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Eid E.,Alexandria University | Dastan S.,Iran University of Medical science | Heckmann J.G.,Municipal Hospital Landshut
Journal of Neurosciences in Rural Practice | Year: 2015

Acute dizziness is a frequent index symptom in the emergency department as well as in the rural practice office. Most acute dizziness, however, is not dangerous, but some types are highly dangerous. Clinical routine acute dizziness can be separated into frequent benign syndromes including benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniθre's disease or vestibular migraine, and what is here referred to as the «white shark» of dizziness, i.e. a stroke in the posterior circulation or more rarely a tumor in the posterior fossa. A practical concept is presented to clarify most frequent acute dizziness syndromes using clinical and low budget methods. Source

Khezri M.B.,Qazvin University of Medical Sciences | Ghasemi J.,Qazvin University of Medical Sciences | Mohammadi N.,Iran University of Medical science
Acta Anaesthesiologica Taiwanica | Year: 2013

Objective Nowadays, conventional analgesic agents, which are widely used for pain relief after cesarean section, provide suboptimal analgesia with occasional serious side effects. We designed a randomized, double-blind, placebo-controlled study to evaluate the analgesic efficacy of intrathecal ketamine added to bupivacaine after cesarean section. Methods Sixty patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of the two groups to receive either bupivacaine 10 mg combined with 0.1 mg/kg ketamine, or bupivacaine 10 mg combined with 0.5 mL distilled water intrathecally. The time to the first analgesic request, analgesic requirement in the first 24 hours after surgery, onset times of sensory and motor blockades, the durations of sensory and motor blockades, and the incidences of adverse effects such as hypotension, ephedrine requirement, bradycardia, and hypoxemia, were recorded. Results Patients who received ketamine had a significantly prolonged duration of anesthesia compared with those who did not in the control group [95% confidence intervals (CI) 195-217; p = 0.001]. The mean time to the first analgesic request was also significantly longer in ketamine group (95% CI 252.5-275; p < 0.001). The total analgesic consumption in the 24 hours following surgery significantly lessened in the ketamine group compared with that of the control group (95% CI 2-2.5; p < 0.001). The two groups did not differ significantly in intraoperative and postoperative side effects. Conclusion Intrathecal ketamine 0.1 mg/kg co-administered with spinal bupivacaine elongated the time to the first analgesic request and lessened the total analgesic consumption in the first 24 postoperative hours in comparison with bupivacaine alone in the control group following elective cesarean delivery. Copyright © 2013, Taiwan Society of Anesthesiologists. Published by Elsevier Taiwan LLC. All rights reserved. Source

Sheikhtaheri A.,Iran University of Medical science | Farzandipour M.,Kashan University of Medical Sciences
AJOB Primary Research | Year: 2010

Informed consent is regarded as a pillar of medical ethics. The purpose of this study was to evaluate perceptions of the informed consent process prior to surgery. Three hundred elective surgery patients were randomly selected from three teaching hospitals in Kashan, Iran, and asked to complete a questionnaire about four key aspects of the informed consent process: information disclosure, voluntariness, comprehension, and their relationship with physicians. Data were scored and analyzed using univariate and multivariate methods. Based on the responses, the perceived quality of information disclosure (7.96 ± 4.9 out of 18 points), comprehension of the consent form (0.55 ± 1.1 out of 4 points), and voluntariness (1.73 ± 2.1 out of 8 points) were considered to be unacceptable and the perceived quality of the physician-patient relationships (10.6 ± 4.1 out of 14 points) acceptable. Most of the participants (88.7%) reported that they had requested to be informed about the complications of the surgical procedures, including severe complications such as death, but most of them did not receive this information. The most important factors associated with the perceived quality of informed consent were the patient's level of education and type of surgery. In conclusion, practices consistent with the principles of informed consent have not been adequately implemented in the surgical departments of these hospitals in Kashan. To improve current practices, patients should receive more information about the risks and benefits of surgery as well as any available alternatives. Information about the expected length of hospital stay, post-discharge follow-up, and the cost of surgery should also be provided to patients. To improve the perceived quality of the informed consent process, more emphasis should be placed on ensuring that patients receive the requested information in amanner they can comprehend. Redesigning consent forms may be an important step in improving the patients' experience of the informed consent process. © Taylor & Francis Group, LLC. Source

Ghazaei F.,Iran University of Medical science
American Journal of Physical Medicine and Rehabilitation | Year: 2016

ABSTRACT: Vasculitis is a group of disorders characterized by inflammation and destruction of blood vessels, resulting in ischemic injury to the involved tissue. Sometimes, peripheral neuropathy is one of the first symptoms of systemic vasculitis. Although the classic form of peripheral nervous system vasculitis is mononeuritis multiplex, it can also present as a mononeuritis. In this case report, the patient presented with progressive rapid onset numbness in her right hand for 2 months. She underwent carpal tunnel decompression surgery with initial diagnosis of acute carpal tunnel syndrome but failed to respond to the surgery, and two month later, she presented with foot drop. The final diagnosis was vasculitic mononeuritis multiplex. The present case report demonstrates the importance of identification of median mononeuritis as one of the first presentations of vasculitic disorders and distinction from acute carpal tunnel syndrome. The natural history of many of the systemic vasculitides is rapidly progressive, and they are likely to be fatal without early treatment. In this regard, timely diagnosis of vasculitis is critical because of the vital role of early immunosuppressive therapy in preventing multiorgan damage and decreasing mortality rate. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source

Naghdi S.,Tehran University of Medical Sciences | Ansari N.N.,Tehran University of Medical Sciences | Mansouri K.,Iran University of Medical science | Hasson S.,Angelo State University
Brain Injury | Year: 2010

Primary objective: To determine the extent to which the Brunnstrom recovery stages of upper limb in hemiparetic stroke patients are correlated to neurophysiological measures and the spasticity measure of Modified Modified Ashworth Scale (MMAS). Research design: A concurrent criterion-related validity study. Interventions: Not applicable. Methods and procedures: Thirty patients (15 men and 15 women; mean ± SD 58.8 ± 11.5 years) with upper limb spasticity after stroke were recruited. Wrist flexor spasticity was rated using the MMAS. The neurophysiological measures were Hslp/Mslp ratio, Hmax/Mmax ratio and Hslp. Main outcomes and results: There was a significant moderate correlation between the Brunnstrom recovery stages and the neurophysiological measures. The Brunnstrom recovery stages were highly correlated to the MMAS scores (r -0.81, p < 0.0001). Conclusions: The Brunnstrom recovery stages are moderately correlated with neurophysiological measures and highly correlated with the MMAS regarding the evaluation of motor recovery in stroke patients. The Brunnstrom recovery stages can be used as a valid test for the assessment of patients with post-stroke hemiplegia. © 2010 Informa UK Ltd. All rights reserved. Source

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