Showing papers in "Medicinski arhiv in 2012"
TL;DR: In this paper, the authors explore experiences of Iranian parents with a hospitalized premature infant in Neonatal Intensive Care Unit (NICU) and examine socio-cultural factors associated with having a less than perfect infant.
Abstract: Introduction: To explore experiences of Iranian parents with a hospitalized premature infant in Neonatal Intensive Care Unit (NICU) and examine socio-cultural factors associated with having a less than perfect infant. Methods: Purposely selected 21 participants in this study were 6 fathers, 7 mothers, 5 nurses and 3 physicians specialized in neonatology. Semi-structured in-depth interviews using inductive approach and content analysis helped obtain and analyze data by open encoding for classification and theme abstraction. Results: Findings revealed that parents of hospitalized NICU infants in Iran experienced: job and income loss; shattered confidence in parental role; challenges to family dynamics; shame as a social stigma; loss of control; overwhelmed with uncertainties; and stress induced physical and emotional problems. Conclusion: Unique and outstanding finding of this study was the social stigma of shame for parents of an NICU infant which directly explained the socio-cultural aspect of Iranian society where families place great importance on having a healthy and strong infant. Having a premature infant with anomalies is viewed as a family flaw. Physicians and nurses must focus more on communication with parents and fulfill an important role to educate, assure and comfort parents. Establishing support system for parents of NICU infants seem urgently needed to improve parent-infant bonding.
51 citations
TL;DR: A prophylactic preoperative single dose of i.v. 0.5 mg/kg dexamethasone in combination with a single doseof ketamine significantly decreased post-tonsillectomy pain compare with using i.V. ketamine or i.
Abstract: Background: The aim of the present study is to evaluate the effect of preoperative 0.5 mg/kg i.v. dexamethasone in combination with 0.5 mg/kg i.v. ketamine on pain, early oral intake and vomiting in pediatric patients undergoing tonsillectomy during the first 24 hours of the postoperative period. Methods: One hundred twenty children who were scheduled for tonsillectomy were randomly assigned to receive a single dose of dexamethasone 0.5 mg/kg i.v. as Group D (n = 30), receive ketamine 0.5 mg/kg i.v. as Group K (n = 30), receive dexamethasone 0.5 mg/kg i.v. and ketamine 0.5 mg/kg i.v. as Group KD (n = 30) and an equivalent volume of saline as Group C (n = 30) 15 minutes before the induction of anesthesia. Post-operative pain was evaluated using an observational pain score (OPS) on arrival to the post-anesthesia care unit (PACU), at 15, 30, 45, and 60 minutes after that and at 1, 2, 4, 6, 12, and 24 hours after arrival to the ward. Results: OPS scores were significantly lower at the time of arrival to the PACU, and at 15, 30, 45, and 60 minutes in the Group KD compared with Group C (p < 0.05). Postoperative OPS scores were significantly lower at 1, 2, 4, 6, 12, and 24 hours after operation in Group KD compared with Group C (p < 0.05). Conclusion: A prophylactic preoperative single dose of i.v. 0.5 mg/kg dexamethasone in combination with a single dose of i.v. 0.5 mg/kg ketamine significantly decreased post-tonsillectomy pain compare with using i.v. ketamine or i.v. dexamehasone separately.
30 citations
TL;DR: The waiting time in emergency department services at Ayatolahkashani Hospital is determined to propose scenarios for reducing waiting time and results show that add one intern to the Ear Nose Throat service makes the most reduction on the waiting time.
Abstract: Introduction Emergency Department (ED) provides urgency clinical and Para clinical care for patients who injured in accidents and incidents. Simulation is one of the decision supporting techniques that analyze risk factors and strategies in decision-making. Goal The aim of this study was to determine the waiting time in emergency department services at Ayatolahkashani Hospital to propose scenarios for reducing waiting time. Methods This study was an analytical and cross-sectional in which data collected by forms and observations. Population included waiting and service time in all stations related to ED's treatment processes along with diagnostic departments (e.g. Laboratory, Radiology, Ultrasonography, and C-T Scan) over a two-week period for 663 patients. For data analysis, SPSS software and simulation technique were used. Results Results show that add one intern to the Ear Nose Throat (ENT) service makes the most reduction on the waiting time from 112.19 to 99.24 minutes. In this option the mean of ENT services time will be reduced to 26.54 minutes, neurology services time will be reduced to 6.58 minutes and the mean of orthopedic services time were reduced to 5.98 minutes. Conclusion Health care managers, in the ED are usually physicians who are not familiar with principals of management. Hence, they need simple tools for logical decision-making. Operation research methods such as simulation should be suitable for them.
24 citations
TL;DR: CRIB score, birth weight, gestational age, base excess, Apgar score, respiratory distress syndrome and hemodynamic instability are valuable predictors for a neonatal mortality in population of preterm infants with very low birth weight.
