Razi Journal of Medical Sciences

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ABSTRACT Post anesthesia shivering induces a number of complications, which causes a variety of therapeutic approaches. Meperidine has been used as a drug of choice for the treatment of the complications in some patients while it is forbidden for some (e.g. those who use M.A.O inhibitors). In a randomized clinical trial 50 cases were selected and divided randomly in two groups, the first group received 25 mg meperidine (I.V) while the second group received methadone 2.5 mg/ 70kg (I.V) The anti- shivering effects were compared in the recovery room. The first group had a mean age of 33.76 years and second group 34.4 years. The mepridine group had a mean axillary temperature of 36.1 degrees ˚C while the second group had a mean of 36.08 degrees centigrade (P.value > 0.05) Also, the two group had shivering relief 84%, and respectively. The meperidine group had shivering relief after 30 seconds and the methadone group after 60 seconds, but these differences were not statistically significant (P.value > 0.05). The above results suggest similar anti- shivering effects for the two drugs and so, the two drugs could be used interchangeably.

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    Background & Aim: Postanethesia shivering is a common complication of modern anesthesia. With due attention to this point that duration of administration of anesthetic drugs is related to the occurrence of post anesthetic shivering, we studied the effect of duration of anesthesia on the appearance of post anesthesia shivering. Patients and Methods: This double-blind study was performed on 60 patients aged between 20-50 years and ASA class I. Based on duration of anesthesia patients were divided in three groups: In group(1) duration of anesthesia was less than one hour group(2) between 1-3 hours and group(3) between 3-5 hours the amount of post anesthesia shivering was detected at the end of surgery. The anesthesia protocol was similar in the three groups. The results were analysed with chi-square test and Cramer Vi index. Results: Based on our results there was a clear relationship between duration of anesthesia and appearance of post anesthesia shivering. This association becomes more apparent when duration of anesthesia is more than three hours. Conclusion: Increase in duration of anesthesia to more than three hours is a cause for increase in post anesthesia shivering.

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    Background & Aim: Postop shivering is a common complication that needs attention and treatment. Mepridine is an effective drug in treatment of shivering but it has important side effects such as respiratory depression. It is also contraindicated in some patients. The aim of this survey was to compare effects of mepredine and tramadol in treatment of postop shivering in order to find a good substitution for mepridine. Patients and Methods: Ninety women undergoing elective cesarean section under general anesthesia, in ASA class I and II, were enrolled in this double-blind clinical trial. They were randomly divided in three equal groups(n=30 in each group) 1st group received mepredine 0.5 mg/kg, 2nd group received tramadol 0.5mg/kg and 3rd group received tramadol 1mg/kg for treatment of shivering. Data of patients during shivering, time interval between injection of drug and cessation of shivering, incidence of respiratory depression, nausea and vomiting were registered and statistical analysis was done by chi-square test. Results: Shivering ceased in 1st group after 3.9±1.6min, in 2nd group after 4.8±2.6 min and in 3rd group after 2.6±1.1 min(p<0.05). Incidence of respiratory depression in 1st group was %6.66, in 2nd and 3rd groups it was zero(p<0.05). Incidence of nausea and vomiting in 1st group was %13.3, in 2nd group %10 and in 3rd group it was %16.6(P<0.05). Conclusion: According to these findings, tramadol can be substituted with mepredine in treatment of postop shivering and dose of 1mg/kg of tramadol is suggested.

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    Background & Aim: Although shivering is one of the consequences of perioperative hypothermia and is rarely considered as the most serious complication, it occurs frequently and remains poorly understood. While cold-induced shivering has an obvious etiology, post-general anesthetic shivering is attributed to numerous causes. Until now, dexamethasone has been used for the treatment of post-general anesthetic shivering. The objective of the present study is to evaluate the effects of intravenous dexamethasone on the prevention of post-general anesthetic shivering. Patients and Method: 80 patients who were candidates for elective knee arthroscopic surgery were selected and randomly divided into case and control groups. Immediately after the induction stage of anesthesia, which was the same for both groups, 0.15 mg/kg of intravenous dexamethasone was administered to the case group. The same amount of distilled water was intravenously administered as placebo to the control group. The temperature of the operating room was kept between 20 and 25 degrees centigrade. When the operation ended, shivering score was measured and recorded by a trained nurse in the recovery room. The patients and the nurse were blind to case and control allocation of the patients. Results: The mean age of the patients, the temperature difference between operating room and patient's body, and shivering score were 27.34 years, 9.52 degrees centigrade and 1.76 respectively. Both groups were matched for age, weight, operating room and patient's body temperature difference, surgery time, recovery time, and the amount of administered fluids. There were statistically significant differences in score and incidence of shivering between the two groups. A statistically significant correlation was also found between administered fluid volume and shivering score in both groups. Conclusion: The obtained results revealed that intravenous dexamethasone is effective in the prevention of post-general anesthetic shivering. This confirms previous studies and it seems that this study supports central mechanism of post-general anesthetic shivering rather than peripheral one.

