Acta Medica Iranica
Volume:52 Issue: 11, Nov 2014

Several studies have shown that hepatocyte membrane composition changes in patients with cholestasis and cirrhosis. These alterations that are because of intracellular oxidative stress are supposed to be reflected in erythrocyte membrane. The aim of this study was to investigate the modification of erythrocyte membrane along with hexokinase and antioxidant enzymes during development of cirrhosis. Cirrhosis was induced by intraperitoneal injection of CCl4 in male Wistar rats. The test groups were: baseline, cholestatic, early cirrhotic and advanced cirrhotic along with an equal number of sham-control animals. The erythrocyte membrane modifications (protein sulfhydryl, protein carbonyl, and lipid peroxidation), as well as NO metabolites, were assessed. Activities of GPX, CAT, SOD and HK were also measured. Protein sulfhydryl content of the erythrocyte membrane (after 2, 6 and 10 weeks of injection) had significant progressive decrease. In contrast, protein carbonyls were remarkably increased 2 weeks after injection but significantly decreased after 6 weeks and returned to normal levels after 10 weeks. No significant difference in erythrocyte HK activity or MDA content was observed. Test groups showed significantly lower erythrocyte GPx activity after six weeks and CAT and SOD activities along with NO metabolites content after two weeks (P<0.05). This study indicates that the progression of cirrhosis is accompanied by alterations in antioxidant enzyme and decreased NO metabolites. Protein carbonyl alteration occurs in the early stages of cirrhosis while protein sulfhydryl alterations have a progressive decrease in advanced cirrhosis.

According to limitations in blood product resources and to prevent unnecessary transfusions and afterwards complications in perioperative period of total hip arthroplasty, authors administered fibrinogen concentrate in a pilot randomized clinical trial to evaluate bleeding and need to blood transfusion in preoperative period. Thirty patients (3-75 years old) with ASA physical status class I or II and candidate for total hip arthroplasty consequently enrolled in this study and randomly assigned into two groups: taking fibrinogen concentrate and control. Two groups were similar in serum concentration of fibrinogen, hemoglobin, and platelet preoperatively. After induction of general anesthesia 30mg/kg fibrinogen concentrate was administered in the fibrinogen group. Blood loss, need to blood transfusion and probable complications were compared between two groups. The mean operation time was 3.3 ± 0.8 hours in the fibrinogen group and 2.8 ± 0.6 hours in the placebo group, and this difference was statistically significant (P=0.04). There was a significant correlation between operation time and blood loss during surgery (P=0.002). The mean transfused blood products in the fibrinogen and control group was 0.8 ± 1.01 units and 1.06 ± 1.2 units respectively (P: 0.53). The mean of perioperative blood loss was 976 ± 553 ml in the fibrinogen group and 1100 ± 350 ml in the control group, but this difference was not significant between two groups. By adjusting time factor for two groups, we identified that the patients in fibrinogen group had lower perioperative bleeding after adjusting time factor for two groups (P=0.046). None of the patients had complications related to fibrinogen concentrate administration. The prophylactic administration of fibrinogen concentrate was safe and effective in reducing bleeding in the perioperative period of total hip arthroplasty.

To assess the association between polymorphisms of the IL-6 -174 G/C and Behçet's disease (BD) in Tunisian patients. DNA was extracted from blood samples taken from 43 Tunisian patients and 43 healthy controls. The polymorphisms were analyzed by PCR with the PCR-RFLP. No significant association was found between patients and controls concerning polymorphism of IL6 -174 G/C between the (allelic frequency: C (17.44 vs 8, 13%; P=0.17) et G (82,55 vs 91,86%; P= 0.21). Neither age of onset of BD nor sex appears to be influenced by allelic variation of SNP-174 G / C of IL6. Disease duration of BD was longer in patients having the form 174 G-allele. SNP -174G/C was more frequent in patients without significant association (32.5 vs 16,26%; P=0.07). SNP -174 G/C was not associated with the HLA B51. Neither age of onset of BD nor sex appears to be influenced by SNP-174 G / C of IL6. Disease duration of BD was longer in the absence of the SNP-174 G/C IL6, with no significant difference (79.2 + / -45.095 vs.70.28 + / - 47.034 months, P=0.59). The polymorphism of IL6 -174 G/C does not modulate clinical expression of BD. The single nucleotide polymorphisms of the IL-6 do not appear to be associated with BD reconstruction.

