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The Relationship between Iron Deficiency and Hair Loss in 10 -45 Year Old Females in Qom Province, Iran
J Makarem
Qom University of Medical Sciences Journal , 2012,
Abstract: Background and Objectives: Iron deficiency is a highly prevalent problem in developing countries. One of the reasons for telogen effluvium is Iron deficiency. This study was conducted to determine the relationship between Iron deficiency and hair loss in Qom Province, Iran. Methods: This study was conducted in two separate stages. In the first stage, a cross- sectional, population-based study was performed. In the second stage, a case control study was carried out. The study was conducted during 2007 and 2008 on 10 to 45 year-old females in Qom Province. 2200 females in the first stage and 410 females in the second stage (205 females with telogen effluvium as cases, and 205 females without telogen effluvium as controls) were studied. Females with positive pull test and without exclusion criteria were considered as telogen effluvium. In both case and control groups, CRP and serum ferritin tests were done. Correlation of variables with hair loss and serum ferritin level was evaluated. Chi Square test, Student’s T test and Mann Whitney Test were taken for statistical analysis in SPSS ver. 16 software. Multiple logistic regressions were used for statistical modeling. Results: Median (range) of serum ferritin level in the case group was 18.7μg/L (0.7-174.5μg/L) but in the control group it was 22.1μg/L (2.8-167.9μg/L) (P=0.01). In 93 (45.4%) females of the case group and in 71 (34.6%) females in the control group ferritin level was lower than 15μg/L (P=0.02). In 1182 (53.7%) of 2200 female hair-loss was detected. In multivariate analysis older age and weight, being housekeeper and smoking were directly associated with hair loss. However, higher monthly income and possession of private house had opposite relationship with hair loss. Conclusion: Hair loss was a prominent problem in females in Qom Province and telogen effluvium was related to iron deficiency. In females in Qom Province, improvement of body iron resources with better nutrition style, administration of iron supplements and fortifying food with iron supplements is recommended.
Ultrasound-guided brachial plexus block: a study on 30 patients
Amiri HR,Makarem J
Tehran University Medical Journal , 2009,
Abstract: "n Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection. Standard approaches used today (elicitation of paresthesia or nerve-stimulated muscle contraction), unfortunately, are all "blind" techniques resulting in procedure-related pain and complications. Ultrasound guidance for brachial plexus blocks can potentially improve success and complication rates. This study presents the ultrasound-guided brachial plexus blocks for the first time in Iran in adults and pediatrics. "n"n Methods: In this study ultrasound-guided brachial plexus blocks in 30 patients (25 adults & 5 pediatrics) scheduled for an elective upper extremity surgery, are introduced. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. Besides basic variables, block approach, block time, postoperative analgesia duration (VAS<3 was considered as target pain control) opioid consumption during surgery, patient satisfaction and block related complications were reported."n"n Results: Mean adult age was 35.5±15 and in pediatric group was 5.2±4. Frequency of interscalene, supraclavicular, axillary approaches to brachial plexus in adults was 5, 7, 13 respectively. In pediatrics, only supraclavicular approach was accomplished. Mean postoperative analgesia time in adults was 8.5±4 and in pediatrics was 10.8±2. No block related complication were observed and no supplementary, were needed. "nConclusions: Real-time ultrasound imaging during brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern and extend of local anesthetic spread.
