مجله دانشکده پزشکی اصفهان
پیاپی 490 (هفته دوم مهر ماه 1397)

Penetrating traumas to joints if not detected and properly treated, will be damaged, and causes intra-articular contamination and septic arthritis. At present, saline test is used to detect penetrating wound into the joint. Considering that it is invasive and painful, and is prone to infectious complications especially in busy emergency wards, the purpose of this study was to determine the consensus of computed tomography (CT) scan with saline test to increase the detection rate of penetrating knee trauma cases. This cross-sectional diagnostic study was done in the year 2017 in an emergency hospitals of the Iran University of Medical Sciences, Tehran, Iran. 62 patients with knee trauma were selected using convenience sampling method, and were evaluated using saline test and CT scan. Findings: Saline test was positive in 19 cases of 62 patients. Kappa agreement rate was 54.5% between the results of saline test with CT scan reported by radiologist and 43.9% with CT scan reported by emergency medicine specialist. According to the results of the study, there was no acceptable agreement between the results of saline test and CT scan, and CT scan could not be a good alternative to saline testing. However, concurrent testing and CT scan can be helpful; as there were negative results of saline test in cases of septic arthritis, which had positive CT scan results.

Chronic cough is a diagnostic and therapeutic challenge in today's society. This disease easily affects patients’ quality of life. Recently, the effect of gabapentin on the treatment of a chronic cough has been studied in some researches. This study aimed to evaluate the effect of gabapentin on the number and severity of daily cough in patients with a chronic cough. In this clinical trial study, 100 patients with chronic cough (more than 8 weeks) and without any specific cause, such as infection, were included. Patients were randomized to receive gabapentin (up to a dose of 900 mg/day) and placebo for up to 4 weeks. The severity of cough was evaluated in patients after 2 and 4 weeks of treatment. Findings: The mean number of attacks per day, the number of coughs per turn, and the visual analog scale (VAS) in the 2nd and 4th weeks after treatment in the group treated with gabapentin was significantly lower than the placebo group (P < 0.05). Moreover, the prevalence of cough with activity and wakefulness due to coughing in the second and fourth weeks was significantly lower in the group treated with gabapentin than in the placebo group (P < 0.05). The initiation of gabapentin treatment up to a maximum of 900 mg per day for 4 weeks reduces symptoms such as waking up from sleep due to coughing or coughing with activity, as well as cough severity and chronic cough attacks.

Anemia is a usual systemic complication of inflammatory bowel disease (IBD) and can be presented in combination of iron deficiency anemia (IDA) and anemia of chronic disease (ACD). In the present study, anemia in IBD was assessed. This was a cross-sectional study conducted on 25 patients with Crohn’s disease (CD), 49 patients with ulcerative colitis (US), and 14 patients with undetermined colitis in years 2016-17. Hematological indices including ferritin, transferring saturation, hemoglobin, mean corpuscular volume (MCV), vitamin B12, and folate were measured. Demographic information and region of intestinal involvement were compared as well. Findings: Based on gender distribution, anemia was not significantly different between Crohn’s disease, ulcerative colitis, or undetermined colitis (P = 0.89). In addition, type of anemia including iron deficiency anemia, anemia of chronic disease, and macrocytic anemia was not different (P = 0.97) between the colitis types. Anemia was not in association with site of intestinal involvement (P = 0.89). Based on the findings of the current study, anemia is not statistically associated with type of bowel involvement, and site of bowel involvement. Further studies are recommended.

Using intrathecal opioid in surgery operation causes a desirable analgesic. But one of its side effects is pruritus and then, patients’ dissatisfaction. Therefore, the present study investigated the effect of intravenous propofol or pentazocine in preventing pruritus resulted from prescribed fentanyl. This was a controlled randomized double-blinded clinical trial study carried out on 150, 18-65-year-old adults, candidate for lower limb surgery under spinal analgesia, who were selected using simple random sampling method. The first 50 patients received 20 milligrams of intravenous propofol, the second 50 patients received 15 milligrams of intravenous pentazocine, and the third 50 patients received placebo, 10 minutes after analgesia. The side effects resulted from drug injection were recorded if any occurred. All the patients were under spinal anesthesia by 3 milliliters of 0.5% Marcaine, and 25 microgram fentanyl. The hemodynamic situation of patients was recorded at regular intervals before, during, and after surgery. Findings: Meaningful modifications in heart rate (HR) and mean arterial pressure (MAP) were reported in all three groups (P < 0.05), but the modifications in oxygen saturation (SaO2) were meaningless (P > 0.05). Pruritus in patients receiving propofol was relatively constant, but in control and pentazocine group, meaningful increase in pruritus was reported (P < 0.05). Propofol beside fentanyl in comparison to pentazocine or placebo plays more significant role in decreasing pruritus; however, pentazocine can be effective too with intrathecal opioid.

Ovarian pregnancy is a rare form of ectopic pregnancy, and usually is diagnosed after complication. The most common risk factor for ovarian pregnancy is the use of the intrauterine devices (IUD). Case Report: Our patient was a 20-year-old woman with a history of salpingectomy, gravid 2, with one previous ectopic pregnancy presented with abdominal pain for one week, nausea, vomiting, and orthostatic hypotension. Beta-human chorionic gonadotropin (βhCG) was positive with a titer of 105000 mIU/ml. Sonography showed a uterus of normal size with no gestational sac, but an echogenic mass with size of 44 × 32 mm at the right adnexa, and with free fluid in abdomen was detected, ectopic pregnancy was suggested, and laparotomy was performed. In women that present with history of menstrual retard, abdominal pain, and spotting, ectopic pregnancy is the first differential diagnosis. Patient should be evaluated by checking βhCG and sonography, and be treated based on clinical examination and paraclinical evidence.