Cardiovascular health knowledge of patient attendants in southern of Iran, Shiraz

Knowledge about coronary artery disease and it's risk factors is a very important factor in prevention of ischemic heart disease. The aim of this study was to investigate knowledge of patient attendants about coronary artery disease and its risk factors in southern of Iran; Shiraz. Cross sectional study. Shiraz University of Medical Sciences. 800 patient attendants [persons accompanying patients] selected randomly and divided into two groups [study and control] each including 400 patient attendants. Face to face interview was done and knowledge was measured by correct answers to our standard questionnaire. The median knowledge score was 6.89 for study group and was 2.82 for control group out of a possible maximum of 15. Majority of respondents in study group could identify up to three risk factors for coronary artery disease, but in control group could identify only one risk factor. About 5.8% in study group and 37.5% in control group were not able to identify even a single risk factor for coronary artery disease. According to our results there is a big gap in knowledge about coronary artery disease and it's risk factors in our population. It means that more educational programs are needed to prevent the increasing rate of coronary artery disease

Helicobacter pylori in nasal polyposis

Nasal polyposis is an inflammatory condition of unknown etiology. Recently concern regarding GER or Helicobacter pylori as a possible pathologic cause of nasal polyps has been increasing. The present study was planned to investigate the presence of Helicobacter Pylori in nasal polyps by PCR, rapid Urease test and serology. Case control study. ENT ward of Shiraz, Khalilli Hospital, Iran, April 2006 to March 2008. 37 patients with nasal polyps who had undergone nasal endoscopic sinus surgery and 38 control subjects who had undergone septoplasty and turbinectomy. Biopsy specimens of nasal polyps and inferior turbinates were assessed by PCR and Rapid Urease test. Blood sample of both study and control subjects were evaluated for anti H.pylori Ig G by ELISA. HP status was regarded as positive, if 2 tests were positive. Seropositivity was more common in the patients with nasal polyps [72.97%] than in the control patients [31.57%] [P-value= 0.000] RUT was positive in 9 [24.3%] of 37 patients with nasal polyps, but was not positive in control group [P-value= 0.001]. Only 3 of [8.1%] of 37 patients with nasal polyps were positive for both RUT and ELISA [P-value=0.115]. PCR was negative in all patients and controls. Polypoid tissue can be colonized by some other agents containing a urease enzyme other than Helicobacter Pylori. So, result of RUT can be false positive, and addition test may be performed. In the our study by using PCR, we were not able to confirm presence of Helicobacter pylori in the nasal polyps. However, further epidemiologic studies using different and specific diagnostic tests with control of documented GER is recommended

Catheter related bladder discomfort comparison of ketamine and tolterodine; for reduction of catheter related bladder discomfort

Bladder discomfort is a common side effect after surgical procedures that involve either extensive bladder dissection or prolonged postoperative catheter drainage. Various treatments have been tried with varying degrees of success for managing this adverse effect. In this study we compared the efficacy of ketamine and tolterodine in prevention of catheter induced bladder discomfort. Three hundred patients who were scheduled for open prostatectomy or transurethral resection of prostate [TURP] were randomized into three groups. The first group received placebo, the second one received tolterodine before operation, and the third group received ketamine 250 ig/kg IV, just before the anesthesia induction. Bladder discomfort was assessed by anesthesiologist who was unaware of the type of medication. The assessment was done on arrival in the post anesthesia care unit [PACU] and then at 0, 1, 2 and 6 hours after patient's consciousness. Severity of discomfort was recorded as none, mild, moderate, or severe. The absence or presence of adverse effects were recorded. The data were analyzed using SPSS and Pearson chi-squared and ANOVA tests were applied for further statistical evaluations. Both the incidence rate of bladder discomfort and its severity in the control group was significantly higher compared with ketamine and tolterodine groups [P<0.001]. Comparing the ketamine and tolterodine groups, tolterodine had lead to lesser degree of bladder discomfort at 0, 1, 2 hours, while ketamine was more effective at 6 hours. Pretreatment with either ketamine or tolterodine is effective in decreasing the incidence and severity of catheter related bladder discomfort in patients under going open prostatectomy or TURP

effects of ETT suction education on the knowledge and performance of intensive care nurses

