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Volume 58, Issue 2 (5-2000)
There are now several tests available that can assess fetal status. A series of 164 cases of high risk pregnancies were studied in order to assess predictive value of a nonstress test. The majority (36%) of patients complained about postdate pregnancy. A nonreactive test was identified in 24 of the patients (14.6%). Fetal distress, low Apgar score in 1 and 10 minutes after birth and mean of Apgar score in 5 minutes, cesarean section due to fetal distress, congenital anomalies, need of neonatal care, IUGR, abnormal presentation and perinatal death were much more common in the group of pregnancies with a nonreactive NST than in the group with reactive test. The difference was statistically significant. A reactive test was found to be a good predictor of the healthy fetus. Negative predictive value and specifity of the test were found 80% and 91.9%, respectively. The nonreactive test could identify a population at risk but it was not helpful as a stand alone modality in decision making, because of the low sensitivity and positive predictive value rates (33.3% and 58%).
Volume 62, Issue 2 (5-2004)
Background: The purpose of this study was to compare electronic fetal heart rate monitoring (EFM) characteristics between Appropriate for Gestational Age (AGA ) and Small for Gestational Age (SGA) fetuses and to determine whether SGA fetuses have specific abnormalities.
Materials and Methods: Among children born from Apr 2002 to Mar 2003 in Arash hospital, we identified 300 singleton infants born after 36 weeks' gestation of uncomplicated pregnancies in whom second-trimester (24-27 weeks' gestation) EFM records were obtained. Individual components of fetal heart rate (FHR) pattern baseline rate, baseline FHR variability, presence of acceleration and periodic and episodic deceleration , and birth characteristics were compared between AGA and SGA infants or between pregnancies with or without second-trimester decelerations. Statistical analysis was performed using Student t, Chi square and Fisher exact test.
Results: Among 300 infants, 261 (87%) were AGA and 39 (13%) were SGA 65 had and 235 did not have second-trimester decelerations. Baseline FHR variability, second- trimester decelerations and intrapartum FHR decelerations were significantly higher in SGA fetuses than in AGA fetuses (P<0.05). Birth weight and gestational age were significantly lower in SGA fetuses than in AGA fetuses (P<0.05). There were no significant differences in baseline rate and acceleration ,maternal age and parity, Apgar score in 1 minute, meconium staining, mode of delivery, NICU admission, between SGA and AGA infants. Small for Gestational Age infants were more frequent in pregnancies with second-trimester decelerations compared with those without second-trimester deceleration (P<0.05). Baseline FHR variability in pregnancies with second-trimester decelerations was significantly higher than in pregnancies without second-trimester deceleration (P<0.05).
Conclusion: Periodic or episodic decelerations and increased FHR variability during late second-trimester EFM were associated with an increased risk of SGA infant
Volume 66, Issue 11 (2-2009)
Background: Direct monitoring of arterial pressure using a transducer system is not affordable in most operating rooms and ICU wards in Iran. It is, however, possible to use an aneroid manometer instead, but it is not standardized yet, nor studied enough and its measurements may not be interpretable.
Methods: To study the correlation of the arterial pressure readings between a manometer and a transducer system, systolic and diastolic arterial pressure was measured 105 times using both systems via arterial cannulation in seven patients during surgery. Mean arterial pressure was directly recorded in the transducer system, while it was calculated in the manometer system. In the manometer system, the extension tube was filled with saline halfway from the patient and the other empty end was connected to a manometer. The transducer and the air-fluid interface in the extension tube were positioned at same level. Correlation of the arterial pressures between the systems was tested using linear regression and Pearson correlation.
Results: Mean arterial pressure differed by 2 (1-3) mmHg [mean (CI 95%)] between the systems, however, pulse pressure was lower in the manometer system by 37 (33-41) mmHg. The mean arterial pressure in the transducer system (MAPT) correlated well and linearly with the systolic arterial pressure in the manometer system (SAPM) by R=0.966. Therefore, MAPT can be regarded as a function of SAPM through the following formula: MAPT = (1.03 ´ SAPM) - 7.34.
