The effect of aminophylline on the recovery profile after hysterectomy: A randomized controlled double-blinded study.

Background and Aims: In anesthesia practice, aminophylline is clinically used to treat bronchospasm. However, due to its antagonistic effect on adenosine, studies have recently focused on the drug's ability to enhance the recovery profile. The aim of this study was to investigate the hypothesis that the administration of aminophylline leads to better recovery after general anesthesia in hysterectomy. Methods: This randomized controlled double-blinded study, was conducted at Alzahra academic hospital in Guilan, Iran. During December 2022 to March 2023, 70 eligible women scheduled for elective abdominal hysterectomy were divided into two groups. Group A: received 3 mg/kg IV aminophylline diluted in 100 mL of normal saline and Group C: received 100 mL IV normal saline. The time to recovery of consciousness, tracheal extubation and discharge from post anesthesia care unit were recorded. In addition, heart rate, and mean arterial blood pressure were measured at 10 point times including; baseline (T0), immediately before the administration of aminophylline (T1), every 5 min until the end of the surgery(T2,T3,T4,T5,T6), and every 15 min in PACU(T7,T8,T9). Results: There was no significant difference in terms of demographic data between the study groups. Comparing the two groups, the time of ROC was shorter in Group A than group C; 5.95 ± 1.12 and 8.5 ± 1.77 for Groups A and C, respectively (p < 0.001). The extubation time was shorter in Group A than group C; 7.79 ± 1.48 and 10.55 ± 3.02, for Groups A and C, respectively (p < 0.001). In addition, the discharge time was also shorter in group A than Group C; 30.17 ± 5.24 and 37.57 ± 4.41 for Groups A and C, respectively (p < 0.001). Not serious side effects were reported among 71.4% of cases in Group A and 51.4% in Group C (p = 0.086). Conclusion: Administration of aminophylline at a dose of 3 mg/kg IV improves the recovery profile after abdominal hysterectomy without serious adverse effects.

The utero-tonic effects of low dose intravenous ketamine in cesarean section under spinal anesthesia; A randomized double-blind clinical trial.

Background: Recently, the prevalence of cesarean section (CS) has been on the rise and the proper uterine tone is an important issue. We investigated the effects of intravenous (IV) ketamine on intraoperative bleeding and the need for oxytocin in CS under spinal anesthesia (SA). Methods: This study, took place at Alzahra hospital during 2020. Pregnant women candidate for elective CS under SA were divided into two groups of ketamine and placebo. In group K, after umbilical cord clamping, 0.25 mg/kg ketamine and in group P 2ccs normal saline was injected. Mean arterial pressure and heart rate were recorded at baseline, before and 5 minutes after cord clamping and at the end of the surgery. The drop in hemoglobin values, the administrated units of oxytocin and side effects were also recorded. Results: No significant difference was found in terms of patients' demographic data (P ≥ 0.05). The mean units of administrated oxytocin in group K was 34.61±6.63 and in group P; 48.47±12.15, which was significantly different (P=0.0001). The drop in Hb was less in group K, however not statistically significant (P=0.094). The need for methergine was significantly higher in group P (P=0.0001). The mean HR was significantly higher in group P (P=0.027), however, no significant difference was observed regarding the MAP (P=0.064). The incidence of hallucination (4.8%) and nystagmus (21%) was significantly higher in group K (P= 0.0001), but nausea and vomiting were more significant in group P (P= 0.027). Conclusion: Prophylactic administration of low-dose ketamine in CS under S.A could significantly reduce the administrated oxytocin units and the need for additional utero-tonics and was associated with less drop in Hb values.

Maternal Attitude and Knowledge Regarding Painless Labor: A Report from a Referral Hospital in Northern Iran.

