Exposure to radiofrequency radiation emitted from mobile phone jammers adversely affects the quality of human sperm

Background: The health effect of rapidly increasing everyday exposure of humans to radiofrequency radiation is a major global concern. Mobile phone jammers prevent the mobile phones from receiving signals from base stations by interfering with authorized mobile carriers' services. In spite of the fact that mobile jammer use is illegal, they are occasionally used in offices, shrines, conference rooms and cinemas. The purpose of this study was to investigate the biological effects of short term exposure of human sperm to radiofrequency radiation emitted from a commercial mobile phone jammer

Materials and Methods: Fresh semen samples were obtained by masturbation from 50 healthy donors who had referred with their wives to Infertility Treatment Center at the Mother and Child Hospital, Shiraz University of Medical Sciences. Female problem was diagnosed as the reason for infertility in these couples. The semen sample of each participant was divided into 4 aliquots. The first aliquot was subjected to swim-up and exposed to jammer radiation. The second aliquot was not subjected to swim-up but was exposed to jammer radiation. The third and fourth aliquots were not exposed to jammer radiation but only the 3rd aliquot was subjected to swim-up

Results: Semen samples exposed to radiofrequency radiation showed a significant decrease in sperm motility and increase in DNA fragmentation

Conclusion: Electromagnetic radiation in radiofrequency range emitted from mobile phone jammers may lead to decreased motility and increased DNA fragmentation in human semen. It can be concluded that mobile phone jamming might exert adverse reproductive health effects

[Effect of anti - cyclic citrullinated peptide antibody and Rheumatoid factor on clinical diseases activity index in patients with rheumatoid arthritis]

Background and Objective: Rheumatoid arthritis is a chronic, inflammatory and systemic disease with peripheral, symmetric polyarthritis symptoms. Several genetic, environmental, and immunological factors contribute greatly to the disease pathogenesis. This study was done to evaluate the effect of anti-cyclic citrullinated peptide [anti - CCP] and rheumatoid factor on clinical disease activity index [CDAI] in the patients with rheumatoid arthritis

Methods: This prospective cohort study was done on 64 rheumatoid arthritis patients according to ACR criteria [1978] whom referred to Rheumatology Clinic of Hajar Hospital in Shahrekord, Iran. Patients were clinically examined for primary CDAI and tested for anti - CCP and rheumatoid factor in the prior and six months after the initiation of the study

Results: 81.3% and 74% of the patients had high titers of anti - CCP antibody and positive rheumatoid factor, respectively. A non-significant recudtion was observed in intensity of secondary clinical activity of the disease in compare to primary clinical activity in the patients with high antibody titer

Conclusion: This study indicated the important role of rheumatoid factor and anti- CCP antibody in the on time diagnosis of rheumatoid arthritis

[Corrolation of coagulant factors deficiency with preeclampsia]

Thrombophilia is characterized by increasing blood coagulability. It causes preeclampsia and repeated abortions. This study was done to determine the corrolation of coagulation factors deficiency with preeclampsia. This case-control study was carried out on 142 pregnant women with preeclampsia as caess and 142 pregnant women without preeclampsia as controls. Coagulation factors including Prs, prc, and anti-thrombin-3 were measured using ELISA and chromogenic methods. Prs deficiency was found in 2 [1.4%] and 6 [4.2%] of cases and controls, respectively. This difference was not significant. Prc and anti-thrombin- 3 deficiencies was not found in cases and controls. There is not any relation between deficiencies of coagulation factors with preeclampsia

Alterations of PSA, CA15.3, CA125, Cyfra21-1, CEA, CA19.9, AFP and Tag72 tumor markers in human blood serum due to long term exposure to high levels of natural background radiation in Ramsar, Iran