Conclusion: The mean arterial pressure in the transducer system can be reliably estimated by monitoring the systolic arterial pressure in the manometer system.
Volume 67, Issue 3 (6-2009)
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Methods: The study was
conducted at the Bandar-Abbas district in Hormozgan province, Iran. 123 patients were
enrolled and considered. The patients were treated with a standard 3-day regimen of
chloroquine and were followed-up clinically and parasitologically. The results
were interpreted as mean parasite clearance time (MPCT) in P. vivax and early
treatment failure (ETF), late treatment failure (LTF) and adequate clinical and parasitological response (ACPR) in P. falciparum.
Results: The patients with
vivax malaria were responded to the regimen of chloroquine within 24-216 hours. Most cases of
the parasite clearance time occurred at 48 hours (50.40%), and less of them at 120, 168, 192 and 216 hours with 0.81% for each of them. MPCT in this study was
calculated as 61.07 (±26/47) hours for all of the patients. 33.33% and 66.66% of the patients with falciparum malaria
were found at ACPR
and LTF groups, respectively.
Conclusion: This study confirms the efficacy of chloroquine on P.vivax.
The extended parasite clearance time in a number of patients may be an early
sign for reduced susceptibility of P.vivax to chloroquine in the studied
areas. Most of the patients with falciparum malaria (66.66%)
considered in this study did not respond to the regimen of chloroquine because
of chloroquine- resistance in P.falciparum at the area.
Volume 72, Issue 7 (10-2014)
Background: Morbid obesity is associated with a some of significant comorbidities. Early and uneventful postoperative recovery of obese patients remains a challenge for anesthesiologists. It seems Bispecteral Index (BIS) monitoring may reduce drug usage and hasten recovery time in inhalation anesthesia. The aim of this study was to investigate the effect of BIS monitoring on intraoperative isoflurane utilization and the early recovery profile. Methods: Fifty morbidly obese adult patients (Body Mass Index (BMI) of 35 kg/m2 or grater) undergoing elective laparoscopic cholecystectomy in Urmia Imam Khomeini Hospital were enrolled in this prospective, Cohort and single blind study. Duration of this study was six months between April to September 2012. Patients were randomly divided two groups (25 patients per group). In the first phase of the study, patients were anesthetized without the use of BIS monitoring and isoflurane being administered according to standard clinical practice (this group formed the control group). In a second phase, with use of BIS monitoring isoflurane was titrated to maintain a BIS value between 40 and 60 during surgery, and then 60-70 during 15 min before the end of surgery (this group formed the BIS group). Isoflurane consumption and recovery time were compared between two groups. Results: All patients completed the study. No differences were noted between demographic data. The isoflurane consumption in the BIS group was 30-35% lower than in the control group (P< 0.001). The time to awakening and duration of extubation in the BIS group were significantly less than the control group (P< 0.001). Furthermore, analgesic consumption in the recovery room and sedation score during postoperative phase were similar between the groups. Significant differences were noted in recovery time between two groups (P< 0.001). Conclusion: The addition of Bispectral index monitoring to standard monitoring reduced isoflurane usage. We found use of BIS hastened recovery time after isoflurane anesthesia.
