The predictive role of coping styles and sense of coherence in the post-traumatic growth of mothers with disabled children: a cross-sectional study.

BACKGROUND: Coping and accepting stressful events can lead to positive psychological changes, growth, and excellence. In this regard, the present study was conducted to determine the relationship between coping styles and sense of coherence with post-traumatic growth in mothers with disabled children in Bushehr (a southern city in Iran). METHODS: The present cross-sectional study was performed on 260 mothers with children with disabilities who were filed in the rehabilitation centers covered by the Welfare Department of Bushehr in 2018. Demographic information form, Tedeschi and Calhoun post-traumatic growth questionnaire, Antonovsky sense of coherence, and Billings and Moos coping styles were employed to collect data. Data were analyzed by SPSS software using Pearson correlation coefficient and linear regression analysis at a significance level of less than 0.05. RESULTS: The mean age and standard deviation were 35.83 ± 7.41 for the mothers, and 7.20 ± 4.05 for the children. The mean and standard deviation of post-traumatic growth was 64.88 ± 14.90, sense of coherence was 116.36 ± 22.65 and coping styles was 30.59 ± 6.39. The results of linear regression show that only the two dimensions of meaningfulness (p = 0.013 and ß = 0.170) and manageability from the sense of coherence (p = 0.001 and ß = 0.432) can predict post-traumatic growth in mothers with disabled children in Bushehr. Also, from the coping style dimensions, only the emotion-focused variable (p = 0.001 and ß = 0.353) is a predictor of post-traumatic growth. CONCLUSION: Considering the role of sense of coherence and coping style in predicting post-traumatic growth, to implement rehabilitation programs and support the families of these children, it is essential to plan for the development of social and psychological support for mothers with disabled children.

Parental bonding styles in schizophrenia, depressive and bipolar patients: a comparative study.

BACKGROUND: Numerous bio-psychosocial factors play a role in the etiology of psychiatric disorders. In this regard, the relationship between parents and their children is significantly involved in developing the offspring mental health. However, there is no clear-cut answer as to which parental bonding style is more strongly associated with psychiatric diseases of patients. This study aimed to compare parental bonding styles in patients with schizophrenia, depression, and bipolar disorder in Bushehr province, Iran in 2018. METHODS: In this cross-sectional comparative study, 130 patients with schizophrenia, depression, and bipolar disorder who referred to four outpatients psychiatric centers in Bushehr were selected using quota sampling. The patients were assessed and compared in terms of parental bonding styles. Data were collected using a valid and reliable parental bonding instrument (PBI). Data were analyzed using SPSS software (ver. 22), Chi-square and Kruskal-Wallis tests at a significant level of 0.05. RESULTS: Results showed that the optimal parental bonding style (low control, high care) in bipolar disorder (43.05%), major depression (47.7%), and schizophrenia (38.5%) was the most prevalent style of parental bonding; however, 62.30% of the above patients suffered from inefficient paternal bonding styles and 51.53% from inefficient maternal bonding styles. Furthermore, the patients' maternal bonding styles were significantly different (p = 0.007) while their paternal bonding styles did not show any significant differences (p = 0.848). CONCLUSIONS: Most of the patients with psychiatric disorders were affected by ineffective parenting styles. The results also confirmed that despite the several bio-psycho-social factors involved in the development of psychiatric disorders, the crucial roles of parents, especially mothers, should not be ignored. It was further suggested that parents and parental bonding were important and fundamental factors for mental health promotion.

Group meta-cognitive therapy and depression in women with breast cancer: a randomized controlled trial.

