ABSTRACT
The ability of controlling balance is an essential part for all movements. In recent years, new theories in movement and balance has become the basis of some research in evaluating balance. In one of this new methods ( which is used in this study ) controlling balance is evaluated by measuring body sway in standing position during different conditions in which, the availability of sensory information has been changed. This study has a Quasi – Experimental design, and the sample consisted of 90 females, categorized as children, adults and elderly. According to the results, in altered sensory conditions the adults could control their standing balance more effectively than the other two groups. Besides, it seems that in children the function of vestibular system in controlling balance was not as effective as in adults. The results also show that in elderly, the importance of visual information in controlling balance was less than somatosensory information. Key Words: 1) Balance 2) Sensory Information 3) Standing Position
Harlequin Ichthyosis (HI) describes a severe erythrodermic ichthyosis and causes a distinctive and grotesque appearance at birth. Survival is now possible therefore, harlequin ichthyosis is a more appropriate term than harlequin fetus. Incidence is 1 in 300,000 births. An autosomal recessive pattern of inheritance is seen in this disorder, but a new autosomal dominant mutation may possibly be responsible. The prognosis is ominous and most of the affected neonates die in the first hours or days of life. In this case report we present two cases of HI who were the first and the second baby of a family and their parents were cousins.
Background & Aim: Previously, patients with end stage renal failure(ESRF) and lower urinary tract abnormality(LUTA) were often considered high risk for renal transplantation. In order to examine the degree of risk, 48 patients who received renal transplants in Labafi Nejad Hospital were evaluated between 1986 and 2003. Patients & Method: In this retrospective cohort study, the mean age of the patients was 11.5 years in both case and control groups. Girls comprised 35% of the subjects and boys 65%. Urologic anomalies included posterior urethral valves in 4 cases, ureteral obstruction in 4 cases, and neurogenic bladder in 40 cases. Results: Among the subjects of the control group, 2.3% had hyper-acute rejection, 59% acute rejection, and 35% chronic rejection. In patients with LUTA, 8% showed hyper-acute rejection, 75% acute rejection, and 39.5% chronic rejection. However, there was no significant difference between these two groups(hyper-acute rejection: Pv=0.11, acute rejection: Pv=0.52, chronic rejection: Pv=0.29). Graft failure was seen in 33%(16 out of 48) of the patients. This value was the same in children without LUTA who underwent renal transplantation. The mean survival period was 6 years in patients with LUTA and 7.3 years in the control group. This difference was not statistically significant, though(Pv=0.7). In patients with LUTA, the rate of graft survival in the first year after transplantation was 90% rates for the third, fifth and seventh years after transplantation were 76%, 65% and 40% respectively. In the control group, graft survival rate was 88% in the first year, 73% in the third, 70% in the fifth, and 49% in the seventh year after transplantation. Conclusion: Graft survival rate was the same in both groups.
Background & Aim: Acute appendicitis is one of the most common etiologies of attending of patients with abdominal pain to Emergency Department. In order to diagnose, it, it is necessary to obtain patient's history, and perform physical examination and paraclinical tests that would waste time. Therefore because of the severe abdominal pain in these patients and the fear of some surgeons in giving narcotics (because of missed diagnosis in examination), this research was done to prove the fact that early administration of morphine reduces pain and discomfort of the patients without any disturbance in time and accuracy of diagnosis. Patients and Methods: This randomized controlled clinical trial was done on patients who came to emergency department of Hazrat Rasool Akram hospital because of abdominal pain and whose alvarado scores were above 6 and were operated with diagnosis of acute appendicitis. They were divided to 2 groups: double blind group that received 4 mg morphine and placebo group. The time of intervention and diagnosis was noted. Biopsy samples were sent to pathologist for reports. Results were analyzed by parametric tests(t-test and Chi Square) via SPSS software. Results: Overall 200 patients were enrolled in research and divided into two groups who received placebo & morphine. There is no difference inregard to mean of age and distribution of gender between two groups(p>0.05). There is no difference between two groups inregard to percentage of pathology findings(p>0.05). Also the mean duration from our intervention to time of diagnosis of surgery team was not significantly different between two groups(P>0.05). Conclusion: Our research shows that use of morphine does not affect the accuracy and time of surgical diagnosis. Thus it seems that we can use opiate analgesics in patients with abdominal pain, suspected of appendicitis.
