---

Background & Objective: Wound infection in post-operation is one of the side effect that bothering the patients’ quality of life. This study was done to determine the effect of subdermal irrigation with normal saline on the wound infection in abdominal surgery of obstetrics and gynecology. Materials & Methods: A randomized clinical trial of subdermal irrigation with normal saline versus no irrigation was performed on 200 patients who were candidate for abdominal surgery of obstetrics and gynecology. Contaminated wound was excluded. In the case group (100 patients) after facial repair and complete hemostasis, subdermic tissue was irrigated with 1000-milliliter normal saline and skin was closed. In the control group (100 patients) after facial repair and complete hemostasis skin was closed without subdermal irrigation. All of the patients were followed until complete repair of skin. Results: 2 groups were similar in age, BMI, duration of surgery and the type of operation. Wound infection was observed in 1% of case group and in 7% of control groups, which was statistically significant (P<0.05). Conclusion: Subdermal irrigation with normal saline is effective, simple, safe and not expensive which can reduce the wound infection and can be offered particularly in high risk patients for wound infection.

---

Background&Objective: Surgery is an important stressor which makes some harmful physiological reactions shuch as high blood pressure, tachycardia, and repiratory distress. The aim of this study was to investigate the effects of music on the anxiety and some of physiological responses of patients before abdominal surgery, as assessed by objective parameters and a subjective validated questionnaire. Materials&Methods: This study is a semi-experimental study. Total of 134 subjects was randomly assigned to undergo either 20 minutes of music intervention or a rest period. The level of anxiety was measured using Spilberger questionnaire and physiological responses, arterial blood presure, heart rate and respiratory rate. Subjects in intervention group listened to 20 minutes music by Johann Sebastian Bach. The control group listened to no music. The anxiety level and physiological responses were measured before and after intervention. Results: There was no significant difference between the anxiety level and physiological responses in two groups of subjects before intervention. The findings indicate a significant statistical difference in the level of anxiety and mean of arterial blood pressure in the intervention group (P<0.05). There was no significant difference in heart and respiratory rate in two groups of subjects. Conclusion: As indicated by the results of this study, music can provide an effective method of reducing potentailly harmful physiological responses arising from abdominal surgery, therefore it is suggested to use it before surgery.

---

Background&Objective: The ways of prevention of wound infections are too much, and some references mentioned that one of those ways is dressing. Dressing can cause a sort of spiritual transquility for patients, too. In the other side, doing it causes some kinds of limitations such as preventing of taking a bath or spending expenses. So, we decided to consider the influence of continuation of dressing, on the rate of wound infection, after first 48 hours post operation.
Materials&Methods: In this research, we studied on 150 patients who were under the same surgeries, So that in the half of them, after 48 hours dressing were removed, and in the half remaining, dressing were changed daily for one week. In both groups, in the third, seventh and thirtieth day after surgery were inspected and examined by surgeon, in the case for having or absence of symptoms and signs of infection. In subgrouping patients we considered some factors include age, sex, type of operation and predisposing diseases. The 30 th day post operation was the end of our study and information analyzed in the computer with SPSS software.
Results: The average age in the group of without dressing was 35.12±20.19 and in the group with full dressing was 37.61±18.78 years. There were 74 men and 76 women. There was Just one wound infection in our study, who had dressing for one week. The case was woman without serious disease, and a half day before surgery was admitted in the hospital. In the group without dressing, we did not have any wound infection. 5.3% were nervous in the no dressing group and the 17.3% of patients with dressing were anxious of having their bath with delay.
Conclusion: According to the no impression of dressing on the rate of wound infection in the clean surgeries after first two days and also lack of considerable anxiety in the non dressing group, we recommend picking up the clean wounds dressing after 48 hours and make patients feel guaranteed.

---

Background & Objective: Nutritional support is a basic process for survival in trauma patients. The purpose of this study was to evaluate the daily nutritional support practice in head injury patients admitted to Neurosurgery Intensive Care Unit.

