Taleghani Hospital Research Articles

Positive correlation between interleukin-1 receptor antagonist gene 86bp VNTR polymorphism and colorectal cancer susceptibility: a case-control study.

Colorectal cancer (CRC) is one of the most common malignancies worldwide. Genetic variations in cytokine genes and their receptors lead to the severity of the disease. The interleukin-1 receptor antagonist (IL1RN) is a cytokine that inhibits interleukin-1 (IL-1) activity by binding to IL-1 receptors. Also, interleukin-4 (IL-4) is an anti-inflammatory cytokine that can play an important role in several cancers. The present case-control study was aimed to evaluate the association of IL-4 and IL1RN VNTR polymorphisms with the susceptibility to CRC in a sample of Iranian population provided by the Research Center for Gastroenterology and Liver Disease at Taleghani Hospital, Tehran. A total of 123 patients diagnosed with CRC and 152 healthy controls were recruited in the present study. Genomic DNA was extracted by salting out method from whole blood and genotyping of IL1RN and IL-4 VNTR polymorphisms were determined by PCR-based technology. Our study manifested the frequency of 1/2 and 2/4 genotypes of IL1RN 68bp VNTR polymorphism are significantly different between both groups (p = 0.0001 and p = 0.01 respectively). However, we could not find any correlation between IL-4 VNTR polymorphism and CRC cancer. It seems that 1/2 and 2/4 genotypes of IL1RN are correlated with CRC susceptibility in our population, although, more studies are needed to confirm our results.

Investigation of Ondansetron, Haloperidol, and Dexmedetomidine Efficacy for Prevention of Postoperative Nausea and Vomiting In Patients with Abdominal Hysterectomy.

AIM:This study was aimed to compare the effects of ondansetron, haloperidol, and dexmedetomidine for reducing postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy.METHODS:This randomised clinical trial study was performed on p.patients who were candidates for abdominal hysterectomy referring to Taleghani hospital in Arak. In this study, 114 patients with abdominal hysterectomy were randomly assigned to three groups (ondansetron, haloperidol, and dexmedetomidine) using the cubull randomisation method.RESULTS:The results revealed a significant difference between the three groups of ondansetron, haloperidol and dexmedetomidine in terms of scorpion vomiting in recovery, 2 and 4 hours after surgery, and vomiting score was significantly lower in the ondansetron group compared with the other two groups (P = 0.04; P = 0.02; P = 0.001). There was a significant difference between the three groups of e ondansetron, haloperidol and dexmedetomidine regarding the mean dose of metoclopramide in mg for 24 hours after surgery. Therefore, the dosage of dexmedetomidine in the ondansetron group was less than the other two groups (P = 0.001).CONCLUSION:these three drugs are effective in reducing PONV in patients undergoing a hysterectomy. However, the effect of ondansetron was found to be more than the other two drugs in reducing PONV.

Application of a non-parametric non-mixture cure rate model for analyzing the survival of patients with colorectal cancer in Iran.

OBJECTIVESColorectal cancer (CRC) patients are considered to have been cured when the mortality rate of individuals with the disease returns to the same level as expected in the general population. This study aimed to assess the impact of various risk factors on the cure fraction of CRC patients using a real dataset of Iranian CRC patients with a non-mixture non-parametric cure model.METHODSThis study was conducted on the medical records of 512 patients who were definitively diagnosed with CRC at Taleghani Hospital, Tehran, Iran from 2001 to 2007. A non-mixture non-parametric cure rate model was applied to the data after using stepwise selection to identify the risk factors of CRC.RESULTSFor non-cured cases, the mean survival time was 1,243.83 days (95% confidence interval [CI], 1,174.65 to 1,313.00) and the median survival time was 1,493.00 days (95% CI, 1,398.67 to 1,587.33). The 1- and 3-year survival rates were 92.9% (95% CI, 91.0 to 95.0) and 73.4% (95% CI, 68.0 to 79.0), respectively. Pathologic stage T1 of the primary tumor (estimate=0.58; p=0.013), a poorly differentiated tumor (estimate=1.17; p<0.001), a body mass index (BMI) between 18.6 and 24.9 kg/m2 (estimate=−0.60; p=0.04), and a BMI between 25.0 and 29.9 kg/m2 (estimate=−1.43; p<0.001) had significant impacts on the cure fraction of CRC in the multivariate analysis. The proportion of cured patients was 64.1% (95% CI, 56.7 to 72.4).CONCLUSIONSThis study found that the pathologic stage of the primary tumor, tumor grade, and BMI were potential risk factors that had an impact on the cure fraction. A non-mixture non-parametric cure rate model provides a flexible framework for accurately determining the impact of risk factors on the long-term survival of patients with CRC.

