Iranian Red Crescent Medical Journal
Volume:15 Issue: 12, Dec 2013

Cichorium glandulosum (CG), which is a Compositae family plant, is a commonly used traditional Uighur medicine capable of cleansing liver and being cholagogue, strengthening stomach, promoting digestion, inducing diuresis and reducing edema.. To study the liver and spleen indices, the levels of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and the histopathological changes. Rats were intragastrically administered with the extracts of a traditional Uighur medicine Cichorium glandulosum (CG). The expressions of FN, Smard3 IGFBPrPl and TGF-β1 were detected. The liver and spleen indices of the CG-V group were significantly lower than those of the model group (p < 0.01). The hepatic fibrosis symptoms of the CG-V and CG-VII groups were significantly relieved, and more FN, Smard3 and IGFBPrPl were expressed than those in the normal group. The expressions of FN, Smard3 and TGF-β1 in all treatment groups were significantly higher than those in the normal group, and the expressions in the CG-V and CG-VII groups were significantly different from those in the model group (p < 0.05). Compared with the normal group, the apoptotic index of the model group was significantly higher, but the indices of the CG-V and CG-VII groups were significantly lower than that of the model group (p < 0.01). The extracts of CG probably exerted protective effects by influencing the TGF-β/Smads signal transduction pathway.

Intraperitoneal adhesion formation is a serious postsurgical issue. Adhesions develop after damage to the peritoneum by surgery, irradiation, infection or trauma. Using a rat model, we compared the effectiveness of systemic and intraperitoneally administered common immunosuppressive drugs for prevention of postoperative intraperitoneal adhesions. Peritoneal adhesions were induced in 98 female Wistar-Albino rats by cecal abrasion and peritoneal excision. Rats were randomly separated into seven groups, each containing fourteen rats, and the standard experimental model was applied to all of rats. 14 days later, rats were euthanized, intraperitoneal adhesions were scored and tissues were examined histologically using hematoxylin/eosin and Masson’s trichrome staining. Throughout the investigation, no animal died during or after surgery. In all of experimental groups, decrease in fibrosis was statistically significant. Decrease in fibrosis was most prominently in intraperitoneal tacrolimus group (P = 0.000), and decrease was least in intraperitoneal cyclosporine group (P = 0.022). Vascular proliferation was significantly decreased in all experimental groups (P < 0.05) except for systemic tacrolimus group (P = 0.139). Most prominent reduction in vascular proliferation was in intraperitoneal tacrolimus group (P = 0.000).. Administration of immunosuppressive drugs is effective for prevention of intraperitoneal adhesions.

Postoperative nausea and vomiting is one of the most common side effects associated with surgical procedures. The aim of this study was to determine the effect of ginger on intensity of nausea and vomiting after surgical procedures.Patients and This study was a randomized, double blinded, clinical trial. 160 eligible patients were randomly assigned into experimental or placebo groups. The experimental group received 4 capsules containing 250 mg ginger and placebo group received 4 placebo capsules 1 hour before surgery. The severity of nausea and vomiting was measured at 2, 4, 6 hours post operation using visual analogue scale and a structured questionnaire. The data were analyzed by independent t - test, Mann-Whitney U test, chi –square and GEE using SPSS 16 and STATA version 11. Mean nausea score at 2 hours post operation was significantly lower in the experimental group (P= 0.04). Mean nausea score at 4 and 6 hours post operation was lower in the experimental group; however, there was no significant difference between the groups at any time post operation. The frequencies of nausea in the experimental group at 2 and 6 hours post operation were lower than that in the placebo group, however, at 2 hours post operation, it was borderline significant (P = 0.05) There was no significant differences between two group in the intensity of vomiting at any time. Use of ginger was effective at decreasing postoperative nausea. Ginger could be used as a safe antiemetic drug at post operation.

To evaluate the efficacy of prothrombin complex concentrate (PCC) in the management of bleeding in patients with liver disease and patients undergoing surgery or biopsy who had a high uncorrected international normalized ratio (INR). In this study, we examined an Iranian sample and investigated the efficacy of PCC to manage bleeding in patients with liver disease and also patients with high uncorrected INR who were scheduled for surgery or biopsy. A total of 25 patients including 16 patients with post-liver disease bleeding (group 1) and 9 patients with high uncorrected INR who were scheduled for surgery or biopsy (group 2) were enrolled. All patients were treated with 25 IU/kg PCC, and efficacy was defined as any reduction in or cessation of bleeding episodes and correction of INR before surgery or biopsy. The patients were also evaluated for any adverse effects. INR decreased significantly in both groups of patients, with no bleeding episodes during or after the study in group 1 and during or after surgery/biopsy in group 2. All patients tolerated the therapy well without any significant adverse effects. The efficacy of PCC therapy was satisfactory in this study. PCC therapy in patients with liver disease and patients undergoing surgery or biopsy seems to be effective and safe, and may be a good treatment strategy for these patients, if fresh frozen plasma or vitamin K are not effective.

