Advanced Biomedical Research
Volume:5 Issue: 2, Feb 2015

Postoperative nausea and vomiting (PONV) is a common complication after general anesthesia in patients undergoing elective lower abdominal surgery. We aimed to compare the effect of a sub hypnotic dose of Propofol in the prevention of PONV after lower abdominal surgery with that of the conventional antiemetic drug Metoclopramide.

In this prospective, randomized, double‑blind, placebo‑controlled study, 104 patients with American Society of Anesthesiologists (ASA) class I or II status, aged 18–65 years, and undergoing elective lower abdominal surgery were randomized to one of four groups (n = 26 each). The patients in the four groups were administered intravenously Propofol 20 mg (G1), Propofol 30 mg (G2), Metoclopramide 10 mg (G3), and placebo (G4), 15 min before skin closure. All episodes of PONV during the first 24 h after anesthesia were recorded by an investigator who was blinded to treatment assignment.

There were no significant differences between the treatment groups with regard to their gender, age, ASA class, duration of surgery, duration of recovery time and hospital stay, and also body mass index (BMI) (P > 0.05). The prevalence of PONV 0-6 h after anesthesia was 23.08% with Propofol 20 mg (P = 0.005), 15.38% with Propofol 30 mg (P = 0.016), 15.38% with Metoclopramide 10 mg (P = 0.016), compared to 30.77% with placebo (P = 0.005).

Administration of a subhypnotic dose of Propofol (30 mg) was found to be as effective as 10 mg Metoclopramide in reducing the incidence and severity of PONV in adult patients undergoing elective lower abdominal surgeries under Isoflurane‑based anesthesia in the early postoperative period.

Stenotrophomonas maltophilia (S. maltophilia) is a gram‑negative bacillus emerging as an opportunistic, nosocomial pathogen associated with a high mortality rate. The organism has been shown to survive several biocides used in the hospital setting. Hospital water sources can serve as a reservoir for S. maltophilia. The transmission of S. maltophilia to susceptible individuals may occur through direct contact with the source or through the hands of health care personnel. S. maltophilia is usually resistant to third‑generation cephalosporins, aminoglycosides and antipseudomonal penicillins. These microorganisms are intrinsically resistant to carbapenems, and exposure to these agents has been linked to selection of S. maltophilia. There have also been reports of the organism developing resistance to trimethoprim–sulfamethoxazole (TMP–SMX), which was initially considered as the drug of choice for S. maltophillia infections. We describe a case of nosocomial urinary tract infection (UTI) due to S. maltophilia in a diabetic patient, which the patient developed during treatment with meropenem for UTI due to Klebsiella pneumonia that was resistant to TMP–SMX.

Frontotemporal dementia (FTD) is a group of neurodegenerative disorders characterized by atrophy of the frontal and temporal lobes. Clinical features suggestive of FTD include pre‑senile onset before the age of 65, behavioral changes, social and interpersonal disinhibition, fluent and nonfluent aphasia, and loss of insight. FTD and parkinsonism linked to chromosome 17 (FTDP‑17) was defined during the International Consensus Conference in Ann Arbor, Michigan in 1996. FTDP‑17 is an autosomally dominant inherited condition. Most genotypic alterations do not correlate with clinical phenotypes. However, mutations affecting exon 10 splicing are associated with parkinsonism. In the present study, a male case with FTDP who presented with insidious onset of speech difficulty at a young age that was associated with signs of parkinsonism and a positive family history of FTD with MAPT gene mutation at exon 13 has been reported.

Hypertension is a non communicable disease of major public health problem resulting increased morbidity and mortality among population. Prehypertension in adolescents and young adults again an important risk factor for developing hypertension in future. So the present study was carried out among medical students with the objectives of (1) to find out the risk factors associated with prehypertension and hypertension, (2) to suggest measures to decrease risk factors.

It was a cross‑sectional study and study duration was from september 2011 to November 2011. The sample size was 200 and the study subjects was selected by systematic random sampling method. A predesigned pretested schedule was used to collect data. Blood pressure (BP) was measured in sitting posture using a standard sphygmomanometer on two different settings and the average was taken for analysis.

