Comparing the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children.

INTRODUCTION: In this study we aimed to compare the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children. MATERIALS AND METHODS: In this randomized double-blind clinical trial study 60 children with ASA = I-II aged 5-12 years undergoing tonsillectomy were involved. The first group received bupivacaine at a dose of 0.1 mg/kg that was injected into the bed and the anterior crease of each tonsil. The second group was given intravenous acetaminophen at a dose of 12.5 mg/kg. The patient's pain score at 10, 30, 60 min after his/her admission to recovery room and 120, 240 and 360 min after the surgery was recorded using CHEOPS. Patient's sedation score, nausea or vomiting, the time of the first request for analgesia and the time of starting oral feeding were recorded and analyzed too. RESULTS: There was no significant differences in mean age (p value = 0.44), gender (p value = 0.79), weight (p value = 0.36), height (p value = 0.17), anesthesia duration (p.value = 0.85) and surgery duration (p.value = 0.73) between two groups. Postoperative pain was significantly less in the bupivacaine group at 240 and 360 min after the surgery. The mean sedation score was higher in the bupivacaine group but not significantly. There was no significant difference between groups regarding the nausea and vomiting, the first analgesics request time and the start time of oral feeding. CONCLUSION: According to the results of the present study, since administration of peritonsillar bupivacaine compared to acetaminophen had a better effect on managing postoperative pain and improving sedation and also since no complications were reported; therefore, peritonsillar infiltration with bupivacaine is suggested for pediatric tonsillectomy.

A cross-sectional study on the reasons for vaccine hesitancy in children under seven years of age in Isfahan, Iran.

Introduction: The diminution in vaccination coverage in recent years has contributed to the reappearance of infectious diseases, and vaccine hesitancy is one of the main causes. As a result, we investigated the causes of vaccine hesitancy in children. Materials and methods: This descriptive-analytical study was conducted cross-sectionally in 27 comprehensive health service centers in Isfahan City from June to October 2022. This study included Iranian families living in Isfahan who did not vaccinate their children by the due date. A researcher-made questionnaire collected data on children's vaccine hesitancy after verifying validity and reliability over the phone and in person by the researcher. The mothers completed informed consent. Independent T-tests, Pearson's correlation coefficient, analysis of variance, and a generalized linear model were used to analyze the data. Findings: Finally, 298 families participated in the study, 34.3% refused, and 65.7% delayed their child's vaccination. Vaccination was hesitant due to the child being sick at the time of injection (57.3%), believing that vaccination is not necessary to prevent uncommon diseases (49%), and being concerned about severe side effects caused by the vaccine (48.7%). Vaccine hesitancy among mothers with bachelor's degrees and families less than one kilometer from the health center was significantly less than among others. Additionally, Vaccines at birth, four, six, twelve, and eighteen months, and six-year-old vaccines were associated with vaccine hesitancy. Conclusion: Children's illness at the time of vaccination, the belief that vaccination is unnecessary to prevent uncommon diseases, and the worry about severe complications were among the most common reasons for vaccine hesitancy. Mother's education, distance to the health center, and vaccine type were associated with vaccine hesitancy.

The comparison of intraarticular morphine-bupivacaine and tramadol-bupivacaine in postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction.

PURPOSE: To compare intraarticular morphine-bupivacaine and tramadol-bupivacaine as postoperative analgesics in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS: A randomized, double blind, controlled trial study of 60 ASA I-II patients undergoing arthroscopic ACL reconstruction was performed under general anesthesia. Patients were randomly allocated into three groups. The MB group (n = 20) received 10 mg morphine and 0.5% bupivacaine; the TB group (n = 20) received 100 mg tramadol and 0.5% bupivacaine; and the control group (n = 20) received isotonic saline intraarticularly in a total volume of 20 ml after the operation. Postoperative pain was assessed with visual analogue scale (VAS) at 0, 30, 60, 90 min and 2, 4, 6, 12, 24 h being at rest. Analgesic duration as defined was the time of first request for analgesics, the first 24 h analgesic consumption, time to unassisted ambulation, discharge time and incidence of side effects were also evaluated. RESULTS: The VAS scores at 30, 60, 90 min and 2, 4, 12, 24 h were significantly less in the MB and TB groups in comparison with the control group (P < 0.05); VAS scores also decreased significantly in the MB group compared to the TB group at 2, 4 and 24 h (P < 0.05). Analgesic duration was longer and analgesic consumption was substantially less in the MB group (P < 0.05). Moreover, unassisted ambulation time and discharge time were significantly shorter in the MB group than the TB and control groups (P < 0.05). Side effects were similar among the groups. CONCLUSIONS: Intraarticular morphine-bupivacaine provides effective pain relief, longer analgesic duration, less analgesic requirement, shorter unassisted ambulation and discharge time were compared with intraarticular tramadol-bupivacaine after ACL reconstruction arthroscopy. LEVEL OF EVIDENCE: I.