Total spinal anesthesia in an achondroplasic patient: case report
Amiri H R,Makarem J
Tehran University Medical Journal , 2008,
Abstract: Background: Total spinal anesthesia is a complication of lumbar epidural anesthesia following undiagnosed subarachnoid or subdural injection of local anesthetic. Although many achondroplastic dwarfs have a normal spine, catheter insertion may be more problematic with a narrow epidural space making a subarachnoid tap more probable. Other malformations associated with achondroplasia, such as prolapsed intervertebral discs, reduced interpedicular distance, shortened pedicles, and osteophyte formation, combined with a narrow epidural space may make identification of the space difficult and increases the risk of dural puncture. Furthermore, subarachnoid tap or dural puncture may be hard to recognize if a free flow of CSF is difficult to achieve due spinal stenosis. Yet, for those who meet the criteria, epidural regional anesthesia is frequently preferred over other forms, which often have more or more dangerous side effects in this type of patient.Case report: A 22-year-old achondroplastic male dwarf patient was scheduled for pelvic mass resection and was considered a candidate for continuous epidural anesthesia. The anesthesia became complicated by total spinal anesthesia, which was reversed following supportive management for about two hours.Conclusion: There is significant debate over the composition and volume of the test dose, especially for patients with achondroplasia. We nevertheless recommend repeated test-doses during the accomplishment of epidural anesthesia to exclude unintended intravascular, intrathecal or subdural injection, keeping in mind that a test dose of local anesthetic does not completely prevent complications.
The effect of hypnotic drug type on anesthetic depth and amnesia: a randomized clinical trial
Amiri HR,Makarem J,Noyan Ashraf MA
Tehran University Medical Journal , 2009,
Abstract: "n Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Bispectral index (BIS index) shows the depth of anesthesia. The effects of drugs on BIS and amnesia are different. This study was performed to evaluate the association between two different sedative regimens on BIS and amnesia."n"nMethods: In this clinical trial, 60 patients who needed elective orthopedic surgery under regional anesthesia with intravenous sedation were elected. Patients divided in two equal groups based on sedation protocol by block randomization method: midazolam plus fentanyl group (MF group) or propofol group (P group). Dose of sedative drugs were adjusted according to clinical findings of sedation. Depth of sedation in all patients, preserved in four based on modified Ramsey Sedation Score. Patients questioned about spontaneous recall after full awakening in recovery room. Recall of any event during operation considered as failed amnesia. Correlation of BIS index with recall was measured in two different groups separately."n"nResults: The frequency of recall was 2 (6.7%) in P group and 10 (33.3%) in MF group (p=0.01). The mean± SD of BIS in P group was 76±5 (68-91) and in MF group was 93.4±5 (77-98) (p<0.001). The difference of BIS in patients without amnesia (p=0.019) and with amnesia (p<0.001) in two groups were significant, respectively. No delay in recovery was observed."n"nConclusion: Although the Modified Ramsey Sedation Score and clinical sedation indices were the same, but BIS in patients varied in a wide range. Hypnotic drug was a main determinant of BIS score and amnesia.
Post hemorrhoidectomy pain control: rectal Diclofenac versus Acetaminophen
Rahimi M,Makarem J,Maktobi M
Tehran University Medical Journal , 2009,
Abstract: "nBackground: Anal surgeries are prevalent, but they didn't perform as outpatient surgeries because of concerns about postoperative pain. The aim of the present study was to compare the effects of rectal acetaminophen and diclofenac on postoperative analgesia after anal surgeries in adult patients. "nMethods: In a randomized, double-blinded, placebo-controlled study 60 ASA class I or II scheduled for haemorrhoidectomy, anal fissure or fistula repair, were randomized (with block randomization method) to receive either a single dose of 650 mg rectal acetaminophen (n=20), 100 mg rectal diclofenac (n=20) or placebo suppositories (n=20) after the operation. The severity of pain, time to first request of analgesic agent after administration of suppositories and complications were compared between three groups. Pain scores were evaluated in patients by Visual Analogue Scale (VAS) in 0 (after complete consciousness in recovery), 2, 4, 12 and 24 hours after surgery. The period between administration of the suppositories and the patients' first request to receive analgesic was compared between groups. "nResults: Pain scores were lower significantly in rectal diclofenac than the other groups. The period between administration of the suppositories and the patients' first request to receive analgesic in diclofenac group was 219±73 minutes, was significantly longer compared with placebo (153±47 minutes) and acetaminophen (178±64 minutes) groups. No complications were reported. "nConclusions: Diclofenac suppository is more effective than acetaminophen suppository in post hemorrhoidectomy pain management.
