فهرست مطالب محمد علی سیف ربیعی

Renal colic caused by urolithiasis is among the common causes of severe pain and referral to the emergency rooms. Using a multimodal method in controlling this type of pain with available anesthetics such as ketamine can help relieve pain, increase satisfaction, and reduce hospitalization.

The present study was conducted as a double-blind clinical trial. A total of 44 patients with renal colic with the American Society of Anesthesiologists (ASA) class 1 were divided into intervention and control groups. Pethidine (1mg/kg) was administered to both groups. In the intervention group, oral ketamine (0.5 mg/kg) dissolved in 5% dextrose was prescribed, and in the control group, 5% dextrose serum (0.1 ml/kg) was used. Pain intensity was measured by the numeric rating scale before the treatment and half, one, two, and three hours after the intervention.

The mean age of the intervention group was 35.2, and the control group was 38.9 (P=0.092). The average amount of pethidine consumed in the intervention group was 94 mg, and in the control group was 89 mg, and no significant difference was observed between the two groups (P=0.095). In the intervention group, 27.3% and in the control group, 72.7% needed additional pethidine (P=0.000). In first, second, and third hours after the treatment, the intensity of pain in the intervention group was lower than the control group, and only in the third hour this difference was statistically significant (P=0.03).

In patients with renal colic, adding oral ketamine to intravenous pethidine statistically significantly reduces the consumption of opioid, increases patient satisfaction, and reduces pain intensity three hours after treatment. Therefore, oral administration of ketamine is suggested as an adjunctive drug to relieve the pain of renal colic in hospital emergency.

 Despite confirming the positive effect of using masks in preventing disease the level of adherence in some communities has been reported to be very low. This study was conducted to determine psycho-social factors affecting the use of masks during the covid-19 pandemic in Be'sat hospital in Hamadan.

 This Cross-sectional description study was conducted on 384 people who were referred to educational-therapeutic Be'sat hospital in Hamadan and who were selected by the available sampling method in 2022. The data collection tool was a researcher-made questionnaire that included 51 questions to assess the participants' demographic, economic, social, cultural, and spiritual status and was completed by face-to-face interview method. SPSS 26 software and Chi-square, Monte Carlo, Mann-Whitney, and Student's t-tests were used to analyze the data.

 The mean age was 36.76±11.71 years. More than half of the participants (54.7%) were men. The frequency of having a mask at the time of the interview was 48.4%. According to the findings, the frequency of use a mask in men was significantly less than in women.  Also a significant relationship was observed between use a mask and being single, more educated, living in the city, and no smoking history (P< 0.001). A significant relationship was observed between use a mask and higher economic, cultural and social status.

economic, social, and cultural factors were identified as the influential factors of mask use; therefore, it is necessary to pay attention to the preventive behaviors, social norms, and culture during epidemics.

Health promotion is the process of empowering people to increase control over their health promotion. Hospitals should play an important role in promoting health, preventing diseases and providing rehabilitation services. The dominant approach in quality management of hospitals is setting service standards. In 2006, the World Health Organization (WHO) published 5 final standards and 24 sub-standards for the self-evaluation of health promoting hospitals (HPH). This tool has been translated into Farsi and is available to Iranian hospitals through the publisher's website. These standards along with sub-standards were used in the self-evaluation of hospitals that wanted to establish these standards until 2020. Some Iranian hospitals have also used this tool for self-evaluation purposes. After being revised in 2020, the HPH standards were published 5 final standards and 18 sub-standards, which are aligned with the new global strategy of HPH for 2021-2025. These standards have currently been translated into Persian and are available on the WHO HPH network website for use in the self-evaluation of Iranian hospitals.

This study was aimed to investigate the radiological (deformity) and clinical outcomes following two types of medical or surgical treatment in children with spinal trauma.

This study was conducted as a retrospective cohort study containing patients of a 13 years period (2007-2019). Patients under 18 years of age who underwent medical or surgical treatment in one trauma center due to spine trauma in the thoracic and/or lumbar parts were evaluated and followed up. Demographic characteristics, mechanism of injury, clinical, radiological conditions and type of treatment were extracted from medical records. At the time of follow-up, after evaluating the neurological status and spine imaging, the primary and secondary characteristics of the patients were compared.

A total of 79 patients with an average age of 14.36 ± 3.5 years were included in this study and were followed up for an average of 36 months. The fracture was single level in 42 patients and the most common form was compression. Primary neurological deficit was present in 14% of patients, of which 2.6% had incomplete deficit and the rest had paraplegic manifestations. Thirty eight patients were treated surgically. More than one third of patients with neurological deficit at initial examination, finally had neurological improvement and were able to perform personal activities without dependence. Finally 2.53% of patients had scoliosis at the time of follow-up. Scoliosis was more common in patients who underwent surgery. Multiple level fractures was associated with lower amounts of thoracic kyphosis.