The Effect of Low-Dose of Propofol on the Respiratory Complications Immediately After Tracheal Extubation in Children Undergoing Tonsillectomy.

The aim of this study was to determine the effect of low-dose propofol on the respiratory complications immediately after tracheal extubation in children undergoing tonsillectomy. In this randomized double blinded clinical trial study, 70 children (2-12) years old with ASA class I undergoing elective tonsillectomy involved. General anesthesia was performed by the same anesthesiologist and in the same way. The patients were then intubated with oxygen after 3 min of ventilation. After the surgery and muscle relaxant injection and before extubation, 0.5 mg propofol/kg was injected into the intervention group. The control group received normal saline. Finally, the presence of post-extubation laryngospasm, cough and nausea and vomiting was recorded and all data analyzed between two groups. There was no significant difference in age (p value = 0.425), gender (p value = 0.851), cough (p value = 0.239), nausea (p value = 1) and weight (p value = 0.624) between two groups. There was a significant different in incidence of laryngospasm between two groups (p value = 0.04). It can be concluded that the administration of 0.5 mg/kg of propofol before extubation could prevent laryngospasm in patients undergoing tonsillectomy, without inducing any side effects.

EvaIuating the "good death" concept from Iranian bereaved family members' perspective.

Improving end-of-life care demands that first you define what constitutes a good death for different cultures. This study was conducted to evaluate a good death concept from the Iranian bereaved family members' perspective. A descriptive, cross-sectional study was designed using a Good Death Inventory (GDI) questionnaire to evaluate 150 bereaved family members. Data were analyzed by SPSS. Based on the results, the highest scores belonged to the domains "being respected as an individual," "natural death," "religious and spiritual comfort," and "control over the future." The domain perceived by family members as less important was "unawareness of death." Providing a good death requires professional caregivers to be sensitive and pay attention to the preferences of each unique person's perceptions. In order to implement holistic care, caregivers must be aware of patients' spiritual needs. Establishing a specific unit in a hospital and individually treating each patient as a valued family member could be the best way to improve the quality of end-of-life care that is missing in Iran.

Klebsiella pneumoniae pseudoaneurysm of the ascending aorta after coronary artery bypass graft.

Mycotic pseudoaneurysm of the ascending aorta is rare in patients undergoing coronary artery bypass graft (CABG) and usually caused by staphylococcus aureus. We describe a patient with a mycotic pseudoaneurysm of the ascending aorta at the proximal vein graft anastomosis site after CABG. Culture from the sinus tract of the sternum and from the aneurysm sac was Klebsiella pneumoniae. Surgical technique was patch repair of aorta under hypothermic circulatory arrest. He is asymptomatic at 24 months follow-up.

Endovascular treatment of aortobronchial fistula secondary to coronary artery bypass graft (CABG).

Aortobronchial fistula (ABF) is a rare and late complication of cardiac surgery. If untreated, mortality rate is approximately 100% secondary to exsanguinations haemoptysis. Early diagnosis and treatment are essential for successful management. Open surgical repair is associated with high morbidity and mortality rate, ranging from 25% to 41%. Endovascular treatments of ABF is a less invasive treatment modality and have become an important alternative to open surgical intervention in aortic pathologies. We present a case of ABF that successfully is managed by endovascular approach.

The effect of vibration on the severity of restless legs syndrome in hemodialysis patients.