All the participants were between 18‑21 years. Out of 200 study subjects,112 were males and 88 were females. The prehypertension and hypertension percentage was 67% among study subjects. Statistical analysis done was percentage, Chi‑square test.

Health‑care providers should recognize the increased CVD risk of prehypertension and should seek to identify and treat the modifiable risk factors in these persons.

The best treatment for scaphoid nonunion fractures is still controversial. The main aim of this study was to determine the results of the modified Matti‑Russe method of surgery on scaphoid nonunion.

In this prospective interventional study, 30 patients with nonunion scaphoid fracture recruited from clinics of the Isfahan University of Medical Sciences between October 2007 and March 2011 underwent the modified Matti‑Russe method of surgery. Union rate was evaluated four and six months after the procedure. Mayo wrist score (MWS) was calculated for the subjects six months after surgery.

Mean age of the subjects was 25.9 ± 7.8 years, ranging from 16 to 35 years. Twenty‑seven (90%) were men, and three (10%) were women. Four and six months after surgery, 10 (33%) and 26 (86.7%) subjects had a united fracture. Mean MWS was 75.0 ± 8.8 in all the subjects, ranging from 54 to 90 six months after surgery. Three subjects(10%) were grouped as excellent, 9 (30%) good, 16 (53.3%) satisfactory, and 3 (6.7%) poor.

A fracture or nonunion of the scaphoid bone can be a complex and troubling injury, but the modified Matti‑Russe method showed satisfactory results six months after surgery

Sperm dysfunction is one of the main causes of male infertility. Petroselinum crispum (P.crispum) is a member of umbelliferae family that contains different vitamins and minerals and has numerous therapeutic properties. The aim of this study was to evaluate P. crispum effect on sperm parameters, testis tissue and serum nitric oxid levels in mice.

Hydroalcoholic extract of P. crispum was prepared and administered intraperitoneally (0,100, 150 and 200 mg/kg) to 40 mice, which were divided into four groups (n = 10), one control group and three experimental groups, for 14 consequent days. The sperm parameter such as motility, sperm count, morphology, and seminiferous tubules diameter, and weight of prostate and testis, and serum nitric oxide levels were analyzed.

P. crispum administration (100, 150 and 200 mg/kg) significantly increased mean percentage of sperm motility, testis and prostate weight and serum nitric oxide compared to the control group (P < 0.05). However, no significant effect was reported for different doses of P. crispum extract on sperm parameters.

Administrating hydroalcoholic extract of P. crispum has positive effects on some reproductive parameters.

Migration, expansion and survival of endothelial cells that are an important cellular component of blood vessels plays an important role in the induction of tumor growth. Kisspeptins (kp), peptides that bind to coupled-G protein receptor (GPR54), inhibit each step of metastatic cascade include invasion, migration and homing, angiogenesis, survival and proliferation. In this study we investigated effects of kisspeptin-10, the most potent member of kisspeptin family, on Migration and proliferation of endothelial cells that are necessary for angiogenesis and tumor metastasis.

We compared migration of Human Umbilical Vein Endothelial Cells (HUVECs) were treated with 10-100 or 500 nM kp-10 for 24 hours and no treated cells using an in vitro trans membrane migration assay and HUVEC proliferation of treated endothelial cells with 10-100 or 500 nM kp-10 for 48 hours and no treated cells was measured by MTT Cell Proliferation Assay Kit. Analysis of data was performed using the Kruskal-Wallis test followed by the Mann-Whitney test.

Migration and proliferation of endothelial cells were increased at lower concentration of kp-10 specially at 100 nM while higher concentration reduced both migration and proliferation.

Our data showed that different concentrations of kp-10 have distinct effects on migration and proliferation of endothelial cells.

Cancer is one of the major fatal human diseases. Natural products have been used in the treatment of cancer for long time. Bee products including honey and propolis have been introduced for malignancy treatment in recent decades. In this study cytotoxicity of bee products and their effects on the expression of proapoptotic genes have been investigated.