It seems that it would better to use Thoracolumbar Injury Classification and Severity Scale (TLICS) with a more surgical threshold for decision making.

Anti-CCP and rheumatoid factor are among the markers that can be positive in brucellosis patients and even have different levels in the patients with and without osteoarticular symptoms. This study was designed and implemented with the aim of comparison of anti-cyclic citrullinated peptide antibody and rheumatoid factor levels in brucellosis patients with and without osteoarticular symptoms.

In this analytical-descriptive study, 106 brucellosis patients were examined. Anti-CCP antibody and RF levels were measured in patients with and without osteoarticular problems using ELISA method. The results were analyzed using SPSS version 16 software. P<0.05 was considered statistically significant.

Among 106 patients, 68 (64.2%) were male and 38 (35.8%) were female. The mean age of the participants in the study was 33.5 years, with the age range of 20 to 55 years. 69 people (65.1%) had bone-joint symptoms, of which 72.5% had arthralgia and 19 (27.5%) had arthritis. About 60% of the patients with osteoarticular symptoms had spondylitis and the least involvement was observed in shoulder. Mean anti-CCP level in the patients with and without osteoarticular symptoms was 7.9 ± 4.9 and 5.4 ± 2.93 U/ml, respectively (P = 0.02). Although the mean rheumatoid factor and ESR levels in the patients with osteoarticular symptoms was higher than those without these problems, but the difference was not significant.

According to the results of the present study, the level of anti-CCP in brucellosis patients with involvement of the skeletal-motor system is higher than the patients without involvement of this system, which may be misdiagnosed with rheumatological diseases.

Pulmonary hypertension is an increase in blood pressure of the pulmonary artery which leads to right ventricular dysfunction. Therefore, the present study aimed to compare echocardiographic parameters in the study of right ventricular failure in patients with pulmonary hypertension.

In the present descriptive cross-sectional study, data were collected from 100 patients with pulmonary hypertension referred to Farshchian Heart Hospital, Hamadan, Iran between 2017-2019. The cases were detected by two-dimensional echocardiography and tissue Doppler and divided into three groups based on blood pressure of the pulmonary artery. The parameters of PASP, PVR, Tei Index, FAC, IVA, TAPSE, and DTI S Velocity were calculated for each patient.

Out of 100 patients with a mean age of 52. 95 ±16. 62 years, 0. 46% had lung problems. The parameters of PASP, PVR, and Tei Index were positively and significantly correlated with each other. Also, a positive and significant relationship was observed between the parameters of FAC, IVA, TAPSE, and DTI S Velocity. However, the parameters of the first and second groups were negatively and significantly related to each other. The results indicated that the mean difference of all indicators was significant between different groups of pulmonary hypertension. The parameter of PVR parameter was one of the factors affecting pulmonary hypertension based on regression analysis. Also, IVA and Tei Index were more consistent with pulmonary hypertension in terms of abnormal values.

PVR, IVA, and Tei Index were effective parameters for evaluating the right ventricular function and more attention is recommended to be paid to these parameters

Hypotension is a common complication of spinal anesthesia during cesarean section that available treatments do not completely eliminate this complication. Due to the low cost and ease of legs elevation, this study was performed with aim to evaluate the effect of leg's raising on reducing the incidence of maternal hypotension.

This double-blind randomized clinical trial study was performed in 2019-2020 on 101 pregnant women who were candidates for c/s under spinal anesthesia in Fatemiyeh Hospital of Hamadan University of Medical Sciences. The subjects were randomly assigned to the intervention group (raising legs after anesthesia) and control group (without raising legs). After the onset of anesthesia and at different times, systolic and diastolic blood pressure, the incidence of hypotension, bradicardia, nausea, vomiting and used atropin or ephedrin were recorded and compared in the two study groups. Data were analyzed by SPSS software (version 22) and Independent t-test and Chi square test. P<0.05 was considered statistically significant.

No significant difference was observed between the two groups in terms of mean systolic and diastolic blood pressure and heart rate at different times (P>0.05) and only the mean diastolic BP at 25 minutes was lower in the intervention group than the control group (P≤0.05). The incidence of nausea and vomiting was always lower in the intervention group than the control group, but the difference was not significant (P>0.05). The incidence of hypotension was 54% in the intervention and 60.8% in the control group, but the difference was not significant (P = 0.5).

The leg's raising after spinal anesthesia has no significant effect on hemodynamics indices including the occurrence of hypotension.

Patients with Alzheimer's disease have impaired visual function even in the early stages of the disease. Therefore, the present study aimed to determine the visual signs and symptoms in patients with Alzheimer's disease and compare them with those in the control group.

