Journal of Research in Medical Sciences
Volume:13 Issue: 2, Mar & Apr 2008

Phacoemulsification is one of the best surgical treatments for the cataract. Secondary to the technicaladvances in estimating the intraocular lens (IOL) power, the refractive errors, one of the most important surgical complications after surgery, is now reduced. Currently, two methods of biometry are used to calculate the IOL power, ultrasound biometry and optical biometry. Both methods have their own advantages and it is controversial to use which of them before surgery. We would like to know if there is any difference between these two biometry methods to reduce refractive errors after cataract surgery. Present research was a cohort study on the patients undergone phacoemulsification due to cataract in Feiz and Farabi academic hospitals and Aban ophthalmology clinic. We compared eye refractions after cataract surgery in two groups of patients. Ultrasound biometry was done for the first group and the optical biometry for the second one. Mean absolute refractive error (MAE) was compared in the two groups by t test. Eye refractions of 132 patients were studied; 76 patients in group one and 56 patients in group two. The MAE measured 0.67 ± 0.70 diopters for the first group and 0.79 ± 0.76 diopters for the second one and the difference was not significant (P = 0.342). According to our results the refractive errors after phacoemulsification was the same for both ultrasound and optical biometry methods. The claim of optical biometry, however, to gain a higher precision and thus a significantly better prediction of individual postoperative refraction after cataract surgery is not yet fulfilled. To determine which method is definitely better, more studies are required.

Some preliminary findings have suggested that patients with bipolar disorder show a disparate pattern of obsessive-compulsive (OC) symptoms. This study aimed to reevaluate this subject on a different sample within a different cultural background. The present cross-sectional study was carried out in a clinical non-experimental setting on 78 obsessivecompulsive disorder (OCD) patients; 39 with and 39 without bipolar disorder (BD). Subjects underwent a Structured Clinical Diagnostic Interview for DSM-IV (SCID-I) as well as the Yale-Brown Obsessive-Compulsive Rating Scale (YBOCS). The diagnoses in the non-bipolar group were mostly major depressive disorder (38%) and dysthymic disorder (38%). The mean age of the bipolar group was significantly lower than that of the non-bipolars (P < 0.05). The mean score of the Y-BOCS was not significantly different between the two groups. The mean estimated number of obsessive themes – but not compulsive ones – in the bipolar group was significantly higher than that of the non-bipolars (P < 0.0001). The aggressive (P < 0.01), sexual (P < 0.0001) and religious (P < 0.05) obsessions were significantly more prevalent, and the contamination obsession (P < 0.05) was significantly less prevalent in the bipolar group. Also, in the bipolar group the miscellaneous compulsions (P < 0.01) were significantly more prevalent, and the washing compulsion (P < 0.001) was significantly less prevalent. The content of OC symptoms which is not traditionally considered a helpful factor for diagnosing a psychiatric disorder might be able to lead the clinician to the diagnosis of bipolarity in a depressed patient with OCD.

Because of different values of thyroid volume in different populations, and the effects of different trace element and geographic substances on thyroid volume, we decided to evaluate thyroid volume and its determinants using ultrasound in healthy adults of Isfahan, a centrally located city in Iran, an iodine replete area. In a cross-sectional study, 1500 healthy adults were enrolled by cluster sampling. Serum TSH level and morning urine iodine level were measured. Thyroid exam was performed according to WHO criteria and history of previous or present thyroid disease was taken. If all the mentioned results were normal they were considered clinically normal. One third of these normal subjects referred for thyroid ultrasonography. If ultrasonography of thyroid parenchyma texture was normal, and there was no nodule by sonography (thyroid incidentaloma), thyroid volume was measured using ellipsoid formula (X×Y×Z×8/6). Correlation between thyroid volume and age, sex, BMI, TSH level and urinary iodine concentration (UIC) was determined by Pearson correlation coefficient, t-Test and Kolmogorov-Smirnov. Thyroid volume more than 97% of this population was considered as goiter sonographically. Data expressed as mean ± SD, unless otherwise stated. We finally studied 200 subjects (123 Males, 77 females, average age: 37.27 ± 11.80 Years). The overall thyroid volume was 9.53 ± 3.68 ml. Males thyroid volume (10.73 ± 3.44 ml) was significantly higher than the females one (7.71 ± 2.63 ml) (P < 0.001). The thyroid volume ranges were 3-23.9 ml, 3.6-23.9 ml and 3-14.3 ml in all, males and females, respectively. Thyroid volume values more than 97 percentile of this reference range were 10.14 ml, 11.48 ml and 8.37 ml in all, males and females respectively, and were considered goiter sonographically. Thyroid volume had a positive correlation with age (r = 0.163, P = 0.022), but did not have correlation with serum TSH, UIC, and BMI, in both sexes. There was a strong correlation between thyroid volume, and height and body surface area (r = 0.48, P < 0.001). It was documented that thyroid volume is higher in male sex and increases with age, and have a positive correlation with body surface area and height.

