[ comparison of insulin and metformin effects on blood pH, bicarbonate, potassium and magnesium of the non-diabetic patients undergoing coronary artery bypass surgery]

Introduction: There is controversy regarding the effects of insulin and metformin usage in postoperative hyperglycemia after coronary artery bypass graft surgery. The purpose of this study is to compare the effect of insulin and metformin on blood acidity, bicarbonate, potassium and magnesium in nondiabetic patients undergoing coronary artery bypass graft surgery

Materials and Methods: In a clinical trial, 56 nondiabetic patients who underwent coronary artery bypass graft surgery in the Kowsar Hospital in Semnan and suffered post-operative hyperglycemia, randomly received insulin and metformin. Levels of blood glucose, acidity, bicarbonate, potassium and magnesium were measured and recorded for both groups before and after surgery. Data was analyzed [significant level 0.05] using Chi-square, Mann-Whitney and Friedman tests

Results: At the time of admission of patients in the ICU, means of arterial blood acidity, bicarbonate, potassium and magnesium were 7.37+/-0.07, 21.8+/-2.5 mEq/l, 4.3+/-0.5 mmol/l, and +/- 2.1+/-0.3 mg/dl respectively in the insulin group and in the metformin group these values were 7.40+/-0.05, 22.2+/-2.8 mEq/l, 4.1+/-0.5 mmol/l, and 2.1+/-0.4 mg/dl respectively. There was no significant difference between the means of potassium, magnesium and bicarbonate in the two groups at different times [P>0.05]. However, there was a significant difference between the mean values of arterial blood acidity 72 hours after admission in ICU in the two groups of insulin [7.41+/-0.03] and metformin [7.39+/-0.04] [P=0.047]. However mean PH of the blood remained normal

Conclusion: In nondiabetic patients who have hyperglycemia following coronary artery bypass graft surgery, the use of metformin and insulin does not affect bicarbonate, potassium and magnesium of blood. However, overtime the use of metformin may gradually increases the pH of the blood. Therefore, it is recommended that metformin should be used in patients with blood pH control

2-year follow-up of spirometric parameters in workers of a tile and ceramic industry, Yazd, southeastern Iran

Respiratory diseases cause a considerable amount of morbidity and mortality in the world. Pulmonary function tests are important measures for the diagnosis and management of respiratory disorders. Workers in tile and ceramic industry are exposed to high amounts of respiratory pollutants. To identify the changes in spirometric parameters in a 2-year period among tile and ceramic workers in Yazd and compare it with a control group. The study was conducted in 5 tile and ceramic factories selected by cluster sampling between 2009 and 2011 in Yazd, southeastern Iran. Demographic data and spirometric parameters of participants were recorded. Spirometric parameters were significantly reduced during the 2 years. The largest decrease was observed in FVC [=500 mL] in ball-mill and grinding after 2 years. Decrease in all spirometric parameters was significantly higher in industrial workers than office workers. Respiratory exposure in tile and ceramic industry can significantly affect pulmonary function tests

Assessment of conventional Crigler massage in recovery of congenital nasolacrimal duct obstruction

We aimed to determine the success rate of conventional massage in congenital nasolacrimal duct obstruction. 45 children attending to eye clinic with congenital nasolacriml duct obstruction initially were treated with Crigler massage ad conventional procedure. We therefore evaluated the effect of the implemented message upon one week. The overall success rate in all age groups was 84.4%, whereas it was 100% in group 1 [under 8 months], 75% in group 2 [8-12 months] and 100% in group 3 [13-24 months]. One eye did not response to treatment. Congenital nasolariml duct obstruction was more common in girls than boys and left eye involvement was more prevalent than right eye. Conservative treatment of nasolacrimal duct obstruction as a conventional procedure by ophthalmologist could be an efficient outcome

[Risk factors for diabetic retinopathy in type II diabetes mellitus]

To determine the correlation between presumed risk factors and diabetic retinopathy [DR] in patients with type II diabetes mellitus [DM]. This descriptive analytical study was performed on medical records of patients with type II DM referred to a diabetes clinic in Birjand Valiasr Hospital from September 2006 to September 2007. Parameters included age, sex, duration of DM, type of ocular involvement, blood lipid profile and levels of fasting blood sugar [FBS] and hemoglobin A1C [Hb A1C]. The study included 359 patients with mean age of 51.2 +/- 0.8 [range 35-65] years including 66.6% female subjects. Duration of DM was less than 5 years in 54.2%. Overall, 37.3% of patients had ocular involvement including non-proliferative retinopathy in 71.6%, proliferative retinopathy in 20.2% and cataracts in 3.0%. There was a positive correlation between presence of retinopathy and DM duration [P=0.001], age [P=0.006], male sex [P=0.002], high FBS levels [P=0.03] and low Hb A1C levels [P=0.001] but there was no significant correlation between retinopathy and blood lipid profile. Duration of diabetes, aging, male sex, high FBS levels and low Hb A1C levels increase the chance for developing diabetic retinopathy in patients with diabetes mellitus type 2

