Epidural dexamethasone for postoperative analgesia in patients undergoing unilateral inguinal herniorrhaphy: A comparative study

Background. This study was designed to evaluate the effect of adding dexamethasone to epidural bupivacaine on postoperative analgesia in unilateral inguinal herniorrhaphy. Methods. Forty-four patients were enrolled in this double-blind, clinical trial study. Patients were randomly allocated into dexamethasone or control group. In the dexamethasone group, patients received 18ml of bupivacaine 0.5% and 2ml (8mg) of dexamethasone; in the control group, patients received 18ml of bupivacaine 0.5% and 2ml of normal saline. The onset of sensory block and its duration and incidence of nausea and vomiting were recorded. Results. The onset of epidural anesthesia was significantly more rapid in the dexamethasone group than in the control group (P < 0.001). Duration of analgesia was markedly prolonged in the dexamethasone group than in the control group (P < 0.001). Five patients (22.7%) in the control group had nausea in the first hour after the procedure (P = 0.048). None of the patients in the dexamethasone group had nausea. None of our patients had vomiting in the two groups. Conclusions. This study showed that adding dexamethasone to bupivacaine significantly prolongs the duration of postoperative analgesia

Pattern of Pediatric Ocular Trauma in Kashan

Background: Ocular trauma is a significant health problem in pediatric patients. Objectives: The aim of this study was to analyze the characteristics of ocular-trauma-related hospitalization of children in Kashan. Patients and Methods: This descriptive, cross-sectional study included 131 children aged less than 16 years with ocular trauma, who were admitted to the Matini Hospital at the Kashan University of Medical Sciences between April 2006 and March 2009. After admission, detailed ocular examination was performed, and their ocular trauma was classified according to the International Ocular Trauma Classification and Birmingham Eye Trauma Terminology systems. Results: The mean age of the patients was 7.8 ± 2.2 years (age range, 0–16 years), and the male to female ratio was 5:1. The most common cause of admission was hyphema (38.1%), followed by corneoscleral laceration (27.5%). Ocular trauma most commonly occurred at home (43%), and 69% of the patients presented to the emergency room within 24 h of injury. In 30% of the patients, initial visual acuity at the time of presentation was less than 20/200. Conclusions: Ocular trauma is a major cause of unilateral blindness, especially in young boys, and hence, preventive measures and education is required

Comparison of Analgesic Effect Between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy

Background: Tonsillectomy is a common procedure causing considerable postoperative pain. Postoperative pain intensity of 60 - 70 in the scale of visual analog scale (VAS) has been reported up to 3 - 4 days which could continue until 11 days after the surgery. Objectives: The current study aimed to compare the analgesic effect of gabapentin and diclofenac on pain after tonsillectomy with the control group. Patients and Methods: In this double-blind, placebo-controlled clinical trial, 90 patients aged 10-25 years, ASA classes I and II were randomly selected to receive 20 mg/kg oral gabapentin (n = 30), 1.0 mg / kg rectal diclofenac (n = 30) or placebo (n = 30) preoperatively. Pain was evaluated postoperatively on a visual analogue scale at 2, 6, 12 and 24 h. Opioid consumption in the first 24 h after surgery and the side effects were also recorded. Results: There was no significant difference in terms of age, sex, and time of surgery in the three groups. Patients in the gabapentin and diclofenac groups had significantly lower pain scores at all-time intervals than those in the placebo group. The total meperidine consumed in the gabapentin (14.16 ± 6.97 P = 0.001) and diclofenac (16.66 ± 8.95, P = 0.004) groups was significantly less than that of the placebo (33.4 ± 13.97) group. The frequency of side effects such as vomiting, dizziness, and headache was not significantly different among the groups. Conclusions: It can be concluded that gabapentin and diclofenac reduced postoperative pain and opioid consumption without obvious side effects

Epidemiology of Urban Traffic Accident Victims Hospitalized More Than 24 Hours in a Level III Trauma Center, Kashan County, Iran, During 2012-2013

