Isfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952915320111023Frequency of Nosocomial Pneumonia in ICUs of Hospitals of Hamadan University of Medical SciencesFrequency of Nosocomial Pneumonia in ICUs of Hospitals of Hamadan University of Medical Sciences1255126213511FAEbrahimNadiAssociate Professor, Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IranBabakNekouiiGeneral Practitioner, Department of Tuberculosis and Respiratory Diseases Research, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IranAhmadrezaMobinAssistant Professor, Department of Infectious Diseases, School of Medicine, Zanjan University of Medical Sciences, Zanjan, IranArashNekouiiGeneral Practitioner, Department of Tuberculosis and Respiratory Diseases Research, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IranAbbasMoghim BeigiAssistant Professor, Department of Biostatistics and Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, IranJournal Article20101121Background: Nosocomial pneumonia is the most prevalent causes of hospital-acquired infection in intensive Care Units (ICU). The purpose of this research was to detect the frequency and predisposing factors of nosocomial pneumonia in ICUs of hospitals of Hamadan University of medical sciences.Methods: In this cross sectional study, 353 patients that were hospitalized in ICUs of Hamadan hospitals (Besat and Ekbatan) were investigated. In the case of nosocomial pneumonia some variables including connecting until affection, the period of hospitalization in ICU until affection will were recorded for these patients. χ2 test and Fisher exact test were used for data analysis.Findings: 36 people (10.2%) of hospitalized patients in ICUs were affected to nosocomial pneumonia. The average age of studying patients was 51.2 ± 21.9 years old, in which the most affected people (28%) were older than 65 years old. 44.5% of patients with nosocomial pneumonia were affected about 2-5 days after hospitalization in ICU. 66.5% of these patients (24 patients) had ventilator associated pneumonia(VAP) after connecting to ventilation device.Conclusion: Considering to frequency and predispose of nosocomial pneumonia in this study, it's necessary to pay more attention to the patients whom are exposed to hospital–acquired infections. It is also recommended that all unnecessary intervening actions for the patients in ICU should be avoided. In the case of necessity for mechanical ventilation and for reducing the onset of pneumonia, it is necessary to consider all sanitary actions.Background: Nosocomial pneumonia is the most prevalent causes of hospital-acquired infection in intensive Care Units (ICU). The purpose of this research was to detect the frequency and predisposing factors of nosocomial pneumonia in ICUs of hospitals of Hamadan University of medical sciences.Methods: In this cross sectional study, 353 patients that were hospitalized in ICUs of Hamadan hospitals (Besat and Ekbatan) were investigated. In the case of nosocomial pneumonia some variables including connecting until affection, the period of hospitalization in ICU until affection will were recorded for these patients. χ2 test and Fisher exact test were used for data analysis.Findings: 36 people (10.2%) of hospitalized patients in ICUs were affected to nosocomial pneumonia. The average age of studying patients was 51.2 ± 21.9 years old, in which the most affected people (28%) were older than 65 years old. 44.5% of patients with nosocomial pneumonia were affected about 2-5 days after hospitalization in ICU. 66.5% of these patients (24 patients) had ventilator associated pneumonia(VAP) after connecting to ventilation device.Conclusion: Considering to frequency and predispose of nosocomial pneumonia in this study, it's necessary to pay more attention to the patients whom are exposed to hospital–acquired infections. It is also recommended that all unnecessary intervening actions for the patients in ICU should be avoided. In the case of necessity for mechanical ventilation and for reducing the onset of pneumonia, it is necessary to consider all sanitary actions.https://jims.mui.ac.ir/article_13511_3c252fa14f21be6264aa55a74246f4d1.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952915320111023Effect of Infants' Position during Phototherapy on the Level of Serum BilirubinEffect of Infants' Position during Phototherapy on the Level of Serum Bilirubin1263126913512FASayed HosseinFakhraeeProfessor, Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranMohammadKazemianAssociate Professor, Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranSayed AbolfazlAfjehAssistant Professor, Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranMasoodRozatiNeonatologist, Isfahan University of Medical Sciences, Isfahan, IranArmindokhtShahsanaiSpecialty in Community Medicine, Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0002-1384-2464Journal Article20110112Background: Position changing of the infants during conventional phototherapy for hyper bilirubinemia is used in many hospitals. The aim of this study was to compare the efficacy of