Abstract: INTRODUCTION Preterm birth is the most important univariant risk factor of neonatal mortality. Assessment of risk factors affecting mortality in preterm infants with very low birth weight is important for the treatment of this highly vulnerable population. OBJECTIVE Detection of risk factors for neonatal mortality in very low birth weight premature infants. METHODS The current study was conducted in a tertiary research and educational hospital, NICU, Pediatric Clinic KCU Sarajevo, from January 2010 to December 2010. After admission CRIB score was determined to every hospitalized infant with birth weight < 1500 g, born before the full 31 weeks of gestation (30 weeks + 6 days). We also gathered information about the Apgar score in 5th minute, gender, presence of respiratory distress syndrome and hemodynamic stability. 67 infants fulfilled inclusion criteria. RESULTS Mean birth weight was 1136.4 g +/- 250.9, range 550-1500 g. Mean gestational age was 27.29 weeks +/-1.97, range 22-30 weeks. Mean CRIB score was 3.22, range 0-18. Twenty VLBW infants out of 67 died (29.85%). There was significant difference between groups of survived and dead infants regarding gestational age, birth weight, Apgar score, Crib score, base excess, presence of respiratory distress syndrome and hemodynamic stability at the birth. CONCLUSION CRIB score, birth weight, gestational age, base excess, Apgar score, respiratory distress syndrome and hemodynamic instability are valuable predictors for a neonatal mortality in population of preterm infants with very low birth weight.
21 citations
TL;DR: The findings of this study indicated that compared to the healthy control group, patients with FGIDs had higher scores of alexithymia and more severe somatic symptoms, and higher educational levels were associated with decreased risk of aikido.
Abstract: Introduction: The purpose of this study was to examine alexithymia symptoms, demographic variables and the severity of gastrointestinal symptoms in a sample of patients with functional gastrointestinal disorders (FGID) and a comparative sample of healthy controls. Materials and Methods: The sample consisted of 237 individuals, 129 of whom were patients diagnosed with FGIDs. The patients referred to the psychosomatic disorders clinic of Nour Hospital, Isfahan, Iran. The controlled group included 108 healthy individuals (without digestive diagnosis) matched with the patients by age, gender, marital and educational status. The Toronto Alexithymia Scale (TAS-20) and the Gastrointestinal Symptoms Rating Scale (GSRS) were used to collect data. Data was analyzed using multivariate analysis of variance (MANOVA), correlation coefficients and Fisher’s z. Results: There was a significant difference between patients with FGIDs and healthy controls in terms of number of alexithymia symptoms and severity of gastrointestinal symptoms. The results also indicated the existence of a relationship between educational level and alexithymia as well as its dimensions (difficulty identifying feelings and difficulty describing feelings) in both groups. However, no significant differences were found between the two groups in this regard. Conclusion: The findings of this study indicated that compared to the healthy control group, patients with FGIDs had higher scores of alexithymia and more severe somatic symptoms. Furthermore, higher educational levels were associated with decreased risk of alexithymia. Such finding might be due to higher ability to describe and identify emotions in patients with higher levels of education.
20 citations
TL;DR: Ketamine infusion is more effective than morphine on postoperative pain control and tolerance to drug application is not a challenging problem at least during 24 hours after operation.
Abstract: Background: Intractable pain occurs as a result of extensive damage to soft tissue, bones and muscles after fusion of lumbar spondylolisthesis. Although different drugs and protocols have been suggested for postoperative pain management, the best method of treatment has not been proposed yet. Therefore, this study tried to compare the efficacy of ketamine infusion and routine opioid administration on postoperative pain. Methods: A double-blind prospective randomized clinical trial was performed on 45 patients candidate for fusion of lumbar spondylolisthesis. Patients were divided into two groups of A (treatment) and B (control). In group A, pain was controlled by intravenous infusion of ketamine. Morphine was also administrated when the patients scored their pain above 4 on a visual analogue scale (VAS). In group B, intravenous infusions of morphine were performed every 6 hours. VAS and whole dosage of morphine were compared between two groups every 6 hours. Results: Morphine and ketamine were both effective on pain control. Mean values of pain intensity at the first to fourth time points were 2.1, 1.8, 1.6, and 1.7 in group A and 3.9, 3.4, 3.5, and 3.5 in group B, respectively (p < 0.01 for all periods). However, ketamine was more efficient in pain reduction during the first 24 hours (p < 0.001). Conclusion: Ketamine could be a good alternative analgesic after fusion of lumbar spondylolisthesis. However, the probable side effects should also be considered. Ketamine infusion is more effective than morphine on postoperative pain control. In addition, tolerance to drug application is not a challenging problem at least during 24 hours after operation. .
20 citations
TL;DR: Evaluated effects of regular consumption of quercetin on blood lipid values among healthy persons with dyslipidemia discovered on routine laboratory work up for different reasons, finding decrease in cholesterol, triglyceride and LDL values with parallel increase in HDL.
Abstract: Dyslipidemia is a relatively common problem observed in clinical practice, seen both in instances when evaluating patients with subjective problems as well as among those coming to take a regular preventive exams. needless to say, discovery of any significant vascular disease necessitates initiation of proven medical therapy, which, ideally, besides its action on blood lipid values, sholud also exert effect on other, equally important parameters of vascular disease. Study goal: Goal of the sudy was to evaluate effects of regular consumption of quercetin on blood lipid values among healthy persons with dyslipidemia discovered on routine laboratory work up for different reasons. The study was designed as double blind, randomised study with two hunderd patients in each arm and total duration of the study being two months. Results: Groups were randomized in accordance with age and sex of patients as well as degree of blood lipid elevations. Average cholesterol, triglycerides, HDL and LDL value in both groups were similar to statisticaly insignificant differences among groups. Test group A had average values of cholesterol 6,21 mmol/l, triglycerides 3,02 mmol/l, HDL 0,89 mmol/l and LDL 3,98 mmol/l. Control group had values of same parameters as follows 6,17 mmol/l, 3,14 mmol/l, 0,92 mmol/l and 3,84 mmol/l respectively. Upon completion of therapy, test group has demonstrated a decrease in cholesterol, triglyceride and LDL values with parallel increase in HDL. Average cholesterol values at the end of the study were 5,09 mmol/l, whereas HDL and LDL values changed to 1,29 mmol/l and 2,91 mmol/l respectively. Discussion and conclusion: Patients rarely agree to start taking medications on a permanent basis, medications most of which are related to certain, not that infrequent, side effects. So these persons start using other means in an attempt to put blood lipids under control. Some of these means include lifestyle modification, exercise, but also use of food supplements that are proven to lower blood lipids. Among these available supplements, quercetin has recently attracted a lot of attention due to its strong antioxidant effects.