Many neonates require oxygen therapy and mechanical ventilation and endotracheal tube [ETT] suction is a vital protocol for the maintenance of artificial airway patency But suctioning is associated with serious complications including hypoxia. Despite some existing protocols nurses still use it injudiciously in pediatric and neonatal patient groups. Therefore, continuing education has been regarded as a tool to cope with the fast changes in care methods and improving nursing Professional standards. The study was conducted to evaluate the training and educational needs in nurses working with NICUs affiliated to the Shiraz University of Medical Sciences to increase their potential with regards to ETT suctioning. An experimental interventional study. NICUs affiliated to the Shiraz University of Medical Sciences, Shiraz [Iran] during 2006. Sample size was 50 persons caring for neonates with ETTs under mechanical ventilation. Using systematic random allocation, they were divided into study and control groups. Data collection was done by a test with 30 points to evaluate knowledge and a check list with 47 points to evaluate performance. After random allocation, the subjects' knowledge was evaluated. Then, ETT suction education was given to the test group and NICU infection control education was given to the controls. Two days and two months after the intervention, the subjects were re-evaluated. The results were compared. Man-Whitney test showed that the level of knowledge between the two groups at the beginning of the study had no significant difference [p = 0.71], while the average score in the two groups 2 days and 2 months after the intervention [education] had significant difference [p = 0.001]. There was a significant difference 2 days and 2 months after intervention in the performance. It can be concluded that education significantly increases the level of knowledge and degree of performance of neonatal endotracheal tube suctioning; however, with the passage of time, the levels fall, necessitating the need for continued education in this matter

Propofol induced pain; Comparison between effects of lidocaine propofol mixture and metoclopramide premedication

Propofol causes pain on injection in 28% - 90% of patients. A number of techniques have been tried for minimizing propofol-induced pain with variable results.To compare the use of premixed lidocaine-propofol with metoclopramide pretreatment for the reduction of pain during injection of propofol in adult patients. A prospective, double blind, randomized, placebo-controlled study. Shiraz University Hospital, Department of Anesthesiology, Shiraz, Iran. From Jan 2007 to Dec 2007. 202 subjects [ASA I-II] scheduled for elective operations under general anesthesia were allocated into three groups and treated as follows: Group A: 20 ml propofol mixed with 20mg lidocaine%1 following 2ml normal saline; Group B: 20 ml propofol mixed with 2ml normal saline following 5 mg metoclopramide; Group C [control group]: 20 ml propofol mixed with 2 ml normal saline following 2 ml normal saline. Pain intensity was graded by a single, blinded observer and recorded as either severe, moderate, mild or no pain according to the response of the patients to the injection. The incidence of pain was 72% in placebo group compared to 58.7% in the metoclopramide and 28.8% in the lidocaine group. Propofol-lidocaine admixture is more effective than metoclopramide pre treatment in decreasing the pain of propofol injection

Prophylaxis of postoperative nausea and vomiting: a comparison of droperidol alone with droperidol plus dexamethasone combination

Adequate control of postoperative nausea and vomiting [PONV] and early return to normal activity are important anesthetic goals. We compared the efficacy of droperidol alone with droperidol plus dexamethasone combination for preventing PONV. A prospective, randomized, double-blind study. June 2002 to November 2004, at Department of Anesthesiology, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz [Iran]. Two hundred, ASA grade I-II, ambulatory gynecological surgical patients of ages 18-70 yrs received 2.5 mg of droperidol at the time of induction of general anaesthesia. At the end of the operation, group A [n = 100] received 2 ml of intravenous isotonic electrolyte solution [0.9% sodium chloride] and group B [n = 100] received 2 ml of intravenous dexamethasone [8 mg]. A standard general anesthetic technique and post op analgesia were used throughout the operation. PONV were assessed 2, 4 and 12 hours after the operation. The incidence of postoperative nausea decreased significantly in group B as compared to group A [23% vs. 49%], as was the incidence of vomiting [12% vs. 39%] [p - 0.014]. Mean duration of nausea was 34 minutes in group A and 23 minutes in group B [p < 0.001]. We conclude that addition of 8 mg of dexamethasone to droperidol prophylaxis is more effective than droperidol prophylaxis alone for successful control of PONV

Regional anesthesia; bacterial catheter colonization: what are the risk factors?

