مجله دانشکده پزشکی اصفهان
پیاپی 347 (هفته سوم مهر 1394)

Using the combination of exercise training and medicine, especially herbal medicine, is one of the therapeutic approaches in patients with diabetes. Purpose of the present study was to assess the effect of a 6-week aerobic training together with consuming of Pistacia atlantica extract on heat shock protein 70 (HSP70) and protein carbonyl (PC) levels in the heart tissue of streptozotocin-induced diabetic rats. In this experimental study, 40 male Wistar rats were randomly divided into five groups. Diabetes was induced via intraperitoneal injection of streptozotocin (40 mg/kg). The six-week period exercise training program included aerobic training on a treadmill (five sessions per week, 40 minutes per session, with a speed of 20 m/minute and with a slope of 5 degrees). Pistacia atlantica extract was fed five days per week with a dose of 25 mg/kg. The rats were anesthetized 48 hours after the last training session, and their heart were isolated. Then, the levels of HSP70 and protein carbonyl in the heart tissue were determined using enzyme-linked immunoassay (ELISA) and chemical colorimetric method, respectively. The HSP70 level in the diabetic group under aerobic training together with receiving Pistacia atlantica extract was significantly lower than the control diabetic group (P = 0.003); but, there was no statistically significant difference in the level of protein carbonyl between the groups (P = 0.740). It seems that aerobic training with Pistacia atlantica extract consuming, is a better therapeutic approach than using them alone, as a complementary therapy for reducing cardiac side effects in patients with diabetes.

Neonatal sepsis and meningitis is of great importance, due to nonspecific clinical presentation, diagnostic difficulties, complications and high mortality. The main purpose of this study was to investigate the trends of sepsis and meningitis of newborns admitted to the neonatal intensive care unit (NICU). In this study, we reviewed the records of all infants admitted to the NICU of Izadi hospital, Qom, Iran, from April 2010 to March 2014. Length of stay, gestational age, birth weight, sex, type of delivery, premature rupture of membranes, results of blood cultures and cerebrospinal fluid cultures and analysis, white blood cell count and C-reactive protein was extracted and the data were analyzed. A total of 1010 infants were studied. Male to female ratio was 564 to 446. There was no significant difference between percentage of low-birth-weight infants, cesarean section, premature rupture of the amniotic membranes, intrauterine growth retardation, prematurity and length of hospital stay and the admission years. 79 cases of sepsis and 3 cases of meningitis were diagnosed in 4 years. Sepsis was diagnosed in 12.3% in 2010 and 8.7% in 2013. This study showed that the incidence of sepsis and meningitis in Izadi hospital have downtrend; which could be due to the hygiene improve, proper treatment and decrease in the strains causing meningitis.

Pain is one of the most common postoperative complications that can be reduced via different methods like combination of two or more drugs to make synergistic effect. This research aimed to comparing the preventive effect of using combination of ketamine and fentanyl or ketamine and metoclopramide on the postoperative pain after laparoscopic cholecystectomy.

In a double-blinded clinical trial study, 90 patients in class I and II of ASA (American Society of Anesthesiologists) classification who were candidates for laparoscopic cholecystectomy were divided into two groups. Half an hour before completion of the operation, patients in the first group received intravenous metoclopramide (0.1 mg/kg) and ketamine (0.5 mg/kg) slowly; while the patients in the second group received intravenous ketamine (0.5 mg/kg) and fentanyl (0.5 µg/kg) slowly. After completion of operation, the pain severity was evaluated based on the visual analogue score (VAS) and the data were compared between the two groups.

The main pain score in ketamine and metoclopramide group at the end of recovery, also at the 2nd, 6th, 12th, 24th postoperative hours, was significantly lower than ketamine and fentanyl group (P < 0.001).

Preventive administration of ketamine and metoclopramide causes more reduction in postoperative pain than ketamine and fentanyl and is not associated with any severe postoperative complication.

Spinal surgeries are frequently complicated with high rate of intra- and post-operative hemorrhage. It is shown that the serum fibrinogen level is a pivotal factor in determining the degree of intra- and post-operative hemorrhage. This study sought to examine the effect of prophylactic infusion of fibrinogen in preventing hemorrhage in candidates for posterior spinal fusion surgery. 41 patients who were candidates for posterior spinal fusion surgery were randomly devided in two groups of intervention (21 patients) and control (20 patients), receiving either infusion of fibrinogen (1 g in 100 cc of normal saline infused within 5 minutes after induction) or placebo, respectively. Changes in serum hemoglobin and fibrinogen, the severity of intraoperative hemorrhage, and the need for blood transfusion were compared between the two groups. While pre- and postoperative changes in serum hemoglobin and fibrinogen did not differ significantly between the two groups, the mean blood loss (533.3 ± 157.9 vs. 679.0 ± 130.0 ml, P = 0.003) and the need for blood transfusion (0 vs. 30 percent, P = 0.030) were significantly higher in the control group. Prophylactic infusion of fibrinogen in candidates for posterior spinal fusion surgery may significantly decrease the amount of intra-operative hemorrhage and the need for blood transfusion.

Malignant neoplasms are the second most common cause of death in women during childbearing age; however, the occurrence of cancer during pregnancy is rare and only 0.02-0.1 percent of all pregnancies is associated with cancer. By increasing the rate of pregnancies in older ages, the incidence of cancer during pregnancy is also being increased. Breast cancer is the second most frequent cancer presenting during pregnancy. Pregnancy-associated breast cancer is defined as breast cancer that is diagnosed during pregnancy, lactation in or at the first postpartum year. Physiologic changes related to the pregnancy and the fetus are the most important diagnostic and therapeutic challenges in pregnant women. The signs and the symptoms of the pregnancy can mask breast cancer in a pregnant woman and lead to late cancer diagnosis. In addition, concerning fetus safety, there are many limitations and contraindications for using diagnostic and therapeutic methods during pregnancy. Due to the absence of major cohort srudies and large randomized trials, many questions regarding the consequences of the diagnosis and treatment of breast cancer in pregnancy remain unanswered. In this article, we review the most important diagnostic and therapeutic challenges and approaches in this group of patients.