 

Materials & Methods: This descriptive cross-sectional study was done on 115 Head injury adults patients who received enteral nutrition for at least 48h in Rasht Poursina hospital during 2005. Nutritional measurements were included the number of patients who received enteral nutrition, the time to initiate nutritional support, amount of initial feeding and clinical outcome were included the duration of mechanical ventilation, ICU and in-hospital length of stay (loss), in-hospital mortality rates .Data was reported as Mean±SD and percent. T-test analysis was used for comparing of calorie and nutrient intakes and requirements.

 

Results: Mean±SD of age patient was 41.22±21.9, 84% of patients received enteral nutrition. The time to feeding and the amount of initial feeding was 4.6±1 day and 52.79±27.83 ml/h respectively. Duration of ventilation was 12±13.4 day and ICU length of stay 18.96±18.3 day, Hospital length of stays 24.47±19.84 day. Mortality rate in six month was 48%. Mean of energy, carbohydrate, fat and protein (P<0.05) intakes had significant differences compared with requirements.

 

Conclusion: The recording process has revealed undesirable feeding practice in head injury patients. Nutritional outcomes would be improved with implementation of standard protocol in neurosurgery intensive care unit.

---

Endoscopic sinus surgery can cause orbital and intracraniol complications. Anisocoria is one of sings of orbital complication. We report a case with anisocoria during endoscopic sinus surgery. Patient was a 42 years old female that was operated because extensive polyposis in right nose and sinuses and retention in otherwise under general ansthesia. A half on hour after the surgery was started, we found dilatation of pupil in left eye which unresponsed to light. Also, as far as the eye symptoms returned to normal after 8-10h after and there was not any veridence of orbital trauma. It seems difiusion of local injection of adrenalin in surgery nasal cavity can probably case of pupil dilatation.

---

Background and Objective: Anterior cruciate ligament (ACL) tear is one of the most common injuries at knee joint. This study was done to evalute the effect of reconstruction surgery on hamstring reflex in patients with ACL tear. Materials and Methods: In this Quasi- experimental study, 30 patients (16 males, 14 females) with ACL tear, with mean age of 26.52±8.72 years old were recruited during 2007. Patients were selected in a non probability sampling manner. The Kinsiological Electromyography and trauma mechanism were used for testing the hamstring reflex. Muscle activity were measured as a dependent variable. Data were analyzed with Paired T-Test, ICC, SEM and K-S tests. Results: Hamstring reflex in affected knee and after reconstruction surgery was 73.25±3.22 and 47.35±3.85, respectively. This difference was significant (P<0.05). Conclusion: Reconstruction surgery in patients with ACL tear at acute phase is effective in improvement of hamstring reflex.

---

Background and Objective: The incidence of ectopic pregnancy is increasing due to artificial reproductive technology and increasing rate of sexual transmitted diseases. Ectopic pregnancy is the most common cause of maternal mortality in the first trimester and it reduces the chance of future successful pregnancy. Identifying the risk factors can help to reduce the maternal mortality and morbidity due to early diagnosis and on time treatment. This study was carried out to assess the risk factors in ectopic pregnancy in northern, Iran. Materials and Methods: This case control study was carreid out on 150 patients with ectopic pregnancy as cases and 300 women with normal pregnancy as controls. The subjects were selected from teaching hospital in Babol in northern Iran, during 2005-09. The risk factors include history of tuble surgery, ectopic pregnancy, cesarean section, pregnancy with IUD, infertility, assisted fertility with IUI, multiple partener, pre-eighteen years marriages were recorded for each subject by direct interview and file. Data were analyzed using SPSS-16 and Chi-Square and exat Fisher tests. Results: Theraputic assisted fertility with IUI (95% CI: 3.02-185.09, OR: 23.6, P<0.05), previous ectopic pregnancy (95% CI: 1.90-73.94, OR: 8.19, P<0.05) and cesarean section history (95% CI: 1.1-2.6, OR: 1.7, P<0.05) increased the possibility of ectopic pregnancy. There was not significant differnces between pre- eighteen years marriages, infertility history and multiple partener in cases compared to controls. Conclusion: This study showed that assisted fertility with IUI, previous tubal surgery, pregnancy with IUD, previous ectopic pregnancy and cesarean section are the main risk factors of ectopic pregnancy in northern, Iran.