Cerebral sinovenous thrombosis (CSVT) in children has rarely been reported in the literature, especially without underlying disorder. It has increasingly been diagnosed due to clinical awareness and sensitive neuroimaging techniques. The aim of this article was to report a case of cerebral sinovenous thrombosis without underlying disorder. We reported a 5 year old girl, presented with severe headache and seizure. She had a history of fever and diarrhea before the onset of headache. Neuroimaging showed evidence of CSVT on MRI and magnetic resonance venography. Investigations showed no inherited thrombophilia. The patient was treated with low molecular weight heparin (LMWH) which continued by warfarin. This case illustrated severe complications of dehydration in pediatrics without any evidence of underlying disorders..

Approximately 20% of recovered oocytes are immature and discarded in intracytoplasmic sperm injection (ICSI) procedures. These oocytes represent a potential resource for both clinical and basic science application. The aim of this study was to evaluate the ultrastructure architecture of in vitro matured human oocytes using transmission electron microscopy (TEM). A total of 204 immature oocytes from infertile patients who underwent ICSI cycles were included in this prospective study. Immature oocytes were divided into two groups: (i) GV oocytes (n = 101); and (ii) MI oocytes (n = 103). Supernumerary fresh in vivo matured oocytes (n = 10) were used as control. The rates of maturations were 61.38% for GV and 73.78% for MI oocytes in IVM medium (P = 0.07). However, the rate of oocyte arrest was significant between groups (P <0. 05). Ultrastructurally; in vitro and in vivo matured oocytes appeared round, with a homogeneous cytoplasm, an intact oolemma and an intact zona pellucida. However, immature oocytes indicated numerous large mitochondria-vesicle complexes (M-VC). Ultrastructural changes of M-VC in IVM groups emphasize the need for further research in order to refine culture conditions and improve the implantation rate of in-vitro matured oocytes.

Little is known about the duration of combination therapy for patients with chronic hepatitis B (CHB) and suboptimal response to nucleos(t)ide analogues(NAs) monotherapy. This study aimed to assess whether monotherapy could be used for treatment of CHB patients, who poorly responded to Adefovir Dipivoxil (ADV) but obtained good responses after at least 12-month lamivudine (LAM) or telbivudine (LdT) add-on therapy.Patients and : Forty-five patients were enrolled, and the baseline time-point was determined according to enrollment data. Twenty-six patients chose to continue combination therapy (LAM+ADV or LdT+ADV, Group A) and 19 patients switched to single-drug maintenance therapy (LAM or LdT or ADV, Group B). There were no significant differences between two groups in baseline characteristics (P > 0.05). At 12th month, sustained virological response rate was greater in group A compared to group B (96.2% vs. 47.4%, P < 0.001), and the rates of NAs-associated resistance were 0% in group A and 15.8% in group B. Alanine aminotransferase normalization rate was also significantly higher in group A compared with group B (92.3% vs. 36.8%, P < 0.001). Among hepatitis positive patients with Be antigen (HBeAg)-, 40% (4/10) in group A and 9.1% (1/11) in group B achieved HBeAg seroconversion at the 12th month. Of patients in group B with positive-HBeAg before the previous combination therapy and detectable HBV DNA at 6 months of previous combination therapy were associated with high risks of viral relapse after switching to single-drug maintenance therapy. Prematurely switching to single-drug maintenance therapy would be resulted in viral relapse, and prolonged combination therapy was effective to maintain sustained responses for patients with initial suboptimal response to ADV.

The spleen is the most commonly injured intraperitoneal organ in multiple trauma patients. Total splenectomy results in immunodeficiency and predisposes patients to certain infections. Performing partial splenectomy with a safe, simple, and definite technique in trauma patients with hemodynamic instability and accompanying intra-abdominal injury could play an important role in the preservation of immune function and reducing morbidity.Patients and From 2006 to 2009, a total of 20 patients underwent partial splenectomy, at Mobasher and Be’sat hospitals. Patients with splenic injuries of up to stage IV and grade 3 shocks underwent partial splenectomy. The operations were performed without vascular isolation and by wedge resection of the injured splenic tissue and repair with chromic 2/0 sutures in two rows. Three months later, patients were evaluated by a Tc99 liver-spleen scan, complete blood count, and blood smear. There were 16 male and four female patients with an age range of 4 to 54 years old. Ten patients had additional intra and extra abdominal injuries. The salvaged spleen tissue was approximately 30% in nine patients, 40 to 50% in two, and more than 50% in another nine patients. The operation time was less than three hours and hospital stay was 3 to 15 days for 90% of the patients. No complications occurred after the surgery or during the follow up. For all patients, the complete blood count, peripheral smear, and liver-spleen scan were normal after six months. Partial splenectomy with preserving at least 30% of the splenic tissue can be performed for trauma patients using wedge resection of the injured splenic tissue and repair by chromic 2/0 sutures in two rows. Using this technique, there is no need for vascular isolation or hemostatic materials. Splenic function is presented and associated intra and extra abdominal injuries are not contraindications for partial splenectomy.

