Background: Caudal block is one of the methods of pain management performed following lower abdominal surgery, though having its own limitations. Objectives: In the present study, the effects and side effects of adding dexmedetomidine to ropivacaine in the caudal epidural block were investigated in children after lower abdominal surgery. Methods: In this randomized, double-blinded clinical trial, 46 children aged three to six years were divided into two groups to perform a caudal block following lower abdominal surgery under general anesthesia. The injectable solution contained ropivacaine in the R group (1 mL/kg ropivacaine 0.2%), as the control group, and dexmedetomidine (2 µg/kg) and ropivacaine 0.2% (1 mL/kg) in the DR group. The pain score (modified CHEOPS score), duration of analgesia, amount of analgesia consumed (i.v. paracetamol), hemodynamic changes, and possible adverse effects were assessed at one, two, and six hours in both groups. Results: The pain score at one and two hours showed no significant difference between the two study groups (P > 0.05). In the DR group, however, the pain score at the sixth hour was significantly lower, and the duration of analgesia was longer (P = 0.001). The amount of analgesic consumption was also lower in the DR group (P = 0.001). However, there was no significant difference in systolic blood pressure and heart rate (P < 0.05), in the case of diastolic blood pressure, a significant difference (P < 0.05) was seen (DR group lower than the R group). There was no statistically significant difference between the study groups in the duration of surgery, recovery time, and side effects (P < 0.05). Conclusions: In the present study, the addition of dexmedetomidine to ropivacaine in the caudal epidural blockade improved postoperative analgesia without significant adverse effects in pediatric patients.
Aims To investigate the roles of total stigma, enacted stigma, and internalized stigma in the prediction of psychological distress among breast cancer patients, and to evaluate the mediating effect of body image in this process. Design Cross‐sectional. Methods Between Oct‐2014 to May‐2015, a cross‐sectional study was conducted with participation of 223 patients from three cancer centres located in Tehran, Iran. The study variables were assessed using the stigma scale for chronic illnesses 8‐item version (SSCI‐8), body image scale (BIS), and depression anxiety stress scale (DASS‐21). Structural equation modelling using MLR estimator was employed based on the two‐step procedure to validate both the full measurement models and the structural models. Five models were tested to determine predictability of all stigma constructs for psychological distress, including stress, anxiety, and depression, through the mediation of body image. Three equivalent models were further examined to re‐evaluate the direction of the relationships. Results Psychological distress and body image were largely predicted by total stigma, enacted stigma, and internalized stigma. The effect of stigma on psychological distress was mediated through body image. In a serial mediation model, the significance of the pathway of enacted stigma > internalized stigma > body image > psychological distress was confirmed. The serial model in which internalized stigma precedes body image was also supported by the equivalent models. Conclusion Stigma has been identified as a major source of psychological distress among women with breast cancer. Enacted stigma not only psychologically disturbs the patients but also triggers a chain of other identity transformations (i.e. internalization of stigma and distortion of body image), their ultimate result being a full‐blown psychological distress. Impact Both enacted and internalized stigma distorts breast cancer patients' perception of their body image, which in turn renders them psychologically distressed. The serial process of enacted stigma, internalized stigma, and body image plays an important role in perpetuating distress in these patients. To break this chain of psychological consequences and for interventions to have a greater impact on overall well‐being of patients, the effect of enacted stigma on distress via the sequence of two mediators needs to be specifically targeted at each stage.
Background Correcting false cognitions and establishing preventive behaviors in patients with chronic low-back pain can improve self-efficacy and self-discovery of these patients against the physical and psychological consequences of chronic back pain through reinforcing thoughts and constructive behaviors. Objectives This study aimed to investigate the effectiveness of cognitive-behavioral training in self-efficacy, self-discovery, and pain perception of patients with chronic low-back pain. Methods Based on a quasi-experimental design, 40 patients with chronic low-back were selected through purposive sampling and assigned into two groups of intervention (n = 20) and control (n = 20). After administering the pain self-efficacy (PSE) scale, the self-discovery scale (SDS), and the pain perception questionnaire (MPQ) to both groups, the intervention group received the cognitive-behavioral training while the control group did not receive the intervention. The post-test was performed on both groups and the data were analyzed using SPSS. Results The scores of pain self-efficacy and self-discovery (self-awareness and acceptance, commitment and attraction, transcendence and development, and personal growth) were higher in the intervention group than in the control group (P < 0.01). The highest increase with an effect size of 0.514 was related to the self-awareness and acceptance subscale. In addition, the pain assessment perception was the only reduced subscale among the other dimensions of pain perception (P < 0.01). Conclusions Psychosocial complementary therapies can provide patients suffering from chronic pain with better physical and mental conditions to have a higher quality of life.
Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Student’s t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used.There was no significant difference between the 2 groups regarding pH, base excess, or bicarbonate intake (P>0.05). No patient showed lactic acidosis in either group. Lactate levels were 23.0 vs 23.4 in the insulin-metformin and insulin only groups when the study was started, respectively. At the end of the study, those levels were 18.7 vs 18.9, respectively. In addition, the ANOVA repeated measurement test did not show a significant difference in terms of changes in the amount of lactate level between the 2 groups during the five measurement tests of the study period (P>0.05).High-dose metformin (1,000 mg twice daily with insulin) does not cause lactic acidosis in type 2 diabetic patients after coronary artery bypass surgery.
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