مجله دانشگاه علوم پزشکی شهرکرد
سال هشتم شماره 2 (پیاپی 30، تابستان 1385)

Arthroscopic knee surgery is a painful operation and control of its pain causes earlier recovery of the patients. Therefore, the reduction of the post-operative pain is very important. The aim of this study was to evaluate the analgesic effect of intra-articular ketamine injection after knee arthroscopy. In a double blind randomized study, 75 patients with age ranging of 18-60 years who were candidate for elective arthroscopy were chosen and the same anesthetic method was used for all of them. Based on the injected anesthetic drug, they were divided into five equal groups, A-E. Group A received both intra-articular ketamine (0.5 mg/kg) and intravenous placebo. Group B received intra-articular ketamine (0.75 mg/kg) and intravenous placebo. Group C received intravenous ketamine (0.5 mg/kg) and intra-articular placebo. Group D received intravenous ketamine (0.75 mg/kg) and intra-articular placebo. Group E received intravenous and intra-articular placebo. After the operation, if necessary, intra-veouns morphine (0.05 mg/kg) was given for pain relief. Using visual analogue scale (VAS 1 to 10), the pain was evaluated at 4, 8 and 24 hours after the operation. The time of first rescue analgesic request, and the total dose of morphine used was recorded. Statistical analysis was carried out by using SPSS software. The results of this study showed that there was no significant difference in the cases of age, sex, weight and duration of operation among 5 groups studied. Also, the total amount of opioid or the time beginning of analgesic request was not statistically different among the groups during 24 hours observation. Based on our results, intra-articular ketamine injection did not reduce postoperative pain after diagnostic knee arthroscopy and had no sparing effect on total opioid consumption and first postoperative analgesic request.

Postoperative nausea and vomiting (PONV) are common complications after both general and regional anesthesia. A number of different drugs are used for prevention and treatment of PONV. However, the complications are still common. Some of the recent investigations showed that using high concentration of oxygen decreased nausea and vomiting after general anesthesia but there is no study about effects of oxygen on PONV after regional anesthesia. Therefore, in this study the effect of different doses of oxygen is studies on the neusea and vomiting of after spinal anesthesia. In this double-blinded clinical trial, 132 patients with ASA I and II (American Society of Anesthesiologyists) criteria and 15-70 years old who were scheduled to undergo elective surgery for reduction and fixation of tibia open fracture were randomly divided into three equal groups. Spinal anesthesia was performed with 0.5% bupivacaine solution and oxygen with concentrations of 30% (group 1), 50% (group 2) and 70% (group 3) has been administered during operation. The frequency of vomiting and the severity of nausea with regard to VAS (visual analogue scale) were determined. Data was analyzed by ANOVA and c2 tests with SPSS software and a P value< 0.05 is considered significant. The mean of vomiting frequency, nausea intensity and dose of metoclopramid consumption in the patients of the 3 groups were not significantly different. The result of this study revealed that the higher concentrations of oxygen didn’t reduce PONV or metochlopramide consumption during and after the operation.

Based on the available evidence and experiments, problem-based learning (PBL) is one of the most successful methods in achievement of higher education objectives. In this method, learning is basically depended on the group discussion which is helpful in learning of medical subjects on the clinical cases. Despite its advantages, the standard form of problem-based learning method is not applicable in the university courses because of the large number of students and time consuming. In this study, an alteration of the standard PBL was used and the results were compared to those of the lecture-based learning in terms of education and learning. This quasi experimental and two-step study was performed on 60 nursing students, who were attending the course. They were randomly divided into two equal groups of experiment and control. The topics of pediatric nursing were taught to the experimental group and control group by problem-based learning and lecture-based learning, respectively. The students were evaluated for educational achievement using a multiple choice question test. Data was analyzed using descriptive statistics. Our findings showed that the mean of the final score of the students who learned by PBL method was significantly higher (15.5±1.6) than that of the students who learned by lecture-based method (12.6±1.7) (p<0.05). Our results showed that learning by the modified standard PBL method was more effective and successful than that of the lecture-based method. Therefore, this method is recommended for teaching of special nursing courses.

