Search

Background. The pre-operative evaluations of patients should not cause any mental or physical harm to the patient or waste the financial resources of the patient or the public health system by unnecessary actions. Health spending is one of the issues of concern in developed and developing countries. In Iran, 5–10% of government spending is allocated to this sector. The purpose of the present study was to compare the current process of preparing surgical candidates with accepted clinical guidelines. Methods. In this cross-sectional study, sampling was performed by the judgmental/purposive method among the mentioned population; finally, 134 patients were evaluated in this study. The data were categorized as 3 x 4 tables. On one side of the table, patients were divided into small, intermediate, and large surgical groups according to surgical complexity, and on the opposite side of the table, they were assigned to four groups at low, intermediate, high, and very high risk. As a result, each patient was housed in one of the houses on a 12-hole table. The clinical findings and evaluation results before surgery were extracted and evaluated retrospectively. Results. The mean age of the patients was 49.68 ± 16.96 years, and 74.6% were male. The most common type of surgery was transurethral lithotripsy. The incidence of hypertension (21.4%) among underlying diseases and comorbidities was the highest recorded item. The procedures were selected relatively in the same population size from three groups, namely, small, intermediate, and large procedures, with a frequency of 50 (37.3%), 34 (25.4%), and 50 (37.3%) cases, respectively. Conclusion. In the present study, the majority of patients with minor surgeries did not comply with the valuations recommended by guidelines. Among the patients with intermediate surgeries, in nearly half of the cases, and in the major or complex surgery group, most of the time, the evaluations were performed in accordance with the guidelines. Practical Implications. Physicians should consider adhering to current clinical guidelines when requesting preclinical tests, which can pave the way for minimizing unnecessary costs. [ABSTRACT FROM AUTHOR]

Background. One of the common treatments for prostate cancer is radical prostatectomy, which is performed in different ways. One of the advantages of the nerve bundle preservation method is better exposure, decrease in rectal damage the lower rectum. In addition, the possibility of a positive margin is less. Therefore, this study aimed to examine the results of using the high anterior release (HAR) technique in radical open prostatectomy surgery. Methods. In this cross-sectional study, after examining patients and their entry into the study and obtaining their medical records, questions were asked to assess erectile function and urinary incontinence. The prostate-specific antigen level was checked before and after the operation. In addition, the average surgical time, blood loss, and hospitalization time were evaluated. Finally, the data were analyzed using the SPSS statistical analysis program, version 19. Results. In this study, 102 patients underwent radical prostatectomy, with an average age of 62.33 years. About 56.9% of patients had stage t2b. During the 6-month follow-up after surgery, 70.5% of patients had complete urinary continence. Data analysis demonstrated that there is a direct relationship between urinary incontinence, with a history of radiotherapy (P<0.001), and the stage of the disease (P=0.019). After surgery, 61.8% of patients were satisfied with the erection function . Conclusion. The results of this study revealed that urinary incontinence and erectile dysfunction are relatively common complications of this surgery. However, compared to other similar studies, the incidence of these two complications is lower. Practical Implications. Urinary incontinence and erectile dysfunction are relatively prevalent complications of radical prostatectomy surgery using the HAR technique. Nonetheless, the incidence of these two complications is lower compared to other similar studies. [ABSTRACT FROM AUTHOR]

Background Nasal septal abscess, which is the collection of purulent materials between the cartilaginous or bony septum and the mucoperichondrium or mucoperiosteum, often occurs after septal hematoma caused by trauma. Other common factors include surgery, foreign bodies, and sinusitis. In addition to the risk of nasal deformity, septal abscess can cause life-threatening complications such as osteomyelitis, orbital or intracerebral abscess. Objective This study aims to investigate the frequency of nasal septal abscess and its related factors in patients in north of Iran. Methods In this descriptive cross-sectional study on the patients referred to a hospital in north of Iran in 2022. Their demographic and disease-related information were recorded and the risk factors were finally identified. Results In this study, 37 patients had septal abscess. The most common risk factor identified was a history of septoplasty or septorhinoplasty (35.1%), followed by diabetes mellitus (21.6%). Surprisingly, one of the factors in these patients was cauterization for epistaxis treatment (n=6). All patients were treated with broad-spectrum antibiotics and surgical drainage. In five patients, abscess resulted in saddle nose deformity. Positive culture results were reported in five samples. Conclusion Early identification of nasal septal abscess and its risk factors can help control the disease and prevent its serious complications. [ABSTRACT FROM AUTHOR]

Background and Objectives Chelation therapy is essential for beta-thalassemia major. This study aims to determine the complications clinical and laboratory symptoms of monotherapy and combined treatment of iron chelators in beta-thalassemia major patients in Yasuj. Materials and Methods In this cross-sectional-descriptive-analytical study, 103 patients with beta-thalassemia major in Yasuj city were evaluated during 2021-2022. After collecting the demographic, clinical and laboratory information of the patients, the results were reported as mean ± standard deviation and percentage. The degree of statistical differences between ratios was calculated using the Kruskal-Wallis test. Results The average age of our patients was reported to be 24.74 ± 8.34 years. 54.4% (n = 56) of the study patients were men and 45.6% (n = 47) were women. The results of the present study showed that there was a statistically significant difference in mean ferritin among different study groups (p = 0.028). Patients treated with deferoxamine showed the highest mean serum ferritin (5925.5 ± 3397ng%) and patients who took deferoxamine together with deferiprone or deferasirox had a lower mean ferritin compared to deferoxamine alone (3348 ± 2560, 4269 ± 3322 ng%), respectively. Also, the present study showed that after taking iron removers, 47.6% of patients (n = 49) had no clinical complications and 52.4% (n = 54) had at least one complication. Conclusions Our results showed that Deferoxamine can have a great effect in reducing iron deposition and serum ferritin levels in combination with oral drugs. [ABSTRACT FROM AUTHOR]

Background and Objectives Uncontrolled post-operative bleeding can lead to several problems and tissue repair disorder indentistry. This study has been conducted to compare the effect of Chitohem and natural silk on the onset of clot formations. Materials and Methods This laboratory study was carried out with a dependent parallel design. Three drops of blood were taken from each of 32 participants in the study. Fifty milligram Chitohem and natural silk powder were poured on two blood drops, respectively. The clot formation time was measured for all three groups simultaneously. Duration between pouring powder and starting of clot formation was recorded. Data analysis was performed using paired t-test and repeated measure ANOVA methods using SPSS 17 software. Results Participants composed of 20 (62.5%) women and 12 (37.5%) men. The average age of the participants was 43.33 ± 4.08 years. The average time periods of the onset of blood clot formation in Chitohem group, natural silk and control group were 90.97 ± 29.99, 141.97 ± 49.10, and 195.44 ± 58.70 second, respectively. Paired t-test showed the mean time of clot formation was significantly different among groups (p = 0.0001). Conclusions Based on the obtained results, it seems that although effect of “organic natural silk” on coagulation time was less than “Chitohem”, but silk has an acceptable hemostatic effect. The simultaneous use of natural silk and Chitohem can have a synergistic effect. [ABSTRACT FROM AUTHOR]

Introduction: Cataract is one of the most common diseases in the world and the most common cause of vision loss and blindness in the world. Stability of hemodynamic symptoms is one of the most important factors during cataract surgery. Therefore, the aim of this study is to investigate the effect of melatonin and tizanidine on hemodynamic parameters and anxiety in patients undergoing cataract surgery. Materials & Methods: This prospective clinical trial study was conducted on 90 patient's candidates for cataract surgery. Patients into three equal groups; Melatonin, tizanidine and placebo were divided. Hemodynamic parameters were recorded at baseline and every 5 minutes during surgery. After the operation was completed and the patients were transferred to the recovery room, postoperative anxiety in the recovery room and 24 hours after the operation (calling the patient) was checked by means of RASS tools. Results: There was no difference in the variables of age, sex, weight between the studied groups. Heart rate, diastolic and systolic blood pressure decreased over time in all three groups. Diastolic blood pressure in the 10th minute of surgery (late surgery) in the tizanidine group was significantly lower than the control group (P<0.05). Tukey's post hoc test showed that in the recovery room, the level of anxiety in people who received melatonin or tizanidine was significantly lower than the control group (P<0.05). There was no difference between the anxiety levels of the melatonin group and the tizanidine group (P=0.904). Conclusion: The results of this study showed that melatonin and tizanidine can reduce the anxiety of patients in the acute phase after surgery. Since tizanidine may lower blood pressure, melatonin prodrug seems to be a better option for reducing pain and anxiety in patients undergoing cataract surgery. [ABSTRACT FROM AUTHOR]