Narcotics and sedatives can reduce intraocular pressure. This study was performed to evaluate the effect of remifentanil plus ketamine on intraocular pressure and sedation quality in comparison with fentanyl plus ketamine during and after operation in patients undergoing phacoemulsification with topical anesthesia. Forty four patients were randomized into two groups to receive either a continuous infusion of remifentanil (0.2, g/kg/min for 4 min and then 0.1, g/kg/min: Group R, n=22) or bolus intravenous fentanyl (1.5, g/kg: Group F, n=22) for sedation. Patients in both groups received low dose ketamine (0.15 mg/kg) intravenously. Topical anesthesia was performed using tetracaine 0.5% eye drop in both eyes. Intraocular pressure was measured in non-operative eye before sedation (baseline), 2 minutes after sedation, before intraocular lens insertion, at the end of operation and 15 minutes after the end of operation using Schiötz tonometer. Sedation, cooperation, satisfaction and pain scores and also postoperative nausea and vomiting were recorded in all patients. Surgeon satisfaction scores were evaluated at the end of operation. The intraocular pressure did not differ significantly between the two groups throughout the study. The mean (SD) intraocular pressures 2 minutes after sedation, before intraocular lens insertion, at the end of operation and 15 minutes after the end of operation in recovery room were all less than that of baseline in both groups, but the baseline value was decreased only significantly (P < 0.05) in recovery room [13.75 (3.46) to11.91 (3.43) in group R, respectively and 13.74 (3.05) to11.57 (2.33) in group F, respectively]. The incidence of postoperative nausea and vomiting in group R was higher than that of group F (7 patients in group R and no patient in group F, P = 0.009). Combination of remifentanil infusion and intravenous ketamine did not offer any advantages over the combination of intravenous fentanyl and ketamine in order to prevent intraocular pressure rising during phacoemulsification. The lower incidence of postoperative nausea and vomiting and higher rate of appropriate sedation in fentanyl group suggested fentanyl as a more suitable medication for systemic sedation compared with remifentanil.

Since adulthood antisocial, aggressive and delinquent behaviors often have their onset early in life, investigating the association between biological factors and disruptive behaviors in children and adolescents are important and are emphasized on in the recent years. Baseline cortisol level seems to be a valuable biological marker of individuals with Disruptive Behavior Disorder (DBD). This study examined the effect of parent training on salivary cortisol levels of children with DBD. Saliva samples were assayed to determine cortisol levels in nineteen clinic-referred children with DBD (aged 8 through 13 years) before and after an eight-session parent training program. Children’s disruptive behaviors were assessed by Child Behavior Check List before and after the intervention. Children’s salivary cortisol increased significantly after parent training sessions. Children with DBD who had lower basal cortisol levels had more severe disruptive behaviors and a better response to intervention by parent training as assessed by changes in cortisol levels and disruptive behaviour scores. However, post-interventional reduction of disruptive behaviors and increase in cortisol level was significant for all levels of baseline cortisol. Parent training is an effective method for behavioral modification in DBD. Salivary cortisol may be considered a predictive factor for severity of the child or adolescent''s disruptive behaviors and also for response of those behaviors to parent training.