BACKGROUND: Breast cancer is one of the most common cancers in Iranian women. They will experience a mental health problem like depression before, during or after treatment. This study aimed to determine the effectiveness of group metacognitive therapy on depression, cognitive-emotional regulation, and meta-cognitive beliefs in women with breast cancer. METHODS: In this randomized controlled clinical trial, a total of 24 depressed patients with breast cancer were randomly allocated to experimental and control groups. The experimental group received meta-cognitive therapy in 8 weekly sessions, but the control group received treatment as usual. Beck Depressive Inventory, cognitive emotion regulation questionnaire, and meta-cognitions questionnaire were completed before, after and one month after the intervention. Data were analyzed using Wilcoxon and Chi-square tests. RESULTS: The mean score of depression in the experimental group was reduced from 21.6 ± 4.83 in the pre-test to 13.83 ± 8.12 in one-month follow-up (p = 0.16); however, there was no significant difference in the control group. The mean score of cognitive emotion regulation did not show a significant change in the two groups during the study and follow-up period. The mean score of meta-cognitive beliefs reached 68.75 ± 15.74 from 79.51 ± 10.72 in the experimental group during the follow-up period (p = 0.006); however, there was no significant difference in the control group in the score of metacognitive beliefs. CONCLUSION: These findings support the efficacy of meta-cognitive therapy as a viable psychosocial intervention in depressed patients with breast cancer. Trial registration IRCT201606288473N5. Registered on: 05/09/2016 https://www.irct.ir/trial/8946 .

Hospital service quality based on HEALTHQUAL model and trusting nurses at Iranian university and non-university hospitals: a comparative study.

BACKGROUND: Establishment and improvement of patients' trust in healthcare organizations like hospitals necessitate delivery of high-quality services by nurses, as the largest group of healthcare providers. The present study aimed to compare hospital service quality based on the HEALTHQUAL model and trusting nurses at university and non-university hospitals in Iran. METHODS: This comparative cross-sectional study was conducted on 990 patients admitted to university and non-university hospitals located in Bushehr Province, southern Iran, who were selected using the stratified random sampling method. The data were collected through the HEALTHQUAL questionnaire and the Trust in Nurses Scale, and then analyzed via the SPSS Statistics software (version 22) as well as the General Linear Model (GLM) univariate procedure and the Chi-square test with a significance level of 0.05. RESULTS: The study findings revealed that the mean values of real quality (perceptions) and ideal quality (expectations) were 3.89 ± 0.69 and 4.55 ± 0.47, respectively. The gap between the real and ideal quality (- 0.64) was also larger at non-university hospitals from the patients' viewpoints. Comparing various dimensions of service quality, the largest gap at university and non-university hospitals was associated with "environment" (- 0.13) and "empathy" (- 0.18), respectively. Additionally, the mean scores of the patient trust in nurses at university and non-university hospitals were 10.34 ± 5.81 and 8.71 ± 4.05, respectively, being a statistically significant difference (p <  0.001). CONCLUSION: The study results demonstrated that hospital service quality and trusting in nurses were at higher levels at the university hospital than the non-university one; however, hospital service quality was at a lower level than what the patients had expected. Accordingly, hospital managers and policy-makers were suggested to focus on patients to reduce gaps in service quality, to promote service quality, and to provide better healthcare services to patients.

Prevalence of avian influenza (H9N2) in commercial quail, partridge, and turkey farms in Iran, 2014-2015.

Avian influenza virus (AIV) H9N2 subtype is endemic in Iran and causes substantial economic loss to the growing poultry industry within the country. In this study, a cross-sectional analysis was carried out to determine the sero-prevalence of H9N2 in several commercial farms between the years 2014 and 2015. The comparison of the mean of serum titers and the ratio of sero-positive birds between all units were analyzed using one-way ANOVA test. In 2014, a total of 77 farms (58 turkey farms, 14 quail farms, and 5 partridge farms) and 894 birds (682 turkeys, 154 quails, and 58 partridges) were sampled while in 2015, a total of 69 farms (54 turkey farms, 8 quail farms, and 7 partridge farms) and 856 birds (675 turkeys, 105 quails, and 76 partridges) were sampled. Of that, 52 of 77 sampled farms (67.5%) and 437 of 894 samples (48.9%) were positive for H9N2 in 2014 while. Forty-one of 69 farms (59.4%) and 307 of 856 sera (35.9%) were positive in 2015. Furthermore, the mean titer of partridge farms was significantly lower than that of turkey farms (p < 0.01) and the mean percentage of sero-positive turkey farms was significantly higher than partridge farms (p < 0.01) in 2014. In 2015, no significant difference was observed between the mean sera titer amongst farms and percentage of sero-positive birds (p > 0.05). Our results indicated that H9N2 is circulating in these farms. Since many more such farms are being established for operations, in addition to the threat of emergence and continuous reemergence of the disease in these farms, enhanced veterinary biosecurity measures on farms are required for mitigation.

