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Introduction: Thiopental  is  a  short  acting  drug  from  barbiturates  group, that  is  a  favorable  standard  anesthetic  for  induction  anesthesia  because  of  pharmacologic  effects. The  goal  of  this  study  was  to  determine  the  incidence  of  thrombophlebitis  with  thiopental  2.5%  and  5%.
Material  and  Method: Three  hundred  patients  in  ASA  class I  and  II  that  referred  to  one  of  the  college  for  elective  surgery  and  was  admitted  3  days  after  operative  and  was  allocated  in  equal  2  groups (n=150)  randomly.  One  group  received  thiopental  2.5%  4 mg/kg  and  the  other  group  received  thiopental  5% n 4mg/kg  from  one  of  the  Veins  of  dorsum  of  hand.
Results: The  incidence  of  phlebitis  in  this  study  was  1.33% (2  case  from  150  case)  in  first  group  and  2%  (3  case  from  150)  in  second  group.  In  both  groups  phlebitis  was  occurred  in  first  24  operative  period  and  2^nd  days  no  patient  had  not  phlebitis  in  infusion  site.
Conclusion: Thrombosis  was  not  observed  in  patients  in  both  groups.  Incidence  of  phlebitis  with  thiopental  5%  was  greater  than  thiopental  2.5%.

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Introduction: Regarding the extensive use of IUD, as contraception. The present study was conduced to evaluate the complications resulting from muliload 375 and T Cu 380A IUD inserted in women referred to the health and treatment settings of Kermanshah medical sciences university in the year 2002.
Materials and Methods: The study was descriptive-analytic, on 122 women using M.L 375 IUD and 245 others using T 380A IUD were fully assessed. The tools used to collect data were questionnaires evaluating the following variables: Pregnancy, bleeding, ectopic pregnancy, uterine perforation, and expulsion, pelvic inflammation disease (PID). To analyze the data, descriptive statistic and X², student-T and Fisher tests were used.
Results: Severe bleeding during menstrual cycle was the most common complication in the two study groups, especially in the multiload 375 IUD group (75% vs. 41.6%; P<0.001). The multiload 375 IUD had a significantly higher dysmenorrhea rate compared to the T cu 380A (%70.8 vs. %40.8; P<0.001). The rate of intera-uterine pregnancy was low for the two device %1.7 vs. %2, and occurrence of ectopic pregnancy in multiload 375 IUD was 0.8% and in T Cu 380A group was not reported. There was no uterine perforation observed for either device.
Conclusion: According to the results gained, the common complications in each group were not dangerous and their severe and threatening complications were uncommon. The most frequent complications were severe bleeding during menstrual period, dysmenorrhea and spotting which were not life threating and could be controlled by supporting and training their users, although these complications were seen more among those using M.L 375 IUD. These two device were effective enough to prevent pregnancy. It seems that using T Cu 380A IUD is more suitable for those who want to have a long-term contraception.

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Introduction: Considering the importance of diagnosing fetal distress and knowing diagnostic methods with minimum cost and time and high diagnostic value, this study was performed to evaluate the vibroacoustic stimulation test ( VAST) value in predicting fetal distress in women in active phase of labor, reffering to Motazedi hospital, Kermanshah, 2004.
Materials and Methods: This clinical trial study was carried out on women in active phase of labor (dilatation >3-4), full term, single fetus, cephalic presentation, without previous diseases and also abnormal fetus. At first FHR was monitored for 15 minutes, then vibroacoustic stimulation was done for 3 seconds using an artificial larynx of Seimens Servox with high - pitch intensity equal to 105 dB. Results were recorded as non reactive and reactive FHR ( twice 15 beats acceleration for 15 seconds). Other variables such as type of delivery, 1 and 5 minutes Apgar, meconium passing and nuch cord were documented. Data was analyzed by descriptive statistics and diagnostic value test.
Results: Age of women was 25.2 ±5.8, number of pregnancy 1.94 ± 1.33 and 51.8% of them had one pregnancy. FHR before VAST was 61.1% reactive and 26.3% suspicious and after VAST 60.8% reactive and 5.3% suspicious. In VAST method sensitivity, specificity and diagnostic value were 88.3%, 70% and 75.5% respectively and in nonVAST method 68.3%, 66.5%, 23.6%.
Conclusion: This study showed that VAST can assist to reduce suspicious cases of FHR.The prognostic value of VAST in predicting fetal distress was high. It is recommended to carry out further researches about duration and intensity of sound and using periodic FHR

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  Introduction: Patients` staying in recovery unit is associated with risks and complications and is expensive. Decreasing the duration of staying can both increase patients` safety and decrease hospital costs. Laryngeal mask airway (LMA) as a new instrument has been widely used for airway management and in this study, its effect on recovery time is investigated.