Introduction: : One of the most important problems and complications after surgery is tissue adhesion. Carboxymethyl cellulose is a cellulose derivative that can dissolve in water and has high viscosity. In this study, the role and effect of carboxymethyl cellulose in the healing of surgical wounds in rabbits have been discussed. Material & Methods: To conduct the study, 15 male rabbits aged 7-9 months were randomly divided into 3 groups of 5: experimental, control, and skin wound. After preparing the operation site, in both the control and experimental groups, a 4 cm incision was made in the right flank region. In the experimental group, the inside of the abdominal cavity was smeared with carboxymethyl cellulose gel (dose 7 mg/kg); however, in the control group, carboxymethyl cellulose gel was not used. Two groups of abdominal cavity slits were sewn in two separate layers. In the skin wound group, only the skin was cut, and then the wound was covered with carboxymethyl cellulose and sutured. The surface of the wounds was clinically examined daily, and on the 20th day, skin and muscle samples were taken for biomechanical studies. Results: The results showed that, clinically, the wound was repaired in the same way in the three groups, and carboxymethyl cellulose had no difference in the biomechanical parameters, maximum tensile strength, and tissue stiffness, in the skin tissue between the groups, and besides preventing tissue adhesion, it increased the biomechanical parameters in the muscle tissue. Discussion & Conclusion: According to the results, carboxymethyl cellulose had no negative effect on the healing process of the skin and led to better healing and strength of the muscle tissue. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a significant risk factor for postoperative complications and mortality. However, there are different opinions about the relationship between the increase in glycosylated hemoglobin (HbA1c) level and the incidence of surgical complications. Methods: In this retrospective study, 189 diabetic patients referred to Sabalan Hospital in Ardabil who were admitted for surgery were examined in 2021. The data related to demographic information, HbA1c test, postoperative complications, and the outcome of patients’ hospitalization were extracted from the records and entered into the researcher-made checklist. Patients were divided into two groups of uncontrolled diabetes with HbA1c of 7 and above and the controlled diabetes group with HbA1c below 7. Results: Out of 189 patients included in the study, 97 patients were in the uncontrolled diabetes group, and 92 patients were in the controlled diabetes group. The average age of diabetic patients in uncontrolled and controlled diabetes groups was 58.18±8.91 and 61.84±5.52, respectively. According to the results, surgical site infection and the need for re-surgery during hospitalization showed a significant relationship with an HbA1c level (p≤0.05). Other postoperative complications were not significantly different between the two groups. Conclusion: It seems logical that elective surgeries should be postponed in HbA1c levels higher than 7% because the presence of high HbA1c levels indicates that the patient’s diabetes is not under control, and as a result, there is a higher probability of chronic complications of diabetes as well as a higher risk for post-operative complications.

Background and Aim: Low Back pain is one of the most common diseases that face adults with various physical, psychological, economic, and social problems. Due to the fact that patients experience various degrees of disability during this period, the present study was conducted to determine the quality of life and functional outcome in patients with lumbar disc herniation. Methods: This study was a descriptive-interventional study that was performed in 2022. One hundred twenty patients undergoing lumbar disc surgery were included in the study by census method. Patients were investigated before and, 3, 6, and 12 months after the operation using a 12-question short-form questionnaire to measure the quality of life, the Oswestry Functional Disability Questionnaire to measure the severity of the disability, the European Quality of Life Questionnaire to measure the health-related quality of life, and the DASS Questionnaire to measure depression, anxiety, and stress. The data were analyzed using SPSS software (version 22) and the significance level was less than 0.05. Results: The quality of life in the physical dimension improved after 12 months (P<0.05). Oswestry disability index improved from severe to moderate disability and preoperative disability improved compared to 12 months after surgery (P<0.05). The EQ-5D index improved after 12 months and significantly differed from before surgery (P<0.05). There was a significant difference between stress before and 12 months after surgery (P<0.05). The results indicated that there was a significant relationship between Oswestry functional disability index and body mass index (P = 0.002) and age (P = 0.01), and depression with gender (P = 0.003). Conclusion: The results showed that the quality of life, functional ability, and stress in patients undergoing lumbar disc surgery improved after 12 months. [ABSTRACT FROM AUTHOR]

Background. As one of the most frequent procedures, breast surgery puts high healthcare costs. The significance of surgical quality and complications before and after breast surgery entailed using methods with the highest outcomes and the least complications. Methods. Throughout this research, postoperative complications and factors affecting the quality of surgery were evaluated in the Kowsar hospital between the 2019 and 2020.Patients undergoing breast surgeries were randomly categorized into two groups: electrocautery (A) and harmonic scalpel (B). Results. Out of the 56 people, 28 patients were in group A, and the remaining 28 patients were in group B. After matching the patients, intraoperative bleeding, drainage rate, a period of drainage, duration of hospitalization in group B were significantly lower (P<0/05). Further, the extent of pain in both groups was different (P<0/001), so that there was less postoperative pain in women who experienced harmonic breast surgery. Patients throughout Group A reported more complications than in Group B, such that 7 (25%) of patients underwent limb anesthesia and 3 (10/7%) of patients experienced seroma, however, the difference between the two groups was not significant. Conclusion. Harmonic scalpel usage in breast surgery has fewer complications, better operation quality and shorter hospital stay than other older methods, so it is suggested that the use of harmonic scalpel may substitute different surgical strategies. Practical Implications. According to the results of this study, the use of harmonic has fewer complications for patients, and suffering of patients are reduced and they pay less. [ABSTRACT FROM AUTHOR]

Introduction: The nature of septorhinoplasty surgery and hemodynamic instability in patients causes intraoperative bleeding, which affects the quality of the surgical field of view, intraoperative and postoperative complications, and surgical outcome. Materials and Methods: This double-blind randomized clinical trial study was conducted on 60 patients aged 18 to 44 who were candidates for septoranioplasty surgery. Patients were randomly divided into two equal groups. Group 1: received bisoprolol 2.5 mg and group 2 received placebo as a control group. Hemodynamic symptoms will be measured before induction, after induction, 1 minute after induction, 5 minutes after induction, 30, 60, 90 and 120 minutes during operation, entering recovery and exiting recovery. The amount of bleeding during the operation was estimated based on the amount of bleeding in the suction. Data analysis was done using spss software version 21 and descriptive statistics (mean and standard deviation) and inferential statistical tests. Result: In the times before and after induction, 1 minute, 5, 15, 30, 60, 90, 120, in recovery and outside of recovery, there was a significant difference between the two groups in the average systolic and diastolic blood pressure and blood pressure. There was no mean arterial (P<0.05). While the heart rate in these minutes was reported to be significantly lower in the bisoprolol group than in the control group (P<0.05). There was a significant difference between the bisoprolol and control groups in terms of average recovery time (P=0.017) and total surgery time (P=0.044); However, there was no significant difference in the average amount of bleeding between the two groups (P=0.06). Conclusion: The results of this study showed that the use of a dose of 2.5 mg of bisoprolol before the operation can significantly reduce the heart rate, but it does not make a significant difference in the hemodynamic changes and the bleeding rate of patients in septorhinoplasty surgery. [ABSTRACT FROM AUTHOR]

Background Patients who undergo major orthopedic surgery are at risk of acute kidney injury (AKI) due to blood loss, electrolyte disorders, infection, and other co-morbidities. In this study, we aim to investigate the frequency of AKI and its risk factors in patients undergoing major orthopedic surgery in Rasht, Iran. Objective This is an analytical cross-sectional study on 180 patients undergoing major orthopedic surgery. Those with a history of chronic kidney disease and dialysis were excluded. Methods The data including patients’ age, gender, drug history, history of underlying diseases, duration of surgery, mean arterial pressure during and after surgery, and use of inotrope during and after surgery, and creatinine level before and after the surgery. Results The mean age of patients was 47.3±22.8 years. The incidence of AKI was 11.11%. The use of some drugs, duration of surgery, MAP, and inotrope use had no significant relationship. The occurrence of AKI had a significant relationship with the history of heart disease, diabetes, and kidney disease. Multiple linear regression analysis results showed that with the increase of one unit in preoperative creatinine level, the postoperative creatinine level increased by 0.3. Conclusion The incidence of AKI after major orthopedic surgery in Rasht city is relatively high. Careful monitoring of kidney function before, during, and after major orthopedic surgery is important; it can prevent the occurrence of postoperative AKI. [ABSTRACT FROM AUTHOR]

Background and Aims: The surgical removal of mandibular third molar is frequently accompanied by significant postsurgical complications, and different protocols have been described to decrease such complications. The aim of this study was to compare the postoperative complications of mandibular impacted third molar removal with two conventional rotary and piezoelectric methods. Materials and Methods: In this study 27 patients with bilateral mandibular impacted third molars were selected. The patients' teeth were extracted by the piezoelectric method on a random side and the opposite tooth was extracted by conventional rotary technique. On operation and post operation days, edema, pain, and mouth opening were assessed. The duration of each operation was also measured. Data were analyzed by Mann-Whitney test and independent t-test. Results: The mean duration of operation in the rotary group was less than that of the piezoelectric group, which was statistically significant (P=0.001). Pain was significantly higher in the rotary group on days 0 to 5 (P<0.05). Whereas, difference in pain on day 6 was not statistically significant (P=0.067). There was no significant difference between the two groups in each day after surgery regarding mouth opening (P>0.05). Edema was significantly higher in the rotary group on the first, third, and fifth days after surgery (P<0.05). Also, edema was higher in the rotary group on the seventh day after surgery, but not statistically significant (P=0.076). Conclusion: According to the results of the present study, it can be concluded that pain and swelling in patients after impacted tooth surgery using time consuming piezoelectric technique can be reduced. [ABSTRACT FROM AUTHOR]