Background: Pregnant women's knowledge about labor analgesia and the acceptance rate of this method are still undesirable in developing countries. Objectives: This study aimed to examine pregnant women's knowledge, attitude, and acceptance of painless labor. Methods: The present observational study was conducted in a referral university hospital in Northern Iran from September 2022 to April 2023. Eligible women were interviewed; the data were analyzed in SPSS v. 22 and expressed in numbers and percentages. A P-value < 0.05 was considered significant. Results: The data from 369 eligible women with an average age of 30.39 ± 5.42 years were analyzed. Of these women, 7.6% had minimal information about labor analgesia, and 92.4% declared they were almost aware of the procedure. Only 6 women (1.8%) believed that the anesthesiologists were responsible for performing labor analgesia, while 218 (63.9%) considered it the duty of obstetricians-gynecologists. Besides, 294 women (86.2%) requested this method, and 259 (76%) were ready to pay for it. Moreover, 166(48.7%) had no fear of the procedure. Nonpharmacologic methods were the first choice for 164 (48.1%), while Entonox was the last choice for 26 (7.6%). A significant association was observed between maternal level of education and willingness to pay for painless delivery (P = 0.006), knowledge of who performs it (P = 0.015), requesting a painless delivery (P = 0.0001), options related to the preferred method for painless delivery (P = 0.001), and being ready to pay for a painless delivery service (P = 0.0001). Conclusions: Despite the poor maternal knowledge regarding the process of painless labor, the majority of the women requested the method and were ready to pay for it. These promising findings encourage the application of practical strategies to remove barriers.

Safety and efficacy of lidocaine plus epinephrine on intraoperative bleeding in abdominal myomectomy: A double-blind clinical trial.

Background: Uterine fibroid is a common benign pelvic tumor and abdominal myomectomy may cause excessive intraoperative bleeding, which may lead to adverse outcomes. Objective: This study was planned to evaluate the effectiveness of the injection of lidocaine plus epinephrine to reduce intraoperative bleeding in abdominal myomectomy. Methods: During October 2019 and May 2020, 60 eligible women with uterine fibroids were enrolled in a randomized controlled trial. Our patients were divided into two groups of lidocaine plus epinephrine defined as Group L and placebo defined as Group P. In group L, lidocaine 3 mg/kg plus 0.5 ml of adrenaline which reached to 50 cc with saline solution and in group P, 50 ml of normal saline was used. Both the combined solution and normal saline were infiltrated to the serous and myometrium above and around the fibroid before incision. Patients' demographic data, total operative time, hemoglobin changes, and the degree of surgical difficulty were evaluated and compared between the two groups. Results: There was no significant difference between the two groups in terms of demographic data. Hemoglobin changes (p < 0.0001) and the degree of surgery difficulty (p = 0.01) were significantly lower in Group L compared with Group P. In each group the drop in hemoglobin levels from baseline to 4 h postoperatively was significant (p < 0.0001). A significantly meaningful correlation was reported between hemoglobin changes and the degree of surgery difficulty with the size of the uterine and fibroids (p < 0.05). While a negative correlation was found regarding gravidity and surgery difficulty (r = -0.413, p = 0.02). Surgery duration was longer in Group P compared with Group L 70.66 ± 19.85 versus 66.16 ± 14.48, respectively, but with no significant difference (p = 0.32). No significant adverse reaction or serious complication was reported in the two groups. Hemodynamic parameters were kept in the normal range throughout the surgery. Conclusion: A combination of lidocaine plus epinephrine during abdominal myomectomy appears to be a safe and effective method in reducing blood loss.

Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective Study.

Background: Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure. Objectives: This study aimed to investigate the risk factors of bleeding in PNL. Methods: This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient. Results: The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop. Conclusions: Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.

Intraoperative Awareness in Patients Undergoing Cardiac Surgery in an Academic Center in the North of Iran.

Background: Coronary artery bypass grafting (CABG) has distinctive characteristics that may increase the risk of awareness during general anesthesia (AGA). Objectives: This study was conducted to assess the incidence of AGA in cardiac surgery in an academic hospital in Guilan, Iran. Methods: This descriptive cross-sectional study was performed in Dr. Heshmat Hospital in Rasht, Iran. Eligible patients candidates for CABG were enrolled in the survey in 2022. After surgery, when the patient was cooperative enough, a questionnaire including demographic data and specialized questions related to different stages of anesthesia was completed via face-to-face interviews. The data were analyzed using IBM SPSS Statistics 21 with chi-square, Fisher's exact, and t-test. Results: The data from 322 patients were analyzed, of whom 14 (4.3%) experienced AGA. Among them, the "feeling of fear and anxiety" reported by 9 (39.1%) cases was the most common awareness state. "Dreaming during surgery and anesthesia" and "feeling unable to move during anesthesia,", each reported by 6 (26.1%) cases, were the other common types of awareness state. None of the demographic data had a significant association with the occurrence of AGA. Conclusions: The incidence of AGA during CABG was almost acceptable according to the credible evidence.

