Isfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952914420110723Effect of Additioning of Triamcinolon to Cocktail of Fentanil Epinephrinated Bupivacaine in Periarticular Injection for Post Operative Pain and Quality Improvement after Total Knee ArthroplastyEffect of Additioning of Triamcinolon to Cocktail of Fentanil Epinephrinated Bupivacaine in Periarticular Injection for Post Operative Pain and Quality Improvement after Total Knee Arthroplasty79179713456FAMojtabaRahimiAssistant Professor, Department of Anesthesia, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0001-7725-9393MehrdadMasoodifarAssistant Professor, Department of Anesthesia, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0002-4360-5507MehdiMotififarAssistant Professor, Department of Orthopedia, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranAliKhaliliResident, Department of Anesthesia, School of Medicine And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20110618Background: Today, total knee arthroplasty surgery is on the rise in the world. One of the characteristics of this surgery is severe post operative pain. The aim of this study was to evaluate the effect of priarticular injection of Triamcinolon on post operative pain and the function of replaced knee after total knee arthroplasty.Methods: This clinical trial was performed on 64 patients 20 to 80 years undergoing to elective knee arthroplasty surgery. Patients were randomized into two groups (32 patients in each groups). The study group received periarticular injection of triamcinolone acetonide, fentanil, bupivacaine and epinephrine. The control group received only fentanil, bupivacaine, epinephrine and normal saline. Periarticular injection was done by surgeon. The amount of pain, using verbal rating scale (VRS) during recovery, 6, 12, 24 and 48 hours after surgery and articular function (by knee society knee score) were assessed as initial outcomes. The collected data was analyzed by SPSS version 18 by using student t-test and Man-Whitney test.Findings: This clinical trial was performed on 64 patients 20 to 80 years undergoing to elective knee arthroplasty Findings: There were not any significant difference in mean of pain score between two groups in recovery, 6, 12 and 24 hours after surgery (P > 0.05). The mean of pain score in 48 hours after surgery was significantly less in study group (P < 0.05). Morphine consumption after 48 hours was significantly less in study group (P = 0.0001). There is a significant different in articular function (range of motion and walking) between two group base on knee society knee score. There was a greater satisfaction in the study group than control group (P = 0.04).Conclusion: These results shown that the use of periarticular triamcinolon can reduced acute and long term post operative pain and improved articular function and long term good sense in patients.Background: Today, total knee arthroplasty surgery is on the rise in the world. One of the characteristics of this surgery is severe post operative pain. The aim of this study was to evaluate the effect of priarticular injection of Triamcinolon on post operative pain and the function of replaced knee after total knee arthroplasty.Methods: This clinical trial was performed on 64 patients 20 to 80 years undergoing to elective knee arthroplasty surgery. Patients were randomized into two groups (32 patients in each groups). The study group received periarticular injection of triamcinolone acetonide, fentanil, bupivacaine and epinephrine. The control group received only fentanil, bupivacaine, epinephrine and normal saline. Periarticular injection was done by surgeon. The amount of pain, using verbal rating scale (VRS) during recovery, 6, 12, 24 and 48 hours after surgery and articular function (by knee society knee score) were assessed as initial outcomes. The collected data was analyzed by SPSS version 18 by using student t-test and Man-Whitney test.Findings: This clinical trial was performed on 64 patients 20 to 80 years undergoing to elective knee arthroplasty Findings: There were not any significant difference in mean of pain score between two groups in recovery, 6, 12 and 24 hours after surgery (P > 0.05). The mean of pain score in 48 hours after surgery was significantly less in study group (P < 0.05). Morphine consumption after 48 hours was significantly less in study group (P = 0.0001). There is a significant different in articular function (range of motion and walking) between two group base on knee society knee score. There was a greater satisfaction in the study group than control group (P = 0.04).Conclusion: These results shown that the use of periarticular triamcinolon can reduced acute and long term post operative pain and improved articular function and long term good sense in patients.https://jims.mui.ac.ir/article_13456_92251e8665e19be62c86ff039528e16e.