  Materials and methods: In a double blind randomized controlled clinical trial, 62 ASA Ι & Π patients were divided into two equal groups. In one group laryngeal mask and in the other, tracheal tube was used. The anesthetic drugs were similar in both groups. Patients with upper airway infections, as well as patients undergoing thoracic and upper abdominal surgeries were excluded. Those with more than one hour duration of anesthesia and more than 30 seconds need for intubations were also excluded. Duration of anesthesia was measured in minutes. Duration of recovery staying (in minutes) and complications were also recorded. Data was analyzed using Chi Square and Mann Whitney U tests.

  Results: There were no significant differences in age, sex and mean time of anesthesia between the two groups. But mean recovery time in LMA group with 10.65 minutes and tracheal tube group with 16.71 minutes was significantly different (P=0.007). Two patients (6.45%) in LMA and 11 patients (35.48%) in tracheal tube group developed complications during recovery period which was a statistically significant difference (P = 0.004).

  Conclusion: Laryngeal mask airway, decreased recovery time and the number and severity of respiratory complications. Complications such as cough, laryngospasm, bronchospasm, and arterial hypoxemia were significantly less in patients with laryngeal mask airway compared to patients with tracheal tube, so the use of LMA is recommended.

 

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Introduction: Spinal anesthesia is a conventional way of anesthesia for cesarean section (CS), which nausea and vomiting is a common complication of it. Metoclopramide is the standard medication used for preventing intraoperative nausea and vomiting (IONV). Because of extrapyromidal side effects of Metoclopramide and known antiemetic effects of low-dose Propofol and Dexamethasone, this study was performed to compare the effectiveness of these drugs for preventing IONV. Materials and Methods: This study, is a randomized clinical trial which is done on 144 parturients who were admitted for emergency CS. Patients were divided randomly into four groups and received: Metoclopramide 0.1 mg/kg IV, Dexamethasone 150 g/kg IV, Propofol 0.1mg/kg every 5 minutes from clamping umbilical cord till the end of operation and the fourth group received 2 ml distilled water. During the operation parturients were monitored for IONV. Data was analyzed using Kruskal-Wallis and one way ANOVA. Results: The Number of patients having nausea was lowest in Propofol and highest in Dexamethasone group. There was no statistical significant difference between Dexamethasone and placebo groups. The lowest rate of vomiting was in Metoclopramide and Propofol groups and there was no significant difference between them. Also the lowest level of retching was in the Prepofol group. Conclusion: According to results, the antiemetic effects of Propofol and Metoclopramide are similar. Amount of retching in Propofol was slightly lower than Metoclopramide and administration of Propofol was simple, cheap and without serious complications, so we recommend it for emergency CS.

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Introduction: Type of anesthesia is important in the maternal and fetal well being. There are different informations about effect of general and spinal anesthesia on Apgar score, so in this study a comparision was made on Apgar scores of neonates following these two methods. Materials and Methods: This study is a clinical trial and 168 term pregnant women were selected from elective cesarean candidates and divided in to general and spinal anesthesia groups by randomized allocation method. Then Apgar scores in first, fifth and twentieth minutes were mesured in infants. Also maternal age, cause of cesarean, sex and duration of cesarean section time were all documented. Data was analyzed using T and Chi square tests. Results: Mean Apgar scores were 8.66±0.68, 9.8±0.42 and 9.970.15 at first, fifth and twentieth minutes in general anesthesia group, and 90.38, 9.880.32 and 10 at first and fifth and twentieth minutes in spinal group. The group differed significantly for first minute Apgar score (p<0.001) but there were no significant differences in fifth and twentieth minutes Apgar scores. Conclusion: First minute Apgar score of newborns of mothers under spinal anesthesia was more than those of mothers under general anesthesia but there was no difference between their five minute Apgar score.

