jalil makarem

The change in patients' positions has a bold effect on the ventilation and hemodynamic parameters during surgery. In this study, we evaluated the changes in hemodynamic and ventilator values resulting from conversions in the position of patients under the thoracotomy from supine to lateral position and vice versa, to determine the most favourable position with the best hemodynamic stability and ventilation conditions.

In this pre and that post interventional clinical trial, 50 patients scheduled for thoracotomy were included. Following general anesthesia induction and 5 minutes later, hemodynamic data before thoracotomy and after the surgical intervention was measured, the patient was placed in the supine position and all hemodynamic data were recorded. Then, the position of the patient was slightly changed to the lateral recumbent position. Then, at the end of the surgery, the position was changed to supine.

Regarding the change in study indices (including HR, SBP, DBP, MAP, SVV, CO, and PVI), changes in supine to lateral status led to only a decrease in systolic blood pressure, diastolic blood pressure, and mean blood pressure and other indicators did not show a statistically significant change. Similarly, the change in the above indices by changing the lateral to the supine state was only an increase in systolic blood pressure, diastolic blood pressure, mean blood pressure, and other data remained unchanged.

Changing the position of patients during surgical thoracotomy from supine to lateral position or vice versa is associated only with significant changes in patient's blood pressure and has no significant effect on other ventilatory and cardiovascular parameters.

Our goal was to compare two common methods including auscultation and Fiber-Optic Bronchoscopy (FOB) in confirming the correct placement of Double-Lumen Tube (DLT). Seventy six patients were enrolled. After DLT insertion, clinical verification was made by auscultation, then FOB was applied. At lateral decubitus, the position of DLT was rechecked by auscultation, and then by FOB. The incorrect position including malposition and misplacement were compared between two routine methods of auscultation and FOB. After blind intubation, 21.1% of DLTs were considered to be in an incorrect position. Meanwhile, FOB showed that 46.1% of DLTs were not placed correctly. Among all the patients, 53.9% of DLTs were in the optimal position. Misplacement was diagnosed in 35.5% and malposition in 10.5% of the patients. After positioning to the lateral decubitus, using auscultation, we found that 5.3% of tubes were dislocated, but according to FOB, it was 10.5%. The agreement coefficient between auscultation and FOB was 0.42 in the supine position and 0.64 in lateral position. Our results showed that although FOB needs more time to check the position of DLT, it should be used to confirm the exact position of DLT.

This this study aimed to investigate the causes and prognoses of liver re-transplantation in patients referred to Imam Khomeini Hospital Liver Transplantation Center.

Organ shortage is a major problem in the world, a high demand for liver transplantation has exacerbated this problem. Thus, providing more information on the causes of liver re-transplantation, its prognosis, and other issues related to this procedure is of great importance.

This study was conducted in 2018 as a historical cohort. In this study, the records of liver transplantation patients at Imam Khomeini Hospital Liver Transplantation Center between 2000 and 2016 were studied, and data was extracted from the records of patients undergoing liver transplantation. Patient data was entered into SPSS 20 software and analyzed.

In this study, 1030 patients with a mean age of 43.15 ± 14.57 years were studied. There were 426 women (41.4%) and 604 men (58.6%). The number of primary transplants was 966 with a mean age of 43.19 ± 14.72, and the number of re-transplants was 64 with a mean age of 42.56 ± 12.82. Significant differences were found between the two groups in terms of MELD and CHILD scores, cold ischemic time, total and direct bilirubin levels, liver function factors (ALT, AST, and alkaline phosphatase), hemoglobin, and WBC. There was no significant difference between the two groups in terms of age, sex, or platelets (> 0.05). The mortality rate was 241 (23.39%) in all patients and the mortality rate was 206 (21.32%) and in liver transplant patients was 35 (54.68%). The mortality rate in the transplant group was statistically higher (p<0.001). Secondary was primary non-functional graft (PNF) (37.5%) with 1-, 3, and 5-year survival rates of 82%, 81%, and 70% in primary group and 59%, 43% and 32% in re-transplantation, respectively. There was a significant difference in survival between the two groups (p <0.05). Hemoglobin and alkaline phosphatase were predictors of survival rates in transplant patients.