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952914420110723Comparison of Deep Lamellar Keratoplasty and Penetrating Keratoplasty in Patients with Keratoconus: A Clinical Trial StudyComparison of Deep Lamellar Keratoplasty and Penetrating Keratoplasty in Patients with Keratoconus: A Clinical Trial Study79880313457FAHassanRazmjuProfessor, Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranMajidShamsResident, Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranMohammad-AliAbtahiResident, Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranSeyed-HosseinAbtahiStudent of Medicine, Isfahan Medical Students Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20110621Background: There are different surgical methods for the treatment of patients with keratoconus. The aim of this study was to compare deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK) methods.Methods: This clinical trial was performed between 2009 and 2011 on 30 Iranian patients. Subjects were recruited consecutively in Feiz hospital, Isfahan, Iran and were randomly entered two groups (each one including 15 cases) under the treatment of DLK or PK.Findings: Two groups (DLK vs. PK) were matched in age (29.4 ± 2.3 vs. 30.9 ± 4.1, P = 0.61) and sex (P = 0.23). Best-corrected visual acuity (BCVA) was decreased significantly in both groups and no difference was found between the decline level between the groups (P = 0.142). Also, regarding improvement of refractive problems, no difference was observed in decline of spherical equivalent (P = 0.533) and astigmatism (P = 0.791). Mean time of suture removal was significantly (P < 0.001) lower in DLK group (6.20 ± 2.11 months) versus PK group (10.93 ± 2.40 months). No complications were observed during both procedures. However, after PK, four cases complicated with endothelial rejection and one with graft failure. Also, after DLK, one case with interface neovascularization and another with stromal rejection were observed.Conclusion: Both methods are effective in reducing the refractive status of keratoconus patients and result in proper BCVA improvement. However, DLK seems to have more successfulness and fewer complications. Background: There are different surgical methods for the treatment of patients with keratoconus. The aim of this study was to compare deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK) methods.Methods: This clinical trial was performed between 2009 and 2011 on 30 Iranian patients. Subjects were recruited consecutively in Feiz hospital, Isfahan, Iran and were randomly entered two groups (each one including 15 cases) under the treatment of DLK or PK.Findings: Two groups (DLK vs. PK) were matched in age (29.4 ± 2.3 vs. 30.9 ± 4.1, P = 0.61) and sex (P = 0.23). Best-corrected visual acuity (BCVA) was decreased significantly in both groups and no difference was found between the decline level between the groups (P = 0.142). Also, regarding improvement of refractive problems, no difference was observed in decline of spherical equivalent (P = 0.533) and astigmatism (P = 0.791). Mean time of suture removal was significantly (P < 0.001) lower in DLK group (6.20 ± 2.11 months) versus PK group (10.93 ± 2.40 months). No complications were observed during both procedures. However, after PK, four cases complicated with endothelial rejection and one with graft failure. Also, after DLK, one case with interface neovascularization and another with stromal rejection were observed.Conclusion: Both methods are effective in reducing the refractive status of keratoconus patients and result in proper BCVA improvement. However, DLK seems to have more successfulness and fewer complications. https://jims.mui.ac.ir/article_13457_1cd45c346398d2ee6a71296e1fa88796.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952914420110723Massage Therapy by Mother or Nurse: Effect on Weight Gain in Premature InfantsMassage Therapy by Mother or Nurse: Effect on Weight Gain in Premature Infants80481113458FAZohrehBadieeAssociate Professor, Department of Pediatrics, Child Health Promotion Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0001-6165-214XShivaSamsamshariatGeneral Physician, Facultiy of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0002-0911-4085PegahPourmorshedGeneral Physician, Facultiy of Medicine, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20110701Background: Today, with the introduction of surfactant the survival rate of preterm infants was increased significantly and the researchers are looking to improve growth and development of premature infants. The effects of massage therapy on weight gain and bone mineralization in preterm infants has been shown in numerous studies. The purpose of this study was to compare the effect of massage therapy on weight gain in preterm infants.Methods: Our randomized clinical trial has three groups: the infants who only received usual care, those who received massage by an expert nurse and those who received massage by their mothers. Massage therapy was conducted three times a day for five consecutive days. We recorded daily weight gain, the length of hospital stay and fluid intake. We used one way ANOVA and Kruskal-Wallis tests by SPSS software.Findings: The gestational age ranged between 28 to 34 weeks. At the end of the fifth day the group who were massaged by a nurse had significantly more weight gain (6.5 ± 2.5%) compared to two other groups (P < 0.001). The weight gain in the group who were massaged by their mother was 4.6 ± 1% and in the usual care group