Effects of Oral Gabapentin, Local Bupivacaine and Intravenous Pethidine on Post Tonsillectomy Pain

Introduction: Tonsillectomy is one of the most common surgeries performed worldwide. Post-operative pain arising from tonsillectomy is one of the earliest complications that can postpone oral nutrition and increase the hospitalization period. Administration of opioids via injection is usually preferred to relieve pain in these patients. However, the side effects of this approach prompted us to seek alternative treatments. In this study, the effectiveness of oral gabapentin is compared with an intravenous (IV) injection of pethidine and a local injection of bupivacaine in the control of pain after tonsillectomy. Materials and Methods: This clinical trial was performed on 7-15 year-old patients who were candidates for tonsillectomy at Shahrekord Kashani hospital from 2012–2013. The patients were divided into three groups at random. Group 1 was give 20 mg/kg oral gabapentin 1 hour before anesthesia. In Group 2, 2.5 ml bupivacaine 0.25% was injected into each tonsil bed by a surgeon. In Group 3,1 mg/kg pethidine was injected intravenously after intubation. To assess postoperative pain, the Oucher scale was used in recovery as well as 3,6,12, and 24 hours after surgery. Results: The pain score was lowest in the gabapentin group and highest in the bupivacaine group during the study. The pain score in the gabapentin group was significantly lower than that in the bupivacaine group (P<0.05). No statistically significant difference was found between the pain score of the Pethidine group and that of the Bupivacaine group (P>0.05). Conclusion: Gabapentin, with its antihyperalgesic properties and other unknown properties, is a convenient drug for controlling pain following tonsillectomy

Effects of premedication with Melatonin and L-Theanine on Ketamine induced anesthesia in New Zealand White Rabbits

Melatonin, a pineal gland secreted hormone has different effects on mammalian physiology. Recently, specific receptors of melatonine have been found in the central nervous system and spinal cord of rabbits. L - Theanine is a unique amino acid in the tea plant (Camellia sinensis). The effects of this amino acid is based on increasing GABA and dopamine levels in the brain and has a weak effect on the NMDA receptors, receptors that inhibitory effects of ketamine on them have been proven. The aim of this study was to evaluate the effect of oral combination of melatonin and L-Theanine on analgesia and anesthesia characteristics, induced by intramuscular injection of ketamine hydrochloride in New Zealand white rabbits. Five rabbits were anesthetized by intramascular injection of 35 mg/kg of 10% ketamine hydrochloride (Control group). The same rabbits, after 2 weeks, and complete clearance of the drugs from their bodies, were administered orally with the combination of 25 mg L-Theanine and 3 mg melatonin, 60 min prior to ketamine injection (Experimental group). In both groups, time spending to induction of anesthesia, duration of anesthesia, anesthetic depth and vital signs including rectal temperature, heart rate, respiratory rate, SPO2 and palpebral, pedal and righting reflexes were observed. The results showed no significant differences in onset of anesthesia, duration of anesthesia and anesthetic depth, heart rate, respiratory rate, body temperature and oxygen saturation of hemoglobin. As a conclusion, administration of 3 mg melatonin and 25 mg L-theanine could not effect on ketamine hydrochloride anesthesia in New Zealand white rabbits.

Effects of local injection of bupivacaine and dexamethasone on postoperative pain of adenotonsillectomy