Introduction: The most common method of choice for orthopedic lower extremity surgery is intrathecal anesthesia. Despite the benefits of using spinal anesthesia, this method has complications such as headache in the acute postoperative period. Therefore, this study aims to compare Madin and Parmadin methods. The incidence of PDPH (Post-Dural-puncture headache) in patients undergoing orthopedic lower limb surgery was performed by spinal anesthesia. Materials and Methods: This double-blind clinical trial was performed on 60 orthopedic surgery patients referred to Pimayeh Hospital in Jahrom. Inclusion criteria included expressing consent to participate in the study, ASA class 1 and 2, no migraine and chronic headaches, no cardiovascular disease, no coagulation disease. Patients accidentally throwing coins into two groups 1) Medin And 2) paramedins were divided. Vital signs were recorded before and after spinal anesthesia at 5, 15, 30, 45, 60, and 90 minutes during surgery and in recovery. PDPH was collected in patients after surgery for 7 days and once a day by an uninformed person in the form of a questionnaire. After collecting data, the data were statistically analyzed using SPSS software version 21. To report descriptive statistics, qualitative variables were reported using frequency and percentage, and quantitative data were reported using mean and standard deviation. Analysis of variance with repeated measures and Chi-square test were used. P <0.05 will be considered as a significant level. Results: A total of 60 patients undergoing orthopedic surgery were evaluated by spinal anesthesia in the age range of 16 to 90 years (in two groups of 30). In pre-spinal anesthesia, immediately after spinal anesthesia, 5 minutes, 15 minutes and 30 minutes after spinal anesthesia, and in recovery, there was no significant difference between median and paramedic groups in mean systolic and diastolic blood pressure. (05/0> P). In the periods before spinal anesthesia, immediately after spinal anesthesia and 5 minutes after spinal anesthesia, there was a significant difference in mean heart rate between Medin and Paramedin groups (P <0.05). On the first and fourth days, the incidence of PDPH was higher in the paramedin group than in the medin group. But the results of statistical analysis showed that there was no significant difference between the two groups in the incidence of PDPH at different times (p <0.05). Conclusion: Although different benefits have been mentioned for each of Madin and Paramedin methods, but in relation to the incidence of headache, in this study, no significant difference was reported between Madin and Paramedin groups. Therefore, with more studies and more studies related to patient satisfaction, the best method can be used in choosing intrathecal anesthesia technique. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, laser-assisted surgery has become commonplace in dentistry, especially in soft tissue surgeries. The present study aimed to investigate the complications and patient satisfaction after removing exophytic lesions by laser surgery.Materials and Methods: A total of 12 patients requiring removal of peripheral exophytic lesions such as reactive hyperplasia and mucosal surgery were examined to participate in the present study.Results: This surgical procedure had the maximum patient satisfaction (84%) and almost all patients (91.7%) had no postoperative pain. After three weeks, the wound site healed in all patients, although a case of mucosal recurrence was observed in this study.Conclusion: Laser surgery is quite successful due to the absence of pain, maximum patient satisfaction, and wound healing in all patients which is consistent with the results of previous studies, although this method requires a more complete evaluation.

Background & Aims: The aging of the population has caused an increase in the number of elderly people who receive treatment for cardiovascular disease. The prevalence of coronary artery disease is higher in the elderly, and on the other hand, complications after cardiac events are worse in the elderly. The most common cause of death in the elderly is cardiovascular disease. Rapid restoration of blood flow can lead to myocardial survival, preservation of cardiac function, and prolongation of the patient's life, and many clinical trial studies have been conducted to investigate the effect of Thrombolytics, and their results showed that Thrombolytics preserve ventricular function. Primary coronary angioplasty was defined as the primary revascularization strategy for acute myocardial infarction without or with prior thrombolytic therapy. In the last two decades, it has been shown that the complications of coronary artery syndrome have decreased with the development of therapeutic strategies such as revascularization, medical treatment, and risk factors in follow-up after discharge. Data from many cardiovascular centers have shown that angioplasty not only leads to a significant reduction in mortality but also in coronary ischemic events. Elderly people who have concurrent diseases such as lung diseases, kidney diseases, and cerebrovascular accidents and suffer from coronary accidents accept angioplasty with caution. This is even though in symptomatic patients with chronic coronary disease, revascularization leads to the resolution of symptoms and improvement of the patient's life expectancy. Despite the effects of coronary artery disease on the quality of life, morbidity, and mortality of the elderly, in the majority of cardiovascular studies, the elderly 75 years and older were significantly less expressed and directly due to advanced age, and complex co-morbidities, and significant physical and cognitive disabilities., fatigue, living in a nursing home, and decline in daily functioning were excluded from the study. Therefore, recent guidelines cannot provide evidence-based recommendations for the diagnosis and treatment of coronary diseases in the elderly. Choosing the correct treatment strategy for the elderly with acute coronary artery disease is due to the importance of the burden of care from the economic, social, and family points of view. Also, few studies are comparing the effect of medical treatment with revascularization in the elderly 75 years and older. The aim of the study is to determine whether elderly people benefit from primary angioplasty compared to medical treatment alone and the side effects of each of these treatments in the elderly. Methods: The present study is a prospective cohort type, which was approved by the ethical code IR.TUMS.MEDICINE.REC.1397.934 in the ethical code commission of the Faculty of Medicine of Tehran University of Medical Sciences and 97 samples were taken in 9 months from June 2018 to the end of March. were collected and then for 24 hours and 30 days after the treatment (medical/angioplasty), the elderly (mostly 60 years old) with acute coronary artery disease were followed up in terms of the effectiveness and side effects of the treatments. All elderly people diagnosed with acute coronary syndrome hospitalized in two teaching hospitals of Tehran University of Medical Sciences were included in the study and evaluated in two groups. The first group of the interventional treatment group: was patients who were diagnosed with acute coronary syndrome and were treated with angioplasty from the beginning, and the second group, the optimal medical treatment group: patients who were treated with standard medical treatment from the beginning (including Thrombolytics, oral beta blockers, intravenous nitrates, antiplatelet Duals such as aspirin and Clopidogrel, intravenous anticoagulants such as heparin or enoxaparin, statin and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 2) were included according to the latest guidelines. In this prospective cohort study, all patients aged 60 years and older with the acute coronary syndrome were collected by face-to-face interview and case evaluation from two teaching hospitals, Tehran University of Medical Sciences from 2018, and they were divided into two primary and medical angioplasty groups in terms of complications., mortality and efficacy of 24 hours and 30 days were compared. Results: Out of 120 patients with an average age of 71.2±8.2 years, 52 and 68 patients received primary angioplasty and medical treatment, respectively. The majority of patients in the primary angioplasty group were male (57.7%) and female (57.4%) in the medical group (p=0.07). In the first 24 hours, comparing the two groups with the logistic regression method, atrial fibrillation was significantly 11 times higher in the medical group (p=0.016) and improvement of angina in the primary angioplasty group was 3.8 times higher (p=0.04). The 30-day mortality rate was significantly higher in the medical group (p=0.006). Conclusion: These results indicate that we overestimate the risks associated with revascularization in the elderly and deprive people of useful treatments. With increasing age, despite the significant reduction of hospital and short-term mortality by about 5 times, increasing the rate of angina recovery and fewer complications in angioplasty, this treatment method is less often chosen in elderly patients, and elderly people are less likely to choose this method due to their age. They are denied treatment. There are sufficient reasons for the elderly and very elderly with good tolerance to angioplasty. The success rate of immediate angioplasty and the survival rate without complications are similar to young patients, so old age is not a contraindication for angioplasty. Also, old age is not an independent risk factor for poor prognosis. In addition, complete revascularization in very elderly patients may improve prognosis and reduce the incidence of cardiac events. This study included limitations. Collecting samples from two different hospitals, one of these hospitals was not able to perform angioplasty in patients with angioplasty indication due to the lack of an angiography department, and the patients were forced to undergo medical treatment, which also led to a decrease in the number of The samples included in the angioplasty group and the bias in the selection of patients with real indications for medical treatment. On the other hand, it also leads to an increase in complications. The low sample size and the age of the patients included in the study were among the limitations of this study. [ABSTRACT FROM AUTHOR]

