مجله دانشکده پزشکی اصفهان
پیاپی 468 (هفته چهارم فروردین 1397)

Intravenous (IV) administration of fentanyl during induction of general anesthesia often elicits cough, with frequency of 18% to 80%. Therefore, in this study, we aimed to compare the effects of ketamine and dexamethasone on decreasing cough in patients undergoing general anesthesia with fentanyl.
During a double-blind randomized clinical trial study, 99 patients aged 18-64 years with class I and II based on the scale of American Society of Anesthesiologists (ASA) who were undergoing general anesthesia with fentanyl were investigated. Patients were randomly divided equally into 3 groups receiving ketamine (0.5 mg/kg), dexamethasone (0.1 mg/kg), and placebo (5 ml normal saline). All drugs were administered 1 minute before administration of 2.5 µg/kg fentanyl. Vital signs, and frequency and intensity of cough were measured and recorded. Statistical analysis was performed using one-way ANOVA and Kruskal-Wallis tests.
Findings: The frequency of cough was significantly lower in the ketamine group (81.8%) compared with dexamethasone (90.9%) and placebo (93.1%) groups (P = 0.03). The intensity of cough was significantly lower in the ketamine group (mild: 18.2%; moderate: 78.8%; severe: 3.0%) compared with placebo group (mild: 9.1%, moderate: 72.7%; severe: 18.2%) (P = 0.04). Furthermore, there were significant differences between the three groups in variations of systolic blood pressure, diastolic blood pressure, and heart rate (P Administration of low-dose ketamine can effectively reduce frequency and intensity of fentanyl-induced cough during anesthesia in patients undergoing general anesthesia.

Blood-injection phobia is a chronic and debilitating disorder in children and adolescents which can be associated with anxiety avoidance of many essential treatments. Although there are some current recommended treatments for blood-injection phobia, little evidence is available on the virtual reality therapy. Therefore, in this study we aimed to investigate the effect of virtual reality therapy on blood-injection phobia among children and adolescents.
In this quasi-experimental study, 31 children and adolescents aged 6 to 18 years with the diagnosis of blood-injection phobia were investigated. All children received 12 sessions of working with virtual reality software. The children's anxiety level was assessed using Spielberger and specific symptoms of blood-injection phobia questionnaires. Statistical analysis was performed using SPSS software.
Findings: After working with the software, the mean scores of state, trait, and state-trait anxiety and also blood-injection phobia in children were significantly lower than their levels before working with the software (P Virtual reality therapy can effectively reduce state, trait, and state-trait anxiety and also blood-injection phobia in children and adolescents. However, further studies are required to determine the best version of virtual reality software for blood-injection phobia.

Application of toxic inducers, i.e. isopropyl β-D-1-thiogalactopyranoside (IPTG), for production of biopharmaceuticals has been prohibited by regulatory agencies. Here, we sought to evaluate the feasibility of a self-induced expression system for production of YY(3-36) peptide as an active pharmaceutical ingredient (API) in the Escherichia coli expression system.
The sequence of self-induced promoter was obtained from Data banks, and synthetized in pUC18 vector. The nucleotide sequence of YY(3-36) was inserted downstream of the promoter, after the 22 residue of asparaginase II signal sequence. The expression of the peptide was compared with pET21 harboring the same construct under isopropyl β-D-1-thiogalactopyranoside induction in sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE).
Findings: The expression of target peptide was comparable with isopropyl β-D-1-thiogalactopyranoside (1 mM) expressed peptide.
Our results demonstrate the ease and economical application of used self-induced promoter as an alternative system in production of high value added biopharmaceuticals.

Studies show that a considerable part of intractable epilepsy have psychological cause, and long-term monitoring can separate pseudoseizure from epilepsy. So, this study aimed to detect the effect of long-term monitoring on correction of medication among patients with intractable epilepsy.
In a cross-sectional study, patients treated as intractable epilepsy in Ayatollah Kashani hospital, Isfahan, Iran, during the years 2016-2016 were enrolled. Using long-term monitoring, and according to criteria of this program, pseudoseizure cases were separated from true epilepsy, and medication pattern was corrected in these patients.
Findings: 249 patients with intractable epilepsy were studied. According to long-term monitoring, in 65 patients (26.1%), the medication was changed, 75 (30.1%) referred for surgery, 59 (23.7%) referred for further assessment with magnetic resonance imaging (MRL), positron-emission tomography (PET) scan, and single-photon emission computed tomography (SPECT), and 50 (20.1) referred to psychologist due to pseudoseizure.
Long-term monitoring in patients with intractable epilepsy can help to separate of pseudoseizure from true epilepsy. The efficacy of this method was proved in better diagnosis and improvement of patients with non-epileptic seizure, decreasing treatment costs, and prevention of drug side effects.

Probiotics are one of the innovative, effective and accepted ways to mitigate acuteness, and to help cure some diseases at the present era. However, there are some limitations in manufacturing and using live bacteria. Paraprobiotics are of the new methods that can handle these problems at the large scale. They are defined as non-viable form of probiotics that can be utilized as intact or broken cells, and also as cell extract. Treatment of some diseases in human and animals has been demonstrated in case of using edible of topical application of paraprobiotics. In this review, after introducing paraprobiotics and their production techniques, their effects on human health is presented based on researches conducted during the past two decades, especially recent studies.