Journal of

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Introduction: Shivering after anaesthesia and surgery is a common complication. Different methods are used for control of shivering in the recovery room. The opioids such as pethidine are very common in shivering control. Pethidine can be induced apnea, respiratory depression and nausea &vomiting. The respiratory rate and spo2 can lead to more rapid diagnosis and treatment of serious hypoxemia and possibly avoid serious complication.The present study is a randomized clinical trial aimed to survey Rrespiratory Rate, SPO2, nausea and vomiting in the use of three methods(warmed intravenous fluids, combined warming and pethidine) in the abdominal surgery patients with shivering.
Methods: 87 patients in randomized clinical trial study with abdominal surgery by general anesthesia were assigned to three groups (two intervention groups in comparison with pethidine as routine) randomly. When patients meeting inclusion criteria were enrolled in the study, entered one of the three groups by simple Lottery. Patients in warmed intravenous fluids group received pre-warmed Ringer serum (38°C), patients in combined warming group received pre-warmed Ringer serum (38°C) accompanied by humid-warm oxygen, and patients in pethidine group received intravenous pethidine routinely. The Respiratory Rate and SPO2 of the participants were assessed for 20 min postoperatively in the recovery room. Then the collected data they were analyzed by chi-square, ANOVA, repeated ANOVA test, Kruskal–Wallis test, Wilcoxon test, Mann–Whitney U test, Tukey test, Friedman test, and repeated measurements through software SPSS (v. 18) with the significance level (P<0.05).
Results: The mean of SPO2 and RR in the pethidine group was decreased, spo2 from 98% to 97% and RR from 16 to 15. But those changes weren't statistically significant (p>0.05). In the combined warming groups the mean of SPO2 was clear increased from 96% to 98% and this change was statistically significant (p=0.031) but the mean of RR have no change. In the warmed intravenous serum group, the RR and SPO2 were slight decreased and weren't statistically significant (P >0.05). In the pethidine group 11% of patients have nausea& vomiting.
Conclusions: The pethidine induce apnea and respiratory depression. despite this effects and other side effects, the combined warming can be useful for shivering treatment.

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• Introduction: Pain management is one of the most essential components of postoperative care. Nowadays, the common treatment methods for pain include the use of two large groups of analgesics, namely opioids and nonsteroidal anti-inflammatory drugs (NSAIDs). Therefore, the present study aimed to compare the effects of ketorolac (i.e., a non-inflammatory drug) and pethidine (i.e., a synthetic opioid pain medication) on pain and complications due to hemorrhoidectomy.
• Methods: This randomized controlled trial included 90 patients with hemorrhoids who underwent hemorrhoidectomy at Imam Reza Hospital in Birjand, Iran, from May 2017 to 2018. The participants were assigned into two groups, namely the ketorolac group who received ketorolac therapy and the pethidine group who received pethidine. The severity of pain and complications were measured immediately, as well as at 6, and 12 hours after surgery in both study groups. The quantitative data were expressed as mean and percentage. Data analysis was performed using SPSS software (version 22.0) through Mann-Whitney, Friedman, and Chi-square tests. A p-value less than 0.05 was considered statistically significant.
• Results: According to the obtained results, out of 90 patients with hemorrhoid, 70.3% were males. The mean age of the participants was 48.29±8.8 years, and there was no significant difference between the two study groups regarding age (47.2±8.7 years in the pethidine group, and 49.4±9 years in the ketorolac group, P=0.196). In the ketorolac group, the mean pain scores were 2.33±1.36, 2.28±1.00, and 1.57±0.75, immediately, as well as at 6, and 12 hours after surgery, respectively. In addition, in the pethidine group, the mean pain scores were obtained at 3.15±1.61, 2.64±1.00, and 1.97±0.69, immediately as well as at 6, and 12 hours after surgery, respectively. Accordingly, the pain level was significantly lower in the ketorolac group, compared to that in the pethidine group (P<0.05). However, the pain level was higher at 24 hours after surgery in the ketorolac group than that in the pethidine group; nevertheless, the difference was not statistically significant (P=0.996).
• Conclusions: The findings of the present study suggest more significant therapeutic effects of nonsteroidal NSAIDs, compared to opioid drugs on pain after hemorrhoidectomy.