phototherapy in supine versus supine/prone position during phototherapy.Methods: In a randomized clinical trial 40 term jaundiced neonates who were admitted to the neonatal ward of Mofid Children Hospital, a university Hospital affiliated to Shahid Beheshti University of Medical Sciences , Tehran, Iran were Selected. After entry into the study, infants were randomly assigned two groups: turning group were positioned alternately supine to prone every 6 hours and supine group were only positioned supine. Total serum bilirubin (TSB) were measured just prior to initiation and during 24 hours of phototherapy.Findings: No statistically significant differences in TSB after 24 hours were observed between two groups. But decrease in TSB was significantly associated with position change. Decrease in serum bilirubin level was greater in infants with position change after 24 hour.Conclusion: According to results changing the position of term infants with hyperbilirubinemia during phototherapy could increase the efficacy of this treatment.Background: Position changing of the infants during conventional phototherapy for hyper bilirubinemia is used in many hospitals. The aim of this study was to compare the efficacy of phototherapy in supine versus supine/prone position during phototherapy.Methods: In a randomized clinical trial 40 term jaundiced neonates who were admitted to the neonatal ward of Mofid Children Hospital, a university Hospital affiliated to Shahid Beheshti University of Medical Sciences , Tehran, Iran were Selected. After entry into the study, infants were randomly assigned two groups: turning group were positioned alternately supine to prone every 6 hours and supine group were only positioned supine. Total serum bilirubin (TSB) were measured just prior to initiation and during 24 hours of phototherapy.Findings: No statistically significant differences in TSB after 24 hours were observed between two groups. But decrease in TSB was significantly associated with position change. Decrease in serum bilirubin level was greater in infants with position change after 24 hour.Conclusion: According to results changing the position of term infants with hyperbilirubinemia during phototherapy could increase the efficacy of this treatment.https://jims.mui.ac.ir/article_13512_01788bf6c7a271a78202e93a3d90aa46.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952915320111023Anti-MCV Changes in the Treatment of Rheumatoid Arthritis and its Relation to Disease ActivityAnti-MCV Changes in the Treatment of Rheumatoid Arthritis and its Relation to Disease Activity1270127613513FAMansourSalesiAssistant Professor, Department of Rheumatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0001-7108-6188HengamehJamshidiResident, Department of Internal Medicine, School of Medicine And Student Research Committee , Isfahan University of Medical Sciences, Isfahan, IranZibaFarajzadeganAssociate Professor, Department of Community and Preventive Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0002-8811-6678HadiKarimzadehAssociate Professor, Department of Rheumatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Journal Article20110327Background: In some studies Anti-mutated citrullinated vimentin antibodies (Anti-MCV) was known as a specific marker to diagnose and evaluate the process of rheumatoid arthritis (RA). In this study our aim was to evaluate the relationship between the disease activity score (DAS28) and serum titer of Anti-MCV in patients with rheumatoid arthritis.Methods: This study was a clinical trial in which 80 patients with RA were enrolled. All patients were treated for 3 months. ESR, Anti-MCV and DAS28 were measured before and after the treatment. Data was analyzed be Paired t-test and χ2.Findings: Anti-MCV titer was decreased significantly after treatment (P < 0.001). Pearson test showed a significant correlation between DAS28 and Anti-MCV titer (P < 0.05).Conclusion: Our findings suggested that Anti-MCV should be one of the serelogic tests for evaluating DAS28 in patients with rheumatoid arthritis.Background: In some studies Anti-mutated citrullinated vimentin antibodies (Anti-MCV) was known as a specific marker to diagnose and evaluate the process of rheumatoid arthritis (RA). In this study our aim was to evaluate the relationship between the disease activity score (DAS28) and serum titer of Anti-MCV in patients with rheumatoid arthritis.Methods: This study was a clinical trial in which 80 patients with RA were enrolled. All patients were treated for 3 months. ESR, Anti-MCV and DAS28 were measured before and after the treatment. Data was analyzed be Paired t-test and χ2.Findings: Anti-MCV titer was decreased significantly after treatment (P < 0.001). Pearson test showed a significant correlation between DAS28 and Anti-MCV titer (P < 0.05).Conclusion: Our findings suggested that Anti-MCV should be one of the serelogic tests for evaluating DAS28 in patients with rheumatoid arthritis.https://jims.mui.ac.ir/article_13513_acb797b40a9632e6a031b31100b37630.