19 citations
TL;DR: Folic acid administration decreased the level of endothelial dysfunction measured by adhesion molecules, especially VCAM and microalbuminuria, however, it did not significantly affect vWF.
Abstract: Background: Endothelial dysfunction is considered as a fundamental and also preventable factor in the progression of vascular complications among type 1 diabetic patient. It occurs before the clinical manifestation of the mentioned complications. The aim of this study was to evaluate the effects of folic acid on endothelial function by measurements of adhesion molecules and von Willebrand factor (vWF) in patients with type 1 diabetes in Isfahan, Iran. Methods: This double blind, placebo-controlled crossover trial included type 1 diabetic patients aged 5-20 years old. Selected patients were randomized into two groups of A and B to receive folic acid 5 mg daily or placebo for 8 weeks. After a 2-week washout period, patients in the two groups were swapped to receive placebo or folic acid, respectively, for another 8 weeks. Blood and urine samples were taken to evaluate glycosylated hemoglobin (HbA1c), folic acid, vWF, intracellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), and microalbuminuria levels. Results of these measurements were compared in the two groups before and after folic acid and placebo administrations. Results: Fifty five type 1 diabetic patients aged 12.1 ± 3.4 years with diabetes duration of 3.9 ± 2.1 years were enrolled. Mean of folic acid level in the two studied groups was increased significantly (10.1 ± 3.8 vs. 21.2 ± 1.1in group A and 15.5 ± 1.9 vs. 19.9 ± 2.8 in group B, p 0.05). Conclusion: Folic acid administration decreased the level of endothelial dysfunction measured by adhesion molecules, especially VCAM and microalbuminuria. However, it did not significantly affect vWF. Further studies with larger sample size and long-term administration of folic acid are necessary for making precise decisions in this field.
15 citations
TL;DR: This comparative study between laparoscopic and open cholecystectomy according to patients life quality aspects confirms advantages of Laparoscopic technique in comparison to open CholecyStectomy method.
Abstract: BACKGROUND/AIM The aim of this study was to establish Gastrointestinal Life Quality Index scores of patients before and after laparoscopic and open cholecystectomy comparing scores after both operations. SETTINGS AND DESIGN The 120 patients were involved in this prospective study, 51 male and 69 female, 59 of patients were underwent by laparoscopic method and rest of them, 61, by open method on Surgery Clinic on Clinical university center in Tuzla in period from February 2006 to October 2006, chosen by consecutive method. This study evaluates patients life quality according to score of Gastrointestinal Life Quality Index. METHODS Patients have been tested two weeks before the operation and in two, five and ten weeks of post-operative period. Except from Gastrointestinal Life Quality Index total score, established scores,a parts of life quality are: symptoms, physical function, emotional and mental status and also social activities. STATISTICAL ANALYSIS USED For analysis of achieved results, SPSS (Statistical Package for Social Sciences, V 10.01) program with statistical parameters was used: average values and standard deviation. Out of statistical tests, we used Chi-square test and Student t-test. Values p < 0,05 have been accepted as statisticaly significant. RESULTS The results of the study confirm a working hypothesis that patients life quality after two and five weeks of postoperative period is significantly better (p < 0.05) in laparoscopic method group versus open method group. Also, in domains Gastrointestinal Life Quality Index symptoms, physical function, emotional and menthal status and social activities results are significantly better (p < 0.05) in the laparoscopic cholecystectomy group than in open method cholecystectomy group. Ten weeks of post-operative period, results showed that these two groups have no difference in life quality in total score, also in domain score. CONCLUSION This comparative study between laparoscopic and open cholecystectomy according to patients life quality aspects confirms advantages of laparoscopic technique in comparison to open cholecystectomy method.
15 citations
TL;DR: The aim of this study was evaluating the prevalence of upper FGID in iranian young adults and the findings were agreed with some other Asian studies.
Abstract: Background: Functional Gastrointestinal disorders (FGID) are common disorders in gastroenterology which are common in young adults.The aim of this study is evaluating the prevalence of upper FGID in iranian young adults. Methods and Material: This was a cross-sectional study which was on 995 persons who were going to marry. A ROME III based questionnaire was used to determine the frequency of upper GI Syndromes among the sample population. Results: Our results determined 74 subjects had functional dyspepsia (36 subjects diagnosed as postprandial distress syndrome patient and Epigastric pain syndrome was seen in 38 subjects). Functional heartburn was diagnosed in 52 participants. Globus was seen in 35 subjects and 41 had unspecified excessive belching. Discussion: Many epidemiologic studies were done all around the world but there are different reports about prevalence and incidence of FGIDs. Our results were agreed with reported prevalence of FGIDs in Iran in adults. And our findings were agreed with some other Asian studies.
12 citations
TL;DR: Postoperative uncorrected distance visual acuity tended to be better with the smaller incisions, but this trend did not reach statistical significance especially at letter follow-ups.