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    Background & Aim: During recent years, the quality of life as one of the important outcomes of chronic diseases has been paid attention to by clinical researchers. The aim of this study was to determine the quality of life of the patients with HIV/AIDS referred to the West consulting center of behavioral diseases in Tehran and to draw a comparison with the quality of life of healthy persons. Patients and Method: Using simple sampling method, this cross-sectional study was carried out on 139 patients and 139 healthy subjects in the control group matching the patients for age and sex. The study made use of the summarized quality of life questionnaire of World Health Organization(WHO-Qol-Brief). Demographic and clinical variables associated with the quality of life of HIV/AIDS patients were assessed. Statistical tests like t-test, Chi-square, One-way ANOVA, and Linear regression were used for data analysis. Results: The majority of the patients(88.5%) were male with secondary education. 28.1% were married and the majority of them were unemployed. The average age of the cases was 35.49 years(6.42 SD). A significant difference was seen between the patients and the control group in all aspects of quality of life(P<0.001). The variables such as sex, marital status, education, job, CD4+ cells count, and the clinical stage of the disease had a significant effect on the quality of life of the patients. In multivariable analysis, the most important predictive factor in the quality of life of the patients was the clinical stage of the disease. Conclusion: Providing psychosocial services with continuous and multidisciplinary care models besides medical interferences can promote the health-related aspect of quality of life in patients suffering from HIV/AIDS.

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  Background: Post anesthetic shivering is a common and unpleasant postoperative complication. The aim of this study was to compare the efficacy of ondansetron with meperidine in preventing postoperative shivering.

  Methods: A randomized controlled trial was carried out on 60 patients with ASA class I-II undergoing general anesthesia. General anesthesia was performed with fentanyl, midazolam, sodium thiopental and atracurium. The patients were randomly allocated to receive ondansetrone and meperidine intravenously at the beginning of wound closure. Occurrence and severity of shivering was evaluated for 30 min in the recovery room. Also, side effects were assessed in recovery room.

  Results: In the postoperative period incidences of shivering in ondansetron group was 6.7%. Patients in meperidine group have not shivering (p=0.49). Nausea and vomiting occurred in 26.7% of the meperidine group but none in the patients receiving Ondansetron (p=0.005).

  Conclusion: The prophylactic use of ondansetron and meperidine were found to be effective in preventing postoperative shivering.

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Background: In Iran, there has been a considerable increase in the number of women infected with the human immunodeficiency virus (HIV). Within a socio-political context, social rights inequality of HIV positivity is still a prevailing concern among women. Little is known about the understanding of how Iranian women living with HIV, live their social rights experience. The aim of this study was to examine lived experience of these women against their social rights.

Methods: In this qualitative study, a phenomenological–hermeneutic framework was adopted. We conducted narrative interviews with sixteen women. A purposeful sample of Iranian women was chosen.

Results: Five themes were identified to understand the experience of social rights in women: 1) A state of profound suffering 2) lack support 3) Insecurity in a social-economic life 4) Any respecting and 5) Exerting oneself to keeping. For these women, social rights by their HIV status meant: Living the ambivalence of a process of equality/inequality.

Conclusion: Health professionals have to broaden their role and work on individual, interpersonal and inter-organizational levels. Mobilization of actors from different sectors would facilitate the implementation of pertinent and opportune interventions.

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Background: Infective diseases are one of the most important causes of life quality decrease and death in HIV/AIDS‏ ‏patients. The aim of this study was comparison of viral hepatitis B and C and tuberculosis simultaneous infections Prevalence of positive-HIV patients in incubation and AIDS phases and causes of death in Isfahan Behavioral Consultation Center during ten years (1999 to 2009).

