مجله دانشکده پزشکی اصفهان
پیاپی 509 (هفته اول اسفند ماه 1397)

Acid-base disturbances are common in critically ill patients, and contribute to morbidity and mortality. We evaluated the prevalence of acid-base disturbances in cases with acute poisoning admitted to intensive care unit (ICU). In this cross-sectional study, patients with acute poisoning hospitalized in ICU of a university hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran, from March 2016 to December 2017 were included. The acid-base status of the patients on admission time in emergency room, and its association with demographic factors, as well as clinical manifestations and outcome was recorded. Outcome was defined as survived without complication and complication/death. The majority of patients had acid-base disorder (89.7%). Most patients had metabolic acidosis (31.3%) on admission time, and most of them were men (71.6%) (P = 0.01). 48 patients (22.4%) were alert, of whom, 93.8% had an acid-base disorder. 60 patients (28.03%) were admitted with stupor and coma, of whom, 89.1% had acid-base disorder. There was a significant relationship between acid-base state with gender and level of consciousness at the time of admission (P < 0.05). There was also a significant correlation between treatment outcome with age, toxic agents, and abnormal electrocardiography (ECG). Among different evaluated variables, age was the determinant factor in outcome prediction (P = 0.01; odds ratio (OR) = 1.02; 95% confidence interval (CI) = 1.004-1.04). Acid-base disorders are common in patients with acute poisoning. The level of consciousness on admission and gender are important associated factors. The status of acid-base on the admission is not the only factor affecting outcomes and prognosis, and should be assessed along with other factors.

Postoperative sore throat after extubation is a common complication after surgery following general anesthesia. Several methods have been proposed, such as the use of intracuff dexamethasone to control these complications, but there is not always a standard method for it. The purpose of this study was to compare the precautionary effect of two different doses of intracuff dexamethasone (4 and 8 mg) on postoperative sore throat and cough. In this clinical trial study, 90 patients underwent general anesthesia with intubation were included. Patients were randomly divided into three groups. The first group received 4 mg, and the second one, 8 mg dexamethasone, and the third, physiologic serum in the form of intracuff before intubation. Postoperative sore throat and cough were compared between the three groups. The mean intensity of postoperative sore throat at recovery, and 1 and 24 hours later, and the number of coughing in recovery in the first and second groups was significantly lower than the placebo group (P < 0.05). On the other hand, there was no significant difference between the first and second groups based on postoperative sore throat and cough (P > 0.05). Moreover, there was no significant difference between the three groups based on demographic data. The use of intracuff dexamethasone in doses of 4 and 8 mg has a beneficial effect on reducing complications after extubation, such as sore throat and postoperative cough, and there is no difference between the two doses in reducing these complications.

Fracture or dislocation of scaphoid are commonly present in carpal tunnel bones, which is associated with complications such as scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) in these patients. The aim of this study was to compare the therapeutic effect of proximal row carpectomy (MCA) and midcarpal artherodesis (PRC) in the patients with SNAC and SLAC in stage 2. In this cross-sectional study, 30 patients with SNAC (21 patients) and SLAC (9 people) underwent PRC or MCA surgery in years 2015-2016 were included. According to the type of PRC or MCA surgical technique, the patients were divided into two groups, and factors such as the pain severity, range of motion (ROM), and grip strength were investigated at 2, 6, and 12 months intervals after the surgery. The mean pain severities at 2, 6, and 12 months after surgery were 3.30, 2.50, and 0.75 in the PRC group and 1.85, 1.01 and 0.35 in the MCA group, respectively. There were significant differences between the two groups based on the severity of pain 2 and 6 months after surgery (P < 0.05), but there was no significant difference based on severity of pain 12 months after operation (P = 0.28). There was also no significant difference between the two groups based on the ROM and the grip strength (P > 0.05). Postoperative pain in patients with MCA is less than those with PRC, but there is no difference between the two methods in ROM and grip strength.

Extensive use of computed tomography (CT)-scan imaging is associated with an increase in cumulative dose. Stereoradiography by electro-optical system (EOS) is an X-ray imaging technology that can reduce patient absorption dose, and increase image quality by removing scattered radiation. The aim of this study was to quantify the dose of radiation in CT-scan and stereoradiography imaging, and to compare the dose values between the two methods. This descriptive-analytical study was carried out in the Shahid Sadoughi hospital of Yazd City, Iran, with two different types of imaging apparatus, stereoradiography and CT-scan. Fifteen patients were selected randomly for each imaging method. Prior to irradiation, nine thermoluminescence dosimeters (TLDs) were installed on the target area in anterior-posterior (AP), right transverse (RT), and left transverse (LT) views. 85-110 and 120 kilovoltage peaks (kVp) were used for stereoradiography and CT-scan, respectively. The TLDs were read, and the mean dose of radiation was calculated. Finally, the statistical analysis was performed using one-way ANOVA method via SPSS software. The mean dose of radiation in stereoradiography imaging from the lower regions with AP, RT, and LT views were 0.75, 0.26, and 1.14 mGy, respectively. These values with similar views in CT-scan images were 18.08, 10.87, and 10.37 mGy, respectively. According to the results of statistical analysis, radiation dose in the all views of stereoradiography imaging was significantly lower than CT-scan. Using stereoradiography imaging instead of CT-scan impose a lower dose to the patient in detecting lower limb malformations, and thus reducing the risk of cancer and side effects.

Mesenchymal stem cells can be differentiated into multiple cell lineages, and secrete different factors. These secretions contain molecules and extracellular vesicles that have some effects. Exosomes are nanovesicles that enter protein and genetic material to target cells, and thereby induce proliferation, survival, and neural differentiation in target cells. So, exosomes can be considered as an ideal source for non-cellular therapy. The aim of this study was to investigate the effects of human adipose stem cell (ASC)-derived exosomes on survival and neural differentiation of pheochromocytoma cell line (PC12). The adipose tissue samples were obtained from young donors after signing the consent. The stem cells were isolated and cultured. Then exosomes were isolated from supernatant. In order to neural differentiation, the PC12 cells were treated in four groups with exosomes, nerve growth factor (NGF), NGF/exosome, and control for 7 days. The cells survival was assayed using MTT assay and neural differentiation of cells was confirmed by real-time polymerase chain reaction (real-time PCR). Based on MTT assay, there was significant difference in cell survival between exosome-treated group and other groups at days 1, 3, and 7. The results of real-time PCR showed that the expression of neural marker microtubule-associated protein 2 (Map2) significantly increased in exosome-treated group compared to other group at day 7 (P < 0.001). This study revealed that ASC-derived exosomes improved the survival and neural differentiation of PC12 cells. Our results suggest that exosomes may pave the way for non-cellular treatment of neurodegenerative diseases.