Comparison of fentanyl and combination of pethedine and midazolam for pain control during extracorporeal shock wave lithotripsy

زمینه و هدف: با توجه به لزوم کنترل درد حین سنگ شکن، این مطالعه با هدف مقایسه کارآیی و عوارض داروی مخدر فنتانیل با ترکیب پتیدین و میدازولام جهت کنترل درد حین عمل سنگ شکن ضربه ای برون اندامی انجام شد. روش بررسی: در این کار آزمایی بالینی یک سو کور 89 بیمار با سن بالاتر از 18 سال واجد شرایط انجام عمل سنگ شکن ضربه ای برون اندامی به صورت تصادفی به دو گروه مداخله (45 نفر) و کنترل (44 نفر) تقسیم شدند. در بیماران گروه مداخله 1 میکروگرم بر کیلوگرم فنتانیل و در گروه کنترل 7/. میلی گرم بر کیلوگرم پتیدین و 02/. میلی گرم بر کیلوگرم میدازولام به صورت وریدی تزریق شد. سپس در هر دو گروه، سنگ شکن به روش استاندارد انجام و شدت درد حین عمل هر 20 دقیقه و دو ساعت بعد از عمل با مقیاس سنجش درد (VAS) اندازه گیری شد. کارآیی عمل بر اساس پیگیری های بعدی بیماران ارزیابی شد. داده ها به کمک آزمون آماری کای دو تجزیه و تحلیل شدند. یافته ها: گر چه فراوانی عدم درد و درد خفیف در گروه مداخله (به ترتیب 6/26 و 4/24) و فراوانی درد شدید در گروه کنترل بالاتر (5/32) بود ولی این اختلاف معنی دار نبود. همچنین نتایج بررسی میزان کارآیی عمل در بیماران دو گروه مداخله و کنترل تفاوت معنی داری را نشان نداد. نتیجه گیری: فنتانیل تزریقی با دوز کم مانند ترکیب پتیدین و میدازولام در کنترل درد حین عمل سنگ شکنی برون اندامی دارویی با عوارض کم و کارآیی مناسب است و می تواند به صورت سرپایی مورد استفاده قرار گیر

Results and Complications of Spinal Anesthesia in Percutaneous Nephrolithotomy

Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large kidney calculi, staghorn calculi, and calculi that are multiple or resistant to shock wave lithotripsy. In many centers, PCNL is performed under general anesthesia. However, complications under spinal anesthesia can be less frequent. We evaluated the impact of spinal anesthesia on intra-operative and postoperative outcome in patients undergoing PCNL. Materials and Methods: The intra-operative and postoperative anesthetic and surgical outcomes were evaluated in 160 consecutive patients who underwent PCNL under spinal anesthesia in the prone position. Results: The mean age of the patients was 40.0 ±14.3 years, and the mean operative time was 95.0 ± 37.8 minutes. The mean calculus size was 34.2 ± 9.8 mm. Ten patients had staghorn calculi (mean size, 4.2 ± 1.1 cm; mean operative time, 140 ± 40 minutes). Return of sensory and motor activity took 140.0 ± 19.7 minutes and 121.0 ± 23.8 minutes, respectively. During the first part of anesthesia, 18 patients developed hypotension, which was controlled by ephedrine, 10 mg, intravenously. Ten patients (6.3%) needed blood transfusion and 6 complained of mild to moderate headache, dizziness, and mild low back pain for 2 to 4 days after the operation, which improved with analgesics and bed rest. Seventy percent of the patients had complete clearance of calculus or no significant residual calculi larger than 5 mm on follow-up ultrasonography. Conclusion: Spinal anesthesia is safe and effective for performing PCNL and is a good alternative for general anesthesia in adult patients

preventing of osteoporosis: Applying the Health Belief Model

Background and aim: osteoporosis as a disease, is characterized by low bone mass and loss of bonemicrostructure known. According to the importance of identifying the preventive behaviors in premenopausalwomen by nurses and other health personnel, This study aimed to determine the predictingfactors of nutritional behaviors for preventing of osteoporosis according to the Health Belief Model wasperformed.Materials and Methods: This cross-sectional study was conducted on 147 women aged 35-49 were referredto Health Centers in Bandar Abbas, Iran. A systematic cluster sampling method was applied. Data collectiontool was included demographic information, knowledge, health belief model constructs and calcium andvitamin D rich foods frequency questionnaires. The data were analyzed using descriptive statistical, PearsonCorrelation and Linear Regression.Findings: The result showed that self-efficacy, perceived benefits, perceived barriers had a significantrelationship with nutritional behaviors . Structure barriers predict calcium intake. Also, Structural barriers andperceived benefits were identified as strong predictors for vitamin D.Conclusion: According to the results, The health belief model could become suitable framework forinterventional programs, However, taking into account social -cultural factors related to the preventivebehaviors could have effective role for improving preventive nutritional measures.Keywords: nutritional behavior, osteoporosis, prevention, health belief mode

A home-based, transtheoretical change model designed strength training intervention to increase exercise to prevent osteoporosis in Iranian women aged 40–65 years: a randomized controlled trial

Physical activity (PA) helps to prevent osteoporosis, but older women are often sedentary. This study used a pre-post randomized controlled design to evaluate a 12-week exercise education intervention program based on the stages of change (SoC) and processes of change from the transtheoretical change model (TTM) to improve adherence with strength and balance training recommendations at levels sufficient to prevent osteoporosis in Iranian women aged 40-65 years. The home-based exercise prescription consisted of strength and balance training that was progressive, individually tailored and included a walking program. Individuals in the training group (n = 61) had a positive, significant progression in psychological SoC (P n = 55). After the intervention, the training group demonstrated significant improvements in PA, lower body muscle strength, static and dynamic balance, with no significant changes in the control group. These results support the applicability of the TTM for a PA intervention and indicate that this training program is very effective in improving balance and lower body strength in older women

Cognitive Predictors of Cousin Marriage Among Couples Visiting Counseling Centers in Kohgiluyeh-Boyer Ahmad Province

Background and Objectives: Giving birth to a child with disabilities is two-three times more likely in consanguineous marriages. Due to the various negative consequences of such marriages, this study aimed to determine the cognitive predictors of consanguineous marriages. Materials and Methods: In this cross-sectional study, convenience sampling was applied to select 516 people who visited four different marriage counseling centers in Kohgiluyeh-Boyer Ahmad Province. A self-report questionnaire was administered to collect data. Bivariate correlations and logistic regression analysis were performed to analyze the data in SPSS-20. Results: The mean age of the respondents was 23.43 ± 3.96 years (range: 15-30 years). About 43.4% of the participants had married a relative. Regression analysis suggested subjective norms (OR = 1.304) and cultural factors (OR = 1.244) as the best predictors of cousin marriage. Conclusion: Considering the high rate of cousin marriage in the studied population, it is pre-marriage genetic counseling seems essential. Designing educational interventions on subjective norms and cultural factors related to cousin marriage may also be useful in reducing the rates of cousin marriages