Introduction: The restless legs syndrome (RLS) is a neurological disorder in patients undergoing hemodialysis. This syndrome causes individual's disturbed rest, discomfort, and stress, and secondarily to weakened functioning and disturbance in occupational activities and familial life. Objectives: The present study aimed at investigate the effect of vibration on the severity of the manifestation of symptoms of RLS in hemodialysis patients. Patients and Methods: This is an interventional before-after study conducted on 80 patients with RLS in hemodialysis wards of Yazd hospitals. The samples were selected randomly and intervention was performed on the patients as vibration for 10 minutes three times per week during 4 succeeding weeks. The questionnaire of severity of RLS was completed before the study and at the last day of intervention before and after vibration. The data were analyzed with SPSS 23 using descriptive statistics and paired t test (P<0.05). Results: Our findings showed that most patients were at the moderate level of severity of symptoms before (68.8%) and after (78.8%) intervention and there was a significant difference in the mean score of RLS between before (18.99) and after (12.82) intervention (P=0.001). Conclusion: Based on the results of this study, it can be concluded that vibration decreases the severity of symptoms of RLS in hemodialysis patients. Hence, it is recommended that vibration be used as a cost-effective and safe procedure to improve the symptoms of RLS in this group of patients.

Determinants of physical activity in middle-aged woman in Isfahan using the health belief model.

INTRODUCTION: Nowadays with respect to the automation of the lifestyle, immobility statistics in middle-aged women has increased and they are at risk for complications of immobility. One of the models used to identify factors associated with physical activity is Health Belief Model utilized in different age and different cultural backgrounds and different results have been obtained from those studies. The purpose of this study was to investigate the factors affecting on physical activity in middle-aged women using Health Belief Model. MATERIALS AND METHODS: This descriptive-correlation study was conducted on 224 middle-aged women referring to health centers in Isfahan. Health Belief Model structures including perceived susceptibility and severity, perceived barriers and benefits, and self-efficacy were measured by questionnaire and physical activity was assessed using the international physical activity questionnaire. Collected data were analyzed using descriptive statistics and Pearson correlation coefficient test and regression analysis. RESULTS: There wasn't significant correlation between perceived susceptibility (P = 0.263, r = 0.075) and perceived severity with physical activity duration (P = 0.127, r = 0.058) but there was positive and weak correlation between physical activity duration with perceived benefits (P = 0.001 and r = 0.26) and perceived self-efficacy (P = 0.001, r = 0.54) and had weak and inverse correlation with perceived barriers (P = 0.001, r = -0.25). Regression analysis also showed that from among all the Health Belief Model structures just self-efficacy structure has influenced on behavior independently and other structures are affected by it. CONCLUSION: The obtained results implied on a correlation between benefits, barriers and perceived self-efficacy with and moderate physical activity. Therefore it is necessary to develop appropriate educational programs with emphasis on structures of Health Belief Model that has the maximum impact on physical activity in middle-aged women.

Development and initial psychometric evaluation of the hospitalization-related stressors questionnaire for elderly patients.

BACKGROUND: Various factors threaten the health and recovery of hospitalized elderly, including stressors in medical service centers. Therefore, the aim of the present study was to develop and preliminary validate a measurement tool to assess hospitalization-related stressors (HRS) among the elderly. MATERIALS AND METHODS: This methodological research was conducted in 2015. The study was performed in two main phases. In the first phase, which was to develop the questionnaire, the data were collected through literature review, interview with few elderly patients, and calculating content validity index with the participation of 16 experts. The second phase included preliminary validation of the questionnaire in which a convenient sample of 200 hospitalized elderly patients recruited from 4 educational medical centers of the Isfahan University of Medical Sciences were studied. Principal component analysis method was used to identify the factorial structure of the questionnaire. In order to evaluate validity, Cronbach's alpha coefficient was calculated. RESULTS: After evaluating the results and relocating and merging some of the items, a version of 26 items in 7 categories was prepared with acceptable internal consistency (Cronbach's alpha coefficient from 0.67 to 0.78 for the components and 0.83 for the tool). CONCLUSIONS: In this study, we were able to identify a set of important components and indicators of HRS in elderly; so it can be used as a useful instrument. Future studies are recommended in order to develop and validate this tool in other communities.