Background and Aim: Anxiety is an unpleasant condition that occurs in the majority of people before surgery, and it can cause bleeding and complications after surgery and it can also affect the induction of anesthesia and recovery from it. Nowadays, due to the side effects of medications, nonpharmacological and non-invasive treatments are receiving a lot of attention.The purpose of this research is to determine the effectiveness of acupressure and recommended recitals on the patients’ anxiety before surgery in the hospitals of Ferdows city in 2019-2020. Methods: This study was a double-blind clinical trial research that was conducted on 150 patients who were candidates for surgery. The samples were selected using convenience sampling .The participants were randomly assigned to one of the three acupressure groups (n=50), recommended recitals (n=50) and the control group (n=50). In order to apply acupressure, the third eye point (Yintang) was pressed for 10 minutes, and in the recommended recitals group, the patients listened to Surah Hamad and Zekr several times using an audio source and headphones. In the control group, pressure was applied to the false point for 10 minutes. The level of anxiety was measured using the VAS questionnaire in all three groups before, after and 30 minutes after the intervention respectively. Data were entered into SPSS software version 19 using descriptive and inferential statistical methods. Results: In recommended recitals group, the average anxiety score before, after and 30 minutes after the intervention had a significant difference with each other (P<0.001). Also, the average anxiety score after the intervention was significantly lower than immediately and 30 minutes after the intervention in this group (P<0.001). Meanwhile, the average score of anxiety in the acupressure group (p=0.06) and the control group (p=0.10) did not show any significant difference with each other at three times. Conclusion: Recommended recitals can reduce anxiety before surgery and can be used as a nondrug, safe and cheap method to reduce anxiety before surgery. Background and Aim: Anxiety is an unpleasant condition that occurs in the majority of people before surgery, and it can cause bleeding and complications after surgery and it can also affect the induction of anesthesia and recovery from it. Nowadays, due to the side effects of medications, nonpharmacological and non-invasive treatments are receiving a lot of attention.The purpose of this research is to determine the effectiveness of acupressure and recommended recitals on the patients’ anxiety before surgery in the hospitals of Ferdows city in 2019-2020. Methods: This study was a double-blind clinical trial research that was conducted on 150 patients who were candidates for surgery. The samples were selected using convenience sampling .The participants were randomly assigned to one of the three acupressure groups (n=50), recommended recitals (n=50) and the control group (n=50). In order to apply acupressure, the third eye point (Yintang) was pressed for 10 minutes, and in the recommended recitals group, the patients listened to Surah Hamad and Zekr several times using an audio source and headphones. In the control group, pressure was applied to the false point for 10 minutes. The level of anxiety was measured using the VAS questionnaire in all three groups before, after and 30 minutes after the intervention respectively. Data were entered into SPSS software version 19 using descriptive and inferential statistical methods. Results: In recommended recitals group, the average anxiety score before, after and 30 minutes after the intervention had a significant difference with each other (P<0.001). Also, the average anxiety score after the intervention was significantly lower than immediately and 30 minutes after the intervention in this group (P<0.001). Meanwhile, the average score of anxiety in the acupressure group (p=0.06) and the control group (p=0.10) did not show any significant difference with each other at three times. Conclusion: Recommended recitals can reduce anxiety before surgery and can be used as a nondrug, safe and cheap method to reduce anxiety before surgery. [ABSTRACT FROM AUTHOR]

In this case report study, the patient was a 95-year-old woman who was referred to the health center due to inability to swallow liquids and solids for 6 months. After determining the cause of dysphagia due to a large Zenker's diverticulum in the initial part of the esophagus, and the inability of patient to tolerate surgery due to her age and general deterioration, she underwent the endoscopic diverticulectomy. Under a two-hour endoscopic surgery, the wall of the cricopharyngeal muscle was first identified and diverticulectomy was performed by cutting the muscle with an endoscopic needle knife, using the Olympus flexible endoscope and closing the surgery site with clips. There were no complications during or after the surgery. The patient was kept fasting for 48 hours. After that, liquid feeding was started; 5 days later, the patient was discharged from the hospital with a good general condition and the ability to swallow food. This was the first case of endoscopic diverticulectomy in the southwest of Iran. [ABSTRACT FROM AUTHOR]

Background and Aims: Although dental implants have become a successful and predictable long-term treatment for patients, not all implant treatments are necessarily successful and pre-implant diseases are spreading. The aim of this study was to determine the prevalence of peri-implantitis in patients one year after prosthetic loading in Khorramabad in 2021. Materials and Methods: In this cross-sectional study, 53 patients who had implants and undergone prosthetic loading for one year were studied. In each of the 53 patients, the probing depth (PD) and bleeding during probing (BOP) around the implant and the characteristics of the surrounding soft tissue, including gingival redness and tissue sensitivity were evaluated and recorded. To assess the bone level or possible bone resorption, a P.A. graph was taken from the patient using a parallel technique. Information such as demographic characteristics and specialized information about the disease were collected through a checklist. Data were collected using SPSS22 software. Frequency tables and chi-square and t-tests were used to analyze the data. Results: The mean age of patients participating in the present study was 46.5±10.63 years. The number of women was 33 (62.3%). The prevalence of peri-implantitis was 17% at the patient level and 9.3% at the implant unit level. There was a significant relationship between the age (P<0.03) and systemic disease (P<0.03) with the prevalence of peri-implantitis. However, there was no statistically significant relationship between the prevalence of peri-implantitis and other demographic variables (P<0.05). Conclusion: The results of the present study showed that the prevalence of peri-implantitis was higher in people with a higher mean age. In addition, systemic diseases are a protective factor for peri-implantitis. [ABSTRACT FROM AUTHOR]

Background and purpose: Femoral neck fracture is associated with a high rate of side effects, especially in young people, who are usually affected by severe energy shocks. Results after injury depend on some factors, including displacement, fragility, bleeding rate, proper placement, and stable and strong fixation. The aim of this study was to compare dynamic hip screw (DHS) or multiple cannulated screws (MCS) in fractures of the femoral neck base. Materials and methods: In this cross-sectional study, 78 patients with femoral neck fracture were treated by internal fixation: MCS (n= 26) and DHS (n= 52) in Babol Shahid Beheshti Hospital, 2016-2018. Complications, including pain and lameness, infection, avascular necrosis (AVN), and nonunion were investigated in both groups. The visual analog scale (VAS) score and Harris Hip Score (HHS) were also compared between the two groups. Results: Mean ages of the patients in MCS group and DHS group were 54.19 ± 23.35 and 58.50 ± 21.06 years, respectively. In patients treated by MCS, infection, AVN, no welding, and pain and lameness were seen in 3, 2, 3, and 6 patients, respectively, while these complication were observed in 1, 1, 1, and 4 patients in the DHS group, respectively. The rate of complications were not found to be significantly different between the two group (P>0.05). The mean VAS score was significantly lower in the DHS group compared to that in the MCS group (P

Background Laparoscopic cholecystectomy is the treatment of choice for cholecystitis. The aim of this study was to evaluate the frequency of complications in patients referring to educational centers in Rasht Materials and Methods: In this descriptive cross-sectional study, the records of 132 patients referred to Poursina and Razi Hospitals of Rasht in 2006 were studied. Complications such as the need for open surgery, surgical site infection, and bile duct injury were evaluated in subsequent visits. Results: The subjects aged between 19 and 80 years with a mean of 14.65 ± 53.06 years. An open surgical procedure was reported in 8.2% of the subjects. Biliary duct injury and surgical site infections in patients undergoing laparoscopic cystectomy were estimated 4.1% and 8.2%, respectively. 2% of the subjects suffered from a surgical abscess. Vomiting and fever were reported in 16.3% and 8.2% of the cases, respectively. The mean age of the subjects with the surgical site infection was significantly higher than others. In addition, the open surgery rate in men was significantly higher in women. Conclusion: Laparoscopic cholecystectomy is a safe and effective method with low complications and, as a standard method of cholecystectomy, in the conditions and facilities available in our country, has a high success rate. [ABSTRACT FROM AUTHOR]

Background: Delayed awakening is one of the biggest challenges after general anesthesia and surgery. Hypothermia is common after coronary artery bypass surgery, and even mild hypothermia can cause severe complications after surgery. It is important to know the effective methods in accelerating awakening and correcting hypothermia. Materials and Methods: In this randomized clinical trial, Warm Touch forced air warming system was compared with routine method (a blanket) in increasing tympanic temperature and FOUR score in patients after elective coronary artery bypass surgery. A total of102 patients were equally divided into intervention and control groups. Tympanic temperature and FOUR Score were checked and recorded every 15 minutes for 225 minutes. Results: Tympanic temperature and FOUR Score were significantly higher in the intervention group (P<0.001). Conclusion: Forced air warming system was more effective in increasing tympanic temperature and FOUR Score compared to the routine method. Awakening time was shorter and tympanic temperature increased faster. [ABSTRACT FROM AUTHOR]