To determine the minimum effective dose of intravenous administration of tramadol on controlling postanesthetic shivering (PAS) and frequency of effects. Seventy five patients who had shivering grade III or IV after general anesthesia with isoflurane in the recovery room were included in the study. The patients were divided randomly among five groups to receive the same dose of tramadol: 0.2 mg/kg, 0.4 mg/kg, 0.6 mg/kg, 0.8 mg/kg and 1 mg/kg. The shivering grades, tympanic temperature immediately prior to administering the treatment, time spent to control shivering, shivering relapse, time interval between the two shivering periods and side effects were registered. Data were analyzed with SPSS software, version 14. Chi-square test, t-student test and analysis of variance were used where they were appropriate. P value < 0.05 was considered significant. There were no statistically significant differences among treatment groups with respect to demographic data, duration of anesthesia, room temperature of postanesthesia care unit, shivering grade before treatment and central temperature at the time of treatment. There was no significant difference among the number of patients who stopped shivering with 0.2 mg/kg compared with 1 mg/kg of tramadol. There was no significant difference among the five doses for shivering relapse. Frequency distributions of side effects were not different among the five groups. All patients completely stopped shivering with tramadol 0.4 mg/kg or more in 5 minutes after treatment. With 0.2 mg/kg only 80% of patients stopped shivering. Although the difference between 0.2 mg/kg and 1 mg/kg was not statistically significant, because of the limited number of cases we were not able to reject type two errors. According to this study, we suggest 0.4 mg/kg of tramadol for shivering control

This study assessed the long-term results of photorefractive keratectomy (PRK) with mitomycin C in high myopia (.7 diopter). In this retrospective study, visual acuity, refractive error, pachymetry, topography, contrast sensitivity, corneal haze safety, predictability and complications (with emphasis on ectasia) of 37 high myopic patients (72 eyes) who had PRK surgery with mitomycin C in the last 10 to 40 months were assessed. The exclusion criteria included previous ocular surgery other than LASIK, current ocular disease and any systemic illness. The mean follow up period was 27.2 ± 7.9 months. The spherical equivalent error was significantly reduced, from a mean of -9.10 ± 2.12 diopters (D) (range of -7 to -18.25 D) before PRK to a mean of -1.81 ± 1.57 D (range of - 8.5 to 0 D) after (P = 0.001). Postoperatively, 34.72% of eyes were within ± 0.5 D of attempted correction and 58.33% within ±1 D and 84.72% within ±2 D. 80.5% of eyes had a vision of 20/40 or better. Best corrected visual acuity (BCVA) was unchanged or improved in 93.05%. The safety index was 0.96 [the ratio of mean postoperative BCVA (0.84) to mean preoperative BCVA (0.87)] and efficacy index was 0.8 [the ratio of mean postoperative uncorrected visual acuity (0.7) to mean preoperative BCVA (0.87)]. Corneal haze formation was seen in 5 patients (6.9%) with grade +1. The minimum stromal residual bed was 400 Cm. No eyes had progressive corneal ectasias at the time of post-op control. The topical intraoperative application of 0.02% mitomycin C can reduce haze formation in highly myopic eyes undergoing PRK. Predictability of refractive results, however, was poor.

Soy protein contains beneficial components like complex carbohydrates, unsaturated fatty acids, vegetable protein, soluble fiber, oligosaccharides, vitamins, minerals, inositol-derived substances and phytoestrogens, particularly the isoflavones genistein, diadzein, and glycitein, which might affect different cardio-metabolic abnormalities. Soy consumption has been reported to beneficially affect features of the metabolic syndrome in animal models and also in humans to some extent. There are inconsistent reports regarding the hypothesis of the effectiveness of soy protein on obesity. While some studies have shown that soy consumption can improve the features of the metabolic syndrome without affecting body weight, others showed that soy consumption has beneficial role in weight management and might improve the metabolic syndrome by affecting body weight control. Several studies have consistently reported the effects of soy on cardiovascular risks. Beneficial role of soy intake on diabetes is another aspect of soy inclusion in the diet. The present study discusses the effects of soy consumption on different cardio-metabolic abnormalities and provides information regarding the possible mechanisms by which soy protein might exert its beneficial roles.

Ventricular septal defect represents an uncommon sequel of penetrating cardiac trauma. A high index of suspicion, follow- up, and a complete evaluation of the patient who survives a penetrating heart injury is required. We report an unusual case of posttraumatic ventricular septal defect in a patient who had a stab injury to the chest requiring emergency operation. After the first surgery, the patient presented with dyspnea and signs of heart failure. Intraoperative assessment revealed ventricular septal defect.