The study data showed that the pregabalin have the same effect. Pregabalin and gabapentin are both useful and safe for control of hemodynamic pressor response as premedication.
Babak Mostafazadeh , Mohammad Hosien Kamaloddini , Fares Najari ,
Volume 75, Issue 6 (9-2017)
Volume 75, Issue 6 (9-2017)
Abstract
Background: The death certificate is a document consisting of the deceased individual’s basic information and identification which is filled out, registered and signed by a doctor. the World health organization’s policies in their health planning, provide a suitable database with knowledge of the required elements for planners and other authorized information demanders. During a multi-year cooperation between various organizations, the first uniformed death certificate according the ICD-10 standard got published in the country in the year 2004.
Methods: This is a retrospective study which is about all of the deceased individuals in Tajrish and Modares Tehran hospitals from april 2013 until the march 2014 who had death certificates. In this study the data related to 777 individual’s death certificates and medical files was analyzed. The sampling method was census and all the cases in the study’s time period who had death certificates were studied. The cases that had a gap in their required information were ruled out of the study. The data that included age, sex, place of death, issuing doctor’s expertise, general information and the cause of death was extracted from the archived files.
Methods: This is a retrospective study which is about all of the deceased individuals in Tajrish and Modares Tehran hospitals from april 2013 until the march 2014 who had death certificates. In this study the data related to 777 individual’s death certificates and medical files was analyzed. The sampling method was census and all the cases in the study’s time period who had death certificates were studied. The cases that had a gap in their required information were ruled out of the study. The data that included age, sex, place of death, issuing doctor’s expertise, general information and the cause of death was extracted from the archived files.
| Results: The cases studied, 421 people died in Tajrish Hospital and 356 in Modarres Hospital. The highest number of deaths in both hospitals were in the internal wards (336 cases) and surgery (168 people). 45.6% of death certificates have been issued by a forensic expert. 64.8% cases correctly inserted ICD-10 code. Conclusion: Training of physicians for the importance of death certificate and how it should be completed is very important. This research showed that in the cases which the death certificates were completed by the hospital forensic medicine specialists were more useful and accurate. |
Hossein Ghayoumi Zadeh, Mostafa Danaeian, Ali Fayazi , Farshad Namdari, Sayed Mohammad Mostafavi Isfahani ,
Volume 76, Issue 1 (4-2018)
Volume 76, Issue 1 (4-2018)
Abstract
Background: One common symptom of diabetes is diabetic retinopathy, if not timely diagnosed and treated, leads to blindness. Retinal image analysis has been currently adopted to diagnose retinopathy. In this study, a model of hierarchical self-organized neural networks has been presented for the detection and classification of retina in diabetic patients.
Methods: This study is a retrospective cross-sectional, conducted from December to February 2015 at the AJA University of Medical Sciences, Tehran. The study has been conducted on the MESSIDOR base, which included 1200 images from the posterior pole of the eye. Retinal images are classified into 3 categories: mild, moderate and severe. A system consisting of a new hybrid classification of SOM has been presented for the detection of retina lesions. The proposed system includes rapid preprocessing, extraction of lesions features, and finally provision of a classification model. In the preprocessing, the system is composed of three processes of primary separation of target lesions, separation of the optical disk, and separation of blood vessels from the retina. The second step is a collection of features based on various descriptions, such as morphology, color, light intensity, and moments. The classification includes a model of hierarchical self-organized networks named HSOM which is proposed to accelerate and increase the accuracy of lesions classification considering the high volume of information in the feature extraction.
Results: The sensitivity, specificity and accuracy of the proposed model for the classification of diabetic retinopathy lesions is 98.9%, 96.77%, 97.87%, respectively.
Conclusion: These days, the cases of diabetes with hypertension are constantly increasing, and one of the main adverse effects of this disease is related to eyes. In this respect, the diagnosis of retinopathy, which is the same as identification of exudates, microanurysm and bleeding, is of particular importance. The results show that the proposed model is able to detect lesions in diabetic retinopathy images and classify them with an acceptable accuracy. In addition, the results suggest that this method has an acceptable performance compared to other methods.
Methods: This study is a retrospective cross-sectional, conducted from December to February 2015 at the AJA University of Medical Sciences, Tehran. The study has been conducted on the MESSIDOR base, which included 1200 images from the posterior pole of the eye. Retinal images are classified into 3 categories: mild, moderate and severe. A system consisting of a new hybrid classification of SOM has been presented for the detection of retina lesions. The proposed system includes rapid preprocessing, extraction of lesions features, and finally provision of a classification model. In the preprocessing, the system is composed of three processes of primary separation of target lesions, separation of the optical disk, and separation of blood vessels from the retina. The second step is a collection of features based on various descriptions, such as morphology, color, light intensity, and moments. The classification includes a model of hierarchical self-organized networks named HSOM which is proposed to accelerate and increase the accuracy of lesions classification considering the high volume of information in the feature extraction.
Results: The sensitivity, specificity and accuracy of the proposed model for the classification of diabetic retinopathy lesions is 98.9%, 96.77%, 97.87%, respectively.
Conclusion: These days, the cases of diabetes with hypertension are constantly increasing, and one of the main adverse effects of this disease is related to eyes. In this respect, the diagnosis of retinopathy, which is the same as identification of exudates, microanurysm and bleeding, is of particular importance. The results show that the proposed model is able to detect lesions in diabetic retinopathy images and classify them with an acceptable accuracy. In addition, the results suggest that this method has an acceptable performance compared to other methods.
Atiyeh Vatanchi , Leila Pourali , Mona Jafari ,
Volume 76, Issue 2 (5-2018)
Volume 76, Issue 2 (5-2018)
Abstract
Background: Laparoscopy is an acceptable procedure for cholecystitis in pregnancy. Laparoscopic complications during pregnancy can be unique. Uterine perforation is a rare complication during laparoscopy of pregnant women. Acquaintance with this complication can help surgeons and gynecologist to manage these patients properly. We will report a case of uterine perforation during laparoscopy.
Case presentation: Our patient was a 24-year pregnant woman with gestational age of 28 weeks. She had nausea and vomiting and right upper quadrant tenderness, she was admitted in surgery ward on January 2017 in an academic hospital in Mashhad and candidate for laparoscopic cholecystectomy with diagnosis of cholecystitis. Her fundal height was 28 centimeters. Laparoscopy was done with Hasson technique and three punctures. During abdominal trocar insertion uterine perforation occurred. Amniotic fluid leaked in the abdomen. Perforation repaired immediately and then cholecystectomy was done. Fetal heart rate was normal. After surgery according to stable vital signs and absence of bleeding and contraction, the patient was transferred to the midwifery department. The patient received one course of betamethasone for fetal lung maturation. Antibiotic therapy initiated. During the hospitalization, the patient was monitored daily for vital signs (fever and tachycardia), uterine contraction, vaginal bleeding and vaginal bleeding. Daily fetal heart monitoring was performed. After close prenatal care cesarean section was done in 38 weeks of pregnancy and a healthy baby was born with appropriate Apgar score.