Abstract: Goals: To evaluate the effect of micro-incision (2.2 mm) and small-incision (3.0 mm) coaxial phaco-emulsification on surgically induced astigmatism (SIA). Methods: Cataract patients (n = 60, 60 eyes) were randomized into two groups: 30 eyes in the 2.2-mm incision group, 30 eyes in the 3,0-mm group. Phaco-emulsification was followed by intraocular lens implantation via the Monarch II injector with the C cartridge (Alcon Laboratories Inc., Fort Worth, TX, USA). Uncorrected distance visual acuity, corneal keratometry and corneal astigmatism and SIA were assessed 1, 7 and 30 days after cataract surgery. Results: At 1, 7 and 30 days postoperative, SIA of the 3.0-mm group was greater than SIA of the 2.2-mm (p or = 0.07) especially at letter follow-ups. Conclusion: Incision size contributed to postoperative corneal astigmatism especially at earlier postoperative period. When incision size was reduced from 3.0 mm to 2.2 mm, SIA was reduced and refractive stabilization was faster. In longer period of time difference between 3,0 mm and 2,2 mm incision size groups decreases.
TL;DR: Hospitalized acute stroke patients have no high risk of falling, the incidence of serious injury is low, and the falls are more frequent in the first five days of hospitalization and occur mostly during the night, which indicates Severity of neurological deficit, impaired spatial orientation and aphasia are highly correlated with falls.
Abstract: The aim of this study was to analyze the fall frequency and some of its characteristics in hospitalized acute stroke patients. Patients and methods: It was analyzed 1809 acute stroke patients hospitalized at the Department of Neurology in period of one year. A fall was defined as any unplanned «touch to the floor» of any part of a patient’s body, excluding the feet. Results: Out of 1809 acute stroke patients, 1544 (85.35%) had cerebral infarction (CI) and 265 (14.65%) intracerebral hemorrhage (IH). In group of patients that fell (61/3.3%), 49 (80.33%) had infarction and 12 (19.67%)(p=0.25) had hemorrhage. Out of 61 patients that fell, 42 (68.86%) suffered from impaired spatial orientation and 47 (77.05) were aphasic. The neurological deficit, impairments of spatial orientation and presents of aphasia were highly correlated with falls (p
TL;DR: It was found that increased age and positive family history of prostate cancer could be considered as some potential risk factors for prostate cancer in the studied population and a higher intake of tomato sauce was found to have a protective effect against prostate cancer.
Abstract: Background: This study was conducted in order to determine the risk factors of prostate cancer in Isfahan, Iran. Methods: In this case-control study 95 cases of incident, pathologically confirmed PC and 95 controls were recruited. Odds ratios (OR) and the corresponding 95% confidence intervals (CIs) were estimated using conditional logistic regression models. Results: The risk of prostate cancer increased with increasing age (OR: 1.09, 95% CI: 1.04-1.13; p
TL;DR: In this paper, the authors evaluated the relationship between ingested tricyclic antidepressant dosage and electrocardiographic findings (duration of QRS, QT and PR intervals, the amplitude of R wave in lead aVR and right axis deviation) and found that there was a strong relationship between TCA dosage and QRS duration in the TCA group.
Abstract: Aim: Tricyclic antidepressant (TCA) overdose is generally associated with central nervous system (CNS) and cardiovascular toxicity manifested by seizure, electrocardiographic (ECG) abnormalities and arrhythmia. The objective of this study was to determine whether TCA toxicity would be reduced in patient where benzodiazepine (BDZ) was co-ingested with TCA. Design: Patients who were diagnosed to be poisoned by ingestion of both a tricyclic antidepressant and benzodiazepine (TCA-BDZ), and patients intoxicated solely by a TCA were assessed, provided that they had one or more clinical signs of toxicity (anticholinergic, cardiovascular or CNS findings) and no underlying cardiac disease. TCA poisoned patients who had ingested any drugs other than benzodiazepines were excluded. Patients transferred from elsewhere and those admitted after the first 24 hours were also excluded. The clinical manifestations of TCA toxicity and outcome of the patients poisoned only with TCA (N=60) were compared with those of the patients who had co-ingested TCAs and BDZs (N=60). Main Results: The frequency distribution of sinus tachycardia, “QRS more than 100 ms, R/S aVR equal or more than 0.7, RaVR equal or more than 3 mm”, arrhythmia, and generalized tonic colonic seizure was less in patients who had co-ingested BDZ with TCA. Evaluating the relationship between ingested TCA dosage and electrocardiographic findings (duration of QRS, QT and PR intervals, the amplitude of R wave in lead aVR and right axis deviation) in both study groups, demonstrated that there was a strong relationship between TCA dosage and QRS duration in the TCA group. This was significantly different from the same correlation in the TCA-BDZ group (r, 0.50 in TCA group versus r, 0.04 in TCA and BDZ group, P < 0.05). No significant differences were found in complications (aspiration pneumonia, non-cardiac pulmonary oedema and death) between the two groups. Conclusions: cardiovascular toxicity and seizure may be less in TCA-BDZ poisoned patients compared with patients intoxicated with TCA-alone. .
TL;DR: A case of liposarcoma with pulmonary metastases with secondary pulmonary venous (tumor) thrombosis and infarction, presenting 3 years after diagnosis of the original tumor is reported.
Abstract: Pulmonary vein thrombosis has been described in several patients including those with malignancy, pulmonary veno-occlusive disease, fibrosing mediastinitis, and after lung transplantation. 1-5 Although liposarcoma frequently metastasizes to the lungs, to our knowledge pulmonary venous (tumor) thrombosis with lung infarction has not been previously mentioned as part of this disease. We report a case of liposarcoma with pulmonary metastases with secondary pulmonary venous (tumor) thrombosis and infarction, presenting 3 years after diagnosis of the original tumor.