---

Background and Objective: Nausea and vomiting are common complications after surgery which creates spasm, hypoxia and pulmonary aspiration. This study was done to determine the effect of ondansetrone, metoclopramide associated with dexamethasone on postoperative nausea and vomiting in cholecystectomy surgery using Laparoscopic method. Methods: In this double blind clinical trial study, 100 patients with ASA class I and II undergoing laparoscopic cholecystectomy divided randomly into two groups. The patients in the first group were received metoclopramide (10mg/kg/bw) with dexamethasone (8mg/kg/bw) and the second group were received ondansetron (4mg/kg/bw) with dexamethasone (8mg/kg/bw) intravenously 5 min before the final stage of surgery. Premedication and induction of anesthesia in patients were equal 5 minutes to 4 hours after surgery, postoperative nausea and vomiting were recorded for each patient. Results: The rate of nausea in the first and the second groups were recorded 38% and 28%, respectively. The rate of vomiting in the first and the second groups were recorded 30% and 16%, respectively. These values were not significant. Conclusion: Ondansetron with dexamethasone non significantly reduced postoperative nausea and vomiting after laparoscopic cholecystectomy in comparison with metoclopramide with dexamethasone.

---

Background and Objective: Bariatric surgery is the most effective treatment for morbid obesity. The classic procedure, jejunoileal bypass, has many complications. This study was carried out to assess the evaluation of clinical complications in morbid obese patients after modified jejunoileal bypass surgery. Method: This descriptive – analytic study was carried out on 120 morbid obese patients referred for bariatric surgery. A modified jejunoileal bypass was performed in which the defunctionalized organ eliminated by anastomosing its ends to the gall bladder and cecum. Weight loss and clinical complications were recorded after one year follow up. Results: The mean weight and body mass index reduced from 136 kg and 48 kg/m2 before surgery to 83 kg and 29/8 kg/m2 after one year follow up, respectively (P<0.05). Before surgery, articular pain (24.3%), dispana (21.6%), cardiovascular disorders (10.8%), fatty liver (5.4%) and sleep disorder (5.4%) due to obesity were recorded. One year follow up after surgery, articular pain (1.5%) and dispana (1.5%) were seen in patiants. No serious post-operative clinical complication was observed. Conclusion: One year follow up after surgery showed that the modified jejunoileal bypass is very effective in reducing body weight and does not lead to serious complication.

---

Background and Objective: Squamous carcinoma accounts for the majority of esophageal carcinoma worldwide. This study was done to evaluate the survival rate of patients with esophageal cancer in Iran.

Methods: This historical cohort study was carried outon 105 patients with esophageal squamous cell carcinoma whom admitted to Firoozgar hospital in Tehran, Iran during 2009-14. Patients with esophageal squamous cell carcinoma were treated with chemoradiation either with or without surgery.

Results: The mean age of patients was 63 years. Frequency of esophageal cancer in both sexes in the age group 51-60 years was higher than other groups. 5-year survival in patients with esophageal cancer treated with chemoradiation without surgery was 9.5% and in patients treated with chemoradiation with surgery was 31.7 % (P<0.05). One-year, three-year and five-year survival rate in patients were treated with chemoradiation with or without surgery was 68.5%, 38% and 22.8%, respectively.

Conclusion: The survival rate of patients with esophageal cancer is very low, but the treatment with chemoradiation with surgery can increase life expectancy of patients.

