Pattern of Traumatic Injuries in Patients with Tramadol Poisoning: A Cross-Sectional Study in a Tertiary Care Hospital.

Objective: This study aimed to investigate the incidence and pattern of tramadol-induced seizures and injuries in patients admitted to the hospital. Methods: The cross-sectional study included 300 patients with alleged tramadol intoxication. Demographic information, tramadol dosage and duration of abuse, co-existing illicit drug abuse, hospital stay length, and occurrence of seizures and trauma (type and site of injuries) were collected. Different statistical tests, including the Mann-Whitney U-test, Pearson's Chi-square test, and Student's t-test, were conducted to compare the patients with and without seizures, trauma, and co-ingestion of illicit drugs. The analysis was performed using SPSS software (version 21.0). A p value of less than 0.05 was considered statistically significant. Results: The average patient's age was 24.66±5.64 years, with males comprising 84.3% of the sample. The mean tramadol dose and duration of abuse were 1339.3±1310.2 mg and 2.43±1.35 years, respectively. Seizures were observed in 66% of patients, with men having a higher incidence (69.6% vs. 46.8%; p=0.004). Trauma was reported in 23% of patients, accounting for 35.4% of seizure cases. All trauma patients had experienced seizures, with the head and neck being the most prevalent injury sites (55.1%), typically presenting as abrasions (55.9%). Patients with seizures and trauma had an average hospital stay of 1.73±0.94 days, which was significantly longer. Conclusion: Trauma occurs in more than one-third of tramadol-induced seizures, highlighting the need to perform physical examinations to detect and localize injuries. Tramadol-associated traumas prolonged hospitalization times and thus required prompt attention to prevent further injuries during pre-hospital handling and transferring to hospitals.

Relationship between health literacy level and sexual function in women in the Northwest of Iran in 2020- a cross sectional study.

BACKGROUND AND PURPOSE: Sexual health means coordination and adaptation of physical, emotional, intellectual and social aspects of human beings. One of the variables that affect sexual function and sexual satisfaction is health literacy. The aim of this study was to investigate the relationship between health literacy level and sexual function in married women in Qazvin health centers. METHODS: In the cross-sectional study, 340 married women were selected from four health centers in Qazvin, Iran, in 2020. These selected centers were chosen randomly from 26 health centers. Participants were included in the study by using the proportional selection method based on the sample size of the all health centers. Data collection tools include three questionnaires: demographic information, The Health Literacy Questionnaire (HELIA), and Female Sexual Function Index (FSFI). Data were analyzed using SPSS 24 software. A significance level of P < 0.05 was considered for statistical analyses. RESULTS: The highest and lowest scores of dimension's sexual function are satisfaction, pain, and lubricant, respectively. The level of women's health literacy in Qazvin was inadequate and borderline (56.4%). Each of the sexual function dimensions had significant positive correlations with health literacy (P < 0.001). There was a significant relationship between health literacy level with age, education, and occupation (P < 0.05). According to linear regression analysis, with the increase in years of marriage, sexual function is decreased (P < 0.02). CONCLUSION: Health literacy was inadequate in more than half of the study sample and health literacy was significantly associated with sexual function. Educational programs were necessary in order to promote women's health literacy in health centers.

Comparison of elevated cardiac troponin I with SAPS-II and APACHE-II score in predicting outcome of severe intoxications.