چکیده: زمینه و هدف: تانسیلکتومی از شایع ترین اعمال جراحی است که دارای عوارضی همانند درد، خونریزی، لارنژیت و لارنگواسپاسم می باشد. کنترل درد بدلیل کاهش رنج و بیقراری در کودک و کاهش احتمال خونریزی بعد از عمل از اهمیت خاصی برخوردار است. در حال حاضر کنترل درد بوسیله داروهای مخدر انجام می شود که بدلیل داشتن عوارض ناگوار جبران ناپذیر مانند تضعیف و یا قطع کامل تنفس موجبات نگرانی پزشکان را به همراه دارد. اخیراً استفاده از بعضی داروهای دیگر مثل دگزامتازون و بوپی واکائین نیز توصیه شده است ولی در مطالعات اولیه، ما نتایج قابل قبول از پاسخ ها به دست نیاوردیم. لذا این مطالعه به منظور تعیین اثر و همچنین مقایسه تأثیر احتمالی تزریق موضعی دگزامتازون و بوپی واکائین بر شدت درد پس از عمل جراحی لوزه انجام گرفته است. روش بررسی: این مطالعه به صورت مداخله ای بر روی 90 بیمار 30-3 ساله که در بهار و تابستان 84 در بیمارستان آیت ا...کاشانی شهرکرد تحت عمل جراحی تانسیلکتومی قرار گرفتند انجام شد. بیماران بصورت تصادفی در سه گروه 30 نفری A,B,C تقسیم شدند. پس از برداشتن لوزه ها در بستر هر لوزه به گروه A، 2 میلی لیتر بوپی واکائین 5/0، به بیماران گروه B، 2 میلی لیتر دگزامتازون و به گروه C، 2 میلی لیتر نرمال سالین تزریق گردید. کلیه بیماران 6، 12 و 18 ساعت پس از عمل جراحی توسط پژوهشگر ویزیت شدند و شدت درد آنها با استفاده از پرسشنامه McGill مورد بررسی قرار گرفت. داده ها توسط تست آماری کای دو مورد تجزیه و تحلیل آماری قرار گرفت. یافته ها: از نظر میانگین سنی گروهها، اختلاف معنی داری بین سه گروه مورد مطالعه وجود نداشت. 6/45 از بیماران مرد و بقیه زن بودند. شدت درد در 6 ساعت پس از عمل جراحی در گروه دریافت کننده بوپی واکائین بیشتر از گروه پلاسبو بود (05/0

Provision of frequency stability of an islanded microgrid using a novel virtual inertia control and a fractional order cascade controller

Nowadays, the renewable energy sources in microgrids (MGs) have high participation to supply the consumer’s demand. In such MGs, the problems such as the system frequency stability, inertia, and damping reduction are threatened. To overcome this challenge, employing the virtual inertia control (VIC) concept in the MG structure could be considered as a viable solution to improve the system frequency response. Hence, this work proposes a novel modeling for VIC in an islanded MG that provides simultaneous emulation of the primary frequency control, virtual inertia, and damping. To show the efficiency of the proposed technique, a comparison is made between the dynamic performance of the proposed VIC and conventional VIC under different scenarios. The results indicate that the proposed VIC presents superior frequency performance in comparison with conventional VIC. In addition to VIC modeling, a new cascade controller based on three-degrees of freedom and fractional-order controllers (FOCs) is proposed as an MG secondary controller. The effectiveness of the proposed controller is compared to tilt-integral-derivative and FO proportional-integral-derivative controllers. The Squirrel search algorithm is utilized to obtain the optimal coefficients of the controllers. The results demonstrate that the proposed controller improves the MG frequency performance over other controllers. Eventually, the sensitivity analysis is performed to investigate the robustness of the proposed controller in the face of the variations of the parameters

Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) among Young Landmine Amputees