Conclusion: Laparoscopy in pregnant women is usually safe. Pregnancy-specific complications such as uterine injury are not common, but with a series of precautions before and during surgery. These complications can be reduced. Uterine perforation during laparoscopy if properly managed is usually not associated with significant risk.
Case presentation: Our patient was a 24-year pregnant woman with gestational age of 28 weeks. She had nausea and vomiting and right upper quadrant tenderness, she was admitted in surgery ward on January 2017 in an academic hospital in Mashhad and candidate for laparoscopic cholecystectomy with diagnosis of cholecystitis. Her fundal height was 28 centimeters. Laparoscopy was done with Hasson technique and three punctures. During abdominal trocar insertion uterine perforation occurred. Amniotic fluid leaked in the abdomen. Perforation repaired immediately and then cholecystectomy was done. Fetal heart rate was normal. After surgery according to stable vital signs and absence of bleeding and contraction, the patient was transferred to the midwifery department. The patient received one course of betamethasone for fetal lung maturation. Antibiotic therapy initiated. During the hospitalization, the patient was monitored daily for vital signs (fever and tachycardia), uterine contraction, vaginal bleeding and vaginal bleeding. Daily fetal heart monitoring was performed. After close prenatal care cesarean section was done in 38 weeks of pregnancy and a healthy baby was born with appropriate Apgar score.
Conclusion: Laparoscopy in pregnant women is usually safe. Pregnancy-specific complications such as uterine injury are not common, but with a series of precautions before and during surgery. These complications can be reduced. Uterine perforation during laparoscopy if properly managed is usually not associated with significant risk.
a case of acute leukemia with multiple complications due to leukemia and it's treatment: case report
Fatemeh Rajabipour, Negar Sajjadian ,
Volume 76, Issue 4 (7-2018)
Volume 76, Issue 4 (7-2018)
Abstract
Background: Acute leukemia is one of the most common types of childhood malignancies and one fourth of malignancies in this age group is acute leukemia. Acute leukemia may be myeloid or lymphoid. Acute lymphoblastic leukemia is characterized with abnormal proliferation of lymphoid cells and symptoms related to this are acute and if disease is not treated appropriately, it progresses rapidly and end up to death. Diagnosis of these types of malignancies is easily made with evaluation of bone marrow and peripheral blood cells by an expert hematologist. One of the primary sites of leukemic involvement in childhood is oral cavity which is caused by infiltration of leukemic cells in this area. This causes signs and symptoms, for instance, oral lesions gingival hemorrhage and swelling.
Case presentation: We present a 13-year-old girl who was referred to local physician due to toothache and gingival lesions. Some medications were prescribed for her without any improvement. Then excision of this painful gingival lesion was done and diagnosis of acute lymphoblastic leukemia was confirmed. After diagnosis and start of appropriate medical therapy, patient developed many different complications of acute lymphoblastic leukemia and its related therapies. What make this presented case as an outstanding and interesting one is the mentioned complications which were more significant with multiple organ involvement in comparison with similar cases. These complications were treated by appropriate managements.
Conclusion: With new advance in treatment of ALL, survival rate of patients is increased but unfortunately morbidity rate is significant. These complications may be managed by appropriate therapies and close follow-up.
Case presentation: We present a 13-year-old girl who was referred to local physician due to toothache and gingival lesions. Some medications were prescribed for her without any improvement. Then excision of this painful gingival lesion was done and diagnosis of acute lymphoblastic leukemia was confirmed. After diagnosis and start of appropriate medical therapy, patient developed many different complications of acute lymphoblastic leukemia and its related therapies. What make this presented case as an outstanding and interesting one is the mentioned complications which were more significant with multiple organ involvement in comparison with similar cases. These complications were treated by appropriate managements.
Conclusion: With new advance in treatment of ALL, survival rate of patients is increased but unfortunately morbidity rate is significant. These complications may be managed by appropriate therapies and close follow-up.
Kamran Aghakhani , Maryam Ameri ,
Volume 76, Issue 6 (9-2018)
Volume 76, Issue 6 (9-2018)
Abstract
Although electrical energy is one of the best and cleanest energy sources, the proper protection and utilization of it, always and everywhere is problematic. One of the most important problems is electric shock and the dangers that can sometimes be lost in the lives of people. When a body or part of it is completely located in a strong power supply field or a contact with a device that is connected to a high voltage power supply, the person experiences an electrical burn. Electrical burn injuries account for about 5% of beds in large burn centers. The type of complications due to electrical burns varies according to the location of the current flow, its severity and tissue resistance. But usually the most severe physical and emotional complications are in the upper arms and legs of the body. While electrical injuries primarily result in burns, they may also cause fractures or dislocations secondary to blunt force trauma or muscle contractions. In high voltage injuries, most damage occur internally. On the other hand, psychological trauma and subsequent disability and unemployment problems affect the lives of electric burn victims. Understanding and managing the short-term and long-term complications of electrical burns is important in addition to proper and timely treatment of the injured person. Electric current with a high voltage of 1000 Volts causes a wide and deep burn which may not be estimated exactly at the onset of a visit by the doctor and also patient himself. So, it should be mentioned the issues legally, to the patients and their relatives, in terms of the severity of lesions and the complications of probable amputation. On the other hand, because prevention is always better than cure, so appropriate information through the mass media can reduce the number patients and their complications. In this review study, introducing various types of electrical burns and the reported statistics, various complications of electrical burn are discussed. Awareness of the incidence of electrical burns in the population and its various complications can help to plan and manage the problems of electric burn injuries, as well as adopting strategies to prevent these incidents.
Zahra Esfandiari, Mohammad Reza Marasi , Fatemeh Estaki , Vahid Sanati , Elnaz Panahi , Nader Akbari , Roya Alsadat Madani, Jila Mosberian Tanha ,
Volume 77, Issue 1 (4-2019)
Volume 77, Issue 1 (4-2019)
Abstract
Background: Nutrition education and introduction of procedures for choosing healthier food have an important role to reduce the rate of non-communicable diseases. It was shown the amount of risk factors of non-communicable diseases such as energy, salt, sugar, fat and trans fatty acid on the traffic light of food labelling. The status of risk is presented through three colors of red, yellow and green that are the signs of risk, precautious and safe use of food. The object of this study was to evaluate the influence of education on the knowledge, attitude and practices of Isfahan University of Medical Sciences students to the traffic light on food labeling.
