Background:Melatonin has anxiolytic and potential analgesic effects. Several studies have indicated the sedative and anti-anxiety effects of melatonin when used as premedication before surgery. Hence, we assessed the efficacy of melatonin premedication in tourniquet-related pain and analgesia in patients receiving intravenous regional anesthesia (IVRA).Materials and Methods:Fifty patients undergoing elective hand surgery under IVRA were randomly divided into two groups (25 patients each) to receive either melatonin 6 mg (melatonin group) or placebo (control group) as oral premedication. IVRA was achieved with lidocaine, 3 mg/kg, diluted with saline to a total volume of 40 mL. Anxiety scores, sensory and motor block onset and recovery times, tourniquet pain, and 24-h analgesic requirements were recorded.Results:The onset of motor and sensory block was statistically significantly shorter in Group M (P < 0.001), and recovery of motor and sensory block was statistically significantly longer in Group M (P < 0.001). The time of starting tourniquet pain was longer in Group M (P < 0.001). The mean anxiety score in the study group was 3 ± 0.81 and in the control group was 4.20 ± 1.04 (P = 0.001). There was a statistically significant difference in the need for opioids between the two groups (P < 0.05).Conclusions:Melatonin is an effective premedication before IVRA because it reduces patient anxiety, decreases tourniquet-related pain, and improves perioperative analgesia.
Antimicrobial resistance has become a serious public health concern all over the world. The objective of this study was to determine susceptibility patterns of microorganisms to antibiotics in 11 hospital laboratories in Kurdistan province. During one month period (February, 2010), all the clinical specimens which were received from the laboratories were processed for isolation and identification of bacteria to the species level by standard methods. Testing procedures were validated following the Kirby-Bauer disc diffusion technique using Muller Hinton agar. Susceptibility testing was performed on MuellerHinton agar. A total of 4395 clinical specimens were obtained from 4301 patients among them, 1062 (24.7%) were male and 3239 (75.3%) were female, giving on overall male to female ratio of 0.32. Their mean age was 31.3 years (range: 4 to 74 years). Based on data 310 pathogens were isolated and Escherichia coli 183 (59.3%), followed Klebsiella pneumoniae 40 (01.29%) and Staphylococcus aureus 39 (1.25%) were the predominant isolated bacteria. The most resistant antibiotics tested against isolated bacteria were penicillin, ampicillin, and amoxicillin. Lastly, these resistance rates leave imipenem and ciprofoxcacin as the reliable agent for the empirical treatment in this province. The present study has shown that the urinary tract infection (UTI) patients have a higher rate of infection.The risk of antibiotic resistance in isolated bacteria, particularly E. coli, emphasizes the importance of hospital control measures and rational prescribing policies. Lastly, these resistance rates leave ciprofloxcacin and imipenem as the reliable agent for the empirical treatment in this province.
Background:CXCR4 is a cognitive receptor for stromal-derived factor-1 (SDF-1) and has been previously shown to be associated with tumor growth and invasion of many cancers. However, its expression and function in gastric cancer has not been well clarified.Materials and Methods:Herein, we studied the expression of CXCR4 on gastric samples from patients with gastric adenocarcinoma in comparison with precancerous lesions by employing qRT-PCR.Results:Our qRT-PCR data show that CXCR4 is highly expressed in tissue samples from patients with gastric cancer than precancerous lesions (2.4 times higher, P value < 0.05). When we correlated the level of CXCR4 with clinicopathological findings, we observed that CXCR4 level is associated with staging of the disease and lymphatic invasion.In conclusion:We present evidence that CXCR4 level is significantly elevated in later stages of gastric cancer. Thus, CXCR4 may play a crucial role in gastric cancer progression.
ObjectiveSatisfactory results have been seen with epidural steroid injections (ESI) in patients with herniated disks (HD), but the role in lumbar spinal stenosis (LSS) has been less investigated. We compared long-term effects of ESI in HD and LSS patients.MethodsIn a prospective, single-blind uncontrolled study, 60 patients with radicular pain due to HD (n = 32) or LSS (n = 28) were enrolled over a 9-month period. Methylprednisolone acetate 80 mg plus 0.5% bupivacaine 10 mg were diluted in normal saline up to a total volume of 10 mL, and injected into the epidural space. The amount of pain based on numeric pain score, level of activity, and subjective improvement were reported by patients after 2 and 6 months by telephone. Demographic data were analyzed with the chi-square test. The differences in numeric pain scale scores between the two groups at different times were analyzed with the t-test.ResultsThere were no differences between HD and LSS patients regarding age, sex, and average duration of pain prior to ESI. The degree of pain was significantly higher in LSS patients in comparison with HD patients in the pre-injection period. The amount of pain was significantly reduced in both groups 2 months after injection. This pain reduction period lasted for 6 months in the HD group, but to a lesser extent in LSS patients (P < 0.05).DiscussionEpidural methylprednisolone injection has less analgesic effect in LSS, with less permanent effect in comparison with HD.