Efficacy of intranasal ketamine and midazolam for pediatric sedation: A double-blind, randomized clinical trial.

BACKGROUND: Pediatric patients feel significant fear and anxiety when undergoing surgeries. The ideal drug and its administration route have not been found yet. The aim of this study was to compare the efficacy and safety of intranasal (IN) ketamine and midazolam as premedication in children. METHODS: We studied 71 eligible pediatric patients undergoing elective urologic surgeries, aged 2 to 6 years. The degree of sedation and separation scores was compared between the two groups. Additionally, hemodynamic parameters, before premedication, after induction of anesthesia, and during surgery were documented and compared between two groups. Postoperatively, any side effect was recorded as well. RESULTS: Finally, the data from 71 children were analyzed. Recovery time was significantly longer in group K (ketamine) compared to group M (midazolam); 27.86±4.42 vs 38.19± 6.67 minutes respectively (P=0.01). No significant difference was observed in terms of sedation score between two groups of K & M; 3.29±0.78 vs 3 ±0.71 respectively (P=0.17), and not regarding separation score; 2.51±0.61 & 2.31±0.52 respectively (P=0.01). Vital signs were kept within the physiological limits in both groups with no marked fluctuations. CONCLUSION: To produce sedation in young children, both midazolam and ketamine were effective and safe by IN route.

Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section.

BACKGROUND: Shivering frequently occurs in cesarean section (CS) under spinal anesthesia (SA), resulting in several complications. To date, pethidine has been considered as the gold standard for post-SA shivering control, but it is contraindicated in breastfeeding women. METHODS: This randomized, double-blind study was conducted at Alzahra hospital in Guilan, Iran, From January 2019 to November 2020. A total of 508 eligible term parturient women were enrolled and randomly divided into four groups of low dose ketamine (K), tramadol (T), ondansetron (O), and placebo (P). The incidence and severity of shivering and patients' complications were recorded and compared among the groups. RESULTS: The patients were homogenous in terms of demographic variables. Shivering was witnessed in 68 (53.5%), 26 (20.5%), 75 (59.1%), and 82 (64.6%) patients in K, T, O, and P groups, respectively (P = 0.0001). Regarding shivering severity, there was a significant difference among the four groups (P = 0.0001). In addition, a significant difference was seen regarding Apgar scores at the first minute, but not at the fifth minute (P = 0.168). CONCLUSIONS: Considering the high incidence of shivering in placebo group, prophylactic intervention in CS under SA seems to be necessary. Among the studied drugs, tramadol was the most effective one, followed by a low dose of ketamine and ondansetron.

Glycemic Control in Coronary Artery Bypass Graft Surgery: A Different Perspective.

Background: Hyperglycemia during coronary artery bypass graft surgery (CABG) strongly predicts intra- and post-operative adverse consequences. Objectives: This study aimed to evaluate the quality of glycemic management during CABG in an academic center regarding peripheral blood and coronary sinus values. Methods: This prospective descriptive study encompassed 55 eligible patients undergoing on-pump CABG surgery in 2020. Peripheral blood glucose (BG) was measured four times, before anesthesia induction (T0), before cardiopulmonary bypass pump (CPB) (T1), during CPB (T2), at the end of CPB (T3), and at the end of surgery (T4). The surgeon also took a sample of the coronary sinus BG. Results: The BG variations from T0 to T4 were statistically significant (P < 0.0001). The higher values detected in the ASA class III compared to ASA classes II were statistically significant at T1 (P = 0.01) and T2 (P = 0.025): patients with the higher BMI showed the higher levels of BG. In this regard, the differences were significant at T0 (P = 0.0001), T2 (P = 0.004), and T3 (P = 0.015). Regarding coronary sinus, the mean BG was 222.18 ± 75.74 mg/dL. It was also observed that the ASA class III (P = 0.001), longer duration of CPB (P = 0.021), higher IV fluid volume administrated during surgery (P = 0.023), higher BMI (P = 0.0001), and less urine volume at the end of surgery (P = 0.049) were significantly associated with the higher BG of the coronary sinus. Conclusions: The existing glycemic management protocols on the CABG patients were acceptable in our hospital. However, the BG level of the coronary sinus was higher than the peripheral one.