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952915320111023Effect of a Physical Therapy Program Based on Balance and Gait in Patients with ParkinsonEffect of a Physical Therapy Program Based on Balance and Gait in Patients with Parkinson1277128513514FAHamidrezaTaheriAssistant Professor, Department of Physical Education, School of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran0000-0002-0878-604XAkbarPejhanAssistant Professor, Department of Physiology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran0000-0002-7196-8524JavadTaherzadehInstructor, Department of Physical Education and Sport Sciences, Naragh Branch, Islamic Azad University, Naragh, IranMohammadSeyedahmadiInstructor, Department of Physical Education and Sport Sciences, School of Literature and Humanities, Velayat University, Iranshahr, Iran0000-0001-6060-8358FahimehKeavanlooDepartment of Physical Education, Iranshahr Branch, Islamic Azad University, Iranshahr, IranJournal Article20110423Background: Parkinson is a degenerative disorder in basal ganglia in brain. This disease is an increasing and chronic one, and mostly affects the old people. Physical therapy is one of the ways to help these people to improve their health. The purpose of this study was to examine the effect of a physical therapy program that was designed based on balance and gait in patients with Parkinson.Methods: 24 patients with parkinson disease were participated voluntarily in this study. Subjects were randomized to the experimental (n = 12) or control group (n = 12). The intensity of disease in studied patients was moderate. Both groups used medicines with the same doses. Experiment group had passed a physical therapy program (10 weeks and 4 sessions in each week. Each session prolonged 1 hour) with emphasis on the tensional and supple exercises, while the control group did not passed any exercise program during this time. To assess the balance and gait, we used the berg balance scale (BBS), tinetii balance scale (tbs) and gait and balance scale (GABS). The balance and gait degrees were measured before and after the physical therapy period and the raw data were analyzed by student t-test and paired t-test.Findings: The gait and balance scores in experimental group improved significantly after the intervention (P < 0.000). The score of balance was decreased significantly in control group in the end of the study (P < 0.008). The score of gait had no significant change in control group (P = 0.820).Conclusion: Our findings showed that the stretching and sapling exercises have significant effect on the balance and gait in Parkinson disease.Background: Parkinson is a degenerative disorder in basal ganglia in brain. This disease is an increasing and chronic one, and mostly affects the old people. Physical therapy is one of the ways to help these people to improve their health. The purpose of this study was to examine the effect of a physical therapy program that was designed based on balance and gait in patients with Parkinson.Methods: 24 patients with parkinson disease were participated voluntarily in this study. Subjects were randomized to the experimental (n = 12) or control group (n = 12). The intensity of disease in studied patients was moderate. Both groups used medicines with the same doses. Experiment group had passed a physical therapy program (10 weeks and 4 sessions in each week. Each session prolonged 1 hour) with emphasis on the tensional and supple exercises, while the control group did not passed any exercise program during this time. To assess the balance and gait, we used the berg balance scale (BBS), tinetii balance scale (tbs) and gait and balance scale (GABS). The balance and gait degrees were measured before and after the physical therapy period and the raw data were analyzed by student t-test and paired t-test.Findings: The gait and balance scores in experimental group improved significantly after the intervention (P < 0.000). The score of balance was decreased significantly in control group in the end of the study (P < 0.008). The score of gait had no significant change in control group (P = 0.820).Conclusion: Our findings showed that the stretching and sapling exercises have significant effect on the balance and gait in Parkinson disease.https://jims.mui.ac.ir/article_13514_db4a1766c395480fd973a96c6105f86e.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952915320111023Etiologic Causes of Invasive Fungal Sinusitis among Patients of, University Hospitals in Shiraz, IranEtiologic Causes of Invasive Fungal Sinusitis among Patients of, University Hospitals in Shiraz, Iran1286129613515FAHosseinRouzbahaniResident, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, IranParisaBadieeAssistant Professor, Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, IranMaryamBarkhordarResident, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, IranAbdolrezaBadieeResident, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, IranAbolhassanFaramarziAssistant Professor, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, IranMohsenMoghadamiAssociate Professor, Department of Internal Medicine, Unit