Background: Recognition of influential factors is necessary for predicting the severity of cholecystectomy. We aimed to evaluate the diagnostic power of the proposed scoring system for predicting the severity of laparoscopic cholecystectomy. Materials and Methods: In this cross-sectional study, there were 122 patients who underwent cholecystectomy in Shahid Beheshti Hospital during 2018. Prior to surgery, accurate history, and clinical, laboratory, and ultrasound information were recorded and scored on a checklist. Finally, the difficulty of cholecystectomy was divided into three categories of easy (less than 60 minutes, uncomplicated) and difficult (between 60 and 90 minutes, divided into controllable) and very difficult (between 90 and 120 minutes with uncontrollable complications or open surgery). Data were analyzed in SPSS software, version 22, and the indicators were calculated for the purpose of the study. Results: There were 28 (22.4%) men and 97 (77.6%) women. The mean ± SD ages of the patients in easy and difficult operations were 44.71 ± 13.56 and 44.52. 14.56 years, respectively (p = 0.939). The patients’ sex and history of acute cholecystitis attacks did not have a significant relationship with the difficulty of laparoscopic cholecystectomy (p ≥ 0.05). However, between the palpable gallbladder (p < 0.0001), impacted stone (p < 0.0001), gallbladder wall thickness (p < 0.0001), and body mass index above 30 (p < 0.0001) there was a statistically significant relationship between the difficulty of operation. There was also a significant relationship between AST (p = 0.034), T Bill (p = 0.008) WBC (p < 0.0001), and the difficulty of laparoscopic cholecystectomy, but between ALT (p =0.065), the severity of cholecystectomy was not significantly related. Sensitivity (86%), specificity (58%), positive predictive value (44%) and negative predictive value (91%) were calculated for the scoring system for the difficulty of laparoscopic cholecystectomy. Conclusion: To predict the difficulty of laparoscopic cholecystectomy, we strongly recommend the preoperative scoring system. It is also recommended to conduct further studies on the use of the scoring system during surgery. [ABSTRACT FROM AUTHOR]

The use of Surgicel is one of the methods used to stop bleeding during various surgical operations, especially neurosurgery. The use of Surgicel may cause complications such as inflammation, delayed tissue repair, and necrosis. This case is a 60-year-old woman with a history of craniotomy and reaction to Surgicel who presented to the hospital with symptoms of seizures. The patient underwent craniotomy after a mass diagnosis in the parasagittal region. After reviewing this case, we concluded that the use of Surgicel can have complications for patients, Therefore, it is recommended to use Surgicel in the patient's body so that it is not treated as a mass, abscess, or hematoma in the postoperative period. [ABSTRACT FROM AUTHOR]

Background and Objectives Administering unnecessary blood can cause many complications in patients and add to medical costs. This study aimed to evaluate blood consumption pattern and its relation with causes of mortality in Geneal ICU Ward of Besat Educational Medical Center of Hamadan in 2018- 2019. Materials and Methods This cross-sectional study was performed retrospectively in 2018-2019 on all eligible patients. A checklist was developed to collect demographic and clinical data. Finally, the data were analyzed by Kruskal-Wallis Test, Spearman's Correlation Coefficient, Chi-square Test, Mann- Whitney U by SPSS version 22. Results 227 patients including 130 (57.3%) males and 97 females (42.7%) with the mean age of 39.02 ± 12.83 years were studied. The mean blood unit administered to each patient was 1.68 ± 1.02 and the mean hospital stay period was 8.43 ± 6.03 days. 19.4% of the patients died and the most common cause of death (8.4%) was attributed to brain and nervous system diseases/ damages. The most common type of blood products used was packed red blood cells (70%). The most common indication for blood prescription was surgery (75.3%) followed by bleeding (7.5%). There was a direct and significant relationship between the number blood units and final outcome of the disease (p < 0.001). Conclusions Since the most common type of administered blood products was packed RBCs and there was a direct relationship between the number of prescribed blood units and the incidence of death, it is recommended to avoid unnecessary administration of packed RBCs. [ABSTRACT FROM AUTHOR]

Background and purpose: Femoral neck fracture is associated with a high rate of side effects, especially in young people, who are usually affected by severe energy shocks. Results after injury depend on some factors, including displacement, fragility, bleeding rate, proper placement, and stable and strong fixation. The aim of this study was to compare dynamic hip screw (DHS) or multiple cannulated screws (MCS) in fractures of the femoral neck base. Materials and methods: In this cross-sectional study, 78 patients with femoral neck fracture were treated by internal fixation: MCS (n= 26) and DHS (n= 52) in Babol Shahid Beheshti Hospital, 2016-2018. Complications, including pain and lameness, infection, avascular necrosis (AVN), and nonunion were investigated in both groups. The visual analog scale (VAS) score and Harris Hip Score (HHS) were also compared between the two groups. Results: Mean ages of the patients in MCS group and DHS group were 54.19 ± 23.35 and 58.50 ± 21.06 years, respectively. In patients treated by MCS, infection, AVN, no welding, and pain and lameness were seen in 3, 2, 3, and 6 patients, respectively, while these complication were observed in 1, 1, 1, and 4 patients in the DHS group, respectively. The rate of complications were not found to be significantly different between the two group (P>0.05). The mean VAS score was significantly lower in the DHS group compared to that in the MCS group (P<0.05). The HHS scores were not significantly different between the two groups (P<0.05). Conclusion: According to this study, MCS is more appropriate in the treatment of femoral neck fractures due to less bleeding and shorter operation time. [ABSTRACT FROM AUTHOR]

Background and Aim Postoperative shivering is a common complication after recovering from anesthesia, and due to its subsequent side effects, its prevention and treatment is of special importance for anesthetists. In this study, the efficacy and onset of action of meperidine (which is a potential cause of hemodynamic and respiratory complications) in treatment of post-anesthesia shivering are compared with those of ondansetron. Methods & Materials In this clinical trial study, patients with post-anesthetic shivering during recovery were randomly divided into two groups of meperidine (n=27) and ondansetron (n=29). Their shivering scores were recorded every minute for up to 10 minutes. After this time, if patients did not improve, meperidine was used in both groups to treat shivering. Ethical Considerations The study obtained its ethical approval from the Research Ethics Committee of Iran University of Medical Sciences and has been registered in Iranian Registry of Clinical Trials (IRCT201109224969N3). Results The number of patients completely treated at 10 minutes was higher in the meperidine group (P= 0.05), and the decrease in mean shivering score occurred faster in meperidine group (P= 0.047) Conclusion Although ondansetron has been shown to be effective in treatment of postoperative shivering, the effectiveness and onset of action of meperidine was clearly better. [ABSTRACT FROM AUTHOR]

Background: Common complications of intubation is cough and sore throat after surgery, which increase the complications and dissatisfaction of patients, therefore, it is necessary to find a way to treat this complication. Therefore, the aim of this study was to evaluate the effect of lidocaine injection with two different concentrations (2% and 4%) in the tracheal cuff on cough and sore throat after surgery and compared with control group (normal saline). Methods: This study was performed on 96 patients undergoing surgery (32 patients in each group). Patients were randomly assigned into three groups (2 to 5 cc lidocaine 2%, lidocaine 4%, and normal saline) and the drugs were prescribed preoperatively in cuff of the endotracheal tube. Vital signs, sore throats and frequency of coughing were recorded in the patients. Chi-square and ANOVA tests were used to compare the data. Results: The mean score of pain in recovery and 24 hours after extubation in the lidocaine group was 4% and was the highest in the normal saline group (P = 0.002 and P = 0.019). The prevalence of cough after 12 and 24 from extubation in the lidocaine 4% group (2.6% and 0 respectively) and in the normal saline group was highest (37.5% and 25% respectively) (P=0.003 and P=0.007, respectively). Conclusion: The results of our study showed that the prevalence of cough and the mean pain in patients receiving lidocaine 4% was significantly better than the 2% and normal saline groups, and also no other complications such as hemodynamic changes was not observed in the three groups. [ABSTRACT FROM AUTHOR]

Background and Aim: Post extraction Bleeding is a well-known and frequent complication that can continue for 8-12 hours after surgery and if not controlled, it can create a range of complications from a simple hematoma to a large amount of blood loss. Calcium alginate dressing, can result in hemostasis and accelerate healing of tissue. The aim of this study was to determine the effect of calcium alginate dressing, compared to conventional dressing on bleeding and complications after tooth extraction. Materials and Methods: The study was a clinical trial (Split mouth).This study was performed on 30 patient and 60 Samples referred to the Oral and Maxillofacial surgery department, who needed bilateral simple extraction in one jaw, which did not have the exclusive criteria. Two teeth of each jaw were randomly divided into two groups of control and case group. In the case group, after removing the tooth, we used calcium alginate dressing, and in the control group, we used the conventional dressing (gaz). The groups were assessed for bleeding, at one hour and 24 hours after tooth extraction and also, at the third and seventh day after extraction. The pain was evaluated by VAS criteria at 10 degrees and the dry socket was evaluated based on BLUM criteria and tissue healing (by Healing Scale) at 10 degrees from 0 to 9. These indices were analyzed by MANN-U-WHITNEY test in two groups. Result: Study was conducted on 30 patients and 60 samples (17 male and 13 females) with a mean age of 33±6.5.Bleeding in one hour after extraction in the control group was 66.7% and in the calcium Alginate group was 43.3%(p<0.06). Bleeding after 24 hours was 26.7% in the control group and 3.3% in the case group (p<0.02). At the third day, the pain level in the control group was 1.8±1.3 and in the case group was 2.1 ±1.5(p<0.4). Healing in the control group was 6.37±1.7 and in the case group was 6.4±2.2(p˂ 0.8). Dry socket occurrence in the control group was 6.7% and in the case group was 3.3%(p<0.7). On the seventh day follow up, the pain level in the control group was 0.9 ±0.8 and in the case group was 0.9±0.7(p<0.8). The healing rate and dry socket occurrence were similar in both groups. Conclusion: This study showed that calcium alginate dressing reduced the amount of bleeding after tooth extraction significantly, but is not affect the other complications. [ABSTRACT FROM AUTHOR]