Diagnostic Efficacy of 24-hr Esophageal pH Monitoring in Patients with Refractory Gastroesophageal Reflux Disease.

BACKGROUND:Gastric reflux is one of the most important causes of the referral of patients to the internal clinic, which in some cases causes problems for patients due to resistance to common treatments. Therefore, timely diagnosis and treatment of this group of patients are very important.AIM:The purpose of the present study was to determine the off-proton pump inhibitor (off-PPI) 24 h pH-impedance analyses in patients with refractory gastroesophageal reflux disease (GERD) attending to Taleghani Hospital since 2009 to 2017.METHODS:In this observational descriptive-comparative off-PPI study, 572 patients with refractory GERD who were referred to Taleghani Hospital in Tehran from 2009 to 2017 were selected, and the results of 24 h pH Impedance analysis were then assessed.RESULTS:The results of 24h pH-impedance indicated that 7% of cases belonged to Pure Acid Reflux followed by weakly Acid (1%), non-acid (0.3%), mixed & gas (5.2%), functional (58.4%) and oesophagal hypersensitivity (28%). Furthermore, weakly acid plus acid was also found to be 8% and Weakly Acid + Acid + Non-Acid were determined as 8.3%.CONCLUSIONS:Our findings suggested that nearly more than half of the patients with refractory GERD would have a functional disorder in the 24h pH-impedance analysis.

Risk Factors for Resistance and Mortality in Patients with Extensively Resistant Acinetobacter Bacteremia in Taleghani Hospital in Tehran, Iran

Objectives: This study describes the antibiotic resistance pattern in patients with Acinetobacter bacteremia and investigates the factors leading to extensively drug resistance (XDR) and mortality. Methods: This descriptive analytical study was conducted in patients with Acinetobacter bacteremia between February 2014 and February 2015. The microorganisms were identified with conventional bacteriological methods and then, following the clinical and laboratory standards institute (CLSI) recommendations, susceptibility testing was performed on all isolates. Moreover, we used electronic records to extract the patients’ data and analyzed them using Chi-square test or Fisher’s exact test and T-Test. Results: Among the influencing factors, the severity of clinical symptoms at the time of admission, longer duration of hospitalization especially in the ICU, and use of invasive devices such as ventilator had a significant relationship with the occurrence of resistance and mortality in the patients. In addition, the central venous catheterization and history of drug resistance such as XDR were associated with mortality. Conclusions: Given the increasing prevalence of XDR Acinetobacter strains causing resistant nosocomial infection, especially in immunocompromised patients, it is necessary to reduce the risk factors leading to drug resistance and mortality. Furthermore, early administration of empiric antibiotic therapy can have a good effect on the outcomes.

Transcultural Adaptation and Validation of Persian Version of Celiac Disease Questionnaire (CDQ); A Specific Questionnaire to Measure Quality of Life of Iranian Patients

Background: The assessment of health-related quality of life has become an important primary or secondary outcome measure in clinical and epidemiologic studies. The aim of this study was to validate a Persian version of Celiac Disease Questionnaire (CDQ) for Celiac disease (CD) among Iranian patients. Materials and Methods: The English version of the CDQ adapted to the Persian language by a forward-backward translation by 3 professional bilingual translators (1 medical, 2 nonmedical). The content validity of translated questionnaire were studied by 5 experts who complete the validity form regarding the questionnaire. Then in a pilot study, translated CDQ completed by 81 CD patients who referred to Taleghani Hospital, Tehran. For assessing the validity and reliability of the questionnaire, confirmatory factor analysis and Cronbach’s alpha coefficient have been done, using Lisrel and SPSS software. Results: Of 81 CD patients entered to this study with mean age of 30.54 years old, 71.6% were female. Also, 56.8% were married and 45.7% were high educated. The mean of CDQ total score was 119.18±34. The calculated Cronbach’s alpha coefficient for CDQ questionnaire was 0.9. Also, for each subgroups the Cronbach’s alpha coefficient were calculated as the following; emotion: 0.92, Social: 0.89, Worries: 0.73, Gastrointestinal: 0.78. Confirmatory factor analysis indicated that all questions could be remain in questionnaire respectively. Conclusion: The reliability of the Persian version of CDQ was excellent with Cronbach’s alpha coefficients and Persian version of CDQ retains the psychometric properties of the original instrument and should be useful to assess outcome in studies and clinical trials involving Iranian patients with CD. [GMJ.2018;7:e1106]