Background and Aims: To date, different methods have been invented to risk-stratify critically ill patients, however, there is a paucity of information regarding assessing the severity of poisonings. This study was designed to determine the comparative efficacy of Simplified Acute Physiology Score-II (SAPS-II) and Acute Physiology and Chronic Health Evaluation-II (APACHE-II)score with cardiac troponin I (cTnI) in predicting severe intoxication outcomes. Methods: This was a prospective study conducted on patients who fulfilled defined severe intoxication criteria necessitating intensive care unit (ICU) admission over a period of 6 months. SAPS-II and APACHE-II scores were calculated and cTnI concentrations were measured. These indicators were compared to determine which has the better ability to prognosticate mortality and complications. Results: A total of 55 cases (median age, 35 [24-49] years) were enroled. Eight patients (14.5%) died. Mean SAPS-II, median APACHE-II score and median cTnI concentrations were 32.05 ± 11.24, 13 [10-17] and 0.008 [0.002-0.300] ng/ml, respectively, which were significantly different between the survivors and non-survivors. Receiver operating characteristics curve results of SAPS-II, APACHE-II score and cTnI concentrations in predicting mortality were 0.945, 0.932 and 0.763 and in predicting complications were 0.779, 0.739 and 0.727, respectively. High cTnI concentration (>0.37 ng/ml) correlated with soft clinical outcomes, including length of ventilatory support, length of ICU stay and length of hospital stay (LOS) (r: 0.928, 0.881 and 0.735 respectively; all P < 0.001). Conclusion: SAPS-II scores were superior in predicting death and complications, while cTnI correlated more closely with soft clinical outcomes, such as the length of ventilator support, length of ICU stay or LOS.

Improving Door-to-Balloon Time for Patients With Acute ST-Elevation Myocardial Infarction: A Controlled Clinical Trial.

According to the latest guidelines, the best intervention to restore blood flow through occluded coronary arteries is angioplasty at a time less than 90 minutes. Thereby, the present study was conducted to determine the impact of implementing ST-elevation myocardial infarction (STEMI) code on door-to-balloon time in patients with ST-segment elevation myocardial infarction. This clinical trial was conducted in 2019 at Booali Sina heart center hospital in Qazvin, Iran, in 2019. Fifty-eight patients with STEMI were purposively and consecutively enrolled in the study. Patients were then divided into control and intervention groups, based on their referral period. In both groups, patients were observed since their Arrived by emergency medical services to emergency department until inflating the balloon in the occluded coronary artery, and the intended times were recorded by the researchers. For Participants in the intervention group the "STEMI code" was designed and activated by an emergency physician once there is a patient experiencing a chest pain and early confirmed as a myocardial infarction. The SPSS program (v. 16) was used for data analysis at a significance level of less than 0.05. The difference in the door-to-balloon mean time in both control (113.5 ± 43.6 minutes) and intervention (79.3 ± 27.4 minutes) groups, was statistically significant (P = 0.001). Regarding other parameters, the reduction in the mean between Cath lab time (26.2 ± 18.2 minutes) and balloon time (15.5 ± 7.8 minutes) was also statistically significant (P = 0.008). In this study, implementation of the "STEMI code" could greatly prevent parallel work and squandering time while treating patients with acute myocardial infarction. As the door-to-balloon time gets shorter, the bed occupancy rate in the emergency department had reduced which in turn allowed more patients to be admitted.

Effect of intravenous lignocaine infusion on bispectral index during spinal anaesthesia for caesarean section: A prospective randomised double-blind study.

BACKGROUND AND AIMS: Systemic lignocaine has been shown to have sedative effects. We designed this randomised-double-blind, placebo-controlled study to evaluate the effect of intravenous lignocaine on the bispectral index (BIS) during caesarean section under spinal anaesthesia. METHODS: 80 patients scheduled for elective caesarean section under spinal anaesthesia were randomly allocated to 2 study groups. Group L received intravenous 1.5 mg/kg of lignocaine bolus, 15 minutes before spinal anaesthesia followed by an intravenous infusion 1.5 mg/kg/h for 60 minutes intravenously. The patients in the control group (C group) were given 0.9% sodium chloride in a double-blind fashion. Spinal anaesthesia was performed with 10 mg of 0.5% bupivacaine. The changes of Sao2, BIS and hemodynamic variables during caesarean section, Apgar score of neonate and the incidence of adverse effects were recorded. RESULTS: BIS values were lower in the L group compared to C group (P ≤ 0.001). Comparison of mean arterial pressure (MAP) changes during spinal anaesthesia and surgery reveal statistically significant difference between two groups through repeated measure analysis (P ≤ 0.001), but comparision of heart rate (HR) changes during spinal anaesthesia and surgery failed to reveal any statistically significant difference between two groups. (P = 0.261). The Apgar scores did not reveal a significant difference between the two groups at first and five minutes after delivery (P = 0.99). CONCLUSION: Intravenous lignocaine infusion given with spinal anaesthesia in women undergoing elective caesarean delivery providing lower BIS values without respiratory depression, in the absence of foetal compromise.