This cross-sectional descriptive study was conducted on 19 Alzheimer patients and 19 cognitively healthy people referring to Farshchian Sina Hospital, Hamadan in 2020-2021. They underwent visual examinations, including visual acuity, slit lamp exam, fundoscopy,contrast sensitivity assessed by CVS-1000 test, color perception test, investigating eye movements, and pupillary light reflex. Moreover,  OCT images were taken from all patients and the control group to measure macular thickness and volume. The data were analyzed in SPSS software (version 16) using X2 statistical test.

A significant reduction in visual acuity (P=0.006 for the right eye and P=0.003 for left eye), contrast sensitivity (P˂ 0.001), impaired color vision (P=0.016), increased cup to disk ratio (P˂0.001 for both eyes), reduction in temporal vascular diameter of both eyes (P˂0.001), disturbed movement (P=0.001), and sluggish pupillary light reflex (P˂0.001) were observed in patients with Alzheimer disease. Moreover, a significant reduction was detected in macular thickness and volume, especially in the inferior quadrant, in patients with Alzheimer's, as compared to the healthy group (P˂0.001). Nonetheless, there was no significant difference between the two groups in the incidence of age-related macular degeneration, cataracts, and pseudoexfoliation.

Patients with Alzheimer's disease have abnormal results on eye examinations.

Tinnitus is hearing a sound without an external source, which occurs anywhere in the head and one or both ears. It is one of the most common symptoms associated with hearing loss due to chronic otitis media. This study aimed to determine the effect of autologous primary ossicular reconstruction on the recovery of tinnitus due to chronic otitis media.

This study was conducted based on a before-and-after design and included 25 patients aged 18-70 years with tinnitus and chronic otitis media. The participants had undergone initial reconstruction of the bone chain using an autologous graft in the Department of Ear, Nose, and Throat of the Hamadan Besat Hospital, Hamedan, Iran, in 2019. The Tinnitus Matching Test and the Tinnitus Handicap Inventory were used to assess patients' tinnitus.

A total of 25 patients participated in this study, including 13 (52%) men and 12 (48%) women. The mean scores of the age of the subjects, duration of tinnitus, frequency of tinnitus were obtained at 45.76±12.76 years, 53.25±37.25 months, and 5,000 Hz, respectively. The difference between the mean values of tinnitus loudness was significant before (8 dB) and after the surgery (4 dB) (P<0.001). Moreover, a significant difference (P<0.001) was observed between the scores of the Tinnitus Handicap Inventory before (39.48) and after the surgery (17.84).

Primary reconstruction of the middle ear bone chain using autologous graft improved tinnitus and its resulting disability in patients with chronic otitis media.

Occurrence of pleural effusion occurs in both hospitalized and outpatients. Recognizing the most important and common causes of pleural effusion in each region and in different communities can be a useful step in early and timely diagnosis of the causes and, consequently, timely treatment and thus reducing the time and burden of diagnostic and therapeutic costs imposed on patients.

In this descriptive cross-sectional study, 407 patients admitted to Sina and Shahid Beheshti hospitals in Hamadan were studied by census. Data were analyzed with SPSS software (ver. 16).

From 407 patients with pleural effusion in this study, 262 persons (64.4%) were men and 145 (35.6%) women. There were 244 persons (60%) with exudative pleural effusion, 110 persons (27%) with transudate effusion and 53 persons (13%) with empyema. Out of 244 exudative effusion cases, in 135 cases (55.3%) were recorded pneumonia, 50 cases (20.5%) lung malignancy, 33 cases (13.5%) other malignancies, 13 cases (5.3%) tuberculosis, 7 cases (2.9%) pulmonary thromboemboli and 6 remained cases  (2.5%) were other causes. Pneumonia was the most common cause of empyema.

According to results of this study, exudative pleural effusion was the most common type of effusions. In all types of pleural effusions, the most common site of involvement was right hemithorax. Identifying common causes of pleural effusions in each region facilitates the initial treatment of pleural effusions until reaching a definitive diagnosis.

Health care associated infections (HAIs) are a class of infections that infect patients during hospital admissions and receive medical services. These infections occurs within 48 to 72 hours of admission and up to 6 weeks after discharge. Surveillance of device-associated infections (DAIs) in intensive care units (ICUs) is substantial in planning healthcare strategies. This study was conducted to determine the device-associated infections' burden and antimicrobial resistance patterns.