Methods: This project was an empirical study performed by random sampling of 379 students of nine schools in Isfahan University of Medical Sciences from January 2017 to March 2018. The knowledge, attitude and practices of students toward the traffic light were assessed by self-administered and structured questionnaire. Education was performed face to face with the usage of pamphlet. In the period of three to six months, questionnaires were refilled out by students to determine knowledge, attitude and practice. Descriptive statistics were calculated using SPSS in mean± SD. Paired t-test was performed to assess the influence of education in total score of knowledge, attitudes and practices in test-retest. P value was considered less than 0.05 as statistically significant.
Results: Before education, the average of scores for knowledge, attitude and practice was 1.12±0.84, 14.44±4 and 2.25±2.2, respectively. Afterwards, the scores were increased to 11.72±0.75, 18.67±3.18 and 17.69±4.7 after education. Significant difference was observed in the scores of knowledge, attitude and practice of students before and after education (P<0.05).
Conclusion: Education of traffic light had a significant role in the improvement of knowledge, attitude and to some extent of practice of students in selection of healthier food.
Methods: This project was an empirical study performed by random sampling of 379 students of nine schools in Isfahan University of Medical Sciences from January 2017 to March 2018. The knowledge, attitude and practices of students toward the traffic light were assessed by self-administered and structured questionnaire. Education was performed face to face with the usage of pamphlet. In the period of three to six months, questionnaires were refilled out by students to determine knowledge, attitude and practice. Descriptive statistics were calculated using SPSS in mean± SD. Paired t-test was performed to assess the influence of education in total score of knowledge, attitudes and practices in test-retest. P value was considered less than 0.05 as statistically significant.
Results: Before education, the average of scores for knowledge, attitude and practice was 1.12±0.84, 14.44±4 and 2.25±2.2, respectively. Afterwards, the scores were increased to 11.72±0.75, 18.67±3.18 and 17.69±4.7 after education. Significant difference was observed in the scores of knowledge, attitude and practice of students before and after education (P<0.05).
Conclusion: Education of traffic light had a significant role in the improvement of knowledge, attitude and to some extent of practice of students in selection of healthier food.
Fahimeh Ghotbizadeh Vahdani , Maryam Deldar Pasikhani , Tahmineh Ezazi , Zahra Panahi ,
Volume 77, Issue 3 (6-2019)
Volume 77, Issue 3 (6-2019)
Abstract
Background: A professional vision at education is necessary, because of the increasing development of technical education in the field of medical education. In the conventional methods, although mastering in the field and being up-to-date is necessary, today, the faculty member must be able to design and implement a group of learning experiences for the students in order to learn and to conduct valid exams.
Methods: Our study was an interventional study, conducted on obstetrics and gynecology residents of the 3rd and 4th year at Tehran University of Medical Sciences in March, 2016. The number of participants was 66. The data collection was performed by a questionnaire. The included 19 questions about the anatomy of pelvic floor. At first, the questionnaires were administered to pre-test students to assess the amount of information before and then the theoretical and practical class about the anatomy of pelvic floor were held. At the end of classes, pre-test questionnaires were returned to residents. The responses to questions before and after the training were analyzed.
Results: Our study was conducted on 66 obstetrics and gynecology residents. Of the 66 subjects, 30 were in the pre-test and 66 were in the post-test. The mean score of residences in the anatomy of the pelvic floor before intervention was 5.388±7.14 and after intervention was 12.57±2.181 (P=0.001). The difference in mean before and after education was significant at all levels of study. The general knowledge scores in the post-test, was significantly (P<0.05) higher than pre-test.
Conclusion: According to our findings, it can be stated that the implementation of scholarship project regarding the knowledge of obstetrics and gynecology residences by the method of theoretical and anatomical teaching of anatomy of pelvic floor increases their knowledge, consequently, increase ability of surgical procedures of the residents and reduce complications. It is recommended that other education centers use a similar method to educate obstetrics and gynecology residents.
Methods: Our study was an interventional study, conducted on obstetrics and gynecology residents of the 3rd and 4th year at Tehran University of Medical Sciences in March, 2016. The number of participants was 66. The data collection was performed by a questionnaire. The included 19 questions about the anatomy of pelvic floor. At first, the questionnaires were administered to pre-test students to assess the amount of information before and then the theoretical and practical class about the anatomy of pelvic floor were held. At the end of classes, pre-test questionnaires were returned to residents. The responses to questions before and after the training were analyzed.
Results: Our study was conducted on 66 obstetrics and gynecology residents. Of the 66 subjects, 30 were in the pre-test and 66 were in the post-test. The mean score of residences in the anatomy of the pelvic floor before intervention was 5.388±7.14 and after intervention was 12.57±2.181 (P=0.001). The difference in mean before and after education was significant at all levels of study. The general knowledge scores in the post-test, was significantly (P<0.05) higher than pre-test.
Conclusion: According to our findings, it can be stated that the implementation of scholarship project regarding the knowledge of obstetrics and gynecology residences by the method of theoretical and anatomical teaching of anatomy of pelvic floor increases their knowledge, consequently, increase ability of surgical procedures of the residents and reduce complications. It is recommended that other education centers use a similar method to educate obstetrics and gynecology residents.
Fares Najari , Babak Mostafazadeh , Mitra Bahrami , Dorsa Najari ,
Volume 77, Issue 3 (6-2019)
Volume 77, Issue 3 (6-2019)
Abstract
Background: Trauma is one of the main causes of maternal mortality and morbidity in societies, which annually causes millions of deaths worldwide and imposes a high financial burden on health facilities, the purpose of this study was to determine the frequency of physical trauma and its associated factors during pregnancy.
Methods: All data for this cross-sectional study were collected from medical records of pregnant women, who referred to the Mahdeeyeh Hospital in Tehran, Iran, as a result of trauma through 2015. Information related to the pregnant women with trauma was extracted from their medical records based on a researcher-made collection form. All patients who meet criteria for entering the study (based on entry and exit criteria from the study) were selected as samples. The significance level of the tests was considered as P<0/05, the Spearman correlation coefficient tests and Chi-square were used.