The results of this study showed that the survival rate of re-transplant patients was significantly lower than that of primary transplant patients, and the mortality rate in re-transplant patients was significantly higher.

 The aim of this study was to assess the quality of the surgical field, amount of blood loss, and duration of surgery following induced hypotension with labetalol, nitroglycerin, and high dose propofol in patients undergoing FESS under general anesthesia.

One hundred and eight patients scheduled for FESS under general anesthesia were recruited in this randomized trial and were allocated to one of the three study groups: 1) Nitroglycerine (NTG) group: nitroglycerine with a dose of 2-5 μg/kg/min was administered; 2) Labetalol (LAB) group: an IV bolus dose of labetalol (20 mg) was injected at first and then IV infusion of labetalol at a rate of 1-2 mg/min; 3) High dose propofol plus normal saline (0.5-1 ml/min) group. Hemodynamic variables and the amount of bleeding were recorded intraoperatively and the surgeons' satisfaction was asked following each surgery considering the surgical field quality using a 5-item Likert scale.

The average blood loss (ml) in patients in the LAB group was significantly less than patients in NTG and high dose propofol groups (127 ml vs 198 and 145 ml, respectively) (p- value=0.001) and the surgeons expressed greater satisfaction with the surgical field quality in the LAB group (p- value=0.001).

Labetalol infusion may be a safe and effective method for induction of controlled hypotension to provide a comparatively bloodless field. High dose propofol may be a second choice if labetalol is not available.

Inappropriate administration of antimicrobials has led to increased antibiotic resistance as well as burden of infectious diseases. Antibiotic stewardship programs (ASPs) help prevent resistance through improved utilization of antimicrobial agents while potentially decrease costs of treatment.

We reviewed 186 infectious disease (ID) consultations from two internal disease wards in a tertiary center where ID specialists were asked to confirm carbapenem use in patients within 48 hours of initiation. The records were reviewed in terms of age, gender, and final decision about carbapenem use. The crude mortality rates during the 5-month period of the study (May to September 2016) as well as hospital spendings were compared with the same time of the year before implementation of the ASP.

Of 186 consultations conducted by the ID specialists, 28 consultations (15%) led to antibiotic change, 46 (25%) led to discontinuation, while in 112 (60%) carbapenems were continued. An estimate of 14,000 € were saved based on annual hospital costs during the 5-month period of the study. Although antimicrobial resistance patterns could not be evaluated, the crude mortality rate in the two IM wards was calculated to be 2.6% with no significant change compared to previous year (CMR: 2.9%).

Based on findings of the present study. ASPs for carbapenems (as wide-spectrum agents) can lower costs with no increased mortality rates in a tertiary center located in a middle income country.

COVID-19 has literally ravaged the entire world. People from all walks of life are badly affected because of compulsory lockdown around the world. Timely diagnosis is a problem as there is no single test that can achieve the highest acceptable sensitivity. Some of the tests are indeed costly and footing the bill by the governments can cause a tremendous load on the Treasury. As it stands, the current tests are beyond patient means and, thus, the patient would never have it performed. Lastly, there is no consensus as to whether everyone should be tested for COVID-19 and not based on presence of clinical features.Unfortunately, since the disease has been declared a pandemic, all should be considered to be infected unless provenotherwise by the tests that are performed.

The novel coronavirus (COVID-19) emerged for the first time in China and then rapidly spread and swept the entire world like a tornado killing thousands of patients around the planet. People were advised to stay in-doors to prevent the spread of this deadly disease, and this slogan helped to a greater extent in containing the spread of the virus. Unfortunately, there is no treatment for the disease at present, but extensive research is going on to find a definitive treatment. Regarding endotracheal intubation (ETI) of COVID-19 patients, data are scarce and no randomized clinical trials are available to develop and formulate succinct and acceptable guidelines in tackling the problem of ETI in these highly risky and vulnerable patients.

