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Abstract: Investigating the Effect and Immunity of Tissue Plasminogen Activator in the Treatment of Acute Ischemic Stroke

Journal of Intellectual Disability - Diagnosis and Treatment

Investigating the Effect and Immunity of Tissue Plasminogen Activator in the Treatment of Acute Ischemic Stroke  - Pages 100-106

Gholam Reza Shamsaei, Shahram Rafie and Zeinab Rahimi

DOI: https://doi.org/10.6000/2292-2598.2020.08.02.2
Published: 15 May 2020

 

Abstract: Background and Objective: Although current evidence has demonstrated the efficacy and immunity of Alteplase, further studies are needed to evaluate its functioning in the therapeutic system. This study aims to assess the effect and immunity of tissue plasminogen activator (tPA) in the treatment of acute ischemic stroke (AIS).

Methods: This study was conducted as a retrospective observational study on patients with AIS referred to Ahvaz Golestan Hospital in 2017-2018. By using the hospital database, demographic information, the cause of lack of thrombolytic therapy, the onset of symptoms and admission were extracted. The National Institutes of Health Stroke Scale (NIHSS) at the time of referral, 24 hours after treatment, and at the time of discharge, the modified Rankin Scale (mRS) scores at discharge time and 3 months after discharge, complications and mortality at the time of admission and 3 months after discharge were recorded.

Results: The mean of the event to needle (hrs) was significantly lower in the tPA group (P <0.0001), and delay in visiting time and loss of golden time were of the main reasons for not receiving tPA in the control group. The mean difference and the decrease in NIHSS score 24 hours after admission and discharge in the tPA group was significantly higher (P <0.0001). At the time of discharge, the mean score of mRS in the two groups was not significantly different. Three months after treatment, the mean score of mRS in the tPA group was significantly lower than that in the control group (P <0.05). The percentage of patients with bleeding complications was higher in the tPA group (7.27%) than that in the control group (4.89%). The percentage of deaths during the hospital stay in the tPA group (3.64%) was higher than that in the control group (1.63%).

Conclusion: Patients with AIS under intravenous thrombolytic therapy with tPA showed improvement in functional measurements and neurological outcomes compared with the control group. Lack of significant difference in the rate of complications and mortality between the two groups indicated the safety and high efficacy of thrombolytic therapy in patients with AIS.

Keywords: Acute ischemic stroke, Thrombolytic therapy, NIHSS, mRS.

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Abstract: The Effect of Intravenous Dexmedetomidine on Postoperative Pain Intensity in Patients undergoing Abdominal Hysterectomy

Journal of Intellectual Disability - Diagnosis and Treatment

The Effect of Intravenous Dexmedetomidine on Postoperative Pain Intensity in Patients undergoing Abdominal Hysterectomy  - Pages 107-111

Sholeh Nesioonpour, Kaveh Behaeen, Ahmad Reza Mohtadi, Ali Ghomeishi and Negin Babadi

DOI: https://doi.org/10.6000/2292-2598.2020.08.02.3
Published: 15 May 2020

 

Abstract: Objective: The control of perioperative pain and its practice can play an important role in short and long term postoperative convalescence. The aim of this study was to evaluate the effect of dexmedetomidine on postoperative pain in patients undergoing abdominal hysterectomy (TAH).

Methods: This double-blind, randomized controlled clinical trial study was conducted on 70 women aged 35-65 years undergoing general anaesthesia for TAH. In dexmedetomidine group, immediately after induction, a bolus dose of dexmedetomidine 1 μg/kg was injected for 15 minutes and then a dose of infusion 0.5 μg/kg until the end of surgery. In the control group, normal saline was injected. Patients were evaluated for pain intensity according to the visual analogue scale (VAS), the amount of analgesic use during 24 hours after surgery and time of administration of the first dose of pethidine.

Results: Although the mean pain intensity at all times in dexmedetomidine group was lower than the control group, there was a significant difference at 4, 8, 16, and 24 hours after surgery (P <0.05). The time of the first request for administration of the first dose of pethidine was greater than the control group, but there was no significant difference in first-time administration of opioid in the two groups (P >0.05). Although the mean dose of pethidine was lower in the dexmedetomidine group, there was no statistically significant difference between the mean values in the two groups (P >0.05).

Conclusion: This study showed the efficacy of dexmedetomidine in reducing post-operative pain and receiving pethidine after surgery.

Keywords: Dexmedetomidine; Abdominal Hysterectomy, Postoperative Pain.