The effect of sevoflurane versus propofol anesthesia on troponin I after congenital heart surgery, a randomized clinical trial.

BACKGROUND: The ischemic preconditioning phenomenon can save myocardium against move severe ischemic damages and reduce infarction size and furthermore a heart rhythm disturbance. In this study we examine relationship between troponin I (as a structural myocardial protein) level and anesthetic agents in the children. MATERIALS AND METHODS: In this study 84 children under 12 years age before cardiac surgery were divided randomly into two groups of 42 each. For anesthetic maintenance sevoflurane with dose of 0.5-1 MAC was used in Group 1 and 100-150 mg/kg/min of intravenous propofol in Group 2 for maintenance of anesthesia. Troponin I level was assessed 2 before and 1 hour after anesthetic induction. Outcome measures included the serum cardiac troponin I level in children before and after surgery in two study groups. RESULTS: There was no significant difference between two groups in indices and both groups were homogenous in this point of view. The troponin I level after surgery was significantly increased in two groups. In the sevoflurane group it was 0.04 ± 0.12 to 0.05 ± 0.09 ng/ml (P value = 0.003) and the propofol group was 0.12 ± 0.26 to 0.19 ± 0.38 ng/ml (P value = 0.001). CONCLUSIONS: In this study two Anesthetic regimens were compared to assess the mean troponin I level before and after pediatric closed heart surgery, and it was shown that mean troponin level before and after surgery in the sevoflurane group was less than the propofol group. But this result was not statistically significant. These results indicate that although more protective effects of sevoflurane on myocardial injuries during pediatric cardiac surgery is predominant but this effect has no significant difference in the propofol group.

Evaluations of topical application of tranexamic acid on post-operative blood loss in off-pump coronary artery bypass surgery.

OBJECTIVE: One of the major complications of cardiac surgery is the presence of post-operative bleeding. The aim of the present study was to investigate the topical application of tranexamic acid in the pericardial cavity on post-operative bleeding in off-pump coronary artery bypass graft (CABG) surgery. MATERIALS AND METHODS: This study was on 71 patients who underwent off-pump CABG. The anesthesia and surgery methods were the same for all patients. Patients were assigned to two equal groups. In the first group, 1 g of tranexamic acid in 100 mL of normal saline solution (NSS) was applied to pericardium and mediastinal cavity at the end of surgery. In the second group, only 100 mL of NSS was applied. Chest drainage of the patients after 24 h and the amounts of blood and blood products transfusion were also recorded during this time. RESULTS: Patients were the same regarding demographic information and surgery. The average volume of blood loss after 24 h was 366 mL for the first group and 788 mL for the control group. There was a statistically significant difference between the two groups (P < 0.001). The amount of packed red blood cells transfusion in the first group was less than that of the control group, which was not statistically significant. There was no statistically significant difference between the amount of hemoglobin, hematocrit, platelets, prothrombin time and partial thromboplastin time in the post-operative stage in the two groups. CONCLUSION: The topical application of tranexamic acid in off-pump CABG patients leads to a decreased post-operative blood loss.

The effect of community health nurse home visit on self-care self-efficacy of the elderly living in selected Falavarjan villages in Iran in 2010.

BACKGROUND: Perceived self-efficacy is a strong predictor for behavior. Considering the importance of health-promoting self-care behaviors in increasing quality of life in the elderly, this study was aimed at defining the effect of nurse home visits on self-care self-efficacy of the elderly in rural areas. MATERIALS AND METHODS: This is a pre and post quasi-experimental study conducted on 33 older adults randomly selected from five villages in Falavarjan province in Iran. Intervention program was in the direction of self-care self-efficacy in four domains including nutrition, health practice, physical activity, and well-being in the form of five home visit programs and one group session by a nurse during 6 weeks, and included two different sections of education and nursing interventions administered based on needs assessment and determination of the tasks for the clients and their families. Theoretical framework of this study was supported by Bandura's self-efficacy, Orem's self-care theory, and Pender's revised health promotion model. The data were collected by self-care self-efficacy and demographic information questionnaire before and after the intervention. Data were analyzed by descriptive statistics and paired t-test. RESULTS: The mean elderly score in the four aforementioned domains increased after the home visit program. A significant difference was seen in the mean total scores of self-care self-efficacy and its subscales by paired t-test before and after intervention (P < 0.001). CONCLUSIONS: It was observed that home visit program, integrated with the theories, had a positive influence on improving self-care self-efficacy of the elderly, and was supported by Bandura's theory of self-efficacy suggesting four sources of performance accomplishment, vicarious experience, verbal persuasion, and emotional arousal. With regard to the importance of self-care behavior in health promotion of the elderly, multifaceted low-cost interventions with the highest effect seem essential.