TL;DR: There is a direct relationship between social support and control of diabetes and the patients who had better instrumental, emotional and informational social support, better controlled their diabetes.
Abstract: Introduction: Diabetes causes premature mortality, disability and sometimes irreversible health consequences. Scholars believe that social factors directly and indirectly could impact patient in control of diabetes. The main purpose of this research is to understand how social support related to control of diabetes. Methods: 320 diabetic patients were randomly chosen from specialized clinic of Dr. Gharazy hospital in Isfahan. The element was questionnaire which its reliability was calculated according to coefficients Cronbach’s alpha (r = 0.78). The patients ’two previous sessions ’blood sugar level and also their HbA1C were studied via referring to their medical records.Then the patients were categorized into successful and unsuccessful groups in controlling the diabetes. Their relationship of social support and diabetes control was analyzed through SPSS software. Results: The findings show that there is a direct relationship between social support and control of diabetes. The patients who had better instrumental, emotional and informational social support, better controlled their diabetes.
TL;DR: Assessment of basically levels of aggression and anxiety of athletes might be valuable not only in sport activities, but in overall aspects of life.
Abstract: INTRODUCTION: in fighting sports there are many opened issues related with levels of aggression and anxiety. MATERIAL AND METHODS: Our study is performed with healthy young athletes: kick boxers, karate fighters, and boxers. Examined group consisted of 55 members (45 male) with average age of 20.2 +/- 3.8 years. In analysis of level of aggression Questionnaire A-87 is used. Its purpose is assessment of aggressive behaviour in provoked situations, or measurement of impulsive aggression. Questionnaire A-87 consists of 15 items of different situations with five possible responses. RESULTS AND DISCUSSION: The possible responses or reactions are the five most frequent forms of aggressive responses: a) verbal manifest aggression (VM); b) physical manifest aggression (PHM); c) indirect aggression (IND); d) verbal latent aggression (VL), and e) physical latent aggression (PHL). In the analysis of anxiety is used Beck Anxiety Inventory, BAI. Average training period was 7.8 +/- 3.6 years. Even 37 athletes during sporting carriers were injured, and most of examiners (precisely 13) experienced 3 injuries. Average value of BAI was 12.7 +/- 8.7. Average value of total aggression was 152.2 +/- 40.9; highest levels were observed in VM (33.9) and VL (30.1). Significant positive correlations of all components of aggression with level of anxiety is observed (p Language: en
TL;DR: The data do not support the concept that pentoxifylline elevates hemoglobin level and improves anemia, and further studies on a larger number of patients are required to assess whether or not pentoxifyinglline is useful in these patients.
Abstract: Background: Anemia is a major problem in patients with end-stage renal disease on chronic hemodialysis. rh-EPO is used mostly to elevate serum hemoglobin level and improve complaints caused by anemia, although in some patients it may not be totally effective for treating the disease. In this study, we aimed to evaluate pentoxifylline as a drug for treating anemia. Methods and material: Fifty patients were enrolled in the study and divided into 2 groups. The case group took 400 mg of pentoxifylline daily for 6 months, while the control group took placebo for the same time. The levels of hemoglobin and serum albumin, TIBC, iron, ferritin, and PTH, and use of rh-EPO were estimated. The data were analyzed using SPSS-18 software. Results: Of the 50 patients, 33 (66%) were male and 17 (34%) were female. Student paired t tests showed no significant difference in hemoglobin and serum albumin, TIBC, ferritin, and PTH levels, or use of rh-EPO between the case and control groups. However, iron level was significantly different in the 2 groups. Conclusion: In contrast to previous studies, our data do not support the concept that pentoxifylline elevates hemoglobin level and improves anemia, Further studies on a larger number of patients are required to assess whether or not pentoxifylline is useful in these patients.
TL;DR: Systematic examination of women represents an efficient way of organized screening and prevention of cervical cancer and colposcopic image is an indicator for the abnormal cytological result.
Abstract: Aim of this study was to examine the frequency of cervical cancer and cervical intraepithelial lesions of a different degree in women, corelation between cytologically diagnosed CIN I, CIN II and CIN III lesions and colposcopic findings and corelation between cytologic and pathohistologic findings of CIN III lesion. Material and methods: Cytologic and colposcopic findings have been analysed retrospectively in 2652 women who went through systematic examinations in Women’s Health Care Department at Health Center “Dr.Mustafa Sehovic” Tuzla in period 2008-2011. For 93.2% (N=2475) cytology results were normal. Abnormal cytology result was found in 6.71% (N=178): CIN I in 5.54% (147), CIN II in 0.67% (18) and CIN III in 0.49% (13) of women examined. Results and discussion: Colposcopy in women with cytology results CIN I, CIN II and CIN III showed abnormal result in women with CIN I in 29.9% (44/147), CIN II in 61.1% (11/18) and CIN III in 61.5% (8/13). Significant association between abnormal colposcopic and abnormal cytologic findings (X²=36.30,p
TL;DR: Results were achieved from this study showed that Tibial proximal osteotomy is appropriate treatment for young and middle age patients with progressive deformity, symptomatic varus knee.