Volume 72, Issue 11 (2-2015)
Background: Diarrhea is the most common bacterial infections, and the main cause of death in the children. Worldwide, food and waterborne diseases are estimated to cause more than two million deaths per year. Foodborne diseases and resistance to antimicrobial agents are two problems worldwide and are increasing. However, standard surveillance systems do not routinely collect information on controls. The aim of this study was to analysis epidemiological data of foodborne outbreaks at the country level. Methods: This is a descriptive study, in total 305 fecal swab samples from 73 outbreaks during one year from April 2012 to March 2013 in different provinces of Iran, were collected and transferred to the microbiology laboratory of Public Health School of Tehran University of Medical Sciences to identify the cause’s diarrhea. The patterns of antibiotic-resistance were determined by using Kirby Bauer method. Results: In total 73 food borne outbreaks that were studied, the largest number 26 (35.6%) were found in Hamadan province with 103 samples (34.2%). Out of 73 outbreaks 40 (54.79%) of were related to foods, 6 (8.22%) to water, and 27 (36.98%) were unspecified (P< 0.0001). Fifty seven outbreaks (78.08%) in the city and 16 outbreaks (21.92%) occurred in rural areas (P< 0.0001). The most dominated Gram-negative isolated organisms were Shigella (6.9%) and Gram-positive bacteria Staphylococcus aureus (12.8%). The dominated age group was under five years (16.4%), and dominant gender group was men 186 (61.8%) (P< 0.0001). In total 69 (22.9%) were hospitalized and 11 deaths were reported. Most clinical symptoms of abdominal cramping (82%), nausea and vomiting (68.4%), bloody diarrhea (23.3%), and non-bloody diarrhea (76.7%). All the isolated gram-negative were sensitive to ciprofloxacin and resistant to clindamycin. The gram-positive were sensitive to cephalexin and resistant to penicillin. Conclusion: The knowledge of bacterial agent of foodborne diseases and determination of antimicrobial resistance pattern are helpful to reduce the rate of foodborne outbreaks, the cost of treatment. The prevention control of outbreaks is also very important.
Volume 73, Issue 8 (11-2015)
Background: Tramadol is a synthetic drug which is prescribed in moderate and severe pain. Tramadol overdose can induce severe complications such as consciousness impairment and convulsions. This study was done to determine the convulsions incidence after tramadol use until one week after hospital discharge. Methods: This prospective study was done in tramadol overdose patients without uncontrolled epilepsy and head injury history. All cases admitted in Loghman and Rasol Akram Hospitals, Tehran, Iran from 1, April 2011 to 1, April 2012 were included and observed for at least 12 hours. Time interval between tramadol intake and first seizure were record. Then, patients with second drug-induced seizure were recognized and log time between the first and second seizure was analyzed. The patients were transferred to the intensive care unit (ICU) if clinical worsening status observed. One week after hospital discharge, telephone follow-up was conducted. Results: A total of 150 patients with a history of tramadol induced seizures (141 men, 9 women, age: 23.23±5.94 years) were enrolled in this study. Convulsion was seen in 104 patients (69.3%). In 8 out of 104 patients (7.6%) two or more convulsion was seen. Time interval between tramadol use and the onset of the first and second seizure were 0.93±0.17 and 2.5±0.75 hours, respectively. Tramadol induced seizures are more likely to occur in males and patients with a history of drug abuse. Finally, one hundred forty nine patients (99.3%) were discharged with good condition and the only one patient died from tramadol overdose. Conclusion: The results of the study showed tramadol induced seizure most frequently occurred within the first 4 hours of tramadol intake. The chance of experiencing a second seizure exists in the susceptible population. Thus, 4 hours after drug intake is the best time for patients to be hospital discharged.
Volume 75, Issue 10 (1-2018)
Methods: This cross-section study was done in April 2016. The study population was 95 patients, more than 30 year old with hypertension and chronic renal failure. Patients were selected from clinics of two private and university hospitals affiliated to Qom University of Medical Sciences Shahid Beheshti Hospital and Vali-e-Asr Hospital, Iran. Checklist containing data such as age, sex, duration of renal failure and cause of renal failure were filled. Serum creatinine and serum urea levels were measured and entered in the checklist. The circadian rhythm of blood pressure in all patients was assessed by Holter monitoring. patients who had less than 10% decrease in blood pressure overnight were considered non-dipper and those who had 10% or more decrease in blood pressure overnight were considered dipper.