Linezolid has been recognized as a safe and effective medicine against a wide variety of Gram-positive pathogens.
The primary objective of this study was to assess utilization appropriateness of linezolid and explore the efficiency of protocol intervention to proceed to rational drug usage.
The project was conducted in a referral teaching hospital from September 2015 to January 2017 in two phases. In the first step, a six-month survey was performed to evaluate the prescribing appropriateness of linezolid. Patients receiving linezolid were identified using hospital IT system and the medical charts were analyzed based on accurate indications and duration of linezolid prescription. Subsequently, a restrictive protocol was developed and communicated after a consensus by Drug and Therapeutics Committee in May 2016. After introduction of the protocol, an active daily surveillance of patients was done by hospital pharmacists. The appropriateness of linezolid utilization and infectious consultations were compared before and after protocol implementation.
In the first phase of the study, the indication of linezolid was appropriate in 56.2% of cases and improved considerably to 68.6% (P value: 0.04) after protocol enforcement. Furthermore the duration of the linezolid consumption was correct in 66.6% of patients, increasing to 88.5% after protocol introduction (P value 0.07). In the first step, 56.9% of linezolid prescriptions were based on infectious disease consultation which enhanced remarkably to 87.5% in the second step (P value 0.001), while, 65.5% and 73.8% of these consultations were appropriate in the study surveys respectively.
The protocol intervention could improve appropriate prescribing of linezolid in the hospital setting. However, ongoing audit studies are recommended to maintain the rational prescription of linezolid.

Pruritus is a troublesome side effect of intrathecal opioids. Midazolam can reinforce GABA-mediated inhibition of the medullary dorsal horn neurons, and thus theoretically has potential to suppress opioid-induced pruritus.
This prospective double-blinded randomized trial aimed at comparing the effects of propofol, midazolam, and a combination of the two on the prevention of pruritus induced by intrathecal sufentanil.
Eighty-four patients undergoing spinal anesthesia with 3 mL hyperbaric bupivacaine 0.5% and 5 μg sufentanil (1 mL) were randomly allocated to one of the three study groups: Group 1, who were administered 20 mg intravenous (IV) propofol bolus, then 50 μg/kg/min IV infusion; Group 2, who were administered 0.03 mg/kg IV midazolam bolus, then 0.02 mg/kg/h IV infusion; and Group 3, who were administered 10 mg IV propofol and 0.015 mg/kg IV midazolam bolus, then 25 μg/kg/min propofol and 0.01 mg/kg/h midazolam IV infusion. The incidence rates and severity of pruritus were assessed intraoperatively and postoperatively for 24 hours.
The Ramsay Sedation Score was highest for the propofol group throughout the duration of the anesthetic process. Overall, 17 patients in the propofol group (60.7%), eight patients in the midazolam group (28.6%), and nine patients in the propofol-midazolam group (32.1%) developed pruritus (P = 0.027). Intraoperative pruritus was observed in seven patients in the propofol group (25%), two patients in the midazolam group (7.1%), and five patients in the midazolam-propofol group (17.9%) (P = 0.196). Postoperative pruritus developed in 12 patients in the propofol group (42.9%), six patients in the midazolam group (21.4%), and four patients in the midazolam-propofol group (14.3%) (P = 0.041). There was no significant difference between the groups with respect to the severity of pruritus (P > 0.05).
This study showed that in comparison with propofol, the administration of 0.03 mg/kg IV midazolam bolus followed by 0.02 mg/kg/h could be more effective in the prevention of intrathecal sufentanil-induced pruritus without increasing sedation and other side effects.

