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The pain of the chest and abdominal injuries in patients who undergoing mechanical ventilation is controlled by regional or systemic administration of drugs. We designed this study for comparison of effect of intravenous and epidural injection of fentanyl on pain reduction and hemodynamic status in patients with abdominal and thoracic injuries. In this prospective clinical trial study, we randomly allocate 60 patients aged 16 to 80 years who were undergoing mechanical ventilation due to thoracic or abdominal injuries, to two groups. In B group during first 24 hour of admission pain management was done by epidural infusion of fentanyl and in the next 24 hours, this method was changed to intravenous infusion of fentanyl. In A group, initially method was intravenous and after 24 hours, we changed it to epidural method. We assessed pain score and hemodynamic status at the specific times. In both groups after first 2 hours, pain sore was significantly lower in intravenous method but after 6 hours, pain score was significantly lower in epidural method. Hemodynamic status in epidural method was significantly more stable than IV method. This study showed that for patients who were undergoing mechanical ventilation due to chest or abdominal injuries, intravenous infusion of fentanyl provides more pain relief during first two hours but after six hours epidural method is better than intravenous infusion
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Background and Objective: Evaluating students' ability in diagnosing and treating patients after graduation has been recognized as a priority for medical education. The aim of this study is to evaluate students' ability after graduation from Kerman University of Medical Sciences, Iran, in diagnosing and treating orthopedic problems
Methods: This is a retrospective, cross sectional study carried out on 115 graduated general practitioners of 2001-2006 academic year. In this study, to evaluate the competency of general practitioners graduated from KUMS in musculoskeletal medicine, participants were asked to complete a standard questionnaire with 36 questions in 9 domains
Results: The total competency of the studied people was 65%. The highest competency level was related to the domains of treatment of fractures and dislocation, the initial treatment of open fractures, and diagnosis of fracture and dislocation [80%, 77%, and 73%, respectively]. The lowest competency level was related to the domains of congenital deformity of feet, musculoskeletal system tumors, and congenital dislocation of the hip [47%, 50%, and 52%, respectively]. No difference was observed between men and women in the mentioned domains
Conclusion: The results of our study revealed that in general the competency of graduated physicians was average. Accordingly, it is recommended that universities recognize weaknesses of graduated general practitioners according to a compiled program. Moreover, annual education programs can prevent more problems from occurring in the work setting and higher levels of education of these general practitioners
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The effect of opium addiction on the appearance of different types of arrhythmias after acute myocardial infarction [AMI] has been assessed in few studies. This study is aimed to determine the effect of opium on post-MI arrhythmia and also to address the differences in the appearance of different types of arrhythmias after AMI between opium addicted and non-addicted patients. In this comparative study, participants were classified into two groups with opium addiction [n=94] and without opium addiction [n=106]. Post-MI arrhythmias were determined among each group. Study populations were included all patients with first AMI admitted within 6 hours of the onset of chest pain to coronary care units [CCU] of two teaching hospitals affiliated to Kerman University of Medical Sciences [KUMS] in the city of Kerman, Iran. Opium addicted subjects had significantly more frequency of arrhythmia than non-opium addicted subjects [80.9% vs. 22.6%, respectively; P<0.001]. Opium addiction was a strong predictor for the occurrence of post- MI arrhythmias in two models of crude analysis [crude OR=14.4, P<0.001] and after adjusting for potential confounder factors [adjusted OR = 21.9, P<0.001]. The prevalence of sinus tachycardia, sinus bradycardia and atrial fibrillation in opium addicts were significantly higher than non opium addicts [P<0.05]. The results of our study showed that opium addiction is a potential and strong risk for occurring post-MI arrhythmias
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Pregnant women with previous gestational diabetes mellitus are at increased risk of progressive carotid artery disorders. The current study evaluated carotid intima-media thickness [IMT] in pregnant women with gestational diabetes at two time points of mid-term and full-term pregnancy to determine whether gestational diabetes mellitus causes increased IMT. This cross-sectional study carried out at Afzalipour Hospital [Kerman, Iran] between 2009 and 2010, recruited 50 women who were at high risk of gestational diabetes during pregnancy and had an oral glucose challenge test [OGCT] as screening for gestational diabetes. B-mode ultrasound scans were performed at baseline and at two time points of midterm pregnancy [20 to 24 weeks] and full-term pregnancy [36 to 38 weeks] on all the participants. The mean IMT of common carotids and internal carotid arteries from two walls [near and far walls] at four different angles was assessed. An overall comparison between the impaired OGCT test group and the control group revealed significant differences in carotid IMT in the mid-term [0.65 +/- 0.07 vs. 0.59 +/- 0.06 mm; p value = 0.002] and full-term [0.65 +/- 0.05 vs. 0.59 +/- 0.04 mm; p value < 0.001] pregnancy; however, the trend of the changes in carotid IMT during mid to full-term pregnancy was insignificant in each group [p value > 0.05]. Carotid IMT was significantly higher in the women with gestational diabetes than that in the normoglycemic group in different trimesters. This finding denotes that atherosclerosis might start years before the diagnosis of gestational diabetes in vulnerable women
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Intracytoplasmic sperm injection [ICSI] has revolutionized the treatment of azoospermic men. The aim of this study was to evaluate the factors interfering in the success of ICSI, including sperm collection method, testicular histology, age and hormonal assay of the couple, the number of retrieved oocytes, and the number of transferred embryos. In this retrospective cohort study, 246 azoospemic men [52 with obstructive azoosprmia [OA] and 194 with non obstructive azoospermia [NOA]] who were underwent sperm retrieval with PESA or TESE and ICSI protocol were studied. By long protocol of ovarian stimulation, oocytes were retrieved 36h after hCG administration. After 48h, cleaved embryos were replaced in the uterine cavity. Clinical pregnancy rates [21.1% in OA versus 10.8% in NOA] was significantly correlated with sperm origin [P<0.05]. Female partner's age and serum FSH significantly influenced pregnancy rates in both groups [p<0.001] and also pregnancy rates was significantly influenced by number of retrieved oocytes and transferred embryos in NOA groups [P<0.05]. ICSI can make a chance for fertility in azoospermic men. Higher success rates in OA patients can be related to better quality of sperm. The value of male hormonal assay and testicular biopsy was not remarkable.