Prevalence of Intestinal Parasites among Rural Inhabitants of Fouman, Guilan Province, Northern Iran with Emphasis on Strongyloides stercoralis.

BACKGROUND: Intestinal parasitic infections (IPIs) are among the most important etiologies of gastrointestinal disorders in developing countries. The present study was performed to determine the prevalence of IPIs in rural inhabitants of Fouman, northern Iran. METHODS: Overall, 31 villages were randomly selected during 2015-2016. Stool samples were collected from 1500 inhabitants aged 2-87. The samples were examined by direct wet smear, formalin ethyl-acetate concentration and agar plate culture. Trichrome staining and modified acid-fast staining were used as confirmatory tests for intestinal amoeba and flagellates and cryptosporidium spp., respectively. Data were analyzed with Chi-Square and Fisher exact tests using SPSS. RESULTS: 8.06% of participants were positive for at least one intestinal parasite. The prevalence of mixed parasitic infections was 0.87%. The most prevalent IPIs were caused by Trichostrongylus spp. (3.13%), followed by Strongyloides stercoralis (1.5%), Giardia lamblia (1.3%), and Entamoeba coli (1.0%), Blastocystis hominis (0.86%), E. histolytica/dispar (0.53%), Endolimax nana (0.26%), Iodamoeba butschlii (0.13%), Trichuris trichiura (0.07%), Enterobius vermicularis (0.07%), Hook worm (0.07%) and E. hartmani (0.07%). Statistically, the prevalence of IPIs showed significant differences regarding the age groups, education status, occupation (P<0.001), and the habit of eating raw vegetables (P<0.007), whereas, the differences were insignificant with regard to sex (P=0.924) and water supply (P=0.088). CONCLUSION: The prevalence of IPIs, especially soil-transmitted helminthes (STHs) has sharply decreased in northern Iran. Excluding Trichostrongylus spp. and S. stercoralis, other intestinal parasites only produce a marginal and unnoticeable health problem in this area, today.

Relationship between antifungal susceptibility profile and virulence factors in Candida albicans isolated from nail specimens.

INTRODUCTION: The aim of this study was to evaluate some virulence factors in Candida albicans isolates from patients with onychomycosis and determine the correlation between these factors and the antifungal resistance profile. METHODS: Seventy species of C. albicans were confirmed using polymerase chain reaction amplification of the HWP1 gene. According to the Clinical & Laboratory Standards Institute guidelines, the susceptibility profile of four antifungal agents was investigated, and the production of aspartyl protease, phospholipase, haemolysin, and biofilm was determined. The correlation between these profiles was also investigated. RESULTS: The isolates indicated different levels of resistance and production of virulence factors. Significant correlations were observed between the minimum inhibitory concentration (MIC) of fluconazole/itraconazole and biofilm production, between phospholipase production and fluconazole/itraconazole MIC, and between fluconazole MIC and hemolytic activity in C. albicans isolates. The results also showed significant correlations between phospholipase activity and biofilm production. CONCLUSIONS: Our findings will contribute to a better understanding of the pathogenesis of C. albicans and characterize the relationship between virulence factors and antifungal resistance, which may suggest new therapeutic strategies considering the possible involvement of the virulence mechanism in the effectiveness of treatment.

The Effect of Individual and Group Education Done by Nurses on Smoking Dependency and Smoking Cessation Motivation in Patients with Coronary Artery Disease.

