Journal of Kermanshah University of Medical Sciences
Volume:21 Issue: 2, 2017

Post-Operative Nausea and Vomiting (PONV) occurs in 20%-30% of patients, and is the second most common complaints after pain. This unpleasant complication can lead to rare but serious medical complications such as aspiration of gastric contents, suture dehiscence, esophageal rupture, subcutaneous emphysema, or pneumothorax. Annual PONV-related health care costs reach several hundred million dollars. Many interventions have been done to control PONV, but complications of drug interactions limit the use of drugs.
For example, Dropridol has been placed on the Black Box Warning because of the risk of cardiac arrhythmias.
This clinical trial recruited 80 patients with American Society of Anesthesiologist (ASA) class I or II who were scheduled for elective gynecologic laparoscopic surgery. They were randomly divided into two groups: Propofol and Dexmedetomidine. The data was collected by the first nurse in PACUs and the second nurse in post-surgery ward, including age, weight, smoking history, nausea, vomiting and severity of vomiting. Patients and observers were blinded to the prescribed hypnotic drugs. The severity of nausea was assessed by visual analogue scale (ranging 0 to 10) in 0-2, 2-6 and 6-24 hours. The state of nausea was also recorded.
The incidence of nausea and the severity of vomiting significantly decreased in the dexmedetomidine group compared to the Propofol group (PV=0.001).
The results showed that Dexmedetomidine can reduce the incidence of nausea and severity of vomiting compared to Propofol.

Cognitive problems such as dementia are common in older adults and their prevalence increases with age. The early identification and diagnosis of patients with dementia can help with their treatment and improve their quality of life. The present study was conducted to investigate the psychometric properties and validate the Addenbrooke's Cognitive Examination (ACE) in a sample comprising older adult Iranians.
The present cross-sectional and correlational study recruited 300 older adults in Kahrizak Geriatric Nursing Home in Iran, including 198 men and 102 women selected using simple random sampling. The data collection tools comprised the ACE-III, the Mini–Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS). Confirmatory factor analysis was used to investigate the construct validity of the test, and the Pearson’s correlation coefficient to examine its convergent and divergent validity. Cronbach’s alpha was also used to investigate the internal consistency of the items. To examine the diagnostic validity, cut-off point, sensitivity and specificity of the test were calculated.
The results found correlations between the ACE-III and other tools (P>0.01), thus suggesting a proper convergent and divergent validity. The test-retest reliability coefficient with a two-week interval and the Cronbach’s alpha of the ACE-III were respectively calculated as 0.90 and 0.95. The optimal cut-off point that struck a balance between sensitivity and specificity was found to be 75, with a sensitivity of 0.99 and specificity of 0.95. The results of the factor analysis indicated a good fit of the single-factor structure of this test.
The ACE-III has good psychometric properties and it can be used to screen for dementia.

Hypertension is defined by a chronic elevation of arterial pressure above a certain threshold value (140/90 mmhg). Pre-hypertension is the harbinger of systemic hypertension. Brachial artery flow-mediated dilation (FMD) that messured by high resolution ultrasound is used to assess endothelial dysfunction in humans. the purpose of this study was to investigate the acute effects of a continuous aerobic session on Flow-Mediated Dilation and blood pressure in women with prehypertension (SBP=120-139 mmhg and DBP=80-89 mmhg).
The study method was laboratorial and crossover design. Subjects included 12 women with prehypertension (age: 29/4±3/6 yrs), without exercise activities or any cardiovascular disease, were participated in two control and aerobic exercise trials. Continuous aerobic exercise concluded 45 minutes with 65 to 70 percent of maximum heart rate running on the treadmill. Flow mediated dilation was measured before and 1 hour after the exercise session. Also blood pressure was measured pre exercise, immediately post exercise and every ten minutes to 60 minutes after exercise. For data analysis independent t-test and paired t-test were used.
Flow-Mediated Dilation increased significantly 1 hour after exercise (P=0.000). Also blood pressure levels decreased significantly from 30 to 60 minutes after the exercise.
Performing continuous aerobic exercise, with improving in Flow-Mediated Dilation and blood pressure in women with prehypertension, can be helpful for these patients.