The effect of gabapentin versus intrathecal fentanyl on postoperative pain and morphine consumption in cesarean delivery: a prospective, randomized, double-blind study.

PURPOSE: Pain after cesarean delivery is a leading cause of chronic pain and there are many attempts to reduce it without total success. Gabapentin is effective in reducing acute and chronic pain with little experience in parturient. The purpose of this study is to compare the effect of pre-emptive gabapentin with intrathecal fentanyl on reducing postoperative pain and morphine consumption in cesarean surgery. METHODS: Seventy-eight primiparous women who scheduled for non-emergency cesarean delivery were enrolled in the study and separated into two groups. The control group received 12.5 mg of heavy bupivacaine 0.5 % plus 10 µg of fentanyl intrathecally and the case group received 300 mg of gabapentin orally 2 h before surgery and 12.5 mg of heavy bupivacaine 0.5 % intrathecally. Data collection including blood pressure, heart rate, neonate sedation, Apgar score, visual analogous scale at several hours, at first, need to analgesic postoperatively. RESULTS: In the fentanyl group, the need for analgesic drug was earlier, total dose of morphine in 24 h and patient satisfaction was higher than the gabapentin group. The mean visual analogous scale at several hours postoperatively in the fentanyl groups was significantly higher than the gabapentin groups (P = 0.001). CONCLUSION: Preemptive use of gabapentin is a safe and effective way to reduce postoperative pain and morphine consumption in parturients after cesarean surgery.

Comparing two teaching methods based on concept map and lecture on dental students' knowledge and performance of post-exposure prophylaxis to hepatitis B: A quasi-experimental study.

BACKGROUND: Dental students are at high risk of hepatitis B virus (HBV) infection during clinical activities. Therefore, preventive measures are essential after exposure to the HBV. This study aimed to compare the effectiveness of the concept map and the lecture methods on dental students' knowledge and performance regarding hepatitis B post-exposure prophylaxis (PEP) after possible exposure to the HBV. MATERIALS AND METHODS: This quasi-experimental study was conducted on 70 dental students at Shiraz University of Medical Sciences, Iran. Subjects were categorized into two groups, each receiving either the concept map or the traditional lecture methods. After the interventions, dental students' knowledge and performance were measured by a researcher-made questionnaire. RESULTS: The statistical analysis showed significantly higher knowledge and performance in the concept map group compared to the lecture group (P = 0.030 and P = 0.022, respectively). Although both groups' knowledge and performance decreased after the six-month intervention, the second group who received the lecture method showed more decline in knowledge and performance (P = 0.041 and P < 0.001, respectively). CONCLUSION: Both the concept map and lecture methods have proved to be effective ways of improving the knowledge and performance of dental students. However, the present study revealed that the concept method was more effective on dental students' knowledge and performance regarding preventive measures after exposure to HBV. Thus, the concept map method is recommended for informative and educational purposes.

Risk perception regarding social determinants of health among women with breast cancer in Iran: a qualitative study.