Cytotoxic effects of Astragalus honey, ethanol extract of propolis and a sugar solution (as control) against HepG2, 5637 and L929 cell lines have been evaluated by the MTT assay. Total RNAs of treated cells were isolated and p53 and Bcl‑2 gene expression were evaluated, using real‑time PCR.

Propolis IC50 values were 58, 30 and 15 µg/ml against L929, HepG2 and 5637, respectively. These values for honey were 3.1%, 2.4% and 1.9%, respectively. Propolis extract has increased the expression of the Bcl‑2 gene in all cell lines whereas the honey decreased that significantly (P < 0.05). Also, we found that honey and propolis decreased p53 gene expression in HepG2 and 5637 significantly but not in L929 cells. The sugar solution increased the expression of p53 in two cancer cell lines but no significant changes were observed in the expression of this gene in L929 as normal mouse cell.

By downregulation of Bcl‑2 expression it could be concluded that the cytotoxicity of honey was more than two fold against tested cancer cells compared with the sugar solution. No significant changes were observed in the expression of p53 in honey‑treated cells. Propolis had no significant effect on Bcl‑2 and p53 gene expressions (P > 0.05).

During adolescence, sex hormones play an important role in regulating proliferation, differentiation, maturation, and the scheduled death of chondrocytes. Although some studies have reported the regulatory role of estrogen in the development and progression of cartilage, some of the mechanisms still remain unclear, including the role of estrogen in the expression of cartilage‑specific genes in chondrogenesis process, which we cover in this study.

In the present study, we used adipose‑derived stem cells (ADSCs) to differentiate into cartilage. Differentiated cartilage cells were used in the control (without estrogen E2 in the culture medium) and experimental (with estrogen in the culture medium) groups to evaluate the expression of type II collagen and aggrecan as chondrogenic genes markers, with -real‑time polymerase chain reaction technique.

Our results indicated that estrogen leads to inhibition of type II collagen gene expression and reduction of aggrecan gene expression.

Therefore, estrogen probably has negative effects on chondrogenesis process of ADSCs.

Oral mucositis is a debilitating side effect of cancer treatment for which there is not much successful treatments at yet. We evaluated the effectiveness of topical morphine compared with a routine mouthwash in managing cancer treatment‑induced mucositis.

Thirty head and neck cancer patients with severe mucositis (World Health Organization Grade III or IV) were randomized into the morphine and magic mouthwash groups. Patients received morphine sulfate 2% or magic solution (contained magnesium aluminum hydroxide, viscous lidocaine, and diphenhydramine), 10 ml for every 3 h, six times a day, for 6 days. Both groups received same dietary and oral hygiene instructions and care. Mucositis was graded at baseline and every 3 days after treatment. Patients’ satisfaction and drug effect maintenance were also evaluated.

Twenty‑eight patients (mean age of 49.5 ± 13.2 years, 63.3% female) completed the trial; 15 in the morphine group and 13 in the magic group. There was a decrease in mucositis severity in both of the morphine (P < 0.001) and magic (P = 0.049) groups. However, at the 6th day, more reduction was observed in mucositis severity in the morphine compared with magic group (P = 0.045). Drug effect maintenance was similar between the two groups, but patients in the morphine group were more satisfied by their treatments than those in the magic group (P = 0.008).

Topical morphine is more effective and more satisfactory to patients than the magic mouthwash in reducing severity of cancer treatment‑induced oral mucositis. More studies with larger sample size and longer follow‑up are required in this regard.

Type 2 diabetes mellitus (T2DM) is a worldwide problem that threatens the public health and economies of all countries. A multifactorial etiology and interaction between environmental factors and genetic components are responsible for triggering and progression of T2DM. Recently, rs7754840 single nucleotide polymorphism (SNP) in the CDKAL1 gene was reported to be associated with T2DM in various populations. However, due to inconsistent results in various populations about the association of rs7754840 with T2DM, and lack of information in the Iranian population, we have evaluated its association with T2DM in a subset of the Iranian population from Isfahan province, central part of Iran.

The study included 140 patients and 140 controls selected based on the World Health Organization guidelines. Genomic DNA was extracted from blood samples and the rs7754840 SNP was genotyped using a polymerase chain reaction-restriction fragment length polymorphism assay with specific primers and restriction enzyme (Ac1I).