of Infection Disease, Healthy Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IranRezaRouzbahaniSpecialist in Community and Preventive Medicine, Researcher, Isfahan University of Medical Sciences, IsfahanJournal Article20110425Background: This study aimed to determine the causes of invasive fungal sinusitis in patients of Shiraz University hospitals, Iran.Methods: This cross sectional study was conducted during 18 months (from 21 March 2009 till 22 September 2010) in three Shiraz University Medical Hospitals Thirty six patients with sings of invasive fungal sinusitis were enrolled, and tissue samples were investigated for histopathology, culture and antifungal susceptibility test. The laboratory results with host factor and sinus computed tomography scan were evaluated for classification of patients as proven, probable and possible invasive fungal sinusitis.Findings: Thirty five patients have involved with at least one risk factor (immune compromised disease, diabetes mellitus, or use of immune suppressed drugs). Radiological findings of para sinus invasion or necrosis were present in 20 patients. By histopathology, 21 patients was considered as proven, from these 17 samples had positive growth. The culture etiology agents were 4 Candida, 8 Aspergillus, and 5 Mucor. All positive culture samples were “Match”ed with histopathology findings. Significant association were considered for radiologic finding and histopathology and culture (P < 0.05). From 8 patients with mucormycosis histopathology, 6 suffered from diabetes mellitus. None of the antifungal agents were effective on these three types of infections. Conclusion: Imaging procedures can be used for diagnosis of infection in early stage of complication in high risk patients. Background: This study aimed to determine the causes of invasive fungal sinusitis in patients of Shiraz University hospitals, Iran.Methods: This cross sectional study was conducted during 18 months (from 21 March 2009 till 22 September 2010) in three Shiraz University Medical Hospitals Thirty six patients with sings of invasive fungal sinusitis were enrolled, and tissue samples were investigated for histopathology, culture and antifungal susceptibility test. The laboratory results with host factor and sinus computed tomography scan were evaluated for classification of patients as proven, probable and possible invasive fungal sinusitis.Findings: Thirty five patients have involved with at least one risk factor (immune compromised disease, diabetes mellitus, or use of immune suppressed drugs). Radiological findings of para sinus invasion or necrosis were present in 20 patients. By histopathology, 21 patients was considered as proven, from these 17 samples had positive growth. The culture etiology agents were 4 Candida, 8 Aspergillus, and 5 Mucor. All positive culture samples were “Match”ed with histopathology findings. Significant association were considered for radiologic finding and histopathology and culture (P < 0.05). From 8 patients with mucormycosis histopathology, 6 suffered from diabetes mellitus. None of the antifungal agents were effective on these three types of infections. Conclusion: Imaging procedures can be used for diagnosis of infection in early stage of complication in high risk patients. https://jims.mui.ac.ir/article_13515_bfb7adf7a99438807f685ad24c7dd7fd.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952915320111023Perspectives of Pregnant Women about Commitment of Obstetricians and Gynecologists to Informed Consent Principle Regarding Delivery Method, Isfahan, IranPerspectives of Pregnant Women about Commitment of Obstetricians and Gynecologists to Informed Consent Principle Regarding Delivery Method, Isfahan, Iran1297131013516FAAhmad RezaZamaniAssociate Professor, Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences,
Isfahan, IranZibaFarajzadeganAssociate Professor, Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran0000-0002-8811-6678RezaSirousGeneral Practitioner, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20111103Background: Natural vaginal delivery is usually considered as the best method of delivery. However, the rate of cesarean section has been increasing several times during recent decades. Nowadays, approximately 50-65% of deliveries in Iran are performed as cesarean section. This trend can be dealt with by providing correct information about the advantages and disadvantages of cesarean and vaginal delivery. The present study aimed to investigate the extent of information gynecologists provide to pregnant mothers about the advantages and disadvantages of various childbirth methods (informed consent factors).Methods: This cross-sectional, descriptive study was conducted on 482 pregnant women at the third trimester of pregnancy who had been admitted in obstetrics and gynecology ward of a certain number of private hospitals, university hospitals, non-academic public hospitals, and hospitals affiliated to Social Security Organization for delivery or any other reason. Pregnant mothers were selected though convenient non-randomized