Ramsar [Mazandran province] is known for its extremely high levels of natural background radiation. Although no excess cancer rate is reported in these areas by epidemiological studies, the study of tumor markers in the inhabitants of these areas may shed some light on the impact of high levels of background radiation on cancer induction. The level of background gamma radiation as well as indoor radon was determined using RDS-110 and CR-39 dosimeters. Thirty five individuals from a high background radiation area [HBRA] and 53 individuals from a normal background radiation area [NBRA] were randomly selected to participate in the study. Commercial ELISA kits [sandwich type ELISA tests] were used to measure the serum levels of PSA, CA15.3, CA125, Cyfra21-1, CEA, CA19.9, AFP and Tag72 tumor markers. Among the eight biomarkers investigated, the means of PSA, CA15.3, CA125, CA19.9 and AFP concentrations between the HBRAs and NBRAs were not significantly different. However, Cyfra21, CEA and Tag72 in HBRA group revealed statistically significant increases compared to those of NBRA group [P<0.05]. Furthermore, a statistically significant correlation between the external gamma dose as well as indoor radon level and the concentration of CEA [P<0.001], Cyfra-21[P<0.001] and TAG 72 [P<0.001 and 0.01 respectively] biomarkers were observed. Chronic exposure to high background radiation induces significant alterations in Cyfra21, CEA and Tag72 levels. We believe that studies with other relevant tumor markers might overcome the limitations of epidemiological studies on cancer incidence in high background radiation areas

[Sexual health challenges of adolescents in Iran: a review article]

Becoming to an adult who is sexually healthy is one of the key developmental activities for adolescents. sexual health is included of sexual development and reproductive health and also the ability to create and maintain good interpersonal relationships, are valued for their body, Respectful engagement with both sexes in correct method and expressed a desire, love and intimacy based on personal and stable social values. In this study, using key words adolescence, sexual behavior, sexual risk behavior and sexual health and peers, related studies from 1370 to 1390 in IranMedex, Irandoc, Medlib, SID and Google scholar were investigated. Factors and challenges are associated with adolescent sexual health can be categorized into the following 4 themes [12 sub themes]: Religious beliefs and spirituality [abstinence]; lack of sexual education [false beliefs and knowledge about sexual function; adolescents' attitudes toward risky behavior and sexual relations; information sources of adolescents; skills for "say no"]; community and youth issues[gender differences; relationships with peers; monitoring and control by the family; communication challenges between teen and parents; socioeconomical factors; Centers for reproductive health services to adolescents]; adolescents sexual relationship outcomes [catching sexually transmitted diseases probability]. In some areas, including relationships between parents with children, gender differences, attitudes and sexual behavior and the influence of peers, Studies conducted in our country is well. But in areas such as spirituality and religious beliefs, self-control, prevalence of sexually transmitted diseases and AIDS, life skills in adolescents and intervention strategies to promote sexual health of adolescents there are a great gap

[ effect of nursing process-based care on patients' anxiety of candidates for women's elective surgery]

Although surgery as a means of therapy is used today and saves many patients' lives but it has also some complications. One of its most important psychological complications is preoperative anxiety. The aim of this study was to determine the effect of nursing process based care on patients' anxiety of candidates for women's elective surgery. Using a randomized clinical trial, 60 candidates for women's elective surgery in kosar hospital of Qazvin city were randomly assigned to either control or experimental groups. The experimental group was assessed based on nursing process after admission. If any nursing diagnoses including anxiety, knowledge deficit, or fear were found, then the required training was provided to the patients. The control group just received routine care. Data was collected using Amsterdam Preoperative Anxiety and Information Scale [APAIS] and a laboratory test for measurement of serum cortisol level. Data analysis was performed by descriptive and inferential statistics [Chi-square test, fisher's exact test, paired t test, independent t test, Wilcoxon and Pearson correlation] using SPSS-PC [v.17]. Paired t test results showed that the mean score for preoperative anxiety in the experimental group [13.6 +/- 3.3] compared to the time of admission [23.33 +/- 3.6] has been significantly decreased [p=0.001, t= - 4.7]. Whereas the mean score for preoperative anxiety in the control group [23/4 +/- 4.28] compared to mean score of anxiety at admission time [17/03 +/- 3.96] had been increased [p=0.001, t= -7.39]. Results of independent t test showed that the mean preoperative anxiety score in the experimental group was significantly less than control group [p=0.001, t=-10.3]. According to the results, nursing care based on nursing process as an effective and non pharmaceutical intervention can be recommended for reducing anxiety and concerns of these patients

[Female sexual satisfaction with different contraceptive methods]