BACKGROUND: This study was carried out to reveal the effect of individual and group education done by a nurse on smoking dependency and smoking cessation motivation in patients with coronary artery disease (CAD). METHODS: The present randomized controlled trial study was conducted in Iran. A total of 255 patients were randomly divided into three groups: 1) individual education, 2) group education, and 3) control. Data were collected using the Fagerstrom Test of Nicotine Dependence (FTND) and Smoking Cessation Motivation Questionnaire (Q-MAT) one time before the intervention and two times after intervention (1st and 3rd months). FINDINGS: The mean scores of motivation for smoking cessation and smoking dependency in patients in the individual and group education were significantly better than the control group after the intervention (1st and 3rd months) (P < 0.05). Although there was no significant difference in the mean scores of smoking cessation motivation and smoking dependency in patients in the individual education and group education groups after education, the status of the patients in the group education was slightly better. CONCLUSION: Education by nurses might have a significant impact on smoking cessation motivation and smoking dependency in patients with CAD. Further studies are recommended.

Relationship between antifungal susceptibility profile and virulence factors in Candida albicans isolated from nail specimens

Abstract INTRODUCTION: The aim of this study was to evaluate some virulence factors in Candida albicans isolates from patients with onychomycosis and determine the correlation between these factors and the antifungal resistance profile. METHODS: Seventy species of C. albicans were confirmed using polymerase chain reaction amplification of the HWP1 gene. According to the Clinical & Laboratory Standards Institute guidelines, the susceptibility profile of four antifungal agents was investigated, and the production of aspartyl protease, phospholipase, haemolysin, and biofilm was determined. The correlation between these profiles was also investigated. RESULTS: The isolates indicated different levels of resistance and production of virulence factors. Significant correlations were observed between the minimum inhibitory concentration (MIC) of fluconazole/itraconazole and biofilm production, between phospholipase production and fluconazole/itraconazole MIC, and between fluconazole MIC and hemolytic activity in C. albicans isolates. The results also showed significant correlations between phospholipase activity and biofilm production. CONCLUSIONS: Our findings will contribute to a better understanding of the pathogenesis of C. albicans and characterize the relationship between virulence factors and antifungal resistance, which may suggest new therapeutic strategies considering the possible involvement of the virulence mechanism in the effectiveness of treatment.

Sleep Quality and Blood Lipid Composition Among Patients with Diabetes.

BACKGROUND: Recent literature has mentioned that people with sleep disorder, experience insulin sensitivity reduction and accordingly higher levels of blood glucose. OBJECTIVES: This study aimed to investigate the relationship between sleep quality and blood lipid composition in patients with diabetes referring to Minoodar health center in Qazvin, Iran in 2017. METHODS: Sleep duration and quality were assessed in 347 patients with diabetes using the Pittsburgh sleep quality index (PSQI). The glycosylated hemoglobin A1c (HbA1c) test was used to measure the glycemic control and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were used to determine blood lipid composition of the patients. Multiple regression analyses were applied to examine the associations between sleep measures and HbA1c and lipid parameters using SPSS version 20. RESULTS: The patients in the poor sleep quality group had higher levels of fasting blood sugar (FBS) (146.07 ± 57.06 versus 132.8 ± 53.3 mg/dL, P = 0.02), body mass index (BMI) (29.1 ± 3.9 versus 27.6 ± 4.2 kg/m2, P = 0.005) and total cholesterol (209.9 ± 53.4 versus 193.4 ± 45.8, P = 0.02). Furthermore, the patients with short sleep duration had higher total cholesterol level compared with long sleep and medium sleep duration group (202.3 ± 50.2 versus 196.6 ± 47.7 and 195.7 ± 47.4, respectively, P = 0.05). Among different PSQI measures, subjective sleep quality was associated with lower TC and TG in unadjusted models (ß = -0.0.1, P = 0.05). Furthermore, greater sleep disturbance was positively linked with higher levels of TC and TG (ß = 0.1, P = 0.01 and ß = 0.02, P = 0.05). CONCLUSIONS: In an Iranian population with diabetes living in Qazvin city, sleep disorder is common and as study findings revealed sleep quality was recognized as an influencing factor on some of the lipid profiles, including TC and TG. Thus sleep assessment of patients with type 2 diabetes to find the early recognition of their sleep disorder should be considered an important part of the patients' treatment.