Methods: In this cross-sectional study, Tuberculosis and viral hepatitis B and C simultaneous infections of positive-HIV patients in incubation and AIDS phases and causes of death in Isfahan Behavioral Consultation Center were investigated; they were selected by census method. Patient information was entered to SPSS version 19 software and data were analyzed via descriptive analytic statistical methods.

Results: Totally 116 (48.1%) of 241 patients had one or two disease hepatitis C and B and Tuberculosis (TB) that 18 patients (15.5%) were in AIDS phase. In incubation phase hepatitis C and in AIDS phase TB had the most frequency. 72 patients died that 18 patients (25%) were in AIDS phase. The most causes of death in patients, including 18.1% in incubation phase and 14% in AIDS phase, was AIDS (p≤ 0.001).

Conclusion: The most prevalent of simultaneous infective disease in incubation phase was hepatitis C and in AIDS phase was TB. Clearly simultaneous Hepatitis C and TB in AIDS phase had more prevalent. The most prevalent cause of death in incubation phase was drug intoxication and in AIDS phase was AIDS, but death due to AIDS had the most prevalent in both phases.

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Background: Recently, with the advances in the medicine of boosting the immune system, high ability of peptides for the treatment of viral diseases has been proved. By now, there is no effective vaccine against HIV-1 infection. Previous studies confirmed the efficiency of capsid and envelope proteins of papilloma, Herpes and Adeno viruses in new vaccines design. The present study was planned to predict T-cells epitopes from P24 protein by bioinformatics tools and study their effects on lymphocyte proliferation. Methods: To this aim, sequences of 22 peptides corresponding to P24 protein were obtained from NIBSC and have been examined using HLAPred, Propred, SVMHC, SYFPEITHI, and IEDB server. In this experiment, the peptides were prepared at concentrations of 10,100,500 and 1,000 µg/ml. At the end, the selected peptides were tested on the Iranian blood lymphocyte cells (PBMC). Results: The results demonstrated that positive peptides significantly increased lymphocyte proliferation. However the negative peptides did not have any effect on lymphocyte proliferation. Results also showed that p16 and p3 among tested peptides had highest and lowest effects on lymphocytes proliferation respectively. Conclusion: The results of present study confirmed that epitope predictions tools can be reliable alternatives to experimental work.

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Exploring  educational structure needed for reproductive health in men related to sexually transmitted Diseases and HIV / AIDS: A qualitative study Abstract Background: Due to the low awareness of men in reproductive health and its different aspects, such as sexually transmitted diseases and HIV / AIDS need to explain the educational structure in this context. this subjective perception by recognizing men and informative people, led to the discovery of the structure of subjective views based on their experience.  Material &Methods: In this study, a qualitative approach was applied and data was gathered via in-depth interviews. The subjects were selected via purposive sampling  in two large cities of Iran including  Tehran and Mashhad .Overall, 30 man were enrolled in this study. Participants were selected from public health centers, hospitals and offices. Data were analyzed using conventional qualitative content analysis with MAXqda software. Results: Two themes were derived from the experiences of participants that can be required in relation to reproductive health. The emergent categories were: "education based on gender empowerment" and "favorable consideration to the characteristics of education". conclusion: To improve the educational structure of men, planning to inform and empower men with the desirable features of education in the national and regional level, is essential to prevent risky behaviors. It is possible to gain the support of officials contribute to a responsible and comprehensive implementation of such programs should be the basis of government policies and community education.

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Background: Unfortunately, during the past years an increase in HIV infection is reported, especially through high-risk sexual relations. In this study, the effect of stigma, mental health and coping mechanisms on risky behaviors in HIV-positive patients were examined.

Methods: This study is a cross-sectional study. Using convienient sampling method 450 HIV-positive patients were enrolled from Behavioral and Infectious Disease Clinic in Imam Khomeini Hospital in Tehran. The data were collected using demographic questionnaire, Berger Scale Stigma, General Health-28 Questionnaire, and Lazarus coping strategies questionnaire (WOCQ). The data were analyzed using independent t-test, ANOVA and regression.

Results: Mental health, stigma and coping mechanisms of problem solving were associated with risky behaviors (p<0.05) and rate of stigma was more in women and mental health lower in this group compared with men.

Conclusion: Psychological interventions may be effective in improving mental health and reducing risk behaviors.