The frequency of the C allele in the cases was higher than that in the controls (72.9% vs. 65%; P = 0.045). Using logistic regression analysis, we found a significant risk association of CC genotype with T2DM susceptibility (OR = 2.319, 95% CI = 1.436-3.744, P = 0.001). Furthermore, compared with the CC genotype, individuals with the GC genotype had a lower risk (protective association) of developing T2DM (OR = 0.332, 95% CI = 0.202-0.547, P < 0.001).

We confirmed that there is a significant risk association between rs7754840 polymorphism and development of T2DM in a subset of the Iranian population from Isfahan province.

Generally 50 to 70 percent of women suffer from a severe and unbearable pain during their childbirth. Abnormal fetal heart patterns, an increase of caesarian delivery rate, prolonged labor and low APGAR score in newborn are some of adverse effects of labor pain. Disagreement between different studies regarding the efficiency and effectiveness of acupuncture on labor pain led us to do this study.

This is a clinical trial study. Sampling was done randomly in Esfahan, Shahid Beheshti Hospital, based on the subjects’ characteristics. Patients were classified into three groups of control, Pethidine and acupuncture (27–30 women in each group). All women with a first and second pregnancy. VAS pain ruler was used as data collection tool. Data were analyzed in SPSS software, and using ANOVA and kruskal–Wallis tests.

The average pain score in control group 30 min after intervention was 7.80, while in Pethidine and acupuncture groups respectively were 6.87 and 5.77. Kruskal–Walis test showed that three groups in pain severity had significant difference at this time. The average length of the active phase of labor in Pethidine and acupuncture groups was 175 min while this time in control group was 243 min that ANOVA test showed a significant difference (P = 0.000).

Results showed that acupuncture can significantly reduce labor pain in 30 min after intervention, while it had no effect on labor pain at full dilatation. However, both in Pethidine and acupuncture groups, the length of the active phase has been considerably shortened.

VAP is defined as pneumonia in patients who use ventilators. The acute physiology and chronic health evaluation (APACHE II) scoring system was originally developed for predicting mortality in patients who were admitted to the intensive care unit. Due to the complexity, a simpler score called IBMP-10 was developed. We designed the study to confirm and further investigate these two methods.

This cross-sectional and analysis-descriptive study was done at the moment of VAP diagnosis on 60 patients in intensive care units. APACHE II and the IBMP-10 scores were calculated. ROC curves were generated to compare the new prediction rule with the APACHE II score. Results were reported as adjusted odds ratios with 95% confidence intervals (CIs). Analyses were performed using SPSS, version 20 and P values of 0.05 were considered to be statistically significant.

APACHE II Score means (P < 0.001) and IBMP-10 score (P < 0.001) means had significant increase in Non-survivor patient than in patients who survived. APACHE II can be used as a good prediction measure for mortality rate. In IBMP-10 method, specificity and PPV were greater than APACHE II, but in mc-nemar test, there was no significant difference between the two methods (P = 0.55). Both prediction rules had high NPV. In our study, survivors’ prediction value in APACHE II was 46.7%, and in IBMP-10, it was 46.7%.

IBMP-10, compared to APACHE II, has greater sensitivity, specificity, and AUC to predict mortality. So the consequence of the use of IBMP-10 was better than APACHE II.

Wastewater contains a variety of pathogens and bio ‑aerosols generated during the wastewater treatment process, which could be a potential health risk for exposed individuals. This study was carried out to detect Legionella spp. in the bio ‑aerosols generated from different processes of a wastewater treatment plant (WWTP) in Isfahan, Iran, and the downwind distances.

A total of 54 air samples were collected and analyzed for the presence of Legionella spp. by a nested‑ polymerase chain reaction (PCR) assay. A liquid impingement biosampler was used to capture bio ‑aerosols. The weather conditions were also recorded.

Legionella were detected in 6% of the samples, including air samples above the aeration tank (1/9), belt filter press (1/9), and 250 m downwind (1/9).

The result of this study revealed the presence of Legionella spp. in air samples of a WWTP and downwind distance, which consequently represent a potential health risk to the exposed individuals.