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• Introduction: Appendectomy is one of the most performed surgeries worldwide. There are lots of factors involved in the incidence of appendicitis, and most of them vary among populations. Therefore, the present study aimed to evaluate the epidemiological aspects of appendicitis in Birjand, Iran, for the first time.
• Methods: This prospective study included 666 cases out of 673 acute appendicitis patients treated surgically in Imam Reza Hospital in Birjand, Iran, from May 2017 to 2019. The data were analyzed regarding gender, age groups, and season in SPSS software (version. 22) using a t-test and the Chi-square test. A p-value of less than 0.05 was considered statistically significant.
• Results: The annual incidence of acute appendicitis in Birjand was 12.74 per 10.000 population with the mean age of 25.43±14.97 years. The highest frequency of appendectomy was observed in 11-20-year-old groups (32.1%) and then in 21-30-year-old groups (27.3%). The frequency of the appendectomy was higher in males than females (P=0.005), and the peak of the surgeries was in the summer. Moreover, the majority of the admitted patients in the summer were male (n=123), whereas the frequency of female patients in the autumn was higher than that of males (n=81). The most frequent pathological diagnosis in both genders was acute gangrenous appendicitis (i.e., 44% in females and 40% in the male). Furthermore, the incidence rates of advanced stages of appendicitis, such as "acute supportive appendicitis and periappendicitis" and "acute supportive appendicitis and priappendicitis with perforation" were significantly higher in males than females (P<0.05).
• Conclusions: The findings of this study provide basic epidemiological information for the first time regarding appendicitis status in Birjand, Iran. Since appendicitis was more frequent among youth and was more complicated in males, it is essential to inform these target groups about the signs and symptoms of this medical emergency.

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• Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new virus from the coronavirus family (1) regarded as enveloped, positive-sense, single-stranded ribonucleic acid (RNA) viruses with helical symmetric nucleocapsid (2). According to the whole genome sequencing and phylogenetic analysis of coronavirus strains, a distinct clade of betacoronavirus is shown to be associated with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (3). This novel clade is called the 2019 novel coronavirus (2019-nCoV) and due to more similarity to the SARS virus is also called severe acute respiratory syndrome coronavirus 2. The disease is known as COVID-19.

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• Introduction: Heart valve disease in pediatricsis an increasing global concern, especially in developing countries. This study aims to determine the clinical outcomes of pulmonary valve replacement (PVR) surgery in pediatrics.
• Methods: The authors retrospectively identified all pediatrics undergoing PVR surgery at Imam Reza hospital (Mashhad, Iran) between 2000 and 2020. Their medical records were reviewed for demographic characteristics, clinical data (intra-operative and postoperative), and follow-up results. Echocardiography and electrocardiography were performedonall patients before the surgery and periodically after the surgery.
• Results: Among 50 pediatrics undergoing surgical PVR, 38 (76%) were female and others were male (14%), with a mean age of 10.39±5.31 years. The leading cause of PVR was the Tetralogy of Fallot. There was a significant relationship between age at the time of surgery and the size of the pulmonary valve(P=0.02).There were also statistically significant differences between QTc intervals before and after surgery (P=0.001). Further more, there was a significant correlation between QTc intervals before and after surgery and the ageof pediatrics at the time of surgery (P=0.01, r=-0.6).There was also a statistically significant relationship between the ICU stay (P=0.01) and the weaning time of the mechanical ventilation (P=0.03).
• Conclusion: It is recommended that this procedure ispostponed as much as possible to decrease postoperative life-threatening events in pediatrics.In addition, if this surgery is conducted with good surgical and nursing management, it can be safe with low complications among other cardiac valve procedures.