 

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Background & Aims: Acquired Immune Deficiency Syndrome (AIDS) is a chronic disease with a high mortality rate and is completely different from other diseases. It is an infectious disease caused by HIV, which is transmitted through contact between blood and semen. The disease is a rapidly expanding health challenge, and research findings show that people struggling with chronic diseases such as HIV + show high levels of psychological problems and dysfunction. HIV + is also associated with low resilience. Resilience is the ability to adapt to stressors in the face of adversity, which is a learnable skill and its mechanisms moderate the relationship between pain and its consequences. In other words, resilient and stubborn people can overcome a variety of adverse effects, have a greater ability to solve problems and respond better to adverse conditions to maintain their psychological well-being. Accordingly, research shows that people with HIV + have low psychological well-being in addition to low resilience. Psychological well-being is the pursuit of perfection in the realization of one's potential, which includes self-acceptance, positive relationships with others, autonomy, purposeful living, personal growth, and mastery of the environment. Unfortunately, in addition to affecting and lowering the quality of life of an infected person, HIV + can also affect the functioning of the family and the quality of life of those around them, including parents. Quality of life is a social concept according to which a person gives a mental understanding of the good or bad of life. Accordingly, the World Health Organization defines the quality of life as an individual's perception of life in the context of society's culture and values in line with the individual's goals and interests and relates it to physical, mental, beliefs, self-reliance, and social relationships. Knows. Therefore, some researchers believe that there is as much quality of life as there are people on earth because everyone can give a different perception and meaning to life. Compassion-focused therapy (CFT) was proposed by Paul Gilbert. Although the components of this treatment were initially proposed by Neff and he introduced them as awareness, kindness to oneself, and a sense of fellowship with humanity, it was Gilbert who used these structures in treatment sessions and introduced CFT. Although research findings support the effectiveness of compassion-focused therapy in a wide range of clinical problems, the researcher's research shows that so far a study on the effect of this treatment on variables of resilience, psychological well-being, and quality of life in HIV + patients Has not taken place. Accordingly, this study seeks to answer the question of whether a course of treatment focused on compassion has a significant effect on resilience, psychological well-being, and quality of life of HIV + patients?
Methods: The present study was applied and included experimental designs of pre-test-post-test with an experimental group and a control group. The statistical population of the study is all 330 HIV + patients in the Center for Behavioral Diseases in 1397. According to Fidel and Tapachik's (2001) purposeful sampling method, 107 people (104+ number of dependent variables) had the criteria for inclusion in the study. They were selected from the mentioned community. For screening, the selected candidates first answered the Connor and Davidson Resilience Questionnaire (2003), the Reef Psychological Well-Being Questionnaire (1989), and the Weir and Sherborn Quality of Life Questionnaire (1992), followed by 55 people with the lowest scores. Were selected in response to the questionnaires, and finally 30 people who met the inclusion criteria and declared their readiness to conduct the study were included in the study. Candidates were randomly assigned to a 15-member experimental group and a 15-member control group. Inclusion criteria included at least one year of HIV + infection, not receiving any other psychological intervention during the study, the age range of at least 20 and at most 30 years, higher education, single marital status, and no gender consideration is. Exclusion criteria included the unwillingness of volunteers to continue the sessions and the absence of more than one session in group interventions. The experimental groups underwent 8 sessions of 120-minute treatment focused on compassion therapy (CFT). The control group did not receive any intervention until the end of the study. At the end of the interventions, all three groups were re-evaluated and the results of the interventions were compared with each other. To evaluate the stability of treatment, 1 month after the interventions, the volunteers were re-evaluated. The instruments of this study included the Connor and Davidson Resilience Questionnaire (2003), the Reef Psychological Well-Being Questionnaire (1989), and the Weir and Sherborne Quality of Life Questionnaire (1992). Data analysis was performed in two parts: descriptive and inferential. Covariance analysis was used to analyze the data.
Results: The findings indicate that the independent variable, ie compassion-focused treatment, has affected all research variables including resilience, psychological well-being, and physical and psychological quality of life, and are significant at the level of 0.001.
Conclusion: Explaining the findings of this study in the sense that compassion-focused therapy affects the variables of resilience, psychological well-being, and quality of life, it can be said that compassion-focused therapy, like acceptance and commitment therapy, is opposed to clinical diagnosis. And these variables, as described earlier, are positive psychological variables. The three basic principles taught to people living with HIV in this treatment include mindfulness awareness, common human principles, and self-kindness. People in the group learned how to be kinder to themselves and useless self-blame. This may also provide a good explanation for how this affects research variables.