effect of 12 weeks regular physical activity and vitamin E in the treatment of non-alcoholic steatohepatitis: a pilot study

Despite the prevalence of Non-Alcoholic Fatty Liver Disease [NAFLD] and Non-Alcoholic Steatohepatitis [NASH], there was no treatment has been proven to be effective in these common diseases. Although many studies have shown that lifestyle modifications such as increasing physical activities and exercise could be effective in the treatment of these common diseases, the optimal strategy was still not determined. According to the beneficial effects of antioxidant agents in the treatment of NASH, vitamin E has been used for this purpose by some clinicians. We designed this study for assessing beneficial effects of regular physical activity on the biochemical and imaging responses in patients with NASH and comparing this with vitamin E as an accepted treatment for NASH. This study was Randomized and single-blind clinical trials were carried out in Gonbad-e Kavus through which a total of 30 consecutive patients with the ultra sonographic diagnosis of non-alcoholic steatohepatitis [NASH]were enrolled and randomized to one of the three groups: Vitamin E 800 mg/day, regular physical activity, or both. In all treatment groups improvement in liver transaminases level, serum lipids and ultrasonographic grading of fatty liver occurred after three months of treatment. When these decrement was compared between the treatment groups, there was no statistically significant difference in the value of improvement between the three groups [ANOVA: p>0.5]. I.e. all three interventions improved the biochemical and ultrasonographic finding of fatty liver in the same way. Both groups with regular exercise had significant mean weight loss in comparison with the vitamin E group [a mean decrease of 3.0 kg in exercise group, 5.8 kg in subjects on regular exercise plus vitamin E and 0.2 kg in vitamin E group, ANOVA: p=0.04]. There were no significant differences between exercise and vitamin E alone or in combination regarding the reduction in the level of liver enzymes and sonographic evidences of fatty liver although both resulted in significant improvements in biochemical endpoints. This implies that physical activity could be considered as effective as vitamin E in the improvement of biochemical and ultrasonographic presentations of NASH and the addition of Vitamin E does not offer any benefits. According to the findings of this pilot study a full-powered study with a control group should be designed

Dexamethasone for prevention of postoperative shivering: a randomized double-blind comparison with pethidine

Postoperative shivering is very common and followed by many problems such as increasing oxygen consumption, blood pressure, intracranial and intraocular pressure, and postoperative pain. Therefore, prevention of shivering is important, especially in elderly and ischemic heart disease patients. The goal of this study was to compare the effect of pethidine [meperidine], dexamethasone, and placebo on prevention of shivering. This double-blind clinical trial study was carried out on 120 patients who were candidates for surgery under general anesthesia. The patients were randomly divided into three groups. Induction and maintenance of anesthesia for all patients were similar. Temperature of patients was measured every 5 min interval. After induction, saline 0.9%, dexamethasone and pethidine were injected to groups a, b, and c, respectively. In recovery, patients were controlled for visible shivering. All data were statistically analyzed by analysis of variance [ANOVA] and Chi-square tests. There were no significant differences among three mentioned groups regarding gender, age, duration of surgery and anesthesia, extubation time, duration of recovery, and basic clinical characteristics. Nineteen cases [47.5%] of placebo group had postoperative shivering, whereas in dexamethasone group only four cases [10%] had shivering and the difference between the two groups was significant. Also in pethidine group, 15 cases [37.5%] had shivering and the difference with placebo group was significant [P value = 0.001]. The present study showed that pethidine and dexamethasone are effective drugs for prevention of postoperative shivering in elective surgery and the effect of dexamethasone in preventing the postoperative shivering is better than pethidine

Comparison of the effects of remifentanil and alfentanil on intraocular pressure in cataract surgery

Anesthesia for ophthalmic surgery requires management of intraocular pressure [IOP] during perioperative period. In an open eye, in conditions such as after traumatic injury or during cataract surgery, IOP increase can lead to permanent vision loss. Administration of narcotics concomitant with anesthetics has the ability to reduce this increase of IOP. This clinical trial aims to compare the efficacy of remifentanil and alfentanil in preventing an increase in IOP after administration of succinylcholine, intubation and during anesthesia. This double-blind clinical trial was conducted on 50 patients undergoing elective general surgery for cataracts. Patients were randomly divided into two groups. Alfentanil [20 microg/kg in 30 s] for group 1 and remifentanil [1 microg/kg in 30 s] for group 2 were injected before induction of anesthesia, and 0.5 microg/kg/min alfentanil for group 1 and 0.1 microg/kg/min remifentanil for group 2 were infused during the anesthesia. Systolic and diastolic blood pressure, heart rate, and IOP from normal eye were measured before the induction, after administration of thiopental and succinylcholine, after tracheal intubation, and 2 min later, and were repeated in 2-min intervals until the end of operation. IOP decreased after injection of anesthetics and remained lower all through the operation in both groups, but IOP decreased after injection of succinylcholine in remifentanil group while it increased in alfentanil group [P<0.05]. Results of this study indicate benefits of both remifentanil and alfentanil in managing IOP after induction and during anesthesia. It seems that remifentanil is better than alfentanil in controlling the IOP after injection of succinylcholine