was 3.7 + 1.5% (P < 0.05). There was no significant difference in the length of hospital stay among groups. Conclusion: This study showed that a five days massage therapy was a safe procedure for stable preterm infants to facilitate weight gain. Mothers can use this effective and low cost method for weight gain in their preterm infants.Background: Today, with the introduction of surfactant the survival rate of preterm infants was increased significantly and the researchers are looking to improve growth and development of premature infants. The effects of massage therapy on weight gain and bone mineralization in preterm infants has been shown in numerous studies. The purpose of this study was to compare the effect of massage therapy on weight gain in preterm infants.Methods: Our randomized clinical trial has three groups: the infants who only received usual care, those who received massage by an expert nurse and those who received massage by their mothers. Massage therapy was conducted three times a day for five consecutive days. We recorded daily weight gain, the length of hospital stay and fluid intake. We used one way ANOVA and Kruskal-Wallis tests by SPSS software.Findings: The gestational age ranged between 28 to 34 weeks. At the end of the fifth day the group who were massaged by a nurse had significantly more weight gain (6.5 ± 2.5%) compared to two other groups (P < 0.001). The weight gain in the group who were massaged by their mother was 4.6 ± 1% and in the usual care group was 3.7 + 1.5% (P < 0.05). There was no significant difference in the length of hospital stay among groups. Conclusion: This study showed that a five days massage therapy was a safe procedure for stable preterm infants to facilitate weight gain. Mothers can use this effective and low cost method for weight gain in their preterm infants.https://jims.mui.ac.ir/article_13458_33463bc0c4fcc9398bdb211fd530afa4.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952914420110723Poisoning with the New Anticonvulsant Drugs: Clinical Findings and the OutcomePoisoning with the New Anticonvulsant Drugs: Clinical Findings and the Outcome81282313459FANastaranEizadi-MoodAssociate Professor, Department of Anesthesiology, Isfahan Clinical Toxicology Research Center, Isfahan, IranHosniehNaderiStudent of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranFarzadGheshlaghiAssociate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0002-8972-7366Ali MohammadSabzghabaeeAssociate Professor, Department of Pharmacotherapy, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran0000-0001-8115-4615ZahraDana-SiadatAssistant Professor, Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20110702Background: Poisoning is one of the medical emergencies. Poisoning with new Anticonvulsant drugs such as lamotrigine, sodium valproate, topiramate and gabapentin has been observed alone or in combination with other drugs in the last few years. Therefore this study was performed regarding the poisoning with new anticonvulsant drugs with respect to demographic, clinical manifestations, length of hospital stay, outcome and correlation between the outcome and different variables.Methods: This study was a descriptive-analytical and cross-sectional study. Simple sampling method was performed in the Noor and AliAsghar Hospital on poisoning cases with new anticonvulsant drugs. Need to intubation, connected to ventilator and aspiration pneumonia were considered as outcome Statisticial analysis was done by SPSS17 using ANOVA, Student t-test and logistic regression.Findings: Poisoning with Sodium valproate was more common than Lamotrigine, Topiramate and Gabapentin. The Mean (SD) age of study population was 27.67 (9.74) years old. The most important prediciting factors in outcome incidence were sex (male), seizure, cardiovascular and respiratory symptoms in poisoning with Sodium valproate and seizure in poisoning with Lamotrigine. One death occurred in poisoning with Sodium valproate. Conclusion: Average age of patient was about 27.67 years which may be due to the use of these drugs in the younger age groups. The higher length of hospital stay in patients with respiratory symptoms in Sodium valproate and Lamotrigine poisoning would be because of more complications (intubation, ventilation and aspiration penumonia) observed with these two drugs.Background: Poisoning is one of the medical emergencies. Poisoning with new Anticonvulsant drugs such as lamotrigine, sodium valproate, topiramate and gabapentin has been observed alone or in combination with other drugs in the last few years. Therefore this study was performed regarding the poisoning with new anticonvulsant drugs with respect to demographic, clinical manifestations, length of hospital stay, outcome and correlation between the outcome and different variables.Methods: This study was a descriptive-analytical and cross-sectional study. Simple sampling method was performed in the Noor and AliAsghar Hospital on poisoning cases with new anticonvulsant drugs. Need to intubation, connected to ventilator and aspiration pneumonia were considered as outcome Statisticial analysis was done by SPSS17 using ANOVA, Student t-test and logistic