Evaluating resident physicians' knowledge, attitude, and practice regarding the pain control in cancer patients

Pain has been one of the most debilitating symptoms of cancer. The aim of this study was to evaluate residents' knowledge, attitude, and practice regarding pain control in cancer patients. In a descriptive study, 69 randomly selected third-year various residents practicing in teaching hospitals of Shahid Beheshti School of medicine participated in this study. They have provided their demographic characteristics and completed a questionnaire, based on their "knowledge", "attitude" and "practice" regarding cancer pain and its management. Data analysis has performed using SPSS v.19. A p value of less than 0.05 has considered as significant. Obtained Data from 69 participants including 32 anesthesiology residents has included to our study. The average scores were 35.8 +/- 6.1 [ranging from 20 to 49] for the residents' attitude, 25.1 +/- 9.1 [ranging from 0 to 53] for their knowledge and 11.2 +/- 4.1 [ranging from 0 to 17] for their practice. The overall scores of the questions have related to attitude and knowledge were higher for residents of anesthesiology but the difference was not statistically significant [A: 37.1 +/- 4.9 vs. 34.7 +/- 6.8, p=0.106, K: 27.2 +/- 11.8 vs. 23.3 +/- 5.6, p=0.076]. The average score for questions on physician' practice was significantly higher in residents of anesthesiology [P: 12.8 +/- 3.2 vs. 9.7 +/- 4.2, p=0.001]. In order to provide patients with adequate pain relief, it has seemed advisable for medical schools to focus on improving the educational curriculum and integrating it into clinical practice

[Subclavian vein cannulation success or failure in neonates and children]

Central vein cannulation [CVC] allows administration of large volumes of fluids in short times and at high osmolaritiy for rehydration, volume replacement, chemotherapy and parenteral nutrition. Percutaneous central venous line insertion has replaced peripheral venous cut-down as the primary mode of short term venous access in children. 3264 subclavian vein cannulations in neonates and children were analyzed regarding successful attempt for catheterization and early complication rates after the procedure retrospectively. We had 1340 newborn patients [first 28 days of life] in our study population. In this group, only 55cannulations were failed, 1 patient were complicated with pneumothorax, in 21 cases guide wires became malfunction and only in 981 cases attempts to cannulation were successful in first attempt. In the remaining 1924 patients, 1 month to 8 years old, only 14 attempts to cannulation of subclavian vein was failed and in 1655 cases cannulation performed successfully at first attempt. CVC success rate was significantly higher in children older than 1 month compare to less than 1 month age [P=0.03]. Cannulation of central vein in neonates and children in a skilled hand would be performed with great success rate and low complications but in neonates less than 1 month age it has higher failure rate

Clinical evaluation of disc battery ingestion in children

The purpose of this study was to evaluate the characteristics, management, and outcomes of disc battery ingestion in children. We reviewed the medical records of children admitted to Mofid Children's Hospital due to disc battery ingestion from January 2006 to January 2010. Clear history, clinical symptoms and results of imaging studies revealed diagnosis of disc battery ingestion in suspected patients. The clinical data reviewed included age, gender, clinical manifestation, radiologic findings, location of disc battery, duration of ingestion, endoscopic results and surgical treatment. We found 22 cases [11 males and 11 females] of disc battery ingestion with a mean age of 4.3 years [range: 9 months to 12 years]. Common symptoms were vomiting, cough, dysphagia, and dyspnea. The mean duration of ingestion was 2.7 days [4 hours to 1.5 months]. A total of 19 patients had histories of disc battery ingestion, but three cases referred with the above symptoms, and the batteries were accidentally found by x-ray. Only three cases had batteries impacted in the esophagus. Twelve batteries were removed endoscopically, 6 batteries spontaneously passed through the gastrointestinal [GI] tract within 5 to 7 days, and 4 patients underwent surgery due to complications: 3 due to tracheo-esophageal fistula [TEF] and 1 due to intestinal perforation. There was no mortality in our study. Most cases of disc battery ingestion run uneventful courses, but some may be complicated. If the battery lodges in the esophagus, emergency endoscopic management is necessary. However, once in the stomach, it will usually pass through the GI tract

comparison between sedative effect of propofol-fentanyl and propofol-midazolam combinations in microlaryngeal surgeries