Background: Patient safety is a major component of healthcare quality that is defined as avoiding, preventing and correcting the damage and undesirable consequences caused by the process of healthcare provision. The likelihood of occurrence of medical errors and untoward events is maximized in intensive care units (ICUs) due to the complexity of patient conditions and treatment process. The present study was conducted to determine the degree to which nurses observe the safety of patients hospitalized in the ICUs of selected hospitals affiliated to Yasuj University of Medical Sciences, Yasuj, Iran. Materials and Methods: The present descriptive study observed 2106 nursing caregivers associated with patient safety who were selected using purposive event-based sampling. The morning shift performance of 54 nurses working in three ICUs of selected hospitals affiliated to Yasuj University of Medical Sciences, Yasuj, Iran was investigated in winter 2016 using a researcher-made 39-item checklist comprising six subscales. After confirming its reliability and face and content validity using the intraclass correlation coefficient, the checklist was completed by the researcher observing the performance, and the data were analyzed using descriptive statistics. Results: The findings obtained found the mean degree of conformity between nursing care associated to patient safety and the checklist to be 53.43 out of 100 (undesirable). The maximum degree of conformity was associated to blood transfusion subscale with a mean score of 89.52 (desirable), and the lowest was associated to surgical complications with a mean score of 23.3 (undesirable). Conclusion: Nursing care associated to patient safety provided in ICUs is substandard. Healthcare administrators are therefore strongly recommended to conduct regular audits and make efforts to promote care-giving processes, and hospitals authorities are urged to perform reforms and hold consistent training programs to improve the performance of the staff, especially nurses. [ABSTRACT FROM AUTHOR]

Introduction: Implants are a successful method for replacing missing teeth. General dental practitioners interested in implants should have the necessary knowledge in this field to improve public health in order to provide their advanced dental services. This study aimed to assess the knowledge of dentists in Isfahan about problems and complications during and after implant surgery in 2017 in Isfahan. Materials & Methods: A total of 100 general dentists of Isfahan were selected for the purpose of this crosssectional study. Questionnaires were completed by the dentists. Data collected from the questionnaires were analyzed with independent t-test and Pearson’s correlation coefficient, using SPSS 22 (α = 0.05). Results: Most dentists (78%) had low or average level of awareness. Age (p value = 0.66) and experience of practice (p value = 0.45) had no significant relationship with knowledge score. Mean knowledge scores of dentists who had implant therapy experience were significantly higher than the others (p value < 0.001). Conclusion: The level of knowledge of general dentist was not adequate about the problems and complications encountered during and after implant surgery. In addition, the level of theoretical and practical education in particular in this area was limited and general dentists were not properly instructed in implant dentistry during their years of training. [ABSTRACT FROM AUTHOR]

Background: Radical prostatectomy is the preferred treatment for prostate cancer, and sexual dysfunction is one of its complications. Various causes, including ischemic heart disease, diabetes, and cigarette smoking, can also cause sexual dysfunction in healthy people. Concurrent study of these cardiovascular risk factors with Surgery on the degree of sexual dysfunction in any study in Iran was not performed. The purpose of this study was to compare the risk factors of ischemic cardiovascular disease in locally diagnosed prostate cancer patients with and without sexual dysfunction after radical prostatectomy. Methods: In this longitudinal study, 96 patients underwent radical prostatectomy from 103 patients. The presence of risk factors for cardiovascular disease including cigarette smoking, diabetes, hypercholesterolemia, hypertention, history of heart attacks were asked from patients. Electrocardiogram findings, echocardiography, Exercise test and cardiac thalium scan were investigated by a cardiologist. Sexual function status of patients before and after 6 months of surgery was evaluated by Persian IIEF questionnaire. The qualitative variables of the frequency of reporting and comparing them were done using Fisher's exact test and Chi-square test. Subsequently, all data were analyzed with spss version 19. Results: The mean age of the patients was 63.37 ± 7.9 years. Patients with and without sexual dysfunction were 22 (22.9%) and 74 (77%), respectively. The number of cardiovascular risk factors was statistically significant between the two groups with and without sexual dysfunction (P = 0.001). 84 patients were tested for exercise and 12 patients underwent cardiac thalium scan. Of the 84 patients, 32 (40.7%) were positive for the test, 52 (59.3%) were negative. Comparison of the IIEF score in two groups was statistically significant (p = 0.003). Conclusion: According to the results of this study, the risk factors of cardiovascular diseases and bad cardiovascular disease in patients undergoing radical prostatectomy surgery can affect the sexual potency of patients after surgery. [ABSTRACT FROM AUTHOR]

Background and Objective: Percutaneous endoscopic gastrostomy (PEG) is the technique of choice for providing enteral access to patients who require long-term enteral nutrition. This study was performed to evaluate the outcomes and complications of PEG. Materials and Methods: In this semi-experimental study, 77 patients (45 men, 32 women; age mean: 58.9±19.7 years, Min: 14 years, Max: 89 Years) who underwent initial PEG placement in Vali-e-asr hospital, Zanjan-Iran, from 2014 to 2015 were included. The complications were assessed three weeks and three months after PEG insertion. The quality of life (QoL) was evaluated with Karnofsky questionnaire before PEG placement and three months after that. Results: The most common indications of PEG placement were cerebrovascular accidents (26.5%), cardiopulmonary disease (20.6%), and drug and substance abuse toxicities (16.2%). Complications occurred in 26.5% (18 cases) of the patients. The frequencies of the complications at end of the third week and third month were 17.6% and 11.8%, respectively. The most common complication was tube leakage. Also, no significant difference was found between mean of QoL scores pre- and post- PEG placements (p> 0.05). Conclusion: Percutaneous endoscopic gastrostomy is a safe and minimally invasive endoscopic procedure associated with a low morbidity rate. [ABSTRACT FROM AUTHOR]

Background and Aim: The aim of this study was to evaluate the success rate and complications of Ahmed Glaucoma Valve (AGV) insertion during a follow up of at least 5 years. Materials and Methods: In this retrospective case series study, patients with 5 years of follow up after AGV insertion were enrolled. Success was defined as intraocular pressure (IOP) < 21 mm Hg (criterion A) and IOP < 16 mm Hg (criterion B), with at least 20% reduction in IOP, either with no medication (complete success) or with no more than preoperative medication (qualified success). Cumulative success was defined as sum of qualified and complete success. Findings: This study included 40 eyes of 40 patients with mean age of 40.63± 22.91years, (range 1 to 88). Cumulative survival success rates were 90%, 73% at 1 and 5 years after surgery according to criterion A and 42%, 25% based on criterion B with the median survival time of 60 months and 22.36 months, respectively. Complications were observed in 4 eyes of 4 patients (10%) and included wound dehiscence, choroidal detachment, encapsulated bleb and lid retraction. There were not any early complications such as hypotonia or hyphema. Conclusion: The present study was one of the largest series that reported the long-term outcome of AGV implantation in Asian patients with refractory glaucoma, and showed the wide difference of success rate between criterion A and B. [ABSTRACT FROM AUTHOR]

Background and Objective: Primary hyperhidrosis is a common disorder in adolescents and young adults due to the hyperactivity of thoracic sympathetic nerves. This disorder often does not respond to medical treatments. The aim of this study was to evaluate the therapeutic results of uniportal sympathectomy. Materials and Methods: In this retrospective study, all patients with severe hyperhidrosis that were operated by uniportal or multiportal endoscopic sympathectomy from 2010 until the end of 2011 were compared regarding demographic variables, admission duration, rate of recovery and complications. Results: In 9 cases from the uniportal group (45%) and 10 cases from the multiportal group (50%), a bilateral procedure was performed in one session. Mean age, gender, marital status and location of symptoms were not significantly different between the groups. Mean admission duration in uniportal and multiportal groups was not significantly different. Recovery rate was 100% in both groups. The prevalence of hematoma and hemothorax was zero in both groups. The prevalence of pneumothorax in uniportal and multiportal groups was not significantly different (P=0.629) . Conclusion: Therapeutic results and complications are not different in uniportal and multiportal methods of thoracic sympathectomy for treatment of hyperhidrosis. Therefore, based on the better cosmetic results of the uniportal method, it is suggested as an alternative to the mulitiportal procedure. [ABSTRACT FROM AUTHOR]