In this descriptive-analytic study, three common device-associated infections included central line-associated bloodstream infection (CLA-BSI), ventilator associated pneumonia (VAP), and catheter-associated urinary tract infection (CA-UTI), were assessed in intensive care units of Besat Hospital in Hamedan from April 2017 to April 2018. In order to determine the incidence of device-associated infections, the number of device-associated infection cases was calculated during the study period and divided into the number of device-days used. The device-days included all days of exposure to that device (vascular catheter, endotracheal tube (ventilator), or urinary catheter) in all patients in the study population.

Out of 1806 intensive care unit admitted cases, 168 patients (9.3%) were device-associated infection with distribution of 92 cases (55%) of ventilator-associated pneumonia (VAP), 56 cases (34%) of catheter-associated urinary tract infection (CA-UTI) and 20 cases (11%) of central line-associated bloodstream infection (CL-BSI). The incidence of VAP, CA-UTI and CL-BSI was 44.7, 17.5, and 21.61 days, respectively. The most organisms were Acinetobacter (27.4%), Klebsiella (18.3%), Escherichia coli (E. coli) (15.4%). Vancomycin-resistant enterococcus (VRE) was 75%. Acinetobacter resistance to colistin and carbapenem was 16.8%. About half of Pseudomonas isolates were resistant to meropenem.

According to the present findings of this study, a high incidence of device-associated infections and resistant organisms in our intensive care units were documented, which represents a need to reinforce the preventive and control programs. Various results in different studies can be due to differences in the level of health care in different centers and countries.

Awareness during anesthesia is a side effect associated with general anesthesia and refers to a condition in which brain awakens by a stimulus during a period of general anesthesia. The experiences are stored in explicit memory and patient might recall a few things after recovering from anesthesia. The experiences are sometimes in the form of pain perception, but the patient is not able to show a reaction due to the administration of muscle relaxants, the feeling of weakness and helplessness caused by intraoperative awareness might cause some patients to develop lasting and significant psychological issues. Given the importance of monitoring and maintaining the depth of anesthesia, this study aimed to determine the incidence of awareness and recall during general anesthesia.

A total of 400 patients who were referred to Besat Hospital and underwent various surgical procedures in 2016 were involved in this study. Data collection was performed using a questionnaire previously utilized by other researchers to study the same topic. Patients were visited 24 to 36 hours after recovery and interviewed about their experiences before, after and during operation. The data collected from each patient were then recorded in the patients questionnaire form.

data were obtained from patients indicates that out of 400 patients, 249 patients were men (62.3%) and 151 patients were women (37.7%). In order to induce, propofol was used in 71.8%, thiopental sodium in 27.3% and ketamine in 0.9% of patients. Benzodiazepines were used as 1 . نویسنده مسوول: [email protected] 53 preanesthetic agents in 87.8% of cases. Ten patients (2.5%) had pointed to issues that suggested consciousness during anesthesia. The only significant connection in this study was found to be the lack of use of benzodiazepines and awakening during anesthesia.

Given the increased risk of awakening during anesthesia without use of benzodiazepines as preanesthetic drugs, we suggest administration of these agents as far as possible in general anesthetics. Also, our findings indicate that the prevalence of consciousness during anesthesia is higher in our country compared to other countries.

 Sever pain due to various reasons is one of the most important complaints of patients in the emergency department; so, management of pain is one of the main challenges there. The present study aimed to evaluate the effect of ketorolac in comparison to morphine on pain reduction in patients with spinal trauma in emergency department.  This randomized controlled clinical trial study was done on 100 patients with spinal trauma who were randomly assigned in two groups of ketorolac (30 mg) and morphine (0.1 mg/kg). Drugs were infused in both groups in 100 cc normal saline solution during 15 minutes. Pain was assessed based on visual analog scale (from 0 means no pain to 10 means the worst pain possible), and adverse effects, as the main outcomes, were measured and compared between the groups at baseline, and minutes 5, 15, 30, 45, and 60 after drugs injection. Pain scores were compared using independent t test, and adverse effects using chi-square test.  Pain score at minutes 45 and 60 after injection was significantly lower in ketorolac group than morphine group (P < 0.050). In morphine group, 34.8% of patients and in ketorolac group, only 2.1% of patients reported nausea during the study (P < 0.001). The trend of change in pain score was not significantly different between studied groups during study period (P = 0.106).  Due to better effects of ketorolac on pain reduction in studied patients, with lower side effects in comparison to morphine, it seems that ketorolac can be considered as a good alternative of morphine for pain management in patients with spinal trauma referred emergency department.

