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Background and Aim: Recent developments in anesthesia have brought human beings to realize analgesia as the main objectives of painlessness, so they try to find the simplest method and the most economical drug with less side effects for it. This research has been done to compare the effects of three drugs, epinephrine, fentanyl and sufentanil with lidocaine on spinal anesthesia to find the best drug. Materials and Methods: This is a clinical trial and the samples were 50-60 year men reffering to Gonabad 15 khordad hospital, for inguinal hernia operation 120 patients were divided into 3 groups randomly each group consists of 40 men. In one group (E) 0.2 mg epinephrine and in other group (F) 25 µg fentanyl and in the 3rd group (S) 2.5 µg sufentanil with 100 mg lidocaine 5% were used for spinal anesthesia. A check list and a questionaire were used for data collection, and then the data were analyzed by computer softwares and chi-square and ANOVA. The p value < 0.05 was considered significant. Results: The mean duration of analgesia in group E was 82.1±15.7 minutes and in group F was 99.37±18.61 minutes and in group S, it was 153.62±26.62 minutes. So, there was a significant difference between the three groups regarding the duration of analgesia (F=121.1, P<0.001). In group F the occurance of hypotention was %15, bradycardia was %10 and vomiting and nausea was %7.5 but in group F, it was %37.5, %27.5 and %10 and in group S, it was %40, %32.5 and %15, respectively that was not significant. Conclusion: The length of analgesia in spinal anesthesia with sufentanil was more than fentanyl and with fentanyl It was more than epinephrine and there was a significant difference, but it was not significant regarding to side effects like hypotention, bradycardia,vomiting and nausea.

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Background and Aim: Infertility is a significant cause of anxiety in the couples that begin their life. This problem is not only a disappointing agent but also a destroyer agent that is effective on the male or female personality evolution and their identification. To study the prevalence if women infertility, both primary and secondary in rural and urban areas of Gonabad and some demographic factors in a given population of women. Materials and Methods: An interview-questionnaire survey of 380 married women in age (15-49) who lived in Gonabad city. Method of women selection was two stages, at first stage stratified sampling and at second stage systematic. The type of study was cross-sectional analysis of data performed by SPSS. Results: Among the 380 women contacted, (88.1%) reported no difficulties in having children. The prevalence of infertility was 11.9%. 6.5% women had primary infertility and 5.4% had secondary infertility. The prevalence of infertility in Gonabad city was 12.8% and in rural area was 11.4%. Between demographic data women and period of menstruation were not significant difference. Conclusion: According to the results of study, the prevalence of infertility in Gonabad city was 11.9%. Which is different with other studies so it is necessary to survey in the case of etiology and other infertility factors.

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Background and Aim: Inadequacy of dialysis is one of the main reason of mortality of dialysis patient and it is completely effective on forewarning. The aim of this study was to determine the adequacy of dialysis and its relationship with the kind of filter in patient referred to 22-Bahman hospital of Gonabad . Materials and Methods: This crossover study was done on all patients underlying dialysis that enrolled in the study in 22-Bahman Hospital. They were divided into two groups in simple random sampling. Each group involved 15 patients. In one group High flux filters and in another group low flux filters were used. The filters were changed after one month. Dialysis was done 3 times a week and lasted 4 hours .KT/V > 1.2 was considered as dialysis adequacy. Results: The result showed 60% of the patients had dialysis adequacy >1.2. The means of KT/V was 1.34±0.42 in Low flux group. 80% of the patients had dialysis adequacy>1.2 and the means of kt/v was 1.44±0.32 in High flux group. There wasn’t a significant relationship between dialysis adequacy and the kind of filter (p=0.29). The means of Haemoglobin was 11 .49± 2.03 in Low flux group and 12.58±2.01 in High flux group. There was a significant relationship between Haemoglobin and the kind of filter. (p=0.04) Conclusion: In this study dialysis adequacy with High flux filter was desired in comparison with other studies. Although there wasn’t a difference between Low flux and High flux filter in dialysis adequacy, but the means of KT/V in High flux filter was more than Low flux filter and also the most patients that used High flux filter had enough dialysis adequacy (80% against 60%). The means of Haemoglobin in High flux was more than Low flux filter. So it is recommended to use High flux filter if there is any contradiction.

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Background and Aim: The “nil by mouth” policy of women during labor is an unnecessary medical intervention however no science evidence has supported it. Up to now the finding from trials, which examined the effecting during labor on birth outcomes, does not provide convincing evidence to change practice. Changing policy NPO for women during labor require many trials. This study examined the effect of food intake during the first stage of labor on maternal and fetal outcomes in the low-risk pregnant women. Materials and Methods: This study is a randomized clinical trial which was done in 22 Bahman hospital in Gonabad. 180 low-risk pregnant women in active phase of labor randomly were assigned to either an intervention or usual care group. Women in the intervention group (n=87) were selected and received one of the three diets (three dates and water or three dates and tea or 110 cc of orange juice) during the active phase of labor. Conversely, the control group (n=90) underwent fasting. Results: The second phase of labor duration was smaller than that of the control (p=0.047). The incidence of vomiting and active stage labor length were unaffected by food intake. Conclusion: The intake of carbohydrate foods during labor cause the reduction of the second stage of labor duration in spit of lack of accelerated vomiting incidence.