Background: Up to now, there is no single opinion on how to control pain after surgery and clinical research in this area has been continuing. This study aimed to compare the effect of intravenous Acetaminophen, Dexamethasone and placebo on postoperative pain after cataract surgery under sedation and topical anesthesia. Materials and Methods: In a clinical trial study, 120 patients undergoing cataract surgery under sedation and topical anesthesia were distributed into three equal groups. 10 minutes before the end of surgery, the first group received 0.01 mg/kg Dexamethasone, the second group received 15 mg/kg Acetaminophen and third group received the same volume on normal saline as placebo. Pain intensity and additional analgesic consumption were assessed during operation and recovery and compared between the three groups. Results: In the three groups of Acetaminophen, Dexamethasone and control groups, 6, 10 and 18 patients had postoperative headache (16.7%, 27% and 47.4% respectively) and there was a significant difference between the three groups(p=0.014). Also, pain intensity was significantly higher in control group compared with other two groups from 30 minutes after arrival to the recovery room until 24 h postoperatively (p<0.05). Also, the incidence of headache was higher in Dexamethasone group compared with Acetaminophen group, but there was no statistical difference between the two groups in this regard (p>0.05). Conclusion: Intravenous Acetaminophen administration is more effective than Dexamethasone and placebo to reduce pain and analgesic requirements after cataract surgery. [ABSTRACT FROM AUTHOR]

Background: Fractures of tibia and fibula are one of the most common fractures of extremities in traumatic patients. Treatment of these fractures usually is surgical fixation of the tibia but there is not plenary study about the fixation of the fibula. Methods: All patients refers to Rasool hospital from Oct. 2009 to Oct. 2011 that achieved including criteria were entered in this prospective education and divided in to two groups: group 1 with 31 patients that was treated with fixation of the tibia and the fibula and group 2 with 34 patients that was treated with fixation of the tibia without fixation of the fibula and then severity of pain after the surgery, time of union, complication of the treatment and duration of the surgery were compared between them. Results: In group 1 severity of the pain and time of the union were significantly less than group 2. No nonunion was observed in group 1 but one was seen in group 2 that finally required surgical management. Duration of the surgery in group 1 was significantly longer than group 2. Conclusion: Although fixation of the fibula has taken longer duration of surgery, have better clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Common bile duct (CBD) stones exist among 12% of patients with cholelithiasis. They may result in some complications including pancreatitis and cholangitis. The common therapeutical method is endoscopic sphincterotomy during ERCP(Endoscopic Retrograde Cholangio-Pancreatography) and stones removal. This method does not have a reasonable success rate for stones with a diameter larger than 15 mm and may cause serious complications. The aim of this study was to evaluate the CBD stenting method in the treatment of large CBD stones. Materials and Methods: This study was performed on 32 patients who presented to the ERCP unit of Shahid Beheshti hospital in Qom with large CBD stones. Success rate in CBD clearing and rate of some complications including rupture of CBD, pancreatitis, and cholangitis were evaluated after the first ERCP for stent replacement, and the second for its removal. Results: The success rate in complete CBD clearing was 93.8%. A reduction in size and number of stones was seen during a 2-month period, which was statistically significant. No case of CBD rupture and cholangitis was detected and the incidence of pancreatitis was 18.8%. Conclusion: CBD stenting has a reasonable success rate for reducing the size and number of CBD stones. [ABSTRACT FROM AUTHOR]

Introduction: Toothextraction is one of the invasive treatments in dentistry and in some cases it is associated with some complicationssuch as pain, dry socket and inflammation. Given the antibacterial effects of metronidazole, the aim of this study was to assess the effects of 0.75% metronidazole gel on complications after extraction of mandibular third molar teeth. Materials & Methods: This clinical trial was conducted on mandibular third molars of 20 male volunteers 20‒30 years of age. After extraction of two similar mandibularthird molar teeth, 0.75% metronidazole gel was placed in the extracted tooth socketon one side andno material was placed in the socket on the other side as control. The severity of pain and swelling were determined with visual analog scale and by determining the change in the distance ofthe angle of the mandible from thedental midline, respectively. Clinical examination was performed to determine the presence or absence of dry socket. Data on pain, swelling and dry socket were analyzed with SPSS (p value ≤ 0.05). Results: The severityof painafter tooth extraction exhibited a significant difference at6-and12- hour intervalsbetweenthetwo sides (p value = 0.04 and p value = 0.03). However, at24-and 48-hour intervals after toothextractionthe differences were not significant (p value = 0.09 and p value = 0.06). In relation to swelling, inthe area from the mandibular angle to the midline, no difference was observed between the two sides after 24 hours (p value = 0.05) but there was a significant difference between the two sides after 48hours (p value = 0.05). Thedifferenceindry socket incidence was not significant between the two sides (p value = 0.2). Conclusion: Application of 0.75 % metronidazole gel can reduce pain and swelling after tooth extraction but it might have no effect on dry socket incidence. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the effect of ondansetron, midazolam and metoclopramide with placebo in preventing PONV following strabismus surgery. Materials and Methods: 160 patients were divided into 4 groups of 40 by simple random method: group ON received Ondansetrone 0.05mg/kg, MT group received Metoclopramide 0.15mg/kg, MD group received Midazolam 0.03mg/kg intravenously and group CT received the solution of NaCl 0.9% as placebo infused with the same volume and the same manner 30 minutes before the end of surgery. The patients were evaluated for nausea, vomiting, need and dosage of anti-emetic drugs, time of liquid and solid diet tolerance, drug complications and satisfaction score for the initial 24 hours after anesthesia. Results: The frequency of nausea (p=0.001) and vomiting (p=0.084) was lower in ON group and both of these complications were lower in MD group compared with MT and CT group. Use of rescue antiemetic was higher in MT and CT groups (p=0.001). Patient satisfaction was higher in ON group compared with other 3 groups (p=0.001). Conclusion: Prophylactic use of Ondansetron is more effective with fewer side effects than Metoclopramide and Midazolam in the prevention of PONV following strabismus surgery. Furthermore, metoclopramide was less effective and was associated with more adverse effects compared with other 2 drugs. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative delirium is one the most common and serious complications that patients develop after undergoing cardiac surgery. Objective:The present study aimed To investigate the preoperative anxiety and depression of the patients decided to undergo heart bypass surgery and to examine the relationship between these two factors and the incidence of postoperative delirium in the patients. Materials and Methods: In this cross-sectional research study, as many as 108 patients referred to the surgery department of Heshmat Educational-Therapeutic Center in Rasht, north of Iran, for elective cardiac surgery were targeted. For the purpose of the data collection, the Hospital Anxiety and Depression Scale (HADS), the SpeilbergerState-Trait Anxiety Inventory(STAI), and theMini Mental State Examination (MMSE) were distributed among the patients before they undergo the surgery and a Postoperative Delirium Scale (DOS) was given to them three days after the surgery. The data were then analyzed using descriptive statistics (frequency, mean, and standard deviation) and inferential statistics (independent t-test and chi-square). Results: On average, delirium was reported in 38% percent of the patients three days after the surgery. It was also discovered that the average age of the patients with delirium was not significantly different from that of those without delirium. Moreover, the findings indicated that the frequency of experiencing delirium was not significantly different among patients in terms of being diabetic and non-diabetic and in terms of their sex, education, life condition, and marital status. State anxiety and trait anxiety were reported in 72% percent and 65% percent of the patients respectively. The frequency of experiencing delirium by the patients with state-trait anxiety as well as hospital anxiety and depression was not significantly different from that of those without disorders. It was shown that 31% of the patients had reported degrees of minor cognitive disorders before the surgery; the frequency of delirium in this group of the patients was not significantly different from the patients without any psychological disorders. Conclusion: Despite the prevalence of anxiety and depression in the patients before the heart bypass surgery, they did not experience more delirium than the patients without psychological disorders. [ABSTRACT FROM AUTHOR]

Background: The definite treatment of indicated Hypertrophy of the tonsils is Tonsillectomy. The aim of this study was to compare the efficacy and necessity of diclofenac suppository and simultaneous prescription of acetaminophen alone in controlling and reducing pain and improving swallowing and satisfaction after surgery for tonsillectomy in children. Materials and Methods: In this clinical trial, 180 children 7 to 14 years Tvnsykltvmy surgery were enrolled. Patients in an improbable way, easy and were divided into three groups of 60. Immediately after the surgery acetaminophen, diclofenac, or a combination of both was used. The cases of pain in the early hours, seventh, thirteenth and nineteenth after surgery were compared. Results: There was a significant difference between the average pains of all groups in all hours (p<0.05). There was a significant difference between the groups from the point of view of side effects such as Nausea, Vomiting and Pyrexia (p<0.05), But there was no significant difference between the groups from the point of view of After Surgery Bleeding (p>0.05). Conclusion: We can say that Rectal Diclofenac is a more effective medication for reducing pain after the Tonsillectomy surgery in contrast with Rectal Acetaminophen or a mixture of the two, which may cause the patients to use less Narcotics after the surgery. [ABSTRACT FROM AUTHOR]

Objective(s): To investigate about seroma formation in breast cancer patients after definitive surgery. Material & Methods: A convenience sample of breast cancer patients was entered into the study. Eligible patients were those who underwent surgical therapy (modified radical mastectomy or breast preservation and axillary lymph node dissection). The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, pathological type, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, duration of drainage and arm activity. In all, 135 breast cancer patients were studied. The mean age of the patients was 46.2 (SD= 11.8) year and mostly presented with the stage II disease (59%). Seventy-two percent underwent modified radical mastectomy and the remaining 28% received breast preservation surgery. Results: Seroma occurred in 39% of patients. In logistic regression analysis an association of postoperative seroma with pathological type was noted (ductal versus non-ductal, odds ratio= 17.7, P = 0.0 I). The seroma formation did not show any significant results by any other variables studied. Conclusion: The findings suggest that breast cancer patientschr('39') pathological characteristics are an independent predicting factor for seroma formation.