OBJECTIVES: Breast cancer is the most common cancer among women all around the world. Today, in addition to factors including hormones and genetics that are involved in the occurrence of breast cancer, special attention is paid to the role of social and non-medical determinants of health. This study aims to explore the perception of Social Determinants of Health (SDH) in women with breast cancer. DESIGN: Qualitative study design with a conventional thematic analysis approach. SETTING: The study was conducted in Tehran, Iran, between December 2021 and February 2023. PARTICIPANTS: 19 women with breast cancer were selected through purposeful and snowball sampling with maximum variation. Sampling continued until data saturation was reached. PRIMARY AND SECONDARY OUTCOME MEASURES: The study categorised the extracted codes from interviews into three main categories and 12 subcategories related to SDH in women with breast cancer. RESULTS: The study identified factors such as personal and family health records, health behaviours and lifestyles and medical screening and follow-up as key themes in the perception of SDH among women with breast cancer. The main categories were also categorised into 12 subcategories, 'including family history', 'environmental factors', 'hormonal and medicinal changes', 'metaphysical factors', 'traditional medicine-related factors', 'stress', 'body weight', 'physical activity', 'nutrition', 'smoking and tobacco use', 'screening', 'self-examination' and 'barriers to medical follow-up'. 'Near the telecommunications tower', 'Improper use of supplements', 'Being subjected to the evil eye regularly', 'Eating cold nature foods', 'Breast weight' and 'Being ashamed of the doctor' were some examples of the codes. CONCLUSIONS: Participants identified a number of environmental, personal and cultural factors as contributing to the disease. Woman's screening behaviours were influenced by factors such as fear of disease and death, disbelief in getting sick and shame, depending on cultural context. The study suggests the need for further research to explore the impact of these factors on screening behaviours and outcomes in different cultural contexts.

Comparison the effects of oxytocin and methylergonovine in elective caesarean section under spinal anesthesia.

PURPOSE: In order to prevent postpartum hemorrhage in caesarean section under spinal anesthesia, patients routinely receive oxytocin. In this study we compared the efficacy of Methylergonovine and Oxytocin on hemodynamic stability and bleeding amount in caesarean section. MATERIALS AND METHODS: In this randomised controlled trial study, 80 patients candidate for elective caesarean section under spinal anesthesia divided to two groups: 40 patients in control group received oxytocin and 40 ones in case group received methylergonovine. RESULTS: There was no differences between groups in Mean age, baseline hemodynamic values, after spinal anesthesia and recovery (except diastolic blood pressure min 20), time of uterine atony, dizziness; nausea and vomiting. After drug administration (oxytocin and methylergonovine), systolic blood pressure in minutes 1, 10, 15 and diastolic blood pressure in minutes 1, 3, 20 increased in case group statistically more than control group. In control group, heart rate in minutes 1, 5 increased significantly more than the other group. Mean arterial blood pressure in minutes 1, 3, 5, 10, 15 reduced significantly more than in control group. Need to vasoconstrictor drug statistically was less in case group (p < 0.0001). CONCLUSION: Methylergonovine induced significantly more hemodynamic stability. Adverse effects were similar between two groups. We recommend the use of methylergonovine in patients with caesarean section under spinal anesthesia because of its hemodynamic stability and low need to vasoconstrictor drugs.

Evaluation of HIV-Related Cardiomyopathy in HIV-Positive Patients in Bushehr, Iran.

Objectives In 2020, according to the UNAIDS (Joint United Nations Programme on HIV/AIDS), more than 37 million people lived with human immunodeficiency virus (HIV) infection worldwide. The disease is known to affect several organs, and one of the most affected organs is the heart. Cardiac diseases are highly prevalent among HIV-infected individuals, and recent findings suggest that this could be due to the damage caused by the virus. HIV patients are subject to advanced immunosuppression, which may lead to cardiac muscle damage and, in turn, cardiomyopathy. We aimed to study the incidence of HIV-related cardiomyopathy. Methods A pilot cross-sectional study was conducted to assess cardiomyopathy among 200 HIV patients who presented to the Heart Center, Bushehr, Iran. Patients' files were used to determine the demographic data including age, gender, education, marital status, history of illicit drug use, unsafe/unprotected sexual contact, and whether the patient was a prisoner. Several laboratory data were also collected from these files. Physical examination of the cardiovascular system and echocardiography were also included as part of the evaluation. Results Although at least four out of five patients presented with some kind of cardiac damage, including valvular damage and pericardial effusion, none was diagnosed with cardiomyopathy. Valvular dysfunction was detected in 88.5% of the patients. Diastolic dysfunction was found in 7.7% of them. The mean ejection fraction was found to be 58%. In addition to cardiomyopathy, none of the patients developed systolic dysfunction, wall motion abnormality, intra-cardiac mass, or vegetation. Conclusions Cardiovascular complications are common among HIV-infected patients. Cardiomyopathy was not detected in our patients. In addition, the most common manifestations that were detected among our patients were valvular heart diseases and pericardial effusion.

