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 Background & Objectives: Cholangiocarcinoma is a malignant tumor of the biliary tract epithelium. Although it is not a common tumor, it has a high mortality rate so that the five-year survival of the patients is only 5%. Most patients are found to have irresectable tumor on initial presentation. These have led to an emphasis on the role of palliative treatment.

 Methods: 43 patients with Cholangiocarcinoma (from 1996-2003) based on ERCP were included in this study. Demographic aspects, clinical and Para clinical manifestations as well as the risk factors were investigated and survival rates of the patients were compared with or without stenting of the biliary tract.

 Results: 27 patients (62.8%) were male and 16(37.2%) were female with mean age of 65. Ulcerative colitis accompanied with PSC was diagnosed in just one case. Jaundice, weight loss and pruritus were the main complaints of the patients. Twenty-seven cases received stent in biliary tract through ERCP while no treatment was performed in other patients due to technical failure or patients’ disagreement. Mean survival time for all patients was 125 days. There were no statistically significant difference between survival rate of the patients with stent and without it.

 Conclusion: In this study cholangiocarcinoma in our patients was less frequently seen to accompany UC and PSC. Curative surgical resection is not possible in the majority of cases, and palliative treatment only decreases the severity of the symptoms but has no significant effect on survival.

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  Background & Objectives: Tension headache is one of the most common types of headaches that millions of people suffer from it. So far different treatments have been used to confront with tension headaches. According to the studies, tension headaches usually respond well to nonpharamacological treatment. The objective of this survey is the comparison between efficacy and effectiveness rate of SIT and medical treatment for tension headache treatment.

  Methods: In this study, 30 patients who had referred to neurology clinic of Alavi Hospital and private clinics, during the months of June and July in 2003, with chronic tension headache complaint, were selected randomly. These 30 patients were entered to two study groups and the third control groups. The patients in the first and second group received SIT and medical treatment respectively. The third group was considered as the control group and received no intervention. Indices of headache (frequency, severity and duration) were evaluated in 3 stages (Before treatment, after treatment and within one-month follow up period) by using a headache record device for all of patients. The collected data were analyzed by inferential statistical SIT methods, variance analysis and LSD pair comparison.

  Results: The data found from ANOVA methods (Analysis of variance) showed that both methods (Stress inoculation training and medical treatment) are effective in the treatment of chronic tension headache, but comparison between two groups showed that the group who received SIT had a significant difference compared to the group who received medical treatment in terms of efficacy rate on duration and consistency of headache symptom (p<0.05). In other indices of headache (freauency and severity), there was no significant difference between these two groups.

  Conclusion: This study showed that effiectiveness rate of stress inoculation training is more effective than medical treatment of tension headache (in terms of headache symptoms duration and consistency).

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  Backgroud & Objective : Inducing of safe airway and rapid , is very important in the anesthesia of emergency patients and it reduces many complications because of delay in the endotrachal intubation .In this group of patients, administration of succinylcholin is a choice. But, this drug has serious complication, that is sudden increase of serum potassium level , and could cause cardiac arrest .So ,it is suggested, use of non blocker dose of non depolarizant neuromuscular blocker (defasciculation), for reducing this response . So , the aim of this study , was to determine the effect of pretreatment atracurium on serum potassium level associated with administration of succinylcholine .

  Methods: This study was performed clinical trial on 82 elective patients aged between 15 -70 years whit ASAI-II (American society of anesthesiology of physical status class)who where scheduled undergo operate general surgery. Premedication drugs are used to all patients , according to weight. and first blood sample was taken, considered as control group. then pretreatment atracurium injection (50mcg/kg) and after three minutes, was performed induction with thiopental sodium (5mg/kg) and succinylcholine (1.5 mg/kg ), and after 5 minutes , second blood sample was taken, test group . blood samples, were poured in the espicial tube of serum potassium and immediately , serums were separated . Then , potasiom level of serums were measured with micro light . The datas analyzed with statistical program ( spss) and then , were compared .

  Results: According to the obtained results , the mean of serum potassium level after administration of succinylcholine associated with defasciculation atracurium and before the administration of pretreatment atracurium (base level) was not different . It was not seen , a statistically significant difference between two groups, with attention to paired- t-test(p=0.936) and wilcoxon signed ranks test (p=0.594).

  Conclusion: Regarding the results of this study , administration of pretreatment atracurium is not effective in prevention of hyperkalemia induced by succinylcholin with attention base level.

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Background & objectives: Type 2 diabetes mellitus (DM) is a metabolic disorder that is common throughout the world. Meta-analysis is a statistical technique in which the results of two or more independent studies, with similar objectives, are mathematically combined in order to improve the reliability of the results. The aim of this study was to compare the efficacy of metformin and linagliptin in patients with type 2 diabetes.
Methods: To identify relevant studies, PubMed, ISI Web of Science, Embase, Cochran library, Scopus and Ovid databases were searched from January 2000 to August 2016. Mean difference (MD) with 95% confidence interval (CI) for efficacy were calculated and pooled analysis was performed using Stata V.12 and RevMan V.5.3 software.
Results: Four studies recruiting1260 patients with DM (682 patients in group linagliptin and 578 patients in metformin group) were included in this study. The MD of HbA1C outcome of 0.5 mg linagliptin was effective (0. 7295, % CI = 0. 69 - 0. 75). The MD of fasting blood sugar (FBS) test revealed that linagliptin was effective at 0.5mg (MD = 36.79, 95% CI = 35.20 - 38.38) and 5 mg (MD = 12.65, 95% CI = 2.68 to 22.63) doses.
Conclusion: Our results suggest that some doses of linagliptin versus metformin may be an effective treatment for DM2. However, the number of studies was limited, and further research is needed.
 

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Background & Objective: Futile or fruitless life-saving interventions are in conflict with the four principles of medical ethics, which are not only ineffective for the patients, but also have a high burden on society. Therefore, this study aimed to determine the causes of unsuccessful life-saving treatment and interventions from the point of view of care providers in the neurology and neurosurgery departments of Tehran University of Medical Sciences hospitals.
Methods: The present study is a descriptive cross-sectional study that was conducted on 64 doctors and 72 nurses working in hospitals affiliated to the Tehran University of Medical Sciences in 2018. A 25-item researcher-made questionnaire was used to collect data. Spss-24 software and descriptive statistics tests were used to analyze data.
Results: The average age of doctors and nurses was 34.25±5.1 and 35.12±8.2 years, respectively. From the point of view of physicians and nurses, the most important reason for the ineffective provision of life-saving services was the lack of legal, moral and Islamic permission and guidelines to cut off life support devices and the lack of resuscitation in patients facing death (end stages of life).
Conclusion: The results of this study showed that, from the point of view of nurses, the most common reasons for providing futile care and cure are the moral and humane obligation of the treatment and care team to provide ineffective life-saving interventions, and from the point of view of the physician, the lack of legal, ethical and religious permission and instructions to cut off life support devices in patients has resulted in death. Some of the causes of unnecessary care were presented in this study, and some of these causes cannot be solved without solving theoretical problems and practical expert studies. Developing guidelines to define futile treatment, especially in end-of-life care, and providing solutions to control and manage treatment and unsuccessful life-saving interventions seems necessary.