The effect of intravenous low dose ketamine on postoperative pain

زمینه و هدف: درد پس از عمل جراحی، آثار نامطلوب بسیاری از جمله عوارض طبی، افزایش هزینه های درمانی و تجویز مخدر ها را در پی دارد. اگر چه برخی تحقیقات اثر مناسب کتامین را در پیشگیری از درد پس از عمل جراحی نشان داده اند، اما دوز مورد استفاده در اغلب این تحقیقات دوز زیاد (بیش ازmg/kg 1) این دارو بوده است، که اثرات جانبی بیشتری را در مقایسه با دوز کم در پی خواهد داشت. لذا هدف این مطالعه تعیین اثر کتامین وریدی با دوز کم (mg/kg 5/0) در مقایسه با دارونما بر میزان درد پس از عمل جراحی بود. روش بررسی: این مطالعه به صورت کارآزمایی بالینی دو سوکور اتفاقی انجام شد. به این منظور 60 خانم حامله که تحت عمل سزارین دلبخواه قرار گرفتند، به صورت اتفاقی به دو گروه 30 نفری تقسیم شدند. بیماران گروه مورد و شاهد یک دقیقه قبل از القاء بیهوشی، به ترتیب mg/kg 5/0 کتامین و دارونما دریافت کردند. تکنیک جراحی و بیهوشی در دو گروه یکسان بود. شدت درد پس از عمل با استفاده از پرسشنامه McGill طی چهار نوبت (در ریکاوری و سپس هر 6 ساعت) ثبت گردید. یافته ها: میانگین نمره درد پس از عمل جراحی در گروه مورد و شاهد به ترتیب 2/3±7 و 49/3±9/7 به دست آمد که این اختلاف معنی دار بود (05/0

The Role of Index and Ring Fingers in Gender Identification and Height Estimation

Background: It is a challenge in forensic medicine to identify deceased bodies when body dismembered from remaining body parts, such as hands, arms, and feet. We aimed to determine gender and the correlation between stature, and index and ring fingers in an Iranian population.Methods: In this cross-sectional study, 200 Iranian students aged between 18 and 25 years were included (2016-2017). The length of the nondominant index and ring fingers were measured from proximal crease to the tip. The exclusion criteria were a history of heavy physical work by hand, hand vocational sports, anatomical musculoskeletal deformities, and chronic internal diseases (diabetes, thyroid disorders, renal failure, etc.). The obtained data were analyzed using SPSS. t-test, Pearson’s correlation coefficient, and correlation and regression models were used to analyze the achieved data.Results: The mean height was 179 cm in males and 164 cm in females. The mean index and ring fingers lengths were 73 mm and 74 mm in males, and 68 mm and 68 mm in females, respectively. The mean sum of index and ring fingers lengths were 147 mm in males and 136 mm in females. Height, index and ring fingers length, and the sum of them significantly differed between genders (P<0.0001). The accuracy of gender determination was 92%, 71%, 73% and 74.5% in terms of stature, index finger length, ring finger length, and the sum of index and ring fingers length, respectively. The correlation between height and index finger length, as well as the height and ring finger length, were significant in males, females, and total cases (P<0.0001).Conclusion: Based on this study, index and ring fingers lengths can be used to predict height and determine gender.

Comparing the Accuracy of Morphometric and Morphological Criteria of Hip Bone in Gender Determination

Background: A primary aim of forensic medicine is gender determination. Although hip is the optimal bone for this purpose, different determining criteria of this bone do not have the same accuracy. This is important in conditions that only parts of hip remain to determine gender. This study aimed to evaluate the accuracy of different hip criteria in gender determination. Methods: This cross-sectional study evaluated a total of 160 paired hips (80 males and 80 females) removed from the bodies for bone transplantation. Morphometric criteria were vertical and horizontal acetabular diameters and superior and inferior pubic ramus widths. Morphological criteria were a greater sciatic notch, obturator foramen, pubic body, preauricular sulcus, acetabular fossa position, and ischial tuberosity. The obtained data were analyzed using Cross Tab, t-test, and logistic regression analysis by SPSS. The significance level was set at P<0.05.Results: There was no significant difference in morphometric and morphological criteria between the studied left and right hip bones (P>0.05). In gender determination, acetabular diameter and greater sciatic notch had the highest accuracy (85%), and obturator foramen (67.5%) and superior and inferior pubic ramus widths (65%) had the lowest accuracy.Conclusion: Hip bone is not always completely available and preserved to determine gender. Moreover, sometimes not all anthropometric criteria of the bone are in favor of one gender. Therefore, investigating the accuracy of different criteria can be very important in interpreting the results. Thus, it has always been emphasized on the use of all available information in gender determination

Collo-Diaphyseal Angle as an Optimal Anthropometric Criterion of Femur in Gender Determination

