Comparing the use of Memantine with Dextromethorphan and Placebo to Reduce Pain before Orthopedic Surgery

Introduction: To compare the use of Memantine with Dextromethorphan and placebo to reduce pain after orthopedic surgery.Materials and Methods: The present study was a double-blind clinical trial including180 patients undergoing elective orthopedic surgery of the lower limbs. Patients were divided randomly into three groups of 60 patients each. The first group (Group M) received 30 mg Memantine orally, the second group (Group D) received 45 mg of Dextromethorphan and the third group (Group P) received only placebo, two and a half hours before the operation. The intensity of pain (VAS score), sedation score, and nausea and vomiting were recorded postoperatively.Results: In this study, 60 patients were enrolled in each group. The total VAS (Visual Analogue Scale) score was significantly lower among patients receiving Memantine and the satisfaction was significantly higher compared to the Dextromethorphan and placebo groups (P-value <0.001).Conclusion: The present study results indicate that Memantine has a relatively better outcome compared to Dextromethorphan or placebo in reducing the post surgical pain among patients undergoing orthopedic surgeries. It also reduced the need for post surgical opioid use and improved the patients’ satisfaction. 

Evaluation of infection in nylon and staple sutured wounds in surgeries of intertrochantericfemoral fractures

Infection of surgical wounds is an important complication and delays recovery and  the length of hospital stay. This study was aimed to determine the rate of infection in proximal femoral fracture surgeries in two methods of closure with nylon thread and stapl

Intravenous injection of tranexamic acid in patients with pelvis or acetabulum fractures to reduce blood loss: a randomized double-blinded controlled trial

Background: Despite their low incidence, pelvis and acetabular fractures have a high mortality rate due to extensive hemorrhage. Tranexamic acid (TXA) is an antifibrinolytic drug that inhibits the production of plasminogen. This study aimed to evaluate the safety and efficacy of TXA use to reduce blood loss and the need for blood transfusion in patients with pelvis or acetabulum fractures. Methods: 108 patients were recruited from two tertiary care hospitals, and assigned evenly either to the intervention (TXA) or the control (CTL) group. TXA group received 15mg/kg TXA 30 minutes before the fracture reduction and fixation surgery. The number of transfused blood units before, during, and after the surgery was registered. Blood loss was assessed by calculation of estimated blood loss (EBL), collected blood with drain, collected blood with suction and weight of the used gauzes during the surgery. The time between fracture occurrence and the surgery, the duration of the surgery, and the days of admission were assessed. Results: The mean age was 39.49 ±15.81, 69.4% were female. 6 patients had pelvic and 102 patients had acetabulum fractures. The duration of the surgery was not significantly different. The time gap between fracture occurrence and the surgery was significantly higher in the TXA group (P value=0.032). The mean postoperative hospitalization time was significantly lower among TXA group patients (P value=0.037). The mean hemoglobin was significantly higher in TXA group postoperatively (P value =0.028). The mean EBL, the amount of collected blood volume by suction or drain, the weight of the used gauzes during the surgery and the number of transfused units were significantly lower in the TXA group patients. The transfusion rate was significantly lower in patients with a shorter time gap between fracture occurrence and reduction surgery (P value=0.021) Conclusion: Tranexamic acid can reduce blood loss, the number of transfused blood units during and after the surgery, and hospital admission duration. Moreover, it did not increase the chance of PTE or DVT in the patients receiving tranexamic acid; thus, it can be assumed as a safe and efficient drug in patients with acetabulum or pelvis fractures

A Rare Cause of Elbow Pain, Osteoid Osteoma of The Coronoid Process of The Ulna: Report of a Case

Osteoid osteoma is a moderately common bone lesion, accounting for 10-12% of benign bone tumors (1, 2). It primarily affects young people in their first two decades of life, with the majority of cases occurring between the ages of 5 and 30 (3). Men are 2-4 times more likely to be affected than women (4). The tumor can develop in almost any bone in the body; however, in more than 70% of cases, the long bones are the source of the tumor, with the femur and tibia being the most frequently affected (50-60%). The diaphysis or metaphysics of long bones are the most common sites for osteoid osteomas. With a frequency of around 10-13%, epiphyseal and intra-articular locations are deemed rare, with the hip being the most common site (4-7). Other less impacted areas include the ankle, elbow, wrist, and knee. When a lesion develops at the extremity of long bones, near or inside the joint, in a bone confined by the capsule, very close to it, and to the synovia, it is classified as intra-articular (3). This condition's etiology remains unclear and the incidence of a familial occurrence is exceptionally unlikely. Cytogenetic modifications such as the deletion of chromosome 22q have been identified in cases of osteoid osteoma, although further research is needed to definitively relate this individual to a clonal mutation (8, 9)

Asymmetrical bilateral traumatic hip dislocation with posterior column acetabulum fracture, report of a rare case