Multiple sclerosis (MS) is the most common disabling disease of the central nervous system. In these patients, fatigue is the most common symptom that causes disorder in the work, social activities and daily functions of the patients. Given the assumption that MS reduces the patients’ psychological well‑being, this study aimed at assessing the psychological well‑being of both the patients and their primary caregivers.

Current research as a descriptive study was conducted on 200 MS patients and 200 primary caregivers. For data collection, the Reef questionnaire was used to determine psychological well‑being of these individuals. Data were analyzed using SPSS software.

According to the obtained results, the mean duration of MS was estimated 6.37 years. The psychological well‑being score of the people with MS and their primary caregivers was slightly higher than average. The total score of psychological well‑being in primary caregivers was higher than the patients.

The mean score of psychological well‑being subscales was significantly different in patients and their caregivers. Regarding the autonomy subscale, there was a significant different in patients with MS, that is, it was lower than average. In terms of two subscales of “positive relationship with others” and “personal growth,” there was no difference between people with MS and the primary caregivers, and for other subscales, the mean score of caregivers was higher than the patients.

Despite being the most common entrapment neuropathy and the most common reason for referral to the electromyography (EMG) laboratory, the diagnosis of carpal tunnel syndrome (CTS) continues to be challenging due to a large number of electrodiagnostic (EDX) tests available. We present a flowchart and propose a practical approach to the diagnosis of CTS using the available literature and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines and the Practice Parameter for Electrodiagnostic Studies in Carpal Tunnel Syndrome.

The intercostobrachial nerve (ICBN) is often encountered during axillary dissection for axillary lymph node dissection (ALND) for diagnostic and therapeutic surgery for mastectomy. The present report is a case observed in the Department of Anatomy at Vardhman Mahavir Medical College, Delhi during routine dissection of the upper extremity of a male cadaver for first year undergraduate medical students. On the right side, the medial cord of brachial plexus gave two medial cutaneous nerves of arm. Both the nerves were seen communicating with the branches of the ICBN. The ICBN and one of its branches were surrounding the termination of an alar thoracic artery. These peripheral neural connections of the ICBN with the branches of the medial cord can be a cause of sensory impairment during axillary procedures done for mastectomy or exploration of long thoracic nerves. The alar thoracic artery found in relation to the ICBN could further be a cause of vascular complications during such procedures.

To report the long‑term findings of corneal cross‑linking (CXL) with riboflavin drops on the corneal endothelial cell.

In this prospective non‑randomized study, we aim to assess the long‑term safety of CXL on the corneal endothelium for the treatment of progressive keratoconus, by endothelial specular microscopy. A total of 68 eyes of 42 keratoconus patients were selected. We checked the corneal thickness (with ultrasonic pachymetry), endothelial cell density, pleomorphism, and polymegathism (with specular microscopy) of the endothelial cells, before CXL and one year after this procedure.

The mean ± SD of the preoperative and postoperative corneal thicknesses were 470 ± 40 µm and 469.8 ± 42 µm, respectively (p‑value = 0.591). The mean ± SD of the preoperative and postoperative endothelial cell densities were 2753 ± 230 cells/mm[2] and 2699 ± 210 cells/mm,[2] respectively (p‑value = 0.004). We found reduction in the endothelial cell density after CXL, but this reduction was less significant in a corneal thickness of less than 400 µm (which was treated with hypo‑osmolar riboflavin 0.1% drops) compared to the corneal thickness of more than 450 µm. We did not find any significant differences in the cell shapes (pleomorphism) (p‑value = 0.517), but the cell sizes (polymegathism) were changed after the procedure (p‑value = 0.021).

We found a significant decrease in endothelial corneal cell density after CXL, but this reduction was low; also the size of these cells increased after CXL. We believe that other parameters besides the corneal thickness may be the determinant factors for the changing of cell density and cell size in corneal endothelial cells.