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• The Tetralogy of Fallot is the most common cyanotic congenital heart disease that is often associated with chromosomal aberration had a high prevalence rate of all congenital heart diseases. The association of the Tetralogy of Fallot (ToF) with other congenital cardiac defects, especially with hypertrophic cardiomyopathy, is infrequent. While, unlike the tetralogy of Fallot, hypertrophic cardiomyopathy is accompanied by specific gene loci.
• We report this scarce association in a 6-month male infant, cyanotic since birth and known with ToF, in her first hospital admission for treatment of recurring cyanotic crises. After the preliminary evaluations and the unsuccessful stenting of the patent ductus arteriousus (PDA) under an angiographic manner, he was prepared to undergo cardiac surgery to establish a modified Blalock-Taussig Shunt procedure. The patient was discharged in good condition and suggested that his parents follow up on his cardiac function after it. On follow-up at the age of three, the child had no cyanotic crises in this period.

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• Introduction: Peripheral arterial disease in coronary artery disease (CAD) is associated with poor cardiovascular outcomes. This issue is more highlighted in patients undergoing coronary artery bypass graft surgery after catheterization procedures.
• Methods: This study was observational on participants who recourse to the heart clinics and candidates for coronary angiography, based on inclusion and exclusion criteria. In the first, coronary angiography was performed, and so, if the patients had significant involvement of coronary arteries and had at least one inclusion criteria, for assessment of peripheral arterial disease (PAD), peripheral angiography through the femoral artery was performed. The statistical analysis was done by SPSS software (Version 16) and the data were analyzed using the descriptive statistics method, variance analysis, and Fisher's Exact Test. The level of significance was considered to be (0.05).
• Results: Among all patients, there was no significant difference in the demographic variables such as gender (P= 0.497) and age (P= 0.069). The commonest peripheral artery involved in patients was the right femoral artery. A statistically significant relationship between gender and PAD was seen (P=0.001). There was no significant relationship between the type of involved coronary artery and gender (p=0.043; Fisher's Exact Test = 10.719).
• Conclusion: More than one-third of participants with CAD had peripheral arterial involvement in iliofemoral arteries in this study. This situation increased the risk of complications in vascular blind catheterization. So, Improving PAD detection is crucial for more effective cardiovascular prevention and treatment.

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• Introduction: Adopting a suitable strategy to reduce the complications of cholecystectomy plays a significant role in the well-being of patients. We investigated the effects of atorvastatin on clinical symptoms, and inflammatory markers of patients undergoing cholecystectomy.
• Methods: This double-blind randomized controlled trial was conducted in Imam Reza Hospital, Birjand in 2021. In this study, 47 patients received 40 mg atorvastatin (intervention group) and 47 patients received placebo both daily for 4 weeks (placebo group). Then, the frequency of fever, abdominal pain, and nausea before and after cholecystectomy, as well as peri-operative data (duration of operation, and intraoperative bleeding) and laboratory data [White Blood Count (WBC), C-Reactive Protein (CRP), Aspartate AminoTransferase (AST), and Alkaline Phosphatase (ALT)] was collected. The data was analyzed using (SPSS Version 22) based on chi-squared, and independent t-tests at the significance level of (P≤0.05).
• Results: The duration of hospitalization was not significantly different in both groups (P=0.26), however, the duration of operation was significantly longer in the intervention group (P<0.001). The frequency of fever, abdominal pain, and nausea after cholecystectomy was not statistically different (P>0.05). The volume of intraoperative bleeding in the placebo group was more than the intervention group (P=0.05). The decrease of WBC, CRP, and the ALT levels after cholecystectomy was not statistically different (P>0.05); however, AST level after cholecystectomy was higher in the intervention group (P=0.05).
• Conclusions: The use of atorvastatin effectively reduced the volume of intraoperative bleeding. However, this intervention with this dose and duration could not have a significant role in reducing the duration of patients’ hospitalization, duration of operation, and levels of WBC, CRP, ALT, and AST.