Iranian Red Crescent Medical Journal
Volume:15 Issue: 7, Jul 2013

Direct laryngoscopy and tracheal intubation can result in blood pressure and heart rate increase which in turn may lead to myocardial ischemia, cerebral hemorrhage, and even death in susceptible patients. Tizanidine is α2-receptor agonists that suppresses central sympathetic system.. This study evaluates the effects of oral Tizanidine on hemodynamic responses during operations and aims to determine the appropriate Propofol dosage to maintain anesthesia under BIS monitoring.. A double-blind clinical trial has been performed on 70 candidates for elective abdominal surgery undergoing general anesthesia in Educational Hospital of Ghaem, Mashhad, Iran. 35 randomly selected patients (the case group) were given 4 mg of oral Tizanidine 90 minutes before the induction of anesthesia whereas the remaining subjects (the control group) were given placebo. Blood pressure and heart rate before and after induction of anesthesia, and after intubation and extubation, existence of postoperative shivering, and the needed Propofol dosage were measured and recorded. Data analysis was done with T-test and Chi-squared test, using SPSS software version 16.. Variations of blood pressure and heart rate after anesthesia induction, intubation and extubation were less in Tizanidine group generally. Postoperative shivering was reported in 28.6% and 11.4% of patients in control and case group respectively. Average propofol needed dose for anesthesia maintenance in case group was 25% less than the needed amount in the control group.. Using oral Tizanidine as a premedication, yielded stability in blood pressure and heart rate during surgery and decreased required Propofol. Considering its short duration of action, Tizanidine use as a premedication is recommended for sedation and stabilization of hemodynamic responses during the operations..

Little is known about the possible influence of demographic and histological risk factors on the survival of patients with esophageal and gastric cancer.. Based on the available registry and follow-up information, this study compares 1-5 year survival rate of gastric and esophageal cancer..Patients and Through a concurrent (prospective) cohort study, all 366 patients with definite diagnosis of esophageal and gastric cancer who had been hospitalized at the Towhid Hospital, Sanandaj city, Kurdistan province, western Iran during a five-year period from 2006 onwards were recruited. The survival time of patients stratified by this grouping method were analyzed by Kaplan-Meier analysis and Cox regression.. Amongst the 366 patients, 23 had esophageal adenocarcinoma, 94 esophageal squamous-cell carcinoma and 239 had gastric adenocarcinoma. Age at diagnosis (P = < 0.001), tumor grade (P = 0.008) and practice treatment (P = < 0.001) had significant associations with the variation of survival rates in patients with esophageal but not with gastric cancer. The five-year survival rates (by year) for esophageal cancer were 49%, 27%, 24%, 22% and 19%, respectively and for gastric cancer were 41%, 17%, 13%, 10% and 5.4%, respectively.. Major differences between these cancers were seen in the survival rates of patients and their incidence classified by sex. Age at diagnosis and histological types were prognostic factors for survival of patients with esophageal cancer but this wasn’t the case for gastric cancer..

Macrophages derived foam cells are key factors in the maladaptive immune and inflammatory response.. The study of the cholesterol homeostasis and the molecular factor involved in these cells is very important in understanding the process of atherosclerosis and the mechanisms that prevent its occurrence.. This experimental study investigated the effects of c9, t11-Conjugated Linoleic Acid (c9, t11-CLA). Alpha Linolenic Acid (LA), and Eicosapentaenoic Acid (EPA) on the PPARα and ACAT1 mRNA expression by Real time PCR and cholesterol homeostasis in THP-1 macrophages derived foam cells.. Incubation of CLA, LA, EPA, and synthetic ligands did not prevent increasing the cellular total cholesterol (TC). Free cholesterol (FC) is increased by Sandoz58-035 (P = 0.024) and decreased by fatty acids and Wy14643 (Pirinixic acid) (P = 0.035). The pattern of distribution of %EC is similar to the EC pattern distribution. The ACAT1 mRNA expression was significantly increased by EPA (P = 0.009), but c9, t11- CLA, LA, Wy14643, and Sandoz58-035 had no significant effect on the mRNA level of ACAT1 expression compared to DMSO(Dimethyl sulfoxide).. In comparison to the control of Wy14643, Sandoz58-035, c9 and t11-CLA, EPA increased the PPARα mRNA levels (P = 0.024, P = 0.041, P = 0.043, and P = 0.004, respectively), even though, LA had no significant effect on the PPARα mRNA expression (P = 0.489).. Variations in the chemical structure of fatty acids can affect their physiological function..