Parenteral Nutrition Administration by Critical Care Nurses in Iran: A Performance Evaluation.

In Iran, nurses are responsible for administering parenteral nutrition (PN) to hospitalized patients in intensive care units (ICUs). However, little information is available among nurses in Iran regarding best practices in PN administration. This study evaluates the performance of critical care nurses in Iran in the administration of PN. The performance of 50 nurses in the administration of PN in the ICU was observed 3 times during a 5-month period for a total of 150 observations. A researcher-developed checklist, "Critical Care Nurses' Performance in Parenteral Nutrition Administration," was used for data collection. The total score in this checklist ranged from 0 to 52. Based on the procedural steps in the checklist and whether the steps were performed appropriately, nurses' performance was scored as poor, moderate, or good. The mean score of nurses' performances in PN administration skills was 24.6 ± 2.5. This study found that 46 nurses had moderate skill levels in PN administration, and 3 demonstrated poor skills. Overall, the results indicated that critical care nurses in Iran have poor to moderate PN administration skills.

Comparing the effects of upper limb and breathing exercises on six-minute walking distance among patients with chronic obstructive pulmonary disease: a three-group randomized controlled clinical trial.

INTRODUCTION: Physical exercise can improve patient outcomes and reduce hospitalization and mortality rates among subjects with chronic obstructive pulmonary disease. This study aimed to compare the effects of upper limb and breathing exercises on six-minute walking distance among these patients. MATERIAL AND METHODS: This three-group randomized controlled clinical trial was conducted in 2017-2018 in Velayat hospital, Qazvin, Iran. Seventy-five patients were purposively selected from the outpatient lung clinic of the hospital and randomly allocated to either the 25-patient groups of upper limb exercise, breathing exercise, or control. The patients in the first group were performing upper limb exercises thrice weekly for one month in the study setting. Their counterparts in the second group were doing pursed-lip and diaphragmatic breathing exercises four times daily for one month at their homes. However, the patients in the control group received no exercise intervention. Six-minute walk test was performed by each participant both before and after the study intervention. The SPSS for Windows program (v. 23.0) was used to analyze the data via the Chi-square test, the paired-sample t test, and the one-way analysis of variance. RESULTS: Before the intervention, the groups did not significantly differ from each other respecting six-minute walking distance. During the study, walking distance in the control group did not change significantly, while it remarkably increased in both the upper limb exercise and the breathing exercise groups (p < 0.05). After the intervention, walking distance in the upper limb exercise group was significantly greater than the breathing exercise group (p < 0.05) and the control group (p < 0.05); however, the difference between the breathing exercise and the control groups was not statistically significant (p > 0.05). CONCLUSION: Upper limb exercise is more effective than breathing exercise in increasing walking distance among patients with chronic obstructive pulmonary disease. Therefore, upper limb exercise can be used as a safe, simple, and inexpensive rehabilitation technique for these patients.

Relationships between maternal characteristics and infant birth weight.

