Acta Medica Iranica
Volume:52 Issue: 12, Dec 2014

The isolated perfused rat liver (IPRL) model has been used into toxicology study of rat liver. This model provides an opportunity at evaluation of liver function in an isolated setting. Studies showed that Cd, in a dose-dependent manner, induced toxic effects in IPRL models, and these effects were associated with aminotransferase activity and lipid peroxidation. The aim of this study was to investigate whether Mg and/or Se could have protective effects against the Cd toxicity in the IPRL model. Male Wistar rats (9-10 weeks) weighing 260-300 gr were used in this study. They were randomly divided into 8 groups of 4-6 rats per cage. In group 1, liver was perfused by Krebs-Henseleit buffer without MgSO4 (Control). Groups 2-8 were exposed to Mg, Se, Cd, Mg +Se, Cd + Mg, Cd + Se, Cd + Mg + Se respectively in Krebs-Henseleit buffer with no added MgSo4. Biochemical changes in the liver were examined within 90 minutes, and the result showed that the exposure to Cd, lowered glutathione level, while it increased malondialdehyde level and aminotransferase activities in IPRL model. Mg administration during exposure to Cd reduces the toxicity of Cd in the liver isolated while Se administration during exposure to Cd did not decrease Cd hepatotoxicity. Nevertheless, simultaneous treatment with Se and Mg on Cd toxicity have strengthened protective effects than the supplementation of Se alone in the liver.

Pemphigus Vulgaris (PV) is often complicated by osteoporosis. Although corticosteroid therapy undoubtedly plays a causative role, inflammation associated with PV may also contribute to osteoporosis. This study was designed to determine the prevalence of osteoporosis in patients with PV before corticosteroid therapy and to compare these findings with those reported previously in healthy volunteers. Newly diagnosed patients with PV, who had not received systemic corticosteroids, were enrolled. Bone mineral density (BMD) was measured both in the lumbar spine (L1-L4) and hip region. Data were compared with those of a healthy Iranian population. The association between the disease duration and severity and BMD was evaluated. A total of 50 patients (27 women) with a mean age of 42.6±14.5 years were enrolled. Osteoporosis was seen in 7 (14%) patients, 3 (11.1%) women, 4 (17.4%) men, and in both genders it was more common when compared to the population of healthy Iranians (8.2% in women and 4.9% in men). Osteopenia was found in 26 (52%) patients, 13 women and 13 men. Although both osteopenia and osteoporosis were more common in severe disease, neither the duration nor the severity of PV showed a statistically significant association with osteopenia or osteoporosis. The presence of a higher than expected rate of osteoporosis in patients with PV argues for osteoporosis screening and efforts aimed at prevention and early initiation of treatment to prevent unnecessary morbidity.

One of the important factors which should be considered in (Coronary artery disease) CAD cases is increased carotid intima-media thickness (IMT) which has been considered to be associated with coronary artery disease severity and cardiovascular events. The goal of this study was to compare risk factors and carotid IMT in cases with CAD and healthy subjects and to determine the association between severity of CAD and IMT. In this case-control study, 250 proved CAD cases and 250 healthy ones were enrolled. Ultrasound evaluation of carotid IMT Ultrasound quantification of the right and left carotid IMTs was obtained. Demographic characteristics (age and sex), risk factors (presence of diabetes, hyperlipidemia (HLP), hypertension (HTN) and smoking) were recorded for all participants. Presence of diabetes, HTN, HLP and mean age was significantly higher in patients than controls. There was positive correlation between IMTs and advancing CAD (for right IMT, rho=0.34, P<0.001, for IMT rho=0.47, P<0.001). Sex, HTN, HLP, right and left IMT measures were independent predictors of CAD. The best cutoff point for right IMT to differentiate patients from controls was 0.82 with sensitivity and specificity of 70% and 50% (AUC=0.70, P<0.001). The best cutoff point for left IMT to differentiate patients from controls was 0.85 with sensitivity and specificity of 80% and 55% (AUC=0.70, P<0.001). Carotid IMT increase should be considered as a surrogate factor for CAD.