Surgical outcome in espohageal atresisia and tracheoesophageal fistula: a comparison between primary and delayed repir

The purpose of this study was to investigate outcomes of surgical repair of esophageal atresia [EA] or tracheoesophageal fistula [TEF] in newborns, with respect to incidence of death and other complications in early or late operations. Charts of all 80 infants with EA/TEF, operated in Alzahra hospital [A tertiary hospital of Isfahan University of Medical Sciences] from 2002 to 2004 were reviewed. Patients were designed in two groups as, primary and delayed repair groups. Patients demographics, frequency of associated anomalies, and details of management and outcomes were studied. There were 48 male and 32 female patients with a frequency of 28[35%] preterm infant and mean birth weight of 2473 +/- 595 g. Overall survival rate was 71.2%. Mortality rate in delayed repair group was significantly higher than the other one [22.5% vs. 6.3%] but with matching, according to full term/preterm proportion, the significant differences were failed. Female sex and being preterm were the most powerful predictors of death [nearly odds ratio=7 for both]. in this study mortality and complications rates are higher in delayed repair than early one, although our data proposed that in absence of sever life threatening anomalies the most important factor for death is gestational age and female sex, and primary repair is opposed to it. Although mortality rate and complications are equal in two strategies, with matching cases for being preterm, but primary repair stays the better choice due to economic considerations

Early and late complications following surgical repair of Hirschsprung's disease in pediatric patients: single-staged versus multiple-staged pull through

Background: early diagnosis and repair make a better prognosis in Hirschsprung's disease [HD] patients. Two basic approaches, namely single staged and multiple staged pull through are commonly applied to treat such patients. In this study we tried to compare short-term and long-term complications of the two procedures to provide a guide for choosing the safer and more effective approach

Methods: the study involved all the HD cases treated via either of the two common approaches during a seven-year period from 1995 to 2002 in Isfahan, Iran. Fourteen patients underwent single-staged repair [SS] but the remaining 48 were treated via a multiple-staged approach [MS]. Short-term and long-term complications together with patients' defecation patterns were compared between the two groups

Results: early wound infection was significantly more prevalent among MS group [9 [19%] in MS groups vs. 1 [7%] in SS group; P < 0.05]. Intestinal obstruction, severe enterocolitis, and anastomotic stricture were considerably lower in SS repair than in MS procedure. Defecation patterns in both groups were comparable. Compared with the MS approach, the number of hospital admissions and total length of stay were significantly lower in the SS group

Conclusions: although restoration of normal function is achieved with both procedures, early and late complications, number of admissions and the total length of hospital stay are considerably lower with the SS pull through. Therefore, with an earlier diagnosis, SS repair can be an improved strategy, which will bring a better prognosis for HD patients

normal position of umbilicus in the newborn: an aid to improve cosmetic result in exomphalos major

Background: position of umbilicus is an important esthetic landmark and its absence or deformity may be associated with poor self-image. In abdominoplasty, the creation of a normal-looking, well shaped and sufficiently deep umbilicus on a normal position seems essential. The aim of this study was to determine the normal position of umbilicus and hence to improve the cosmetic result of exomphalos major repair

Methods: in a cross-sectional study the position of umbilicus was determined in a random sample of 200 healthy and normal neonates [107 boys and 93 girls] who were born in Isfahan University hospitals from Oct. 2002 till Mar. 2003, with respect to the xiphisternum and pubis

Results: the normal umbilical position was 59.3 +/- 5.2 percent of the way from the inferior border of xiphisternum to the superior border of the pubis in the midline and it was independent of gender and neonatal growth indices

Conclusions: recent years have witnessed major improvements in the survival of newborns with exomphalocele. The primary repair of the abdominal wall with umbilicoplasty is generally considered the treatment of choice, and the cosmetic appearance of the navel becomes increasingly important as children grow older. In repair of exomphalos major, the most esthetically pleasing result is obtained if the umbilicus is placed 59.3% of the way from the xiphisternum to the pubis