A comparison of prophylactic use of meperidine, meperidine plus dexamethasone, and ketamine plus midazolam for preventing of shivering during spinal anesthesia: a randomized, double-blind, placebo-controlled study.

STUDY OBJECTIVES: The aim of this study is to compare the efficacy of combination of meperidine and dexamethasone with that of placebo, meperidine alone, and the combination of ketamine and midazolam in preventing shivering during spinal anesthesia. DESIGN: This is a prospective, placebo-controlled study. SETTING: The setting is at an operating room of a university-based teaching hospital. PATIENTS: Two hundred American Society of Anesthesiologists I and II patients undergoing orthopedic and urologic surgery under spinal anesthesia were included. INTERVENTIONS: Subarachnoid anesthesia was performed by using 15mg of 0.5% hyperbaric bupivacaine. Patients were randomly allocated to receive saline (placebo, group C), meperidine 0.4mg/kg (group Me), ketamine 0.25mg/kg plus midazolam 37.5µg/kg (group KMi), and meperidine 0.2mg/kg plus dexamethasone 0.1mg/kg (group MeD). All drugs were given as an intravenous bolus immediately after intrathecal injection. MEASUREMENTS: During surgery and stay in the recovery room, shivering score, blood pressure, and some other adverse effects were recorded at 5-minute intervals. Axillary and tympanic temperatures were recorded at 15-minute intervals during the perioperative period. MAIN RESULTS: The incidence of shivering after 30minutes of spinal anesthesia in groups C, Me, KMi, and MeD was 64%, 20%, 20%, and 4%, respectively, which was significantly higher in group C compared with other groups (P<.0001). Regarding adverse effects, there was no significant difference between groups (P≥.2). Axillary temperature significantly increased in the 15th-120th-minute interval in groups Me, KMi, and MeD (P<.0001) and in group MeD was higher than that in other groups. Core temperature decreased in the 15th-120th-minute interval in group MeD, lower than that in other groups (P<.0001). CONCLUSIONS: Prophylactic use of meperidine 0.2mg/kg plus dexamethasone 0.1mg/kg was more effective than meperidine 0.4mg/kg as a sole agent or the combination of ketamine 0.25mg/kg and midazolam 37.5µg/kg in preventing shivering resulting from spinal anesthesia.

Gender differences in depression scores of Iranian and german medical students.

OBJECTIVE: The aim was to evaluate gender differences in depression scores of Iranian and German medical students. METHODS: Two hundred Iranian medical students (100 men and 100 women) and 200 German medical students (100 men and 100 women) were selected randomly and completed the English form of the self-rating Beck Depression Inventory (BDI). RESULTS: Analysis gave a mean rating of 10.7 ± 6.6 for Iranian men and 10.9 ± 7.81 for Iranian women (NS). Also, 5 ± 4.9 for German men and 5.6 ± 5.0 for German women (NS). On Item 2, which asked whether the person was pessimistic 33% of Iranian men and 30% of Iranian women indicated that they were pessimistic (NS). Also, 21% of German men and 20% of German women indicated that they were pessimistic (NS). On Item 9, which asked about suicidal tendencies, 9% of Iranian men and 13% of Iranian women reported as having suicidal tendencies (NS). Also, 13% of German men and 21% of German women reported as having self-harming thoughts (NS). CONCLUSION: The present study showed no gender differences in Iranian and German medical students' scores on the BDI.

Gastro-esophageal reflux symptoms and body mass index: no relation among the Iranian population.

An association between obesity and symptoms of gastro-esophageal reflux disease (GERD) has been frequently reported in western societies. A recent study indicated a consistent association between abdominal diameter and reflux-type symptoms in the white population, but no consistent association in the black population or Asians. It is unclear whether an association persists after adjusting for known risk factors of GERD among Asian populations. We did a population-based, cross-sectional interview study to estimate the strength of association between body mass and symptoms of reflux. During interviews, participants completed a valid gastro-esophageal reflux questionnaire. Odds ratio (OR) with 95% confidence interval (CI), calculated by logistic regression with multivariate adjustments for covariates, were the measures of association. Symptoms of reflux at least once a week over the past 3 months were reported by 522 (9.1%) of the 5733 interviewees. Among those who were overweight or obese (BMI> 25 kg/m2), the OR of having symptoms of reflux was 0.88 (95% CI: 0.66-1.16) compared with those who were not overweight or obese. Thus, among Asians, symptoms of GERD occur independently of body mass index.

Gastro-oesophageal reflux disease and irritable bowel syndrome: a significant association in an Iranian population.

BACKGROUND: Gastro-oesophageal reflux disease and irritable bowel syndrome are common diseases, which may be related. AIM: To assess the association between gastro-oesophageal reflux disease and irritable bowel syndrome in a country with high prevalence of Helicobacter pylori. METHODS: This study was designed as cross-sectional and population-based in Tehran province, Iran. The participants were interviewed by using a valid and reliable questionnaire. Gastro-oesophageal reflux disease was defined by weekly or more frequent heartburn and/or acid regurgitation. Irritable bowel syndrome was diagnosed according to the Rome III. The association between these two disorders was calculated using a statistical model that allows the odds ratio (OR) to be measured. RESULTS: A total of 6526 individuals were selected randomly, the response rate was 87.8%. Among the respondents, 178 (3.1%) participants reported both the diseases. The OR of having gastro-oesophageal reflux disease and irritable bowel syndrome together was estimated to be 16.55 (95% confidence interval: 12.85-21.33) indicating significant association between the two diseases. Thirty-four percent of patients with gastro-oesophageal reflux disease and 61.5% with irritable bowel syndrome suffered from both diseases. Sex did not have a significant effect on the OR of coexistence. Older participants were statistically more prone to the coexistence of two diseases. CONCLUSION: The association between gastro-oesophageal reflux disease and irritable bowel syndrome was significantly higher in our community compared with others. Their association occurs predominantly in older participants. Further studies for understanding of the pathophysiological mechanisms behind these two diseases are required.