A review of neuroradiological abnormalities in patients with coronavirus disease 2019 (COVID-19).

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to various neurological manifestations. There is an urgent need for a summary of neuroimaging findings to accelerate diagnosis and treatment plans. We reviewed prospective and retrospective studies to classify neurological abnormalities observed in patients with the SARS-CoV-2 infection. METHODS: The relevant studies published in Scopus, PubMed and Clarivate Analytics databases were analysed. The search was performed for full-text articles published from 23 January 2020 to 23 February 2021. RESULTS: In 23 studies the number of patients with SARS-CoV-2 infection was 20,850 and the number of patients with neurological manifestations was 1996 (9.5%). The total number of patients with neuroradiological abnormalities was 602 (2.8%). SARS-CoV-2 has led to various neuroimaging abnormalities which can be categorised by neuroanatomical localisation of lesions and their main probable underlying pathogenesis. Cranial nerve and spinal root abnormalities were cranial neuritis and polyradiculitis. Parenchymal abnormalities fell into four groups of: (a) thrombosis disorders, namely ischaemic stroke and sinus venous thrombosis; (b) endothelial dysfunction and damage disorders manifested as various types of intracranial haemorrhage and posterior reversible encephalopathy syndrome; (c) hypoxia/hypoperfusion disorders of leukoencephalopathy and watershed infarction; and (d) inflammatory disorders encompassing demyelinating disorders, encephalitis, vasculitis-like disorders, vasculopathy and cytotoxic lesions of the corpus callosum. Leptomeninges disorders included meningitis. Ischaemic stroke was the most frequent abnormality in these studies. CONCLUSION: The review study suggests that an anatomical approach to the classification of heterogeneous neuroimaging findings in patients with SARS-CoV-2 and neurological manifestations would lend itself well for use by practitioners in diagnosis and treatment planning.

The gap in the clinical learning environment: The viewpoints of nursing students.

INTRODUCTION: The clinical environment is an essential and irreplaceable resource in preparing nursing students for their professional role. Despite many changes that occur in the clinical learning environment (CLE), these environments remain important to nurse training. With regard to the importance of students' viewpoints in the evaluation of CLE, this study was performed to the determination of nursing students' viewpoint of the actual and preferred CLE at Bushehr University of Medical Sciences in Iran 2013. MATERIALS AND METHODS: In this cross-sectional analytic study, due to the small size of the research population, all nursing students (86 students) of Bushehr University of Medical Sciences in Iran who had passed at least one clinical course were selected through the census. Participants were invited to complete anonymously the actual and preferred Farsi versions of the CLE Inventory consisting of 42 items originally developed by Professor Chan (2001). Data were analyzed using frequency distribution, mean, standard deviation, and paired t-test. RESULTS: The results indicated that there were significant differences between students' perceptions of the actual and the preferred CLE (P < 0.001). The highest and lowest mean scores of actual CLE belonged to student involvement and individualization, respectively, and the highest and lowest mean scores of preferred CLE belonged to task orientation and individualization, respectively. CONCLUSION: In general, students prefer a more positive CLE than what they actually have experience and would prefer an environment with higher levels of clarification of personalization, student Involvement, satisfaction, task orientation, innovation, and individualization.

Knowledge, attitudes, and practice of iranian dentists with regard to HIV-related disease.