Although several potential risk factors have been discussed, risk factors associated with bacterial colonization or even infection of catheters used for regional anesthesia are not very well investigated. The prospective observational trial. Department of Anesthesiology Shaheed Beheshti Hospital Shiraz. Period: From April 2003 to April 2004. 297 catheters at several anatomical sites where placed using a standardized technique. The site of insertion was then monitored daily for signs of infection [secretion at the insertion site, redness, swelling, or local pain]. The catheters were removed when clinically indicated [no or moderate postoperative pain] or when signs of potential infection occurred. After sterile removal they were prospectively analyzed for colonization, defined as > 15 colony forming units. 50 [16.7%] of all catheters were colonized, and 27 [9.1%] of these with additional signs of local inflammation. Three of these patients required antibiotic treatment due to superficial infections. Stepwise logistic regression analysis was used to identify factors associated with catheter colonization. Out of 26 potential factors, three came out as statistically significant. Catheter placement in the groin [odds-ratio and 95%-confidence interval: 3.4; 1.5-7.8], and repeated changing of the catheter dressing [odds-ratio: 2.1; 1.4-3.3 per removal] increased the risk for colonization, whereas systemic antibiotics administered postoperatively decreased it [odds ratio: 0.41; 0.12-1.0]. Conclusion Colonization of peripheral and epidural nerve catheter can only in part be predicted at the time of catheter insertion since two out of three relevant variables that significantly influence the risk can only be recorded postoperatively. Catheter localization in the groin, removal of the dressing and omission of postoperative antibiotics were associated with, but were not necessarily causal for bacterial colonization. These factors might help to identify patients who are at increased risk for catheter colonization

Polymerase chain reaction; detection of human papilloma virus [HPV] type - 16 and 18 infection in laryngeal and oral squamous cell carcinoma in southern Iran

One fifth of cancers world wide are associated with viral infection. Epidemiologic and biomolecular evidence suggested that Human Papilloma Virus [HPV] infection may be associated with the development of head and neck cancer. [1] To clarify the role of HPV infection in head and neck cancers. [2] To evaluate the presence of HPV DNA in laryngeal and oral squamous cell carcinoma in southern Iran and comparison of results with studies in other regions Department of Otolaryngology-Head and Neck Surgery, Khallili Hospital, Shiraz Medical University Iran From 2003 to 2006. Eighty three [83] patients with Squamous Cell Carcinoma [SCC] of the larynx, 40 patients with benign mucosal lesion of the larynx [control], 47 patients with SCC of oral cavity and 10 patients with benign oral lesion were studied for the presence, of HPV DNA by Polymerase Chain Reaction [PCR]. None of the laryngeal SCCs or control group was positive for HPV DNA. Only 3/47 specimens from oral SCC were positive for HPV DNA. Oral control group was negative for HPV DNA. The present work suggests that HPV infection has not important role in carcinogenesis of laryngeal or oral SCC in southern Iran. However a multi center case-control study is needed to clarify this association

Ephedrine for prevention hypotension; comparison between intravenous, intramuscular and oral administration during spinal anesthesia for elective cesarean section

To ameliorate post spinal anesthesia hypotension in patients undergoing cesarean section. To compare the incidence of maternal hypotension associated with spinal anesthesia for cesarean section when intravenous [IV], intramuscular [IM] or oral prophylactic boluses of ephedrine were used. Prospective randomized double blind Department of anesthesiology, Zainibiae Hospital, Shiraz University, Iran. June 2004 to November 2005. 60 ASA grade I-II pregnant mothers were enrolled. Spinal anesthesia was performed using 60-70 mg of 5% solution of lidocaine. The patients were divided into three equal groups [n=20]. Oral and IM ephedrine [25 mg] was administered to the first two groups 30 to 60 minutes before induction of anesthesia [Group A and B, respectively]. In the last 20 patients, IV Ephedrine [25 mg] was administered immediately after induction of spinal anesthesia [Group C]. Maternal blood pressure and pulse rate was checked every 2 minutes. Hypotension was promptly treated with 10-mg ephedrine boluses. Both IM and IV prophylactic doses of ephedrine significantly decreased the incidence of hypotension, compared to oral prophylactic dose of ephedrine [4/20 and 0/20 in the IM and IV ephedrine groups, respectively vs. 9/20 in the oral ephedrine group [p < 0.05]]. Oral prophylactic dose of ephedrine is not effective in preventing hypotension in pregnant women undergoing cesarean section with spinal anesthesia. Therefore, we only recommend a single bolus of IV ephedrine with a dose of 25mg

Comparison between intravenous, intramuscular and oral administration of ephedrine for prevention of hypotension during spinal anesthesia for elective cesarean delivery