The choice, acceptance and satisfaction of women with different types of contraceptive methods would affect their quality of life and sexual function. The aim of this study was to determine and compare the female sexual satisfaction with different types of contraceptive methods in clients referred to Qazvin city clinics. It was a descriptive cross-sectional study that was carried out among 467 women in 6 midwifery units of Qazvin city health centers in 2009 using cluster random sampling method. Sexual satisfaction was assessed with Larson Sexual Satisfaction Scale among women using different contraceptive methods. Data analysis was performed by descriptive and inferential statistics [Chi-square test, Pearson correlation test and ANOVA] using SPSS-PC [v.16]. According to the findings, the percentage of using withdrawal, condom, OCPs, DMPA, IUD, TL and vasectomy were 25.5%, 26.3, 13.3%, 6.6%, 18.8%, 6% and 3.4%, respectively. Most of the participants [54.9%] had moderate sexual satisfaction. There were a significant difference between the mean score of sexual satisfaction and use of different types of contraceptive methods [P=0.041]. The most sexual satisfaction was found with condom [28.6%] and withdrawal [26.5%] methods. The findings revealed that contraceptive methods can affect women's sexual satisfaction. Accordingly, executing family planning training programs for counselors regarding the suitable choose of contraceptive method considering women's sexual satisfaction is recommended

[ effect of balloon inflating on venous opening pain in children]

Venous opening is a usual but painful procedure in bedridden children. Performing anything to distract the child from thinking of pain could reduce the pain. This study was performed to determine the effect of balloon inflating on venous opening pain in 4-7 years old children. This was a randomized controlled trial in which 60 children [30 in balloon inflating group and 30 in control group] aged 4-7 years old who were referred to surgical department of Qods hospital investigated. A questionnaire including the demographic characteristics and FACES Wong-Baker pain gradation index was used to collect data. Using simple randomization, the patients were divided into two groups. In balloon inflating group, the children were educated on how to inflate a balloon prior to injection and later, using the pain determination tools, the severity of pain was measured at the time of venous opening. In control group, without any intervention, the venous was opened and the severity of pain determined. Data were analyzed using statistical tests including the chi square test and independent T test. The mean pain severity in balloon group was 1.60 +/- 1.42 and in control group 5.26 +/- 3.46 and the difference between two groups was significant, statistically. According to findings of the present study, balloon inflating is an effective, non medical, cheap and available method to reduce the pain in children when venous opening procedure is performed. Hence, it could be widely used to control and reduce the pain in children at time of therapeutic interventions

[ effect of family centered empowerment model on the quality of life in elderly people]

The proportion of older adults in the population continues to grow in the developing countries. In addition, in elderly persons decrease quality of life in geriatric because of several factors, such as, low physical activity and impairment in mobility. This study was performed to assess the effect of family centered empowerment model on the quality of life in charmahalobakhtiari elderly people This quasi-experimental study was conducted older adults in 2007-2008. In this study 60 elderly persons were randomly [Stratified Sampling] divided into two groups; experimental [30] and control [30]. Family centered empowerment model was administrated to the individual of experimental group for 3months; subsequently using SF-36 questionnaire, the level of quality of life was measured in the two groups at the beginning and the end of the study. The data was analyzed by using chi-square and nonparametric tests. quality of life score mean in contro group was 41.71. pair test analysis showed that by Using family centered empowerment model, mean of level of quality of life[75.46] in different were increase statically significant [p<0.01], whereas in the control group, these parameters, were unchanged. Our study results showed that using a family centered empowerment model can increase the level of quality of life in older adult in different dimension

Therapeutic effect of transmyocardial laser revascularization [TMLR] in patients with chest pain and normal coronary angiography [cardiac syndrome X]

Patients with syndrome X coronary disease represent a heterogeneous group of patients. Medical treatment with dilators and calcium channel blockers are not very effective. We evaluated the use of transmyocardial laser revascularization [TMLR] in treating 5 patients with this syndrome. Between May 2002 to December 2005, 5 patients with cardiac syndrome X [mean age of 49.7 years] underwent TMLR. All our cases were postmenopausal women. Mean class of Canadian class of angina was 3.4. Patients were none responding to maximum medical treatment. Angiograms showed small coronary arties with a large gap between branches which corresponded with severe ischemic on Thallium scan. We used Co2 laser between 35 to 45 joules of energy and we made 20 to 30 channels on the beating heart controlled by trans-esophagus echocardiography. Our patients were followed for 2.8 years. During follow up our patients remained asymptomatic and without any need medical treatment. Mean of Canadian class of angina after intervention was 1.8. Our patients returned to full activities. TMLR is an effective treatment in patients with syndrome X and coronary insufficiency

