mojgan rahimi

Choosing a macro strategy in every organization and economic enterprise has a great role in the future of that organization. Since the organization's resources are limited and the organization cannot invest in all its technologies, it is very important to determine the priority of the organization's technologies and to determine the appropriate strategy for these technologies. The aim of the current research was to provide a model to determine the technology acquisition strategies in the welfare organization based on the classical contextual theory. This research is classified as applied. Also, in terms of how to collect the required data, it is in the "exploratory mixed research" group. The statistical population of the research in the qualitative part included experts in the field of technology management and senior managers of Tehran Welfare Organization, but the sampling method was theoretical. The statistical population of the quantitative part included all the managers and experts of Tehran welfare organization. Non-probability sampling method is used in the quantitative part of the research. Therefore, the sample size was determined based on Cochran's formula, including 292 managers and experts of Tehran welfare organization. Based on the data of Glaseri Classical Foundation, the model map for determining the technology acquisition strategies in the welfare organization was determined. Based on this, organizational strategies based on technical strategies and through financial strategies and environmental strategies and taking into account the intervening factors lead to the consequences of the organization's effectiveness, client satisfaction and compliance with the needs of the target society. The type of relationships between the indicators and themes of the model for determining technology acquisition strategies in the welfare organization was also presented according to the coding done in the form of the model.

Due to the associated hypertension and cardiovascular disease in patients with ESRD hemodynamic changes during operations are detrimental and may be life-threatening. Therefore, hemodynamic stability is an important criterion in selecting the anesthetic approach.

72 ASA class III/IV, ESRD Patients were studied in randomized double blind clinical trial. They were divided into two groups by four-block randomization. A group of patients were induced and maintained by etomidate and second of patients were induced by Na thiopental and maintained by isoflurane. Systolic, diastolic and mean arterial blood pressure and heart rate were measured at interval of pre and post induction, postintubation, pre and post abdominal insufflation during and at the end of surgery and in recovery. The total BP modulators were recorded and postoperative nausea and vomiting was registered in the recovery. Data were analyzed by STATA version 12.

There was no significant difference in physical characteristics between two groups. There was no statistical difference between the groups in SBP and HR (P>0.05), although DBP fluctuation>20% at interval postinduction and prior to abdominal insufflation during surgery and at the end of surgery, was significantly higher in the isoflurane group of patients. (P=0.004, 0.001, 0.003 and 0.009, respectively). Also, the MAP fluctuation at interval of post induction, preinsufflation and at the end of surgery was significantly higher in isoflurane of patients. (P=0.04, 0.001, and 0.02, respectively).

The group anesthetized with isoflurane had a higher hemodynamic fluctuation, compared to the group anesthetized with etomidate. As hemodynamic changes are critical in patients with ESRD, etomidate is a more appropriate anesthetic choice for implantation of peritoneal dialysis catheter by laparoscopic approach.

Postoperative nausea and vomiting (PONV) is one of the most common postoperative complaints of the patients that affects the surgical outcome, quality of life, length of hospital stay, and costs. The prevalence of nausea and vomiting is estimated at 52% and 25% within the first 24 hours after surgery. Many risk factors have been identified for PONV, including female gender, being a non-smoker, young age, general anesthesia, use of volatile anesthetics and Nitrous Oxide, and duration of anesthesia. Following receiving reports indicating an unusually high prevalence of PONV in the male orthopedic ward of Imam Khomeini Hospital Complex despite applying regional techniques, the present study was conducted to investigate its prevalence and possible reasons.

After obtaining informed consent, 300 patients admitted to male and female orthopedic wards of Imam Khomeini Hospital complex that had undergone surgery within the past 48 hours were interviewed in person and their medical records were reviewed.

Of 300 patients, 61 (20.3%) had nausea and 39 (13%) had vomiting. Three patients (1%) experienced recurrence of PONV after treatment. The risk factors associated with PONV were female gender, history of motion sickness, general anesthesia with sodium thiopental, atracurium, IV lidocaine, isoflurane, neostigmine, and postoperative administration of ciprofloxacin.

The prevalence of PONV was lower than other studies, which was in contrast to reports received from the ward, indicating a reduction in PONV following the use of regional techniques.

