مجله دانشکده پزشکی اصفهان
پیاپی 491 (هفته سوم مهر ماه 1397)

Traumatic brain injury as one of the main causes of mortality and disability is associated with changes in blood coagulation parameters and coagulopathy. Therefore, in this study, we aimed to investigate the association between prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), and platelet count with Glasgow coma scale (GCS) in patients with brain trauma. In this prospective study, 120 patients with a brain injury admitted to intensive care units (ICU) of Alzahra hospital in Isfahan, Iran, were randomly selected. PT, PTT, INR, and platelet counts were measured at the time of admission to the intensive care unit and 24 hours after it. Findings: At the beginning of admission to intensive care unit, GCS had a significant correlation with platelet count (r = 0.31, P < 0.010), and reverse and significant correlation with PT (r = -0.29, P = 0.001), PTT (r = -0.32, P < 0.010), and INR (r = -0.29, P = 0.001). Similarly, 24 hours after admission to the intensive care unit, GCS had a direct and significant correlation with platelet count and also a significant and inverse correlation with PT, PTT, and INR (P < 0.050 for all). GCS has a direct correlation with blood platelet level, and has an inverse correlation with PT, PTT, and INR, and therefore, these blood coagulation parameters can be used to predict the severity of brain trauma in patients with head trauma.

Impaired angiogenesis and formation of collateral vessels in skeletal and cardiac muscle, is a major complication of type 2 diabetes mellitus in ischemia. The aim of this study was to evaluate the changes in vascular endothelial grows factor (VEGF) and Endostatin gene expression in cardiac tissue of rats with type 2 diabetes mellitus following aerobic continues and high-intensity interval exercise training. In this study, 48 Wistar rats were randomly divided into 4 equal groups of healthy control, diabetic control, diabetic continues, and high-intensity interval training. Type 2 diabetes mellitus was induced by intra-peritoneal injection of streptozotocin, and exercise performed 5 sessions per week for 8 weeks. The levels of VEGF and Endostatin gene expression were evaluated using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) method. Findings: There was a significant reduction in the expression of VEGF and Endostatin in the diabetic control group compared to the healthy control group. Compared to the diabetic control group, diabetic continues and high-intensity interval training groups showed a significant increase in expression of VEGF, but there was significant increase in Endostatin expression in diabetic continues group. The results of this study showed that both training methods were effective to increase the expression of VEGF and Endostatin levels after induction of type 2 diabetes mellitus. Since, there was increase in VEGF/Endostatin ratio, increase in pro-angiogenic activity in heart may be occurred, but the high-intensity interval exercise training was more effective to increase the expression of VEGF.

One of the main problems of women during childbirth is fear of labor pain; so far, different ways to reduce it have been recommended. The aim of this study was to compare normal labor indexes in two methods of delivery of labor in water and routine delivery. In a prospective cohort study, 180 pregnant women were enrolled. The first group (n = 90) from the beginning of the active phase of labor, entered the water of 37°C, and the second group (90 women) gave birth in the usual manner on dry basis. The two groups were evaluated for pain severity, satisfaction, and complications during and after delivery. Findings: The mean of labor pain severity in the two groups of delivery in water and dry was 7.12 ± 1.42 and 7.87 ± 1.33, respectively, and the severity of pain in the group of water was lower (P = 0.001). Moreover, the delivery group in water had higher satisfaction, so that in the delivery group in water, 9.6% were completely satisfied and 45.2% were satisfied, and in the routine delivery group, 1.2% were completely satisfied and 30.6% satisfied (P = 0.007). Natural delivery in water has been accompanied by a reduction in lower birth rates and more satisfaction of the patients. On the other hand, delivery in water has no effect on the increase of postpartum complications. Moreover, delivery in water, in addition to reducing the delivery, has many other advantages, including lower power loss of pelvic floor muscles.

Epilepsy is one of the most prevalent neurologic disorders in all ages. Epilepsy surgery is widely prescribed for patients with refractory epilepsy, and can control seizure episodes. Controlling seizures is associated with decrease in mortality in these patients. This study aimed to evaluate the prevalence of sudden unexpected death in epilepsy (SUDEP) in patients with refractory epilepsy underwent epilepsy surgery. This was a descriptive epidemiologic study on patients with uncontrolled epilepsy underwent epilepsy surgery in Kashani hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, during the years 2007-2017. They were under long term video electroencephalogram (video EEG) monitoring for presurgical evaluation in Kashani hospital epilepsy center. Patient's records were given from hospital archives, and evaluated for demographic and epilepsy data. Then, telephone call was made to assess the presence of mortality in patients and its causes, and the frequency of mortality and sudden unexpected death was calculated. Findings: In this study, 324 patients with refractory epilepsy, who underwent epilepsy surgery, with mean age of 29.2 ± 9.8 years were evaluated; 59.3% of them were men. The total incidence of mortality was 2.3% (3 cases), and none of them were sudden unexpected death. There was significant and non-significant association between incidence of mortality with gender and age, respectively. The causes of death were tumor recurrence (2 cases) and intracranial hemorrhage during the surgery (1 case). The frequency of sudden unexpected death among the epilepsy patients underwent epilepsy surgery in Iran is lower than other countries.

The aim of current study was to compare the effects of all-pedicle-screw versus hybrid fixation techniques in surgical correction of adolescent idiopathic scoliosis. This clinical-trial study conducted on 40 patients who underwent corrective scoliosis surgery using all-pedicle-screw technique. Surgical outcome was assessed using radiological criteria (major Cobb’s angle correction) and Scoliosis Research Society-30 (SRS-30) questionnaire with measurements done before and two years after surgery. Findings were compared with results of 40 similar patients’ outcomes found in another study with hybrid fixation technique. Findings: Mean correction of Cobb’s angle in all-pedicle-screw and hybrid fixation groups was 82.7 and 76.3 percent, respectively. Rate of correction was significantly higher in all-pedicle-screw group (P = 0.044). Based on SRS-30 questionnaire, all domains scores were significantly improved in all-pedicle-screw group and in comparison to hybrid fixation, this method was only significantly better in patients' personal image/appearance and satisfaction domains (P < 0.001). Both techniques of pedicle screw and hybrid fixation are effective in correction of scoliosis, but this correction is more desirable in all-pedicle-screw group. Patients who had undergone all-pedicle-screw technique in comparison to hybrid fixation showed higher rate of satisfaction from surgery and personal image/appearance.