---

Background and Objective: Prolonged hospitalization lead to considerable financial burden for patients as well as health care system. This study aimed to identifying important factors resulting in excess hospitalization days in patients undergoing abdominal surgeries using the multilevel zero-inflated Poisson regression model.
Methods: In this descriptive - analytic study, 485 patients from five teaching and private hospitals in Shiraz (southern Iran) were selected based on convince sampling method. Multilevel zero-inflated Poisson regression model was used to determine the risk factors of excess hospitalization day. Maximum likelihood method was used to estimate parameters of the model. Moreover, Akaike Information Criterion (AIC) and Bayes Information Criterion (BIC) indices were applied to assess the goodness of fit of the model.
Results: The primary analysis of data showed that 81.2% of the patients did not undergo excess hospitalization days. Based on findings, age, respiration rate, blood infusion, fever, smoking and drug abuse did not affect excess hospitalization days. In contrast, gender, renal diseases, operation history, laparoscopic gallbladder removal, prostate surgery and ileus significantly led to excess hospitalization days (P<0.05). Laparoscopic gallbladder removal, prostate surgery increased the chance of excess of hospitalization days to 4.64 and 9 times, respectively (P<0.05).
Conclusion: Geder, renal diseases, operation history, laparoscopic gallbladder removal, prostate surgery and ileus significantly led to excess hospitalization days.

---

Background and Objective: Patients experience full stress condition after open heart surgery. Foot reflexology massage has a potential impact on the comfort of patients with special care. This study was done to evaluate the effect of soles of feet reflexology massage on feeling of comfort in open heart surgery patients.
Methods: This clinical trial study was done on 70 patients who were divided into intervention and control groups using permutable blocking method. 35 patients in interventional group were received Soles of feet Reflexology Massage after mesearment of vital sigins for six days. 35 patients in the control group did not receive any intervention received routine care. Data gathering tools were demographic items and HCQ questionnaire, which was completed in two stages, 24 hours after surgery, before massage and the 6th day after massage.
Results: The mean total comfort score in the intervention group was 103.1±9.04 and 110.63±7.6 before and after the intervention, respectively. This differnce was not significant. The mean total comfort score in control group was 105.14±10.37 and 111.29±7.56 perior and the end of study, respectively, this difernce was not significant. Also, there was no significant difference between considering the mean scors of comfort between the tow in the intervention and control groups.
Conclusion: Reflexotherapy massage had no effect on feeling of comfort in open heart surgery patients.

---

Background and Objective: Control of postoperative pain is one of the most important stages in the recovery of patients after surgery. This study was done to compare the effectiveness of combined Ondansetron and Apotel on the post-operative pain after surgery of upper limb fractures.
Methods: This double blind clinical trial study was done on 50 individual (41 male and 9 female) with upper limb fractures referring to 5 Azar hospital in Gorgan northern Iran during 2017. Patients were assigned (block randomization) into control and intervention groups. After the end of operation in the recovery phase, both groups received pain PCA (Patient Controlled Analgesia). In control group, the pain pump consisted of 2 grams of Apotel and in the intervention group; the pain pump consisted of 2 grams Apotel and 8 mg of ondansetron. Visual Analogue Score (VAS) was evaluated in both groups after surgery for 24 hours. Pain score of patients compared in the 2 groups during the 3 time intervals after surgery.
Results: 4 hours after upper limb fracture surgery, the mean pain was significantly decreased in the intervention group (3.20±0.707) compared to control group (3.64±0.569) (P<0.05). 12 hours after upper limb fracture surgery The Mean pain, in the intervention group (1.88±0.927) was significantly reduced in compare to control group (2.64±1.186) (P<0.05). 24 hours after upper limb fracture surgery, The Mean pain was significantly reduced in the intervention group (1.40±0.645) in compare to control group (2.08±0.997) (P<0.05).
Conclusion: This study showed that administration of compination of Apotele and Ondansetron in post-operative pain of upper limb fractures is effective than apotele alone.