Background & Aim: Delayed graft function(DGF) generally refers to oliguria or the requirement for dialysis in the first week post-transplantation. It is the earliest and most frequent post- transplantation complication that can occur. DGF is an extremely important post- transplantation complication because its occurrence has short-term or long-term consequences for allograft survival. However, limited studies have been conducted on DGF and its complications in pediatric renal transplantation. Therefore, the aim of the present study was to determine short-term and long-term effects of DGF on allograft outcome in kidney transplanted children. Patients and Method: In this historical cohort study, 230 children who received kidney transplants between 1985 and 2005 in Labafi Nejad Hospital in Tehran were assessed through a mean follow-up period of 60.96(SD=40.46) months (ranging from 1 to 180 months). The children were divided into two groups: 183 children in group B(no DGF) as the control group and 47 patients in group A (DGF) as the case group. Risk factors of DGF and the impact of DGF on renal function within the first year, long-term graft survival, and post-transplantation complications were investigated and compared using Logistic regression model and Kaplan–Meier survival analysis. Results: The incidence of graft failure at the end of follow-up period was significantly higher in DGF group(53.2% vs. 22.4%, P<0.001). The mean graft survival length was 134.2(SEM=6.17) months in group B and 76.52(SEM=12.41) months in group A(P<0.001). The graft survival rate was 94.9%, 91.9%, 83.9%, 79.2% and 72% at 1, 3, 5, 7 and 12 years after transplantation in children without DGF versus 75.6%, 53.2%, 47.2%, 31.9% at 1, 3, 5 and 8 years after transplantation in patients with DGF. Dialysis before transplantation(P=0.039), acute rejection(P<0.001), immunosuppressive protocol without celcept(P<0.001) and the presence of DGF(P<0.001) were found as the significant risk factors for the occurrence of graft failure in the future. Conclusion: The results of our study showed that delayed graft function could remarkably and independently affect graft survival and worsen both short-term and long-term transplantation outcomes. This result is in contrast with the studies that only believe in the effect of DGF on short-term graft survival. However, in our study when patients whose grafts had failed during the first year after transplantation were censored, still significant differences were noted in graft survival between patients with and without DGF. Thus, the prevention of DGF is one of the most important issues in graft survival improvement.
Background & Aim:
departments. Low risk patients can be discharged and receive outpatient treatment if clinical and paraclinical assays are
normal. The recommended pre-discharge evaluations are controversial. However, because of the availability and safety of
bedside echocardiography in emergency departments, we decided to conduct this study.
Unstable angina accounts for about 30% of cardiovascular patients referred to emergencyPatients and Method:
unstable angina and admitted to the Emergency Department of Hazrat Rasoul-e-Akram Hospital. All of the cases
underwent bedside echocardiography before their discharge. Calling the patients one month after their discharge, their
outcomes were recorded. Then we made a comparison between echocardiographic findings and their one-month
outcomes. The data were analyzed via SPSS software using statistical tests such as Fisher, Chi-square and t-test.
This cohort study was done on 140 patients with chest pain who were diagnosed with low riskResults:
cases) were male. The patients with abnormal echocardiographic findings, i.e. EF(Ejection Fraction)<40% and wall motion
abnormality, had a significantly higher rate of re-hospitalization because of chest pain(p=0.000).
The mean age of the patients was 51.39(SD=10.13) years. 42.1%(59 cases) were female and 57.9%(81Conclusion:
cardiovascular events in low risk unstable angina patients.
The study shows that bedside echocardiography before discharge is a reliable method for predictingBackground and Aim: Many different routes have been introduced for prolonging the duration of axillary block in upper extremity procedures. In this study the effect of adding dexamethasone to lidocaine during axillary plexus block has been studied.
Patients and Methods: This study was designed and performed as a double blind randomized clinical trial.The patients candidated for upper extremity procedures in Hazrat Fatemeh Hospital operation room, entered the study based on inclusive and exclusive criteria.The patients were divided in to two 30-person groups randomly. For axillary block in the first group (control or lidocaine group), a combination of 34cc lidocaine1.5 %, 2cc sodium bicarbonate and 2cc distilled water was used in the second group(dexamethasone group) the utilized solution was similar to that used in the first group but with 2cc of dexamethasone (8 mg) used instead of distilled water. The onset of sensory, motor and sympathetic block, duration of sensory and intensity of post operative pain was measured and recorded.The data was analysed with SPSS V.13.The quantitative data was displayed with mean and standard deviation. The qualitative data was displayed with frequency.The Chi square and t-tests were used for quality data quantity data, respectively.
Results: The onset of sensory, motor and sympathetic block was similar in both groups and no significant statistical difference was present.The duration of the block and the time of the first request for analgesia post operatively were meaningfully longer in the dexamethasone group than lidocaine group(control group). Also the intensity of post operative pain from recovery to 6th hour after operation was meaningfully less in dexamethasone group than in control group.
