Introduction: Identification and promotion of diagnostic methods has been a continuous effort to reduce disease and its complications and reduce costs associated with treatment. Despite all these efforts and improving our knowledge of diseases and diagnostic tools, pediatric appendicitis remains part of the diagnostic challenge in the surgical field. The aim of this is to compare the two diagnostic criteria of appendicitis (Children's Appendicitis Score [PAS] Versus Pediatric Appendicitis Score [CAS]) and evaluation of the diagnostic features of them. Methods: A retrospective cohort study was conducted on all children admitted to the hospital's emergency center with a possible diagnosis of appendicitis (270 patients) during 2018 and 2019 at Tabriz Pediatric Hospital. Based on the clinical examinations and para-clinical findings some of the patients were underwent the surgical intervention (220 cases) and some discharged and followed up for a period of 2 and 4 weeks later (50 cases). The data were analyzed through SPSS ver. 16 software. Results: The results of the present study indicated that if CAS was associated with ultrasound, the specificity of these criteria would improve and could be more acceptable compared with the PAS. In addition, it was revealed that WBC≥ 11000, as well as PMN≥ 65% and guarding were very specific for diagnosis and complication of acute appendicitis. There was a significant relationship between US findings and pathology reports (P<0. 05). Conclusion: In conclusion, the CAS criteria were more sensitive and the PAS was more specific in diagnosing pediatric acute appendicitis.

Introduction: The pain after nephrectomy, just as any other surgery, is one of the problems that the surgeons confront. Given that acupuncture is a therapeutical method with thousand of years of history, and has been effective for pain relief, we decided to evaluate the relieving effect of this therapeutical method on the pain experienced after nephrectomy.Methods & Materials: This was a clinical trial study that was performed on candiadate patients for nephrectomy. After matching for sex and age, the patients were devided into two groups of acupuncture and sham. In acupuncture group 4 points were stimulated for 30 minutes and in sham group other points were ineffectively stimulated for 30 minutes. Then the pain experienced in the first 6 hours after the surgery was registered by a blind observer upon acupuncture based on VAS. Data were analyzed using SPSS software and T-test.Results: Our results showed that in acupuncture group pain severity was significatly lower than sham group (P value<0.05) and also in true acupuncture group there were 6 patients who required the opioids compared to 12 patients in sham group. Mean opiate demand in sham group was significantly more than acupunture group (P value<0.05).Conclusion: acupuncture in patients undergoing nephrectomy, can reduce pain severity and demand for the opioids.

Background: Traumatic brain injury (TBI) is one of the leading causes of death, which ranges from mild and irreversible to severe and life-threatening injuries. Objectives: This study aimed to compare the pain score in patients with brain disorders using Care Pain Observation Tool (CPOT) and Nonverbal Pain Scale (NVPS). Methods: A descriptive comparative study was performed in Ilam province, Iran, in a group of head trauma patients admitted to the intensive care unit who were intubated. One hundred twenty observations of nurses’,practice were performed. A purposive sampling method was utilized. The CPOT and NVPS assessed the pain, and the Glasgow Coma Scale (GCS) assessed the state of consciousness. Data were analyzed by SPSS version 16 software. Results: Patients’,mean ±,SD age was 38. 45 ±,4. 2 years. The mean ±,SD pain score on the CPOT before the procedure was 0. 39 ±,0. 49 in the facial expression dimension, 0. 56 ±,0. 49 in activity, 0. 54 ±,0. 50 in muscle tension, and 0. 55 ±,0. 49 in compatibility with the ventilator. The mean ±,SD pain score on the NVPS before the procedure was 0. 97 ±,0. 20 in facial expression dimension, 0. 94 ±,0. 49 in activity, 0. 95 ±,0. 31 in guarding, 0. 64 ±,0. 49 in vital signs, and 0. 92 ±,0. 53 in excitement. Conclusions: Both CPOT and NVPS were effective in diagnosing patients’,pain, but the CPOT was more appropriate for diagnosing pain in intubated patients.