Results: A total of 68 people were enrolled on the basis of selected criteria, meanwhile, the mean age of subjects was 26 years and 100% had no history of abortion. In all cases the trauma was blunt and included 63% abdominal, 24% lower back, and 14% flank trauma. Abortion was reported in 3% and 8% of the cases with abdominal and lower back trauma, respectively. Also, according to the results of this study, in cases where the placental abruption (six cases) were lateral face pairs, in all of them physical trauma was also posed. It is necessary in the traumatic pregnant women referring with placental abruption symptoms and sign, due to the legal importance of doing a thorough examination and sonography, the type of placental abruption (lateral or central) is made sure and then documented in patients' files.
Conclusion: Physical trauma also is common in the pregnant women and the lateral aspect placental abruption can be one of the obvious evidence for physical trauma.
Methods: All data for this cross-sectional study were collected from medical records of pregnant women, who referred to the Mahdeeyeh Hospital in Tehran, Iran, as a result of trauma through 2015. Information related to the pregnant women with trauma was extracted from their medical records based on a researcher-made collection form. All patients who meet criteria for entering the study (based on entry and exit criteria from the study) were selected as samples. The significance level of the tests was considered as P<0/05, the Spearman correlation coefficient tests and Chi-square were used.
Results: A total of 68 people were enrolled on the basis of selected criteria, meanwhile, the mean age of subjects was 26 years and 100% had no history of abortion. In all cases the trauma was blunt and included 63% abdominal, 24% lower back, and 14% flank trauma. Abortion was reported in 3% and 8% of the cases with abdominal and lower back trauma, respectively. Also, according to the results of this study, in cases where the placental abruption (six cases) were lateral face pairs, in all of them physical trauma was also posed. It is necessary in the traumatic pregnant women referring with placental abruption symptoms and sign, due to the legal importance of doing a thorough examination and sonography, the type of placental abruption (lateral or central) is made sure and then documented in patients' files.
Conclusion: Physical trauma also is common in the pregnant women and the lateral aspect placental abruption can be one of the obvious evidence for physical trauma.
Mehdi Sanatkar , Mehrdad Goudarzi ,
Volume 77, Issue 3 (6-2019)
Volume 77, Issue 3 (6-2019)
Abstract
Background: Cataract is one of the most common eye diseases especially in children and adolescents in two age ranges, and many of these patients need to surgery throughout life. The purpose of this study was to compare the efficacy and side effects of midazolam-ketamine and midazolam-fentanyl for sedation in adult cataract surgery.
Methods: In this study, which was a case-control study, 80 patients were referred to Farabi Hospital in Tehran from November to December 2018 for cataract surgery and underwent surgery. The patients were divided into two groups (n=40). In this study the method of using midazolam-ketamine (ketamine group) was compared with the combination of midazolam-fentanyl (fentanyl group). The hemodynamic variables such as blood pressure and heart rate before surgery were measured and then measured every 5 minutes during operation and were recorded. In addition to hemodynamic variables, other variables such as agitation, surgeon satisfaction, recovery nurse satisfaction, degree of oxygen saturation during surgery, and nausea and vomiting were compared between the two groups.
Results: In this study, 18 patients (45%) of fentanyl group and 17 patients (42.5%) of ketamine group were female. Patients in the two groups had similar demographic distribution before surgery. In this study about blood pressure after surgery, from 80 patients, 22 cases had blood pressure below 119.79 mmHg, of which 3 (13.6%) cases were in ketamine group and 19 cases (86.4%) in fentanyl group. In general, 7.5% of ketamine group and 47.5% of fentanyl group had a blood pressure lower than 119.79 mmHg. Hemodynamic changes and hypotension after sedation was more in fentanyl group. Two groups did not differ in terms of heart rate, arterial oxygen saturation during surgery, surgeon satisfaction during surgery, and postoperative nausea and vomiting.
Conclusion: Administration of ketamine-midazolam versus fentanyl-midazolam in patients who underwent cataract surgery by sedation led to more stable hemodynamic variables intraoperatively and other side effects such as heart rate, oxygen saturation, surgeon satisfaction, nausea and vomiting were similar between two groups.
Methods: In this study, which was a case-control study, 80 patients were referred to Farabi Hospital in Tehran from November to December 2018 for cataract surgery and underwent surgery. The patients were divided into two groups (n=40). In this study the method of using midazolam-ketamine (ketamine group) was compared with the combination of midazolam-fentanyl (fentanyl group). The hemodynamic variables such as blood pressure and heart rate before surgery were measured and then measured every 5 minutes during operation and were recorded. In addition to hemodynamic variables, other variables such as agitation, surgeon satisfaction, recovery nurse satisfaction, degree of oxygen saturation during surgery, and nausea and vomiting were compared between the two groups.
Results: In this study, 18 patients (45%) of fentanyl group and 17 patients (42.5%) of ketamine group were female. Patients in the two groups had similar demographic distribution before surgery. In this study about blood pressure after surgery, from 80 patients, 22 cases had blood pressure below 119.79 mmHg, of which 3 (13.6%) cases were in ketamine group and 19 cases (86.4%) in fentanyl group. In general, 7.5% of ketamine group and 47.5% of fentanyl group had a blood pressure lower than 119.79 mmHg. Hemodynamic changes and hypotension after sedation was more in fentanyl group. Two groups did not differ in terms of heart rate, arterial oxygen saturation during surgery, surgeon satisfaction during surgery, and postoperative nausea and vomiting.
Conclusion: Administration of ketamine-midazolam versus fentanyl-midazolam in patients who underwent cataract surgery by sedation led to more stable hemodynamic variables intraoperatively and other side effects such as heart rate, oxygen saturation, surgeon satisfaction, nausea and vomiting were similar between two groups.
Shayesteh Khorasanizadeh , Faranak Behnaz , Masih Ebrahimy Dehkordy , Houman Teymourian , Homeyra Kouzekanani ,
Volume 77, Issue 6 (9-2019)
Volume 77, Issue 6 (9-2019)
Abstract
Background: Hypoglycemia is a condition when blood glucose level is lower than 70 mg/dl in people without diabetes. The symptoms of hypoglycemia include tachycardia, sweating, pallor, pupillary dilatation. Hypoglycemia is a non-lethal and often preventable clinical problem in non-diabetic patients that can occur during fasting or after dining.