This retrospective cohort study aimed to assess the frequency of emergency cesarean sections with epidural analgesia and its implications on Apgar scores and Neonatal Intensive Care Unit (NICU) admissions among patients at Tehran University of Medical Sciences Hospitals from 2017 to 2018.Data from 7170 patients were extracted from the hospital information system (HIS) through a consensus method. Descriptive statistics, cross-tabulation, and logistic regression analyses were conducted using Stata v17 software.Out of 9387 patients, 62.7% underwent cesarean sections, and 37.1% had normal vaginal deliveries. Epidural analgesia was administered to 127 patients, with 98.4% achieving successful normal vaginal delivery. Nulliparous women constituted 64.29% of those receiving epidural analgesia. Apgar scores at five and ten minutes were comparable between epidural and non-epidural groups. Emergency cesarean rates with epidural analgesia were low (1.6%).Findings align with previous research indicating no significantimpact of epidural analgesia on Apgar scores. Nulliparous women predominated in the epidural group, consistent with pain pattern disparities. The study supports recent research showing epidural analgesia does not increase emergency cesarean rates, even inhigh-risk pregnancies.This study suggests that epidural analgesia does not significantly impact Apgar scores, NICU admissions, or emergency cesarean rates. While the comprehensive dataset enhances reliability, retrospective design limitations are acknowledged. Prospective studies exploring factors contributing to neonatal mortality and overall labor duration are recommended for more robust evidence.

There are several methods for teaching emergency medical technicians (EMTs) cardiopulmonary resuscitation (CPR); but choosing the most effective option depends on several factors. This study was designed to compare the effectiveness of three different CPR training methods, including traditional, peer, and virtual methods, for EMTs.

This study was a pretest-posttest study, which was performed from March to September 2020 in Tehran, Iran. Participants were EMTs working in the operations department of the EMS center. In the first step, for the pretest evaluation, an Objective Structured Clinical Evaluation (OSCE) exam was held for all participants. Thereafter, the subjects were divided into 3 groups including master-centered traditional collective education, peer training, and virtual courses. Then the participants underwent educational intervention and after that, another OSCE exam was held about 1 week after the sessions to evaluate the effect of interventions.

At first, 156 volunteers entered the study and participated in the pretest OSCE exam, of which 125 volunteers participated in the posttest OSCE exam. Of these, 51 volunteers participated in the peer education group, 35 volunteers were in the virtual education group, and 39 volunteers in the classic education group. The mean score of the participants in all 4 assessed skills, including endotracheal intubation, laryngeal mask airway insertion, basic life support, and advanced life support, increased significantly after educational intervention in all 3 groups (p<0.05); and this increase was higher in the virtual group compared to the other two groups (p<0.05).

We found that virtual training was more effective than classic and peer training for CPR training of EMTs.

This case report presents the successful placement of a subclavian vein catheter through a subclavian approach under ultrasound guidance in a patient with a displaced, dilated colon in the neck .

The patient had a history of achalasia and had undergone several surgeries, which required a central vein due to the presence of several indications. Because of the dilated colon, access to the anterior neck space was not possible, making cannulation of the internal jugular vein unsafe. The subclavian vein was chosen for catheterization because of its lower risk of infection and thrombosis and its ability to remain safely in place for long periods of time.

Ultrasound-guided central venous cannulation has become a gold standard because it can reduce the risk of complications associated with blind cannulation. There are different methods for ultrasound-guided subclavian vein catheterization, including supraclavicular versus subclavicular visualization and long-axis versus short-axis vein visualization, and in-plane versus out-of-plane needle placement. Additional techniques and equipment are also available, such as hydrolocation and microconvex array pediatric probes, which have been introduced in various studies .

In conclusion, it should be noted that mastery and optimal visualization of vessels is important when using ultrasound guidance for subclavian vein catheterization. We suggest that ultrasound-guided subclavian vein catheterization via a subclavian approach offers a safe and effective alternative for patients with similar clinical presentations .

The term "outpatient surgery" has become a common procedure in most hospitals around the world. On other hand, Spinal aesthesia can mimic the outcome sought by the principle of outpatient surgeries since it takes a short time to recover and limits the need for post-operative pain medication Therefore, the objective of this study is to focus on finding a method to reduce the side effects that commonly accompany the procedure of spinal aesthesia and to avoid the possible hemodynamic changes that may occur.