---

Background and Objective: Todays, coronary artery disease is one of the most important health issues. Antioxidants are the agents that can play important role in reducing cardiovascular diseases. The present study was done to determine the effect of resveratrol supplementation during rehabilitation exercises training on systemic inflammation factors in patients after coronary artery bypass surgery.
Methods: This clinical trial study was done on 40 patients after coronary artery bypass surgery in the heart rehabilitation center of Farshchian cardiovascular specialist hospital in Hamadan, Iran during 2016. Patients randomly assigned into four groups including control (Con; n=10), resveratrol supplementation (RS; n=10), rehabilitation exercise training (RXT; n=10), and resveratrol supplements-cardiac rehabilitation exercise training (REX; n=10). Rehabilitation exercise training was done in nonconsecutive three sessions for eight weeks in the form of endurance training at 50-70% HRmax for 15-20 min, and resistance training at 20-50 one-repetition maximum (1RM). The number of repetitions was 8-15 reps, where done based on the capacity and ability of the subject, while the subjects in supplement groups consumed daily 400 mg of resveratrol. Blood sample was done before and 48 hours after exercise training and supplementation, and concentrations of Tumor necrosis factor alpha (TNFα), Interleukin- 6 (IL-6), Interleukin 1 beta (IL-1β) and C-reactive protein (CRP) were measured in the plasma.
Results: CRP, TNF-alpha and IL-1beta and IL-6 were significantly reduced in resveratrol supplements-cardiac rehabilitation exercise training group in compared to control, resveratrol supplementation and rehabilitation exercise training groups (P˂0.05).
Conclusion: This study showed that combination of consuming resveratrol with rehabilitation exercise training in reducing some inflammatory factors was evaluated selectively, more effective than rehabilitation exercise training and resveratrol supplementation alone.

---

The rise in patients seeking corneal refractive surgery, despite having systemic autoimmune diseases, underscores the need for special considerations when treating these individuals. Recent studies have expanded our knowledge in identifying and evaluating autoimmune disorders and their potential side effects in the results of corneal refractive surgery with laser. This study briefly examines the pathogenic factors, clinical aspects, and possible complications in patients with systemic autoimmune disorders subjected to these surgeries. In total, 132 articles were selected for this research among the reviewed studies. Considering that the release of various cytokines caused by systemic autoimmune disorders can lead to destructive corneal consequences, the need for early diagnosis before any laser surgery for refractive errors seems essential. Although procedures such as LASIK and PRK are commonly performed on patients with autoimmune disorders, important considerations must be made. Studies have not yet confirmed definitive contraindications to laser refractive surgery for autoimmune disorders.

---

Background and Objective: Weight regain following bariatric surgery is a significant challenge for this obesity treatment method. This study aimed to identify factors associated with weight regain after bariatric surgeries in obese patients in Gorgan, Iran.
Methods: This longitudinal study included 143 obese individuals (125 women and 18 men) with a mean age of 43.13±9.83 years who underwent bariatric surgery in Gorgan, Iran during 2013-19. Participants were invited to join the study via phone calls. Research variables (type of surgery, blood group, pre-surgery weight, and body mass index [BMI]) were extracted from patient records, and their current weight and waist circumference were measured and recorded. Weight regain was determined based on one of three different criteria: (1) regaining more than 25% of the maximum weight lost post-surgery, (2) regaining more than 10 kg from the minimum weight post-surgery, or (3) an increase of more than 5 BMI units from the lowest BMI post-surgery.
Results: Overall, 33% of individuals experienced weight regain, with 26.6% according to the first definition, 29.4% according to the second definition, and 18.2% according to the third definition. Men had a higher rate of weight regain (P<0.05). Additionally, 93.6% (44 cases) of those with weight regain had abdominal obesity. On average, 79.7% of participants who were 48 months post-bariatric surgery experienced some degree of weight regain. Individuals with a pre-surgery BMI of 50 or higher had a 2.69 times greater chance of weight regain compared to those with BMI lower 50 (P<0.05). The mean weight loss after surgery was significantly higher in individuals who experienced weight regain than those who did not (P<0.05). There was no significant statistical association between weight regain and the type of surgery, age, education level, marital status, or blood group.
Conclusion: Weight regain over time is a reality after bariatric surgery, indicating that this method is not a definitive cure for obesity. Therefore, long-term follow-up for weight control is crucial, especially for individuals with a pre-surgery BMI of 50 or higher or those who experienced significant weight loss post-surgery.