Infective endocarditis occurs due to the presence of microorganisms in the endocardium or the heart valves. Nowadays, infective endocarditis is still a major cause of death with an incidence rate of 5 to 7.9 per 100,000 populations. The aim of the study was to determine antibiotic resistance pattern of bacterial agents isolated from blood culture of patients with infective endocarditis. In this retrospective study, infective endocarditis patients who were admitted to Sina and Ekbatan hospitals in Hamadan City, Iran, from March 2005 to February 2014, were enrolled. All demographic data, clinical manifestations, physical examinations and echocardiography reports of the patients were recorded in a check list. For all patients, blood cultures in Mueller Hinton agar and antimicrobial susceptibility testing for ceftriaxone, ceftazidime, oxacillin, cefazolin, vancomycin, imipenem, clindamycin, etc. were done by disk diffusion method. All data analyzed by SPSS statistical software, version 16 (IBM, Armonk, NY, USA). A total of 61 patients with definitive infective endocarditis were included in the study, 50 of them (82%) were males and 11 patients (18%) were females. The mean age of the patients was 37.45±14.79 (range 17-74) years and 37 (60.7%) of the patients lived in urban areas. The mean duration of admission was 20±13.59 days. In addition, 38 patients (62.3%) were injection drug users (IDUs) and 23 (37.7%) non-IDU. Meanwhile, 54 (88.5%) of them had normal valve endocarditis and 7 cases (11.5%) had a prosthetic valve endocarditis. Moreover, the most common underlying disease in the natural valve endocarditis was rheumatoid fever (6.6%). Blood cultures were positive in 44.3% of the patients. The most common isolated organism was staphylococcus aureus in 15 cases (55.55%), which had the highest resistance to oxacillin. Most patients were managed by antibiotic therapy, but 15 cases (24.6%) underwent cardiac surgery. In follow up patients between 3 months to 9 years, 19.7% of the patients had complete recovery and 8.2% of them died. According to the findings, antibiotic resistance pattern of bacterial agents isolated from blood culture of patients with infective endocarditis was changed.

Pterygium is a fibrovascular and wedge-shaped lesion that extends from bulbar conjunctiva to the cornea. Pathogenesis of pterygium depends on several factors and sunlight exposure is an important risk factor for this syndrome. Surgery is regarded as the key to successful treatment of pterygium. With this background in mind, the aim of this study was to determine the effect of amniotic membrane transplantation (AMT) for the treatment of pterygium. Moreover, this technique was compared clinically with conjunctival autograft transplantation (CAT). In this randomized clinical trial, 70 patients either referred to the ophthalmologic clinic of Farshchian Hospital in Hamadan, Iran, or diagnosed by an ophthalmologist with primary or recurrent pterygium were enrolled in this study. The patients were randomly divided into two groups, (n=35). One group underwent pterygium surgery using AMT and the other one was subjected to CAT. Furthermore, the inflammation and recurrence rates after surgery were compared in both groups. Data were analyzed in SPSS software (Version16) through the Chi-square and the independent sample t-tests. According to the results, the mean ages of patients in the AMT and CAT groups were 47.34±14.85 and 48.26±15.26 years, respectively (P=0.778). Moreover, inflammation was observed in 28.6% and 8.6% of patients in the AMT and CAT groups, respectively. The recurrence rates were 22.9% and 11.4% in the AMT group and CAT group, respectively (P=0.205) The AMT had a higher recurrence rate and postoperative inflammation, compared to the CAT. Although this difference was not statistically significant, the CAT is widely used as a treatment for patients with pterygium.

Lung cancer is one of the most common types of cancer and the main reason of cancer-caused mortality in Iran. The awareness of cancer epidemiologic and pathologic characteristics helps to prevent the prevalence and incidence of cancer. This comparative descriptive study was conducted on patients with lung cancer referring to Ekbatan and Shahid Beheshti Hospitals during 2001-2016. Risk factors as well as clinical and demographic data were collected from medical records. The mean age of the patients was 61.11 ±12.23 years and 166 patients (83%) were male. A total number of 120 (66.7%) patients lived in urban areas. The frequency of patients who had a positive history for consumption of opioid, industrial drugs, cigarette, and hookah were 2%, 0%, 42.2%, and 1%, respectively. The most common symptoms were cough and dyspnea.  The time interval between the appearance of clinical signs and diagnosis was 5.32 months. The most common paraneoplastic symptom was bone pain (45.5%), and the most frequent pathologic form was squamous cell carcinoma (33.5%). The right upper lobe (27.5%) and left upper lobe (23.5%) were the most common lobes. Since the time interval between clinical signs and diagnosis was long and squamous cell carcinoma was the most common type of cancer, it is important to control risk factors, specifically smoking, to  prevent cancer.