Preemptive analgesia is one of the pain sedative methods which is based on the blocking of pain receptor before any painful stimulation. Ketamine is a NMDA (N-Methyl D-Aspartate) receptor blocker, which has been used to reduce central sensitization. This study was performed to evaluate the preemptive effect of low dose ketamine (0.5 mg/kg, i.v.) on postoperative pain of cholecystectomy. In this study, sixty patients aged 30-60 years, with Anesthesia Society of America Scoring I or II (ASA I or II), candidate for elective cholecystectomy were randomly divided into two groups. The same operation and general anesthetic methods were used for the two groups. The patients in group1 received 0.5 mg/kg ketamine, 20 min. before surgical incision and normal saline (the same volume), 20 min. after the operation. The patients of group 2, received normal saline (0.5 mg/kg) 20 min. before surgical incision and ketamine (0.5 mg/kg) 20 min. after that. In the postoperative period, analgesia was maintained with pethidine Using Visual Analogue Scale (VAS), pain was measured at 0 (arousal), 6, 12 and 24 hrs after the operation. The time interval for the first request of analgesia and the total amount of analgesic consumption during 24 hrs were reported. The data was analyzed using t and c2 tests. The mean value of pain intensity at 0, 6, 12 and 24 hrs after the operation in group 1 (3.24±0.97) was significantly less that that of the group 2 (4.18±1.09) (p<0.05). The time interval to request the first analgesic supplement was longer in the group 1 than that in the group 2 (31.12 min versus 18.12 min; p<0.05). Also, the total pethidine consumption was significantly different between two groups (p<0.05). Based on our results, using pre-incisional ketamine (1 mg/kg) has more preemptive effect on reducing pain and analgesia requirement after cholecystectomy compared to those of post-operative ketamine.

Although the short-term benefit of medical nutrition therapy (MNT) on the management of diabetes has been shown by previous studies, long-term efficiency of MNT has not been adequately investigated. The aim of this study was to investigate the efficiency of MNT during a 1-year follow-up period in the type II diabetic patients. In a follow-up study, 163 newly-diagnosed type II diabetic patients received MNT, including the educational materials on calorie, quantity and frequency of food intake, as well as the snakes. Patients were asked to have a second nutritional consulting after 1 month. Body weight, FBS and HbA1c were measured at 3, 6 and 12-month intervals and the results were compared using repeated-measures ANOVA. The mean of patients’ age was 51.2±9.3 years. HbA1c, weight and BMI decreased significantly after 3 months of MNT (p<0.001, p<0.001, p<0.01, respectively), followed by continuous but non-significant decrease in the mentioned variables during the next 9 months. Though the weight, BMI, FBS and HbA1c did not decrease significantly beyond 3 months of MNT, but the changes were significant as compared to the beginning of the study. It is probable to enhance the long-term effect of MNT on weight and glycemic control by increasing the number of sessions of nutritional consulting.

Menopause is accompanied by a number of complications, which affects the life quality and diminishes feeling of health. The most common of these complications is hot flash. Hormone therapy is commonly used for treatment of this symptom but it has a few side effects and thus is not used in some patients. Therefore, this study was aimed to determine the effect of valerian on hot flash in a group of menopausal women. This double-blinded clinical trial was performed on 48 women aged 45-65 years complaining from hot flash. The women were randomly divided into two groups of experimental (taking valerian) and control (taking placebo). The women were interviewed and a questionnaire consisting individual characteristics and hot flash severity (using Kupperman index) was filled. Hot flash severity was measured before and 30 and 60 days after treatment. The data was analyzed by SPSS using mann-whhitney and Wilkokson tests. Based on our results, 37.9% of the experimental group was suffered from severe hot flash. One month and two months after treatment, the rate decreased to 6.9% and 3.4%, respectively (p<0.001). In the control group, the rate was 36.8%, before and 15% one and two months after the treatment (p<0.05). Mann-Whitney test indicated that valerian was more effective than placebo in reducing the severity of hot flash during the menopausal period (p<0.01).This drug reduced duration of hot flash, two months after the treatment (p<0.05) and decreased its frequency one (p<0.05) and two months (p<0.01) after treatment. The results of this study showed that valerian is effective for treatment of hot flash during menopausal period and it may be used as an alternative for hormone therapy.

Toxin Beautiful appearance is important for many people particularly with aging. Botulinum A toxin has been used for cosmetic purposes for several years. One of its applications is removal of hyper dynamic facial lines. Its use is very popular due to cheaper and more simplicity, compared to the surgical methods. Also most patients are interested to using it for the second time. Therefore, the aim of this study was to evaluate in the onset and duration of action of this toxin, following the first and the second injection compared to the first injection. This interventional study, was carried out on 61 patients (48 females and 13 males) referred to Al-Zahra and Kashani hospitals of Isfahan for treatment of their facial hyper dynamic lines. At the first visit, 25 units of botulinum were injected at 5 points of the face of the patients and followed up for 6 months. At the end of 6 months, the second injection was administrated to the available patients (25 individuals) using the same dose of toxin and locations. The onset and duration of action in the two periods were recorded. The data was analyzed using t-test. The onsets of clinical actions following the first and the second injections were 3.1±0.77 and 1.5±0.41 days, respectively (p<0.001). Means of the duration of action for the first and the second injection were 14±2 and 18±2 weeks, respectively (p>0.05). The onset of action for the second injection was faster. However, there was no significant difference in duration of action between the two injections.