Neurotrophins are small molecules of polypeptides, which include nerve growth factor (NGF) family, glial cell line–derived neurotrophic factor (GDNF) family ligands, and neuropoietic cytokines. These factors have an important role in neural regeneration, remyelination, and regulating the development of the peripheral and central nervous systems (PNS and CNS, respectively) by intracellular signaling through specific receptors. It has been suggested that the pathogenesis of human neurodegenerative disorders may be due to an alteration in the neurotrophic factors and their receptors. The use of neurotrophic factors as therapeutic agents is a novel strategy for restoring and maintaining neuronal function during neurodegenerative disorders such as multiple sclerosis. Innate and adaptive immune responses contribute to pathology of neurodegenerative disorders. Furthermore, autoimmune and mesenchymal stem cells, by the release of neurotrophic factors, have the ability to protect neuronal population and can efficiently suppress the formation of new lesions. So, these cells may be an alternative source for delivering neurotrophic factors into the CNS.

The pulsatility index (PI),measured by transcranial Doppler (TCD) ultrasonography,can reflectvascular resistance induced by cerebral small-vessel disease (SVD). We evaluated the value of TCD-derivedPI for diagnosing SVD as compared with magnetic resonance imaging (MRI).Materials,

Fifty-six consecutive cases with SVD (based on MRI),48 controls with normalMRI underwent TCD. Based on MRI findings,patients were categorized into five subgroups of preventricularhyperintensity (PVH),deep white matter hyperintensity (DWMH),lacunar,pontin hyperintensity (PH),andPVH+DWMH+lacunar. The sensitivity,specificity of TCD in best PI cut-off points were calculated ineach group.

The sensitivity,specificity of TCD in comparison with MRI with best PI cut-off points were asfollows: In PVH with PI,0.83,the sensitivity,specificity was 90%,98%,respectively. In DWMH withPI,0.79,specificity was 75%,87.5%,respectively. In lacunar with PI,0.80,thesensitivity,specificity was 73%,90%,respectively. In PH with PI,0.69,specificitywas 92%,respectively. And,in PVH+DWMH+lacunar subgroup with PI,the sensitivityand specificity was 90%,96%,respectively.

Increased TCD derived PI can accurately indicate the SVD. Hence,TCD can be used as a noninvasive,inexpensive method for diagnosing SVD,and TCD-derived PI can be considered as a physiologicindex of the disease as well.

This double‑blinded, randomized clinical trial was designed to evaluate intraocular pressure (IOP) change in cataract surgery using the combination of propofol and remifentanil or the combination of isoflurane and remifentanil.

One hundred sixty patients were randomly allocated to a maintenance anesthetic consisting of remifentanil + isoflurane (group I), normal saline + isoflurane (group II), propofol + remifentanil (group III) or normal saline + propofol (group IV). IOP was measured at seven predefined time points, baseline (T0), 3 min after the start of continuous remifentanil infusion (T2), after induction of anesthesia (T3), immediately after laryngoscopy and intubation (T4), 5 min after laryngoscopy (T5), immediately after the block of continuous remifentanil infusion (T6) and 3 min after T6 (T7). Outcomes included IOP, systole blood pressure (SBP) and diastole blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR).

The mean of IOP in Group III was lower than other groups and in group IV was higher than other groups. At time point T4 and T5 differences in the mean of IOP between groups III and IV was significantly different (P > 0.05). The trend in changes in the mean of IOP was statistically significant among groups (P value = 0.01). The trends in changes in the mean of SBP, DBP and MAP were not significantly different among groups (P value = 0.41). HR in group III was significantly lower than other groups. The trend in changes in the mean of HR was significantly different among groups (P value = 0.002).

Propofol with remifentanil was more effective than placebo or adding remifentanil to isoflurane in management of IOP in cataract surgery

Painful sensation has been reported after propofol injection in most of the patients but no definite mechanism for this painful sensation has been proposed yet. The present randomized clinical trial compares analgesic effect of ondansetron, magnesium sulphate (MS) and placebo on patients after propofol 2% injection.

The present randomized clinical trial with parallel design was performed on 90 patients American Society of Anesthesiologists I-II undergoing general anesthesia within vitrectomy operation with propofol induction. Subjects were randomly allocated into three groups with 30 patients each: (1) MS group (2) ondansetron group and (3) normal saline (NS) group as placebo group. Anesthesia induction and maintenance were the same between groups. Pain intensity of propofol injection in subjects was assessed by a four-point scale (none 0, mild 1, moderate 2 and severe 3) at four time intervals (5, 10, 20 and 25 s) after injection.