Undescended Testis (UDT) is a congenital anomaly that occurs when the testicular descending process is impaired and the testes are not lowered into the scrotum but stay in the abdomen. In term and especially preterm infants, it is one of the most common congenital disorders and its common complications include testicular malignancy, infertility, testicular torsion, risk of traumatic dislocation of the testis in the inguinal region, psychological effects, and inguinal hernia. Treatment of UDT is a surgical procedure, and since is always with a hernia sac, one of the stages of the surgery is separating, removing and ligation of the hernia sac, in order to avoid an inguinal hernia. In this study, we investigated whether surgical procedure without inguinal hernia sac ligation and only with separating and removing it at the deep ring level in infants with UDT could be a more appropriate alternative to the classic surgical procedure.
This clinical trial was conducted in the Department of Surgery of Dr. Mohammad Kermanshahi Pediatric Hospital in 2012-2013, on children of 2 months to 11 years old with UDT. The patients were followed up for 4 to 5 years.
A total of 109 patients underwent orchiopexy during the study. Minimum and maximum ages of subjects were 2 months and 11 years, respectively. The highest frequency was under the age of 2 years. UDT was on the right side in 44.9% of cases, on the left side in 36.7%, and bilateral in 18.4%. Among them, 38.33% underwent orchiopexy with ligation of the hernia sac and 61.46% underwent orchiopexy without ligation of the hernia sac and with separating it at the deep inguinal ring. No cases of an inguinal hernia were observed in the two groups during the follow-up period of 4-5 years. Other complications such as wound infection, hydrocele, swelling and inflammation of the spermatic cord, hematoma, and hemorrhage at the surgical site also did not differ significantly between the two groups.
Regarding the findings of this study, it appears that the use of the non-ligation technique does not increase inguinal hernia, and can be a good alternative to the classical method of hernia ligation. The non-ligation technique prevents the possibility of complications such as the risk of damage to the vas deferens and the spermatic cord vessels.

Diabetic patients do not have a good quality of life. Sleep disorders and sleep quality are the factors affecting the quality of life. This study aimed to evaluate various aspects of sleep and quality of life in people with type 2 diabetes.
This cross-sectional study was carried out in 2015-2016 on 180 patients with type 2 diabetes presenting to endocrine clinic of Taleghani Hospital, Kermanshah University of Medical Sciences. Pittsburgh sleep quality questionnaire and quality of life SF-36 were used to collect data. SPSS 22 was used for statistical analysis.
Subjective quality of sleep, sleep latency, sleep disturbances, sleep medications, and daily functional disorders were significantly associated with poor quality of life in people with type 2 diabetes. (P Reduced sleep quality in patients with type 2 diabetes is associated with a decline in the quality of life. Therefore, medical teams are recommended to address sleep quality in these patients.

Thyroid nodules are one of the most common clinical conditions. Needle aspiration is used to detect malignancy. This study aimed to determine the diagnostic accuracy of fine needle aspiration in thyroid nodules.
In this cross-sectional study, fine needle aspiration slides of 115 patients were examined by two independent pathologists and the results were reported according to the Bethesda System. Then, the diagnostic accuracy of the cytological results of fine needle aspiration was compared with the pathology result of the surgical specimen.
A total of 115 patients were assessed, with a mean age of 40.12 years. Most cases were female (84.35%), most were unilateral and on the right side (50.4%) and the mean TSH was 2.13±1.1 in the study patients. The first pathologist reported 39.13% and 60.87% of cases, respectively benign and malignant while the second pathologist respectively reported 52.63% and 63.48% benign and malignant. Kappa agreement coefficient between the two pathologists was 0.69 for the diagnosis of benign and malignant cases in thyroid nodules. The diagnostic accuracy of the first and second pathologists was 79.13% and 90.43%, respectively, in comparison with surgical pathology samples.
The pathologist has a crucial role in differentiating benign and malignant nodules in FNA specimens and preventing surgery.

Umbilical endometriosis is a rare disease with a prevalence of 0.5%-1%, which is more common at childbearing age in women. This condition normally presents as an over-6-cm mass, with localized symptoms and periodic pain in 81.5% of the cases. The symptoms include bleeding and inflammation.
The present case report is about a rare disease, i.e. umbilical endometriosis, in a female patient.
The patient was a 35-year-old woman treated for five years’ history of endometriosis, and presenting to Imam Reza Hospital. She had suffered umbilical pain, enlargement and change of color for three months before presentation. Two weeks before presentation, she had also experienced bleeding from the umbilicus once and ultrasound ruled out umbilical hernia. She had a fairly echogenic 15*15 mm subcutaneous mass.
Given the patient’s records and clinical history and the fact that umbilical bleeding is uncommon in adults, she was suspected to have an umbilical endometriosis and underwent surgery. The specimen sent for pathology also confirmed endometriosis.