Abstract: NTRODUCTION Tibial proximal osteotomy is one of the treatments for patients with knee compartment osteoarthritis. Studies showed 80% good prognosis in five years follow up after osteotomy. Almost always this method is used for pure medial knee compartment osteoarthritis that has a varus deformity. THE AIM of all methods is reforming varus deformity and lower limb alignment to gain 3 to 5 degree extra reformation and take knee in 10 degree valgus. One of the main etiologies for patients inconvenience and no decreasing in their pain is overcorrection or undercorrection, but unfortunately these can't be noticed. Therefore we must make sure that additional stress on the medial joint line was eliminated and regeneration of cartilage was facilitated or at least occurrence of osteochondritis was decreased. So we aimed to determine the efficacy of tibial proximal osteotomy in lower limb alignment indexes in patients with osteoarthritis in medial compartment of knee. MATERIAL AND METHODS This study is a clinical trial study that has done in Alzahra University Hospital of Isfahan Medical Science University in Iran since June 2010 till February in 2011. Patients had pain, pure medial knee compartment osteoarthritis and varus deformities were determined for study. Patients who wouldn't come for control, those who had no convenience for giving their data or osteoarthritis of all three compartments were excluded from study. Number of patients has determined 40 persons according to previous studies. Sampling occurred convenient. Before any surgical processes, the AP x-ray radiography was applied for alignment view. The demographic and radiographic data was registered. Six months later we applied AP x-ray radiography again and obtained data and analysis them with SPSS software and T-Paired statistical method. RESULTS The mean of anatomical limb angle before and after surgical process were 5.1 +/- 3.4 varus and 11.9 +/- 3.4 degree valgus, respectively,so with T-test there was a significant difference between them (P < 0.001). The mean of mechanical limb angle before and after surgical process were 12.6 +/- 3.4 varus and 4.75 +/- 3.5 degree valgus, respectively. Therefor with T-test, there was significant difference between them (P < 0.001). CONCLUSION Results were achieved from this study showed that Tibial proximal osteotomy is appropriate treatment for young and middle age patients with progressive deformity, symptomatic varus knee. Key words: Tibial proximal osteotomy, Knee, Osteoarthritis, Varus deformity.
TL;DR: Patients with a smaller prostate volume, lower PSAD and a higher number of biopsy samples in rebiopsy have a higher chance of prostate cancer detection.
Abstract: Aim: Establish the main differences in the prostate volume, prostate specific antigen density (PSAD), number of biopsy samples in patients with primarily or rebiopsy detected prostate cancer. Materials and methods: In the 2007-2009 period, at the KCUS Urology Clinic, there were 379 TRUS guided prostate biopsies in 323 patients with known prostate volume. The total of 56 patients (17.3%) underwent the first rebiopsy, primarily due to precancerous lesions. The mean prostate volume, ranges of prostate size, PSAT, PSAD and the number of biopsy samples were analysed retrospectively, and the main characteristics in patients with primarily and rebiopsy diagnosed Pca were evaluated as well. Results: The first biopsy cancer detection rate was 29.6% (112/379). The rebiopsy detection rate was 30.3%. There was no statistically significant difference in the prostate volume and the number of biopsy samples among the total number of patients with prostate cancer against the group with benign (suspected) findings. There was a higher Pca detection rate in patients with the prostate volume 60 cm3. PSAD was significantly higher in patients with PCa (0.24 vs. 0.18; p=0.013). The total of 27.2% of the patients with negative biopsy findings and 48% of the patients with diagnosed Pca had PSAD >0.15. PSAD showed sensitivity and specificity in prostate cancer detection of 50% and 75%, with PPV of 48%. Furthermore, the patients with PSAD >0.15 had a higher Gleason score versus the patients with PSAD
TL;DR: This study indicated that lamellar body counting test has a high positive predictive value with a good sensitivity, specificity and negative predictive value and future studies for different cellular counters are warranted.
Abstract: BACKGROUND Respiratory distress syndrome (RDS) is one of the important causes of mortality in neonates. This study was designed to assess the role of the amniotic fluid lamellar body counting in predicting fetal lung maturity. METHOD This study was conducted during 2010, April to 2011, February, at Isfahan University of Medical Sciences, Isfahan, Iran. One hundred and twenty eight amniotic fluid samples were obtained during normal delivery, or before rupturing the membrane in cesarean, and lamellar body was assessed by cellular counter. The respiratory statuses of neonates were determined at delivery and the optimal cut-off point was assessed by receiver operating characteristic (ROC) curve. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were evaluated in optimal cut-off point. RESULTS One hundred and twenty eight amniotic samples and 131 infants were evaluated. The means of maternal and gestational ages were 28.12 +/- 3.84 years and 32.56 +/- 2.72 weeks, respectively. The mean of lamellar body was 31266 +/- 15831 microl in matured lung infants compared to 63081 +/- 16966 microl in immature lung infants (p < 0.001). The optimal cut-off point was evaluated as 47500 microl in predicted pulmonary maturity with sensitivity of 85.1%, specificity of 91.2%, positive predictive value of 92.6% and negative predictive value of 82.5%. CONCLUSION This study indicated that lamellar body counting test has a high positive predictive value with a good sensitivity, specificity and negative predictive value. Future studies for different cellular counters are warranted.
TL;DR: Sildenafil facilitated weaning of COPD patients from the ventilator by improving the respiratory parameters, and this randomized double blind clinical trial study was carried out with 40 patients suffering from COPD.