regression.Findings: Poisoning with Sodium valproate was more common than Lamotrigine, Topiramate and Gabapentin. The Mean (SD) age of study population was 27.67 (9.74) years old. The most important prediciting factors in outcome incidence were sex (male), seizure, cardiovascular and respiratory symptoms in poisoning with Sodium valproate and seizure in poisoning with Lamotrigine. One death occurred in poisoning with Sodium valproate. Conclusion: Average age of patient was about 27.67 years which may be due to the use of these drugs in the younger age groups. The higher length of hospital stay in patients with respiratory symptoms in Sodium valproate and Lamotrigine poisoning would be because of more complications (intubation, ventilation and aspiration penumonia) observed with these two drugs.https://jims.mui.ac.ir/article_13459_c2e03087da138478aa65a194e4768a3b.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952914420110723Scrutiny Relationship between Distributions of Hypothyroidism with Environmental Iron Deficiency in Isfahan Province, IranScrutiny Relationship between Distributions of Hypothyroidism with Environmental Iron Deficiency in Isfahan Province, Iran82483013460FAMasoumehRashidiDepartment of Geomorphology- Hydrology, School of Literature and Humanities, Najaf Abad Branch, Islamic Azad
University, Isfahan, IranMohammad HosseinRameshatProfessor, Department of Geography, School of Literature and Humanities, The University of Isfahan, Isfahan, IranRezaRouzbahaniDepartment of Community Medicine, Researcher, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranMajidGhiasPhD Student, Department of Rural Planning, School of Literature and Humanities, The University of Isfahan, Isfahan, IranNaghmeh SadatDehdashtiBSc, Department of Health Treatment Services Management, Vice Chancellour of Treatment, Isfahan University of Medical Sciences, Isfahan, IranParinazPoursafaEnvironment Research Center, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20110615Background: Hypothyroidism is one of the most common endocrine diseases and both mild and severe forms of this disease can affect multiple body organs.Hypothyroidism is a treatable disease and we can prevent the progression of its complications. This study was done to evaluate the relation between the prevalence of neonatal hypothyroidism and the distribution of iron deficiency in Isfahan province, Iran, in order to identify risk areas in Isfahan province, Iran to prevent neonatal hypothyroidism.Methods: In this descriptive study, the recorded data of the prevalence of hypothyroidism in newborns in Isfahan province, Iran during the years 2007-2009 were obtained from the Isfahan Province Health Center and the spatial distribution map of disease was plotted based on the data. The spatial distribution map of the iron in Isfahan province was drawn and the areas with iron deficiency were determined. Then the relationship between iron deficiency and hypothyroidism maps was investigated.Findings: The highest prevalence of hypothyroidism in neonates in Isfahan province was seen in Isfahan city with 0.954, and Semirom with 0.186 neonate in every 10000 neonate. By comparing the spatial distribution maps of hypothyroidism and iron distribution a relation obtained between these maps.Conclusion: The results reflect the impact of iron deficiency on the prevalence of hypothyroidism in neonates in Isfahan and Semirom. Women in childbearing age, pregnant women and infants are more susceptible to iron deficiency anemia, and this will explain hypothyroidism in infants.Background: Hypothyroidism is one of the most common endocrine diseases and both mild and severe forms of this disease can affect multiple body organs.Hypothyroidism is a treatable disease and we can prevent the progression of its complications. This study was done to evaluate the relation between the prevalence of neonatal hypothyroidism and the distribution of iron deficiency in Isfahan province, Iran, in order to identify risk areas in Isfahan province, Iran to prevent neonatal hypothyroidism.Methods: In this descriptive study, the recorded data of the prevalence of hypothyroidism in newborns in Isfahan province, Iran during the years 2007-2009 were obtained from the Isfahan Province Health Center and the spatial distribution map of disease was plotted based on the data. The spatial distribution map of the iron in Isfahan province was drawn and the areas with iron deficiency were determined. Then the relationship between iron deficiency and hypothyroidism maps was investigated.Findings: The highest prevalence of hypothyroidism in neonates in Isfahan province was seen in Isfahan city with 0.954, and Semirom with 0.186 neonate in every 10000 neonate. By comparing the spatial distribution maps of hypothyroidism and iron distribution a relation obtained between these maps.Conclusion: The results reflect the impact of iron deficiency on the prevalence of hypothyroidism in neonates in Isfahan and Semirom. Women in childbearing age, pregnant women and infants are more susceptible to iron deficiency anemia, and this will explain hypothyroidism in infants.https://jims.mui.ac.ir/article_13460_9aad93328ed02110438566b1162f48b8.pdf