Experiences of vasectomy: a phenomenological study.

BACKGROUND: Irregular growth of population is considered as a serious threat to the international community. It is a major obstacle for socioeconomic development. One of the methods to control the population is by providing effective methods of contraception. Vasectomy, as a simple and effective contraceptive method, has been approved by the World Health Organization (WHO). It is very important to involve men in the control of population and the promotion of reproductive health. AIMS: This study was conducted with the aim of describing the experiences of the men who underwent vasectomy. MATERIALS AND METHODS: This qualitative study was performed by using a phenomenological research design. The sample consisted of 14 vasectomized men selected through purposive sampling method. In-depth and open interviews with participants were conducted to collect the data. RESULTS: The results were transcribed and recorded in comprehensive field notes. Colaizzi's method was used to analyze the data. Four themes emerged from the obtained results of the present study, which described the structure of the experiences of men as follows: Opinions about vasectomy, own perceptions about vasectomy, experiences with the procedure, and recommendation of vasectomy to others. CONCLUSION: Vasectomy can influence achievement of family planning goals and participation of men in this regard. The results of this study can help the planners and health-care providers for appropriate interventions, and training and counseling programmers to increase the acceptability and uptake of vasectomy in the society.

The effect of Ti Chi exercise on the sleep quality of the elderly residents in Isfahan, Sadeghieh elderly home.

BACKGROUND: Sleep disturbances are common among older adults. Recently there is much interest in complementary and alternative medicine (CAM) from the population in general, and the elderly are no exception. Tai Chi exercise as a CAM can be performed by older adults. The purpose of this study was to evaluate the effects of Tai Chi Exercise on sleep quality of elderly residents in Sadeghiyeh elderly care home. METHODS: In this Clinical Trial, 62 older subjects aged older than 65 years residents of elderly home in Isfahan were studied. They randomized in two experimental and control groups. The intervention was the Tai Chi Exercise sessions were held three times per week for 12 weeks. Duration of exercise was 5 minutes at first session which gradually increased to 20 to 25 minutes by the midpoint of intervention. The Pittsburgh Sleep Quality Index (PSQI) was used for pre and post evaluation of older adult sleep quality. Data analyzed using the SPSS(14) software. RESULTS: There were no differences in demographic characteristics or psychological variables between two groups. Mean age of studied subjects in experimental and control groups was 68.74(5.48) and 69.42(5.34), respectively. In the Tai Chi group sleep quality was improved significantly with decrease in PSQI global score. In control group sleep quality was not changed significantly. At the end of study, mean differences of PSQI global score between two groups different significantly. CONCLUSIONS: Our finding is coherent with other studies in this field indicated that the Tai Chi Exercise can have a significant effect on sleep quality in older adults.

Perioperative predictors and clinical outcome in early and late ICU discharge after off-pump coronary artery bypass surgery.