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Abstract: The Effect of In-Hospital Intervention to Reduce Door to Needle Time in Patients Receiving Tissue Plasminogen Activator

Journal of Intellectual Disability - Diagnosis and Treatment

The Effect of In-Hospital Intervention to Reduce Door to Needle Time in Patients Receiving Tissue Plasminogen Activator  - Pages 112-116

Gholamreza Shamsaei, Shahram Rafie and Fatemeh Pourshams

DOI: https://doi.org/10.6000/2292-2598.2020.08.02.4
Published: 15 May 2020

 

Abstract: Background and Objective: Attempts have been made to confirm the diagnosis of stroke at the earliest stage and to prevent the development of neurological deficits. Tissue plasminogen activator (tPA) plays a logical role in the treatment of acute stroke by converting plasminogen to plasmin, and recent studies have shown that the drug can be injected up to four and a half hours after the onset of symptoms. The present study aimed to evaluate the effect of an in-hospital intervention to reduce door to needle (DTN) time in acute stroke patients.

Methods: This epidemiological case-control study was performed on patients with acute ischemic stroke from September to March 2016 (n= 25) (group A) who were treated with tPA according to stroke guidelines. Their basic specifications, DTN and Door to Computed Tomography scan (DTC) time were recorded. Then, from April to August 2017, an intra-hospital recipe for tPA injection was provided by investigating the obstacles and causes of intra-hospital delays. Subsequently, stroke patients receiving tPA from September to March 2017 (n= 23) (group B) were examined, and their DTN and DTC were compared with patients in the first group.

Results: The mean DTN and DTC in group A were 67.27±28.83 and 30.40±10.59 minutes, and in group B, were 45±25.98 and 22.17±8.50, minutes, respectively, which made a significant difference between the two groups (P=0.005, P=0.006, respectively). The percentage of patients with DTN less than 60 minutes increased from 52% in group A to 95.6% in group B. The percentage of patients with DTC less than 25 minutes decreased from 32% to 69.56% (P<0.001). The percentage of patients with symptomatic cerebral haemorrhage increased from 12% to 8.7% (P<0.001). The percentage of patients with independent ambulatory (mRS: 0-2) at three months after discharge increased from 48% to 56.5% (P=0.003). The mortality rate also decreased from 24% to 13.4% (P<0.001).

Conclusion: By resolving the causes of intra-hospital delays and using a proper team program, the mean DTN and DTC of patients receiving tPA were reduced. This decrease in DTN time was accompanied by reduced complications in the form of reduced symptomatic cerebral haemorrhage and mortality and improved prognosis.

Keywords: Door to Needle, Door to CT, Thrombolytic plasminogen activator.

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Abstract: Clinical Comparison of Ibuprofen Drug Effect and Low Power Laser Diode on Orthodontic Separator Implementation Pain

Journal of Intellectual Disability - Diagnosis and Treatment

Clinical Comparison of Ibuprofen Drug Effect and Low Power Laser Diode on Orthodontic Separator Implementation Pain  - Pages 117-123

Vahid Mollabashi, Elham Maleki, Loghman Rezaei-Soufi, Sepideh Soheilifar, Payam Amini and Azadeh Kazemisaleh

DOI: https://doi.org/10.6000/2292-2598.2020.08.02.5
Published: 15 May 2020

 

Abstract: Objective: Placing orthodontic separators is one of the common tasks in orthodontics. It can cause low to moderate pain, because of the pressure of the periodontal ligament and the release of prostaglandins. The purpose of this study was to compare the analgesic effects of Ibuprofen® 400mg (Gelophen, Zahravi Pharmaceutical Co, Tabriz, Iran) and LLLT on pain after the placement of orthodontics separator.

Material and Methods: In this randomized clinical trial study, 61 orthodontics patients were randomly divided into two groups: group one LLLT (31 patients) and group two Ibuprofen drug (30 patients). The age of the patients was 13 to 25 years old. After obtaining informed consent from the patients, Maxillary first molars were selected to place separators in mesial and distal contacts.

Results: After receiving the questionnaires, 11 patients (6 patients from the laser group and 5 patients from drug group) due to the taking of another medication during the study period, were set aside. Data from 50 of them were analyzed. Using the Chi-square test, no difference was seen between two groups base on the amount of pain experienced, time to start pain and other causes of pain. Only in the drug group initiation of pain was observed later than the laser group.

Conclusion: As there was no difference in pain experienced between the two groups according to cost and time, it is not preferable to use low-power laser compared to medicine. The drug seems to be more effective.

Keywords: Pain, Orthodontics, Anti-inflammatory agents, Low-Level Laser Therapy.

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