Background: Posttraumatic Stress Disorder (PTSD) is a severe anxiety disorder occurred due to past adverse experiences. Several researches have demonstrated that PTSD is quite common among patients discharged from critical care unit. Objectives: This study aimed to investigate the prevalence of PTSD and its related factors among patients discharged from critical care units in Kashan, Iran, during 2014. Patients and Methods: A descriptive prospective study was performed on 332 patients admitted to critical care units of Kashan Shahid Beheshti Hospital using a convenience sampling method. Data were collected in wards during hospitalization and one month after their discharge from hospital using questionnaires on demographic, medical information and PTSD Checklist (PCL). The PCL scores of 45 or more were considered as PTSD. Data were analyzed using chi-square, t-test, Mann-Whitney U and logistic regression. Results: From a total of 332 patients, 160 cases (48.2%) had PTSD and the mean total PCL score in participants was 44.24 ± 19.89. There was a significant difference between the total score of PTSD and its domains in patients with and without PTSD. the univariate analysis showed a significant association between PTSD and increasing age, increased length of hospital stay, more children, having additional comorbidities, unemployed, use of mechanical ventilation (P < 0.001), drug abuse (P = 0.003) and single patients (P = 0.028). However, there was no significant association between PTSD and gender, type of the critical care unit, level of education and admission due to trauma. However, in multivariate analysis using logistic regression, factors associated with PTSD were older age of the participants, use of mechanical ventilation having additional comorbidities, unemployed (P<0.001) and being single (P=0.04) Conclusions: Prevalence of PTSD is high among patients discharged from ICUs and some medical individual factors such as elderly, unemployed, being single, using mechanical ventilation and pre-existing diseases are risk factors. Therefore, it is recommended to perform appropriative educational plan for these patients to reduce the risk of PTSD

Epidemiological profile of extremity fractures and dislocations in road traffic accidents in Kashan, Iran: A glance at the related disabilities

Background: Apart from the mortality, road traffic injuries are associated with significant morbidities. This study has aimed to examine the pattern of traffic accident-related extremity fractures/dislocations and their related disabilities. Methods: A retrospective hospital-based study was conducted to assess the characteristics of limb fractures/dislocations among road traffic accident victims registered in Trauma Research Center registry of Kashan University of Medical Sciences, Kashan, Iran, during 2012-2013. Age and sex distribution, cause of injury, and site of fractures/dislocations were recorded. Years lived with disability (YLD) was calculated as a scale to measure the disability. One-way ANOVA and chi-square tests were used for data analysis. Results: From a total of 962 subjects, 812 (84.4%) were males (the male/female sex ratio: 5.4:1). The mean age of victims was 32.7±17.9. Leg (37%) and forearm (19%) fractures were the most frequent fractures. Shoulder dislocations were among the most affected joints accounting for 36.6% of the cases. The total calculated YLD was 135.6 (34.4 for temporal and 101.2 for lifelong disabilities, and totally 117.3 and 18.3 for males and females, respectively). The highest YLD was for motorcyclists (104) and while the most YLD was for 15-29 years (68.2). Conclusion: Young men motorcyclist accidents are a major problem in Kashan region. Generally, they have been accounted for the highest YLD due to fractures/dislocations, especially in lower extremity. Although the calculated YLD will be decreased with increasing age, the elder people also had the high rate of traffic-related limb injuries

Agreement of Cerebral State Index and Glasgow Coma Scale in Brain-Injured Patients

Background: Variables derived from electroencephalogram like cerebral state index (CSI) have been used to monitor the anesthesia depth during general anesthesia. Observed evidences show such variables have also been used as a detector of brain death or outcome predictor in traumatic brain-injured (TBI) patients. Objectives: The current study was designed to determine the correlation between Glasgow coma score (GCS) and CSI among TBI patients. Patients and Methods: In 60 brain-injured patients who did not need and receive sedatives, GCS and CSI were daily measured during the first ten days of their hospital stay. Correlation between GCS and CSI was studied using the Pearson's correlation test. The Gamma agreement coefficient was also calculated between the two variables for the first day of hospitalization. Results: A significant correlation coefficient of 0.611-0.796 was observed between CSI and GCS in a ten-day period of the study (P < 0.001). Gamma agreement coefficient was 0.79 ( P < 0.001) for CSI and GCS for the first day of hospitalization. An increased daily correlation was observed in both CSI and GCS values. However, this increase was less significant in CSI compared with the GCS. Conclusions: A statistically significant correlation and agreement was found between GCS and CSI in the brain-injured patients and GCS was also found to be more consistent and reliable compared with CSI