The method for the study will be a narrative review of various medical journals, conferences papers, and unpublished documents using the dual keywords, outpatient surgeries spinal aesthesia, and ambulatory aesthesia, we include in this research thirty-one original articles, fifty-three reviews articles, two books, three handbooks, and two guidelines searched in the deferent database (google scholar, Research gate, pub med, science direct).

Consideration should be given to the quality of patients who participate in outpatient concepts. Finally, in terms of cost, side effects, and patient satisfaction, the spinal aesthetic approach gives a favourable outcome since it covers post-operative time without the need for analgesia and reduces the percentage of postoperative nausea and vomiting, and reduces the time staying in the hospital.

In conclusion, the study discovered that a major proportion of surgeries performed over our lifetimes are outpatient procedures. Therefore, Discharge criteria should be posed with one precise criterion. There is no standard protocol to serve these types of surgeries and patients. The only criteria found and practiced served general conditions for outpatients and inpatients. There have been several attempts to create a protocol that can meet the pleasing outcome of outpatient surgeries. Consequently, we need more research to cover this lack and serve the Genuine needs of a protocol to define the criteria and categories that concern the term outpatient and outpatient surgeries and lead to improving the quality of outpatient surgeries with fewer side effects and minimum hemodynamic changes.

The correct placement of the endotracheal tube is a cornerstone of safe anesthesia. Different methods, such as auscultation, capnography, and ultrasound, have their own limitations regarding the confirmation of endotracheal intubation, reinforcing the idea that a single technique is not foolproof. This study proposes a new technique in this regard.
A total of 600 patients were enrolled in this study, and tracheal intubation was checked with palm pressure and disposable plastic glove inflation and pulsation.
The data were analyzed using the t-test and Mann-Whitney U test that indicate 94% and 94.8% sensitivity for palm pressure and bag pulsation, respectively, and a 100% positive predictive value for both tests.
Palm pressure and bag pulsation are accurate, inexpensive, and reliable techniques to confirm proper tracheal intubation.

Anorectal pathology is commonly perceived it and handled in common surgical practitioners’ fistula and abscess, hemorrhoids, fissures, condyloma, and other pathological conditions. Because of the strong sensory innervations of the canal of anal, patients endure severe discomfort during anorectal surgery. It is generally most severe in the first twenty-four hours especially after excisional hemorrhoidectomy. the aim of this study is a comparison between different analgesic protocols used to relieve pain postoperative anorectal surgery.

PubMed, Embase, Medline, Science Gate, Scientific Report, Elsevier, Google Scholar, and Cochrane Evidence Based Medicine Reviews were used to conduct a review search. Review of newly released books and papers with regard to the topic, as well as manual searches (Comparison of various analgesic protocols for control of postoperative pain following anorectal surgery), was started at (May,2021). we searched the published studies from 2011 to the present date by the full text:(various analgesic protocols post anorectal surgery).

Anorectal surgery is marked by excruciating discomfort after the procedure. Using the new technique during anorectal surgery as hemorrhoidectomy to avoid more excision of anal mucosa and the skin, putting the suture nearest to the dentate line and away from the internal anal sphincter, and good hemostasis to avoid the inserting of the anal pack are the most essential methods to lessen pain postoperatively regardless of the type of anorectal surgery performed or the instrument to use during it. We found more protocols using multimodality pain management for the relief of pain, topical drugs that produce direct relaxation of the internal anal sphincter, topical intervention as a pudendal nerve block, a method of surgery as surgical sphincterotomy, and technical tips to reduce pain as ligasure.

Multimodal pain treatment has been demonstrated to minimize pain intensity and opioid doses in various kinds of surgery.According to the highest degree of proof, using current technological procedures and tools as a ligasure with some topical agent as GTN glyceryl trinitrate ointment provided amazing excellent alleviation of postoperative pain following anorectal surgery.

Pregabalin is a co-analgesic to improve the pain control after colorectal cancer surgeries. There is less knowledge about the effect of Pregabalin on postoperative sleep and the ability to change the position of patients after surgery. This study aimed to assess the impact of Pregabalin on postoperative morphine consumption, pain, sleep, mood, and ability to change position after colorectal cancer surgery.