Nowadays, pain, nausea, and vomiting are regarded as important complications of anesthesia and surgery. The current study aimed at assessing the effect of preemptive intravenous acetaminophen on control of pain, nausea, vomiting, shivering, and drowsiness following the general anesthesia for retina and/or vitrectomy surgeries.
In a randomized, double-blind, clinical trial, 83 candidates for retina or vitrectomy eye surgery under general anesthesia were distributed into 3 groups: A) 41 patients in the control group who received 100 mL of normal saline just before the surgery and 100 mL of normal saline 20 minutes before the end of surgery; B) 21 patients in the preemptive group who received acetaminophen 15 mg/kg in 100 mL normal saline just before the surgery and 100 mL normal saline 20 minutes before the end of surgery; C) 21 patients in the preventive group who received 100 mL normal saline just before the surgery and acetaminophen 15 mg/kg in 100 mL normal saline 20 minutes before the end of surgery. Pain, nausea, vomiting, and shivering were assessed at the recovery and 2, 4, and 24 hours after the operation. Anesthesia emergence situation was assessed after arrival in the recovery room by the Richmond agitation-sedation scale (RASS) questionnaire. Blood pressure and heart rate were recorded before anesthesia induction, just after intubation, before extubation, and on discharge from the recovery room.
Total intraoperative fentanyl, duration of operation, and duration of anesthesia were not different among the studied groups. Vital signs were not statistically different among the groups at before anesthesia induction, just after intubation, before extubation, and on discharge from the recovery room. Thirty-three patients in the control group (87.8%), 11 in preemptive (52.4%), and 14 in preventive groups (66.7%) needed acetaminophen in the first 24 hours after the surgery (P value = 0.008). Pain scores measured by visual rating scale (VRS) was lower in the preemptive and preventive groups, compared with those of the control group, in the recovery (P value = 0.006), 2 hours after the surgery (P value = 0.008), and 4 hours after the surgery (P value = 0.012), but not in 24 hours after the operation (P value = 0.1).
Intravenous acetaminophen administered as preemptive or preventive medication was effective and safe to control acute postoperative pain and analgesic request after the vitrectomy eye surgery.

The aim of this study was to assess the effect of premedication with intravenous midazolam or fentanyl on anxiety and hemodynamic changes following spinal anesthesia in pregnant women
145 pregnant women scheduled for cesarean section were randomly recruited into three study groups in this randomized clinical trial. The severity of anxiety in all women were assessed using Depression Anxiety Stress Scales (DASS) at the time of entrance to the operating room. In first group (group Midazolam) 1 mg midazolam (in 1 ml volume), in second group (group Fentanyl) 50 µg fentanyl (in 1 ml volume) and in third group (group control) , 1 ml normal saline were administered intravenously before preparing for anesthesia and then spinal anesthesia was done for all women in lateral position. Variables such as age, body mass index, duration of surgery, level of sensory block, gravidity, Apgar score, heart rate, systolic, diastolic and mean arterial pressure before spinal anesthesia and then after every minutes until 5 minutes and then every 5 minutes until the end of surgery were recorded for all patients. Data were analyzed using SPSS (version 22).
Demographic variables, duration of surgery and Apgar score of neonates were not different between study groups. Women in three group were not different with respect to incidence of hypotension and bradycardia needed to treatment. The incidence of hypotension and bradycardia in patients with severe anxiety were statistically different between control and midazolam groups, but the same difference was not seen in patients with mild, moderate and very severe anxiety.
In this study, we showed that intravenous midazolam before spinal anesthesia for cesarean section can decrease the incidence of hypotension and bradycardia in patients with severe anxiety without any risk for mother and her neonate.