Lack of adequate social support, stress, and generally poor quality of life during pregnancy leads to adverse pregnancy outcomes for both the mother and the baby.. This study aimed to investigate the relationship of social support and quality of life with level of stress during pregnancy.. This was a descriptive-correlative study conducted on 210 pregnant women (meeting study criteria), attending Shahriar Social Services Hospital during 2012. Purposive convenient sampling was used. Study subjects completed questionnaires of obstetrics and demographics, VAUX social support, World Health Organization quality of life, and stress during pregnancy. Data were analyzed with SPSS-19 and Lisrel 8.8, utilizing statistical path analysis.. The final path model fitted well (CF1 = 1, RMSEA = 0.00) and showed that direct quality of life paths with β = -0.2, and indirect social support with β = -0.088 had the most effects on reduction of stress during pregnancy.. Social support indirectly and quality of life directly affect stress during pregnancy. Thus, health officials should attempt to establish measures to further enhance social support and quality of life of pregnant women to reduce stress and its consequences during this time..

In addition to physical adaptation and psychosocial adjustment to chronic renal disease, hemodialysis (HD) patients must also adapt to dialysis therapy plan.. The aim of the present study was to examine the effect of Roy’s adaptation model-based patient education on adaptation of HD patients..Patients and This study is a semi-experimental research that was conducted with the participation of all patients with end-stage renal disease referred to the dialysis unit of Shahid Beheshti Hospital of Yasuj city, 2010. A total of 59 HD patients were randomly allocated to two groups of test and control. Data were collected by a questionnaire based on the Roy’s Adaptation Model (RAM). Validity and reliability of the questionnaire were approved. Patient education was determined by eight one-hour sessions over eight weeks. At the end of the education plan, the patients were given an educational booklet containing the main points of self-care for HD patients. The effectiveness of education plan was assessed two months after plan completion and data were compared with the pre-education scores. All analyses were conducted using the SPSS software (version 16) through descriptive and inferential statistics including correlation, t-test, ANOVA and ANCOVA tests.. The results showed significant differences in the mean scores of physiological and self-concept models between the test and control groups (P = 0.01 and P = 0.03 respectively). Also a statistical difference (P = 0.04) was observed in the mean scores of the role function mode of both groups. There was no significant difference in the mean scores of interdependence modes between the two groups.. RAM based patient education could improve the patients’ adaptation in physiologic and self-concept modes. In addition to suggesting further research in this area, nurses are recommended to pay more attention in applying RAM in dialysis centers..

Low birth weight is one of the most important public health issues in developing and developed countries and identifying its etiology is important for prevention.. Considering the unknown impact of physical activity on low birth weight, this research was conducted to investigate the relationship between physical activity and low birth weight..Patients and This research was conducted using a case-control design. The control group was made of 500 women with normal birth weight infants and the case group included 250 women with low birth weight infants from the selected hospitals in city of Tehran. The information was gathered using a researcher-made questionnaire which was prepared for determining the relationship between mothers’ lifestyle during pregnancy and infants'' low birth weight using social determinants of health approach. In this questionnaire, scope of physical activity was investigated in three groups of athletic activities, activities at home and leisure activities. Activity intensity was determined using MET scale and the data were analyzed in SPSS software using independent t-test, Chi-square and logistic regression.. In the present research, based on the results of multiple logistic regression test, an increase in the time spent on sport activities (OR = 2.20) and home activities (OR =1.44) (P = 0.003) was accompanied by increased chance of giving birth to low birth weight infants; in contrast, one hour increase of leisure activities decreased the probability of low birth weight infants by 0.32 (P = 0.008).. An increase in the time spent on sport and home activities, even after considering other influential factors, was related to low birth weight..

In patients with symptomatic cholelithiasis, laparoscopic cholecystectomy (LC) is the standard method of treatment. Laparoscopic cholecystectomy has a low rate of postoperative infections probably owing to smaller wounds and minimal tissue damage compared with the open procedure.. This study assessed the effect of cefazolin prophylaxis on postoperative infection in patients undergoing elective laparoscopic cholecystectomy. Additionally, we determined the risk factors of cases with postoperative infection..Patients and A total of 753 patients were enrolled in the study. Among these, 206 were excluded from the study. As a result, 547 patients with symptomatic cholelithiasis who underwent elective laparoscopic cholecystectomy were selected for this prospective study. Patients were randomized consecutively and divided into 2 groups: patients in the cefazolin (CEF) group (n = 278) received 1 g of cefazolin and those in the control group (n = 269) received 10 mL of isotonic sodium chloride solution. Patient characteristics and overall surgical outcomes were compared between the groups. All patients were followed for development of postoperative infections.. Postoperative infections occurred in 4 patients in the CEF group and in 2 patients in the control group; no significant difference existed in this regard(P =. 44). Risk of infection increased in patients with previous cholecystitis and/or endoscopic retrograde cholangiopancreatography (P < 0.001), patients with ruptured gallbladders, and patients for whom a suction drain was used (respectively, P < 0.001 and P < 0.001).. No correlation existed between cefazolin prophylaxis and postoperative infections in elective laparoscopic cholecystectomy patients. There may be an increased risk of infection in patients with previous cholecystitis or endoscopic retrograde cholangiopancreatography. In addition, there was an increased risk of postoperative infection in patients with gallbladder rupture and suction drain use..