The duration of ICU (intensive care unit) stay in cardiac surgery patients has an important role in the rate of complications and costs. The aim of this study was to determine the role of perioperative risk factors in clinical outcome based on the time of ICU discharge. In this descriptive study, 219 patients undergoing off-pump coronary artery bypass (OPCAB) surgery in Afshar Hospital in Yazd, an Iranian city, were divided into early (≤24 hrs) and late (>24 hrs) ICU discharge groups according to the duration of ICU stay. The preoperative, intraoperative and postoperative risk factors, the complications and the outcome were evaluated. Age, sex, hyperlipidemia, diabetes mellitus, previous myocardial infarction, renal failure, cerebrovascular accident, and level of hematocrit and creatinine were not significantly different between the two groups. Patients with hemodynamic instability, respiratory dysfunction, ejection fraction <35%, hypertension, inotrope administration, left main coronary artery involvement, use of intraaortic balloon pump (IABP) and arrhythmia had significantly higher mortality and longer ICU stay (>24 hrs) compared to others (P value <0.05). The duration of intubation was significantly lower in the early discharge group (7.8 ± 3.8 hrs compared to 17 ± 9.9 hrs) than in the late discharge group. Time of ICU discharge depends on perioperative risk factors, and risk factor modification may improve clinical outcome.

Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery.

General concept and major emphasis on off-pump coronary artery bypass surgery (OPCAB) is maintaining quality of care and patient safety while reducing cost and resource utilization. OPCAB probably avoids the potential complications of cardiopulmonary bypass. However its acceptance depends on clinical and economic outcome. The aim of this study is to compare clinical and economic outcome of off-pump and on pump coronary artery bypass surgery. This is a report of an analytic cross-sectional study on 304 patients underwent coronary artery bypass surgery that were randomized into conventional on pump and off-pump groups. Variables and costs were obtained for each group and these data were analyzed using parametric methods. There was no difference between the two groups with respect to perioperative and intraoperative patient's variables. OPCAB reduced the need for postoperative transfusion requirement (P<0.05) which was statistically significant and showed a trend towards reduction of morbidity although didn't reach statistical significance (P>0.05). There were no statistically significant differences in surgical re exploration and length of stay between the two groups. The mean cost for an on pump surgery was 8312000 ± 2859 Rials per patient that was significantly higher than an off-pump surgery. Based on the findings of this study, clinical outcome has no statistically significant difference between on pump and off-pump CABG but the costs are significantly higher in the on pump group.

Relationship between communication manners of head nurses with job satisfaction of nurses under their supervision in educational hospitals of Isfahan University of Medical Sciences in 2006.

BACKGROUND: Interpersonal communication is considered as an important and effective factor of job satisfaction and efficiency and has special significance in nursing career because of the face to face relationship with patients. This study aimed to determine the association between head nurses' interpersonal communication and job satisfaction of nurses under their supervision. The study was conducted in educational hospitals of Isfahan University of Medical Sciences in 2006. METHODS: This was a descriptive and analytical study on 203 nursing personnel working in educational hospitals of Isfahan University of Medical Sciences in 2006. Data were collected using Job Descriptive Index (JDI) developed by Smith and Kendall and interpersonal communication was measured using a researcher-made questionnaire. Data were analyzed using SPSS software and Pearson's test and presented in tables and diagrams. RESULTS: The majority of the participants (148 subjects, 73%) believed that head nurses' interpersonal communication was excellent and in general Pearson's test showed a significant association between head nurses' interpersonal communication and their personnel's job satisfaction (p < 0.011). CONCLUSIONS: Based on the results of this study on the relationship between interpersonal communication of the head nurses and job satisfaction of their personnel, we can improve the job satisfaction of nursing personnel as well as patients' satisfactory and level of services by developing educational courses and workshops on importance and effectiveness of interpersonal communication for head nurses.

Evaluation of men's participation in group training of their wives in family planning programs.

BACKGROUND: Population growth is still a global concern. In spite of the decrease in population growth and conception rate, Iran and the world population will grow in coming years. Participation of men in contraception interventions to control population growth is of great importance. METHODS: This is a quasi-experimental study, in which the authors provided group training of contraceptive methods to 53 women, and then evaluated the effect of training on the dependent variable of husbands' participation in family planning. The data was gathered using a questionnaire and a checklist, and then was analyzed using SPSS software, by paired t-test. RESULTS: The results indicated that the mean score of knowledge level of the case group members and their husbands changed significantly after the training program (p < 0.001). Also, it was found that 51% of the participants and their husbands used contraceptive methods after the training program. CONCLUSIONS: Considering the results, providing group training for couples to increase the participation rate of men in family planning programs is recommended.