فهرست مطالب

Reviews in Clinical Medicine - Volume:6 Issue:2, 2019
  • Volume:6 Issue:2, 2019
  • تاریخ انتشار: 1398/04/10
  • تعداد عناوین: 8
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  • Masoumeh Sarbaz, Khalil Kimiafar, Majid Khadem, Rezaiyan *, Mohammad Javad Ghasri, Mohammad Reza Farhang Far, Yones Bondar Sahebi, Alireza Omranzadeh Pages 40-44
    Introduction
    An adverse event (AE) is defined as an intended condition caused by medical errors or during hospitalization. Evidence in this regard is scarce and outdated. The present study aimed to evaluate the prevalence of medical and surgical AEs in three tertiary hospitals in the northeast of Iran.
    Methods
    This cross-sectional study was conducted on all the admitted patients to three trauma-specialized hospitals affiliated to Mashhad University of Medical Sciences due to AEs (n=1,121) in 2014. Identification of the AEs was accomplished using the International Classification of Diseases 10.
    Results
    The prevalence of AEs was estimated at 1.2%. The mean age of the patients exposed to AEs was 36.5±19.5 years, and 74% of these cases (n=830) were male. The mean length of hospital stay in these patients was 9.8±12.7 days. The majority of the reported AEs (n=1,020; 91%) were caused by surgical and other medical procedures, such as the abnormal reaction of patients, later complication, and not mentioning the misadventure upon the procedure. The mortality rate among the patients was determined to be 2.4%.
    Conclusion
    Although the rate of postoperative complications was relatively low, more strict academic protocols must be exploited in order to prevent AEs, especially in critical periods, such as summer.
    Keywords: Adverse Reactions, Drug-related Side-effects, International Classification of Diseases
  • Mohsen Sabermoghaddam Ranjbar *, Mojtaba Khezri, Majid Rajabian Pages 45-48
    Introduction
    The pain induced by propofol injection is a common adverse complications caused by propofol, which is ranked seventh among the 33 clinical symptoms of anesthesia. The present study aimed to investigate the effects of pre-treatment with ketamine and tourniquet inflation on the pain induced by propofol injection.
    Methods
    This randomized controlled clinical trial was conducted on 120 patients with the American Society of Anesthesiologists (ASA) physical status classification I. The patients were assigned to six groups. In groups one and four, tourniquet was inflated above the angiocatheter. In groups two and five, ketamine was injected 30 seconds before propofol injection with no tourniquet. The patients in groups three and six were injected with propofol alone. To assess the severity of pain, verbal rating scores were used. Data analysis was performed in SPSS version 20.
    Results
    In total, 74 male and 46 female patients were examined. In terms of pain severity, the lowest level of pain was experienced with the injection of ketamine before propofol with the use of a tourniquet (groups one and four). Based on the injection site, the total pain scores were higher with the injection of propofol into the veins on the dorsum of the hand. In addition, the mean pain score in groups one, two, four, and five was significantly lower compared to groups three and six (P< 0.05)
    Conclusion
    According to the results, use of ketamine, especially with a tourniquet, could alleviate the pain induced by propofol injection.
    Keywords: Anesthetics, Ketamine, Propofol, Tourniquet
  • Mohammad Gharavi Fard, Mohsen Akhondi * Pages 49-54
    Introduction
    The present study aimed to compare the conventional and new techniques of laryngeal mask airway (LMA) insertion in terms of the rate and severity of postoperative sore throat.
    Methods
    This clinical trial was conducted on 80 patients referring to Khatam-ol Anbia Hospitalin Mashhad, Iran for phacoemulsification. The patients underwent general anesthesia, and the conventional technique was performed by pushing down the LMA with the dominant hand with the simultaneous support of the index finger of the dominant hand. In addition, the new technique was carried out by conducting the LMA with the dominant hand and simultaneous use of the non-dominant hand to prevent the contact of the cuff with the palate and oropharynx tissues. All the variables were assessed one day after the operation.
    Results
    The rate of postoperative sore throat was 7.5% in the conventional technique and 1.25% in the new technique. Comparison of the rate of postoperative sore throat between the study groups showed a significant difference in this regard (P=0.048). The overall rate of postoperative sore throat one day after the operation was 3.75%, while it was estimated at 3.75% in the conventional technique. However, comparison of the rate of postoperative sore throat between the study groups demonstrated no significant difference in this regard (P=0.077).
    Conclusion
    Considering the higher effectiveness of the new LMA insertion technique compared to the conventional one technique in the prevention of preventing mucosal bleeding and postoperative sore throat, the new this technique is recommended as a can be used as a safe alternative to for the conventional technique. In the new LMA insertion technique, the this method, the rate of postoperative sore throat decreased due to the declined diminished due to reduced pressure on the tissues of the oropharynx tissues.