method. The informed consent questionnaire consisted of 30 questions about disadvantages, advantages, costs, alternative methods, and the method and quality of presenting information to mothers. The data was analyzed by chi-square, Kruskal-Wallis and Mann-Whitney tests in SPSS16.Findings: Mean total information presented to the pregnant women was 1.06 ± 0.93 out of 4. The presented information included complications of cesarean (0.82 ± 1.07), complications of natural vaginal delivery (0.85 ± 1.1), advantages of cesarean (1.29 ± 1.00), advantages of vaginal delivery (1.34 ± 1.00), costs (2.29 ± 1.30), and alternative deliveries (0.95 ± 1.10). Quality of information presentation was scored as 1.21 ± 1.14. Conclusion: The commitment of obstetricians and gynecologists to obtain informed consents from mothers was very low. In addition, it was associated with a particular bias in some cases. Thus, implementing developed and proper planning seems necessary to educate and promote awareness and knowledge of patients toward patient rights. On the other hand, the attention of physicians needs to be attracted toward concentrating more on patient rights.Background: Natural vaginal delivery is usually considered as the best method of delivery. However, the rate of cesarean section has been increasing several times during recent decades. Nowadays, approximately 50-65% of deliveries in Iran are performed as cesarean section. This trend can be dealt with by providing correct information about the advantages and disadvantages of cesarean and vaginal delivery. The present study aimed to investigate the extent of information gynecologists provide to pregnant mothers about the advantages and disadvantages of various childbirth methods (informed consent factors).Methods: This cross-sectional, descriptive study was conducted on 482 pregnant women at the third trimester of pregnancy who had been admitted in obstetrics and gynecology ward of a certain number of private hospitals, university hospitals, non-academic public hospitals, and hospitals affiliated to Social Security Organization for delivery or any other reason. Pregnant mothers were selected though convenient non-randomized method. The informed consent questionnaire consisted of 30 questions about disadvantages, advantages, costs, alternative methods, and the method and quality of presenting information to mothers. The data was analyzed by chi-square, Kruskal-Wallis and Mann-Whitney tests in SPSS16.Findings: Mean total information presented to the pregnant women was 1.06 ± 0.93 out of 4. The presented information included complications of cesarean (0.82 ± 1.07), complications of natural vaginal delivery (0.85 ± 1.1), advantages of cesarean (1.29 ± 1.00), advantages of vaginal delivery (1.34 ± 1.00), costs (2.29 ± 1.30), and alternative deliveries (0.95 ± 1.10). Quality of information presentation was scored as 1.21 ± 1.14. Conclusion: The commitment of obstetricians and gynecologists to obtain informed consents from mothers was very low. In addition, it was associated with a particular bias in some cases. Thus, implementing developed and proper planning seems necessary to educate and promote awareness and knowledge of patients toward patient rights. On the other hand, the attention of physicians needs to be attracted toward concentrating more on patient rights.https://jims.mui.ac.ir/article_13516_2a7550fa14704e90f8a12992cf7499bb.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952915320111023Assessment of Patients before Cataract Surgery: Are Routine Tests Cost-Effective?Assessment of Patients before Cataract Surgery: Are Routine Tests Cost-Effective?1311131913517FANafisehSoheilipourStudent of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranMohammad AliAttariAssociate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20111024Background: Cataract surgery is considered as one of the low-risk and low-stress surgeries. Preoperative examination by an anesthesiologist is an integral and necessary part of every surgery to reduce mortality rate, complications, costs, and hospitalization duration. However, the quality and quantity of cataract preoperative assessment are controversial. On one hand, a large number of routine clinical tests would lead to a prolonged and costly process of treatment. On the other hand, because most patients are elderly with poor general health status, taking non-scientific risks and inappropriate preoperative assessment do not make sense. The present study aimed to determine the value of routine tests before cataract surgery by reviewing their potential advantages and disadvantages.Methods: This prospective analytical study was conducted in Feiz Educational Hospital and Aban Ophthalmology Clinic (Isfahan, Iran) in 2010 and 2011. It included 700 cataract patients with physical status grades 1-3 (according to the rating of American Society of Anesthesiologists). Local anesthesia was used in all patients. They all aged over 25 years old. The patients were divided into two groups (n = 350 in each group) and underwent preoperative assessments. The