Crystal violet in culture media for diagnosis of neisseria species

Neisseria species are gram negative diplococci; an important characteristic of these bacteria is resistance against crystal violet. This study was done to investigate the effect of crystal violet on the growth of Neisseria, to observe the outcome of adding this substance in culture media for isolating these organisms, and finally to make a specific medium for isolation of the Nisseria species. The study was done in 3 phases: 1] Initially urethral discharge from 106 male patients with urethritis was cultured on NYC, chocolate agar and chocolate violet agar with various concentrations of violet from 1:100000 to 1:250000. We also made direct smears for gram stains. 2] Pharyngeal secretions from 230 healthy persons were cultured on chocolate agar, Muller Hinton agar, and Thayer Martin agar with different concentrations of violet between 1:50000 to 1:500000. Also direct smears were made for gram stains. 3] The standard strain of gonococcus [ATCC] were cultured on the three media. Concurrently we added various concentrations of violet from 1:50000 to 1:200000 to the above media and studied the effect of adding crystal violet on the growth of the standard strain. In first step, 69 out of 106 patients with urethritis were suspicious of gonorrhea, with positive culture of gonococcus on NYC medium from 64 patients. On chocolate agar only 54 positive cultures, [with 84% sensitivity against NCY medium], were seen together with a growth of normal flora. Chocolate agar plus violet in concentration 1:150000, showed 58 positive cultures, [with 91% sensitivity against NYC medium], with minimal growth of normal flora. In second step, 228 out of 230 healthy persons had positive culture of Neisseria, these organisms grew in different concentrations of crystal violet between 1:500000 and 1:50000. However, with minimal concentration of violet, there was a dense growth of normal flora and with gradual increase in concentration, normal flora grew sparsely. In direct exam, 228 cases of gram negative Neisseria like diplococci were observed. In third step, result of growth of the standard Neisseria gonorrhea in chocolate agar, Muller-Hinton agar and Thayer-Martin agar with and without different concentrations of crystal violet are as follow: In all media without crystal violet, the growth of the bacteria was perfect and abundant; while in media containing crystal violet, minimum colony count was observed in concentrations of 1:50000 and maximum colony count occurred at concentrations of 1:200000. To isolate pathogenic species of Neisseria, for e.g. gonococcus, we can use a specific chromogen medium like chocolate-violet agar 1:150000, or Thayer-Martin-violet agar or Muller-Hinton-violet agar with a concentration of 1:200000. Although nonpathogenic Neisseria have high resistance to crystal violet and were isolated from cultures with 1:50000 dilutions of this substance, but growth become sparse with higher concentrations. We can make chromogen media of varying strengths by adding different amounts of crystal violet in various media to get the desired results

Detection of Mycoplasma DNA from the sperm specimens of infertile men by PCR

Infections in accessory sex glands are considered as potential hazards to male fertility. These infections can affect different sites of the male reproductive tract such as the testis, epididymis and male accessory sex glands. Transmission of these infections to female partners causes genital infection, infertility and abortion. The aim of this study was to detect Mycoplasma, as one of the causatives, from the semen of infertile males using PCR assay. The survey considered 100 infertile men who referred to clinics and had not used antibiotics for 7 days prior to sampling. The infertility of cases was confirmed by a physician specialist. The sperm specimens were collected in sterile condition and sent to the laboratory rapidly. Specimens were examined for presence of Ureaplasma urealiticum and Mycoplasma hominis by PCR. Meanwhile, the history of vaginal infections and abortion in the female sexual partners was investigated. The results of multiplex PCR were compared with spermogram. All patients had no symptoms of genital infection. Of 100 infertile men, 33 [33%] were positive for CMU organisms [Chlamydia, Mycoplasma and Unreaplasma]. Uureaplasma urealiticum and Mycoplasma hominis were detected in 17 and 3 of patients respectively. Due to some problems in culturing of CMU organisms, PCR can be used as a diagnostic technique to detect such pathogens from seminal fluid of infertile men that leads to choose appropriate therapy in a shortest time

[Extra cardiac conduit Fontan procedure in 41 patients]