Background and Aim: One of the common blocks used in upper extremity surgery is axillary block. The aim of this study was to make a comparision between the effects of dexmedtomedian and fentanyl as adjuvants to lidocain on axillary plexus block. Methods and Materials: This double-blinded clinical terial included 36 patients and was performed in Besat and Kosar Hospitals in Sanandaj in 2017. Patients were randomly divided into two equal groups. Patients in group 1 received 40 cc of lidocaine 1% and normal saline plus 50 μg fentanyl. Group 2 patients received 100 mg of dexmedetomidine plus 40 cc of lidocaine 1% (Matched with group 1). Using SPSS software version 21, data were analyzed by independent sample t-test. Results: There was a significant difference between the two groups in regard to the beginning and quality of the sensory block (p≤0.01) and motor block (p≤0.05). Based on visual analog scale addition of fentanyl to lidocaine at all times had a greater effect on reducing the pain intensity compared to the addition of dexmedetomidine and there was a significant difference between the two groups (p≤0.01). There was no significant difference in the incidence of nausea, vomiting, dizziness and seizure between the two groups. But, the groups showed significant differences in the incidence rates of heart arrhythmias and hypotension (p≤0.01). Conclusion:Comparison between fentanyl and dexmedetomidine showed that addition of fentanyl to lidocaine led to a greater effect on the properties of the axillary plexus block.
Background: Volatile anesthetics are the most prevalent drugs in maintenance of anesthetics and their platelet effects are compared. Functional endoscopic sinus surgery is known as a common type of nasal surgery. One of the most problems in this surgery is the blood filling up the nose or obscuring the lens of the camera as well as the surgeon’ view. It can cause the procedure take longer or accidently damage surrounding structures such as eye and brain. Objectives: This study was performed for comparing the effectiveness of isoflurane and sevoflurane on the bleeding rate of functional endoscopic sinus surgery (FESS). Methods: This study is a triple blind study on elective functional endoscopic sinus surgery. A total of 23 patients were assigned to each group, and after informed consent, isoflurane was administered for one and sevoflurane for another group. The evaluation was performed by an anesthetic assistant who arrived at the end of study plus the grade score. The surgeon also evaluated the extent of bleeding during the surgery. The results were assessed by Spearman and Mann-Whitney tests. Results: the average age of isoflurane group (43.3) was older than the sevoflurane group (33.96). Systolic blood pressure was also higher in the isoflurane group (141) than in the sevoflurane group (133.6). Conclusions: There was no difference between the bleeding rate and grade score of surgeons. There was no difference between the systolic blood pressure and the bleeding rate either.
Background: Epidural anesthesia (EA) today has been used extensively in surgical procedures and the management of pain associated with midwifery and chronic pain. This type of anesthesia can be done in different technical, physiological, and pharmacological ways. The aim of this study was to compare the effects of thoracic EA with general anesthesia (GA) on hemodynamic changes and its complications in patients underwent laparoscopic colonoscopy. Materials and Methods: This clinical trial study was conducted on 80 patients undergoing laparoscopic cholecystectomy with EA or GA based on inclusion and exclusion criteria. The patients were randomly divided into two groups of 40 and changes in blood pressure, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and arterial blood oxygen saturation were measured. The incidence of nausea, vomiting, chills, and itching in the two groups was recorded. The analysis was performed descriptively and also using t -test and Chi-square tests. Results: The results showed that the mean of SBP and DBP, HR, and arterial blood oxygen saturation and the incidence of nausea and vomiting was statistically significant ( P < 0.05) between the two groups at 4, 6, and 12 h after anesthesia and it was higher in a group of GA. There was no significant difference in shivering and itching between the two groups ( P > 0.05). Conclusion: The results of this study indicated that thoracic EA in patients with laparoscopic cholecystectomy has significant effects on factors such as SBP and DBP and arterial blood oxygen saturation. Furthermore, EA has fewer complications than GA, and it is the preferable approach.
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