Conclusion: This study revealed that addition of dexamethasone to the combination of sodium bicarbonate and lidocaine for axillary plexus block can prolong the duration of block.Increase in the duration is more prominent for sensory than motor block. Meanwhile the post operative analgesia in this group was more than lidocaine group.
Background and Aim: Clonidine has been found to decrease the tourniquet pain and enhance analgesia, when added to lidocaine in Intravenous Regional Anesthesia (IVRA) for upper extremity surgery. Our study evaluates the efficacy of oral clonidine as premedication before IVRA with that of lidocaine for upper extremity surgery and compares it to that of clonidine added as adjunct to lidocaine solution for IVRA.
Patients and Materials: We conducted a prospective randomized double-blinded study on 60 patients undergoing upper extremity surgery under IVRA. Patients were randomized to receive plain lidocaine, 200 mg in 41 ml for IVRA(group IVRA), lidocaine 200 mg in 40 ml plus clonidine 2 µg/kg in 1 ml (group IVRA–C), or plain lidocaine, 200 mg in 41 ml for IVRA plus oral clonidine 2mg as premedication 1.5 hrs before surgery (group IVRA-OC). Patients in the first two groups received a placebo as premedication. Times of proximal tourniquet deflation and distal tourniquet inflation(T1), time of first intraoperative request for analgesics(T2) , time of first postoperative request for analgesics(T3), and the total analgesic consumption were recorded.
SPSS V. 13 was used for statistical analysis. Quantitative data are shown as mean+/- SD and qualitative data are presented with frequency. Chi square and ANOVA tests were used for data analysis. p<0.05 was considered as significant.
Results: In this study 60 patients were divided in to three groups of 20 each. The groups were IVRA, IVRA-C and IVRA–OC. There were no significant differences among the three groups in regard to the demographic characteristics and the duration of surgery. Time duration of proximal cuff deflation and distal cuff inflation was 49.5 +/_ 10.5 minutes in group IVRA–C, which was almost twice that of the other two groups (p= 0.0001). Time for first intraoperative request for analgesics was significantly different (longer) in group IVRA–C as compared to group IVRA p= 0.01). Time for first postoperative request for analgesics and the total analgesic consumption were significantly longer and lower, respectively in group IVRA-OC (p = 0.0001).
Conclusion: The addition of clonidine to lidocaine for IVRA, delays the onset of tourniquet pain and decreases analgesic consumption for tourniquet pain relief intraoperatively. Oral clonidine, on the other hand, is mostly effective in postoperative pain relief.
Background & Aim: The stressful environment of the emergency department exposes the staff to the hazards posed by physical and verbal violence.This can affect not only the job security and satisfaction among the personnel but also the service and care offered to the patients. This study has been designed to determine the incidence rate of physical and verbal violence inflicted by patients and their companions on the emergency department personnel of Hazrate-e-Rasoul Hospital in the fourth trimester of the year 1385.
Patients and Method: In this cross-sectional descriptive study, all the emergency department staff of Hazrat-e-Rasoul Hospital were asked to fill in a questionnaire about experiencing physical and verbal violence in the last trimester of the year 1385. 166 respondents included 17 attending physicians, 33 residents, 15 interns, 32 nurses, 15 ancillary staff, 20 laboratory technicians, 10 radiology technicians, 18 security guards and 6 orderlies. Data were collected and analyzed using SPSS software version 15 , t-test and Chi-square.
Results: The mean age of the staff was 32.20±7.67 years. 39% of the subjects were female and 61% were male. 77.5% had experienced verbal or physical violence at least once.The mean rate of verbal violence in the fourth trimester of the year 1385 was 31.1 times. 74% of verbal assaults were committed by men and 26% by women. 15.93% of the emergency department staff had experiences of physical violence in this trimester, and in 78% of the cases the violent person was a man and in 22% of the cases a woman. 13% of the emergency staff felt a high degree of security during their shift work, 52% felt a moderate degree of security, 27% felt a low grade of security and 8% felt no security during their shift work. 96.15% of the staff had received no education in this regard, and 87.4% reported that they think security measures provided to decrease violence in emergency department are insufficient.
Conclusion: This study shows that the incidence of violence in emergency department is high and this is a concern for the emergency department staff. Most of the violent behaviors which were displayed by patients’ companions can be controled by considering a good waiting area for them and avoiding their crowding in the ward.
Background & Aim :Low density lipoprotein (LDL) particles are heterogenous with respect to their size,density and lipid composition. Among LDL particles ,the smaller and denser LDLs (small dense (sd)LDL) are believed to be atherogenic since these particles are taken up more easily by arterial wall.They are readily oxidized and have reduced affinity for LDL receptor and increased affinity for arterial proteoglicans. Therefore, they are strongly associated with development of coronary artery disease(CAD).The aim of this study was to compare sdLDL levels in CAD patients and healthy individuals.