Acceptable control of blood glucose is one of the most important goals of treatment management in diabetic children. An insulin therapy regimen with multiple daily injection or continuous subcutaneous insulin infusion has been admitted as a desirable therapeutic approach in children with diabetes mellitus type 1. This study was designed to evaluate the effect of intensive insulin therapy on HbA1c as an alternative for the conventional two-injection insulin therapy. This descriptive-cross sectional study was conducted on 100 children and adolescents with diabetes mellitus type 1 at Pediatric Endocrinology Outpatient Clinic of Besat Hospital, Hamadan, Iran in 2017. The present study was conducted on the patients that were previously treated with twice-daily NPH and regular insulin, and then with four injections of insulin Aspart per day before each meal and insulin Glargine at bedtime. Demographic data included: age of onset of diabetes, weight, height, body mass index, duration of diabetes, number of hypoglycemic events, number of episodes of diabetic ketoacidosis (a year before and after the change of insulin regimen), number of insulin injections, type of insulin, injection device, and mean of HbA1c (a year before and after the change of insulin regimen). The data were analyzed using SPSS software (version 16) and appropriate statistical tests. The mean age of the patients was 11.41 years. Out of 100 subjects, 60 cases (60%) were female and 75% were male. In addition, 75% and 25% of the cases were urban and rural, respectively. The average body mass index was 19.65. The average number of visits to the clinic and measurement of HbA1c were 3.33 times a year. The mean of HbA1c before and after four injections per day was 8.4 and 8.1, respectively. There was a statistically significant difference (P= 0.03). The mean reduction was significant (P= 0.001) in subjects that were referred to the clinic and performed HbA1c more than three times a year. The frequency of reported hypoglycemia was 1.4 each year and the difference was not statically significant .There were no differences in terms of hypoglycemia events before and after four injections per day. The findings of this study confirmed that multiple daily injection of insulin is associated with improved metabolic control of blood glucose. However, HbA1c levels were not in the range of good control.

Bleeding is one of the most common problem during nasal surgeries, including the functional and aesthetic surgeries. One of the methods to reduce intraoperative hemorrhage is the administration of anti-fibrinolytic agents, such as tranexamic acid. Regarding this, the present study aimed to determine the effect of intravenous transaxamic acid on bleeding volume and operative field quality during nasal surgery. This clinical trial was conducted on 70 patients within the age range of 18-65 years referring to Besat Hospital in Hamadan, Iran, for nasal surgery. The participants were assigned into two groups of case (n=35) and control (n=35) using the table of random numbers. The case group was administered a mixture of 500 mg tranexamic acid and 500 ml ringer serum infused with a maximum rate of 15 mg/min at a concentration of 1 mg/ml. However, the control group just received ringer serum infusion. The mean age of the patients was 34.64±15.43 years and 61.4% of them were male. There was no statistically significant difference between the two groups in terms of age, gender, and weight (P>0.05). The mean scores of surgeon satisfaction were obtained as 73.6 and 51.4 in the case and control groups, respectively, which were significantly different between the two groups (P=0.000). The mean volumes of blood in suction were 208±97.64 and 273.71±147.72 ml in the case and control groups, respectively, which showed a significant difference between the groups (P=0.032). Furthermore, the mean surgery durations were estimated as 119.2±34.58 and 139.71±38.46 min in the case and control groups, respectively, and this difference was statistically significant (P=0.02). Additionally, the mean volumes of infused fluid were 1057.14±217.31 and 1260±497.168 ml in the case and control groups, respectively, which were significantly different between the two groups (P=0.030). The mean difference of hematocrit level between the pre- and post-surgical stages were obtained as 1.67% and 3.13% in the case and control groups, respectively, which were significantly different between the study groups (P=0.001). No tranexamic acid side effects were observed in the patients. According to our study, the intravenous infusion of tranexamic acid could reduce hemorrhage and improve the quality of nasal surgery field without any significant side effects.

Reform program in Medical education including integration of basic and clinical sciences without attention to professors and students’ views has been done in Hamadan university of medical sciences from 2011, so this study was conducted to examine the viewpoints of the professors and students toward this program.
This cross-sectional study has been done on students and professors involve in reform program through census method. For collecting data a researcher- made questionnaire that its’ validity and reliability confirmed was used and included questions regarding the objectives, horizontal and vertical integration and quality of education centers. Data were analyzed using Descriptive Statistics, Chi-square, Kruskal Wallis tests and One-Way ANOVA through SPSS software.
Totally 118 students and 12 professors participated in the study. 47.05% of the students reported that the program's goals were not initially elaborated. Effective factors in Students’ satisfaction were respectively the quality of education centers and functioning of the departments including surgery, pediatrician and internal (P based on results, more than half of the students and professors who participated in this study were satisfied with the reform plan.