Case presentation: A 52 years old man referred to Shohada-e-Tajrish Hospital, Tehran, with diagnosis of kidney stones candidate for percutaneous nephrolithotomy (PCNL). The patient underwent general anesthesia and after 40 minutes, the surgeon requested injection of tranexamic acid because of bleeding, but unintentionally the patient received 100 unites of crystalline insulin by nurse anesthesia. Vital signs were stable, the patient's blood glucose was 85 mg/dl and he had no sweat. Then the therapeutic intervention consisted of administering a bolus dose of 50 cc 50% dextrose water (DW) and then infusion of 50% dextrose water over that time. The patient was monitored for 10 hours in recovery and also received 1 mg of glucagon. The blood glucose was checked frequently. Fortunately, there were not any detectable hypoglycemic attacks (blood glucose less than 70 mg/dl) during that time. Throughout the first three hours in ICU, he suffered from severe hypoglycemic episodes and treated by DW 50% (bolus stat and infusion) and after stabilization of vital signs he transferred to ward.
Conclusion: The mortality of iatrogenic hypoglycemia is lower than other causes of hypoglycemia. However, on time diagnosis and aggressive treatment can prevent serious complications. In addition, proper communication between health care providers and precise checking of drugs labels before injection can dramatically decrease these events.
Case presentation: A 52 years old man referred to Shohada-e-Tajrish Hospital, Tehran, with diagnosis of kidney stones candidate for percutaneous nephrolithotomy (PCNL). The patient underwent general anesthesia and after 40 minutes, the surgeon requested injection of tranexamic acid because of bleeding, but unintentionally the patient received 100 unites of crystalline insulin by nurse anesthesia. Vital signs were stable, the patient's blood glucose was 85 mg/dl and he had no sweat. Then the therapeutic intervention consisted of administering a bolus dose of 50 cc 50% dextrose water (DW) and then infusion of 50% dextrose water over that time. The patient was monitored for 10 hours in recovery and also received 1 mg of glucagon. The blood glucose was checked frequently. Fortunately, there were not any detectable hypoglycemic attacks (blood glucose less than 70 mg/dl) during that time. Throughout the first three hours in ICU, he suffered from severe hypoglycemic episodes and treated by DW 50% (bolus stat and infusion) and after stabilization of vital signs he transferred to ward.
Conclusion: The mortality of iatrogenic hypoglycemia is lower than other causes of hypoglycemia. However, on time diagnosis and aggressive treatment can prevent serious complications. In addition, proper communication between health care providers and precise checking of drugs labels before injection can dramatically decrease these events.
Ali Ameri ,
Volume 77, Issue 7 (10-2019)
Volume 77, Issue 7 (10-2019)
Abstract
Background: Deep learning has revolutionized artificial intelligence and has transformed many fields. It allows processing high-dimensional data (such as signals or images) without the need for feature engineering. The aim of this research is to develop a deep learning-based system to decode motor intent from electromyogram (EMG) signals.
Methods: A myoelectric system based on convolutional neural networks (CNN) is proposed, as an alternative to conventional classification methods that depend on feature engineering. The proposed model was validated with 10 able-bodied subjects during single and combined wrist motions. Eight EMG channels were recorded using eight pairs of surface electrodes attached around the subject’s dominant forearm. The raw EMG data from windows of 167ms (200 samples) in 8 channels were arranged as 200×8 matrices. For each subject, a CNN was trained using the EMG matrices as the input and the corresponding motion classes as the target. The resulting model was tested using a 4-fold cross-validation. The performance of the proposed approach was compared to that of a standard SVM-based model that used a set of time-domain (TD) features including mean absolute value, zero crossings, slope sign changes, waveform length, and mean frequency.
Results: In spite of the proven performance and popularity of the TD features, no significant difference (P=0.19) was found between the classification accuracies of the two methods. The advantage of the proposed model is that it does not need manual extraction of features, as the CNN can automatically learn and extract required representations from the EMG data.
Conclusion: These results indicate the capacity of CNNs to learn and extract rich and complex information from biological signals. Because both amplitude and frequency of EMG increases with increasing muscle force, both temporal and spectral characteristics of EMG are needed for efficient estimation of motor intent. The TD set, also includes these types of features. The high performance of the CNN model shows its capability to learn temporal and spectral representations from raw EMG data.
Methods: A myoelectric system based on convolutional neural networks (CNN) is proposed, as an alternative to conventional classification methods that depend on feature engineering. The proposed model was validated with 10 able-bodied subjects during single and combined wrist motions. Eight EMG channels were recorded using eight pairs of surface electrodes attached around the subject’s dominant forearm. The raw EMG data from windows of 167ms (200 samples) in 8 channels were arranged as 200×8 matrices. For each subject, a CNN was trained using the EMG matrices as the input and the corresponding motion classes as the target. The resulting model was tested using a 4-fold cross-validation. The performance of the proposed approach was compared to that of a standard SVM-based model that used a set of time-domain (TD) features including mean absolute value, zero crossings, slope sign changes, waveform length, and mean frequency.
Results: In spite of the proven performance and popularity of the TD features, no significant difference (P=0.19) was found between the classification accuracies of the two methods. The advantage of the proposed model is that it does not need manual extraction of features, as the CNN can automatically learn and extract required representations from the EMG data.
Conclusion: These results indicate the capacity of CNNs to learn and extract rich and complex information from biological signals. Because both amplitude and frequency of EMG increases with increasing muscle force, both temporal and spectral characteristics of EMG are needed for efficient estimation of motor intent. The TD set, also includes these types of features. The high performance of the CNN model shows its capability to learn temporal and spectral representations from raw EMG data.
Fatemeh Nevisi , Marjan Yaghmaie , Hossein Pashaiefar , Kamran Alimoghaddam , Masoud Iravani, Gholamreza Javadi , Ardeshir Ghavamzadeh ,
Volume 77, Issue 11 (2-2020)
Volume 77, Issue 11 (2-2020)
Abstract
Background: Gastric cancer (GC) is considered as one of the most common types of cancer worldwide with poor prognosis and generally limited treatment options. Recent studies have indicated that HER2, MDM2, MYC, MET, and TP53 play an important role in the development of gastric cancer. Therefore, the aim of this study was to evaluate the incidence of amplification/deletion of these genes in patients with gastric cancer.
Methods: In this descriptive study, a total of 37 gastric cancer tissue samples from GC patients including 23 males (62.2%) and 14 females (37.8%) referred to the Hematology-Oncology and Stem Cell Research Center of Shariati Hospital, Tehran, from March 2015 to February 2016 were evaluated. The patient's age at diagnosis ranged from 33 to 85 years (median: 65 years). The amplification pattern of HER2, MDM2, MYC and MET genes and TP53 deletion were investigated by fluorescence in situ hybridization (FISH) technique performed on 3 to 5 micron section obtained from formalin-fixed and paraffin-embedded cancer tissues.
