Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial / Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós-operatórios em laparotomia: estudo clínico randomizado

Abstract Background: Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. Methods: A single-blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided into two groups of Total Intravenous Anesthesia (TIVA) and inhalational anesthesia. The incidence and the severity of PONV were examined at 0, 2, 6, 12 and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated. Results: 50.9% of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the inhalational group and 3.8% of the TIVA group (p = 0.15). 24.5% of patients in the inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043). Conclusion: The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug and the severity of nausea in patients were significantly lower in the TIVA group.

Resumo Justificativa: Náusea e Vômito no Pós-Operatório (NVPO) é uma complicação multifatorial com etiologia não esclarecida. A técnica anestésica, as características dos pacientes e o tipo de cirurgia são considerados fatores que afetam a NVPO. O presente estudo foi desenhado para comparar o efeito da anestesia inalatória com anestesia intravenosa na incidência e gravidade de NVPO na cirurgia abdominal. Método: Foi realizado estudo clínico mono-cego prospectivo randomizado com 105 pacientes com idades de 18 − 65 anos. Os pacientes foram divididos em dois grupos, Anestesia Total Intravenosa (TIVA) e anestesia inalatória. A incidência e gravidade de NVPO foram avaliadas em cinco momentos: 0, 2, 6, 12 e 24 horas pós-cirurgia. O uso de antiemético de resgate também foi avaliado. Resultados: NVPO ocorreu em 50,9% dos pacientes no grupo inalatória e 17,3% dos pacientes no grupo TIVA (p< 0,001). A incidência de vômitos relatados foi 11,3% no grupo Inalatória e 3,8% no grupo TIVA (p = 0,15). Necessitaram de medicação antiemética 24,5% dos pacientes no grupo Inalatória e 9,6% dos pacientes no grupo TIVA (p = 0.043). Conclusão: A incidência de náusea e vômito no pós-operatório, a necessidade de administração de droga antiemética de resgate e a gravidade da náusea foram significantemente mais baixas no grupo TIVA.

The knowledge, attitude, and action of Northern Iranian women about cervical cancer and screening

Background: Cervical cancer is one of the most prevalent cancers in the world among women which its early diagnosis plays an important role in the prognosis. There are many factors that contribute to the participation in the screening programs, most notably the level of knowledge and attitude of people towards cancer. Understanding the level of these factors in the female population and its association with participation in screening programs is important. Therefore, the aim of this study was to determine the knowledge, attitude and practice of women in the north of Iran to compare these factors between two groups with different baseline knowledge.Methods: This cross-sectional study was carried out among female medical clients and healthcare staff in a healthcare center in the north of Iran. All the eligible patients were interviewed and were asked to fill a questionnaire containing the demographic data, knowledge, attitude, and action about cervical cancer and screening. The data were analyzed by SPSS v24.Results: A total of 283 females entered our study of which 156(55.1%) were clients of the healthcare center and 127(44.9%) were non-physician healthcare staff. Ninety (60.8%) of clients and 39(56.5%) of the staff have performed pap smear at least once (p=0.556). The levels of knowledge and attitude were significantly lower in the clients (p < 0.001 and p=0.003, respectively). There were no significant differences regarding the level of knowledge and attitude between those who performed pap smear and those who did not (0.621 and 0.788, respectively).Conclusions: Increasing awareness, especially improving attitudes in the female population, should be the focus of the health care system to encourage more women to participate in screening programs.

[Clinical correlation between findings of renal scintigraphy and clinical/laboratory findings in children with febrile UTI]

Urinary tract infection [UTI] is one of the most common bacterial infections in children. Non-specific symptomatology in infants and young children makes the clinical differentiation between lower UTI and acute pyelonephritis [APN] difficult. The aim of this study was to assess the correlation between APN findings of renal cortical scintigraphy and selected clinical/laboratory findings of febrile UTI in infants and children admitted at our center. A prospective study was conducted in 83 infants and young children aged I month -8 years hospitalized with febrile UTI in nephrology ward of Abuzar children's hospital. Within the first 5 days after admission, Tc-99m DMSA renal scintigraphy, ultrasonography [US], voiding cystoureterography [VCUG], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], hemoglobin [Hb], white blood cell count [WBC] and urine analyses were performed. Mean age was 24.3 months with 82% [68] girls. DMSA scintigraphy showed APN findings in 45/83[54.2%] patients, with a mean age of 30.2 months, including 9 males [20%] and 36 [80%] females. There were statistically significant correlations between the APN findings of DMSA scintigraphy and the fever duration, body temperature, lucocytosis, anemia, proteinurea, CRP levels and ESR [p<0.05]. Vesicoureteral reflux was found in 20.5% of patients with no statistically significant correlations to the APN findings of DMSA scintigraphy. Although initial DMSA renal scintigraphy is useful for determination and localization of kidney involvement during febrile UTI, some clinical and paraclinical findings can predict the scintigraphycal findings of kidney involvement that need further evaluations for portable complications in the future

[Goldenhar syndrome]

Goldenhar syndrome [GS] or Oculo-Auriculo-Vertebral Syndrome is a rare disease characterized by craniofacial anomalies such as hypoplasia of the mandible and malar bone, microtia, and vertebral anomalies. GS is an etiologically heterogeneous disorder that may have a genetic basis in some cases. Here, a 3-month-old girl with GS is reported. She was brought for routine check-up. On physical examination, the unusual features were facial asymmetry, unilateral macrostomia, a preauricular tag low set ear, atresia of external ear canal and an epibulbar dermoid cyst at the left side. Brain-stem evoked response audiometry showed severe-profound conductive hearing loss on the left side. She has an older brother with the same problems. Congenital malformations in patient with GS are unilateral. Early detection and treatment of hearing loss is very important in the development of the patient