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Background and Aim: Electroconvulsive Therapy (ECT) is one of the less dangerous treatments for psychological disorders and the best one which receives much consideration in psychiatry today and it is also performed under general anesthesia. Because sodium thiopental and propofol are the most common drugs used for this purpose, in this study we compared sodium thiopental and propofol for convulsion time and recovery duration in ECT. Materials and Methods: In this semi-experimental study, 26 subjects were divided into two groups randomly. In one group propofol was used and in the other one sodium thiopental for induction, but muscle relaxation and premedication were the same for both groups. The subjects were monitored for blood pressure and cardiovascular response, and after ECT the time of convulsion and recovery was recorded. Blood pressure and heart rate of patients were checked and recorded before anesthesia, one and five minutes after ECT. The data were analyzed through SPSS software, version 11.5, applying independent t-test (p<0.1). Results: The mean of convulsion duration was 34.4±6.3 minutes in propofol group and 41.7±9.7 in thiopental group which showed that there was a significant difference between the groups (p=0.003). The mean of recovery duration in propofol group was less than that of thiopental group which indicated that there was a significant difference (p=0.09). Also, the mean of blood pressure in propofol group was less than that of thiopental group, a difference which was statistically significant (p<0.1). Conclusion: The results of this study showed that ECT with propofol causes a faster recovery and reduces the occurrence of homodynamic changes. Therefore, it is suitable to use propofol instead of sodium thiopental for ECT especially in patients with high blood pressure.

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Abstract Background and Aim: Postoperative pain is a major consequent of lumbar laminectomy. Hence, this study was conducted to determine the efficacy of morphine injection versus sublingual buprenorphine in postoperative pain after lumbar laminectomy in Booali Hospital in 2007-2008. Materials and Methods: This study was conducted as a single-blind randomized clinical trial. The patients (in two groups of 25 subjects) were randomly assigned to receive either 0.4 mg of sublingual buprenorphine or 10 mg of intravenous morphine three times. The patients were monitored for postoperative pain in a period of 24 hours after surgery. The data were analyzed through SPSS software version.13 using t-test and chi-square. Results: Before intervention, VAS was 8±1.04 and 7.72±1.06 in morphine and buprenorphine groups, respectively, a finding which was statistically insignificant (p. Between 12 and 24 hours after intervention, visual analogue scale (VAS) was decreased 2.08±0.95 in morphine group and 3.28±0.67 in buprenorphine group (P=0.0001). 24 hours after intervention, VAS was decreased 2.08±0.9 in morphine group and 2.6±0.95 in buprenorphine group (P=0.055). Conclusion: Totally, it may be concluded that sublingual buprenorphine may be used as an easy and effective method for pain reduction after lumbar disc surgeries in comparison with intravenous morphine.

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  Abstract

  Background and Aim: Health providers and patient's knowledge and awareness of patient's rights bill require respect. Therefore, this study was performed to determine the awarness of patients and health providers about patient bill of rights and its observance rate in one of the hospital s in Gonabad.

  Materials and Methods: This descriptive-analytic study used a questionnaire to assess awareness and observance rate of patient's rights bill in 2010. The awareness was ranked in three categories (good, moderate and weak) and respecting patient's rights Bill in three floors (ideal, average and poor) . Sampling for patients was based on the objectives and for health providers was random classification. The obtained data were analyzed by SPSS software version 14 descriptive using statistics, Chi-square, T-independent, ANOVA and Pearson correlation coefficient at %5.

  Results: The results showed that 189 patients ( 60.8%) were females , 122 patients ( 39.2%) were males and 20 health providers ( 60.6%) were females and 13 ( 39.4%) were males. Health providers and patient awareness of patient 's rights bill was sufficient & patient's bill of rights in the study population is observed 69.1% of cases. There was a significant relationship between awareness and observance rates of patient's rights bill so that as patient awareness increased , observance patient's rights bill increased, too (p=0.007). The results also showed that despite optimal health provider's awareness of patient's rights bill , observance rates aren't satisfactory in comparison with other studies.

  Conclusion : Patients and staff awareness in the medical group level is good, but the observing rate isn't satisfactory . This study recommends that the managers of hospital develop a practical strategy to provide written information for patients about the rights when they are admitted. In order to preserve the patients' sanctity, students and health providers should be taught to get permission from patients before attending the bedside.

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 Abstract

  Background and Aim: One of the social problems of communities is the currently increasing rate of divorce and family disintegration host building. The aim of this research is to understand the condition and factors influencing divorce and identifying some practical solutions to reduce it in Gonabad.

  Materials and Methods: This is a descriptive-analytic research. 123 divorced couples who got divorced in 1387-88 in Gonabad city were selected and completed a researcher-made questionnaire including demographic information.