Transcultural Adaptation and Validation of Persian Version of Celiac Disease Questionnaire (CDQ); A Specific Questionnaire to Measure Quality of Life of Iranian Patients.

Background: The assessment of health-related quality of life has become an important primary or secondary outcome measure in clinical and epidemiologic studies. The aim of this study was to validate a Persian version of Celiac Disease Questionnaire (CDQ) for Celiac disease (CD) among Iranian patients. Materials and Methods: The English version of the CDQ adapted to the Persian language by a forward-backward translation by 3 professional bilingual translators (1 medical, 2 nonmedical). The content validity of translated questionnaire were studied by 5 experts who complete the validity form regarding the questionnaire. Then in a pilot study, translated CDQ completed by 81 CD patients who referred to Taleghani Hospital, Tehran. For assessing the validity and reliability of the questionnaire, confirmatory factor analysis and Cronbach’s alpha coefficient have been done, using Lisrel and SPSS software. Results: Of 81 CD patients entered to this study with mean age of 30.54 years old, 71.6% were female. Also, 56.8% were married and 45.7% were high educated. The mean of CDQ total score was 119.18±34. The calculated Cronbach’s alpha coefficient for CDQ questionnaire was 0.9. Also, for each subgroups the Cronbach’s alpha coefficient were calculated as the following; emotion: 0.92, Social: 0.89, Worries: 0.73, Gastrointestinal: 0.78. Confirmatory factor analysis indicated that all questions could be remain in questionnaire respectively. Conclusion: The reliability of the Persian version of CDQ was excellent with Cronbach’s alpha coefficients and Persian version of CDQ retains the psychometric properties of the original instrument and should be useful to assess outcome in studies and clinical trials involving Iranian patients with CD.

Transcultural Adaptation and Validation of Persian Version of Celiac Disease Questionnaire (CDQ); A Specific Questionnaire to Measure Quality of Life of Iranian Patients

Background: The assessment of health-related quality of life has become an important primary or secondary outcome measure in clinical and epidemiologic studies. The aim of this study was to validate a Persian version of Celiac Disease Questionnaire (CDQ) for Celiac disease (CD) among Iranian patients. Materials and Methods: The English version of the CDQ adapted to the Persian language by a forward-backward translation by 3 professional bilingual translators (1 medical, 2 nonmedical). The content validity of translated questionnaire were studied by 5 experts who complete the validity form regarding the questionnaire. Then in a pilot study, translated CDQ completed by 81 CD patients who referred to Taleghani Hospital, Tehran. For assessing the validity and reliability of the questionnaire, confirmatory factor analysis and Cronbach’s alpha coefficient have been done, using Lisrel and SPSS software. Results: Of 81 CD patients entered to this study with mean age of 30.54 years old, 71.6% were female. Also, 56.8% were married and 45.7% were high educated. The mean of CDQ total score was 119.18±34. The calculated Cronbach’s alpha coefficient for CDQ questionnaire was 0.9. Also, for each subgroups the Cronbach’s alpha coefficient were calculated as the following; emotion: 0.92, Social: 0.89, Worries: 0.73, Gastrointestinal: 0.78. Confirmatory factor analysis indicated that all questions could be remain in questionnaire respectively. Conclusion: The reliability of the Persian version of CDQ was excellent with Cronbach’s alpha coefficients and Persian version of CDQ retains the psychometric properties of the original instrument and should be useful to assess outcome in studies and clinical trials involving Iranian patients with CD. [GMJ.2018;7:e1106]                           Â

Sexual Satisfaction, Marital Intimacy, and Depression in Married Iranian Nurses With and Without Symptoms of Secondary Traumatic Stress.