Chronic kidney disease in southwestern Iranian children

The aim of the study was to determine the etiology of Chronic Kidney Disease [CKD] among children attending the pediatric nephrology service at Abuzar children's hospital in Ahvaz city, the referral center in Southwest of Iran. We reviewed the records of 139 children, diagnosed to have CKD over a 10-year period. CKD was defined a glomerular filtration rate [GFR] below 60 ml/1.73 m2/min persisting for more than 3 months. Among 139 children 81 [58%] were males. The mean age at diagnosis of CKD in the patients was 4.2 [ +/- 3.6] years. Mean level of serum creatinine at presentation was 1.9 [ +/- 1.4] mg/dl. The mean GFR at presentation was 33.5 [ +/- 15.4] ml/1.73m2/min while 22% of the patients were already at end stage renal failure indicating that these children were referred too late. Congenital urologic malformation was the commonest cause of CKD present in 70 [50.4%] children [reflux nephropathy [23.1%], hypo/dysplastic kidney [15.8%], obstructive uropathy [10.8%], and prune belly syndrome [0.7%]]. Other causes included hereditary nephropathies [17.2%], chronic glomerulo-nephritis [6.5%], multisystemic diseases [4.3%], miscellaneous and unknown [each one 10.8%]. The mean duration of follow-up was 26 [ +/- 24.67] months. Peritoneal or hemodialysis was performed in 10 patients. Six patients underwent [4 live-related and 2 non-related] renal transplantation. The rest have died or received standard conservative management for CKD. The commonest causes of CKD were reflux nephropathy, hypo/dysplastic kidney, hereditary nephropathy and obstructive uropathy. Patients presented late, had severe CKD and were malnourished and stunted

Idiopathic nephrotic syndrome in Iranian children.

Of 231 children with nephrotic syndrome, 87% were steroid sensitive and 13% steroid resistant. Of patients with steroid sensitive nephrotic syndrome, 38.8% were non-relapsers, 34.8% frequent relapsers and 26.4% infrequent relapsers. Among those with steroid resistant nephrotic syndrome, 37.5% had focal segmental glomerulosclerosis with a high mortality rate of 44%

Idiopathic hypercalciuria in Iranian children

The aim of this study was to determine the prevalence of idiopathic hypercalciuria [IH] in school children in Ahvaz, a city with different ethnic groups located in the Southwest of Iran. In a descriptive cross sectional study from October to December 2006, we determined urinary calcium [UCa] and urinary creatinine [UCr] in the morning urine samples of 500 primary school children. The levels of 24-hour UCa and UCr were measured in these children. Level of 24-hour UCa exceeding 4 mg/kg/day was considered as hypercalciuria, and UCa/UCr ratio exceeding 0.21 [mg/kg] was considered abnormal. Children who had hypercalciuria with a normal concentration of serum Ca were categorized as idiopathic hypercalciuric. Of 500 children aged 6-12 years, 231 were males and 269 females. In the first screening, 64 [12.8%] children [45 males, 19 females] had an abnormal UCa/UCr ratio. But in the end only 15 had the criteria of IH, i.e. the prevalence of IH was 3% [1.8-4.8%, confidence interval of 95%]. The prevalence in females and males was 0.74% and 5.6%, respectively [P= 0.003]. Of these children 10 had hematuria [including 2 cases of gross hematuria], 8 children gave a history of recurrent abdominal pain, 5 children suffered from dysuria and 3 persons had a history of personal or familial urolithiasis The study showed that 3% of primary school children in Ahvaz had IH predisposing to short-term and long-term complications of the disease. IH was significantly more common in boys than in girls

Association of urinary tract abnormalities in children with first urinary tract infection

Urinary Tract Infections [UTI] may be a variety of presentation of underlying urinary tract abnormalities including vesicoureteral reflex [VUR], obstructive uropathy, urolithiasis, and ureteral duplication. The long-term complications of UTI with these conditions are renal scarring, hypertension, and chronic renal failure. The aim of this study was to determine the incidence of urinary tract anomalies associated with first UTI. We reviewed 158 patients [aged one month to 15 years] who were hospitalized with symptomatic UTI during a 2-year period [2001-2003]. Patients with incomplete investigations were excluded from the study. One hundred twenty six patients [100 girls and 26 boys] were included in the study. Ninety-seven [77%] were under 5 years. Confirmed cases of UTI underwent renal and urinary tract ultrasonography [US], voiding cystourethrography [VCUG],and 99mTc-dimercaptosuccinc acid [DMSA] scan. The most common presentation were fever [83%] and dysuria [48%]. The commonest causative agent was E coli [88%]. VUR was found in 50 [39.6%], 39 girls, and 11 boys. Other urinary tract abnormalities were renal stone in 10 [8%] patients, pelvic ureteric junction obstruction in 8 [6.3%], neurogenic bladder in two boys and one girl, double collecting system in 2 girls, posterior urethral valves in two boys and ureterocele in one girl, respectively. Forty percent of patients had VUR and 20% had other associated abnormalities in urinary tract. We recommend that US, VCUG and DMSA scan should be routinely performed on all patients after the first UTI