Abstract: Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common disease that tends to occur worldwide and is a common cause of respiratory failure requiring mechanical ventilation and admission to the intensive care unit (ICU). The present study was carried out to investigate the efficacy of sildenafil in facilitating the weaning of COPD patients from the ventilator. Methods: This randomized double blind clinical trial study was carried out with 40 patients suffering from COPD. The patients were divided in two study groups. 20 patients belonging to Group I received 20 mg sildenafil tablets twice a day for one week while 20 patients of the second group (Group II) received placebo tablets with the same dosage. Respiratory parameters like rapid shallow breathing index (RSBI), mixed venous oxygen pressure (PvO2) and plateau pressure were measured in both groups. Data were analyzed on the basis of student’s t – test and ÷2 test using SPSS 16 software. Results: The results are expressed as mean ± SE and P < 0.05 is considered statistically significant. According to our findings RSBI was lower in Group I compared with Group II after one week of treatment (P= 0.032). PvO2 value was higher in sildenafil group compared with placebo group (P=0.025). Plateau pressure was lower in first group than group II (P=0.022). Conclusion: Sildenafil facilitated weaning of COPD patients from the ventilator by improving the respiratory parameters.
TL;DR: The results of this study shows that preoperative volume loading is associated with lower variability of blood pressure and heart rate during operative period and also reduces the severity and incidence of postoperative nausea and vomiting.
Abstract: Introduction: Preoperative volume loading (PVL) in addition to counteract the decreases in blood pressure during intraoperative period, also may decrease postoperative nausea and vomiting (PONV). This study was designed to investigate the effect of preoperative volume loading on the intraoperative blood pressure variability and postoperative nausea and vomiting. Methods: Thirty subjects scheduled for elective orthopedic procedures randomly divided into case and control groups. The patients in the case group received lactated Ringer 10 ml/kg before induction of general anesthesia. Mean arterial blood pressure (MAP) and heart rate were recorded in two groups every 3 minutes from induction of anesthesia until five minutes after extubation. Variability of mean arterial blood pressure and heart rate were defined as the standard deviation (SD) of the measured values for each patient. Means of these individual SD values were compared between two groups using Mann-Whitney U test. Results: The mean variability of mean arterial blood pressure and heart rate ware significantly lower in case group (8.3 ± 3 mmHg and 8.4 ± 2.5 bpm vs. 13 ± 6 mmHg and 11 ± 2.6 bpm in control group; p < 0.5). The severity of nausea (measured as a ten-point visual analog scale) was significantly lower in case group (1.2 ± 0.9 vs. 3.9 ± 1.8 in control group; p < 0.05). No patients in case group developed postoperative vomiting (compared to 5 patients in control group). Conclusions: The results of this study shows that preoperative volume loading is associated with lower variability of blood pressure and heart rate during operative period and also reduces the severity and incidence of postoperative nausea and vomiting.
TL;DR: Assessment of the impact of pro-inflammatory indices in patients with liver cirrhosis, in relation to bacterial infection and their evaluation as possible prognostic factors on functional liver deterioration, length of hospitalization and lethal outcome found that CRP and the Le count values were most significant predictive factors for length ofospitalisation and lethal outcomes.
Abstract: Introduction: Certain pro-inflammatory indices serum levels, such as leucocytes count and C-reactive protein appears to be a significant and simple clinical tool in prediction of unfavorable course of liver cirrhosis, its complications due to the bacterial infections, length of hospitalisation and lethal outcome. Cirrhotic patients often have a complications due to bacterial infection, demanding the unexpected need for hospitalization in 30% to 50% of the cases. The aim of this study was to assess the impact of pro-inflammatory indices in patients with liver cirrhosis, in relation to bacterial infection and their evaluation as possible prognostic factors on functional liver deterioration, length of hospitalization and lethal outcome. Material and methods: The research was conducted as a prospective study, on 120 patients with liver cirrhosis, who were in divided into two groups: I-experimental one of 60 patients with bacterial infection and II-control one of 60 patients, with no infectious complications diagnosed end treated in period 2005.-2010. Year. Results: Most of the patients of experimental group were in C stage of disease, compared to those in the control one (p
TL;DR: Attention on cardiovascular changes and ECG monitoring particularly in intoxicated patients with severe loss of consciousness, should considered; it will lead to prevent unexpected complication, mortality and to decrease the length of hospitalization.
Abstract: Background: Carbamazepine is an iminostilbene derivative structurally related to cyclic antidepressants which implies its potential cardiotxic properties, especially in acute poisoning. This study aimed to determine the frequency and severity of cardiovascular complications in carbamazepine intoxication and its relationship with level of consciousness. Methods: Patients with carbamazepine intoxication referred to our department recruited using convenience sampling method. Analysis included following parameters: systolic (SBP) and diastolic (DBP) blood pressure, ECG parameters: heart rate (HR), QRS width, PR interval and corrected QT interval (QTc). Relations between features on admission, 12 and 24 hours later and level of consciousness evaluated. Results: 77 patients (28 males, 49 females; median age 25.1) which got our criteria included in this study. QRS complexes in 9 cases(11.7%) were wider than normal and PR interval and corrected QT interval (QTc) were normal. There was no significant relationship between QT interval, QRS width and pulse rate changes with level of consciousness during 24 hours post admission, but blood pressure [systolic, diastolic and mean arterial blood pressure (MABP)] progressively decreased and PR interval changes progressively increased during this period. Further, there was negative correlation just between sever decrease of level of consciousness (coma) and blood pressure [systolic, diastolic and mean arterial blood pressure (MABP)], and positive correlation with QRS complexes widening at 12 hours after admission. There was no correlation between loss of consciousness and diastolic blood pressure, QT interval and PR interval on admission and 12 hours and 24 hours later. Conclusion: Regarding the relationship between level of consciousness and cardiovascular changes at 12 hours after admission, particular attention on cardiovascular changes and ECG monitoring particularly in intoxicated patients with severe loss of consciousness(coma), should considered; it will lead to prevent unexpected complication, mortality and to decrease the length of hospitalization.