How to Cite This Article: Poor Zamany Nejat Kermany M, Modirian E, Soroush M, Masoumi M, Hosseini M. Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) Among Young Landmine Amputees. Iran J Child Neurol. Summer 2016; 10(3):42-47. AbstractObjectiveTo determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation.Materials &amp; MethodsAll youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test.ResultsThere were 38 male and 3 female with the mean age of 15.8±2.4yr. The mean interval between injury and follow-up was 90.7±39.6 months. Twelve (44.4%) upper limb amputees and 11 (26.8%) lower limb amputees had PLS. Nine (33.3%) upper limb amputees and 7 (17.1%) lower limb amputees experienced PLP. Of 27 upper limb amputees, 6 (14.6%) and among 15 lower limb amputees, 6 (14.6%) had both PLS and PLP. One case suffered amputation of upper and lower limbs and was experiencing PLS and PLP in both parts. PLS had a significant difference between the upper and lower amputated groups. Significant relationship was observed between age of casualty and duration of injury with PLP.ConclusionPhantom limb sensation and pain in young survivors of landmine explosions appear to be common, even years after amputation. References Nikolajsen L, Jensen TS. Phantom limb pain. Br J Anaesth 2001; 87:107-16.Tseng CC, Chen PY, Lee YC. Successful treatment of phantom limb pain and phantom limb sensation in the traumatic amputee using scalp acupuncture. Acupunct Med 2014;32(4):356-8.Davis RW. Phantom sensation, phantom pain, and stump pain. 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Chronic pain in land mine accident survivors in Cambodia and Kurdistan. SocSci Med 2002; 55(10):1813-6.Wartan SW, Hamann W, Wedley JR, McColl I. Phantom pain and sensation among British veteran amputees. Br J Anaesth 1997; 78(6):652-9.Krane EJ, Heller LB. The prevalence of phantom sensation and pain in pediatric amputees. J Pain Symptom Manage 1995; 10(1): 21-9.Wilkins KL, McGrath PJ, Finley GA, Katz J. Phantom limb sensations and phantom limb pain in child and adolescent amputees. Pain 1998; 78(1): 7–12.Mariane L. Simmel. Phantom experiences following amputation in childhood. J Neurol Neurosurg Psychiat 1962; 25(1): 69-78.Mohammadi Seilabipour N, Mohammadi Fallah S, Kazemi H, Shariat SV. Phantom limb correlates among amputee war veterans. Adv Cognitive Sci 2013; 15(2): 32-9.Modirian E, Shojaei H, Soroush MR, Masoumi M. Phantom pain in bilateral upper limb amputation. DisabilRehabil 2009; 31(22): 1878-81.Explosive remnants of war-Unicef. http://www.unicef. org/sowc2013/focus_war_remnants.htmlRayegani SM, Aryanmehr A, Soroosh MR, Baghbani M. Phantom Pain, Phantom Sensation, and Spine Pain in Bilateral Lower Limb Amputees: Results of a National Survey of Iraq-Iran War Victims’ Health Status. JPO 2010; 22(3): 162-165.Subedi B, GrossbergGT. PhantomLimbPain:Mechanisms and Treatment Approaches. Pain Res Treat 2011, Article ID 864605, 8 pages.Laura L. Burgoyne, Catherine A. Billups, José L. JirónJr, Roland N. Kaddoum, Becky B. Wright, George B. Bikhazi, et al. Phantom limb pain in young cancer-related amputees: Recent experience at St. Jude Children’s Research Hospital. Clin J Pain 2012; 28(3): 222–5.Sin EI, Thong SY, Poon KH. Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital. Singapore Med J. 2013; 54(2): 75-81.Melzack R, Israel R, Lacroix R and Schultz G. Phantom limbs in people with congenital limb deficiency or amputation in early childhood. Brain 1997; 120(9): 1603– 20.Rahimi A, Mousavi B, Soroush M, Masumi M, Montazeri A. Pain and Health-Related Quality of Life in War Veterans with Bilateral Lower Limb Amputations. Trauma Mon2012; 17(2):282-286.Ketz AK. The experience of phantom limb pain in patients with combat-related traumatic amputations. Arch Phys Med Rehabil 2008, 89(6): 1127-32.Boyle M, Tebbi CK, Mindell ER, Mettlin CJ. Adolescent adjustment to amputation. Med Pediatr Oncol 1982; 10(3): 301-12.Patricia A. McGrath, Loretta M. Hillier. Phantom limb sensations in adolescents: A case study to illustrate the utility of sensation and pain logs in pediatric clinical practice. J Pain Symptom Manage 1992; 7(1): 46–53.Vida L. Tyc. Psychosocial adaptation of children and adolescents with limb deficiencies: A review. Clin Psychol Rev 1992; 12(3); 275–291. 