Results: The tumors were preferably identified at the distal stomach (54.05%) in comparison to tumors arising from the gastric cardia. The tumor size varied between 2 and 5 cm (average, 3.5 cm). Seven of the cases (19%) had advanced tumors at the time of diagnosis. HER2, MDM2, MYC, MET and TP53 copy number alteration were successfully determined in all samples obtained from the GC patients. HER2, MDM2, and c-MYC genes were amplified in 2 (5.41%), 1 (2.7%) and 3 (8.11%) of 37 patient samples, however, MET gene amplification and TP53 deletion were not observed in the obtained GC tissue samples. Co-amplification of HER2, MDM2, and MYC genes, and co-amplification of HER2 and MYC genes were detected in one patient.
Conclusion: The results of this study indicate the low frequency of MDM2, HER2 and MYC genes in gastric cancer patient and their copy number alterations may provide diagnostic and prognostic marker for GC patients.
Methods: In this descriptive study, a total of 37 gastric cancer tissue samples from GC patients including 23 males (62.2%) and 14 females (37.8%) referred to the Hematology-Oncology and Stem Cell Research Center of Shariati Hospital, Tehran, from March 2015 to February 2016 were evaluated. The patient's age at diagnosis ranged from 33 to 85 years (median: 65 years). The amplification pattern of HER2, MDM2, MYC and MET genes and TP53 deletion were investigated by fluorescence in situ hybridization (FISH) technique performed on 3 to 5 micron section obtained from formalin-fixed and paraffin-embedded cancer tissues.
Results: The tumors were preferably identified at the distal stomach (54.05%) in comparison to tumors arising from the gastric cardia. The tumor size varied between 2 and 5 cm (average, 3.5 cm). Seven of the cases (19%) had advanced tumors at the time of diagnosis. HER2, MDM2, MYC, MET and TP53 copy number alteration were successfully determined in all samples obtained from the GC patients. HER2, MDM2, and c-MYC genes were amplified in 2 (5.41%), 1 (2.7%) and 3 (8.11%) of 37 patient samples, however, MET gene amplification and TP53 deletion were not observed in the obtained GC tissue samples. Co-amplification of HER2, MDM2, and MYC genes, and co-amplification of HER2 and MYC genes were detected in one patient.
Conclusion: The results of this study indicate the low frequency of MDM2, HER2 and MYC genes in gastric cancer patient and their copy number alterations may provide diagnostic and prognostic marker for GC patients.
Mojtaba Hedayat Yaghoobi , Mohammadmahdi Sabahi , Elahe Ghaderi , Mohammad Ali Seifrabiei , Farshid Rahimi Bashar ,
Volume 77, Issue 11 (2-2020)
Volume 77, Issue 11 (2-2020)
Abstract
Background: Health care associated infections (HAIs) are a class of infections that infect patients during hospital admissions and receive medical services. These infections occurs within 48 to 72 hours of admission and up to 6 weeks after discharge. Surveillance of device-associated infections (DAIs) in intensive care units (ICUs) is substantial in planning healthcare strategies. This study was conducted to determine the device-associated infections' burden and antimicrobial resistance patterns.
Methods: In this descriptive-analytic study, three common device-associated infections included central line-associated bloodstream infection (CLA-BSI), ventilator associated pneumonia (VAP), and catheter-associated urinary tract infection (CA-UTI), were assessed in intensive care units of Besat Hospital in Hamedan from April 2017 to April 2018. In order to determine the incidence of device-associated infections, the number of device-associated infection cases was calculated during the study period and divided into the number of device-days used. The device-days included all days of exposure to that device (vascular catheter, endotracheal tube (ventilator), or urinary catheter) in all patients in the study population.
Results: Out of 1806 intensive care unit admitted cases, 168 patients (9.3%) were device-associated infection with distribution of 92 cases (55%) of ventilator-associated pneumonia (VAP), 56 cases (34%) of catheter-associated urinary tract infection (CA-UTI) and 20 cases (11%) of central line-associated bloodstream infection (CL-BSI). The incidence of VAP, CA-UTI and CL-BSI was 44.7, 17.5, and 21.61 days, respectively. The most organisms were Acinetobacter (27.4%), Klebsiella (18.3%), Escherichia coli (E. coli) (15.4%). Vancomycin-resistant enterococcus (VRE) was 75%. Acinetobacter resistance to colistin and carbapenem was 16.8%. About half of Pseudomonas isolates were resistant to meropenem.
Conclusion: According to the present findings of this study, a high incidence of device-associated infections and resistant organisms in our intensive care units were documented, which represents a need to reinforce the preventive and control programs. Various results in different studies can be due to differences in the level of health care in different centers and countries.
Methods: In this descriptive-analytic study, three common device-associated infections included central line-associated bloodstream infection (CLA-BSI), ventilator associated pneumonia (VAP), and catheter-associated urinary tract infection (CA-UTI), were assessed in intensive care units of Besat Hospital in Hamedan from April 2017 to April 2018. In order to determine the incidence of device-associated infections, the number of device-associated infection cases was calculated during the study period and divided into the number of device-days used. The device-days included all days of exposure to that device (vascular catheter, endotracheal tube (ventilator), or urinary catheter) in all patients in the study population.
Results: Out of 1806 intensive care unit admitted cases, 168 patients (9.3%) were device-associated infection with distribution of 92 cases (55%) of ventilator-associated pneumonia (VAP), 56 cases (34%) of catheter-associated urinary tract infection (CA-UTI) and 20 cases (11%) of central line-associated bloodstream infection (CL-BSI). The incidence of VAP, CA-UTI and CL-BSI was 44.7, 17.5, and 21.61 days, respectively. The most organisms were Acinetobacter (27.4%), Klebsiella (18.3%), Escherichia coli (E. coli) (15.4%). Vancomycin-resistant enterococcus (VRE) was 75%. Acinetobacter resistance to colistin and carbapenem was 16.8%. About half of Pseudomonas isolates were resistant to meropenem.
Conclusion: According to the present findings of this study, a high incidence of device-associated infections and resistant organisms in our intensive care units were documented, which represents a need to reinforce the preventive and control programs. Various results in different studies can be due to differences in the level of health care in different centers and countries.
Shirinsadat Badri , Sara Etemadi-Moghaddam , Azadeh Moghaddas ,
Volume 77, Issue 12 (3-2020)
Volume 77, Issue 12 (3-2020)
Abstract
Background: Amphotericin B is one of the most useful therapeutic modalities for the treatment of patients with invasive fungal infections, in spite of serious side effects, namely kidney injury, electrolyte imbalances, and infusion-related reactions. The goal of this study was to assess the different aspects of premedication practice and the incidence and types of infusion-related reactions in patients receiving amphotericin B.