Fentanyl which is frequently used during cataract surgery has been found to induce cough. The aim of this study was to evaluate the effect of IV lidocaine and dexamethasone and different speeds of injection of fentanyl on cough induced by this drug.
In this randomized double blind clinical trial study, patients were allocated randomly to four groups to receive 1 mg.kg-1 lidocaine (group i), 0.1 mg.kg-1 dexamethasone (group II) and 5 cc normal saline as placebo (group III & IV) intravenously. Four minutes later, all patients were given 1.5 µg.kg-1 fentanyl intravenously. Fentanyl was administered within 15 seconds in group I-III and within 2 seconds in group IV. Incidence, number and intensity of cough were recorded. Heart rate and blood pressure were also recorded before administration of drug, 1 minute after administration of drug and 2 minutes after administration of fentanyl.
139 patients were evaluated. There was no significant difference in demographic features of groups including age, weight, gender and also heart rates and blood pressures. Incidence and intensity of cough was significantly higher in group IV while there was no statistically considerable difference between other groups.
This study demonstrated that slowing injection of fentanyl can effectively reduce the incidence of cough induced by drug; hereby administration of lidocaine or dexamethasone becomes unnecessary in this speed of injection. Additionally cough incidence after fentanyl injection is affected by patient's ethnicity.

Implementation of patient feedback is considered as a critical part of effective and efficient management in developed countries. The main objectives of this study were to assess patient satisfaction with the services provided in hospitals affiliated to Tehran University of Medical Sciences, Iran, identify areas of patient dissatisfaction, and find ways to improve patient satisfaction with hospital services.
This cross-sectional study was conducted in 3 phases. After 2 initial preparation phases, the valid instrument was applied through telephone interviews with 21476 participants from 26 hospitals during August, 2011 to February, 2013.Using the Satisfaction Survey tool, information of patient's demographic characteristics were collected and patient satisfaction with 15 areas of hospital services and the intent to return the same hospitals were assessed.
The mean score of overall satisfaction with hospital services was 16.86 ± 2.72 out of 20. It was found that 58% of participants were highly satisfied with the services provided. Comparison of mean scores showed physician and medical services (17.75 ± 4.02), laboratory and radiology services (17.67 ± 3.66), and privacy and religious issues (17.55 ± 4.32) had the highest satisfaction. The patients were the most dissatisfied with the food services (15.50 ± 5.54). It was also found that 83.7% of the participants intended to return to the same hospital in case of need, which supported the measured satisfaction level.
Patient satisfaction in hospitals affiliated to Tehran University of Medical Sciences was high. It seems that the present study, with its large sample size, has sufficient reliability to express the patient satisfaction status. Moreover, appropriate measures should be taken in some areas (food, cost, and etc.) to increase patient satisfaction.

Deliberate hypotension is a strategy that reduces intraoperative bleeding and increases the speed of surgery in otolaryngology procedures. Magnesium (Mg) sulfate is a vasodilator agent that reduces intraoperative hypnotic requirements and in combination with analgesic agents, it reduces intraoperative and postoperative pain. In this study we evaluated the use of intravenous Mg sulfate for inducing deliberate hypotension in rhinoplasty. Sixty ASA I, II patients aged between 18 to 45, scheduled for rhinoplasty were recruited into a randomized clinical trial. Patients were randomly assigned into placebo (group P) and Mg sulfate (group M) groups. For patients in group M, 40m/kg Mg sulfate was administered before induction and continued with 15mg/kg/hr infusion during the operation. Patients of group P received normal saline as placebo. In each group mean arterial pressure (MAP), mean heart rate, amount of bleeding, anesthetic agents, opioid requirement and duration of surgery were recorded. The incidence of nausea, vomiting, shivering and the score of pain were recorded in post-operative period in both groups. Patients in group M had lower MAP (P= 0.0001), less intraoperative bleeding (P=0.0001), lower anesthetic agents (P=0.0001) and opioid consumption (P=0.001), and shorter duration of procedure (P=0.0001). Mean heart rate was lower in group P (P=0.001). Moreover, surgeon`s satisfaction was more in group P (P=0.001).They also had less incidence of post-operative nausea and vomiting (P=0.008), shivering (P=0.001) and lower pain scores postoperatively (P=0.0001). Magnesium sulfate can be a useful drug to induce controlled hypotension in rhinoplasty surgery. By employing this agent patients have better anesthetic condition and recovery profile