Aim and Background: Memantine is one of NMDA receptor antagonists with a rapid onset and limited side effects; its inhibitory effects on neuropathic pain has mentioned while using before nerve injury. Few studies were done on evaluating oral memantine effects on acute post-orthopedic surgery pain.Methods and Materials: In a double blind clinical trial, 60 patients with ASAI, II and upper limb fracture in two groups were enrolled in this study. After signing informed consent by the patients, 1 hour before surgery 20mg memantine prescribed for case group and control group received placebo. The patients received fentanyl and midazolam as premedication then anesthesia induction with propofol and cisatracurium performned. Maintenance of anesthesia was propofol and remifentanil. Pain score with Visual Analogue Scale (VAS) and sedation score measured and recorded in recovery and 6, 8, 24, 36 and 48 hours later. Also total dose of opioid consumption and nausea and vomiting incidence was measured.Findings: No demographic differences exist between them. Pain score in recovery and 6, 24 hours later were lower in case group. Sedation score was significantly different in hour 24 (P=0.04) Morphine dosage in case group was lower in recovery (P=0.01) Incidence of nausea and vomiting was not different between groups.Conclusions: Prescribing 20 mg memantine 1 hour before surgery, has been effective on pain reduction, also could decrease morphine demands in recovery.

Background and Aims: Driving is one of the occupations that afflict a person to get the musculoskeletal disorders because of the awkward working postures and imposition of stretch and strain in the driver’s body musculoskeletal system. We used the cushion for correcting driver’s body posture and their body conditions.Our goal in this study was the survey of cushion usefulness to posture correcting.Materials and Methods: 95 persons of bus drivers for this descriptive, analytic, interactive and cohort study were selected. In this research driver's postures while driving were assessed with RULA method (Rapid Upper Limb Assessment) in two stages, before and after the cushion usage. Then the data were analyzed by Spearman, Wilcoxon and Paired Sample tests with the aid of SPSS software program.Results: The statistic tests results show that RULA Grand Score for these drivers is between 2-6. Wilcoxon test results for comparing of RULA indices before and after using the cushion show that using this cushion decrease neck score (P<0.001), trunk score (P<0.001) and Grand Score (P<0.001).Conclusion: This cushion affects correcting drivers posture but this correction isn’t so idealistic. Therefore our recommendation to designers is that further study and redesign of cushion is necessary to cushion optimizeation.

The paragigantocellularis nucleus (PGI) is a part of brain stem pontomedullary reticular formation that has an important role in pain processing . Investigations have shown that PGI neurons contain some neurotransmitters such as GABA ,neuropeptides, Monoamines , substance P, enkephaline and serotonine. It has been Also suggested that PGI is a main cholinergic source in rat brain stem . There is a little evidence about presence and importance of cholinergic receptors on PGI neurons for nociception . In present study 38 NMRI young male rats , 200-300 gr were used . They were aneasthetized with Ketamine Hydrochloride (110 mg / kg / ip ) and a guide cannule were implanted in dorsal or lateral subdivisions of left PGI of both test and sham animals . One microlitter contain 781 micromoles of scopolamine ( 0.3 mg/ml ) was injected in dorsal or lateral PGI ( DPGI or LPGI ) after 7-10 days recovery period . Acute and chronic pain were evaluated by formalin test (50 microlitters formalin %2.5 injected in right hind paw subcutaneously) ten minutes after injection of scopolamine . Sham animals were received same volume of normal saline . Results showed that injection of scopolamine in DPGI or LPGI reduces pain score in both acute and chronic phases significantly. Also injection of scopolamine in LPGI has induced longer analgesic effect. These data suggest that:1)PGI neurons contain cholinergic muscarinic receptors,2)these receptors involve in pain processing , and 3) the injection of scopolamine has longer effect on chronic pain in LPGI than DPGI .