Background: Episiotomy is one of the most common gynecologic surgery that was done in the second stage of labor, in order to facilitate the delivery. Cutting this area is associated with pain and discomfort. Healing causes pain relief and returning to daily activities became faster. Considering that the high rates of episiotomy infection, we decided to examine the effect of topical cream, saffron 20%, on women who had undergone episiotomy. Materials and Methods: This randomized, double-blind clinical trial study was performed on 60 primiparous women in 2013-2014 who underwent vaginal delivery and episiotomy at in Taleghani Hospital of Arak. Intervention group recieved 20% topical cream containing saffron extract three times daily for 2 weeks and the control group received a placebo cream. Wound status and its healing were investigated in the first, seventh and fourteenth postpartum. Results: There was a significant difference between both groups with healing of episiotomy location in seventh(p=0.54) and fourteenth(p=0.003) days and the continuity process of the wound edges in the first (p=0.015), seventh(p=0.013) and fourteenth(p=0.001) days. there was no statistically significant difference about the opening the wound in the first day(p=0.492), There was a statistically significant difference between the two groups in seventh(p=0.001) and fourteenth(p=0.026) days. Conclusion: This study showed that saffron extract cream 20% can be effective for episiotomy wound healing and wound edges continuity. [ABSTRACT FROM AUTHOR]

Introduction: After elective surgery of head and neck region, one of the complaints of patients is unsteadiness and vertigo. This complaint was seen more in some surgeries in clinical experiences, one of which is rhinoplasty. Given the community's increasing trend to rhinoplasty, considering this complaint of patients is important for appropriate prevention or treatment Objective: To evaluate vertigo occurrence inpatients undergoing rhinoplasty, Amiralmomenin Hospital of Rasht Materials and Methods: In this case-control study, 63 patients in case group (Rhinoplasty) and 50 patients in control group (Functional Endoscopic Sinus Surgery), were evaluated for vertigo. The two groups were matched for possible confounding factors. All the patients were evaluated for vertigo l week, land 3 months after surgery. Also, in rhinoplastic patients, lateral osteotomy approach was considered as a possible factor. Using SPSS 19, data were analyzed with t and /2 tests and P<0.05 was considered significant. Results: Fifty patients of case group and 45 patients of control group were followed for 3 months. Female patients comprised 80 and 44.4% of case and control groups, respectively. The frequency of vertigo in patients of case group was 17, 3 and 2, respectively. Only one case was due to benign paroxysmal positional vertigo and others were due to orthostatic hypotension. In control group, frequency of vertigo was 11,1 and 1, respectively. The cause of all cases was orthostatic hypotension. The rhinoplastic patients with external and internal lateral osteotomy approach complained of vertigo in 58.6 and 11.5%, respectively. This difference was significant statistically (P<0.0001). Conclusion: This study showed that the most frequent cause of vertigo in both groups is pseudo vertigo and due to orthostatic hypotension. It seems that true vertigo is not associated with operation types (including rhinoplastic and nasal endoscopy). We advised more detailed investigations with larger sample size in this area. [ABSTRACT FROM AUTHOR]

Background and Objective: Four percent of fractures were happened in clavicle bone. This study was done to evaluate the outcomes of superior reconstruction plating method in middle third of clavicle fracture. Materials and Methods: This descriptive study was carried out on 31 patients with middle third of clavicle fracture in Tehran-Iran, during 2009-12. The patients were treated surgically with superior reconstruction plating method. The treatment outcomes were determined by regular follow up in constant shoulder score, duration of union and complications of surgery. Results: The mean value of constant shoulder score was 87.6 which are reduced by chronical age. Non union rate and infection occurred in 3.2% and 6.5% of subjects. Duration of union and pre-scapular pain is increased by chronical age. Conclusion: Superior reconstruction plating method is recommended for middle third of clavicle fractures due to low complication, high constant shoulder score and lower treatment cost. [ABSTRACT FROM AUTHOR]

Background and purpose: Sore throat is one of the most common complications of general anesthesia. The source of pain perhaps is from the pharyngeal, laryngeal or tracheal and maybe is the cause of unpleasantness, discomfort and a bad memory after general anesthesia. This study evaluated the effectiveness of lubricating lidocaine gel on the sore throat; cough and scratching of throat after laryngeal mask airway (LMA) insertion. Materials and methods: Sixty patients -who scheduled for elective eye surgery- underwent general anesthesia and with the inclusive criteria and were randomly divided into two groups of intervention and control in a double-blinded study. The posterior surface of LMAs was lubricated with lidocaine gel 2% in the intervention group and non-medical lubricant gel in the control group. After induction of anesthesia that was similar in two groups, the LMA was inserted using classical method by an anesthesiologist who was unaware of the used gel, and after ensuring adequate ventilation LMAs were fixed in site. Twenty-four hours after the operation the patient's sore throat, coughing and itchy throat were checked. Results: Results showed that the two groups had no statistically significant differences regarding age and gender (P > 0.05). Furthermore, there was no statistically significant difference between the two groups regarding the amount of blood staining on LMA cuff after removal. The severity of sore throat in 24 hours after the surgery, the incidence of cough and itchy throat were similar as well. Conclusion: The gel used to facilitate placement of LMA has no impact on the postoperative sore throat, cough, and blood staining on LMA, and throat itching. [ABSTRACT FROM AUTHOR]

Background: Sternal ulcer infections have a great importance and complexity following coronary artery bypass graft (CABG) surgery. Although this kind of infection has a low prevalence but the complications are severe. The purpose of this study was to determine the type of microorganism and antibacterial resistance in sternal wound infections following CABG surgery in Shahid Chamran hospital in Isfahan, Iran, from 2009 to 2012. Methods: In this descriptive and analytical study, 275 cases of CABG operation were entered. Sternal wound secretion samples of suspected patients were cultured and the type of the causative bacteria were determined. Also, antibiogram test was done on the grown strains and antibacterial resistance patterns were determined. Findings: Of 275 CABG surgeries, 13 cultured sternal wound samples showed positive bacterial colonization. The types of bacterial samples were Staphylococcus epidermidis, Klebsiella, Escherichia coli and Pseudomonas in four, four, three and two cases, respectively. The mean age of patients with and without sternal ulcer infection had no specific differences (P = 0.43). The differences of sex distribution between the case and control group was not statistically significant (P = 0.31), but having diabetes was significantly different between the groups (P < 0.01). Aortic clamping time and body mass index (BMI) showed no significant differences between the groups (P > 0.05). Conclusion: The incidence of sternal infection in patients undergone CABG surgery in this study was moderate compared to other studies; this is influenced by several factors including host, staff relating, environmental and medical equipments factors. Therefore, it is necessary to implement preventive measures at the time of hospitalization and provide appropriate educational programs and preventive methods for staff, patients and their families. [ABSTRACT FROM AUTHOR]

Background and purpose: Post anesthetic shivering is a common and unpleasant postoperative complication. The aim of this study was to evaluate the efficacy of low-dose prophylactic ketamine in preventing postoperative shivering after general anesthesia. Materials and methods: A double-blind randomized controlled trial was carried out in 60 patients of ASA class I-II undergoing general anesthesia. General anesthesia was performed with fentanyl, midazolam, sodium thiopental and atracurium. The patients were randomly allocated to receive either saline 0.9% or ketamine 0.25 mg kg-1 intravenously at the beginning of wound closure. Occurrence and severity of shivering was evaluated for 30 min in the recovery room. Side effects were also assessed in the recovery room. Results: In postoperative period incidences of shivering were 36.07% and 6.7% in control group and ketamine group, respectively. The difference between ketamine group and control group was statistically significant. (P=0.005) The number of patients with shivering score of 2 was significantly higher in control group compared with that of the ketamine group. (p=0.02) The incidence of side effects was similar in the two groups. Conclusion: Prophylactic low dose ketamine (20mg) was effective in preventing postoperative shivering without significant side effect. [ABSTRACT FROM AUTHOR]