Chloral hydrate (CH) is a sedative agent that is widely used in infants and children for several decades. The purpose of this study was to evaluate the safety and efficacy of CH before general anesthesia in pediatric population undergoing eye examination. 165 pediatric patients with retinal tumor were examined from December 2014 to May 2015. 158 (95.7%) children were sedated by CH before general anesthesia. CH was used at a dose of 25 mg/kg with an augmentation dose, if necessary, in 20-30 minutes. We recorded the safety of CH, the success or fail of sedation, augmentation CH dose, time to sedation and complications of CH administration. In our study 158 (95.7%) children were sedated by CH and sixty four (40.5%) of these patients were under one year of age and ninety four (59.5%) were older. Successful sedation was achieved in 150/158 (94.9%) of the children. The success rate of sedation was higher in children below 1 year of age (63/64; 98.4%) compared to subjects older than 1 year (88/94; 93.6%) (P=0.01). The mean of time to sedation was 20.8±12.4 and 22.4±14.8 minutes in children below 1 year of age and older than 1 year respectively (p=0.91). Complications were observed in 4/158 (2.5%) of the children. We observed no episodes of desaturation after administration of CH in all subjects. CH is a safe and effective sedative agent for children before general anesthesia provided it is used in a hospital setting with appropriately trained staff.

B Vitamins deficiencies in humans and animals have been known for some time to induce pain and inflammation. These symptoms can be readily alleviated by appropriate administration of Vitamins B. The aim of this study was to evaluate opioids requirements and hemodynamic variables and analgesic effect of B Vitamins and B Vitamins-diclofenac in general anesthesia and Post-anesthesia care unit (PACU). In this randomized prospective and double-blinded clinical trial study 105 patients undergoing orthopedic surgery were assessed. Patients were then randomized to receive placebo, B vitamin and diclofenac plus B Vitamins. Preinduction and postinduction hemodynamic parameters and opioid requirement were measured. Sufentanil requirement postoperatively was significantly lower in the DB group (0.12 µg/kg) and B group (0.17 µg/kg) compared with the Placebo group (0.2 µg/kg) (P=0.001). Maximum mean systolic blood pressure related to basal heart rate were increased in DB group 20±6%, B group 30± 17% and P group 35± 9% with significant difference in three groups (P= 0.0001). Analgesic effect of diclofenac plus B Vitamins was better than B Vitamins and required less opioid agents.

The present study is an overview of the causes of patient complaints against physicians and the medical staff in Imam Khomeini Hospital Complex، and strategies to reduce the complaints. For this purpose، complaints that had been filed with the clinical governance office of Imam Khomeini Hospital Complex in 2012 and 2013 were investigated. The information in the forms included age and sex of the plaintiffs، their level of education، type of complaint and similar details. Of the 309 complaints، 174 had been recorded in 2012 and 135 in 2013. The plaintiffs were males with a mean age of 50. 5، and 69. 6% of them had high school diplomas or lower. Most (16. 2%) of the complaints pertained to the emergency department، while 48. 5% and 22. 7% of the complaints were related to doctors and nurses respectively. In 62. 5% of the cases، the accused had been acquitted and 34% had been convicted. The main cause of complaint involved treatment and care at 40. 1% and 36. 6% respectively. In general، the most common causes of complaints were treatment and care for doctors، and lack of respect for nurses and others. Thus، more attention should be paid to the continuous education of medical students and residents during training years in order to increase the knowledge and skills of physicians. Other measures that can reduce complaints are: providing sufficient information to patients before diagnostic or therapeutic procedures; improving the equipment in health centers; educating the society and raising public awareness of the treatment process; offering the necessary information during medical procedures; obtaining informed consent; careful choice of the medical team and assigning them to the right position; and holding communication skills workshops.