The Effects of Intravenous Vitamin C on Stress Response Severity in Abdominal Hysterectomy Following Prolonged Fasting Time.

BACKGROUND: Inevitable prolonged fasting time before surgery leads to inflammatory reactions, surgery-related stress response, and consequently unfavorable outcomes; thus, developing strategies to mitigate these consequences is crucial. OBJECTIVES: In this study, we evaluated the effect of ascorbic acid on stress response reduction in abdominal hysterectomy following prolonged fasting time. METHODS: Eligible women candidates for abdominal hysterectomy following prolonged fasting time were enrolled in the study and divided into 2 groups of vitamin C [group C; 1 g intravenously (IV) before surgery] and placebo (group P). Before induction of anesthesia, C-reactive protein (CRP), mean arterial pressure (MAP), heart rate (HR), and blood sugar (BS) were measured and compared between the 2 groups at 4-point times, 24 and 48 hours immediately after extubation. RESULTS: Finally, the data of 80 patients were included for the final analysis. A statistically significant difference was observed between the 2 groups in terms of CRP and BS values in T1 CRP serum levels; at the end of the study, CRP values were 0.5 ± 0.55 and 0.92 ± 0.69 in groups C and P, respectively (P = 0.012), and BS levels were 124.12 ± 18.11 and 152.0 ± 17.36 in groups C and P, respectively (P = 0.0001). However, this significant difference was not observed at T2 regarding CRP (P = 0.145) and BS (P = 0.135), as well as at T3 regarding CRP (P = 0.282) and BS (P = 0.213). However, according to both CRP and BS values, the trend of changes from T0 to T3 was significant in the 2 groups (P < 0.0001). Hemodynamic parameters were not significantly different between the 2 groups. No adverse event was reported in the 2 groups. CONCLUSIONS: We found that ascorbic acid could induce short-term positive effects in abdominal hysterectomy following prolonged fasting time. Obviously, the optimal dosage, timing, and specific cases that benefit the most from this intervention should be investigated.

Knowledge, Attitude, and Performance of Pregnant Women Regarding General Anesthesia Neurotoxicity in Children under Three: A Report from an Academic Hospital.

BACKGROUND: Recently, concerns about general anesthesia (GA)-related neurotoxicity has been growing in societies. Parents' information obviously plays an important role to make right decision for elective surgeries on children aged under three years old. OBJECTIVES: The aim of this survey was to evaluate the knowledge, attitude, and performance of pregnant women about the GA-related neurotoxicity in children aged under three years old. METHODS: This descriptive study was conducted at Alzahra Teaching Hospital in Guilan, Iran, during 2020. The eligible pregnant women admitted to this center were interviewed, and a questionnaire containing 10 items was filled out by the responsible resident of anesthesiology. RESULTS: In this research, a total of 361 pregnant women were enrolled and underwent a face-to-face interview. The mean age of the participants was 31.4 ± 7 years, 64.5% were living in urban areas, 82.5% were housewives, and 65.7% were multipara. Moreover, 83.7% of participants believed that receiving information in this regard was crucial, and 81.7% preferred physicians as the source of information. Only 8% of mothers had received information regarding the issue. A significant correlation was observed between the habitat, employment, the level of education, knowledge, and attitude status, and the source of receiving information. CONCLUSIONS: According to our results, the knowledge, attitude, and performance of pregnant women were not optimal and needed to be improved through practical strategies.

Electroconvulsive Therapy-Related Anxiety: A Survey in an Academic Hospital in the North of Iran.