Car accidents are the second leading cause of mortality in Iran. For safe driving, drivers require minimum acceptable visual acuity. In Iran, the accepted routine test to take driving license is Snellen vision chart, which is not adequate for visual acuity determination in real and natural environment. It seems that introducing a more sensitive and specific screening test is necessary. In this survey, we studied whether adding contrast sensitivity test to the present screening protocol is valuable or not.
A cross-sectional study of 200 drivers presenting to the ophthalmologic clinic of Farshchian Hospital in Hamadan, Iran, was performed during 2014-2016. The participants were chosen using the census sampling method. Complete ophthalmologic examination, visual acuity evaluation, and contrast sensitivity test were carried out. Data were analyzed using SPSS, version 20.
The mean age of the participants was 39.6 years. The patients were allocated to a group with normal visual acuity and a normal corrected visual acuity group. The most common refractive errors were concurrent myopia and astigmatism. In normal visual acuity group, the percentages of abnormal contrast sensitivity (in increasing order of frequency) in appropriate lighting condition were 0, 8.3, 13.8, and 22.2 in the right eye and 0, 10.8, 16.21, and 18.91 in the left eye, and in reduced lighting condition, they were 0, 13.8, 33.3, 33.3, and 41.6 in the right eye and 0, 21.62, 21.62, 27.02, and 27.02 in the left eye. With normal corrected visual acuity, the percentages of abnormal contrast sensitivity test in normal lighting condition were 0, 14.28, 35.71, 64.28, and 64.28 in the right eye and 0, 7.69, 46.15, 53.84, and 84.61 in the left eye and 0, 50, 85.71, 92.85, and 92.85 and 0, 61.53, 76.92, 76.92, and 84.61, respectively, in low light condition.
It seems that contrast sensitivity test is a better predictor of visual ability in comparison with visual acuity, thus, it is recommended to be added to the vision-related driving license requirements.

Correct and early diagnosis of infections contributes to proper treatment and helps prevent unnecessary antibiotic treatment. Thus, we aimed to compare the predictive values of the absolute neutrophil count, band count, and toxic granulation of neutrophils with the serum levels of C-reactive protein (CRP) in bacterial infections.
In this descriptive cross-sectional study, we enrolled 200 patients who were admitted to the infectious disease ward of Sina Hospital, Hamadan, Iran, for bacterial infections in the first 6 months of 2016. The participants were chosen using the census sampling method. Before initiating the treatment, to carry out complete blood count (CBC) and quantitative CRP, 5 cc blood was obtained from the patients after obtaining their permission, and the percentages of neutrophils, band cells, and toxic granulation were evaluated in peripheral blood smear. This information and demographic data were collected by a checklist and analyzed by using SPSS, version 16.
The mean age of the patients was 56.26 years (range: 12 to 103 years), and 60.5% of the participants were male. The most frequent causes of hospitalization were pneumonia, soft tissue infections, sepsis, urinary tract infection, septic arthritis, and dysentery. The means of serum CRP, absolute neutrophil count, and band-cell count were 61.18 mg/L, 815.86 per mm3, and 318.86 per mm3, respectively. The correlation coefficients between quantitative CRP and absolute neutrophil count, band count, and toxic granulation severity were 0.43, 0.47, and 0.47, respectively.
The results of the present study shows a linear correlation between CRP and the absolute neutrophil count, band count, and toxic granulation, indicating that these variables can replace CRP in the diagnosis of infections. Also, the predictive values of toxic granulation and band count for replacing CRP are equal and higher than that of absolute neutrophil count.

Pain is an unpleasant sensory and emotional experience that is associated with actual or potential damage to the tissues or resulting from it. Human have always tried to find a means to heal their physical and psychological suffering and relieve their pain. In this study, the effect of acupuncture on pain relief in patients undergoing open cholecystectomy was studied
Material and In this double-blind clinical trial, a total of 40 patients were randomly selected into intervention and control groups. In the intervention group, after an intubation, and before leaving from the operating room, acupuncture was performed by one anesthetist who had passed acupuncture course or familiar with principles of acupuncture and allowed to perform this activity, at two points LI4 and LV3 on both sides, a total of four points were pinpointed manually. At the end of the operation, the needles were removed before the extubation and the patient's be alert. In the control group, before entering the recovery room and when the patient was not alert, in the same areas of the puncture in intervention group, only dressed and the patient dispatched to the recovery room. Patient's pain score was evaluated by the recovery technicians who were unaware of the type of intervention and by the VAS and recorded in the questionnaire. Data were collected by SPSS software version 16 and analyzed statistically. The significance level in this study was considered to be less than 0.05.
In the intervention and control groups, the mean age of participants was 58.8±5.8 and 57.11±9.49 years, the mean score of pain in recovery room was 5.11±1.45 and 5.50±1.50, induction anesthesia using Propofol 55% and 60%, the percentage of using bullous retainer was 66.7% and 33.3%, and the correlation coefficient between age and pain score was 0.138 and 0.238. Respectively. There was no significant difference in pain intensity between the intervention and control groups (P> 0.05). But the percentage of use of bullous retainer in the control group was significantly higher than the intervention group (P = 0.027)
The use of acupuncture in patients undergoing open cholecystectomy does not have a significant effect on reducing their pain intensity in recovery room.