Of 369 registered dentists in Fars province in Iran, 309 (83.7%) responded to a survey regarding knowledge, attitudes, and practices related to human immunodeficiency virus (HIV) infection. The level of knowledge was low and was correlated with years in practice, hours worked per week, and whether additional work in a governmental dental office was performed; only the last was significantly associated with adherence to relevant infection control recommendations.

Iranians' attitudes about possible human immunodeficiency virus transmission in dental settings.

We conducted a cross-sectional survey from October through December 2004 of 8,312 residents of Shiraz, Iran, to investigate Iranians' perceptions about undergoing dental treatment in dental offices where other patients or the dentist and/or dental assistants are infected with human immunodeficiency virus (HIV). Most survey respondents (83%) had acceptable general knowledge about the mode of transmission of HIV and about acquired immunodeficiency syndrome (AIDS); however, many misconceptions were observed. A negative association was detected between the level of concern about contracting HIV/AIDS and the intention to continue treatment in services where patients with HIV/AIDS were also treated or where the dentist and/or dental assistants had HIV/AIDS.

Attitudes, beliefs, and infection control practices of Iranian dentists associated with HIV-positive patients.

Of the 309 private dental practitioners in Fars, Iran, surveyed most, 77.7% believed they had a professional duty to treat HIV-positive patients, with 61.4% expressing some level of discomfort about treating these patients, and 75.1% believed they should be treated at a specialist practice. Gloves and masks were not always worn, 15.8% and 9.7%, respectively, and 70.2% of dentist washed their hands before treatment and 60.2% after treatment. Elementary standard precautions were not routinely implemented in private dental practices, despite high levels of concerns about transmission of infection.

Assessment of knowledge, attitudes, and practices regarding isolation precautions among Iranian healthcare workers.

We conducted a survey of 1,048 healthcare workers (HCWs) at 8 Iranian hospitals regarding knowledge, attitudes, and practices related to isolation precautions. We found 75% below acceptable safety levels. Routine handwashing before and after glove use was reported by fewer than half of the HCWs.

Knowledge, attitude and practice towards droplet and airborne isolation precautions among dental health care professionals in Shiraz, Iran.

OBJECTIVE: To determine the level of knowledge, attitude and practice among Iranian dental health care professionals towards droplet and airborne isolation precautions, in Shiraz, Iran. METHODS: A survey was developed and distributed to 152 Iranian dental professionals (faculty and students) from Shiraz University School of Medical Sciences, School of Dentistry, Shiraz, Iran. The self-administered questionnaire was composed of three parts (knowledge, attitude, and practice). After validation of the survey using the Kuder Richardson reliability test and Cronbach's alpha internal consistency coefficient, data was collected and analyzed using Analysis of Variance and the Duncan test to detect the differences among groups. The Spearman coefficient was used to determine the correlation between knowledge, attitude, and practice. RESULTS: The survey was completed by 152 (51.5%) of 295 potential respondents. Mean scores of knowledge, attitude, and practice towards droplets and airborne isolation precautions were poor (98 +/- 3.45, 10.51 +/- 6.26, 2.68 +/- 3.16 from the maximum scores of 11, 55, and 11, respectively). In addition, a positive linear correlation was found between two items of the survey including knowledge-attitude (rho = 0.438, p < 0.001), knowledge and practice (rho = 0.380, p < 0.001). CONCLUSION: Iranian dental professionals seemed to have low levels of knowledge, attitude and practice towards infection control.

Blood Samples of Peripheral Venous Catheter or The Usual Way: Do Infusion Fluid Alters the Biochemical Test Results?