This double-blind, randomized, controlled, single-center clinical trial was performed in   Tehran, Iran, from June 2017 to June 2018. Seventy patients were included for colorectal cancer surgery randomly divided into two groups (A, B). Group A received two doses Pregabalin (150 mg) pre-operative and post-operative, and group B as a placebo was administered at the same scheme. The two groups had similar analgesia and anesthesia regimens. The pain was scored by a numerical rating scale (NRS); disturbance in sleep,and mood. The daily activity was numbered based on a scoring system such as BPI questionnaires; and, nausea- vomiting, morphine consumption, and fatigue headache were evaluated 48 hours after surgery.

Morphine consumption was lower in the Pregabalin group 24 h after surgery (P=0.01). The two groups were similar regarding sleep interference scores and side effects (P>0.05). But, mood and actions interference scores in the Pregabalin group showed a significant improvement in 48 h postoperative (P<0.05) (Table 3).

The results showed that Pregabalin could reduce postoperative morphine consumption and improve mood and actions interference scores after colorectal cancer surgery. However, there was no difference between Pregabalin and placebo in postoperative pain management and sleep interference scores after colorectal cancer surgery.

Supraglottic airway management tools such as the laryngeal mask airway (LMA) have recently emerged as the first choice in pre-hospital and hospital airway management guidelines as well as an alternative strategy after endotracheal tube (ETT) placement failure. However, the pros and cons of the LMA compared to endotracheal intubation are still debated. Given that no study has been conducted to date on the skills of emergency medical technician (EMT) in airway management using LMA compared to endotracheal intubation, we decided to do a study in this regard.

In this objective structured clinical examination (OSCE), EMTs who had a degree of associate or bachelor were participated. The examiner asked the examinees the required information and entered it in the pre-prepared checklists. The participants took part in a two-stage exam. In the first stage, the airway management of the simulated trauma patient was performed by endotracheal intubation, and in the second stage, the same scenario was performed with LMA. At each stage, the examiner evaluated the examinee's performance in 4 fields of Preparation, Pre-oxygenation, Position and Placement, and Post-intubation management using a standard checklist. In addition, the duration of the procedure from the beginning to the time of fixing the ETT or LMA was recorded and compared.

Totally, 105 EMTs participated in this study, of whom, 102 were male (97.1%). The mean age of the subjects was 36.4± 7.3 years old. Of the total participants, 72 passed both practical exams successfully, and they generally insert the LMA faster; so that the duration of intubation and LMA insertion in 1.4% and 30.6% were <1 min, respectively (p< 0.001). However, no significant difference was observed in terms of the mean time (p= 0.427).

In the present study, the skills of the technicians participating in the study in performing advanced airway procedures were moderate, and also, it was found that their skills in LMA insertion were less than endotracheal tube insertion.

Two major complications of surgeries are postoperative nausea and vomiting (PONV) and also postoperative pain (POP). Several studies have compared total intravenous anesthesia (TIVA) with inhalational anesthesia regarding these two complications. Some results have shown a better postoperative recovery conditions, but other contradictory results can also be found.This study was performed to evaluate and compare the effect of inhalational and intravenous anesthesia in patients undergoing elective laparoscopic surgery, on the incidence and the severity of PONV and POP.

This study was performed as a single-blinded prospective clinical trial. All patients aged 18-65, with ASA class I and II who underwent elective laparoscopy were included. Patients were divided into two groups of intravenous anesthesia and inhalational anesthesia. The incidence and the severity of PONV and POP were examined in 5 separated times after the surgery. The use of a rescue antiemetic and analgesic medication were also evaluated.

Overall, 67 patients received inhalational anesthesia and 55 patients received intravenous anesthesia. It was revealed that 47.8% of the patients in the inhalation group and 18.2% of the patients in the intravenous group developed PONV (P<0.001). The severity of PONV was significantly lower in the TIVA group (P<0.001), however, no statistically significant difference was found regarding the severity of abdominal pain (P=0.62).

The incidence of PONV and the need for administration of an antiemetic rescue drug are significantly lower in the TIVA group.

The coexistence of mental health problems in diabetic patients can lead to poor disease management. This study aimed at investigating the mediating role of resilience and diabetes distress in the relationship between depression and treatment adherence in type 2 diabetes among Iranian patients.