Nurses tend to experience a lot of stress and psychological pressure in their workplace. Secondary Traumatic Stress (STS) is a condition that can cause marital and psychological problems in married nurses. The present study was conducted to compare sexual satisfaction, marital intimacy, and depression in married nurses with and without severe symptoms of STS. The statistical population consisted of 303 married nurses selected through cluster sampling from three hospitals in Kermanshah, Iran, including Imam Reza (86 nurses), Imam Ali (110 nurses), and Taleghani (107 nurses) hospitals. Data were collected using the STS Scale, the Sexual Satisfaction Scale, the Marital Intimacy Questionnaire, and Beck's Depression Inventory (short-form) or BDI-13. The results obtained showed that 22.4% of all the nurses, 22.9% of the female nurses, and 21.8% of the male nurses had symptoms of STS and the mean score of the symptoms was higher in the female compared with the male nurses (P < .01). The results of the two-way multivariate analysis of covariance showed higher mean scores of sexual satisfaction and marital intimacy in the group without STS symptoms and a higher mean score of depression in the group with STS symptoms (P < .01). Psychologists and hospital authorities should pay more attention to the psychological problems faced by nurses, such as STS and its effects on sexual satisfaction, marital intimacy, and depression.

Comparison of the Effect of Misoprostol and Chewing Gum on Intestinal Movements after Cesarean Delivery

Cesarean is one of the major surgeries after which mother will need to be hospitalized for a long period of time. One of the leading causes of the increase in the duration of hospitalization of such patients is the surgeons’ projections about the development of ileus and defecation. Given the previous studies, misoprostol can increase bowel movements. Moreover, gum-chewing has been recommended as a cheap and available technique for accelerating the resumption of normal Intestinal Movements. The present study is a singleblind randomized clinical trial which has been done on 324 women over 18 years of age with singleton pregnancy who had visited Taleghani Hospital in Arak and was elective cesarean section candidates. The surgery and anesthesia techniques were similar for all patients. These patients were randomized into three groups of 108, namely control, misoprostol, and gum-chewing groups. The patients in these three groups were compared with one another in terms of normal bowel sound, gas passage, defecation and discharge. The results have shown the mean age of a total of 324 patients has been 26.66 years. The results suggest that the time of hearing the first normal bowel sound, the first gas passage, and defecation have been shorter in the misoprostol group, gum-chewing group and control group, respectively. The difference observed between the three groups has been significant at a 0.05 significance level. Furthermore, no significant difference was observed between the patients in the misoprostol and gum-chewing groups and the patients in the control group while reviewing the time of discharge of these patients. The findings have been indicative of the positive effects of the misoprostol and gumchewing techniques on the intestinal function of patients and mothers’ breastfeeding. Also, it has been observed that using misoprostol can be more effective than chewing gum.

Salivary Lipid Peroxidation and Antioxidant Status in the Patients with Papillary Thyroid Carcinoma: A Case-Control Study

Background: Oxidative stress has been shown to be the most significant influential factor in cancer pathogenesis. Follicular cells are affected in papillary thyroid carcinoma (PTC), which is the most prevalent thyroid cancer associated with oxidative stress. As a noninvasive source of body metabolism, saliva has recently attracted the attention of researchers as an investigative specimen. The present study aimed to evaluate and compare the levels of total antioxidant capacity (TAC) and malondialdehyde (MDA) in the blood and saliva samples of PTC patients and healthy control subjects. Methods: This case-control study was conducted on the patients with PTC referring to Taleghani Hospital in Tehran, Iran. Age- and gender-matched healthy volunteers were selected as the control group. Blood and saliva samples were obtained from all the subjects. Measurement of the MDA and TAC levels was performed using a commercial kit (ZellBio GmbH, Germany) based on colorimetric methods. Data analysis was performed in MedCalc software version 14.8.1. Results: In total, 33 PTC patients and 33 healthy subjects were enrolled in the study with the mean age of 34.6 ± 8.02 years. No statistically significant differences were observed in the demographic characteristics of the participants. Serum TAC and MDA levels were significantly lower and higher in the PTC group (P < 0.0001) compared to the control group (P = 0.0009), respectively. However, salivary TAC (P = 0.48) and MDA (P = 0.25) revealed no significant differences between the study groups. Conclusions: According to the results, PTC patients had oxidant/antioxidant imbalance, which could increase the risk of PTC. Furthermore, there were no significant differences in the TAC and MDA levels measured in the saliva of the PTC patients and control subjects. This finding could be attributed to the ultrafiltration in plasma, which involves the seeping-through of the plasma molecules, not allowing the use of saliva as a substitute for serum or plasma.