BACKGROUND: Electroconvulsive therapy (ECT) is a medical treatment most commonly used in the most severe psychiatric diseases; however due to unreal anxiety, it is not widely accepted by patients and their families. OBJECTIVES: The present study aimed to investigate the main causes of ECT-related anxiety (ERA) in an academic hospital in the north of Iran. METHODS: In this study, the participants were hospitalized psychiatric patients with proper communication skills. A 12-item questionnaire encompassing four sections (namely ECT side-effects, procedure factors, medical team communication, and familial, social, and economic factors) were filled out by a responsible psychiatric resident through a face-to-face interview. The participants' demographic information, including gender, age, psychiatry disorder, level of education, and history of ECT, were also recorded. RESULTS: In this study, 353 cases were analyzed, among whom 329 patients (93.2%) reported at least one item for ERA, and 143 patients (85.6 %) had the history of ECT. All the participants (100%) had no experience in this regard (P = 0.0001). The most common cause of ERA was ECT-related side effects (70.7%) such as memory impairment (60.4%), disablement (24.9%), and death (14.7%) followed by procedure factors (27.2%), general anesthesia (GA) (73.2 %), and electric current (26.8 %). A significant relationship was observed between gender and the history of ECT with the patients' anxiety reasons (P = 0.0001); however, the other variables, including age (P = 0.72), type of disease (P = 0.144), and the level of education (P = 0.012) had no impact on the results. CONCLUSIONS: In this paper, the main causes of ERA were general anesthesia, memory impairment, and electric current. Obviously, a multidisciplinary approach is required to help these patients to handle their fear and anxiety successfully.

Successful Management of a Suspected Case of Meperidine-Induced Anaphylaxis in Cesarean Delivery.

INTRODUCTION: Meperidine is known as the gold standard drug for shivering after spinal anesthesia (SA). This drug has been used widely and safely during the Cesarean Section (CS). CASE PRESENTATION: This case report presents an anaphylaxis reaction to a single intravenous dose of 25 mg meperidine, aiming to control shivering during CS under SA a few minutes after surgical incision. CONCLUSIONS: The condition was well managed with timely intervention. This rare fetal reaction to meperidine is worthy of reporting to make the medical team aware of the potential risks of anaphylaxis due to many routine safe drugs.

General Anesthesia-Related Neurotoxicity in the Developing Brain and Current Knowledge and Practice of Physicians at Guilan Academic Hospitals.

BACKGROUND: Recent articles about the topic of the anesthetic agents-related neurotoxicity have currently attracted the attention to the issue in the anesthesiology community. However, specialists in other fields should also be aware of this potential risk. OBJECTIVES: This study aimed to evaluate the knowledge and practice of physicians at Guilan academic hospitals regarding general anesthesia-related neurotoxicity. METHODS: Firstly, the responsible anesthesia resident explained the purpose of this work to Guilan faculty and residents and if they agreed to participate a questionnaire containing 12 items was filled via a face to face interview. RESULTS: A response rate of 100% was achieved (271 responders from 271 eligible study responders). Also, 89 (33.1%) responders were attending, 180 (66.9%) were residents, 112 (41.6%) were female, and 157 (58.4%) were male. The mean years of experience was 8.8 ± 4.82 (2 - 28 years). According to the achieved data, the majority of the precipitants did not believe in GA toxicity. CONCLUSIONS: This paper revealed that the current curriculum does not sufficiently address the anesthesia-related neurotoxicity problem. Indeed, the need for training and communication with non-anesthesia medical colleagues was highlighted.

Breaking Bad News: A Valid Concern among Clinicians.

Objective: Delivering bad news is the duty of specialist physicians. However, they find it very difficult due to insufficient experience. In this study, the way faculty and residents of Guilan University of Medical Sciences (GUMS) delivered bad news to the patients was investigated. Method : This study was conducted at hospitals affiliated to GUMS during 2017. A questionnaire containing 18 items on environmental and psychical support was filled through a face to face interview. The first 10 questions evaluated psychical support and the next eight environmental supports. The scoring of each question ranged from 10 to 50, with 10 indicating "never" and 50 "always". Results: According to the analysis of 235 questionnaires, only 32 (13.6%) of the participants had been taught to deliver bad news and 195(83%) felt they need educational courses. Also, 40 (17%) believed that they had enough ability to deliver these massages. No significant differences were observed among physicians who had taken teaching courses in breaking bad news to patients. Conclusion: This study revealed that educational courses to improve physicians' communication skill to break bad news to patients are strongly warranted.