Epidemiology of Home-Related Injuries During a Six-Year Period in Kashan, Iran

Background: Injury is one of the leading causes of morbidity and mortality in the world, and the home is one of the most common places for these types of injuries. Objectives: This study is designed to investigate the epidemiology of home-related injuries in Kashan, Iran. Patients and Methods: This investigation is a retrospective cross-sectional study on existing data from the data bank of the Trauma Research Center at Kashan University of Medical Sciences during a six-year period. Demographic data such as; sex, age, place of residence, educational and occupational status, injury mechanism, injured organs and injury outcomes, were analyzed using a chi-squared test and P < 0.05 was considered significant. Results: The number of home injuries was 10146 in total, that included about 25.2% of all injuries in Kashan City. Most of the injured people were men (58.3%), 87.4% lived in the city and 18.6% were aged more than 64 years. The majority (42.7%) had a primary or secondary school education and 27.2% were housewives. Falling from a height was the most common cause of injury (55.3%). Limbs were the most common body region that was injured (73.7%). Young men (under 15 years) and older women (over 65 years) had more injuries, especially from falls. There was a statistically significant difference between the sex and age of the injured people (P < 0.001), sex and injury mechanism (P < 0.001), and also between the injury mechanism and sex in the age groups (P < 0.001). Conclusions: The most common injury mechanism in regard to home accidents was falls; therefore fall-related injury prevention programs should be designed to make homes safer and education should focus on changes in lifestyle to reduce fall susceptibility

Road traffic deaths in Kashan region, Iran: An eight-year study (2006�2013)

Purpose: The aim of this study was to analyze the trend of road traffic fatalities in Kashan Region, Iran, in a period of eight years. Methods: Through a cross-sectional study, all road traffic deaths classified under the V01�V99 codes according to ICD-10 in Kashan region, central Iran, from March 2006 to March 2013 and population data were collected from the registration system of Kashan University of Medical Sciences. Years of lost life (YLL) and mortality rates were calculated regarding age, gender and year of the accident. Generalized linear model (GLM) with Poisson log-linear link was used to evaluate the effects of the mentioned variables on mortality rate. Results: During the period of the study (8 years), 928 people (767 men) died due to road traffic injuries (RTIs). The total YLL was 20,818. The mortality rate due to RTIs has been declined constantly from 43.1 in March 2006 to 21.1 per 100,000 in March 2013. The highest mortality rate was found in the age group of over 60 years old and the lowest in the age group of 0�14 years old. Both mortality rate and YLL was greater in men than in women. Poisson regression showed that age, gender and year of the accidents had a significant effect on mortality rate (p < 0.001). Conclusion: Although there has been a constant decline of mortality rate in Kashan area within the study period, the value remains higher than the mean level of Eastern Mediterranean region and the global average, which is a notable fact for policymakers and authorities. © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical Universit

Road traffic deaths in Kashan region, Iran: An eight-year study (2006�2013)

Abstract Purpose The aim of this study was to analyze the trend of road traffic fatalities in Kashan Region, Iran, in a period of eight years. Methods Through a cross-sectional study, all road traffic deaths classified under the V01V99 codes according to ICD-10 in Kashan region, central Iran, from March 2006 to March 2013 and population data were collected from the registration system of Kashan University of Medical Sciences. Years of lost life (YLL) and mortality rates were calculated regarding age, gender and year of the accident. Generalized linear model (GLM) with Poisson log-linear link was used to evaluate the effects of the mentioned variables on mortality rate. Results During the period of the study (8 years), 928 people (767 men) died due to road traffic injuries (RTIs). The total YLL was 20,818. The mortality rate due to RTIs has been declined constantly from 43.1 in March 2006 to 21.1 per 100,000 in March 2013. The highest mortality rate was found in the age group of over 60 years old and the lowest in the age group of 0–14 years old. Both mortality rate and YLL was greater in men than in women. Poisson regression showed that age, gender and year of the accidents had a significant effect on mortality rate (p < 0.001). Conclusion Although there has been a constant decline of mortality rate in Kashan area within the study period, the value remains higher than the mean level of Eastern Mediterranean region and the global average, which is a notable fact for policymakers and authorities. Keywords Premature Mortality Traffic accident Epidemiology Ira