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Introduction: As tonsillectomy operations are done in vicinity of airways, two important purposes in anesthesia are decreasing bleeding and recovery time. Because of common use of Halothane and its reported side effects, we managed a study for comparing these two factors in two methods of anesthesia with or without Halothane. Materials and Methods: In a single blinded clinical trial, 140 (4-12 years old) children undergoing tonsillectomy, were randomly allocated in two equal groups. In the control group maintenance was done with Halothane-N2O 50% but in the case group without Halothane plus hyperventilation (Liverpool technique). Bleeding volume was estimated according to preoperative and 6 hour's postoperative hematocrit. Recovery time was recorded in minutes. Data was ahalyzed using Mann-Whitney U, T, Leven and K-S tests. Results: There was not any significant difference in sex, age, and weight and operation duration in the two groups. Mean recovery time in the case group was 7.87 minutes and in the control group 15.59 minutes, which showed a significant difference (p=0.00001). Mean bleeding volume in the case group was 44.22 ml and in the control group 58.52 ml, which also showed a significant difference (p = 0.005). Conclusion: According to our study it seems that anesthesia with Halothane causes more bleeding and prolonged recovery time in comparison to Liverpool technique.

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Introduction: Depression is one of the most common affective disorders, and in addition to different neurotransmitters and life events, various internal stressors such as blood glucose, cholesterol, triglyceride and other factors are responsible for it. Considering hyperglycemia as a possible risk factor of this disorder and inconsistency in results of previous studies, we decided to assess the relationship between different levels of HbA1C and major depression. Materials and Methods: This is a cross-sectional analythical study that is carried out on 134 samples. They were chosen randomly among patients with type2 diabetes reffering to Vali-e-Asr hospital. The patients were divided into 2 groups on the basis of their HbA1C test results patients with HbA1C less than 7% (group A), consisting 55 persons and patients with HbA1C more than 7% and equal to it (group B), including 79 persons. Participants were assessed by Hamilton scale of depression. The relation between HbA1C levels and major depression in these 2 groups was assessed using Chi square and Mann Whitney U tests. Results: We found that 40% of depressed patients had HbA1C level lower than 7% and 60% of them had HbA1C level higher than 7%. No significant correlation was found between HbA1C and major depression. But the duration of disease, using Insulin and being hypertensive simultaneously was correlated to major depression in this study. Conclusion: This study indicates that uncontrolled diabetes and high level of blood glucose is cosidered of less importance as an undelying mechanism of depression in patients with type 2 diabetes.

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Introduction: Oral Ketamine is used as a low side effect analgesic in comparison with opioids, in different pain syndromes. This study is designed to evaluate the effect of oral Ketamine in renal colic treatment. Materials and Methods: In this clinical trial study 104 patients with renal colic, hospitalized in emergency department, were divided in to two groups by Random block design. Group B received Pethidine (1 mg/kg up to 100 mg) and placebo, and group A received Pethidine with the same dose and Ketamine (0.5 mg/kg). All patients were assessed for pain by using VAS chart, for nausea by a 0-3 scale and for the number of vomiting at baseline and 1, 2 and 3 hours after taking drug. The results were analyzed by t-test. Results: Average pain score and vomiting in all times and nausea score in one and three hours after receiving drugs were reduced significantly in patients who took Pethidine and Ketamine comparing patients who took Pethidine and placcbo(p < 0.05). Conclusion: Regarding the significant effect of Ketamine in reduction of pain, nausea and vomiting without side effects, it is possible to use Ketamine as an adjuvant drug in treatment of renal colic and to reduce narcotic dosage.

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Background: Post operative nausea and vomiting (PONV) is a very common and distressing complication after surgeries which may result in more serious problems such as incisional hernia wound dehiscence and aspiration. Cataract surgery following increase in intraocular pressure is sensitive to POVN. This study was designed to evaluate the effect of capsicum ointment on Korean acupressure points in reducing PONV and the amont of anti- emetic medications was used. Methods and Materials: This study is a double-blinded clinical trial which was done on 200 patients who were referred to Amir Kabir hospital for cataract surgery. The patients were randomized assigned to two groups, one who received capsicum ointment and the other placebo (vaseline ointment) at the pressure points (K-K9 and K-KD2). After applying the ointments and during the first 12 hours after the operation the patients were assessed for the incidence and intensity of PONV. Results: The incidence of nausea and vomiting during the first 6 and 12 hours was higher in the placebo group in compare to the capsicum group (p=0.001). Nausea scores were also higher in the 6 and 12 hours in the placebo group (p=0.0005). Uses of metoclopramide was significant higher in the placebo group in compare to the capsicum group (p=0.001). There was no significant difference between the two groups for vomiting during first 12 hours ofter opration. Conclusion: Stimulating of both K-D2 & K-K9 Korean acupressure points simultaneously is a simple, noninvasive, cheap and effective method for reducing PONV.