BACKGROUND: Most blood tests require venous blood samples. Puncturing the vein also causes pain, infection, or damage to the blood, and lymph flow, or long-term healing. This study aimed to determine and compare the biochemical laboratory value of the blood samples that were provided through: peripheral vein infusion (PVI) receiving continuous intravenous fluid; and the usual method of blood sampling. METHODS: This is an interventional, quasi-experimental, and controlled study. The selected study sample included 60 patients, who were hospitalized during 2014, in the Internal Medicine, part of Martyrs of Persian Gulf, teaching hospital at Bushehr. Three blood samples were taken from each patient that were provided through PVI line (5 ml blood collected at beginning of IVC and then another 5 cc), and another case was prepared by common blood sampling (control). All the samples were analyzed in terms of sodium, potassium, urea and creatinine using SPSS Ver.19 software, by paired t-test and Pearson's correlation coefficients. RESULTS: There was a statistically significant difference between the amount of sodium and potassium in the first blood samples taken from the intravenous infusion line and vein puncture .However, no significant differences were found among the biochemical amount in the second blood samples taken from the intravenous infusion line and vein puncture. CONCLUSIONS: We can use blood samples taken from peripheral intravenous infusion lines after 5cc discarding from the first part of the sample for measuring the value of sodium, potassium, urea and creatinine.

The Effect of Different Intrathecal Doses of Meperidine on Shivering during Delivery Under Spinal Anesthesia.

BACKGROUND: This study was performed to compare the effect of different doses of intrathecal meperidine on the incidence and intensity of shivering and other side-effects after spinal anesthesia for cesarean delivery. METHODS: One hundred and fifty-six parturient women scheduled for elective cesarean delivery were enrolled in four groups. Spinal anesthesia consisted of heavy bupivacaine 0.5% (10 mg) in the standard group (Group I), heavy bupivacaine 0.5% (10 mg) plus meperidine (0.2 mg per kg) in Group II, heavy bupivacaine 0.5% (10 mg) plus meperidine (0.3 mg per kg) in Group III, heavy bupivacaine 0.5% (10 mg) plus meperidine (0.4 mg per kg) in Group IV. The signs and symptoms were recorded by an observer unaware of the study groups. Data were analyzed using analysis of variance, Kruskal-Wallis H-test and chi-square. A P value less than 0.05 was considered to be significant. RESULTS: The systolic blood pressure, amount of bleeding, Pulse Rate, O2 saturation, neonatal apgar scores, core temperatures and sensory level revealed no difference between groups (P>0.05). The incidence (47.5%, 37.5%, 27.5% and 15.0%, respectively) and intensity of shivering decreased as the dose of meperidine increased (P=0.002) but the incidence of nausea and vomiting (8.0%, 15.4%, 25.9% and 35.8%, respectively) (P=0.000) and pruritis (25.64, 28.21, 38.46, and 48.72 respectively) increased as the dose of meperidine increased (P=0.000). CONCLUSION: The high dose of intrathecal meperidine is effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery but the high incidence of nausea and vomiting is unpleasant for the patient and can be a major problem with a high dose of meperdine.

The effects of warm and cold intrathecal bupivacaine on shivering during delivery under spinal anesthesia.

BACKGROUND: Shivering associated with neuraxial anesthesia is a common problem that is uncomfortable for patients; it is of unknown ethnology and has no definite treatment. PURPOSE: The purpose of this study was to compare the effects of warm intrathecal bupivacaine stored at 23°C and cold intrathecal bupivacaine stored at 4°C on shivering during delivery under spinal anesthesia. METHODS: Seventy-eight parturient women scheduled for nonemergency cesarean delivery were enrolled in the study and separated into 2 groups. The standard group received 10 mg of heavy bupivacaine 0.5% stored at room temperature (23°C) plus 10 µg of fentanyl intrathecally (warm group), and the case group received 10 mg of heavy bupivacaine 0.5% stored at 4°C plus 10 µg of fentanyl intrathecally (cold group). Data collection, including sensory block level, blood pressure, core temperature, and shivering intensity, was first performed every minute for 10 min, then every 5 min for 35 min and, finally, every 10 min until the sensory level receded to L4. RESULTS: There were no differences between the 2 groups in the amount of bleeding, pulse rate, oxygen saturation, neonatal Apgar, and incidence of vomiting. The incidence and intensity of shivering decreased in the warm group (P=0.002). CONCLUSION: Warming of solutions can reduce the incidence and intensity of shivering in parturient candidates for cesarean delivery under spinal anesthesia.