first group underwent routine tests such as echocardiography (ECG), and complete blood cell (CBC) count, blood sugar (BS), blood urea nitrogen (BUN), and creatinine (Cr) tests. However, no tests, expect history taking and physical examination, were performed on the second group. Therefore, subjects over 40 with a history of cardiac diseases underwent ECG. Diabetic patients also underwent a BS test using a glucometer. Afterwards, 11 perioperative and 11 postoperative complications were evaluated in both groups. The complications included nausea and vomiting, sweating, severe lethargy, dysrhythmia, hypotension, hypertension, ischemic heart disease (IHD), O2 saturation drop, apnea, and death. The costs of the assessments were also calculated for both groups. Data was analyzed by t-test, chi-square test, Kendall's Tau correlation analysis and logistic regression model in SPSS16. Findings: The findings of the study showed that out of 11 complications during the surgery, the two groups were only significantly different in hypertension which was more prevalent in the group with more routine tests. In addition, out of 11 postoperative complications, the only significant difference between the two groups was in nausea which occurred more in the group without routine tests. Comparing the mean complications of the two groups showed no significant difference (P = 0.451). Costs in the group with routine tests were almost 7 times higher than the other group. Conclusion: Removing routine tests and replacing them with necessary tests (in many cases only two tests and in some other cases no test was required), will significantly reduce costs and thus result in higher patient satisfaction. On the other hand, cataract surgery is a highly prevalent procedure for most costs of which the government takes the responsibility. Therefore, since routine tests are not cost-effective, by eliminating their useless costs, a considerable and significant saving will occur in macro-level.Background: Cataract surgery is considered as one of the low-risk and low-stress surgeries. Preoperative examination by an anesthesiologist is an integral and necessary part of every surgery to reduce mortality rate, complications, costs, and hospitalization duration. However, the quality and quantity of cataract preoperative assessment are controversial. On one hand, a large number of routine clinical tests would lead to a prolonged and costly process of treatment. On the other hand, because most patients are elderly with poor general health status, taking non-scientific risks and inappropriate preoperative assessment do not make sense. The present study aimed to determine the value of routine tests before cataract surgery by reviewing their potential advantages and disadvantages.Methods: This prospective analytical study was conducted in Feiz Educational Hospital and Aban Ophthalmology Clinic (Isfahan, Iran) in 2010 and 2011. It included 700 cataract patients with physical status grades 1-3 (according to the rating of American Society of Anesthesiologists). Local anesthesia was used in all patients. They all aged over 25 years old. The patients were divided into two groups (n = 350 in each group) and underwent preoperative assessments. The first group underwent routine tests such as echocardiography (ECG), and complete blood cell (CBC) count, blood sugar (BS), blood urea nitrogen (BUN), and creatinine (Cr) tests. However, no tests, expect history taking and physical examination, were performed on the second group. Therefore, subjects over 40 with a history of cardiac diseases underwent ECG. Diabetic patients also underwent a BS test using a glucometer. Afterwards, 11 perioperative and 11 postoperative complications were evaluated in both groups. The complications included nausea and vomiting, sweating, severe lethargy, dysrhythmia, hypotension, hypertension, ischemic heart disease (IHD), O2 saturation drop, apnea, and death. The costs of the assessments were also calculated for both groups. Data was analyzed by t-test, chi-square test, Kendall's Tau correlation analysis and logistic regression model in SPSS16. Findings: The findings of the study showed that out of 11 complications during the surgery, the two groups were only significantly different in hypertension which was more prevalent in the group with more routine tests. In addition, out of 11 postoperative complications, the only significant difference between the two groups was in nausea which occurred more in the group without routine tests. Comparing the mean complications of the two groups showed no significant difference (P = 0.451). Costs in the group with routine tests were almost 7 times higher than the other group. Conclusion: Removing routine tests and replacing them with necessary tests (in many cases only two tests and in some other cases no test was required), will significantly reduce costs and thus result in higher patient satisfaction. On the other hand, cataract surgery is a highly prevalent procedure for most costs of which the government takes the responsibility. Therefore, since routine tests are not cost-effective, by eliminating their useless costs, a considerable and significant saving will occur in macro-level.https://jims.mui.ac.ir/article_13517_088d6dc6ddb3113e9b902711ccdfafef.