Education is the main mission of teaching hospitals، but the residents’ learning in acquiring new techniques does interfere in the overall treatment process of patients. Studies pertaining to the effect of anesthesia residents’ training in operating room on treatment procedures have reported conflicting results. Therefore، this study was performed to investigate the effects of anesthesia residents’ training on start time operative delays. This cohort study was done in neurosurgical operating room، Imam Khomei-ni Hospital، Tehran، Iran during 2010-2013 on a population study comprising of sec-ond year anesthesia residents. Patients were classified into three groups with 30 cases in each one according to the anesthetic team. Group I: one anesthesiologist in charge of two operating rooms and two anesthesia assistants; Group II: one anesthesiologist in charge of one operating room and one assistant; Group III: one anesthesiologist with-out an assistant. Patients in these groups were compared in terms of American society of anaesthesiologists (ASA) class، induction difficulties and type of surgery. Studied variables included: 1) Interval between the patient lying on the bed to till anesthesia، 2) the time devoted to teaching residents، 3) time from the start of anesthesia until the start of surgery. An observer that was blinded to the type of intervention and the study design، recorded the times. ASA class (P= 0. 94)، induction difficulties (P= 0. 66) and type of surgery (spinal cord or brain operation) (P= 0. 41) were not statistically different between patients in groups. Preoperative preparation time for the first group (23. 5±8. 1 min) was longer than the other two groups (21. 5±6. 2 min and 15. 8±9. 1 min)، respectively (P= 0. 001). Differences between the times from start of anesthesia to surgeries in three groups، based on ASA class and type of surgery were not significant (P> 0. 05). There was no re-lationship between the times devoted to teaching residents in the first and second groups (P> 0. 05). Anesthesia residents’ training in neurosurgery operating room may in-crease the time required for preparing for surgery، but this time expended is hardly of any significance.

Neck pain, Risk factor, office worker. One of the most widespread musculoskeletal disorders among office workers is neck-pain. Our purpose was determination of neck pain prevalence and some of its determinants among office-workers in Qom Province. This cross-sectional study was performed on 1500 office workers in Qum Province. Samples were taken using multi-stage cluster sampling. Persian version of NORDIC questionnaire was used for the data collection. prevalence of neck pain was 20.1%, 95%CI (18.1-22.2). In our study variables that significantly were related to neck-pain were: gender (P=0.011), time spent in inconvenient status (P=0.001), employment type (P<0.001), using computer at work (P=0.010), car accident history (P=0.004), frequency of breaks during the work day (P=0.005), office workers’ attitudes towards work status (P=0.016) and physical activity (P=0.009). Many of neck pain risk factors are preventable and controllable. So, planning for improvement of work conditions can play an important role in preventing from and decreasing this disorder among office workers.

Pain control in children is still a therapeutic dilemma. Preschool patients are affected from undesirable effects of postoperative pain more than adults. Tonsillectomy is associated with a high incidence of postoperative pain, not only complicating the recovery, but also delaying patients discharge. Despite employing different surgical and anesthetic strategies in post-tonsillectomy pain relief, this is still a clinical problem. The study was designed to evaluate the efficacy of a low dose ketamine in post tonsillectomy pain relief.Patients and Our prospective randomized double blinded study enrolled 75 pediatric patients (3-10 years old) who were scheduled for a tonsillectomy procedure. Patients were randomly assigned to one of three groups receiving; intravenous (IV) ketamine 0.5mg/kg, subcutaneous (SC) ketamine 0.5 mg/kg and placebo at the end of the operation. Post-operative pain score was assessed using modified CHEOPS. In our study we did not find any significant difference among the three groups regarding sex, age, and weight, duration of operation, hemodynamic stability, and nausea and vomiting. However, in ketamine groups, pain score and analgesic consumption were significantly lower (P < 0.00). The efficacy of the both ketamine groups was similar. The study demonstrated that the both subcutaneous and intravenous injections of ketamine, at the end of the operation, were safe and effective for post-tonsillectomy pain control. Ketamine reduced postoperative analgesic medications consumption without increasing the risk of complications.