Vitamin D Receptor and Vitamin D Binding Protein Gene Polymorphisms Are Associated with Renal Allograft Outcome

Vitamin D deficiency has adverse effects on renal allograft outcomes, and polymorphisms of genes encoding vitamin D-binding protein (VDBP) and vitamin D receptor (VDR) are defined to play a role in these conditions. The goal of the current investigation was to evaluate the connection between those polymorphisms with acute rejection, viral infection history, and recipients’ vitamin D status. In this study, 115 kidney transplant recipients and 100 healthy individuals were included. VDR polymorphisms including FokI (rs2228570), Apal (rs7975232), BsmI (rs1544410), as well as VDBP (rs7040) polymorphisms were studied using high resolution melting (PCR-HRM) analysis among the studied groups. The frequency of G allele in Apal rs7975232 polymorphism in the kidney transplant recipients was 0.63 times lower than healthy individuals (p = 0.026). Further, the G allele frequency in VDBP rs7040 polymorphism was significantly lower in patients with allograft rejection (p = 0.002). Considering the incidence of viral infection, significant differences were identified between the frequencies of VDR FokI (OR = 2.035; 95% CI 1.06–2.89, p = 0.030) and VDBP rs7040 (OR = 0.40; 95% CI 0.24–0.67, p < 0.001) T alleles in the studied groups. Moreover, the VDBP rs7040 GG genotype distribution was low in the recipients with a history of viral infection (p = 0.004). VDR (FokI) and VDBP (rs7040) alleles and their genotype distribution are significantly associated with allograft outcomes including allograft rejection and viral infection in the studied population

Sleep quality in medical students; the impact of over-use of mobile cell-phone and social networks

Background: Poor sleep quality is closely associated with lifestyle habits including use of mobile cell-phones. This study aimed to identify the relationship between sleep quality due to abuse in mobile cell-phones and engagement in social networks. Methods: This cross-sectional study was conducted on 380 undergraduate students selected by proportional stratified sampling in Qom, Iran in 2015. Data were collected by two statndard questionnaire including Cell-Phone Over-Use Scale (COS) and Pittsburgh sleep quality questionnaire beside the status of usage in cell-phone social networks. T-test, chi-square, Pearson correlation coefficient and multivariate logistic regression were used in data analysis. Results: The mean age of participants was 21.8 ±3.2 yr, 69.1% were female, and 11.7% were married. The mean of COS and sleep quality scores were 48.18 ±17.5 and 5.38 ±2.31, respectively. The prevalence of over-use of cell phone was 10.7% (CI 0.95; 8.8%, 12.6%) and the prevalence of poor sleep quality was 61.7% (CI 0.95; 57.1%, 66.3%). The mean of all aspects and total score of sleep quality showed a direct significant association by cell-phone addiction score except sleep duration score that was inversely. Based on multivariate analysis affected to cell-phone addiction, being male gender and studying in general physician level are the most important predictors of poor sleep quality. Conclusions: Over use of internet and social networks via smart phones is related to poor sleep quality and quantity. Predefined sport programs, educational, cultural, and interesting entertainment are the essential needs for all medical students. These interventions are more important especially for male students who have longer educational

Satisfaction of Supplementary Insurance and Medical Services during Trips in War Survivors and their Families