Overactive bladder (OAB) is a disabling disorder. Treatment of cases with OAB includes behavioral, pharmacological, surgical interventions and peripheral electrical stimulation. The goal of this study was to determine effects of posterior tibial nerve stimulation on sexual function and pelvic disorders in women with Overactive bladder (OAB). Fifty women were randomly assigned to PTNS (posterior tibial nerve stimulation) plus tolterodine or tolterodine alone treatment. Tolterodine group received 4 mg tolterodine daily for three months while the other group received this treatment plus percutaneous tibial nerve stimulation for 12 consequence weeks. Two in PTNS group and 8 in the control group withdrew from the study. Age, education level, and occupation status were not significantly different between two groups. Mean total FSFI and its subscales were not significantly different before and after treatment between two groups. Urine leakage associated with a feeling of urgency and loss of stool or gas from the rectum beyond patient’s control became significantly different after treatment between two groups. Posterior tibial nerve stimulation could help urinary problems in women with a neurologic bladder.

While most tinnitus cases have some degree of hearing impairment, a small percent of the patients admitted to Ear, Nose and Throat Clinics or Hearing Evaluation Centers are those who complain of tinnitus despite having normal hearing thresholds. Present study was performed in order to better understanding of the probable causes of tinnitus and to investigate possible changes in the cochlear and auditory brainstem function in normal hearing patients with chronic tinnitus. Altogether, 63 ears (31 ears with tinnitus and 32 ears without tinnitus) were examined. The prevalence of transient evoked otoacoustic emissions and characteristics of the auditory brainstem response components including wave latencies and wave amplitudes was determined in the two groups and analyzed with appropriate statistical methods. There was no difference between the prevalence of transient evoked emissions in the two groups. The mean difference between absolute latencies of waves I, III and V was less than 0.1 ms between the two groups that were not statistically significant. Also, the interpeak latency values ​​of I-III, III-V and I-V in both groups had no significant difference. Only the V/I amplitude ratio in the tinnitus group was significantly larger than the other group (p =0.04). The changes observed in amplitude of waves, especially in the later ones, can be considered as an Audiologic finding in normal hearing tinnitus subjects and its possible role in generation of tinnitus in these patients must be investigated.

Pulmonary hypertension is rare but is one of the complications that occur due to HIV infection. Symptoms of HIV-associated pulmonary arterial hypertension are often non-specific but the main symptom of the disease is dyspnea. In this cross-sectional study, we measured systolic pulmonary arterial pressure (SPAP) by echocardiographic methods among HIV-positive patients who received ART. This research is a descriptive, cross-sectional study of 170 HIV-positive patients that was conducted in Imam-Khomeini hospital, Tehran, Iran during 2011-2013. All patients regularly received antiretroviral therapy at least for recent 2 years. There were not any cardiopulmonary symptoms (cough, dyspnea, exertional fatigue and chest discomfort) in these patients. All participants underwent echocardiography to estimate SPAP. The participants comprised 108 males (63.5%) and 62 females (46.5%). The mean age of patients was 41 years old, and the mean duration of HIV infection was 5.5 years. The mean CD4 cell count was 401cell/µl. The principal regimen of antiretroviral therapy included two nucleoside reverse transcriptase inhibitor (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in the hospital. The mean of systolic pulmonary arterial pressure was 25 mmHg in the participants; 156 (93.4%) of them had SPAP ≤30mmHg (normal), six (3.6%) had SPAP: 31-35mmHg (borderline) and five (3%) had SPAP > 35 mmHg (pulmonary hypertension). Our results indicated a significant increase of pulmonary hypertension in asymptomatic HIV-positive patients that had no association with any other risk factor. Also, antiretroviral therapy was not a risk factor for pulmonary hypertension in this study.

Rising obesity incidence and its complications have lead to change of our view about cardio-metabolic risk factors and need of reassessment of these complications in childhood age. The aim of current study was to evaluate prevalence of obesity and related cardio-metabolic risk factors of children. This was a cross-sectional study in a representative sample of 12 years old children in Rasht, the biggest city in north of Iran. Participants were interviewed and examined by a trained research team and demographic characteristics, detailed examination (height - weight - blood pressure) were recorded. Blood samples were drawn for biochemical testing including Fasting blood sugar, Triglyceride, Cholesterol, HDL & LDL. Data analysis was done using SPSS software. Total participants were 858 children and 550(64%) were male. Prevalence of underweight, normal weight, overweight, obese were 22.5%, 54.4%, 11.3%, 11.8%, respectively. The prevalence of cardio-metabolic risk factors included hypercholesterolemia (6.7%), hypertriglyceridemia (33.6%), high LDL (5.9%), low HDL (28 %), high systolic (7.6%) & diastolic blood pressure (10.6%) (>90th percentile) and abnormal carbohydrate metabolism (12%) revealed hypertriglyceridemia as the most common dyslipidemia. Correlation analysis didn’t show significant correlation between BMI & FBS but LDL, Cholesterol and TG had week positive correlation with BMI (Pearson correlation: 0.161, 0.285, 0.222 respectively, p value <0.001). Obesity and dyslipidemia are common problems in this area and we should note to screen cardiometabolic risk factors in addition of obesity, especially in children with rapid weight gain. This study highly recommended more investigation to evaluate final effect of these factors in adulthood.