Survival Analysis of Colorectal Cancer Patients Using Exponentiated Weibull Distribution

Background: Colorectal cancer is a highly prevalent cancer across the world, which is associated with significant mortality. Therefore, special attention must be paid to the prevention and care of this fatal disease. The present study aimed to evaluate the effective methods to prolong the survival of colorectal cancer patients and determine the influential factors in their longevity using the exponentiated Weibull statistical model. Methods: Medical records of 446 colorectal cancer patients referring to Taleghani Hospital in Tehran, Iran during 1985 - 2013 were reviewed. The exponentiated Weibull model is an extended version of the Weibull model, which is used to investigate the survival of colorectal cancer patients and assess the influential factors in their survival and longevity. We also compared the model with the Weibull-exponential model for better practice. Results: Mean survival rate of the patients was 4.52 ± 0.182 years. According to the exponentiated Weibull model, age at diagnosis was the only significant influential factor in the survival of colorectal cancer patients (P = 0.002). Other factors such as gender, tumor size, family history of colorectal cancer, tumor site, and body mass index had no significant effects on the survival of these patients. The proposed model was considered superior to the Weibull-exponential model due to the lower Akaike’s information criterion. Conclusions: According to the results, age of colorectal cancer patients at the time of diagnosis is the most important influential factor in increasing their survival and reducing the mortality rate. Therefore, it is recommended that proper care be provided for the elderly patients with colorectal cancer, especially at the onset of the disease.

Self-efficacy Relationship With Social Health among Nurses in Taleghani Hospital in Kermanshah

Self-efficacy Relationship With Social Health among Nurses in Taleghani Hospital in Kermanshah

Effect of training after discharge on re-admission and re-hospitalization of patients with heart failure (randomized single-blind clinical trial)

Discharge is the process of transferring a patient from hospital which involves a transfer of responsibility from inpatient service providers or hospitalist to the patient and primary care physicians. Inappropriate follow up after discharge will increase the risk of and re-hospitalization which leads to the poor performance of the health system. The aim of this study was to determine the effect of physician's caring after discharge on and to doctors.This study was conducted as a clinical trial on patients with early intervention for educational instruction. The clinical trial was conducted at a later stage on 120 patients with heart failure who were hospitalized in Taleghani Hospital, Tehran. For a period of five months after discharge, using block randomization, the subjects were divided into two groups, including intervention and control groups. At the time of discharge, the patients in the intervention group received instructions and were trained by physicians, while no intervention was applied for the subjects in the control group . In addition to demographic questions, the patients were asked about two main outcomes, i.e. re-admission and referral to doctors. To collect the required data, the subjects in both groups were contacted via telephone calls (nine times) every week in the first month after discharge and two times per week in the following two months. Generalized linear mixed effects model method was used for evaluating the effect of physicians caring after discharge on and re-hospitalization.The results of this study showed that with the passage of time (weekly) after discharge, there was a significant increase in the rate of in the control group, while there was no significant increase in re-hospitalization. There was no statistical evidence showing a significant difference between the rates of along with the time in the treatment intervals. In other words, the patients in the control group experienced a significant increase in the odds ratio of over the time.