TL;DR: A series of Almanac 2011 papers are appearing more or less simultaneously in many of the Network Journals, providing an approximate description of the new series of papers presenting selected recent research that has driven clinical advances in six major topic areas.
Abstract: The Editors’ Network is a task force of the European Society of Cardiology (ESC), representing the 44 National Society Cardiovascular Journals that are published across 37 countries (1). Among the operational goals enshrined in its mission statement is a commitment to improve the diffusion of scientific knowledge through distribution of common academic material and joint education initiatives (2). Heart already has a strong education section and its content, approved by the European Board for Accreditation in Cardiology (EBAC), is available for free access via the Heart and ESC websites. However, a recent joint publication of the Editors’ Network called for educational initiatives to be extended throughout the national cardiology journals of Europe (3), and it is in response to that call that a series of Almanac 2011 papers are appearing more or less simultaneously in many of the Network Journals. Almanac–a late Middle English word derived via medieval Latin from Greek almenikhiaka–is defined as an annual calendar containing important dates and statistical information. It provides an approximate description of the new series of papers presenting selected recent research that has driven clinical advances in six major topic areas. The content is educative and clinically relevant and its presentation across the national society cardiovascular journals of Europe represents a milestone in collaborative publishing. Plans for Almanac 2012 are yet more ambitious and pave the way for a new era of joint educational initiatives driven by the Editors’ Network of the ESC.
TL;DR: The study showed that invasive cardiovascular procedures do have the risk of developing transient embolism in retinal circulation, however, there have been reports of CRAO and BRAO after diagnostic cardiac procedures, therefore clinicians should be aware of this potential complication.
Abstract: UNLABELLED To determine the occurence of embolism in retinal circulation after invasive cardiovascular procedures and the risk of central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO). MATERIAL AND METHODS During a 3 month period 153 patients (303 eyes)--101 male/52 female--who had undergone coronarography or stent implantation were examined before and 24 hours after the procedure. Best corrected visual acuity (BCVA) was taken, visual field examination was done and fundoscopy was performed. Eyes with the opacities in the anterior segment (corneal leucoma, dense cataracts) were excluded from the study. Prior to invasive procedure none of the patients had embolism in the retinal circulation. RESULTS AND DISCUSSION Embolism was found in 3 patients (male) who all had hyperlipidemia with normal blood pressure. Two of them had coronarography and one patient had stent implantation. One of the patients had a previous branch retinal vein occlusion (BRVO) that was treated with photocoagulation. They did not report any symptoms. BCVA was the same before and after the procedure. Two of the emboli were located in the first branch of the central retinal artery and one was located in the branch of cillioretinal artery. All of the emboli were transient after 48 hours. CONCLUSION The study showed that invasive cardiovascular procedures do have the risk of developing transient embolism in retinal circulation. However, there have been reports of CRAO and BRAO after diagnostic cardiac procedures, therefore clinicians should be aware of this potential complication.
TL;DR: Temporalis flap was used in 16 patients, ages ranged between 12 and 76, and the flap remained viable in all instances and there was no major complications or mortality as a result of performed procedures.
Abstract: Introduction: Pedicled temporalis muscle flap presenting a good flap for closing large craniofacial defects. Careful surgeons usually do not mobilize temporalis muscle flap enough to make appropriate use, fully closure, especially if defect exceeds the median line. Patients and methods: Temporalis flap was used in 16 patients, ages ranged between 12 and 76. In all cases defect reconstruction was done by useing new method of extending standard temporal muscle flap. During surgical procedure it is very important to keep periosteal elevator in close contact with the bone. Then, there is no risk for pedicle injury. After vascular pedicle is identified elevating temporal muscle has to be continued by releasing the muscle insertion from the coronoid process. By this way, flap length and arc of rotation is increased. Results: The flap remained viable in all instances. Most of the patients experienced no perioperative complications. There was no major complications or mortality as a result of performed procedures. Conclusion: With this division, flap length was increased at least 2 cm wich is enough for covering defects crossing the midline. Instead of using bilateral temporalis muscle flaps for defect closure, unilateral is sufficient. With this extension of the pedicle length now rotation point is not at the level of the zygomatic arch but lower part mandibular neck.
TL;DR: Lead affects the blood pressure and is closely dependent on the workplace and the years worked in the mine, and Protective measures are necessary in prevention of lead poisoning in the workplace.
Abstract: Introduction: Biochemical and physiological mechanisms by which lead affects the cardiovascular system by increasing blood pressure are still unknown. But it is believed that the increased arterial pressure disturbance is caused as a result of the concentration of intracellular calcium ions (Ca). Aim of the study:The study had the purposes of analyzing the effect of lead in blood pressure at the mine workers in “Trepca” Stan Terg comparing years worked in the mine. Material and methods: The study included 55 workers at Stan Terg Trepca mine, out of which 44 are direct employees who work within the galleries of the mine and 11 workers outside the galleries of the mine, The Control Group. Results: From the data provided in the study, it is noted an increase of arterial blood pressure value (Systolic and Diastolic) at workers who have worked directly in the mine gallery in comparison with The Control Group. Discussion: Workers with the longest time worked in the mine have the most pronounced increase of arterial blood pressure values than those with less working experience. Lead affects the blood pressure and is closely dependent on the workplace and the years worked in the mine. Conclusion: Protective measures are necessary in prevention of lead poisoning in the workplace.