The Comparison of Mallampati Test in Supine and Sitting Position in Traditional Approach and During Phonation for Predicting of Difficult Laryngoscopy and Intubation
Z Hussain Khan,SH Eskandari,M Rahimi,J Makarem
Tehran University Medical Journal , 2012,
Abstract: Background: Inadequate ventilation, esophageal intubation and difficult intubation are the most common adverse respiratory outcomes in patient undergoing anesthesia .The aim of this study was to compare Mallampati test in supine and sitting positions in traditional approach and during phonation for predicting difficult laryngoscopy and intubation. Methods: In this study performed in Imam Khomeini Hospital in Tehran, Iran, Mallampati test was performed on 661 patients who met the inclusion criteria for the study. The test was done in supine and sitting positions with and without phonation by a rater who was blind to Mallampati test. Subsequently, laryngoscopy view and difficult intubation were evaluated in the four aforesaid positions by Mallampati test for predicting difficult laryngoscopy and intubation. For each situations, sensitivity, specificity, positive and negative predictive values and accuracy were calculated.Results: Overall, 28 (4.2%) patients had difficult laryngoscopy and 9 (1.4%) patients had difficult intubation. The highest sensitivity for Mallampati test in predicting difficult laryngoscopy and intubation was in supine and sitting positions without phonation, and the highest specificity was seen in sitting position with phonation. Negative predictive values were more than 95% in all different positions for Mallampati tests and the highest positive predictive value was seen in supine position with phonation.Conclusion: According to our findings, the highest correlation between Mallampati test and different positions in predicting difficult laryngoscopy and intubation was seen in supine position with phonation. Phonation improved Mallampati score in supine rather than sitting position.
"Prediction of early failure of vascular-access arteriovenous fistula based on immediate postsurgical evaluation"
Keshvari A,Jafarian A,Makarem J,Rabbani A
Tehran University Medical Journal , 2007,
Abstract: Background: For patients requiring chronic hemodialysis, the preferred site for vascular access is an autogenous arteriovenous fistula. Although a properly formed fistula is advantageous because it is less susceptible than other types of vascular accesses to infection and clot formation and can last longer than any other types of vascular access, AV fistula has a high rate of early failure that can increase immediate cost and complications. In this study, the prognostic value of physical examination of arteriovenous fistula by the surgeon at the end of the surgery was evaluated. Methods: In the general surgery ward of Imam Khomeini Hospital in 326 chronic renal failure patients, 354 arteriovenous fistula operations were accomplished by two surgeons from 1377 to 1381 (ca. 1998 to 2002). The performance of each fistula was divided into the following groups by the surgeon at the end of operation: 1) systolic and diastolic thrill, 2) systolic thrill 3) souffle 4) pulse 5) not functional. Clinical function of the fistula was evaluated by the same surgeon in the following days if no souffle or thrill, early failure was detected on initial inspection. Results: In the 354 cases of arteriovenous fistula, the total early failure rate was 12.7%. The lowest early-failure rate was 3.5% in the systolic and diastolic thrill group. The highest early-failure rate was in the not functional group (P<0.001). There was no correlation between early failure and age, sex, surgeon and location of fistula. Conclusion: Optimally, an arteriovenous fistula has a thrill with a soft compressible pulse. At the end of each operation, if the surgeon cannot detect a thrill at the fistula site, can find only pulse, or if the function is otherwise unsatisfactory, considering of a new arteriovenous fistula may be required, however it is better to postpone the surgery.