Marvelon®, a combined oral contraceptive, contains 30 μg ethinyl estradiol (EE) and 150 μg desogestrel (DE), and has been shown to be a well-tolerated and effective combination that provides high contraceptive reliability and good cycle control. However, its efficacy has not been yet evaluated among Iranian women. Thus, the study aimed to determine the effect of oral contraceptive pill on treating premenstrual symptoms and on various parameters associated with well-being and health in a sample of Iranian. This clinical trial (before- after) study was performed at the family-planning clinic of the centers under the supervision of Tehran University of Medical Sciences on sixty-one women. The study protocol was approved by the Ethics Committee of Tehran University of Medical Sciences and all participants received a 21/7-day regimen of oral contraceptive containing 150 μg desogestrel (DE) and 30 μg ethinyl estradiol (EE) for six cycles. Efficacy parameters included changes in premenstrual symptoms were also assessed. Clinical data was collected by calendar of premenstrual experiences (COPE) at baseline and treatment cycles 1,2, 3 and 6. Clinical variables were measured including low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride levels for two timing periods (baseline and last visit).Linear mixed model analyses were used to analyze differences in changes of the four factors of premenstrual syndrome (PMS), weight and blood pressure during these timing periods. The mean age of the women was 28.52 (SD=6.75) years. Participants on average had been pregnant 1.13 (SD=1.16) times. The linear mixed model analyses indicated that premenstrual syndrome symptoms reduced significantly over time (P<0.05). Marvelon® showed no significant effect on reducing LDL and HDL levels, and participant’s weights were also stable during five-time assessments (P>0.05). A combined oral contraceptive containing ethinyl estradiol and desogestrel has a positive effect on women’s health and reduces premenstrual symptoms.

Emergence from general anesthesia can be associated with coughing, agitation, and hemodynamic disturbances. Remifentanil may attenuate these responses. We have examined the effect of remifentanil on the hemodynamic response to the emergence from anesthesia and tracheal extubation. In a double-blind, randomized trial, we enrolled 50 adult patients undergoing abdominal surgery. All patients received a standard general anesthetic comprising propofol, atracurium and 1% isoflurane with 50% nitrous oxide in oxygen. At the end of surgery, a bolus dose of remifentanil 0.2 microgram/kg (n = 25) or saline placebo (n = 25) was given and tracheal extubation was performed when standard criteria were achieved. Arterial pressure and heart rate were measured non-invasively, immediately after tracheal extubation and then at 1-min intervals. Remifentanil attenuated the increase in both systolic and diastolic arterial pressure and heart rate after extubation compared to the control group. No differences in SpO2, cough and laryngospasm were observed between two groups. Use of a low-dose remifentanil has clinically acceptable effect in blunting the cardiovascular changes induced by tracheal extubation.changes induced by tracheal extubation.

An electrocardiogram (ECG) leads physicians to diagnose many potentially life-threatening cardiac, metabolic, electrolyte, and toxicological conditions.This study was designed to evaluate the competency of emergency medicine residents (EMRs) in comparison with cardiologists in the interpretation of ECG when an interpretation checklist is used.This clinical trial was done in the emergency wards of the first grand general hospital of Iran. Patients were categorized in three classes of disorder severity based on ECG abnormalities. The two stages of the study included the survey phase (Stage I), training phase and intervention phase (Stage II). Accuracy of ECG interpretation by EMRs and cardiologists was compared before and after using a Daily ECG Check List (DECKList). One hundred and fifty ECGs were evaluated in Stage I, before DECKList usage, and 150 ECGs were evaluated in stage II, after DECKList usage by EMRs. Mean age of participants was 60.13 years in Stage I and 61.66 years in Stage II. Stage I and II were similar to each other in terms of disorder severity (P=0.22). Mean the ECG interpretation score was significantly different between Stages I and II (P<0.001). Concordance of ECG diagnosis between EMRs and cardiologists was significantly different in Stages I and II (P<0.01). In first-year EMRs, ECG diagnosis scores in stages I and II were not changed significantly. However, ECG interpretation scores increased significantly in first-year EMRs (P=0.04). In second-year EMRs, both ECG interpretation and ECG diagnosis scores improved significantly (P<0.05 and P<0.01, respectively). In third year EMRs, ECG interpretation was not improved but ECG diagnosis based on two methods improved significantly (P<0.05).The significant increase in accuracy of ECG interpretation and final diagnosis can be attributed to the utilization of a checklist by EMRs especially in the first year and second residents.