The aim of the current study was to evaluate anxiety in patients with multiple sclerosis (MS) and factors which are associated with this symptom. Eighty totals of 180 patients with MS were enrolled in this cross-sectional study. They were asked to answer the valid and reliable Persian version of the Beck depression inventory (BDI) and Beck anxiety inventory (BAI) questionnaires. Demographic characteristics (sex and age), duration of the disease, disease course and Kurtzke Expanded Disability Status Scale (EDSS) were recorded for all participants. Mean BDI was 17.5 ± 11.4 in patients while mean BAI was17.7 ± 12.5 in all participants, respectively. Mean BDI and BAI were not statistically different between male and female participants. Patients with higher levels of disability (higher EDSS) had significant higher BDI and BAI scores and there was significant positive correlation between EDSS and BDI and BAI scores (rho=0.42, P<0.001, rho=0.35, P<0.001). Patients with SP (Secondary progressive) type of disease had significant higher BDI and BAI score. Multiple linear regression analysis showed that depression and disability level were independent predictors of anxiety in patients. Anxiety and factors which are related with this symptom should be considered in MS patients.

It has been proved that hyperhomocysteinemia has a high prevalence in patients with end-stage renal disease (ESRD), which may contribute to the high cardiovascular risk in these patients. Cardiovascular disease is the first cause of high mortality rate in ESRD patients. The aim of the present study was to assess five important factors in patients with ESRD (the amount of homocysteine, IL-6, TNF-alpha, hs-CRP, and Total Antioxidant Capacity). These factors were surveyed in ESRD patients to compare with healthy subjects. In a cross-sectional study, we enrolled 80 patients on maintenance hemodialysis and measured the inflammatory and oxidative stress indicators. The plasma samples were assayed for five above mentioned variables using standard protocols. Two-hour post hemodialysis plasma samples were also assayed for TAC. Plasma levels of inflammation markers, IL-6 and hs-CRP, homocysteine were significantly increased in ESRD group versus control group. This increase was also found in TNF-α levels as compared to the controls, but the differences were not statistically significant. Also, the post dialysis samples had significantly lower levels of TAC as compared to predialysis ones.

Oral feeding difficulties are common in children with cerebral palsy (CP). The effect of oral-motor dysfunction on feeding problems has been proved in several studies. The purpose of the present study was to evaluate the effect of oral sensorimotor stimulations on feeding performance in children with spastic cerebral palsy. A total of 12 children with spastic cerebral palsy underwent 24 sessions of oral-motor stimulations (3 days per week). The effect of the intervention was assessed after the 12 and 24 sessions. Feeding skills were assessed using Oral Motor Assessment Scale (OMAS). Data were analyzed using Friedman test and intra class correlation coefficient (ICC). The results of the study revealed a significant improvement in feeding skills including mouth closure, lip closure on the utensil, lip closure during deglutition, control of the food during swallowing, mastication, straw suction and control of liquid during deglutition. There were more improvement in mouth closure and less in straw suction. This study showed sensorimotor stimulation is useful for the treatment of the feeding problems, but the progress was not perfect. This could be due to the role of the position and cognitive skills in feeding functions. Thus, other strategies should be considered to achieve more improvement in feeding performance.

High prevalence of asthma and bronchospasm was observed during induction of anesthesia in patients with chronic suppurative otitis mMedia (CSOM) who underwent tympanomastoidectomy. Although several studies have proposed association of allergic diseases with CSOM but no consensus about it has been established. Current study was designed to determine the coincidence of asthma in CSOM patients. In a cross-sectional study, authors investigated medical records of 106 CSOM patients underwent tympanomastoidectomy, aged 15 to 65 years, and 95 controls, which were matched by age and sex. Participants were admitted to Valiasr Hospital, Tehran, Iran, from April of 2011 to March of 2013. Required information, such as demographic characteristics and history of allergic rhinitis (AR) and asthma were obtained from patient's medical records. The prevalence of AR in the CSOM group was higher than controls’ group (19.8% and 15.8%, respectively) (P>0.05). Asthma prevalence was significantly higher in patients with CSOM (P=0.03) (OR=7.67, 95% CI: 0.9-62.5). No significant association was found between history of AR and chronic ear infections. However, asthma was significantly more common in CSOM patients. Current study indicates that asthma and risk of bronchospasm need particular attention in patients with CSOM underwent tympanomastoidectomy before and during anesthesia.