PURPOSE: Nowadays, the importance of infant birth weight (IBW) as a key factor in determining the future of physical and mental development of children is a growing concern. The purpose of this paper is to investigate the relationship between maternal characteristics and IBW among pregnant women who were referred to health centers in Qazvin city in the year 2016. DESIGN/METHODOLOGY/APPROACH: A descriptive-analytical study was conducted among pregnant women in 28-36 weeks of gestation who referred to healthcare centers and facilities affiliated by the Qazvin University of Medical Sciences in April-June 2016. The associations between maternal physical activity, mothers' socioeconomic status and birth weight were examined by SPSS Software Package version 16 through linear and logistic regression tests. FINDINGS: Linear regression modeling suggested that maternal weight (p=0.001), income (p=0.04), gestational age of delivery (p=0.00) and pre-pregnancy BMI (p=0.02) were positively associated with birth weight, while occupational and heavy physical activity (p=0.003 and 0.008, respectively) were negatively associated with IBW. In this study, low birth weight infants are compared to those with normal weight belonged to mothers who have spent more time in doing heavy physical activities (OR=1.11, 95% CI 1.01-1.23). Also infants with low birth weight compared to others in the normal weight category were born from mothers with lower pre-pregnancy BMI (OR=0.65, 95% CI 0.62-0.78), gestational age of delivery (OR=0.82, 95% CI 0.79-0.86), maternal weight (OR=0.86, 95% CI 0.84-0.88) and income (OR=0.79, 95% CI 0.69-0.83). PRACTICAL IMPLICATIONS: The study findings revealed that certain maternal characteristics could play a significant role in IBW. Despite the importance, in most of developing countries (particularly Iran), future mothers are not advised about an appropriate weight gain during pregnancy or the optimal level of physical activity in such a period of time. Therefore, counseling pregnant women and giving them proper information on appropriate perinatal care would be helpful in order to have pregnancies with optimal outcomes. ORIGINALITY/VALUE: The authors applied several statistical methods to analyze IBW among mothers with different maternal characteristics and predict birth weight based on contributing factors.

Prevalence of Intestinal Parasites among Rural Residents of Takestan in North-West of Iran.

BACKGROUND: Intestinal parasites are one of the health challenges in developing countries. Decreasing the prevalence of intestinal parasitic infections (IPIs) is one of the main aims of health services in these countries. This study was designed to determine the current status of IPIs in rural residents of Takestan a town located in North West of Iran. METHODS: A total of 2280 rural residents of Takestan were randomly selected. Data were collected through questionnaire by interviews and laboratory findings obtained by microscopic examination of stool sample including wet smear and formalin ethyl-acetate concentration. A P<0.05 was considered significant, statistically. RESULTS: In total, 8.7% (199/2280) of participants were positive for at least one intestinal parasite. The prevalence of polyparasitism was 0.7% in study population. Hymenolepis nana was the only helminthic infection which was detected (1/2280). Blastocystis, Entamoeba coli, and Giardia lamblia were the most common IPIs with prevalence of 3.6%, 2.9%, and 1.6%, respectively. Statistically, the prevalence of IPIs showed significant differences among villages (P<0.01) and age groups (P<0.001), and also habit of eating raw vegetables (P<0.005), whereas, the difference was insignificant in terms of sex, education level, and occupation. CONCLUSION: The prevalence of IPIs in rural residents of the study area is considerably low and this reduction was very impressive about helminthic infections.

The Relation between Urinary Tract Infection and Febrile Seizure.

OBJECTIVES: Febrile seizure is the most common type of seizure among children. Identification of factors involved in febrile seizure is highly critical. The present study was conducted to determine the association between children's urinary tract infection and febrile seizure. MATERIALS & METHODS: In this case-control study, 165 children with simple febrile seizure (case group) were compared with 165 children with fever and without seizure (control group) in terms of urinary tract infection (UTI) in Qazvin, central Iran in 2015-2016. The age of children was between 6 months to 5 yr. RESULTS: Among 165 children with febrile seizure, 25 (15.2%) had urinary tract infection. In the control group, only 2 patients (1.2%) had UTI. There was significant difference between two groups regarding urinary tract infection (P=0.001). Among 25 children with UTI in the case group, 17 children (68%) had acute pyelonephritis, and the remaining 8 children (32%) had cystitis. The two patients with UTI in control group had cystitis (P=0.055). CONCLUSION: Urinary tract infection could be a risk factor for febrile seizure. Therefore, all patients with febrile seizure are examined in terms of urinary tract infection.

Evaluating Service Quality from Patients' Perceptions: Application of Importance-performance Analysis Method.