The Fontan operation is the definitive operation for palliation of complex congenital heart disease with single -ventricle physiology. The use of the extra cardiac conduit has recently been gaining popularity. The purpose of this study was to compare the outcomes of extra cardiac conduit Fontan procedure [off-pump technique] and that of traditional technique [lateral tunnel technique] in which cardiopulmonary bypass is routinely used. Forty one patients in different age groups underwent extra cardiac conduit Fontan procedure between April 2001 and December 2004. Data were collected from ICU sheets, files and during follow up visits. Under general anesthesia and through median sternotomy, using two temporary decompressing shunts, superior vena cava implanted on right pulmonary artery and a conduit interposed between transected inferior vena cava and main pulmonary artery. Fenestration was done in almost all patients and previous shunts were closed if there were any. Of our patients, 13 were female and 28 were male. Mean age of the patients was 11.1 years [SD=7.8].In 24.4% of cases Fontan procedure was done as the first palliative surgery and in 75.6% of them there was previous history of palliative procedures. In 6 patients [14.6%] we were constrained to use cardiopulmonary bypass which was predictable or necessary in 50% of cases. There was no reoperation due to post operative bleeding. Two cases suffered from prolonged plural effusion. Our in-hospital mortality was 9.8%. During 2-24 months follow up, we found two cases who were in NYHA functional class II and one case in functional class I. Extra cardiac conduit Fontan procedure could be used in a safe way. The results of this study were comparable and even in some cases better than that of the traditional technique

Detection of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum by multiplex PCR in semen sample of infertile men

The aim of this study was to detect Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum from semen samples of infertile men by Multiplex PCR and investigation of influence of bacteriospermia on semen parameters. Semen samples of 200 infertile men were evaluated by Multiplex PCR. In addition, analysis of semen parameters was performed according to the WHO guidelines. All the patients were without clinical symptoms of urogenital tract infection. Thirty three percent of cases showed at least one bacterium. We found a noticeable relation between the presence of bacteriospermia and the rate of non motile and morphologically abnormal sperms [P< 0.0001]. In addition, sperm concentration was lower in positive cases [P< 0.04]. There was no relation between leukocytospermia and bacteriospermia [P> 0.05]. Asymptomatic existence of Chlamydia and Mycoplasmas in urogenital tracts might play an important role in sperm impairment due to infertility. Bacteriospermia can influence sperm's motility, morphology and concentration

[Frequency comparison of nasal and hand carriage of staphylococcus aureus among the medical and non-medical staffs in Iranian Air Force Be´saat Medical Center]

Background: staphylococci is a resistant bacteria which may exist in normal flora of skin, eye, upper respiratory tract, gastrointestinal tract, urethra and rarely vagina. These species can be the causes of several syndromes such as superficial and deep cutaneous infections, systemic poisoning, and urinary tract infections. In the current survey, we studied the frequency of staphylococcus aureus carriers and compared it between medical and non-medical personnel in Be'saat medical center

Materials and Methods: an analytic cross-sectional study was designed to determine the frequency of nasal cavity and hand carriage of staphylococcus aureus among 253 personnel and compare the index between medical and non-medical staffs. The specimen was provided and cultured in selective media. By bacterial growth and determination of the species using specific diagnostic procedures, results were calculated in both medical and non-medical personnel and compared with chi-square statistical test regarding an alpha level of 0.05 as significant

Results: of total 253 personnel 65 [25.7%] were nasal carriers of staphylococcus aureus which 35 were medical [23% of 153 medical staffs] and 30 were non-medical [30% of 100 non-medical staffs] personnel. On the other hand, from 10 hand carriers of staphylococcus aureus 6 were medical [3.9%] and 4 were non-medical [4%] staffs [p>0.05]

Conclusions: due to our findings, in spite of higher frequency of staphylococcus aureus nasal carriage among medical staffs than non-medical personnel, there is not a significant difference between the prevalence. The same finding was obtained in hand carriage of the germ. So the target group of educating for hygiene improvement to decrease the load of colonies is not only the medical staffs [as the most traditional target] but also non-medical staffs [who are usually out of sight]

[Relationship between ADPKD and post renal transplant diabetes mellitus]