It is a type of analytical study conducted from 2019 to 2020. The statistical population of this study consisted of all-diabetic patients in Tehran. The subjects (200) were selected after purposeful clinical evaluation and qualification of research. In this study, Beck Depression Inventory (BDI), the Persian Version of the Morisky Medication Adherence Scale-8, Diabetes Distress Scale (DDS), Conner & Davison Resilience Scale (CDRS) were used to collect the data. Pearson correlation test by SPSS version 24 and Confirmatory Factor Analysis in AMOS software version 22 were used for analysis (P<0.05).

In the present study, most participants (about 36.5%) were in the age group of 56-65 and 58.5% of them were female. According to the results, the variables of depression and diabetes distress has a negative and significant correlation with adherence to treatment (r= -.408, p<0.05). The resiliency has a positive and significant correlation with adherence to treatment (r= 0.414, p<0.05).

The findings showed a link between depression, diabetes distress, resilience, and treatment adherence. Resilience and anxiety from diabetes play a mediating role between depression and adherence to care.  Paying attention to patient resilience may lead to improved depression and diabetes distress in patients with diabetes, to increase the patient’s involvement in treatment adherence.

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.

Chronic pain is the third main problem of global health and the most common cause of long-term disabilities. The duration that patients suffer from chronic pain is directly proportional to the extent of the suffering and to the amount of health care resources allocated to this problem. There is no research that has studied the risk factors associated with the long pain duration in chronic pain patients.

We investigated the potential risk factors associated with long pain duration in a population with diverse pain conditions in a cross-sectional study. We used a questionnaire that included a number of potential risk factors including sex, age, marital status, household condition, number of children, employment, education, body mass index (BMI), pain intensity, and the level of anxiety/depression. The data were analyzed by univariable and multivariable linear regression models.

We recruited 780 patients. The analyses showed that age and abnormal BMI had a positive correlation with pain duration.

The risk factors that might be associated with longer pain duration include older age and abnormal BMI.

 Lumbar spine operations can be safely performed under general or neuroaxial anesthesia, but there are controversies as to the clinical outcomes and cost benefits of each method. The goal of this systematic review and meta-analysis was to determine the advantages of each technique (i.e., regional or general anesthesia) for lumbar spine surgery with regards to cost, duration of surgery, duration of post anesthesia care unit, and duration of hospital stay.
Data Sources: We conducted a systematic search for articles comparing regional anesthesia (RA) versus general anesthesia (GA) for lumbar spine surgery using three major databases (i.e., PubMed, EMBASE, and Google Scholar), without limitation for date and language of publication. We also manually double checked the references of all the related articles to detect missed articles by electronic searching. The last search was performed before September 2018; the quality of the included articles was assessed by different checklists according to the type of the article. STATA software (V. 10) was used for performing meta-analysis.

Twenty-eight articles were included in this meta-analysis. Cost data were presented in seven studies and reported a significant decrease in the cost of treatment in RA patients compared with GA patients. The standard mean difference (SMD) (95% CI) for cost was 1.64 (1.53 to 1.75); z = 29.17; P < 0.001; I2 = 98.9. Surgical time data were presented in 25 studies, which reported significant reduction in the surgery time in RA patients compared with GA patients, the SMD (95% CI) for surgery time was 0.77 (0.71 to -0.84); z = 23.9; P < 0.001; I2 = 97.9. Post anesthesia care unit (PACU) stay data were presented in 16 studies and reported significant increase in PACU stay in RA patients compared with GA patients. The SMD (95% CI) for PACU stay time was -0.4 (-0.49 to -0.31); z = 8.65; P < 0.001; I2 = 99.2. Hospital stay data were presented in 18 studies and reported significant decrease in hospital stay time in RA patients compared with GA patients. The SMD (95% CI) for hospital stay time was 0.76 (0.68 to 0.84); z = 18.81.; P < 0.001; I2 = 98.3. Egger and Begg’s tests showed no significant publication bias.

This comprehensive systematic review showed that RA has several advantages over GA with respect to cost, surgery time, and duration of hospital stay in patients undergoing lumbar spine surgery, while increase in PACU stay time was observed in RA patients.