Significance of Cardiac Troponin I Elevation in Traumatic Brain Injury Patients.

BACKGROUND: Myocardial dysfunction is frequently described as an underlying cause of mortality in traumatic brain injury (TBI) known as brain-cardiac link. However the impact on prognosis of a disease remains uncertain. OBJECTIVES: The current study aimed at investigating the correlation between TBI and cardiac troponin I (cTnI) rise and in-hospital mortality rate among patients with TBI. METHODS: In the current prospective study TBI patients with abbreviated injury scale score (AIS) > 3 and Glasgow coma scale (GCS) score ≤ 8 with cTnI measurement within the first 24 hours of admission were evaluated. Chi-square, Kruskal-Wallis, Mann-Whitney U and Logistic Regression tests were used for data analysis. RESULTS: A total of 166 eligible patients were studied .The mean age of the cases was 37.64 ± 17.21 years, largely under 65 (93.4%) and male (86.7%).The most common injuries were cerebral contusion (35.1%), while motor vehicle crash (MVC) was the most common cause of injuries (83.73%); 59 % of the patients showed detectable cTnI concentrations within 24 hours of admission; 65.7% of the patients expired; they showed higher levels of cTnI compared to survivors that showed lower levels, 0.148 ± 0.074 vs 0.057 ± 0.055, respectively (P < 0.001). Moreover, a significant association was observed between mortality rate and lower admission GCS 3.49 ± 1.08 vs 6.79 ± 1.66, respectively (P < 0.001). CONCLUSIONS: Increased cTnI levels could be a predictor of mortality among patients with TBI. Its measurement and investigation for therapeutic strategies could lead to better management of these cases.

Does Adding Lidocaine to Intrathecal Bupivacaine Affect Hemodynamic Parameters during Hip Fracture Surgery?

BACKGROUND: Hip fracture is one of the most common problems in elderly that needs surgical repair. As, the majority of these patients have chronic diseases, they are at increased risk of peri-operative mortality and morbidity. The purpose of this study was to evaluate spinal anesthesia with bupivacaine vs bupivacaine in combination with lidocaine in terms of hemodynamic changes in patients undergoing hip fracture surgery. METHODS: This double-blind clinical trial was conducted on 292 patients undergoing surgery for hip fracture under spinal anesthesia. Patients were allocated into two groups of B (10 mg of hyperbaric 0.5% Bupivacaine) and BL (5 mg hyperbaric Bupivacaine 0.5% plus 50 mg Lidocaine 5%). Sensory and motor block and hemodynamic changes were consecutively measured before spinal anesthesia (T0), immediately after spinal injection (T1), every 5 minutes for half an hour (T2- T7), and at 45 minutes (T8) and 60 minutes (T9) after injection. RESULTS: Patients in the two groups were homogeneous in demographic characteristics including age, sex, BMI, ASA Class, baseline blood pressure and heart rate. The onsets of sensory and motor blocks in group BL were faster than group B (P=0.0001). Also, the durations of sensory and motor blocks in group B were significantly longer than group BL (P=0.0001). The BL group had a significantly lower systolic blood pressure in all periods (P<0.05). Although the heart rate in the BL group was lower than group B at all time points, this difference was only significant during T2-T3 (P=0.033 and P=0.0001, respectively). Group BL had significantly more episodes of hypotension, bradycardia, nausea and vomiting (P=0.0001, P=0.023, P=0.003, and P=0.033, respectively). CONCLUSION: According to our findings, using Lidocaine 50 mg in combination with Bupivacaine 5 mg, compared with Bupivacaine 10 mg alone for spinal anesthesia in hip fracture fixation surgeries was associated with more hypotension and bradycardia. As a result, combination of Bupivacaine with Lidocaine at this dose is not recommended for induction of anesthesia in these patients.

VDR and GC gene polymorphisms modulate the risk of lumbar disc degeneration in Iran.