Methods: This observational study was performed on 70 hospitalized patients who received amphotericin B in different departments of two university hospitals, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, from January 2017 to February 2018. Information on physicians’ performance regarding premedication administration for amphotericin B, including the types and doses of medications administered prior to amphotericin B infusion, as well as patients’ clinical data including infusion-related side effects were collected and then analyzed in comparison with the standard practice guidelines.
Results: The study population consisted of 70 patients with the mean age of 51.6±18.3 years, who received amphotericin B for 8.2±3.5 days. From 70 evaluated patients, 21 patients (30%) had encountered the infusion-related reactions, including chills, fever, urticaria, headache, and hypotension. These side effects were evident in 19 patients (27%) who received no premedication and 2 patients (3%) who received only one drug as premedication, before amphotericin B administration. Twenty patients (28%) experienced chills, fever and headache, while 7 patients (10%) had nausea and vomiting during amphotericin B infusion. Hydrocortisone 50-200 mg, was the most prescribed agent for premedication (in 67% of patients), while chlorpheniramine 10 mg (in 50% of patients) and promethazine 10 mg (in 35% of patients) were the second and third prescribed ones, respectively.
Conclusion: In this study, the patients who received no or only one drug as premedication experienced infusion-related side effects. This emphasizes the necessity for standard premedication practices to prevent this type of adverse reactions. Considering the higher price of liposomal form of Amphotericin-B, if prescribed correctly, even the conventional form would be an effective and tolerable treatment for invasive fungal infections.
Methods: This observational study was performed on 70 hospitalized patients who received amphotericin B in different departments of two university hospitals, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, from January 2017 to February 2018. Information on physicians’ performance regarding premedication administration for amphotericin B, including the types and doses of medications administered prior to amphotericin B infusion, as well as patients’ clinical data including infusion-related side effects were collected and then analyzed in comparison with the standard practice guidelines.
Results: The study population consisted of 70 patients with the mean age of 51.6±18.3 years, who received amphotericin B for 8.2±3.5 days. From 70 evaluated patients, 21 patients (30%) had encountered the infusion-related reactions, including chills, fever, urticaria, headache, and hypotension. These side effects were evident in 19 patients (27%) who received no premedication and 2 patients (3%) who received only one drug as premedication, before amphotericin B administration. Twenty patients (28%) experienced chills, fever and headache, while 7 patients (10%) had nausea and vomiting during amphotericin B infusion. Hydrocortisone 50-200 mg, was the most prescribed agent for premedication (in 67% of patients), while chlorpheniramine 10 mg (in 50% of patients) and promethazine 10 mg (in 35% of patients) were the second and third prescribed ones, respectively.
Conclusion: In this study, the patients who received no or only one drug as premedication experienced infusion-related side effects. This emphasizes the necessity for standard premedication practices to prevent this type of adverse reactions. Considering the higher price of liposomal form of Amphotericin-B, if prescribed correctly, even the conventional form would be an effective and tolerable treatment for invasive fungal infections.
Mohammad Taghi Najafi , Mohammad Hossein Shojamoradi , Farzanehsadat Minoo ,
Volume 78, Issue 2 (5-2020)
Volume 78, Issue 2 (5-2020)
Abstract
Background: Resistant hypertension is defined when the blood pressure remains elevated above the therapeutic target levels despite the use of three antihypertensive agents including calcium channel blocker (CCB), renin-angiotensin system (RAS) blocker and a diuretic. These drugs should be used at maximally tolerated doses and white coat effect and non-adherence should also be excluded. In this article, by describing a case of resistant hypertension, we discuss a diagnostic and therapeutic approach to resistant hypertension.
Case Presentation: A 59 years old man, known case of diabetic nephropathy with a serum creatinine level of 1.2 mg/dL and proteinuria of about 3300 mg in 24 hours referred to Hypertension Clinic of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, for evaluation of resistant hypertension. The patient was under treatment by losar-H, diltiazem, and furosemide, which are not appropriate combinations of antihypertensive agents. The ambulatory blood pressure monitoring (ABPM) of the patient revealed daytime and nighttime hypertension and also the non-dipping status of blood pressure. Dihydropyridine CCB was prescribed in combination with RAS blocker (Exforge 50 mg/ 160 mg) and the diuretic was changed to thiazide-like agents. In the next step, spironolactone and carvedilol were added for better control of blood pressure. The patient referred to the sleep clinic for polysomnography and evaluation of obstructive sleep apnea. Following three months prescription of these medications, ABPM revealed relatively appropriate control of blood pressure, so the average 24-hour blood pressure decreased from 157/91 mm Hg to 136/83 mm Hg.
Conclusion: The complications and mortality of hypertension would be increased dramatically in patients with resistant hypertension. So, an appropriate diagnostic and therapeutic approaches should be considered for these patients. Choosing appropriate diuretic agents would be important in the management of resistant hypertension.
Case Presentation: A 59 years old man, known case of diabetic nephropathy with a serum creatinine level of 1.2 mg/dL and proteinuria of about 3300 mg in 24 hours referred to Hypertension Clinic of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, for evaluation of resistant hypertension. The patient was under treatment by losar-H, diltiazem, and furosemide, which are not appropriate combinations of antihypertensive agents. The ambulatory blood pressure monitoring (ABPM) of the patient revealed daytime and nighttime hypertension and also the non-dipping status of blood pressure. Dihydropyridine CCB was prescribed in combination with RAS blocker (Exforge 50 mg/ 160 mg) and the diuretic was changed to thiazide-like agents. In the next step, spironolactone and carvedilol were added for better control of blood pressure. The patient referred to the sleep clinic for polysomnography and evaluation of obstructive sleep apnea. Following three months prescription of these medications, ABPM revealed relatively appropriate control of blood pressure, so the average 24-hour blood pressure decreased from 157/91 mm Hg to 136/83 mm Hg.
Conclusion: The complications and mortality of hypertension would be increased dramatically in patients with resistant hypertension. So, an appropriate diagnostic and therapeutic approaches should be considered for these patients. Choosing appropriate diuretic agents would be important in the management of resistant hypertension.
Hossein Shakeri , Aliasghar Arabi Mianroodi , Mohammadali Haghbin , Narges Khanjani ,
Volume 78, Issue 3 (6-2020)
Volume 78, Issue 3 (6-2020)
Abstract
Background: A major problem in surgical procedures is postoperative pain. The effectiveness of prescribing preoperative tizanidine in reducing postoperative pain is not clear. The aim of this study was to determine the efficacy of tizanidine as a premedication in reducing pain after septoplasty.