MS and ondansetron had significant impacts on pain reduction after propofol 2% injection in comparison with NS as placebo. Comparing two trial groups did not have any significant priority for analgesic impact.

Using ondansetron or MS had no priority on each other on declining propofol injection induced pain.

Pseudomonas aeruginosa is an opportunistic human pathogen that causes serious problems, especially in people, who have immunodeficiency. In recent times, metallo‑β‑lactamase (MBLs) resistance in this bacterium has led to some difficulties in treating bacterial infections. The metallo‑beta‑lactamase family of genes, including blaVIM‑1, is being reported with increasing frequency worldwide. The aim of this study is the detection of the metallo‑β‑lactamase gene blaVIM‑1 in imipenem‑resistant P. aeruginosa (IRPA) strains isolated from hospitalized patients.

In this study, 106 P. aeruginosa samples were isolated from various nosocomial infections. The isolates were identified, tested for susceptibility to various antimicrobial agents by the Kirby‑Bauer disk diffusion method, and all the imipenem‑resistant isolates were screened for the presence of MBLs by using the combined disk (IMP‑EDTA). The minimal inhibitory concentration (MIC) of imipenem was determined by E‑test on the Mueller‑Hinton agar. To detect the blaVIM‑1 gene, the isolates were subjected to a polymerase chain reaction (PCR).

Of all the P. aeruginosa isolates, 62 (58.5%) were found to be imipenem‑resistant P. aeruginosa (MIC ≥32 μg/ml). Twenty‑six (42%) of the imipenem‑resistant isolates were MBL positive. None of these isolates carried the blaVIM‑1 gene using the PCR assay.

The results demonstrated the serious therapeutic threat of the MBL‑producing P. aeruginosa populations. The rate of imipenem resistance due to MBL was increased dramatically. Early detection and infection‑control practices are the best antimicrobial strategies for this organism. None of MBL‑producing isolates in this study carry the blaVIM‑1 gene; therefore, another gene in the MBL family should be investigated.

The autoimmune disease myasthenia gravis (MG), can mimic a variety of neurological disorders leading to a delay in diagnosis and treatment. On occasions, misdiagnosis of MG could lead to unnecessary therapeutic interventions. We report the case of a 50 year‑old man, in whom MG was mistaken for motor neuron disease (MND). Subsequently, correct diagnosis and optimal management resulted in saving his life and significant improvement in his functional status. We discuss the importance of considering MG as one of the potential differential diagnoses among cases of new onset or recurrent unexplained bulbar symptoms, despite exaggerated deep tendon reflexes. Also, a literature review on the misdiagnosis of MG and the potential pitfalls in MG diagnosis are discussed.

Neurotoxicity side effects related to cyclosporine kinetics could lead to dysfunction of kidney graft and patient outcome after transplantation. The aim of this study was evidence‑based pharmacotherapy of kidney transplant recipients and to investigate neurotoxic levels of Iminoral.

The results of 2239 cyclosporine trough levels obtained from 743 patients were studied. Seventy‑five adult kidney recipients who received Iminoral were studied for neurotoxicity symptoms. Demographic, clinical, hematology and biochemical data were recorded in d‑base and analyzed using SPSS application for windows.

The mean value related to cyclosporine C0 was 246.3 µg/l. In the 48% the signs of neurotoxicity such as tremor and headache were noted, but only in 9% the levels of cyclosporine C0 were >400 µg/l. Further studies on 75 patients showed that the incidence of neurotoxic side effects were as follows: Tremor in 35, headache in 24 and anxiety in 34 recipients of kidney. The prescribed drug regimens from the day of transplant in most patients were based on mycophenolic acid or cellcept, pulse therapy using methylprednisolone (daily from kidney transplant up to 3 days after transplant), cyclosporine or Iminoral plus other drugs related to each individual. Administrations of ganciclovir, thymoglobulin, clotrimazol and prednisolone were also distinguished with immunosuppressant‑based therapy simultaneously.

