Comparison of the Effects of Lidocaine Prilocaine Cream (EMLA) and Lidocaine Injection on Reduction of Perineal Pain During Perineum Repair in Normal Vaginal Delivery

Objective: To compare the efficacy of EMLA cream and lidocaine injection to reduce pain during episiotomy repair. Materials and methods: A total of 46 primiparous women with normal pregnancy who referred for normal vaginal delivery and needed episiotomy repair were selected and randomly divided into two groups. For EMLA group, one hour before the estimated time of delivery, 5g of EMLA cream was applied to perinealmediolateral incision, and after the delivery of the fetus and placenta, again 5g of EMLA cream was applied to healthy skin around the episiotomy for repair. In the other group, lidocaine 2% was used before episiotomy and for its repair, too. Results: Only 8 people (19%) were in need of further analgesia. The mean ± SD of pain during repair of episiotomy on the VAS scale in all cases was 4.2 ± 2.3 cm. Most people (97%) were satisfied with their episiotomy repair. Comparing the two groups of EMLA and lidocaine, there was no difference between the two groups in terms of the duration of episiotomy repair, need for further analgesia, pain on the VAS scale, and satisfaction with the repair method. Conclusion: The findings of this study showed that the use of EMLA cream in the site of episiotomy incision in primiparous women can induce a level of analgesia equal to that of lidocaine, and cause a similar level of satisfaction.  

Comparing Bile and Urine Samples as Morphine Detectors in Corpses .......... IJMTFM (2011) 1(1): 12-16

Introduction: The present study aims to compare bile and urine samples of a corpse for detection of morphine.Methods: In this cross-sectional study, forensic examination of the bodies placed 59 of the 366 referred corpses at the high suspicion of opioid overdose. Urine and bile samples of the bodies were analyzed for morphine using thin layer chromatography.Results: All samples were taken from male bodies. There were no urine samples in four corpses (7%) and two urine samples (3%) produced negative results. In the remaining 53 cases, 14(24%) turned out 1+, 29(49%) turned out 2+, 8(14%) bodies turned out 3+ and 2(3%) corpses produced 4+. On the other hand, all bile samples produced positive results, in which 3(5%) turned out 1+, 20(34%) turned out 2+, 22(37%) bodies turned out 3+ and 14(24%) corpses produced 4+. The Spearman coefficient for positive urine or bile samples was 0.377(P = 0.005).Conclusion: The results of the present study show that the concentration of detected morphine in bile is greater than that of urine. Therefore, a bile sample can contribute to the detection of opioid in the corpses, especially when urine samples are not available or are negative.Keywords: Opioid, Morphine, Urine, Bile, Corps

Detecting Narcotics in Solution Extracted from Dried Urine Stain on Cotton Fabri ...................................IJMTFM (2011) 1(2): 54-58

Background:The present study aims to present a new method to trace narcotics in the solution extracted from dried urine stain left on cotton fabric. Material and methods:Narcotic substance was traced in the 50 samples through two methods. In the first method, samples were directly examined through Thin Layer Chromatography (TLC). In the second method, a piece of cotton fabric was soaked in a beaker filled with urine sample. After full absorption, the piece of fabric was left to dry. Then it was soaked in distilled water and shaken so that the stain deposits would dissolve into water. Finally, the solution was extracted from the wet fabric by centrifugal spin and admixed with an equal amount of distilled water. A TLC test was run afterward. The TLC run on the main samples produced the following results: morphine, codeine and other opium alkaloids were detected in 38 samples; in 7 samples only codeine was found. Five samples produced no especial stains. The TLC performed on the solution tapped from the cotton piece of fabric produced similar results except for the lower density of stain colors. Conclusion:The results show that narcotics may be detected using dried urine stains on cotton fabric dissolved in distilled water.Keywords: Narcotics, Urine stain, Crime scene, Thin Layer Chromatography, TLC

Prehospital Emergency Service for Internal Medicine Problems in Pediatrics; Causes, Time Indices and Outcomes

Objective: Although pediatric pre-hospital emergency medical services (EMS) are a main challenge of health care systems, few data exists over it. Current study of ambulance calls for medical causes relating to children in Tehran was conducted with the following aims: 1) assessment of the frequency of causes of EMS call, 2) assessment of time indices of service providing by EMS, and 3) to assess the correlation between outcomes and time indices. Material & Methods: In this retrospective study, all calls to Tehran EMS system (Dial 115) for medical causes of children =<15 years old in Tehran between December 2005 and May 2006 were extracted. Demographic variables, accident type, patient outcome before hospital arrival, and ambulance time indices (response time, scene time, total run time, total run time hospital, transport time, round trip time) were registered. Findings: 1052 (15.5%) calls were for children. From these, 717 (68%) were due to problems of medic problems. The most frequent problem was epilepsy (26.8%), unconsciousness (18.1%) and respiratory disorders (15.2%). 12 (5. 6%) subjects died before ambulance arrival, but no one died between scene and hospital arrival. Mean (SD) delay time, response time and scene time were 3.8 ± 1.8, 15.1 ± 6.9, and 23.5 ± 10.9, respectively. The pre-hospital mortality was not correlated with any of the time intervals. Conclusion:One of six ambulance calls in Tehran is related to pediatric patients, most of them with a medical cause. Epilepsy, unconsciousness and respiratory disorders as the most frequent causes for EMS calls for medical problems highlights the need for planning for training of the EMS personnel with these problems. There is still a need for further improvement in time intervals of EMS services, which may be possible by proper management and equipping by more ambulances

Risk factors of suicidal ideation and attempt in women with drug user spouses

Background: Despite ample evidence of the presence of mental and psychological disorders observed in the family members of drug users, few studies have attempted to focus on suicidal behavior in women whose spouses are drug users. Methods: This cross-sectional study focused on 131 women who had a drug user spouse. They had all been married for >2 years, with no mental or psychological disorders and no history of drug use prior to marriage. Drug use history after marriage, the extent and nature of physical and non-physical wife abuse, and any history of suicidal ideation and attempt in the past year were collected, in addition to data about anxiety and depression. Results: Our study showed that women who identified with a history of suicidal ideation and attempt were younger, had a shorter marital duration, had a more extensive history of drug use, were more likely to be abused by their spouse, and had higher anxiety and depression scores than their counterparts. Suicidal ideation predictors included a personal history of drug use [odds ratio (OR) = 9.217, 95% confidence interval (CI) = 1.727–49.180, p = 0.009] and anxiety and depression (OR = 1.080, 95% CI = 1.022–1.141, p = 0.004), whereas suicidal attempt predictors included a personal history of drug use (OR = 7.236, 95% CI = 1.671–31.326, p = 0.010), exposure to physical abuse by spouse (OR = 4.005, 95% CI = 1.393–11.523, p = 0.008), and anxiety and depression (OR = 1.092, 95% CI = 1.015–1.175, p = 0.018). Conclusion: The findings of this study showed that a personal history of drug use, an elevated anxiety score, and depression and exposure to physical abuse by their spouse may act as predictors of suicidal ideation or attempt in women with a drug user spouse. These findings may serve to benefit and support healthcare systems, associated with ongoing efforts to develop preventive programs for suicidal behavior in this population