Methods: This double blind clinical trial study was performed in 71 patients aged from 18 to 50 years, undergoing septoplastic surgery for the first time, who were classified in ASA (American Society of Anesthesiologists) classes 1 and 2 in the Ear, Nose, and Throat (ENT) Department of Shafa Hospital, in Kerman, Iran from April 2014 to March 2015. Patients were randomly assigned into two groups using numbers from a randomization table. A dosage of 4 mg of tizanidine was administered orally to the patients two hours before the surgery (septoplasty) in the intervention group. In the control group, placebo pills which were 100 mg vitamin B1 were prescribed. The severity of pain was measured and recorded after 4 and 8 hours, and the morning after the surgery.
Results: 62 patients (87.32%) were male and 9 (12.68%) were female. The mean age of the subjects was 24.6±7.5 years. The two groups were similar in regard to age (P=0.54), but the duration of surgery was different in the two groups (P=0.038) and was longer in the group that received tizanidine. The mean of pain was different between the two groups, after 4 hours and was significantly higher in the group that received tizanidine (P=0.043). The mean of pain was not significantly different between the two groups after 8 hours (P=0.95) or one day after surgery (P=0.79).
Conclusion: Although some researchers have reported that taking tizanidine before some surgeries may reduce postoperative pain, in this study the administration of tizanidine before surgery was not effective in reducing pain after septoplasty.
Methods: This double blind clinical trial study was performed in 71 patients aged from 18 to 50 years, undergoing septoplastic surgery for the first time, who were classified in ASA (American Society of Anesthesiologists) classes 1 and 2 in the Ear, Nose, and Throat (ENT) Department of Shafa Hospital, in Kerman, Iran from April 2014 to March 2015. Patients were randomly assigned into two groups using numbers from a randomization table. A dosage of 4 mg of tizanidine was administered orally to the patients two hours before the surgery (septoplasty) in the intervention group. In the control group, placebo pills which were 100 mg vitamin B1 were prescribed. The severity of pain was measured and recorded after 4 and 8 hours, and the morning after the surgery.
Results: 62 patients (87.32%) were male and 9 (12.68%) were female. The mean age of the subjects was 24.6±7.5 years. The two groups were similar in regard to age (P=0.54), but the duration of surgery was different in the two groups (P=0.038) and was longer in the group that received tizanidine. The mean of pain was different between the two groups, after 4 hours and was significantly higher in the group that received tizanidine (P=0.043). The mean of pain was not significantly different between the two groups after 8 hours (P=0.95) or one day after surgery (P=0.79).
Conclusion: Although some researchers have reported that taking tizanidine before some surgeries may reduce postoperative pain, in this study the administration of tizanidine before surgery was not effective in reducing pain after septoplasty.
Mehdi Sanatkar , Mehrdad Goudarzi , Ebrahim Espahbodi ,
Volume 78, Issue 3 (6-2020)
Volume 78, Issue 3 (6-2020)
Abstract
Background: Cataract is one of the most common eye diseases especially in elderly patients and most of these patients require surgery. In the process of sedation, different drugs are used, each with its advantages and disadvantages. Dexmedetomidine is one of the drugs that has recently received special attention for sedation. In this study, we compared the drug combination of dexmedetomidine-fentanyl with midazolam-fentanyl in cataract surgery.
Methods: In a case-control study, the patients who underwent cataract surgery by a surgeon with topical anesthesia and sedation techniques were included in the target group. Seventy patients were divided into two groups of 35 according to a random number table. One group received dexmedetomidine-fentanyl (dexmedetomidine group) and the other received midazolam-fentanyl (midazolam group). Age, sex, weight, systolic and diastolic blood pressure, heart rate, patient sedation, surgeon satisfaction, recovery nurse satisfaction, and postoperative nausea and vomiting were compared between the two groups. The study was performed in the Farabi Hospital, Tehran, Iran, from October to November 2019.
Results: Patients in the two groups were similar in age, sex, weight, and preoperative hemodynamic variables. There was no significant difference in preoperative systolic and diastolic blood pressure between the two groups (P=0.150). However, those who received dexmedetomidine had significantly lower intraoperative heart rate (P<0.001). The difference in postoperative systolic and diastolic blood pressure as well as postoperative heart rate was significantly lower in the dexmedetomidine group (P<0.001). There was no statistically significant difference between the two groups in postoperative sedation (P=0.93). The surgeon’s satisfaction was no significant difference between the two groups (P=0.17). Also, the rate of recovery nurse satisfaction was not significantly different between the two groups (P=0.21). The incidence of nausea and vomiting was similar in both groups (P=1.00).
Conclusion: Sedation with dexmedetomidine decreases blood pressure and heart rate. Therefore, it is recommended to use dexmedetomidine more cautiously in patients with unstable hemodynamics and especially in short surgical procedures.
Methods: In a case-control study, the patients who underwent cataract surgery by a surgeon with topical anesthesia and sedation techniques were included in the target group. Seventy patients were divided into two groups of 35 according to a random number table. One group received dexmedetomidine-fentanyl (dexmedetomidine group) and the other received midazolam-fentanyl (midazolam group). Age, sex, weight, systolic and diastolic blood pressure, heart rate, patient sedation, surgeon satisfaction, recovery nurse satisfaction, and postoperative nausea and vomiting were compared between the two groups. The study was performed in the Farabi Hospital, Tehran, Iran, from October to November 2019.
Results: Patients in the two groups were similar in age, sex, weight, and preoperative hemodynamic variables. There was no significant difference in preoperative systolic and diastolic blood pressure between the two groups (P=0.150). However, those who received dexmedetomidine had significantly lower intraoperative heart rate (P<0.001). The difference in postoperative systolic and diastolic blood pressure as well as postoperative heart rate was significantly lower in the dexmedetomidine group (P<0.001). There was no statistically significant difference between the two groups in postoperative sedation (P=0.93). The surgeon’s satisfaction was no significant difference between the two groups (P=0.17). Also, the rate of recovery nurse satisfaction was not significantly different between the two groups (P=0.21). The incidence of nausea and vomiting was similar in both groups (P=1.00).
Conclusion: Sedation with dexmedetomidine decreases blood pressure and heart rate. Therefore, it is recommended to use dexmedetomidine more cautiously in patients with unstable hemodynamics and especially in short surgical procedures.
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