Hospital information system (HIS) should ideally allow different forms of data to be stored and used for decision making by clinicians and managers alike. This system has been developed since the early 1980's, and many hospitals gradually converted from an unrelated system into an integrated one. In successful implementation of HIS plans, the role of human factors, either individually or as a group, is expected to be very important and decisive. In this phenomenological qualitative research, in-depth personal interviews were conducted with the hospital's senior managers, and discussions were conducted in six to eight member focus groups. To include participants for interviews, purposive sampling was used in an Iranian hospital among doctors, nurses and other healthcare providers who had experience in using HIS. Data collection continued until saturation stage. The meetings took about 90 to 120 minutes, in which the participants were asked about discovering needs as well as facilitating and inhibiting factors regarding HIS application. Two members of the research team independently analyzed the interview transcripts. As a result, problems in HIS isolation were reported to be related to the following: software, hardware, manpower, management and training. About the last point, it was stated that adequate continuing professional development programs did not exist for proper use of computers in the hospital. To achieve the ultimate goal of HISs (e.g. increasing patient satisfaction and decreasing hospital costs), it is necessary to create basic changes in the training system, and to get feedback from hospital personnel. Other steps include addressing software and hardware shortcomings as well as moving towards reinforcing the facilitating factors and refraining from inhibiting ones discovered in this study.

E-learning as an educational approach has been adopted by diverse educational and academic centers worldwide as it facilitates learning in facing the challenges of the new era in education. Considering the significance of virtual education and its growing practice, it is of vital importance to examine its components for promoting and maintaining success. This analytical cross-sectional study was an attempt to determine the relationship between four factors of content, educator, learner and system, and effective e-learning in terms of demographic variables, including age, gender, educational background, and marital status of postgraduate master’s students (MSc) studying at virtual faculty of Tehran University of Medical Sciences. The sample was selected by census (n=60); a demographic data gathering tool and a researcher-made questionnaire were used to collect data. The face and content validity of both tools were confirmed and the results were analyzed by descriptive statistics (frequency, percentile, standard deviation and mean) and inferential statistics (independent t-test, Scheffe’s test, one-way ANOVA and Pearson correlation test) by using SPSS (V.16). The present study revealed that There was no statistically significant relationship between age and marital status and effective e-learning (P>0.05); whereas, there was a statistically significant difference between gender and educational background with effective e-learning (P<0.05). Knowing the extent to which these factors can influence effective e-learning can help managers and designers to make the right decisions about educational components of e-learning, i.e. content, educator, system and learner and improve them to create a more productive learning environment for learners.

Aneurysm can develop in all arteries of the human body. Pseudoaneurysm induced by trauma is known as a rare condition in peripheral arteries. This complication is known as late sequelae of trauma. The incidence of pseudoaneurysm in upper extremities artery is less than lower extremities. Atherosclerotic aneurysms are often seen in large arteries and by aging, but pseudoaneurysm can be seen in penetrating or blunt trauma in patients of every age or every location. Delayed treatment of pseudoaneurysm leads to bleeding, venous edema at the extremities and compression on the adjacent nerve as a result of pseudoaneurysm enlargement. Early diagnosis of pseudoaneurysm is very important, because this complication can induce disabilities such as upper extremities and finger loss. Peripheral arteries pseudoaneurysm in distal locations especially in brachial artery and forearm can cause a thrombotic complication in hands and fingers.

Venous malformations are the most common form of symptomatic vascular malformations. VM s could classify into low-flow lesions (VMs) and high-flow lesions (AVMs). For low-flow venous lesions, direct percutaneous puncture with injection of sclerosing agents (sclerotherapy) has been described as a successful therapy. In this article, we want to introduce a patient who treated with ethanol sclerotherapy for VM located in the right flank. The patients were a 35-year-old man with right flank mass, skin discoloration and hemorrhagic foci. Color Doppler ultrasonography showed low flow vascular malformation while Magnetic Resonance Imaging (MRI) showed that the mass contained fat tissue with branching tubular signal void structures inside. The draining vein was first coiled via tortuous venous malformation vessels access and then VM was embolized.Under ultrasonographic guide, direct puncture of one branches of venous malformation was performed, and contrast media were injected. The patient underwent the sclerotherapy every month for four consecutive months. The patient was followed up for a year, and clinical examination revealed 40-50% size reduction of the lesion while no bleeding was detected from the lesion during the follow-up period. Sclerotherapy with ethanol is a useful method for emboli zing VMs.