Bronchiectasis is an abnormal and permanent dilatation of bronchi. Infection plays a major role in causing and perpetuating bronchiectasis, as reducing the microbial load and attendant mediators are cornerstone of therapy. Zinc, as an integral micronutrient is involved in the immune reactions including response to infection. In several previous studies, mild zinc deficiency has been described in many infectious diseases such as abscess, cellulitis, chronic diarrhea, pneumonia, tuberculosis (TB), etc.. The purpose of this study was to determine serum zinc level in a series of patients suffering from bronchiectasis and to compare it with healthy control group..Patients and Materials: This analytical cross-sectional study was performed on thirty four patients with proven bronchiectasis and twenty nine healthy control subjects referred to Rasoul-e-Akram Hospital, Tehran, Iran, between March 2005 and March 2007. Serum concentration of the zinc was measured for all of the subjects and other information was completed according to their medical records. Both groups (case and control) were frequently matched regarding their age groups.. Patients included 11 (32.4%) males and 23 (67.6%) females with the average age of 55.03 (SD = 17.06) yr. The mean level of serum zinc in the case and control groups were 94.06 (SD = 20/96) mcg/dl and 103.7 (SD = 11.96) mcg/dl, respectively. Independent T-test analysis showed that serum zinc concentration in the case group of bronchiectasis patients was significantly lower than control group (P = 0.02).. The results of our study show that serum zinc level in bronchiectasis patients was lower than the control group and the difference was statistically significant. It seems that the use of zinc supplement can reduce progression of the infectious disease regarding its role in improving the immune system reactions and some unknown mechanisms. Therefore, prophylactic and therapeutic use of zinc must be evaluated in further trials..

Differential diagnosis of hydatidiform moles from non-molar specimens as well as their sub-classification such as complete and partial hydatidiform moles are important for clinical management and accurate risk assessment for persistent gestational trophoblastic disease, but diagnosis based solely on histomorphology suffers from poor interobserver and intraobserver reproducibility.. This study was undertaken to determine whether the expression of Ki-67 protein could differentiate these entities.. We performed Ki-67 immunohistochemical staining in 19 molar (8 partial and 11 complete moles) and 10 non-molar (hydropic abortions) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry had confirmed diploidy in hydropic abortions and complete moles and triploidy in partial moles.. Ki-67 immunoreactivity was assessed in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells. Positive cells were found to be restricted mostly to the villous cytotrophoblasts, while syncytiotrophoblasts showed an absence of immunostaining for Ki-67, and occasional weak nuclear staining was seen in the stromal cells. There was a significant difference in Ki-67 immunoreactivity of cytotrophoblastic cells between hydropic abortions and complete moles (P < 0.001), hydropic abortions and partial moles (P = 0.002) and also between complete and partial moles (P < 0.001). On the other hand, there is significant overlap in the Ki-67 immunoreactivity between complete and partial moles (++ staining category) and between partial moles and hydropic abortions (+ staining category).. Despite the significant differences, Ki-67 immunostaining could not be helpful in distinguishing molar placentas from hydropic abortions as well as partial from complete hydatidiform moles, because there are considerable overlaps between results in different categories..

Toxoplasma gondii is an important zoonotic pathogen. Vertical transmission of the parasite occurs when females were infected primarily during gestation. This parasite is transmitted to the fetus through the placenta and may cause miscarriage, permanent neurological damage, premature birth and visual impairment. It has been found that mouse is susceptible to Toxoplasma and is particularly an interesting model to the study of congenital infection but whether the entry of T. gondii through vagina route is involved in transmission of the parasite to the placenta and fetus or not.. The current study aimed to find a route of infection which perhaps carried the parasite under natural conditions in human.. In the current experimental study, two 6-8 week NMRI female mice were crossed with one male. The pregnant mice were divided into 2 groups: experimental group that was infected by parasite via intra-vaginal (IV) and control group that received the same volume of normal saline via IV. One mouse from each group was killed on the fifth day after infection. The peritoneal fluid, ovary and uterus of mouse samples were taken and divided into two parts. One part used for DNA extraction and the other was kept in formalin and sent for histological study. These steps were repeated seven times and at least 10 mice in each group (case and control) were studied by molecular and histological methods.. PCR using DNA extracted from the experimental group showed that the parasite existed in tissues of the uterus and placenta but not in the embryos and peritoneal fluid. PCR using DNA extracted from the control group was negative.. Tachyzoite of Toxoplasma and DNA of this parasite were observed in sub mucosa and muscles of the uterus and in the villis of placenta, but not in histological sections of the fetus. Therefore, histological and molecular results were consistent..