Background: Gender determination is an important challenge in the identification of skeletal remnants and dismembered bodies. The femur bone is more likely to be preserved during accidents and over time; thus, it is one of the most useful bones in gender determination.Methods: This cross-sectional study was conducted on 54 fresh femur pairs of ˃19-year-old Iranians without anomalies or trauma. We studied the length of the femur, vertical head diameter, bicondylar width, shaft angle with the horizon, and collo-diaphyseal angle in male and female samples. Data were analyzed in SPSS using t-test and Receiver Operating Characteristic curves. P<0.05 was considered as statistically significant.Results: The samples’ mean age was 37 years in males and 41 years in females. The mean values of measurements were not significantly different between the left and right femurs (P>0.05). The vertical head diameter, maximum length, bicondylar width, and the shaft angle were significantly larger in the males, compared to females. The mean degree of collo-diaphyseal angle was significantly wider in females, compared to males (P<0.05). The highest precision of gender differentiation belonged to the collo-diaphyseal angle (96.3%) and the lowest one belonged to the vertical head diameter (77.8%).Conclusion: Based on our findings, even with the existence of only one femur bone, gender determination can be achieved with high precision. Collo-diaphyseal angle would be helpful in gender determination, even with the sole availability of the proximal part of the femur

Incidence, location, and type of isthmus in mandibular second molars among individuals of an Iranian population

BACKGROUND AND AIM: Isthmuses are narrow and strip shaped connections between two canals containing pulpal tissue that may encompass bacteria as well. They are hardly accessible for cleaning; therefore, success and failure of root canal treatments could be affected by their presence. The present study was carried out aiming to evaluate the incidence, location, and type of isthmus in mandibular second molars (MSMs) among individuals of an Iranian population. METHODS: 80 MSMs with inclusion criteria, belonging to individuals of an Iranian population were collected and disinfected. After embedding the samples’ roots in the acrylic resin, teeth were sectioned horizontally at 2, 4, and 6 mm distances from the apices. Then they were viewed and recorded by a stereomicroscope under × 30 magnification. According to Kim classification, two endodontists recorded the number of canals, incidence, and type of the isthmuses. In cases of disagreement, a third endodontist was involved to judge on the right opinion between the two. The acquired data were analysed using chi-square test. RESULTS: The results showed that 96.3% and 3.75% of MSMs had two and three roots, respectively. Type V (described in the following) was the most frequent type of isthmus at mesial and distal roots. C-shaped canals composed 3.7% of the samples and showed isthmus at all the three sections. There was a significant difference in the distribution of isthmuses (P < 0.001). CONCLUSION: According to this study, different types of isthmuses prevail in high rate of mesial and about half of the distal roots of MSMs, which are important for root canal cleaning and shaping. KEYWORDS: Anatomy; Molar; Tooth; Root Cana

Research Paper: Sex Determination Based on Radiographic Examination of Metatarsal Bones in Iranian Population

Background: In forensic medicine, sex can be determined by studying human skeletal remains. This study aimed to evaluate the reliability of metatarsal bones in sex determination in Iranian population. Methods: A total of 184 healthy individuals (103 males and 81 females) were enrolled in the study. The sample was divided into three age groups: 20-34, 35-49, and ≥50 years. The length, width, length to width ratio (L/W), and length by width (L×W) product of sample’s right foot metatarsal bones were measured using their radiographic images.Results: The differences of length, width, L/W ratio, and L×W between two sexes were significant in all age groups (P&lt;0.001). First metatarsal L×W had sensitivity and specificity of 85.4% and 88.8%, respectively, but the mean total L×W value of metatarsal bones had sensitivity and specificity of 94.2% and 78%, respectively. Conclusion: The first and the mean L×W values of all metatarsal bones had the highest accuracy for discriminating sexes (86.9% and 85.2%). The first metatarsal width and mean width of all metatarsal bones had an accuracy of 82.6% and 84.2%, respectively. In forensic medicine, these indexes can be used for sex-differentiation

Research Paper: Using Subpubic Angle in Sex Determination and Stature Estimation: An Anthropometric Study on Iranian Adult Population

Background: Pelvic bone has important sex determining features. However, anthropometric reference values vary by study population. This study aimed to determine the accuracy of subpubic angle for sex determination and height estimation in Iranian adults.Methods: In this study, the subpubic angle in the digital pelvic radiographs of 325 Iranian adults (199 males and 126 females) and their standing heights were measured. Then, the relation of subpubic angle with sex and stature was evaluated. Results: The mean(SD) subpubic angle of the studied population was 116.3 (23.7) degrees. Subpubic angle was significantly wider (P&lt;0.001) in females [140.5(14.3) degrees] compared to males [101.0(13.3) degrees]. Moreover, we observed a significant decrease (P&lt;0.001) in females’ subpubic angle with an increase in age. A significant reverse correlation (P&lt;0.01) was also observed between the subpubic angle and height (r=0.416). Conclusion: This study showed that the mean subpubic angle in Iranian adults is different from the average in other populations. Our reference values can be used in forensic identification

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed