commemorating one thousandth anniversary of the avicenna's canon of medicine: gastric headache, a forgotten clinical entity from the medieval Persia

Although the connection between head and stomach and hence the condition known as [gastric headache] was well known to the ancients, it has received little attention since the early 20[th] century. Herein, we review the teachings of the medieval Persian physicians about the gastric headache along with the related signs, symptoms, types and causes. The medieval Persian scholars adopted the main ideas of the gastric headache from predecessors in the ancient Greece and Rome, added substantial sub-categories and details to the earlier descriptions and therapeutic options. The medieval Persian physicians' contributions to the concept of gastric headache influenced beyond doubt the later accounts of this condition

Propofol for laryngeal mask airway insertion in children: effect of two different doses

To compare two different doses of propofol for laryngeal mask airway [LMA] insertion in children undergoing out-patient surgeries. Insertion of LMA just after anesthesia induction is facilitated using propofol. However, the optimal dose of this drug not determined yet as heavy doses may lead to severe complications, whereas lower doses may not be quite as effective. In a double-blind randomized clinical trial, 120 children undergoing out-patient surgeries were recruited to receive intravenous propofol at a dose of either 2.5 mg/kg [group 1] or 3.5 mg/kg [group 2] for induction. Intravenous midazolam [0.03 mg/kg] and fentanyl [1 microg/kg] were used as pre-medication in all patients and anesthesia induction was initiated using lidocaine [1 mg/kg] prior to propofol administration. Hemodynamic changes, probable complications, quality of the established airway and number of attempts for LMA insertion were compared between two groups. There were no differences in systolic and diastolic blood pressure, heart rate, peripheral oxygen saturation and intraoperative complications between the groups [P>0.05]. LMA insertion was successful at the first attempt in 55 [93.2%] and 54 [91.5%] cases in group 1 and group 2, respectively [P>0.05]. The efficiency of the established airways was adequate in all the patients of both groups. It seems that propofol doses of 2.5 and 3.5 mg/kg are equally effective for LMA insertion following intravenous midazolam, fentanyl, and lidocaine

there a correlation between hs-CRP levels and functional outcome of Ischemic Stroke?

C-reactive protein, a well known marker of inflammation is being investigated as a probable marker of predicting acute cardiovascular events and its severity. The aim of the present study was to assess the possible role of highly-sensitivity C-reactive protein [hs-CRP] in predicting short-term functional outcome of ischemic stroke. A prospective study was conducted on subjects admitted with first attack of confirmed ischemic stroke. It included 50 male and 52 female. Serum hs-CRP was measured in the 2[nd] [CRP-D2] and 5[th] days [CRP-D5] post-stroke. Modified Rankin scale [MRS] was measured in all subjects in the 2[nd] [MRS-D2], 5[th] days [MRS-D5] and also 3 month [MRS-M3] after stroke to assess the short-term functional outcome and mortality of subjects. The mean age of the patients was 71.75 +/- 11.44 years. The mortality rate was 47.1% in the third months after stroke. There was no significant correlation between CRP-D2 and MRS-M3 and also between CRP-D5 and MRS-M3 [P>0.05]. However there was a significant association between high CRP-D2 [CRP>3] and MRS-M3 and also between high CRP-D5 and MRS-M3 [P<0.005]. This study showed that the value of CRP by itself could not predict the severity of short-term functional disability and it might not be useful as a clinical tool for predicting outcome

Electrodiagnostic Evaluation of Peripheral Nervous System Changes in Patients with Multiple Sclerosis

Background: There is supportive evidence that multiple sclerosis (MS) could potentially affect the peripheral nervous system. We assessed peripheral sensory and motor nerve involvement in patients with MS by a nerve conduction velocity test. Methods: We studied 75 patients who had a relapsing-remitting or secondary progressive pattern. We measured amplitude, latency, conduction velocity, Hoffmann reflex (H-Reflex), and F-Waves. Results: The amplitude of the right tibial, right proneal, left tibial, left proneal, and left median motor nerves was less than the mean for the normal population. Right ulnar sensory conduction in the patients showed an amplitude that was less than that of the normal population; there was no significant change in the amplitude of other sensory nerves. Latencies of the right and left median and right proneal motor nerves and left ulnar sensory nerves were statistically less than that of the normal population. Mean motor conduction velocity and F-wave conduction did not differ significantly from the normal population. H-reflex latencies of the right and left lower limbs were significantly more prolonged than those of the normal population. Conclusion: Our results suggest possible peripheral motor nerve abnormalities in MS patients, especially with the amplitude of the motor nerves; however, our results do not demonstrate any significant difference among the nerve conduction velocity parameters of sensory nerves between MS patients and the normal population.

Administration of remifentanil in establishing a more stable post-anesthesia cardiovascular status in neurosurgical procedures

Emergence from general anesthesia and especially post-extubation phase are the stages associated with cardiovascular hyperdynamic status in which patients with increased intracranial pressure [ICP] could be affected by severe cardiac and or cerebral complications. Administering remifentanil could be helpful in maintaining the hemodynamic stability at the end of the surgery and recovery stages and reducing recovery phase length. In a double-blind prospective randomized clinical trial, 60 adult patients with ASA [American Society of Anesthesiologist] class of I-II scheduled to undergo elective neurosurgery operations were randomly divided into two groups receiving remifentanil and placebo as IV infusion within four minutes prior to extubation continued by an IV infusion for 10 minutes after extubation. There was a significant difference between two groups regarding the changes of Mean Arterial Pressure after extubation and five minutes after extubation [P< 0.001].Remifentanil group compared with control group was of significant difference at all heart rate values after extubation [P< 0.001]. Remifentanil could be used in preventing hyperdynamic status throughout extubation phase without extending recovery phase length. However, administration of this medication should be performed cautiously.

evaluation of the effect of morphine on abdominal pain and peritonealirritation signs in patients with acute surgical abdomen

Acute surgical abdomen is one of the most common emergency surgical causes all over the world and also one of the most important abdominal pain causes which is sometimes intolerable for the patients referring to the emergency departments. Diagnosis and planning for operation in these cases is based on time-demanding serial examinations and results of paraclinical data. In this waiting period, patients have to tolerate pain. Therefore, we aimed to study the hypothesis that relieving pain has no influence on valuable findings in physical examination. This double blind randomized clinical trial was carried out on 120 patients above 12 years old referred to an emergency department of a referral hospital with acute abdomen. Patients were divided into two groups of receiving intravenous placebo and Morphine randomly. Pain score, change in tenderness as well as change in rebound tenderness before and after receiving morphine or placebo were measured based on Numeric Pain Assessment Scale. Statistically significant difference was observed between both groups regarding the mean pain score. Prevalence of tenderness and rebound tenderness after medication administration revealed a significant difference between two groups. Furthermore, pain and tenderness showed a significant decrease in patients receiving morphine also a significant difference occurred in rebound tenderness between two groups. Despite the fact that opioid analgesics decrease pain in patients with acute surgical abdomen, they do not tend to eliminate required diagnostic data being obtained from physical examination like tenderness and rebound tenderness. Surprisingly, all the acute abdomen cases had rebound tenderness after morphine administration. Therefore, this research advises a cautious usage of morphine in patients with acute abdomen.

Multimodal preincisional premedication to prevent acute pain after cholecystectomy

Postoperative pain as an important medical concern is usually treated by opioids which also are of various inevitable side effects. The aim of this study was to assess the efficacy of multimodal preincisional premedication on preventing post-cholecystectomy acute pain. In a randomized clinical trial, sixty patients undergoing open cholecystectomy were randomized into two groups. Before anesthesia induction, Diclofenac suppository [100 mg] and oral Clonidine [0.2 mg] were administered in the first group. Immediately before operation, patients received Ketamine [1 mg/kg IV] while the control group received placebo. The site of incision was infiltrated by the surgeon with 20 mL Bupivacaine 0.25% in both groups. Anesthesia induction and maintenance were similar in both groups. The severity of pain was recorded 2, 4, 6, 12, 24 and 48 hours after operation according to Visual Analogue Scale. The severity of pain at two defined stages [6 and 12 hours later] was significantly less in the intervention group than the control group [P<0.005]. The average pain severity score was less than the control group [P<0.005]. In our study, the administration of Clonidine, Diclofenac and Ketamine and bupivacaine infiltration to the site of incision, altogether was associated with a significant decrease in pain score and opioid requirement after cholecystectomy in comparison to bupivacaine infiltration to the site of incision.