Prevalence of resistance to colistin, tigecycline and minocycline in Acinetobacter baumannii isolated from clinical samples in 2014

Background: Colonization rate of Acinetobacter baumannii is increasing in hospitalized patients especially in long term hospitalized one and / or who were treat with extended spectrum antibiotics or anticancer. Antibiotic resistance in A. baumannii is considerable because more prevalence of them cause nosocomial infections and can impose high cost to health systems and patients. The aim of this study was determination of tigecycline, minocycline and colistin resistance A. baumannii in selected center in Tehran, Iran. Materials and Methods: This study was descriptive and functional foundation. In this study A. baumannii were collected from Milad, Mofid, Taleghani, Motahari and Loghman hospital, Tehran and transferred to laboratory of pediatric infections research center. Collected bacteria were identified by conventional microbiology tests. Antibiotic susceptibility testing was determined according to CLSI guide line. Tigecycline, minocycline and colistin resistance strains were isolated. Results: In this study, 105 A. baumannii were collected from five selected hospitals: 48 (46%) from Milad, 33 (31%) from Motahari, 17 (16%) from Loghman, 4 (4%) from Mofid and 3 (3%) from Taleghani hospital. The highest resistance was observed against cefepime and high frequency of carbapenem and minocycline was observed. On the other hand, observed resistance to aminoglycosides was 93% at least. Tigecycline is the most effective antibiotic after colistin. Colistin resistant confirmed just in one isolate by E. test. Conclusion: The results of this study indicated that high rate of antibiotic resistance in A. baumannii even resistant to third and fourth generation of cephalosporin and carbapenem antibiotics. The treatment of MDR strains of A. baumannii become more complicated if the spread of them were not been controlled.

The high frequency of esophageal disorders in Iranian patients with non-cardiac chest pain.

The aim of this study was to evaluate the prevalence of gastrointestinal disorders in non-cardiac chest pain (NCCP) Iranian patients. Gastro-esophageal reflux disease (GERD) is the most common cause of NCCP, which accounts for about one third of cases. This was a descriptive study on consecutive NCCP patients who referred to the gastroenterology clinic at the Taleghani Hospital, Tehran, Iran from 2015 to 2017. Medical history, physical examination and esophageal test including upper gastroenterology (UGI) endoscopy, esophageal manometry and 24 hour ambulatory esophageal pH monitoring were done for each participant. The study included 102 patients, of which 58.9% were women, and the mean age of patients was 41.5 ± 11.2 years. The most common symptoms associated with chest pain were regurgitation in 28.4%, dysphagia in 23.5% and heartburn in 19.6% patients. UGI endoscopy was abnormal in 29.4% cases, esophageal manometry was abnormal in 61.7% cases and ambulatory pH monitoring was abnormal in 37.2% patients. Using UGI endoscopy and combined 24-h pH monitoring determined the prevalence of GERD 44.1% , and based on manometry the most frequent causes of NCCP was ineffective esophageal motility (IEM) in 19.6% patients with NCCP. Detecting etiology of NCCP allows healthcare providers to assure patients of the benign nature of their condition and provide appropriate treatment. It can also help prevent excessive hospital and physician visits as well as the costly and potentially risky testing which often results.

Evaluation of the cardiovascular risk in patients with biliary stones: a descriptive cross-sectional study.

the aim of this study was evaluating the risk of cardiovascular disease in patients with gallstones. Gallstones is the most common Biliary System disorder which its prevalence is increasing. On other hand, cardiovascular disease is the most common cause of mortality in the world. The causes and risk factors of cardiovascular diseases and gallstones are in common. In this descriptive cross-sectional study, patient with gallstones who hospitalized in Taleghani Hospital of Shahid Beheshti University of medical sciences or referred to its clinics in 2017, shared their demographic information and their underlying diseases with us. In addition, more data was collected with clinical examination, blood test, echocardiography and ultrasonography. Data was analyzed by SPSS vs21 software. In addition, online software was used for calculating Framingham and ASCVD risk score for cardiovascular diseases. 105 patients with gallstones and 105 healthy people participated in this study. There was no significant difference between these two groups for existence of main risk factors, but the average amount of ALT, AST, and ALP enzymes in patients with gallstones were significantly more than the control group (P value<0.05). The average amount of Framingham score was not significantly different between these two groups and the average score of ASCVD was statistically lower in our case group. The risk of cardiovascular disease in patients with gallstones is not significantly more than the general population.