OBJECTIVES: Providing high service quality is one of the main functions of health systems. Measuring service quality is the basic prerequisite for improving quality. The aim of this study was to evaluate the quality of service in teaching hospitals using importance-performance analysis matrix. METHODS: A descriptive-analytic study was conducted through a cross-sectional method in six academic hospitals of Qazvin, Iran, in 2012. A total of 360 patients contributed to the study. The sampling technique was stratified random sampling. Required data were collected based on a standard questionnaire (SERVQUAL). Data analysis was done through SPSS version 18 statistical software and importance-performance analysis matrix. RESULTS: The results showed a significant gap between importance and performance in all five dimensions of service quality (p < 0.05). In reviewing the gap, "reliability" (2.36) and "assurance" (2.24) dimensions had the highest quality gap and "responsiveness" had the lowest gap (1.97). Also, according to findings, reliability and assurance were in Quadrant (I), empathy was in Quadrant (II), and tangibles and responsiveness were in Quadrant (IV) of the importance-performance matrix. CONCLUSION: The negative gap in all dimensions of quality shows that quality improvement is necessary in all dimensions. Using quality and diagnosis measurement instruments such as importance-performance analysis will help hospital managers with planning of service quality improvement and achieving long-term goals.

Comparison of renal ultrasonography and dimercaptosuccinic acid renal scintigraphy in febrile urinary tract infection.

Accurate and early diagnosis and appropriate treatment of patient with urinary tract infection (UTI) are essential for the prevention or restriction of permanent damage to the kidneys in children. The aim of this study was to compare renal ultrasonography (US) and dimercaptosuccinic acid (DMSA) renal scan in the diagnosis of patients with febrile urinary tract infection. This study involved the medical records of children with febrile urinary tract infection who were admitted to the children's hospital in Qazvin, Iran. Pyelonephritis was diagnosed on the basis of clinical symptoms, laboratory tests and abnormal DMSA renal scans. The criteria for abnormality of renal US were an increase or a decrease in diffuse or focal parenchymal echogenicity, loss of corticomedullary differentiation, kidney position irregularities, parenchymal reduction and increased kidney size. Of the 100 study patients, 23% had an abnormal US and 46% had an abnormal DMSA renal scan. Of the latter patients, 15 had concurrent abnormal US (P value ≤ 0.03, concordance rate: 18%). Renal US had a sensitivity of 32%, specificity of 85%, positive predictive value of 65% and negative predictive value of 60%. Of the 77 patients with normal US, 31 (40.2%) had an abnormal DMSA renal scan. Despite the benefits and accessibility of renal US, its value in the diagnosis of pyelonephritis is limited.

Knowledge, Attitude and Practice of General Practitioners toward Complementary and Alternative Medicine: a Cross-Sectional Study.

Orientation of public and physicians to the complementary and alternative medicine (CAM) is one of the most prominent symbols of structural changes in the health service system. The aim of his study was a determination of knowledge, attitude, and practice of general practitioners in complementary and alternative medicine. This cross- sectional study was conducted in Qazvin, Iran in 2013. A self-administered questionnaire was used for collecting data including four information parts: population information, physicians' attitude and knowledge, methods of getting information and their function. A total of 228 physicians in Qazvin comprised the population of study according to the deputy of treatment's report of Qazvin University of Medical Sciences. A total of 150 physicians were selected randomly, and SPSS Statistical program was used to enter questionnaires' data. Results were analyzed as descriptive statistics and statistical analysis. Sixty percent of all responders were male. About sixty (59.4) percent of participating practitioners had worked less than 10 years.96.4 percent had a positive attitude towards complementary and alternative medicine. Knowledge of practitioners about traditional medicine in 11 percent was good, 36.3% and 52.7% had average and little information, respectively. 17.9% of practitioners offered their patients complementary and alternative medicine for treatment. Although there was little knowledge among practitioners about traditional medicine and complementary approaches, a significant percentage of them had attitude higher than the lower limit.

Effect of Intravenous Dexamethasone on Preparing the Cervix and Labor Induction.