Nowadays the importance of oral health to life quality is not obvious to anyone in our world. Oral lesions can interfere with daily social activities in involved patients through impacts on mastication, swallowing and speech and symptoms like xerostomia, halitosis or dysesthesia.. To assess the prevalence and types of oral lesions in a general population in Rasht, Northern Province of Iran..Patients and 1581 people aged > 30 years old who were inhabitant of Rasht, Iran, enrolled in a cross-sectional study. For each individual a detailed questionnaire based on the world health organization (WHO) guidelines in order to diagnosis of the lesions was filled and it contained all the required data. Participants were divided into two groups with and without oral mucosal lesions and oral mucosal lesions were divided into two groups with and without. Demographic characteristics and clinical information including age, sex, smoking (cigarette and tobacco), opium consumption, medication and oral and dental hygiene were collected and compared between these two groups.. The prevalence of mucosal lesions in our study was 19.4%. Our data demonstrated higher prevalence of oral mucosal lesions in males and young adults (30-40 years). The most common mucosal lesion among our participants was Fissured tongue(4%), followed by Fordyce granules(2.8%), geographic tongue(2.6%), Pigmentation(2.5%), Candida(1.8%), Smoker Plate(1.6%), lingual Varices(1.5%), Petechiae(1.4%) and lingual labial(1.4%). Leukoplakia was observed only in two people (0.1%).No case of malignant lesions was detected. No statistically significant difference was confirmed between the two groups regarding smoking, opium consumption, medication and oral and dental hygiene.. Our data has provided baseline information about epidemiologic aspects of oral mucosal lesions which can be valuable in organized national program targeting on oral health and hygiene in the society..

Non typhoidal Salmonellae spp. causes clinical symptoms especially in neonates, infants, aged and immunocompromised patients. Hematogenous dissemination may occur in complicated cases whereas the formation of abscess is rare. A 61-year old woman presented to our hospital with pain and a mass in her left arm, without fever and leukocytosis. She was using methotrexate, corticosteroids and quinine for rheumatoid arthritis. She had a history of cervix cancer and was given radiotherapy and chemotherapy 3 years ago. Upon physical examination and magnetic resonance imaging, the mass was considered as an abscess and was surgically drained. Salmonella enterica spp. enterica was yielded in the culture of the drainage material. Ceftriaxon 2g/day was started intramuscularly and continued for 4 weeks. Salmonellosis is usually a self-limited disease, generally restricted to gastrointestinal tract and acquired following food poisoning. Management of Salmonella abscess requires a combination of antibiotherapy, surgical drainage and eradication of primary foci..

A 39-year-old Iranian female patient who was a known case of primary cervical dystonia since 10 years ago presented to a private office for Dysport injection. The patients experienced severe dysphagia after inferior alveolar nerve block which was preceded by cervical botolinum toxin injection. A possible synergistic effect of botolinum toxin and lidocaine to produce severe dysphagia is presented in this case report..

Foreign bodies in lower urinary tract may present in a different number of ways. We report four cases of such unusual presentation. Physical examination and plain radiograph was sufficient enough to confirm our diagnosis in all cases. The cases belonged to different age groups and three out of four cases were managed by open surgical approach. One foreign body was removed using cystoscope. Prompt surgical management prevented urinary tract infections and long term complications in these patients..

The present study aims to report a case of conjunctival necrosis and scleritis due to a subtenon injection of triamcinolone acetonate. A 15-year-old boy received a subtenon injection of triamcinolone acetonate after a pars plana vitrectomy due to an intraocular foreign body. Seven days later, conjunctival necrosis and scleritis appeared at the site of injection. No improvement was seen after seven days of conservative treatment, and necrotic tissue debridement was performed. Within one week the conjunctiva cleared. Conjunctival necrosis and scleritis are rare complications of periocular corticosteroid injections, but an early diagnosis can be very valuable. Improper dosage and injection site of corticosteroids with insufficient prophylactic antibiotics are predisposing factors. If conservative treatment is not sufficient, debridement should be considered as a potential critical treatment option..

Surgery in cervical cancer should be used with intention of cure. Radical abdominal trachelectomy is a feasible operation for selected patients with stage Iα-1β cervical cancer which fertility can be preserved..Case Report: A 30-years-old woman with squamous cell cervical cancer stage (1 A II) diagnosed at September 2011 expressed a wish for fertility-sparing treatment. Radical abdominal hysterectomy and pelvic and para-aortic lymphadenectomy were performed which showed no evidence of lymphatic metastasis. Subsequently, at last follow-up (5 months post-surgery), good oncologic outcomes were found after this procedure. This was the first case of fertility-sparing radical trachelectomy procedures performed at our institution.. Trachelectomy represents a valuable conservative surgical approach for early stage invasive cervical cancer..