Results of this study indicates a significant effect of concomitant use of intravenous acetaminophen and diclofenac suppository on pain severity reduction and reducing the need for repeated doses of narcotics and prolonging the postoperative analgesia.

BackgroundTranexamic acid and vitamin C are potent antifibrinolytic and oxidative stress agents that reduce blood loss and transfusion blood in cardiopulmonary bypass (CPB).ObjectivesThe aim of this study was to evaluate the efficacy of tranexamic acid (TA) and tranexamic acid combined with vitamin C (TXC) on drainage volume (blood loss) and atrial fibrillation (AF) in patients undergoing cardiac bypass surgery in Gorgan, Shafa hospital, Iran.MethodsThis study is a double-blind randomized clinical trial. A sample size of 120 candidates of cardiac bypass surgery were included in this prospective study. Patients were randomly assigned to treatments in two groups. In both groups, 50 mg/kg tranexamic acid was administered intravenously directly before sternotomy: group A (N = 58) patients received tranexamic acid (TA) only and group B (N = 62) tranexamic acid with vitamin C (TXC) half an hour before surgery and 2 g vitamin C with 100 mL 0.9% saline were injected. Subsequently, during 4 days after surgery, 1000 mg of vitamin C and 100 cc 0.9% saline was infused every day. Intraoperative and postoperative blood loss (volume of blood in the drain) and atrial fibrillation complications were recorded for 24 hours after the operation.ResultsThe patients who received vitamin C had less bleeding during operation and in the early hours post-operation. Patients in (TA) group had mean drainage of 34.41 milliliter more than patients in (TXC) group (P < 0.001). Chi-square test showed that arrhythmia (AF) condition was the same in the two groups during 14 times of study (four times during operation and ten times up to 24 hours after the operation), and AF arrhythmia in the two groups was less than 5%.ConclusionsIn this study tranexamic acid with vitamin C have a positive effect on the amount of drainage (blood loss) and there was no significant difference in the incidence of AF between two groups.

Introduction: Musculoskeletal pain accompanied by psychological problem lead to reduce the efficiency of adolescents; so, this study aimed to determine the prevalence of musculoskeletal pain and its association with psychological factors among female adolescents. Materials and methods:The target population of this cross sectional study was female students (3625 in total) from both private and state funded high school children in Gorgan, northern Iran. Self -assessment questionnaires were distributed to 255 students across 8 female high schools. Self-report version of the Strengths and Difficulties (SDQ) questionnaires was used to screen adolescents with Psychiatric symptoms. To evaluate musculoskeletal pain Nordic questionnaire and numeric pain rating scale was used. Data were analyzed by binary logistic regression and the cumulative odds ratio (COR) was carried out for the ordinal level of musculoskeletal symptoms. Results: The prevalence rate of neck, shoulder and low back pain was reported, 23.1%, 27.8% and 27.7%, respectively. Hyperactivity-inattention (OR=2. 82; CI: 1.14-6.97) and peer problem (OR= 2.72; CI: 1.01-7.32) had significant relationship with neck pain, and prosocial behaviors (OR= 3.11; CI: 1.09-10.73) were associated with low back pain in the multivariate model. Ordinal regression showed that the increasing numbers of musculoskeletal symptoms related only to prosocial behavior (COR= 2.78; CI: 1.12-6.91). There was no significant association between shoulder pain and psychological factors. Conclusion: Based on the results, psychological factors were associated with musculoskeletal pain; so, it seems suffering from musculoskeletal pain need to be concurrently noticed with mental feeling for more effective response to attenuate pain.

Introduction: To investigate 28 days survival rate following first acute myocardial infarction (AMI) associated with the presence of classical risk factors and treatment modalities in Gorgan, north of Iran. Materials and methods: Our cohort including all patients hospitalized due to AMI from 2010 to 2013. Data were collected on demographic, prophylactic drugs and classical coronary risk factors. Data were analyzed using Kaplan-Meier and log rank tests. Cox proportional hazard model was built to estimate relative risk by taking into account other variables. Results: Median age of subjects was 58 and 64 for men and women, respectively; moreover, the occurrence of diabetes was 52.5 and 24.5 for them. A poorer outcome was detected in survival rate for women in the final model. Excess death occurrence in Fars or non-Persian ethnicity, and those who were not prescribed statin was detected in the adjusted model. Conclusion: A better survival rate for those who were prescribed statin suggest that it could be beneficial in treatment modality and non-Persian ethnicities needed to be considered as a group of at risk for earlier screening programs. In spite of some other studies a poorer outcome following AMI for women was found even after taking into account age and comorbidity.