Evaluation of two surveillance methods for surgical site infection
M. Haji Abdolbaghi,J. Makarem,M. Rasoolinejad,Sh. Afahami
Tehran University Medical Journal , 2006,
Abstract: Background: Surgical wound infection surveillance is an important facet of hospital infection control processes. There are several surveillance methods for surgical site infections. The objective of this study is to evaluate the accuracy of two different surgical site infection surveillance methods. Methods: In this prospective cross sectional study 3020 undergoing surgey in general surgical wards of Imam Khomeini hospital were included. Surveillance methods consisted of review of medical records for postoperative fever and review of nursing daily note for prescription of antibiotics postoperatively and during patient’s discharge. Review of patient’s history and daily records and interview with patient’s surgeon and the head-nurse of the ward considered as a gold standard for surveillance. Results: The postoperative antibiotic consumption especially when considering its duration is a proper method for surgical wound infection surveillance. Accomplishments of a prospective study with postdischarge follow up until 30 days after surgery is recommended. Conclusion: The result of this study showed that postoperative antibiotic surveillance method specially with consideration of the antibiotic usage duration is a proper method for surgical site infection surveillance in general surgery wards. Accomplishments of a prospective study with post discharge follow up until 30 days after surgery is recommended.
The Relationship between Iron Deficiency and Hair Loss in 10 -45 Year Old Females in Qom Province, Iran
Makarem J,Hejazi Sh,Basi A,Pourazari L
Qom University of Medical Sciences Journal , 2010,
Abstract: Background and Objectives: Iron deficiency is a highly prevalent problem in developing countries. One of the reasons for telogen effluvium is Iron deficiency. This study was conducted to determine the relationship between Iron deficiency and hair loss in Qom Province, Iran.Methods: This study was conducted in two separate stages. In the first stage, a cross- sectional, population-based study was performed. In the second stage, a case control study was carried out. The study was conducted during 2007 and 2008 on 10 to 45 year-old females in Qom Province. 2200 females in the first stage and 410 females in the second stage (205 females with telogen effluvium as cases, and 205 females without telogen effluvium as controls) were studied. Females with positive pull test and without exclusion criteria were considered as telogen effluvium. In both case and control groups, CRP and serum ferritin tests were done. Correlation of variables with hair loss and serum ferritin level was evaluated. Chi Square test, Student’s T test and Mann Whitney Test were taken for statistical analysis in SPSS ver. 16 software. Multiple logistic regressions were used for statistical modeling.Results: Median (range) of serum ferritin level in the case group was 18.7μg/L (0.7-174.5μg/L) but in the control group it was 22.1μg/L (2.8-167.9μg/L) (P=0.01). In 93 (45.4%) females of the case group and in 71 (34.6%) females in the control group ferritin level was lower than 15μg/L (P=0.02). In 1182 (53.7%) of 2200 female hair-loss was detected. In multivariate analysis older age and weight, being housekeeper and smoking were directly associated with hair loss. However, higher monthly income and possession of private house had opposite relationship with hair loss.Conclusion: Hair loss was a prominent problem in females in Qom Province and telogen effluvium was related to iron deficiency. In females in Qom Province, improvement of body iron resources with better nutrition style, administration of iron supplements and fortifying food with iron supplements is recommended.
Cardiac herniation after radical pneumonectomy: a case report and review of the literature
Noyan Ashraf M.A.,Makarem J.,Karimi F.,Peiravy Sereshke H.
Tehran University Medical Journal , 2008,
Abstract: Background: Cardiac herniation is a fatal post pneumonectomy complication. We report the signs, clinical findings, diagnosis and management of a patient with post pneumonectomy cardiac herniation.Case report: A 34-year-old man with lung cancer underwent left pneumonectomy with partial pericardiectomy in the right lateral decubitus position. At the end of the surgery, cardiovascular collapse, severe bradycardia, desaturation and elevated airway pressure occurred just after repositioning the patient to the supine position. This patient survived as we returned him to the right lateral decubitus position and avoided the use of positive pressure ventilation.Conclusions: Attention to the acute complications of pneumonectomy, diagnosis and rapid therapeutic interventions is essential in post pneumonectomy care.
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