Considering the growing trend of laryngeal surgeries and the need to protect the airway during and after surgery, among several therapeutic regimens to induce sedation, two regimens of propofol-fentanyl and propofol-midazolam were compared in microlaryngeal surgeries. Forty ASA I-II class patients undergoing microlaryngeal surgeries and referring routinely for postoperative visits were randomly recruited into two groups. For all the patients, 0.5 mg/Kg of propofol was used as bolus and then, 50 mcg/Kg/min of the drug was infused intravenously. For one group, 0.03 mg/Kg bolus of midazolam and for the other group, 2 mcg/Kg bolus of fentanyl was administered in combination with propofol. Ramsay system was used in order to evaluate the effect of the two drugs in inducing sedation. The need for additional dose, blood pressure, heart rate, arterial blood oxygen saturation, and also recovery time and adverse effects such as nausea/vomiting and recalling intra-operative memories, were assessed. The patients in the two groups were not statistically different regarding the number of patients, age, sex, preoperative vital signs, the need for additional doses of propofol, systolic blood pressure and mean systolic blood pressure during laryngoscopy. However, mean systolic blood pressure 1 min after removal of laryngoscope returned faster to the baseline in midazolam group [p < 0.01]. Mean heart rate returned sooner to the baseline in fentanyl group following removal of stimulation. Besides, heart rate showed a more reduction following administration of fentanyl [p < 0.02]. Mean arterial blood oxygen saturation during laryngoscopy significantly decreased in fentanyl group [p < 0.05] compared to the other group. The time it took to achieve a full consciousness was shorter in midazolam group [p < 0.01]. Nausea/vomiting was significantly more prevalent in fentanyl group while the patients in midazolam group apparently experienced more of amnesia, comparatively [p < 0.01]. Inducing laryngeal block and local anesthesia using propofol-midazolam regimen is not only associated with a more rapid recovery and less recalling of unpleasant memories, but also better in preventing reduction of arterial oxygen saturation during laryngoscopy compared with propofol-fentanyl regimen

Plasma and serum electrolyte levels correlation in the pediatric ICU

Patients in the intensive care unit [ICU] are susceptible to develop electrolyte imbalance resulting in increased mortality rate. Electrolyte measurements especially for sodium and potassium are frequently required in critically ill patients. The purpose of the present study was to compare sodium and potassium concentrations between serum from venous blood and plasma from arterial blood in order to decrease the number of needle punctures required in children admitted to the ICU. Thirty-five patients admitted to the pediatric intensive care unit [PICU] were enrolled in this study; hypotensive patients were excluded. Two cc venous and 1cc arterial blood samples were taken for serum and plasma measurement of sodium and potassium. Venous samples were analyzed within 15 minutes in the hospital laboratory and arterial samples were immediately auto-analyzed in the PICU for sodium and potassium concentrations. Mean serum concentrations of sodium [NaV=137.1 +/- 5.5] and potassium [KV=4.1 +/- 0.7] were higher than plasma concentrations of sodium [NaA=133.1 +/- 11.1] and potassium [KV =3.1 +/- 0.7]; [p<0.02 and p<0.001 respectively]. Linear regression showed NaV= 106+0.23 Na A for sodium; [p=0.005], and KV= 1.96+0.69 KA; [p<0.001] for potassium. Serum concentrations of sodium and potassium were higher than their plasma levels and could be calculated using the plasma sample and the formula given above

Surgical treatment of pulmonary hydatid cyst in 72 children

Hydatid disease is a parasitic infestation which is endemic in many sheep and cattle raising areas [such as Iran] and is still an important health hazard in the world. The aim of this study was to evaluate the outcome of surgical treatment in patients with hydatid disease. This retrospective study evaluated 72 consecutive patients who presented with pulmonary hydatid cyst to Mofid Children's Hospital from 1992 to 2007. Patients' medical records were reviewed and their gender, age, clinical features, cyst localization, diagnostic tools, operative techniques, pathologic report, morbidity and mortality, recurrence, hospital stay and outcome of treatment were evaluated. The patient group consisted of 40[55.56%] boys and 32[44.44%] girls in the age range of 2 to 14 yrs. In general, 72 patients had a total of 87 cysts. Fifty-five patients [76.38%] had single cysts. Fifty-five lung cysts [63.21%] were in the right side, and 31[35.64%] were in the right lower lobe. Cough was the most common symptom and chest radiography gave a correct diagnosis in 68[94.44%] patients. Conservative surgical treatment was carried out in 70 children [97.22%]. There were no mortality or recurrence in our cases. Due to the high accuracy of chest X-ray in diagnosis of lung hydatid cyst, it is the preferred method of diagnosis in endemic regions. Parenchyma-saving surgical procedures such as cystotomy and capitonnage as well as cyst delivering by lung expansion are the preferred methods of treatment for pulmonary hydatid disease in childhood. These methods are safe, reliable and successful