Clonidine, the α2-adrenergic agonist, is usually used as an antihypertensive drug. Dextromethorphan is a non-competitive NMDA antagonist which is routinely prescribed to suppress cough. However, there are not confidential documents regarding their analgesic effects. Due to the controversies over the analgesic properties of these two drugs, this study was designed to evaluate cold pain threshold changes following their administration. This study was conducted to assess the impact of oral clonidine and dextromethorphan on ice-water immersion tolerance. Four closed sachets labeled with codes were dedicated to each participant. Each of these four sachets contained placebo, 0.3 mg/kg dextromethorphan, 0.2 mg clonidine or both of the previous drugs randomly. The cold pain threshold was measured five times for each participant, once before taking any drug (T1) and the next four times (T2-T5) after taking each of the four sachets. 35 volunteers (15 men and 20 women) participated in the study. The study showed that cold pain threshold was higher in men than women (P=0.004) and also in participants above 30 than those under 30-year-old (P=0.007). Moreover, the pain threshold did not change significantly after the administration of clonidine (P=0.33) or dextromethorphan (P=0.21), but the threshold significantly increased after receiving a combination of dextromethorphan and clonidine compared with placebo overall (P=0.001). Cold pain threshold was higher in men and individuals over than 30-year-old and decreased significantly after administration of clonidine and dextromethorphan conjointly. Body mass index has no relation with changes in cold pain threshold by taking mentioned medications.

Stability of the airway is a fundamental element of acute care medical practice. While airway management is conceptually straightforward, the wide variety of clinical circumstances, patients, and tools can make the task of ensuring a stable, open airway under all clinical conditions extremely challenging. Care providers involved in airway management must therefore not only be technically skilled but also sufficiently flexible to adjust changing the conditions, risk/benefit balances, and goals. One aspect of airway management that requires particular attention is the airway that is difficult to secure or keep patent. For clinical or anatomic reasons, both bag mask ventilation and tracheal intubation in such a patient population may be difficult without specialized expertise or tools. Because adequate oxygen delivery through a patent airway is critical to life support and resuscitative efforts, the risks of inadequate airway management are high, adding to the challenge. One significant advance in difficult airway management is the development of algorithms to standardize the technical approach to successful endotracheal intubation in a patient with a difficult airway. Such algorithms are relatively recent (The American Society of Anesthesiologists difficult airway algorithm updated in 2015), and integrate clinical experience, evidence, and technical expertise into a stepwise approach to anticipated and unanticipated airway challenges.

Providing and maintaining normovolemic condition during major surgeries is a major challenge, especially in children. In this respect, third-generation hydroxyethyl starches seem to be more cost-effective than human albumin. However, the efficacy of 6% hydroxyethyl starch (HES) 130/0.4 compared to other alternatives such as human albumin 5% remains uncertain in children. The present study aimed to assess the efficacy and safety of replacing human albumin 5% with 6% HES 130/0.4 for volume replacement therapy in children undergoing ive open cardiac surgery.
This randomized double-blinded clinical trial was performed on 59 children aged less than 2 years and ASA I-III who were candidated for ive open-heart surgery and referred to a children medical center in 2014. The patients were randomly assigned via the block randomization method to the case group (n = 30) receiving a solution of 6% HES 130/0.4 and the control group (n = 29) receiving 5% human albumin. There were no between-group differences in hemodynamic parameters—including pulse rate, systolic and diastolic blood pressures, and mean blood pressure—at the time points of before anesthesia induction, before and after pump ion, and 24 hours after surgery.
Comparisons of the laboratory indices indicated no differences between the 2 groups at the different time points. The volume of packed cell and colloid fluids infused in the case and control group was also similar.
Compared to human albumin 5%, 6% HES 130/0.4 is a safe alternative to fluid supply during cardiac surgery among children. (Iranian Heart Journal 2018; 19(1):37-43)

We investigated the effects of cigarette smoking in non-per os (NPO) period on volume and pH of gastric contents in smoker male patients.
In a prospective cohort study, 86 male smoker patients undergoing elective non-abdominal surgery under general anesthesia, were surveyed. They were NPO for at least 8-12 hrs. prior to surgery without direction to smoking. Then they were divided in two groups in the operation room based on smoking during NPO period. The study was continued until 43 patients entered in each group. After induction of anesthesia, gastric contents were aspirated by NG tube then volume and pH of gastric contents were measured. There were no significant differences in basic characteristics of patients such as age and weight between two groups.
The pH of gastric content was significantly lower in the smokers group (1.57±0.74 vs 3.12±1.90 p=0.001). The mean volume was significantly higher in the smokers’ group (34.60±20.90 vs 19.86±14.72 ml, p=0.001).
Smoking during NPO period in habitual smokers before elective surgery increases the volume and acidity of gastric contents and probably increases risk of acid pulmonary aspiration.