Hip fracture–related pain both before and after surgery is generally reported as severe by most patients. Various regional pain control modalities have been described in order to reduce pain in these patients. Because of the challenges of lumbar plexus block (LPB) and the fact that the effect of combined femoral nerve block/spinal anesthesia in controlling pain after orthopedic surgeries has not been investigated, in this study, we compared the feasibility and efficacy of the 2 techniques in the perioperative management of proximal hip fractures.Patients and The study included 32 patients with femoral intertrochanteric fracture who were randomly divided into the following 2 groups of 16 patients each:combined femoral nerve block/spinal anesthesia group (group I) and LPB group (group II). Patients in group I received 0.17% bupivacaine with 0.7% lidocaine, 20–25 mL for femoral nerve block and bupivacaine 0.5% plus 0.5 mL pethidine (25 mg) for spinal block and patients in group II received 0.17% bupivacaine with 0.7% lidocaine, 30–35 mL. The time for performing the block (12.2 ± 3.3 vs. 4.93 ± 1.6 min, P = 0.001) and achieving the block (7.7 ± 0.9 vs. 2.4 ± 1.0 min, P = 0.001) were significantly longer in the combined femoral nerve block/spinal anesthesia group than in the LPB group. Duration of analgesia in the combined femoral nerve block/spinal anesthesia group was longer than that in the LPB group, but the difference was not significant (17 ± 7.3 vs. 16.5 ± 8.5 h, P = 0.873). There were no significant differences in hemodynamic parameters regarding the method of anesthesia in the 2 groups. This study confirms that the combination of femoral nerve block with spinal anesthesia is safe and comparable with LPB and can provide more effective anesthesia and longer lasting analgesia for intertrochanteric surgery.

The objectives of this study were to determine the frequency of risk behaviors in high school students. In this cross sectional study 2400 high school students in urban areas of Tehran were selected by multy stage sampling. They filled in a questionnire in clasroom. Then, data were analysed in a descriptive function Frequency of health risk behaviors were intentional injuryis (41.5%), unintentional injuryis (88.7%), smoking cigarette (8.7%), alcohol drinking during the 30 days preceding survey (7.4%), other drug abuse (2.7%), sexual intercourse during life (20.2%), unhealthy dietery behaviors (14.7%) and physical inactivity during 7 days preeceding the survery (32.6%). Sex differences were detected in health-risk behaviors. In high school students frequency of health-related risk behaviors were high. School personnel should work with community leaders and health care professionals to provide educational materials for students and their parents. Collaboration of school personnel and health care provider, as a team can develop the knowledge and skill necessery to help students make healthier choices.

Cardiovascular diseases are described as the most important health problems in developing countries which are developed in parallel with industrialization of communities. Based on the high morbidity and mortality of cardiovascular disease, this study was performed for examining the population lab inhabitants’ knowledge and practice. In this cross – sectional study, 1576 inhabitants of the Population Lab Region were studied by cluster random sampling in 2002. 181 persons were selected from this population. The frequency of each cardio- vascular diseases risk factor such as; hyperlipidemia, smoking, obesity, hypertension, Diabetes, family history of heart attack, being man, stress and excitement, sedentary life style, salty food, vegetables fruits, fatty food and red meat consumption, were assessed. In addition, the population study's practice regarding controlling the risk factors of cardiovascular diseases was determined, as well. Moreover, specific questionnaire and direct interview were used for collecting data and then the gathering data was analyzed by SPSS and EPI – Info soft wares. In this study, 71.8% of people were women while 28.2% of them were men. Besides, there was a significant relationship between the people’s knowledge about cardiovascular disease and the level of their education (P < 0.001). According to the results, 65.2% of population believed that heart attack was the most prevalent cause of death in comparison with 44% of them considered car accident and 13.3% agreed with cancers. On the other hand, 74% of people used liquid oil in their food and 77.9% of them knew the side effects of unhealthy foods such as; salty food as one of the cardiovascular risk factors. The inhabitant's knowledge regarding to the risk factors of cardiovascular diseases was approximately acceptable. However, there was a significant different between their knowledge and practice. Therefore, providing suitable educational programs for improving people’s nutrition, physical activity and the other relevant factors for preventing cardiovascular risk factors would be mentioned.