Autosomal-dominant polycystic kidney disease [ADPKD], a common hereditary disease, is characterized by the progressive development and enlargement of multiple cysts in both kidneys, and typically resulting in end stage renal disease [ESRD] by the fifth decade of life. Post-transplant diabetes mellitus [PTDM], a common complication after transplantation with an incidence rate of 2.5-20%, is associated with poor graft and patient survival. In few studies, PTDM has been more frequent in ADPKD transplanted patients. In the present study, we investigated whether there is any association between PTDM and ADPKD in our patients. In this prospective study, 140 non-diabetic and nonsmoker successfully transplanted patients [27 ADPKD and 113 non ADPKD patients] were enrolled during three years. Both groups were matched for age, sex, body mass index [BMI], duration of renal replacement therapy before transplantation and also immunosuppressive protocols after transplant. Post-transplant diabetes mellitus was defined as Clinical Practice Guidelines advocated by Canadian Diabetes Association. All patients were followed for 12 months. PTDM occurred in 11.1% of ADPKD patients and in 13.1% of control group which was statistically insignificant [P > 0.05]. The development of PTDM in ADPKD group was not related to sex, age, and hypertension, duration of renal replacement therapy before transplantation, BMI and serum creatinine levels [P > 0.05]. Post-transplant diabetes mellitus appears not to be associated with autosomal-dominant polycystic kidney disease as an etiology of end stage renal disease

[Detecting legionella pneumophila with sputum culture and urinary antigen test in patients with acute pulmonary infection]

Community acquired pneumonia [CAP] is a common health problem and one of the main mortality factors worldwide. Legionella pneumophila is one of the most common responsible microorganisms for CAP and may lead to severe complications if left untreated. The present study was conducted to determine the frequency of this organism in patients with CAP.We enrolled 118 patients with CAP, COPD and asthma in Masihdaneshvari Medical center during 2004-2005. For microbiological purposes sputum culture and legionella urinary antigen measurement were achieved. The study population included 32 females and 86 males, their age range 58-77 years. The most frequently isolated respiratory microorganism were: streptococcus pneumonia [88%], candida spp. [76.2%], streptococcus beta-hemolytic [61.8%], staphylococcus [40.6%], klebsiella spp. [27.1%], fungi [16.1%], E.coli [8.4%], pseudomonas spp. [5.1%]. Dyspnea, cough, sputum production, and fever were the most common findings. Smoking was the most commonly found risk factor. Atypical pathogens are responsible for 40% of community-acquired pneumonia and several studies have ranked legionella pneumophila among the three most common microbial cause of CAP in patients admitted to the hospitals. So this is important to notice that urinary antigen test is particularly useful, simple and rapid test for legionella positive cases, because it is often easier to obtain urine in ill patients and the results can be available within hours and also reliable to commence treatment

[Comparison of the effects of pethidine plus lidocaine and lidocaine alone on depth and duration of post operative analgesia in IV block of upper limb]

Background and Objective: One of the alternative methods for general anesthesia that has been used for a long time by means of local anesthetic drugs for brief limbs procedures is intravenous regional block. This research was designed to study the effects of pethidine plus lidocaine in intravenous regional anesthesia and comparing it with the conventional method of lidocaine alone in order to intensity the depth of block and duration of postoperative analgesia in upper limb procedures

Methods: In a prospective and clinical trial, 50 patients [20-60 years old] in ASA class I and II were divided into two groups: the patients in group 1 were injected 40 ml lidocaine 0.5% and to the patients in group 2 we added 50 ml pepthidine to their 40 ml lidocaine 0.5% regionally. At the end of surgery, along with tourinquet deflation 50 mg intravenous pethidine was injected to group 1. The onset time of tourniquet was recorded and the depth of the block was assessed according to the patient response to painful stimulation just before beginning of the surgery with five points scale. All the patients were followed up for 12 hours after procedure to determine the onset of postoperative pain and then it was recorded

Findings: the onset time of tourniquet, pain was 29.45 and 42.41 minutes in group I and 2, respectively [p=0.023]. The duration of postoperative analgesia in group 2 was 6.83 hours, which was obviously longer than that of group 1 [3.72 hours] [p=0.002]. The intensity of the block in group 2 was significantly more than group 1 [p=0.13]

Conclusions: According to the results, addition of pethidine to lidocaine in upper limb intravenous regional anesthesia, in contrast to the conventional method of lidocaine alone, not only delays the tourinquet pain and postoperative pain but also increases the intensity of block with clear improvement of the perioperative conditions