Critically ill patient transfer is potentially risky and may be lead to morbidity and mortality. Physician's skill is very important for safe transport. We want to evaluate the effect of clinical course teaching on the promotion of physician's abilities in the transport of critically ill patients. In an interventional study, 320 interns, male and female, were taught about patient transfer in two groups include in one day clinical course as the small group system (n=160) and other group the lecture base learning (n=160). In the clinical course, each participant under observation of an anesthesiologist in the operation room and ICU was acquainted with mask ventilation, intubation and learned to work with a defibrillator, infusion pump, portable ventilator and pulse oximeter. In lecture group, the anesthesiologist explained the topics by video and dummy. At the end of education course, the interns’ abilities were evaluated based on checklist method and scored by the project colleague in all educational items. Three hundred twenty interns, 122 males, and 198 females; were enrolled, two groups. The clinical course training caused improvements in the interns’ knowledge and abilities in intubation and use of the defibrillator and portable ventilator vs.lecture group significantly (P

Obesity is a worldwide health problem which is associated with a lot of complications. One of these comorbidities is the metabolic syndrome that is in correlation with abdominal fat thickness and waist circumference. Various methods were used to reduce abdominal fat thickness such as liposuction. A noninvasive method is the topical agent. In this study, we investigated the effectiveness of Arnebia euchroma (AE) ointment on the abdominal fat thickness.
This study was a double-blind clinical trial which was done at the endocrinology clinic in Khorshid Hospital, Isfahan, Iran, in 2014. After explaining the procedure and obtaining informed consent, the candidates were randomly divided into the case and control groups. The participants of the case and control groups applied AE ointment or placebo for 6 weeks on their abdominal area. Body mass index, waist and buttock circumference, and abdominal fat thickness were measured in both case and control groups at their first visit and then at the next 2,4, and 6 weeks. We used t-test for comparing parametric variables between groups, paired t-test for changes from baseline to final,and repeated measure ANOVA for changes at different steps.
Sixty female candidates participated in this study (thirty in each group). Ten patients left the study and fi fty participants fi nished the trial. At the end of the study, participants had a significant weight loss (2.96 ± 1.6 kg, P Topical AE ointment can reduce the abdominal fat thickness as well as the waist circumference without causing any side effect.

Transport of the critically ill patient is potentially risky and the transport team should be careful in making decision and be prepared to deal with them in any condition. Our physicians are not qualified in safe transport. We want to evaluate the effect of small group teaching method for promotion of physician's skills in transport of critically ill patients.
In an interventional study, 161 interns took part in one day workshop planned in small group system. Each participant under observation of an anesthesiologist in operation room and intensive care unit (ICU) was acquainted with mask ventilation, intubation and learned working with defibrillator, infusion pump, portable ventilator and pulse oximeter. Their knowledge and skill was scored by pre and post tests in all items.
In our precipitants, 62 males and 99 females; training caused improvement in their abilities about care and monitoring of patient during transport. The offered training caused improvements in the interns’ knowledge and ability of intubation, ventilation and use of defibrillator and ventilator (P This method could promote knowledge and skill of interns in transport of critically ill patients.

Anaesthetic and surgical management of abdominal trauma are often challenging.
Case Description: In this case study, we introduced a 10-year-old boy who had a penetrating injury of the abdomen with a metal rod projecting anteriorly. After opening the abdomen, none of the abdominal viscera were injured.
Positioning for intubation and cutting the metal rod were discussed.

Laryngeal multiple mucosal neurinomas can make intubation difficult.. A 16-year-old female referred to the general surgery department complaining of hoarseness and itchy throat for the past 18 months. Her symptoms had not resolved after medical treatments. After examination, the patient was admitted to the hospital and radical neck dissection was scheduled for her. Since it was assumed that lesions similar to lesions of the tongue might exist in the patient’s respiratory tract, outpatient laryngoscopy and fibroscopy was performed. A yellow-white lesion was seen in front of the left-sided vocal cord. Pathological findings of the lesion confirmed neurinoma. Laryngoscopy and tube insertion were done using a GlideScope.. During the laryngoscopy, the neurinoma did not make any difficulty and the patient was intubated successfully..