Anxiety and stress are among the most important problems of modern life. These problems, particularly in elders who their adaptation to the problems is low, result in serious complications in health. This study was performed to assess the effects of progressive muscle relaxation (PMR) technique on anexiety and stress in the hepertensive elders. This quasi-experimental study was coducted in Kahrizak charity foundation in Tehran, in 2005. In this study, 55 elderly men and women who resided in the centre and suffered from hypertension, were randomelly divided into two groups; experimental (27) and control (28). PMR technique was administrated to the individualls of experimental group for 6 weeks (3 times a week, for 20 minutes). Subsequently, using depression anxiety stress (DAS) questionair, the level of anxiety and stress was measured in the two groups at the beginning, in the third week and at the end of the study. The data was analyzed, using Manvitni, Wilkakson and ANOVA tests. Using PMR, mean of anxiety and stress in the individuals of experimental group was 38.8±4.02, before intervention and decreased to 3434.3±3.7, at the third min. and to 33±5.17, at the end of intervention (p<0.01). In the control group, the means were 38.6±4.14, before intervention, 37.5±6.07 at the third week and 39.5±4.16 at the end of intervention. These differences were statistically sinificant (p<0.05). Also, in the individuals of experimental group, there was a significant decrease in SBP, DBP, HR, RR (p<0.01), wherease in the control group, these parameters, except RR were increased (p<0.01). Our results showed that using non theraputic tecniques such as PMR may control both stress and anxiety and thier compications such as hypertension in elders. This would result in healthy and prolonged life in this age group like others.

Medical-nutritional managements would reduce the progress of complications in the diabetic patients. There are a number of controversial findings about the effect of knowledge on improvement of metabolic control in type 1 diabetic patients. Therefore, the aim of this study was to evaluate the effect of nutrition education on knowledge, attitude and practice of patients in Aligoodarz. Using standard methods, the biochemical indices were measured at the beginning of the study and the knowledge, attitude and practice (KAP) questionnaire was filled in by the patients. The patients were trained 12 hrs during 3 days for diet survey and KAP. Three months later, the biochemical indices were measured, the questionnaires were filled in and the data of before and after the training were compared. The data were analyzed by SPSS, using paired t-test and McNemar tests. P values less than 0.05 were considered significant. The mean of the duration of diabetes was 10.9±6.44 years. FBS, HbA1c%, total cholesterol, LDL-C and hypoglycemic attacks decreased significantly (p<0.001). Both knowledge and practice scores increased (p<0.001) significantly from 14.2±3.9 to 21.9±2.6 and 17.2±5.8 to 26.9±4.5, respectively. Attitude also increased significantly (p<0.05). Based on our results, nutrition education increases knowledge, attitude and practice in the diabetics and changes the biochemical indices to improve their metabolic control. Therefore, the appropriate nutrition education, in addition to insulin therapy, is useful in the control of type 1 diabetes.

Free radicals are molecules or atoms that due to their single electron have high reactivity. An imbalance between production of free radicals and antioxidant defensive system of human causes oxidative stress, which can create more than one hundred kinds of disease. Since environmental pollutants are a source of free radicals and Arak is an industrial city, this study was performed to determine the antioxidant capacity of 15-17 years old students of the city. This descriptive-analytical study was performed on 720 students (395 females and 325 males) selected by multiuse sampling. The total antioxidant capacity of saliva in these students was measured by ferric reducing ability of plasma (FRAP) method, which is based on the ability of saliva to reduce ferrous (Fe+3) to ferric ion (Fe+2). The total antioxidant capacity of saliva was 1.53±0.065 μm/ml. This amount was 1.64±0.071 in males and 1.42±0.059 μm/ml in females. Our results showed that antioxidant capacity of Arak students was lower than that of antioxidant capacity in other studies. This factor, as an antioxidant disturbance, may cause different diseases in the students of this city.

Domestic violence during pregnancy causes significant mental and physical impairment in both mother and fetus and is an important threat to social health. The aim of this study was to determine the prevalence and types of domestic violence against pregnant women referred to maternity clinics in Shahrekord, 2003. This descriptive and analytical study was performed on 1600 pregnant women referred to maternity clinics in Shahrekord during year 2003. Using a questionnaire, the demographic characteristics were collected and the data was analyzed using c2 test. The prevalence of domestic violence was % 67.5 including physical (%39.5), psychological (%51.7) and sexual (%13.8) violence. The detrimental effects on the women due to the violence were physical (%17.44), psychological (%12.56) and sexual (%0.4). There was no correlation between the domestic violence and residence place, education and age of marriage. However, the rate of violence in the women with less than five years of marriage life, with poor economical condition, with first pregnancy, with unemployed and drug addicted husbands was statistically higher (p<0.05). Our results showed that the prevalence of domestic violence in this city is high and it is significantly related to poor economical condition, unemployment, addiction, first pregnancy and duration of marriage life.