Ephedrine has been used to ameliorate post spinal anesthesia hypotension in patients undergoing cesarean section. The aim of this study was to compare the incidence of maternal hypotension associated with spinal anesthesia for cesarean section when intravenous [IV], intramuscular [IM] or oral prophylactic boluses of ephedrine were used. June 2004 to November 2005. A prospective randomized comparative study. Educational hospitals of Shiraz University of Medical Sciences. Pregnant mothers classified gradel-II by American Society of Anaesthesiologists [ASA] were enrolled and 60 women were included in the study. Spinal anesthesia was performed using 60-70 mg of 5% solution of lidocaine. The patients were divided into three equal groups [n = 20]. Oral and intramuscular [IM] ephedrine [25 mg] was administered to the first two groups 30 to 60 minutes before induction of anesthesia [Group A and B, respectively]. In the last 20 patients, intravenous [IV] Ephedrine [25 mg] was administered immediately after induction of spinal anesthesia [Group C]. Maternal blood pressure and pulse rate was checked every 2 minutes. Hypotension was promptly treated with 10mg ephedrine boluses. Both IM and IV prophylactic doses of ephedrine significantly decreased the incidence of hypotension, compared to oral prophylactic dose of ephedrine [4/20 and 0/20 in the IM and IV ephedrine groups, respectively and 9/20 in the oral ephedrine group [p <0.05]]. Oral prophylactic dose of ephedrine is not effective in preventing hypotension in pregnant women undergoing cesarean section with spinal anesthesia. Therefore, we only recommend a single bolus of IV ephedrine with a dose of 25mg

Pulse oximetry; knowledge among medical students and nursing staff

Pulse oximetry has emerged as a clinical tool in anesthesia and is becoming popular in developing countries. Unfortunately, its use is usually not accompanied by appropriate staff training. The aim of this study was to evaluate the knowledge about pulse oximetry among the 7th year medical student Interns [MS] and nursing staff [NS] of Intensive Care Unit [ICU], Coronary Care Unit [CCU] and Recovery Room [RR] of four medical-school affiliated hospitals in Shiraz, Iran. Feb 2001- Feb 2002. A 14-item questionnaire [4 demographic and 10 knowledge], multiple-choice and open ended, was developed to assess knowledge of pulse oximetry. Among 150 7th year medical students and 200 nursing staff, 40 from each group was randomly selected and invited to complete the questionnaire. A 100% response rate was achieved. All of the participants used pulse oximetry regularly in their daily work. The mean test scores for MS and NS were 60.5 +/- 21 and 49 +/- 17%, respe ctively [p < 0.05]. None of the participants had adequate training in the use of pulse oximetry. Our study revealed that medical students and staff nurses were untrained in pulse oximetry, lacked knowledge of basic principles, and made serious errors in interpretation of readings. Therefore, we recommend that medical schools and nurse training programs place emphasis on teaching the principles and applications of pulse oximetry and the oxyhemoglobin dissociation curve

impact of operative fluids on the prevention of postoperative anesthetic complications in ambulatory surgery - High Dose vs Low Dose

Adequate control of postoperative [postop.] nausea, vomiting, dizziness and thirst, and early return to normal activity are important anesthetic goals in the context of ambulatory surgery. This study, investigated the impact of different preoperative fluid therapies or regimens on preventing postop. nausea, vomiting, dizziness and thirst. In a prospective randomized double-blind study, from June 2002 to November 2003, two hundred ASA grade I-II ambulatory surgical patients received 20 ml/kg of intravenous isotonic electrolyte solution [0.9% sodium chloride] [group A] or 2 ml/kg of same [group B] [n = 100 in each group], over 30 minutes before induction of anesthesia. A standard general anesthetic technique and postop. analgesia were used throughout the operation. Adverse postop. outcomes [nausea, vomiting, dizziness, and thirst] were assessed at 30 and 60 minutes postop. and at discharge. The incidence of postop. vomiting and thirst significantly decreased in group A compared to group B [p = 0.0 14 and p = 0.029, respectively]. There was no difference in the incidence of nausea and dizziness between the two groups. We conclude that preoperative high dose hydration [20 ml/kg bolus] can efficiently decrease the incidence of postop. thirst and vomiting within the first 60 minutes, it was superior to low dose hydration and therefore, we recommend it in ambulatory surgeries