Spiritual elements play an important role in the recovery process from acute postoperative pain. This study was conducted to assess the effect of pray meditation on postoperative pain reduction and physiologic responds among muslim patients who underwent cesarean surgery under spinal anesthesia. This double-blinded randomized clinical trial study was conducted among muslim patients who underwent cesarean surgery under spinal anesthesia during 2011-2013 at tertiary regional and teaching hospital in Lorestan, Iran. The patients were randomly divided into interventional group (n=80) and control group (n=80). For about 20 minutes using a disposable phone mentioned and listened to pray meditation "Ya man esmoho davaa va zekroho shafa, Allahomma salle ala mohammad va ale mohammad" in interventional group and phone off in control group. Before and during pray meditation, 30, 60 minutes, 3 and 6 hours after pray meditation pain intensity, blood pressure, heart rate and respiratory rate were measured. No statistically significant improvement in pain score was found before and during pray meditation, 30, 60 minutes after pray meditation (P>0.05). Statistically significant improvement in pain score was found at 3 and 6 hours after pray meditation than control group (1.5 ± 0.3 vs. 3 ± 1.3, P=0.030) and (1.3 ± 0.8 vs. 3 ± 1.1, P=0.003). However, there was no significant difference in the physiological responses (systolic and diastolic blood pressure, respiration, and heart rate) any time between the groups. Religion and spirituality intervention such as pray meditation could be used as one of non-pharmacological pain management techniques for reducing pain after cesarean surgery. Also, Pray meditation provides less postoperative nausea and vomiting (PONV) and more relaxation.

Opportunistic infections are the leading cause of hospitalization and morbidity in human immunodeficiency virus (HIV) positive patients and are the most common cause of death between them. We aimed to measure IgG antibody against EBV viral capsid antigen (EBV-VCA IgG) to determine the seroprevalence of this infection in HIV-positive population. A case-control study between September 2011 and October 2012 was conducted in a teaching hospital enrolling 114 HIV-positive patients as case group and 114 healthy individuals as control with similar age and sex. Enzyme-linked immunosurbant assay (ELISA) technique was used for determination of EBV-VAC IgG in obtained samples. Of 114 serum samples obtained from HIV-positive patients, 103 (90.4%) samples were found positive for EBV-VCA IgG antibody. There was no significant difference in seroprevalence of EBV VCA IgG antibody between patients received antiretroviral therapy and naive patients (91.5% vs. 87.5%, P>0.05). There was no statistically significant difference in EBV-VCA IgG seroprevalence between three groups of CD4+ in HIV positive group. In conclusion current study showed that seroprevalence of EBV in HIV-positive patients is higher than HIV-negative healthy participants; however, administration of HAART and CD4+ lymphocyte count did not reveal a significant effect in seroprevalence of EBV. Due to the significance of this virus in mortality and morbidity and causing certain malignancies in patients with AIDS, these patients are strongly recommended to be tested for this virus.

Emergency medicine is a relatively new specialty in Iran. Therefore, the general public and the medical community do not have enough information on its duties, capabilities, its nature, and its work schedule or its degree of occupational difficulty compared to other specialties. Hence, an insight from the early group of residents who selected this specialty can help identify the strengths and weaknesses of this field in order to promote the scientific quality of this field, and attract medical students. It can also help to alleviate deficiencies and strengthen positive aspects of emergency medicine. The aim of this study was to identify the reasons behind choosing emergency medicine as a specialty. A qualitative study was conducted using semi-structured interviews. Maximum variation opportunistic sampling was done, and face-to-face interviews were held with 23 emergency medicine residents and fellows (4 faculty members and 19 residents). Data were analyzed through thematic analysis, and categories and themes were extracted. The main levels extracted were: 1) Individual priorities, 2) the nature of work and the field of study, and 3) professional future. The themes of each main level were extracted and encoded. This study showed that the majority of residents choose emergency medicine specialty to achieve a better social and professional status in one of the most challenging fields of medicine.

Injecting local anesthetic at the seeking current would be appealing.It would save time and avoid potentially dangerous manipulations of the needle. This study aimed to test the hypotheses that in vertical infraclavicular block, injecting local anesthetic at a seeking current of 0.8 mA would produce the same quality of block as injecting at ≤0.5mA. A total of sixty ASA I –III adult patients scheduled for elective surgery on the hand, wrist and forearm in two equal groups of 30 patients, were enrolled in this study. The technique described by Kilka & Geiger used in both groups. After eliciting a clear and visible motor response of all fingers in either extension or flexion, injection was performed at a current of 0.8 mA and ≤0.5 mA in study and control groups respectively. Duration of time to analgesia and to anesthesia was evaluated. The mean duration of onset of analgesia in radial, median and ulnar nerves in both groups, were similar. The onset of anesthesia took a mean of 13.5 minutes in the control group and 15.6 minutes in study group (P=0.064). The onset of analgesia was 4.2 minutes in the control group and 4.3 minutes in study group. (P=0.508). The success rate in both groups was 100%. We had patients in both groups who developed complete anesthesia of the hand within 25 minutes. We conclude that the injection at 0.8 mA would result in a similar quality of block to one injected at ≤0.5 mA. The difference between two groups was not statistically significant.