The use of corticosteroids is one of the methods put forward for the strengthening and speeding up the process of labor. After identification of glucocorticoid receptors in human amnion, the role of corticosteroids in starting the process of labor has been studied in numerous studies. The purpose of this study was to determine the effect of intravenous Dexamethasone on preparing the cervix and on labor induction. A randomized, clinical, and double-blind trial was conducted on 172 women divided into a control and an experimental group. The inclusion criteria were that they had to be primparous, in or before the 40th week of pregnancy, and with Bishop scores (B.S.s) of 4 or lower. The exclusion criteria were diabetes, preeclampsia, macrosomia, twin pregnancy, rupture of the membrane (ROM), breech, and women suffering from background diseases. The B.S.s of the women was measured in charge of the study, and each woman was intravenously injected with eight milligrams of Dexamethasone or eight milligrams of distilled water. Four hours after the injections, the B.S.s of the participants was measured, and they were put under the conditions of labor induction using oxytocin. Information was collected in checklists A and B. The patients were compared with respect to B.S., the time the induction started, the average interval between the start of induction and the beginning of the active phase of childbirth, and the average length of time between the start of the active phase and the second stage of childbirth. The first and five minutes Apgar scores of the two groups of women were compared. The frequencies, the means, and the standard deviations were calculated using the SPSS - 16 software, and analysis of the results was performed with the Student's t- test and the chi-square test with with P<0.05. There were no statistically significant differences between the two groups in terms of their age, period of pregnancy, and B.S. at the start of the study. The average B.S. of women four hours after the injections with Dexamethasone was 5.9 ± 1.57, and the corresponding figure for women in the control group was 4.6 ± 1.72. These figures were significantly different at P<0.001. The average interval between labor induction and the start of the active phase in the group injected with Dexamethasone was significantly less than that of the control group (2.87±0.93 versus 3.80± 0.93 at P<0.001). The average duration of the active phase of the second stage of childbirth was 3.47±1.10 hours in the experimental group and 3.6 ± 0.99 hours in the control group at P<0.49. These two figures were not significantly different. The Apgar scores of the first and fifth minutes after the birth of the children of the two groups of women were not significantly different. It was found that intravenous Dexamethasone improves the Bishop score of the cervix and thus causes softening of the cervix and reduces the length of time between labor induction and the start of the active phase of childbirth.

THE EFFECTS OF INTRATHECAL NEOSTIGMINE ADDED TO BUPIVACAINE ON POSTOPERATIVE ANALGESIC REQUIREMENT IN PATIENTS UNDERGOING LOWER LIMB ORTHOPEDIC SURGERY.

BACKGROUND: Several additives have been suggested to enhance analgesic effect of local anesthetic agents to decrease the adverse effects of them and increase the degree of satisfaction. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy of the neostigmine added to bupivacaine using spinal anesthesia in patients undergoing lower limb orthopedic surgery. METHODS: Sixty patients 18-80 yr old American Society of Anesthesiologists (ASA) physical status I or II, scheduled for femur surgery under spinal anesthesia, were recruited in a prospective, double-blinded, randomized way. The patients were randomly allocated to one of two groups of 30 each. The neostigmine group (group N) received bupivacaine 20 mg combined with 25 µg neostigmine, and the placebo group (group C) received bupivacaine 20 mg combined with 0.5ml distilled water (intrathecally) 5 minutes prior to surgery. The time to the first analgesic request, analgesic requirement in the first 12 hours after surgery, the duration of sensory and motor blockade, the incidence of adverse effects such as nausea,vomiting,hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. RESULTS: Patients receiving neostigmine had a significantly prolonged duration of motor block (C95% CI 30.27 to 87.65; P < 0.001) and sensory block (C95% CI 101.04 to 224.64; P < 0.001) compared to the control group. The difference of the mean time to the first analgesic request was also significantly longer in neostigmine group (C95% CI 83.139 to 208.526; P < 0.001). The total analgesic consumption during the first 12 hours after surgery was devoid of any significant difference between groups N and C (p = 0.41).The two groups were not significantly different in terms of intraoperative and postoperative side effects. CONCLUSION: Intrathecal neostigmine 25 µg with bupivacaine caused a prolonged time to the first analgesic request and its use was not associated with any side effects.