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Types A and B hemophilia are coagulation disorders associated with many complications. Osteoporosis is a skeletal condition characterized by the decreased density of normally mineralized bone. This study aims to determine the relationship between osteoporosis and hemophilic arthropathy in severe hemophilia patients over the age of 20 years in Kerman, Iran. We performed a cross-sectional study of bone density among 40 male patients with severe hemophilia. Lumbar spine and femoral bone mineral density [BMDs] were measured using a Dual Energy X-ray Absorptiometry [DEXA] scan. The T-scores for BMDs were computed and values from -2.5 to -1 were considered as osteopenia. Those less than -2.5 were considered to be osteoporotic. About 42% of patients had normal BMD, 50% were osteopenic, and the rest were osteoporotic. The mean BMI, number of arthropathic joints, and the numbers of joint bleeding during the previous year were significantly higher in osteoporotic patients than osteopenic and normal groups [P = 0.05, = 0.003 and = 0.011, respectively]. The mean for factor replacement, the number of joint bleeding episodes in the past year, and the number of arthropathic joints were significant independent predictors of both spinal and femoral BMD. Their odds ratios [OR] were 1.29 [factor replacement], 1.17 [numbers of joint bleeding episodes], and 1.73 [number of arthropathic joints], which were significant [P < 0.05]. Our results suggest that men with severe hemophilia have reduced BMD. Patients at risk are those with signs of hemophilic arthropathy. Because osteoporosis may complicate the future treatment of patients with hemophilia, screening of patients with hemophilic arthropathy for reduction of BMD and preventive therapies is highly recommended
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To estimate the size of groups at high risk of HIV, Network Scale UP [NSU], an indirect method, was used. 500 Kermanian male aged 18 to 45 were recruited. 8 groups at high risk of HIV were defined: Users of opium, unknown drug, ecstasy, and alcohol; intra?venous drug users [IDUs; males who have extra?marital sex with females [MSF]; male who have sex with female sex workers [MFSW]; and male who have sex with other male [MSMs]. We asked respondents whether they know anybody [probability method], and if yes, how many people [frequency method] in our target groups. Estimates derived in the probability method were higher than the frequency method. Based on the probability method, 13.7% [95% CI: 11.3%, 16.1%] of males used alcohol at least once in last year; the corresponding percent for opium was 13.1% [95% CI: 10.9%, 15.3%]. In addition, 12% has extra-marital sex in last year [95% CI: 10%, 14%]; while 7% [95% CI: 5.8%, 8.2%] had sex with a female sex worker. We showed that drug use is more common among young and mid-age males; although their sexual contacts were also considerable. These percentages show that special preventive program is needed to control an HIV transmission. Estimates derived from probability method were comparable with data from external sources. The underestimation in frequency method might be due to the fact that respondents are not aware of sensitive characteristics of all those in their network and underreporting is likely to occur
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Bronchial anthracosis is defined as appearance of multiple dark anthracotic pigmentations on large airway mucosa with or without airway narrowing or obliteration. Since there has been vague and controversy regarding the relationship between bronchial anthracosis and pulmonary tuberculosis, we conducted this study to shed light on this matter. In this cross-sectional study, data was obtained from reviewing the files of 1, 594 patients who underwent bronchoscopy in Afzalipour Hospital during 2003 to 2007. Those with dark pigmentation on their airways mucosa were considered as having bronchial anthracosis. During bronchoscopy, samples were collected from the airways in the form of bronchoalveolar lavage and then the smear and culture of these samples were examined for acid fast bacilli. Patients with both positive culture and smear and those with positive culture alone for acid fast bacilli were considered as having pulmonary tuberculosis. Of 1, 594 cases studied in this research, 333 [20.8%] had bronchial anthracosis, out of which 158 [55.5%] were women. Risk of bronchial anthracosis was 0.4 times less in men [CI 95%=0.32-0.52] [p<0.001]. In other words, bronchial anthracosis had a significantly less prevalence among men. Also, risk of tuberculosis in people with bronchial anthracosis was 2.6 times more than that of healthy people [CI 95%=1.48-4.75] [p<0.001]. This research revealed a significant correlation between bronchial anthracosis and pulmonary tuberculosis. Therefore, performing necessary tests and follow-ups for pulmonary tuberculosis is necessary in cases that undergo bronchoscopy for any reason and those with bronchial anthracosis