Results: Average (SD) 24-hour ambulatory systolic and diastolic of blood pressure was 136.56 (16.66) and 84.84 (10.86) mmHg, respectively. 70 patients (73.7%) had non-dipper blood pressure pattern and 25 patients (26.3%) had dipper blood pressure pattern. There was no significant difference between two groups (dipper and non-dipper) based on distribution of gender (P=0.744), age (P=0.407), serum creatinine (P=0.569), serum urea (P=0.689) and renal failure duration (P=0.812). Mean of glomerular filtration rate in dipper group was 68.64±4.13 and in non-dipper group was 65.09±16.27 (P=0.337).
Conclusion: The results of this study did not show a significant relationship between circadian rhythm of blood pressure and renal failure severity. In addition, patients with chronic renal failure showed higher rates of non-dipping pattern of blood pressure.
Volume 77, Issue 12 (3-2020)
Methods: In a prospective, cross-sectional, observational study, 42 hemodynamically stable patients candidate for esophagectomy under general anesthesia in supine position were evaluated at Urmia Imam Khomeini Hospital operating room from June 2017 to April 2018. The patients had American Society of Anesthesiologists (ASA) physical status II or III and the patients who had complete heart block and marked arterial blood pressure differences greater than 10 mmHg in the two arms were excluded. After induction of anesthesia and patients monitoring, the radial artery was cannulated for invasive blood pressure monitoring and noninvasive blood pressure was measured via the arm cuff on the other hand at the four-time intervals: after radial artery cannulation (T1), during release of esophagus (T2), during anastomosis (T3) and at the end of operation (T4).
Results: The mean difference between indirect and direct systolic blood pressure was 0.85±2.93, -8.42±2.9, 6.50±3.60 and 2.67±2.6 mmHg and for diastolic blood pressure was 3.53±2.67, 4.57±2.22, 2.10±2.58 and 1.03±1.53 mmHg respectively, at the T1 to T4. At the all-time intervals, there were no statistically differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure (P=0.77)
Conclusion: Noninvasive arterial blood pressure showed acceptable agreement with invasive measurements for systolic, diastolic and mean pressure. According to fhe finding of this study, there were no statistical differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure and these two methods can be used in selected patients.
Volume 79, Issue 12 (3-2022)
Methods: The research method is descriptive-analytical and applied in terms of classification. The data is from the database of the Faculty of Health and Medicine of the University of Tehran, which was collected as an archive from April 1998 to May 1999. The statistical population were all experts, specialists and experts of the Faculty of Health 29 of whom completed the questionnaire. The weight of the criteria was evaluated using the AHP method and in the next stage, the medical centers were ranked using the DS-VIKOR method. The analysis method in this study consists of the following steps steps:
• Implementing a simple VIKOR method.
• Implementing the Dempster-Shafer and Vicker method.
• Implementing the AHP method
• Implementation of the Topsis method.
• Comparing the proposed methods to review and compare which ones work best.
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Results: The weight of medical centers was assessed by AHP method and then the combined centers were ranked by Dempster-Shafer and VIKOR combined methods using the information of four medical centers, the DS-Vikor approach was implemented. The purpose of six criteria and three experts was used for evaluation. The results show that the effectiveness of care and treatment process is more important from the experts' point of view. Dempester-Schaefer and Vicor The medical centers in question are ranked. For validation, at the end, the medical centers were ranked by TOPSIS method.
The integrated system includes various subsystems giving caring and providing health services to patients in medical centers that can be built and configured and are ranked. |
Conclusion: By combining the two methods of Dempster-Shafer and Vicker, the confidence in the whole uncertainty is improved and the results are more reliable. This approach can help reduce the uncertainty caused by people's cognition to increase the level of decision-making, allowing us to overcome the problem of choosing the right level of uncertainty and to deal with uncertainty in a practical and justified way.
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