Type 2 diabetes mellitus, due to its high incidence and mortality rates, is a major health problem around the world. Also, the type II diabetes is a type of metabolic disorder characterized by increased blood glucose, which is due to insulin resistance, insulin deficiency, or both. The current study aimed to assess the mean platelet volume (MPV) in type 2 diabetes patients compared to nondiabetics, and determine the correlation between MPV and fasting blood glucose, glycosylated hemoglobin (HbA1c).
This case-control study was conducted on all patients (n = 120) diagnosed with diabetes referred to the clinical laboratory of Besat Hospital in Hamadan City, Iran, during 2015-2016. The patients were divided into the two groups of case and control (n = 60, each group). The mean platelet volume was measured by an automated blood cell counter. The blood glucose and HbA1c levels were also measured in both groups. Data were analyzed using the Chi-square, t test and Mann-Whitney tests with the SPSS software version 16. The significance level was equal to 0.05.
The mean age of the control group was 41.78 years and that of the case group was 41.58 years. The mean platelet volume was 8.42% in the case group and 7.74% in the control group, which showed a significant difference between the two groups (P = 0.001). The mean platelet volume in people with HbA1c less than 7 in the case group was less than those who had HbA1c more than 7 and this difference was statistically significant (P = 0.001).
The mean platelet volume in diabetic patients was significantly higher than in the nondiabetic group. So, it seems that the elevated MPV can be used as a parameter for the diagnosis of vascular complications of diabetes.

Amphetamine and methamphetamine are man-made materials. They were only used as drugs at the beginning, but gradually outspreaded as psychedelics because of their sympathomimetic effects. Different studies have shown that the frequency of amphetamine and methamphetamine abuse has been increasing; also, there is a close relationship in amphetamine and methamphetamine abuse with psychiatric disorders. Therefore, this study aimed to investigate the frequency of amphetamine and methamphetamine abuse in psychiatric inpatients and evaluate the effects of different factors on that.
In this cross-sectional-descriptive study, 2543 patients were admitted to the psychiatric ward of Hamadan Farshchian hospital in 2013; in order to evaluate amphetamine and methamphetamine abuse, they were enrolled. For detection of amphetamine and methamphetamine, urine test using immunochemical and chromatographic methods was conducted.
The frequency of amphetamine and methamphetamine abuse in psychiatric inpatients was 7.3% (186 cases). Most of the abusers were male (87%), young (mean age: 36 years) and married (60%). However, there was no significant association between age, gender, marital status and frequency of abuse (P > 0.05). Half of abusers were unemployed and 67% of them did not have high school diploma. The most important psychiatric disorder among the abusers of these two substances was bipolar mood disorder (65.1%). Moreover, in this study, there was no significant association between amphetamine and methamphetamine test results (P > 0.05).
The results showed that the frequency of amphetamine and methamphetamine abuse in psychiatric patients was more than other people and patients with mood disorders were at a greater risk. Furthermore, this study indicated that the prevalence of abuse of these substances among females has increased compared to previous studies.

Melasma is a recurrent, symmetric, and chronic acquired hyperpimentation that presents gray-brown macules and patches with determined margins in areas exposed to light. There are many treatment options with different efficacies and side effects. In this study the therapeutic effect of 20% azelaic acid and 4% hydroquinone in treatment of melasma was assessed.
In this clinical trial, the study population consisted of all patients with clinical diagnosis of melasma, who referred to the outpatient clinic of dermatology of Hamadan, Farshchian Hospital from December 2013 to July 2014. A total of 44 patients were recruited. Patients were randomly divided to two groups and each group was treated with either azelaic acid or hydroquinone for four months. The MASI score was used to evaluate the improvement. P values of ≤ 0.05 were considered significant.
Of 44 patients, 21 received 4% hydroquinone and 23 received 20% azelaic acid, with random allocation. Both groups were similar with respect to gender and age, and there were no significant differences between the two groups. The MASI score in both groups had a decreasing trend over time, and at the end of the fourth month, a significant difference was found between the two groups (P = 0.006). The overall mean MASI score in both groups had a significant difference at different times and during the entire trial period, mean MASI score of 20% azelaic acid was lower than 4% hydroquinone (P = 0.001).
Based on this study, we could conclude that 20% azelaic acid in comparison with 4% hydroquinone had better effects on treatment of melasma. Therefore, 20% azelaic acid is a good alternative for 4% hydroquinone in treatment of melasma.