Evidence‑based study related to pharmacotherapy of Iminoral showed that clinical presentation related to neurotoxic side effects such as tremor, headache and anxiety might be due to many factors such as polypharmacy. Planning immunosuppression to individual patients based on programmed therapeutic Iminoral monitoring, avoiding polypharmacy in terms of removal or drug minimization and focusing on first week after transplant seem to be a realistic option.

International travel has become increasingly common and accessible, and it is part of everyday life in pregnant women. Venous thromboembolism (VTE) is a serious public health disorder that occurs following long‑haul travel, especially after air travel. The normal pregnancy is accompanied by a state of hypercoagulability and hypofibrinolysis. Thus, it seems that pregnant women are at a higher risk of VTE following air travel, and, if they have preexisting risk factors, this risk would increase. There is limited data about travel‑related VTE in pregnant women; therefore, in the present study, we tried to evaluate the pathogenesis of thrombosis, association of thrombosis and air travel, risk factors and prevention of VTE in pregnant women based on available evidences. Pregnancy is associated with a five‑ to 10‑fold increased risk of VTE compared with nonpregnant women; however, during the postpartum period, this risk would increase to 20–80‑fold. Furthermore, the risk of thrombosis is higher in individuals with preexisting risk factors, and the most common risk factor for VTE during pregnancy is a previous history of VTE. Pregnant women are at a higher risk for thrombosis compared with other women. Thus, the prevention of VTE and additional risk factors should be considered for all pregnant women who travel by plane.

Night shift workers are more vulnerable to immune-related diseases. Immunoglobulin M (IgM) is a potent activator of complement, and complement has a crucial role in defense against bacterial infections. Circadian type is known as an effective agent on vulnerability and adaptation with shift work due to noncompliance with shift stress. The objective of this study was to investigate the correlation of circadian type and chronic fatigue with the serum concentration of IgM in a group of shift workers.

This cross-sectional study was performed in an industrial organization in Isfahan, Iran. The study population consisted of 221 male employees working at night shifts who were selected by random cluster sampling. The following questionnaires were used: composite morningness (Torsvall and Akerstedt), circadian type (Folkard), and chronic fatigue (Barton and colleagues). The serum concentration of IgM was measured by the nephelometric method. The data were analyzed with the Pearson coefficient correlation and the path analysis for finding the pattern of the structural equations to evaluate the direct and indirect relationships between variables, using the SPSS 15 and LISREL 8.5 statistical software.

Significant correlation was documented between morningness, flexibility, languidness, and chronic fatigue with the serum concentration of IgM (P < 0.01).

The results showed that the shift workers with morningness and languidness experienced more problems during the working hours due to more tiredness,and had decreased serum concentration of IgM. Correct management of shift work may attenuate fatigue in workers and also improve many health issues experienced by the shift workers.

Corneal cross-linking (CXL) with riboflavin and ultra-violet A is less invasive in comparison with other procedures such as penetrating keratoplasty. Hence, we planned this study to evaluate the efficacy of CXL in disease progression and to compare keratoconus indices before and 1 year after cross-linking by Pentacam.

In this prospective clinical trial, we enrolled 37 eyes of 37 patients suffering from keratoconus who were candidates for CXL. All eyes were examined before and one 1 year after surgery with a slit lamp and Pentacam for corneal topography. To compare the mean of each Pentacam parameter and index before and 1 year after the surgery, we used paired t-test.

There were 23 males and 14 females. The mean age was 21.5 years 18-30 years). At the 12th month examination, the corneal thickness had decreased (P = 0.0068) and the Index of Height Decentration (IHD) had increased (P = 0.016). There were no statistically significant differences in other indices and parameters 1 year after CXL.

Most of the parameters and indices had not changed during 1 year after CXL. The procedure seems to be effective in stopping the disease progression at least for 12 months after surgery.

Toxic epidermal necrolysis(TEN) is a rare and life‑threatening allergic drug reaction. We report a 26‑year‑old young female with end‑stage renal disease on maintenance hemodialysis developing TEN while on filgrastim and phenytoin. It was successfully treated with intravenous immunoglobulins and steroids.