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Background: Preoperative anxiety is a common reaction in patients. Many techniques are used for alleviation of it, such as preoperative visit by the anesthetist, reassurance by a psychologist, and prescription of tranquilizer drugs. In this study we surveyed propofol compared to Midazolam on pre-operative anxiolysis. Methods and Materials: In randomized controlled double-blind clinical trial, 60 patient swith ASA class I candidates for elective abdominal operations were randomly allocated in 3 equal groups (propofol, midazolam and normal salin). Anxiety was measured with 2 different scales: visual analogue scale (VSA) and clinical global impression (CGI). Pulse rate (PR), blood pressure (BP), respiratory rate (RR), and saturation PO2 (SPO2) were measured before drug administration and 3 times after that in 2.5 min intervals. Results were analyzed with ANNOVA, repeated measures ANNOVA, TUKEY, and X2 tests. Results: There were no differences in demographic variables between groups. Both propofol and midazolam were more effective than placebo in anxiety reduction. Both drugs had equal effect (p>0.05). There was no significant difference in BP, PR, RR and SPO2 between two drugs. Conclusion: Both drugs were the same and more effective than placebo. Midazolam may be preferred for economical reasons.

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Background: Postoperative shivering is a common problem with multiple complications. This study was compared effect of low doses of Ketamine with Pethidine for controlling postoperative shivering. Methods and Materials: This clinical trial was done on 189 elective cesarean section with ASA class I or II who had postoperative shivering. Patients with grade 2 or higher were divided in three groups and were injected 0.3mg/kg Ketamine and 0.5mg/kg Pethidine intravenously. In 5th and 10th minutes after injection, they were investigated for shivering intensity. Results: After 5 minute of injection drugs rate and intensity of shivering in Pethedine group was less than ketamine group. Ketamine with 0.5 mg/kg was more effective than 0.3mg/kg dose of it and Ketamine(p=0.041). In group with 0.5mg/kg dose of Ketamine, rate and intensity of postoperative shivering was more reduce than group with 0.3mg/kg of it in recovery(p=0/007). In Pethedine group rate and intersity of shivering was more reduce then 0.5mg/kg dose of Ketamine(p<0/001). This demonstrated that Pethedine is more effective than Ketamine. Conclusion: Although 0.5mg/kg dose of Ketamine has considerable effect on control of shivering but Pethedine is still a better choice for this side effect.

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Abstract Background: Over 2 billion world people suffer from iron deficiency. Teenager girls are one of vulnerable groups in this area. Health education with various methods is a suitable tool for motivating and modifying incorrect function. The purpose of this research was determining the effect of health education program base on PRECEDE Model for controlling iron- deficiency anemia. Materials and Methods: This quasi-experimental and two-phase study was done on 72 students placed into case and control groups in 2007-8. Intervention was done in three sections with 45 minutes and 3 months after educational intervention was followed. Questionnaire base on PRECEDE Model parts and blood lab exams (Hb, Hct, Feritin) were data gathering tool. Data were analyzed by pair T- test, independent T- test, Mann- Whitney and Chi- square tests. Results: The mean score of knowledge (p<0.001) and attitude (p<0.001) (Predisposing factors), Using educational resources, taking place educational class and participating in educational programs (Enabling factors), encourage family and teachers (Reinforcing factors) and iron deficiency anemia preventive behaviors had a significant increase in the case group after the educational intervention. Conclusion: Above results indicate positive effect of educational intervention program base on PRECEDE Model and main components (Predisposing, Enabling, Reinforcing factors) in improving of iron deficiency anemia preventive behaviors in the study population.

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Background: Nowadays, mothers have ceased to breastfeed due to several factors and resort to bottle-feeding or other forms of complementary feeding for their children. This results in physical and emotional problems for children, and socio-economic harms in communities. The aim of this study is to assess the impact of BASNEF model based education on successful breastfeeding in pregnant mothers referring to health centers in Arak. Materials and Methods: This quasi-experimental study was carried out with the participation of 88 pregnant women. The participants were randomly allocated to interuention and control groups. Instructions were given in four sessions on the basis of BASNEF model and behavioral objectives. Eventually, the collected data were analyzed by using statistical tests. Results: Mean scores of knowledge, attitude, enabling factors and subjective norms in the inerurntion group before and after education showed a significant difference in comparison with control group (p<0.001). Conclusion: Model-based education has positive impacts on behavior improvements. Thus, in health programs instead of applying traditional instructions, appying planned education programs based on health education models that have measurable and reliable effects is suggested.