OBJECTIVE: Lumbar disc degeneration (LDD) occurs commonly in humans. Vitamin D metabolic and signaling pathway plays a significant role in intervertebral disc degeneration. The aim of this study was to evaluate the influence of the genetic polymorphism in the two key genes of 1,25-(OH)2-D3 pathway, VDR (vitamin D receptor) and GC (group-specific component), in LDD development. PATIENTS AND METHODS: Two single-nucleotide polymorphisms, VDR rs2228570 (FokI) and GC rs7041, were genotyped in 180 patients with LDD and 230 healthy individuals. Genomic DNA was extracted from whole peripheral blood. VDR and GC genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: A significant difference in genotype distributions of rs2228570 in VDR and rs7041 in GC gene were observed between cases and controls (P = .01 and. 005, respectively). The VDR AA homozygous genotype was seen in 30(16.7%) patients with LDD and 20(8.7%) controls (codominant model: OR = 2.48; 95% CI 1.30-4.73, P = .005) with an estimated approximately 2.5-fold risk of developing LDD in individuals with this genotype. Moreover, higher grades of disc degeneration were more related to VDR A allele. The minor allele of GC rs7041 was associated with a decreased risk of LDD (OR = 0.69; 95% CI 0.44-0.82, P = .001). CONCLUSION: In conclusion, our results suggest for the first time that the genetic variants of VDR and GC genes contribute to genetic predisposition to LDD in Iran. These findings need further validation in the large multicenter case-control studies.

Evaluation of Admission Indications, Clinical Characteristics and Outcomes of Obstetric Patients Admitted to the Intensive Care Unit of a Teaching Hospital Center: A Five-Year Retrospective Review.

BACKGROUND: Care of obstetric patients has always been a challenge for critical care physicians, because in addition to their complex pregnancy-related disease, fetal viability is considered. OBJECTIVES: The aim of this study was to review the admission indications, clinical characteristics and outcomes of obstetric patients, admitted to the intensive care unit of Alzzahra teaching hospital affiliated to Guilan University of Medical Sciences, Rasht, Iran. METHODS: This retrospective cohort study was conducted on pregnant /post-partum (up to 6 weeks) patients admitted to the ICU over a 5-year period from April 2009 to April, 2014. RESULTS: Data from 1019 subjects were analyzed. Overall, 90.1% of the patients were admitted in the postpartum period. The most common indications for admission were pregnancy related hypertensive disorders (27.5%) and obstetric hemorrhage (13.5%). Epilepsy (5.4%) and cardiac disease (5.2%) were the most common non-obstetric indications. CONCLUSIONS: Pregnancy-related hypertensive disorders and obstetric hemorrhage were the main reasons for admission, and epilepsy and cardiac disease were the most common non-obstetric indications. Efforts must be concentrated on increasing antenatal care.

Acupuncture and botulinum toxin A injection in the treatment of chronic migraine: A randomized controlled study.

BACKGROUND: Migraine is a common type of headache. Sometimes adequate pain relief is not achieved by conventional treatments. Acupuncture and botulinum toxin-A injection are known as non-pharmacological interventions for this purpose. The aim of this research was to compare the effect of acupuncture with botulinum toxin-A injection and pharmacological treatment in controlling chronic migraine. METHODS: This clinical trial was conducted on patients with chronic migraine in the North of Iran during 2014-2015. Eligible patients were randomly allocated to groups receiving acupuncture (A) or botulinum toxin A (B) and controls (C) by designed quadripartite blocks. All patients were evaluated at baseline, one, two and three months after treatment using visual analogue scale (VAS) score and other parameters. The analysis of data was performed in SPSS software Version 19. RESULTS: One hundred fifty patients (48 males and 102 females) completed this study. During the 3- month study, the pain severity significantly diminished in three groups (P=0.0001), with greater reduction in group A (P=0.0001). The number of days per month with migraine, absence from work and the need for medication significantly decreased in three groups at 3 times of evaluation (p<0.05) with fewer side effects in group A (P=0.021). CONCLUSION: Acupuncture, botulinum toxin-A injection and pharmacological treatment have beneficial effects on chronic migraine; however, acupuncture showed more effectiveness and fewer complications.