Patients and Method: In this comparative cross-sectional and case-control study, the sdLDL levels were determined in 86 patients with coronary stenosis,35 patients without coronary stenosis confirmed by angiography, and 30 healthy individuals. SdLDL was measured by a direct homogenous LDL-C assay in the supernatant of serum that remained after heparin-magnesium precipitation.
Results: The results of ANOVA test showed that the sdLDL levels were higher in patients with coronary stenosis than patients without coronary stenosis and healthy individuals(21.54±7.1 mg/dl,16.88±4.4 mg/dl and 15.45±5 mg/dl respectively, p=0.001). In addition, linear regression analysis and Pearson correlation coefficient revealed that sdLDL levels were positively correlated with serum triglyceride (r=0.494),total cholesterol(r=0.354) and LDL-C(r=0.749) and were inversely correlated with HDL-C(r=-0.586) (p<0.01).
Conclusion: The results suggest that patients with increased levels of sdLDL are at high risk for coronary artery stenosis.
Background: Pneumothorax may be associated with penetrating or blunt chest traumas' that need early diagnosis and treatment. Today the diagnosis modalities are CXR and CT-Scan that are not suitable for unstable patients. Chest sonography can be a fast diagnostic method at patient bedside. The purpose of this study was to evaluate the accuracy of bedside ultrasonography in diagnosis of pneumothorax.
Methods: In this prospective study, 60 cases suspicious of pneumothorax were included in study. Bedside ultrasonography was performed for all the cases. Sonography site was between parasternal and midclavicular lines in 2nd to 4th intercostals spaces of both thoracic sites and performed between 5-10 respiratory cycles. Gold standard results for definite diagnosis were: positive results of chest X ray, chest CT scan and/or air leak after needle or tube thoracostomy. In suspicious results, CT scan was done. Data were analyzed accordingly with statistic tests of “Chi-Square” and “Fisher’s Exact Test”. SPSS V.12 was also used.
Results: Trauma mechanism in 5 cases (8.3%) was stab wound, and in 53 cases(88.3%) multiple trauma there was 1 case of tuberculosis and 1 case of blunt chest trauma as well. Eleven out of the 12 pneumothorax cases (proven by chest Xray or CT scan) were diagnosed by bedside sonography. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of bedside ultrasonography for diagnosis of pneumothorax were 91.6%, 100%, 100%, 97.9% and 98.6%, respectively.
Conclusion: With respect to the results of this study and previous studies, bedside ultrasonography is a good method for diagnosis of pneumothorax.
Background : The etiolog y, pathophysiology and treatment of Peyronie’s disease remain unknown. Few medical therapies have positive effect on this condition. However, penile curvature is the major symptom of Peyronie’s disease, which can be treated by surgical reconstruction. There are many surgical techniques for correcting penile deformity but ther e is the lack of a gold standard procedure. We present a surgical technique to correct penile deformity in Peyronie’s disease.
Methods: In this case series study, w e treated 14 patients with stable Peyronie’s disease with significant curvature that precluded intercourse. We excised the fibrous area and the gap wa s covered with a graft removed from the crural segment of the corpora cavernosa.
Results: In 3, 6 and 12 months follow-up there were straightening of penis in 92.8, 92.8 and
78. 2% of patients and acceptable erectile function in 100, 92.8 and 85.7% , respectively . Thirteen and eleven of 14 patients were satisfactory with the cosmetic and functional result of surgery , respectively . No severe perioperative complication was noted.
Conclusion: Present technique may be consider ed as a treatment option in patients with curvature due to Peyronie’s disease. Tunica albuginea auto graft from crural segment seems to be an appropriate grafting material for this technique.
Methods: In this laboratory experimental study, male Wistar rats were randomly divided into control, Aloe vera extract or normal saline receiving, under acute or chronic immobilization animals of 5 in each group. After 6 weeks blood samples were collected using cardiac puncture method. Following serum collection, SGOT or SGPT level was measured by spectrophotometry method. Data were statistically analyzed and compared between groups using ANOVA.
Results: Serum SGOT level was significantly increased in rats enduring acute or chronic immobilization animals compared with control rats (p<0.01 and p<0.001, respectively). Serum level of SGOT level was significantly increased (p<0.01) and of SGPT was significantly decreased (P<0.01) in extract receiving animals compared with control rats (p<0.001).
Conclusion: Our findings indicate that immobilization and Aloe vera extract is serum SGOT enhancer. In this respect, in clinical considerations, pathological effects of immobilization or Aloe vera intake is important in the field of SGOT biochemical alteration.
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