Bilateral asymmetric hip dislocations are rare in comparison to unilateral dislocations. We present the case of a 20-year-old man who suffered from asymmetrical bilateral hip dislocation, anterior dislocation on the left, and posterior dislocation of acetabulum fracture on the right. In the operating room, all hip dislocations were manually decreased, and skeletal traction was used due to weakness on the right side. A week later, an open reduction and internal fixing were applied to the posterior wall and column fracturing of the right acetabulu

Affecting factors on the performance of community health workers in Iran�s rural areas: A review article

Background: This study aimed to use a mixed-method approach to investigate affecting factors on the performance of Community Health Workers (CHW) in Iran�s villages. Methods: This study was conducted during 2014-2015 with a mixed method in three phases of literature review, Delphi technique and developing a rich picture. Overall, in order to finalize the affecting factors and their relationships between qualitative content analysis, Delphi technique, AHP technique and Focus Group Discussion were used, respectively. Results: Affecting factors on CHW performance were divided into four main categories, 10 sub-themes and 35 contents. Increase in the level of people�s awareness, disease patterns, demographic structure and lifestyle were placed in four priorities respectively on the basis of importance. Conclusion: To the most extent CHW cannot face current needs of rural communities. It challenges equitable access to healthcare services and also conflicts with the primary philosophy of CHW presence in rural areas. CHW can be used in two forms; either as an assistant to rural family physicians or with the same previous functions. © 2016 Iranian Journal of Public Health. All rights reserved

Comparing the Rate of Fusion between Patients with Intertrochanteric Fractures treated using Short Sliding and Non-Sliding Gamma Nail Implants; a Cross-Sectional Study

Introduction: Intertrochanteric fractures, which are one type of hip fracture, have been considered as a major public health issue in many nations. This study was carried out with the aim of comparing the rate of fusion between patients with intertrochanteric fractures treated with short sliding and non-sliding Gamma nail implants. Methods: This is a retrospective cross-sectional study performed in 2018 and 2019, and 47 patients with intertrochanteric fractures, who referred to Imam Hussein Hospital, and were treated using either sliding or non-sliding gamma nail implants were compared. The rates of bone fusion, fused union, and bone repairments were all assessed using radiography 1, 3, 7 and 12 months after the operation. Results: In the current survey, 68.6% of cases were treated with non-sliding gamma nail implants, while 31.4% were treated with sliding gamma nail implants. The mean period of bone fusion was 4.5 months in patients with non-sliding gamma nail implants and 5.5 months in patients with sliding gamma nail implants. In patients treated with sliding gamma nail implants, treatment of 28.5% of patients failed, and in the group of patients treated with non-sliding gamma nail, treatment failure was reported in 12.5% of patients. In addition, mean postoperative Harris Hip Score (HHS) in the group treated with non-sliding gamma nail implants was significantly higher than the group treated with sliding gamma nail implants (P = 0.002). Conclusion: Based on the findings of the present study, it seems that treatment with short non-sliding gamma nail implants is a better method compared to treatment with sliding gamma nail implants.مقدمه: شکستگی­های اینترتروکانتریک که از جمله شکستگی­های مرتبط با هیپ هستند به ­عنوان یک مشکل عمده­ی بهداشت و سلامت عمومی دربسیاری ازکشورها مطرح شده­اند. این مطالعه با هدف مقایسه­ی میزان جوش خوردگی در بیماران با شکستگی اینترتروکانتریک با گاما نیل کوتاه قفل و غیر قفل صورت گرفت. روش کار: مطالعه­ی فوق از نوع مقطعی گذشته نگر می­باشد که طی سال­های 97 تا 98 انجام شد و 47 بیمار دارای شکستگی اینترتروکانتریک که به بیمارستان امام حسین مراجعه کردند، در دو گروه درمان شده با ایمپلنت گاما نیل کوتاه قفل و غیرقفل با یکدیگر مقایسه شدند و میزان جوش خوردگی استخوان، میزان یونیون جوش خورده و میزان ترمیم استخوان از طریق رادیوگرافی و 1، 3، 7 و 12 ماه پس از جراحی بررسی شد. نتایج: در بررسی فوق 6/68% از بیماران در گروه درمان با گاما نیل قفل و 4/31% در گروه درمان با گاما نیل غیر قفل قرار گرفتند. میانگین مدت زمان جوش خوردگی در بیماران گروه درمان با گاما نیل قفل 5/4 ماه و در بیماران گروه درمان با گاما نیل غیر قفل 5/5 ماه به دست آمد. در گروه بیماران درمان شده با گاما نیل غیر قفل، درمان 5/28% از بیماران با شکست رو به رو شد و در مقابل در گروه درمان با گاما نیل قفل شده، درمان در 5/12% از بیماران شکست خورد. همچنین میانگین اسکور هریس هیپ پس از عمل جراحی در گروه درمان شده با روش گاما نیل قفل به طور معنی داری بالاتر از گروه درمان شده با روش گاما نیل بدون قفل بوده است (002/0 = P). نتیجه گیری: بر اساس یافته های مطالعه حاضر به نظر می رسد روش درمانی با گاما نیل کوتاه قفل روش مناسب­تری در مقایسه با درمان با گاما نیل غیرقفل می­باشد