    Keywords: Intubation, Laryngeal mask airway, Oropharynx, Sore throat
  • Milad Ashrafizadeh, Zahra Ahmadi * Pages 55-59
    Statins are the inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A, which are extensively used to decrease the concentration of cholesterol in patients with hyperlipidemia. Statins are divided into two categories based on their own unique properties. Considering the pleiotropic effects of statins, they are applied as antioxidant, anti-inflammatory, anti-thrombotic, immunomodulatory, and plaque-stabilizing agents. In addition, statins affect the diversity and population of gut microbiota, which is a complicated microbial community remarkably involved in the regulation of metabolic responses, immune system, and human health. This community is also associated with age-related health problems, allergy, asthma, and inflammatory intestinal diseases. Therefore, evaluation of the interactions between statins and gut microbiota is essential to predicting the outcomes of these agents. The present study aimed to review the properties and pleiotropic effects of statins. Furthermore, the role of gut microbiota in health was discussed, and the significant effects of statins on gut microbiota and their interactions were described based on clinical and animal studies.
    Keywords: Cholesterol, Gut microbiota, Statins
  • Masoud Keikha, Mohsen Karbalaei Zadeh Babaki, Luiz Augusto Marcondes Fonseca, Jorge Casseb * Pages 60-65
    Human T-cell lymphotropic virus type I (HTLV-I) is a retrovirus, which is the causative agent of adult T-cell leukaemia (ATL) and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Evidence suggests that the interaction of HTLV-1 with the cellular-immune system plays a key role in the development of HAM/TSP. However, the main mechanism in this regard remains unknown. The present study aimed to review the HAM/TSP pathogenesis, current status of HTLV-1 in Iran, and available treatments for HTLV-1 infection.
    Keywords: Infectious Disease, HTLV-1, HAM, TSP
  • Zahra Ahmadi, Sahar Roomiani, Niloofar Bemani, Milad Ashrafizadeh * Pages 66-73
    In recent decades, special attention has been paid to cell death mechanisms, with the exception of apoptosis. This could be due to the resistance of cells, particularly cancer cells, to apoptosis. Among novel pathways, autophagy and endoplasmic reticulum (ER) stress have attracted the attention of researchers. A large number of antitumor drugs have been developed based on their modulatory effects on autophagy and ER stress. On the other hand, ER stress could stimulate autophagy and apoptosis, which is indicative of the dual role of this pathway. Therefore, the monitoring of these pathways could contribute to the treatment of pathological conditions. Among the multiple synthetic and natural modulators of autophagy and ER stress, natural agents are used more extensively owing to their few side-effects, valuable biological activities, and cost-efficiency. Honokiol as a lignin extracted from the bark of magnolia tree. This compound has been reported to have antioxidant, anti-inflammatory, anti-diabetic, and antitumor effects. The present study aimed to first introduce honokiol, autophagy, and ER stress and assess the modulatory effects of honokiol on the autophagy and ER stress mechanisms so as to demonstrate the therapeutic efficacy of this natural compound.
    Keywords: Autophagy, Endoplasmic reticulum stress, Herbal Medicine
  • Kobra Salimiyan Rizi, Hadi Farsiani *, Saeid Amel Jamehdar, Mahboubeh Mohammadzadeh Pages 74-76
    Elizabethkingia meningoseptica is an emerging nosocomial gram-negative, rod-shaped pathogen in patients with underlying diseases. This bacterium is also considered to be a major pathogen in hospitalized patients. Some of the main risk factors for E. meningosepticum infections include immunosuppression (e.g., end-stage hepatic and renal diseases) and prematurity in neonates. Furthermore, E. meningosepticum could cause pneumonia, endocarditis, and bacteremia in adults. The uncommon resistance pattern of this bacterium, as well as its intrinsic resistance to colistin, makes the treatment of the associated infections challenging unless the susceptibility patterns are available. In this article, we have presented the first case of pulmonary coinfection with multidrug-resistant (MDR) Acinetobacter spp. and E. meningoseptica in Iran. A 20-year-old female patient was admitted to our hospital with tetralogy of fallot as an underlying disease since childhood. The patient underwent cardiac surgery. On the third postoperative day (POD), the patient developed lung infection and left-lung collapse. Antibiotic therapy was initiated for MDR Acinetobacter spp. obtained from her primary culture of tracheal discharges. When fever persisted in the patient, the secondary culture of her tracheal discharges was observed to be positive for E. meningoseptica. In this case report, no clinical correlations were observed between the E. meningoseptica isolated from respiratory secretions and the primary respiratory infection, suggesting that E. meningoseptica is an indicator of severe underlying diseases rather than an actual pathogen.
    Keywords: Acinetobacter spp, Colistin resistance, Elizabethkingia meningoseptica, Nosocomial infection
  • Various Phenotypic Expressions of the Bicuspid Aortic Valve
    Tim Paterick * Pages 77-83
    The phenotypic expressions of the bicuspid aortic valve (BAV) are unpredictable and difficult to compartmentalize. In the modern era, BAV has been reported to account for approximately 50% of the cases with severe aortic stenosis requiring surgery and has also been associated with aortic regurgitation, bacterial endocarditis, and aortic dissection. Echocardiography is the diagnostic tool used to identify BAV. The clinical associations and high prevalence rate of BAV have added to the importance of this clinical inquiry. The present study aimed to explore the multifaceted challenges associated with BAV, as well as the current knowledge on this complex entity.
    Keywords: Aortopathy, Bicuspid Aortic Valve, coarctation, Heterogeneity