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Background:Today, in spite of quick and amazing human advancements in prevention treatment, and control of diseases and their positive effects on the community, lack of reliance on the instructions of prophets on spirituality and ethics of human relationships has led to health, social, ethical, and environmental crises that have resulted in spread of emerging diseases such as AIDS. Therefore, the way out of this crisis is the return to the instructions of prophets and religions, especially Islam. This article explains the role of Islam instructions in achieving millennium development goals in the fight against malaria and AIDS. Materials and Methods: In this review article, through access to reliable sources in the form of a descriptive article, practical strategies of Islam for achieving millennium development goals for fighting diseases, AIDS, and malaria are investigated. In so doing, by applying appropriate keywords to electronic and manual search in reliable Islamic and medical resources, data were collected and the central research question was addressed. Results: Based on the results of the reviewed studies, instructions and ideas of Islam on reconstructing the environment, preservation of natural resources, observing personal health, priority of health to treatment, abstinence from risky sexual behaviors, and so forth have practical implications for malaria and AIDS control and prevention so that if there had been commitment to Islam, AIDS as an emerging disease might never have developed. Conclusion: Noticing the availability of resources and instructions in Islam on health and medicine for prevention and fight against diseases, such ideas can be utilized for preventing the emergence and development of other new diseases. Hence, Islamic instructions can be presented to the world as practical strategies for achieving millennium development goals.

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Background: Postoperative pain brings about undesirable effects such as medical complications, increased healthcare costs, and the need for opioids administration. The aim of this study was to determine the effect of low dose (0.15 mg/kg) ketamine in comparison with the placebo on postoperative pain and analgesics consumption after cesarean section. Materials and Methods: In a randomized clinical trial, 120 women undergoing elective cesarean section were randomly divided into case and control groups. Ketamine (0.15 mgkg-1) or an equal volume of normal saline were administered intravenously immediately after initiating spinal anesthesia to the case and control groups, respectively. The anesthesia and surgery techniques were the same for both groups. Data were analyzed using SPSS version 11. Results: Means of age in the case and control groups were 28.85±4.81 and 28.87 ±5.62 years, respectively. Analgesics consumption, pain scores, homodynamic signs, drowsiness of the mothers, and the neonates’ Apgar scores after cesarean section were similar in both groups and no significant differences were found between them (P>0.05). The mean of postoperative arterial pressure in the early hours in the ketamine group showed a significant decrease compared to the placebo group (P>0.03). The means of the first time of request for analgesics after surgery in the ketamine and placebo groups were 99.75±68.88 and 96.1±52.59 minutes, respectively (P>0.05). Conclusion: It seems that the administration of 0.15 mg/kg dose of ketamine (0.15mg/kg) does not have a significant impact on decreasing the postoperative pain in cesarean section. Therefore, in order to obtain the desirable analgesic effects of this drug, further studies should be conducted with greater doses of this drug and its use in combination with other opioids.

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Background: From an administrational point of view, patient satisfaction with healthcare, diagnosis, and rehabilitation services is highly important. The present study was done to evaluate the satisfaction of patients referring to the emergency departments of hospitals in Arak. Materials and Methods: This study was a descriptive-analytic, cross-sectional one which was carried out using a questionnaire. The collected data were analyzed by SPSS software and the related tests. Results: Overall, over the first period, 72.9% of the patients were satisfied with the services, whereas this level of satisfaction reached 73.3% in the second period. By comparison, levels of satisfaction with the physical environment (86.2%), health condition (85.9%), speed and accuracy of care provider (69.6%), the quality of information provision (23.1%), behavior of guards and staff (60.2%), facilities (60.1%), drug availability (66.4%), discharge and costs (51.6%), and consideration of religious issues (86.6%) in the emergency departments over the first period reached 87.4%, 84.1%, 69.7%, 25.6%, 61.7%,67.9%, 50.9%, and 88.1%, respectively over the second period. Conclusion: The findings of this study showed that patients’ satisfaction with emergency departments’ services was reasonable. The greatest dissatisfaction was related to costs, drugs, procedural problems, method of treatment, facilities, wait time, and insufficient information provision.