Carbon monoxide (CO) poisoning is still a health problem all over the world. Informing users about symptoms and suggesting annual inspection of CO producing devices will result in CO poisoning reduction. The goal of this study was to evaluate awareness about CO poisoning symptoms and its prevention ways in Iranian population. In this study, a total of 700 patients’ family members attended Imam Khomeni hospital were asked to enroll in the study. A structured questionnaire was used including demographic characteristics, devices which were used at home, awareness of CO poisoning symptoms, awareness of CO detectors, the last time that tubal patency of devices are checked, if it is helpful to open the window to fix gas leak and if surveying devices by an expert at the beginning of the cold season is recommended. A total of 635 participants completed questionnaires. The most used device was gas water heater followed by gas heater. Five hundred and nine reported that they are aware of CO poisoning symptoms (80.1%), 398 (62.6%) stated that it is possible to detect CO leak and 566 (89.1%) told CO detectors would be helpful for reduction of mortality from CO poisoning. Fifty percent of participants had not checked their devices since they have bought their devices. Five hundred and thirty-six (84.4%) reported that opening window could help CO leak, and 596 (93.8%) agreed that an expert checked their fuel-burning devices at the beginning of the winter. Iranian people are not aware of all CO poisoning symptoms. Developing a national strategy for CO surveillance and people education will be helpful.

Around the world there is a growing consensus that student's rights must be protected, regardless of race, creed, color, sex, religion, and socioeconomic status. One of these rights is the educational equity. However, little is known about these phenomena in nursing education. The aim of this study was to explore the educational equity from the perspective of nursing students. A qualitative study was conducted. Thus, we purposefully recruited for in-depth interviews 13 nursing students (8 female and 5 male). All interviews were transcribed verbatim and analyzed by thematic analysis approach to identify categories and themes. Four main themes emerged from the data: Fair Educational Opportunity, fair evaluation, attempts to combat discrimination, and employing qualified teachers. It is argued that educational equity should be developed in higher education. Principles of equity and students’ rights may form the most basic rationale for all formal and informal efforts to extend the right of equal access to education.

Trauma is a common cause of death and disability in children. Proper approach to pediatric trauma involves adherence to ABCDE sequence in the primary survey and resuscitation in order to promptly recognize and manage immediately life threatening conditions. This readily reviewed sequence includes A: establishment and maintenance of a patent airway while maintaining cervical spine immobilization; B: evaluation of breathing, ventilation and oxygenation, immediate treatment of tension pneumothorax, open pneumothorax and massive hemothorax; C: evaluation and treatment of circulatory compromise and shock; D: Disability and Neurologic Status, assessment of signs of increased intracranial pressure and impending cerebral herniation; and E: Exposure while preventing hypothermia. Implementing these assessment and management priorities can result in more favorable outcomes.

Aluminum phosphide (AlP) is a solid fumigant which is widely used for a suicide attempt in Iran. Although neurologic symptoms are commonly reported, cerebrovascular stenosis is rare in AlP poisoning. We described ischemic stroke as a delayed complication of AlP intoxication. A 30-year-old man was admitted because of sudden onset left side hemiplegia, 11 days after intentional ingestion of three rice tablets. Investigations revealed in situ thrombosis in right middle cerebral artery (MCA) while other causes of stroke in young adults were excluded. Ischemic stroke should be considered as a delayed complication of AlP intoxication even after the acute phase of intoxication.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is an infrequent cytotoxic T-cell lymphoma of the skin with a unique immunophenotypic profile. Here we describe this lymphoma in a 30-year-old Iranian woman. She presented with periorbital edema, mandibular swelling with edematous areas on her face and two small lymph nodes (6-7mm) in the cervical area. Histopathological findings revealed lobular infiltration of atypical lymphoid cells in subcutaneous tissue, especially around individual fat cells. Immunohistochemical evaluation of the atypical lymphocytes showed CD3 and CD8 immunoreactivity and CD4 and CD56 negativity. She was diagnosed as SPTCL based on clinical, histopathological and immunohistochemical findings. This report suggests that SPTCL should be considered in the differential diagnosis of any atypical skin lesion involving subcutaneous fat. Suitable deep skin biopsy and immunohistochemical staining are essential to differentiate between SPTCL and other more common diagnoses.