Introduction: During trips the imposed costs are aggravated due to time and financial limits, not being familiar with treatment centers that are covered by the insurances and charges for accommodation. Insurance, especially supplementary treatment services insurance can be an appropriate solution to decrease these costs. These kinds of insurances cover a range of services including outpatient services to hospitalization and even sometimes unlimited services. The purpose of this study was to evaluate the satisfaction of war survivors and their families under the cover of supplementary insurance from medical care during trips. Methods: This study was cross -sectional descriptive. The size of studied population was 77 people from war survivors and their families who were assessed by a provided questionnaire in 2015. The including criteria was war survivors and their families under the cover of Veterans and Martyrs Affair Foundation (VMAF) and supplementary insurance war survivors. The prepared questionnaire included two sections; the first section was included the personal indications and the second section included satisfaction evaluations. Results: The prevalence of using medical care during trips in war survivors and their families was 2.72% and using medical care with supplemental insurance in trips was 1.5%. The obtained results from the questionnaires revealed that the highest satisfaction on medical care services and its distance belongs to the veterans' families with the mean of 4.57and 4.27, respectively. In the subject of taking back the costs, martyrs’ families were the least satisfied with the mean of 2.17. A significant relationship was found between sex and distance of the medical care services in trips (p=0.046).  Men had more satisfaction compared to women. Finally it can be mentioned that there was not a significant relationship between client group and distance of medical care services during trips (p=0.067). Conclusion: According to the results, affording the costs and paying them back by the insurance company needs modifications

Mental health disorders in child and adolescent survivors of post-war landmine explosions.

BACKGROUND: To describe the mental health status of 78 child and adolescent survivors of post-war landmine explosions. METHODS: Child and adolescent survivors of landmine explosions who were younger than 18 years old at the time of the study were identified and enrolled in this study. The mental health status of the participants was assessed by general health assessment and psychiatric examinations. Psychiatric assessment and diagnosis were undertaken using the Diagnostic and Statistical Manual for mental disorders (DSM-IV) criteria. A psychiatrist visited and interviewed each survivor and identified psychiatric disorders. RESULTS: Seventy-eight child and adolescent survivors with a mean age of 16.11 ± 2 years old were identified and agreed to participate in the study. The mean age of the victims at the time of injury was 8.2 ± 3.12 years old (range 2-15). Thirty-seven (47.4 %) of the adolescent survivors suffered from at least one psychiatric disorder. Twenty-nine survivors (37.1 %) were newly diagnosed and needed to start medication and psychiatric treatment. The most common findings were anxiety disorders (34.6 %), including posttraumatic stress disorder (PTSD) in 20 (25.6 %), and generalized anxiety disorder (GAD) in 7 (9 %) subjects. Mild-Moderate depression was found in 5 (6.4 %) subjects. No personality disorders were observed, and two patients suffered from mental retardation. The study results revealed a significant association between age of casualty, duration of injury and limb amputation, and types of psychological disorders. CONCLUSION: Child and adolescent survivors of landmine explosions had a high prevalence of psychiatric disorders

The synergistic effect of hydroalcoholic extracts of Origanum vulgare, Hypericum perforatum and their active components carvacrol and hypericin against Staphylococcus aureus.

AIM: This study was designed to evaluate the synergistic activities of hydroalcoholic extracts of medicinal plants Origanum vulgare and Hypericum perforatum and their active components, carvacrol and hypericin against Staphylococcus aureus. METHODS: The synergistic effects of the plants, as well as carvacrol and hypericin, were examined using a checkered method against S. aureus (ATCC 12600). RESULTS: A fractional inhibitory concentration of 0.5 was obtained for combination of O. vulgare and H. perforatum and 0.49 for combination of the active ingredients carvacrol and hypericin, both of which indicated a synergistic effect. CONCLUSION: This preliminary evaluation demonstrated a synergistic property of O. vulgare and H. perforatum extracts in treating S. aureus infection. This study indicates that combination of the plants, as well as combination of carvacrol and hypericin, might be used as a new antibacterial strategy against S. aureus. KEYWORDS: Gram positive; Staphylococcus aureus; antibacterial; antibiotic; checkered carried out to Fratini method; combination; fractional inhibitory concentration; herbal medicine; medicinal plant; synergis