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952915320111023A Comparative Study on Density of Nerve Fibers of Calcitonin Gene-Related Peptide, Protein Gene Product 9.5, and Substance P in Inner and Outer Layers of Prepuce of Male GenitaliaA Comparative Study on Density of Nerve Fibers of Calcitonin Gene-Related Peptide, Protein Gene Product 9.5, and Substance P in Inner and Outer Layers of Prepuce of Male Genitalia1320132513518FAArdeshirTalebiAssociate Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranMehrdadMemarzadehAssociate Professor, Department of Pediatric Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranNasrinRasihdiStudent of Medicine, School of Medicine And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20111030Background: Circumcision of boys has been the tradition of all the prophets and has also been emphasized in Islam. Despite the religious teachings, reference books do not provide a standard on how much of the prepuce to leave. It was thus decided to investigate a number of nerve receptors in the inner and outer layers of the prepuce.Methods: This was a descriptive, analytical study. The target group consisted of 32 boys at the age range of 3 months to 10 years who referred to pediatric surgery ward of Alzahra Hospital (Isfahan, Iran) for circumcision surgery from June to November 2009. In this study, inner and outer layers of prepuce were removed through classic circumcision surgery by local or general anesthesia. Inner and outer layers of prepuce were marked and separately placed in formalin. Immunohistochemistry staining was used after cutting and preparation of samples for chemical staining. Substance P (SP), protein gene product (PGP 9.5), and calcitonin gene-related peptide (CGRP) antibodies were prepared and their existence was investigated in the tissue. Student's t-test was used to compare mean density of nerve receptors between the two areas.Findings: In this study, 32 male candidates for elective circumcision through classic method were evaluated. The mean age of subjects was 1.37 ± 0.53 years (range: 4 months-5 years). Mean nerve fibers of PGP 9.5 in the outer and inner layers of prepuce was 6.3 ± 2.3 and 13.4 ± 2.04, respectively (P = 0.001). Mean nerve fibers of SP in the outer and inner layers of prepuce was 2.1 ± 1.6 and 3.2 ± 2.1, respectively (P = 0.09). Mean nerve fibers of CGRP in the outer and inner layers of prepuce was 2.5 ± 1.1 and 5.6 ± 1.7, respectively (P = 0.02).Conclusion: Leaving more of prepuce may cause inappropriate irritation and lack of proper sexual function at the time of puberty. Therefore, in order for better sexual functioning and avoiding potential complications, it is recommended to remove the highest possible amount of prepuce in circumcision surgery.Background: Circumcision of boys has been the tradition of all the prophets and has also been emphasized in Islam. Despite the religious teachings, reference books do not provide a standard on how much of the prepuce to leave. It was thus decided to investigate a number of nerve receptors in the inner and outer layers of the prepuce.Methods: This was a descriptive, analytical study. The target group consisted of 32 boys at the age range of 3 months to 10 years who referred to pediatric surgery ward of Alzahra Hospital (Isfahan, Iran) for circumcision surgery from June to November 2009. In this study, inner and outer layers of prepuce were removed through classic circumcision surgery by local or general anesthesia. Inner and outer layers of prepuce were marked and separately placed in formalin. Immunohistochemistry staining was used after cutting and preparation of samples for chemical staining. Substance P (SP), protein gene product (PGP 9.5), and calcitonin gene-related peptide (CGRP) antibodies were prepared and their existence was investigated in the tissue. Student's t-test was used to compare mean density of nerve receptors between the two areas.Findings: In this study, 32 male candidates for elective circumcision through classic method were evaluated. The mean age of subjects was 1.37 ± 0.53 years (range: 4 months-5 years). Mean nerve fibers of PGP 9.5 in the outer and inner layers of prepuce was 6.3 ± 2.3 and 13.4 ± 2.04, respectively (P = 0.001). Mean nerve fibers of SP in the outer and inner layers of prepuce was 2.1 ± 1.6 and 3.2 ± 2.1, respectively (P = 0.09). Mean nerve fibers of CGRP in the outer and inner layers of prepuce was 2.5 ± 1.1 and 5.6 ± 1.7, respectively (P = 0.02).Conclusion: Leaving more of prepuce may cause inappropriate irritation and lack of proper sexual function at the time of puberty. Therefore, in order for better sexual functioning and avoiding potential complications, it is recommended to remove the highest possible amount of prepuce in circumcision surgery.https://jims.mui.ac.ir/article_13518_f419f44d19be2787d4830e3bd79dd43f.pdf