Ondansetron 8 mg and 4 mg with normal saline against post-operative headache and nausea/vomiting after spinal anesthesia: a randomized double-blind trial

The study aims to evaluate the efficacy of ondansetron in preventing post-spinal headache, considering the high prevalence of the headache in pregnant women and the common use of the adjuvants for prophylaxis against post-operative nausea and vomiting (PONV). This double-blind clinical trial included the 195 patients who were referred to Taleghani Hospital (in Arak, Iran) for cesarean section (C/S) under spinal anesthesia, and then the subjects were assigned to three equally sized groups using block randomization. Participants in the first, second, and control groups received 8 mg, 4 mg of ondansetron, and normal saline, respectively, 5 minutes before surgery. A final volume of 5 cc was prepared by adding normal saline. Participants were examined for headache one week after surgery, and then data analysis was performed using SPSS 20. The incidence of post-spinal headache was significantly higher in the placebo group than in the ondansetron 8-mg and 4-mg groups at 24 hours after surgery (P < 0.010). But, no significant difference was observed between two ondansetron groups (P ≤ 0.05). The overall incidence of the headache was generally lower in ondansetron 8-mg (26.66% vs. 33.68.05%) and 31.66% in ondansetron 4-mg (P < 0.001). Moreover, the PONV incidence was significantly higher in the placebo group than in the other two groups at 24 hours (P < 0.001). The hemodynamic variables were same in three groups. The ondansetron 8-mg dose can be effective to prevent headache after spinal anesthesia for C/S. Moreover, the ondansetron 8-mg and ondansetron 4-mg have same effect in control of PONV after spinal anesthesia for C/S.

Assessment of Limb Fractures in Children Below 12 Years of Age

Background: In Iran, trauma is the second cause of mortality after cardiovascular diseases. Since children are known to belong to one of the high-risk age groups, the identification of the prevalent fractures in this age group could aid the identification of causes of fractures as well as damages observed in this group. Methods: In this descriptive cross-sectional study, a total of 5187 patients under 12 years of age, with definitive diagnosis of fractures referred to the Taleghani hospital of Kermanshah, were evaluated and the information was extracted from the patients’ records according to a researcher-built checklist, the validity of which was confirmed by 2 faculty members. The data was analyzed using SPSS v.16 software. Results: The average age of patients was 6.4±5.32 and their hospitalization duration was 1.2±0.98 days. Herein, 3579 patients (67% of the total number of patients) were male and a significant difference was observed between the 2 genders (P < 0.001). Furthermore, 3498 subjects (65.4%) had upper-limb fractures, 1662 subjects (31.2%) had lower-limb fractures, and 182 cases (3.4%) had non-limbic fractures. The most common cause of fracture was falling from a height (77%). Conclusions: The results demonstrate that a high percentage of fractures resulted from falling from a height, in males younger than 12 years old.

Clinical Manifestations of Mania in Patients With Bipolar I Disorder Based on the Primary Symptoms in DSM-5

Objective According to DSM-5, bipolar disorder is a condition in which the patient experiences one or several manic episodes and sometimes major depressive episodes too. The signs and symptoms of the disorders in DSM are generally influenced by cultural and ethnic factors. Therefore, the present study was aimed at identifying the clinical manifestations of mania in bipolar I disorder in Iranian population.Methods The present work is a cross-sectional study. The participants included 64 patients in the manic phase of bipolar I disorder who were selected from the Razi psychiatric hospital and the Taleghani Hospital, using a convenience sampling method. The study data were gathered using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Young Mania Rating Scale (YMRS).Results According to the findings, the most common signs and symptoms of mania in hospitalized patients with bipolar I disorder included reduced need for sleep (89.1), poor insight (87.5), elevated mood (85.9), talkativeness (79.7), and psychotic features (68.8). The major symptoms of the patients according to DSM-5 criteria included reduced need for sleep (89.1), talkativeness (79.7), and psychomotor agitation (40.6). According to t-test analysis, patients with and without a history of mental disorders did not have significantly different mania scores. The one-way analysis of variance (ANOVA) analysis indicated no significant difference in mania scores based on the age of onset of the disorder, marital status (single, married, divorced, or widow), education level, and number of hospitalizations. The chi-squared test revealed that patients with a lower education level showed more aggressive behaviors.Conclusion According to our results, since the response of a patient to a particular treatment is largely influenced by the symptoms of the disorder, clinicians should pay critical attention to the most common signs and symptoms of any mania.