  Results: In this study, 81 divorced woman and 42 divorced men were surveyed, 50% of the divorces were in affiance time, 60.7% in the early years of marriage or being together as couple, 63.3% in urban areas and 36.7% in rural areas. 54.1% of the divorces were through women's request and 14.2% on the part of men, 31.7% with the couples' agreement. 76.9% of the couples had a diploma or degree below. The marriage age of 45.2% of the couples was under 20 years. 65.4% of the couples had a familiarity with their spouse during marriage.75.2% of them had not conducted enough investigation and surreys on their spouse and his/her family. To study different social, economical, cultural and personal factors, the most important related factors to divorce were: men's addiction, low familiarity of couples with each other, lack of life skills, low age of marriage, urbanization, misunderstanding, mental or physical diseases of the spouse, unemployment, family or other interference from the spouse's family or other people, mandatory marriage, shortage of relationship and sexual skills and hypocrisy . There was also a significant difference in the rate of divorce from location (p=0.0019), the history of familiarity with the spouse (p=0.0013), education (p=0.0000), research and evaluation conducted on a spouse (p=0.0012), physical and mental abuse (p=0.0000), and misunderstanding (p=0.0001) points of view .

  Conclusion: Because of the role of different factors in divorce, preventive strategies and reduction of divorce should be much considered before marriage.

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 Abstract

 Background and Aim: The increase of quality of education depends on the improvement of educational groups. Internal evaluation is effective on the development of education quality. So, this study was designed to investigate the internal evaluation of department of basic sciences in medicine in one of the universities of medical sciences in Iran in 2010.

 Materials and Methods: This research was a descriptive cross-sectional study the population included all faculty members of the department of basic sciences in medicine, the documents and resources. Sampling was based on purpose . A questionnaire was used to collect data which was also completed with interview, observation and document review. The obtained data were analyzed by descriptive statistical methods in the form of frequency distribution tables and indexes of central tendency and dispersion.

  Results: Evaluation results indicated that all factors except theses, study opportunities and seminars are satisfactory. The total score of the mission, goals, and organization was the highest (3 out of 3) and the lowest score belonged to theses, study opportunities and seminars (1.66 out of 3) .

 Conclusion: The evaluation plays a fundamental role in quality improvement. Therefore, it is recommended that to preserve and promote the study factors which have favorable situation and plan a program to improve the factors that weren't good. Also, it is recommended that internal evaluation be repeated in certain time periods. The university administrators should provide conditions and resources to improve the situation.

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Aims: Spinal anesthesia is the procedure of choice for caesarean section. There is no risk of airway hazards, such as difficult airway intubation and aspiration in this method. Some cases avoid to choose this method, because of fear of complications specially headache. This Study has been done to assess the true extent of headache after surgery with spinal anesthesia and its related factors.

Methods: This cross-sectional analytic study was done in 2011 for one year in 22th of Bahman hospital of Gonabad. 200 pregnant women that was candidate for caesarean section under spinal anesthesia were selected by achievable and purposeful sampling method. All procedure was performed in a sitting position and with a disposable 25-gauge needle with 75mg Lidocaine 5% and 25 micrograms Fentanyl. Data were gathered and analyzed using the SPSS 11.5 software and independent T and Chi-square tests.

Results: 12 patients (6%) in 24 hours after spinal anesthesia and 44 cases (22%) in first week after spinal anesthesia experienced headache. Headache happening had a significant relationship with body mass index (p=0.028) and occupational factors (p=0.011) in the first week. Hypotension was the most complication (52.5%) during spinal anesthesia.

Conclusion: Hypotension is the most complications during spinal anesthesia. Those with higher body mass index and those who were employed are at higher risk for headache in first week after spinal anesthesia.

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Abstract Aims: The goal of Coronary Artery Bypass Graft surgery (CABGs) is to improve the quality of life in patients with coronary artery diseases. Many studies have suggested the implementation of a cardiac rehabilitation program after surgery required to achieve this goal. The aim of this study was to examine the effects of cardiac rehabilitation on quality of life in post-surgery patients. Materials & Methods: In this quasi-experimental which was conducted in 2012, 70 patients (35 patients in experimental group and 35 patients in control group) undergoing CABGs in Shahid Rajaei Heart Center of Tehran City were selected by achievable sampling method. The experimental group received 12 sessions of cardiac rehabilitation program according to their health condition. The control group was not participating in the rehabilitation program. The qualities of life of patients of both groups were measured by Ferrans & Powers Questionnaire of quality of life before and after the cardiac rehabilitation program. Data were analyzed in SPSS 16 software by Paired T, independent T and linear regression tests. Findings: The experimental and the control group were matched according to age and sex. There was no significant difference between two groups before intervention in the quality of life score. After intervention, the quality of life score were increased in both the experimental (19.99±1.11) and the control groups (18.49±1.48), respectively (p<0.001). Conclusion: Participation in cardiac rehabilitation program is effective in promotion of quality of life in CABG patients.