[ effect of peritonsilar lidocaine injection on post-tonsillectomy pain in children: a triple blind clinical trial]

Pain management is very important in tonsillectomy in order to reduce the suffering and restlessness in children. The aim of this study was to investigate the effect of peritonsillar injection of lidocaine and placebo preoperatively on postoperative pain relief. This randomized triple blind clinical trial conducted on sixty 3-12-year-old children who were candidate for tonsillectomy. Children were randomly assigned to lidocaine and placebo groups. Anesthesia inducted similarly for all patients and peritonsillary 1 mg/kg lidocaine [per 2 ml volume] in the first group and 2 ml normal saline in the second group was injected. Pain assessment was performed using the self-report Oucher Scale and CHEOPS. The mean pain score in lidocaine group in 5, 15, 30, 60,120 and 240 minutes after surgery was lower than placebo group but this difference [in Oucher scale] was only statistically significant at 240 minuets after surgery [P =0.03]. The preoperative peritonsillar injection of lidocaine is an effective method of reducing post-tonsillectomy pain in children

comparison of alfentanil and remifentanil infusion during anesthesia on post-anesthesia recovery

With consideration the daily increased development of outpatient surgeries and high rate of these surgeries in elderly patients, rapid and safe recovery of patients is necessary. In this clinical trial study, recovery time and nausea and vomiting after the use of two rapid-onset narcotics, Alfentanil and Remifentanil, in elderly patients were evaluated. In this double-blind prospective clinical trial, 40 elderly patients [age above 65 years] candidate to cataract surgery with general anesthesia were studied. The patients were divided randomly into two groups and for first group, 10 microg/kg of Alfentanil was injected and for second group Remifentanil 0.5 microg/kg was injected intravenously during 30 seconds one minute before induction. Both two groups were under general anesthesia with same method and during the anesthesia, first group took infusion of Alfentanil 1 micro g/kg/min and second group took Remifentanil 0.1 micro g/kg/min. In the end of surgery, the time intervals between end of anesthesia drug administration and spontaneous respiration, eyes opening with stimulation, verbal response and discharge of recovery room, also the incidence of complications related to narcotic drugs, especially nausea and vomiting, was recorded. The data were analyzed in SPSS software using descriptive and analytical statistics such as T-test and chi square test. The time of spontaneous respiration in Alfentanil group was 2 minutes and in Remifentanil group was 3.3 minutes, the difference was not statistically significant [P=0.08]. The time of eyes opening with stimulation, verbal response, and discharge of recovery room were not significantly different. During recovery, incidence of nausea and vomiting in Remifentanil group [30% of patients] was significantly more than Alfentanil group [5% of patients] [P=0.045]. Recovery time between Alfentanil and Remifentanil group was not significantly different, but incidence of nausea and vomiting in Remifentanil group was higher than Alfentanil group significantly. It seems that using Alfentanil in the anesthesia for surgical treatment of the elderly people can be preferred

Heart murmur in neonates: how often is it caused by congenital heart disease?

Congenital heart disease [CHD] is the most common form of cardiovascular diseases in children. This study was performed from September 2006 to August 2007 in Ardebil, Westnorthern Iran. The aim was to determine the prevalence of heart murmur in newborns and its correlation with CHD. In a 1-year cross sectional descriptive-analytic study, 2928 newborns were screened for heart murmur during routine neonatal physical examination. All babies with murmur underwent echocardiography. Murmur was detected in 91 [3.1%] neonates, of whom 47 [51.6%] had a congenital heart disease. The most common [17.6%] abnormality was ventricular septal defect. Patent ductus arteriosus was found in 10 [11%] patients. Remarkable high [round 50%] rate of CDH in newborns presenting with heart murmur, urges to observe these neonates closely to establish the diagnosis of congenital heart disease and early referral to pediatric cardiologist