Emphysematous Pyelonephritis (EPN) is an acute suppurative Infection of the kidney. It is an uncommon infection, occurs mostly in patients with diabetes and a predilection for females. It has a high fatality rate; therefore, aggressive medical, early intervention or surgical approach is recommended. We present here a woman with no previous medical history presented with uncontrolled hyperglycemia for the first time associated with EPN.

Pneumothorax is common and life-threatening clinical condition which may require emergency treatment in Emergency Medicine Departments. We aimed to reveal the epidemiological analysis of the patients admitted to the Emergency Department with pneumothorax. This case-control and multi-center study was conducted in the patients treated with the diagnosis of pneumothorax between 01.01.2010-31.12.2010. Patient data were collected from hospital automation system. According to the etiology of the pneumothorax, study groups were arranged like spontaneous pneumothorax and traumatic pneumothorax. 82.2% (n = 106) of patients were male and 17.8% (n = 23) of patients were female and mean age were 31.3 ± 20,2 (Minimum: 1, Maximum: 87). 68.2% (n = 88) of patients were spontaneous pneumothorax (61.36%, n=79 were primary spontaneous pneumothorax) and 31.8% (n = 41) of patients were traumatic pneumothorax (21.95% were iatrogenic pneumothorax). Main complaint is shortness of breath (52.3%, n=67) and 38% (n=49) of patients were smokers. Posteroanterior (PA) Chest X-Ray has been enough for 64.3% (n = 83) of the patients'' diagnosis. Tube thoracostomy is applied to 84.5% (n = 109) of patients and surgery is applied to 9.3% (n = 12) of patients and 6.2% (n = 8) of patients were discharged with conservative treatment. Spontaneous pneumothorax showed statistically significant high recurrence compared with traumatic pneumothorax (P = 0.007). 4.65% of (n = 6) patients died. The average age of those who died (9.3 ± 19.9), statistically were significantly lower the mean age of living patients (32.4 ± 19.7) (t test, P = 0,006). 83.33% of the patients who died were neonatals and in the 0-1 years age group, and five of these patients were secondary spontaneous pneumothorax, and one of these patients were iatrogenic pneumothorax due to mechanical ventilation. Pneumothorax in adults can be treated by tube thoracostomy or surgically. Despite treatment, mortality of secondary and iatrogenic pneumothorax in newborns and 0-1 years age group is high.

Nowadays, using new information technology (IT) has provided remarkable opportunities to decrease medical errors, support health care specialist, increase the efficiency and even the quality of patient’s care and safety. The purpose of this study was the identification of Hospital Information System (HIS) success and failure factors and the evaluation methods of these factors. This research emphasizes the need to a comprehensive evaluation of HISs which considers a wide range of success and failure factors in these systems. We searched for relevant English language studies based on keywords in title and abstract, using PubMed, Ovid Medline (by applying MeSH terms), Scopus, ScienceDirect and Embase (earliest entry to march 17, 2012). Studies which considered success models and success or failure factors, or studied the evaluation models of HISs and the related ones were chosen. Since the studies used in this systematic review were heterogeneous, the combination of extracted data was carried out by using narrative synthesis method. We found 16 articles which required detailed analysis. Finally, the suggested framework includes 12 main factors (functional, organizational, behavioral, cultural, management, technical, strategy, economy, education, legal, ethical and political factors), 67 sub factors, and 33 suggested methods for the evaluation of these sub factors. The results of the present research indicates that the emphasis of the HIS evaluation moves from technical subjects to human and organizational subjects, and from objective to subjective issues. Therefore, this issue entails more familiarity with more qualitative evaluation methods. In most of the reviewed studies, the main focus has been laid on the necessity of using multi-method approaches and combining methods to obtain more comprehensive and useful results.

The level of platelet volume (MPV) has been reported to be a laboratory marker in inflammatory cases. The aim of this study was to seek whether MPV has a role in the diagnosis of acute appendicitis. It was also aimed to show the relationship of MPV with leukocyte count and C-reactive protein (CRP) level. This study was conducted via retrospective assessment of the hospital records of the adult patients who were operated for acute appendicitis between January 2010 and December 2012 and had a pathology report that confirmed the diagnosis of acute appendicitis. The patients in the control group were selected from healthy adults of similar age who applied to check-up clinic. The number of essential cases was defined by performing power analysis. Age, gender, leukocyte count, CRP, and MPV values were recorded. This study is a case controlled retrospective clinical study.. A total of 503 patients in the acute appendicitis group and 121 patients in the control group were included, making up a total of 624 subjects. The median MPV levels were 7.92 ± 1.68 fL in the acute appendicitis group, while 7.43 ± 1.34 fL in the control group. CRP, leukocyte count, and MPV level were significantly higher in the acute appendicitis group (P < 0.001). MPV, leukocyte count, and CRP had a sensitivity and specificity of 66% and 51%; 91% and 74%; and 97% and 41%, respectively. No correlation was found between MPV, CRP, and leukocyte count. MPV level was higher in patients with acute appendicitis. MPV may guide the diagnostic process of acute appendicitis. However, we detected that the sensitivity and specificity of leukocyte count and CRP were superior to those of MPV in the diagnosis of acute appendicitis.

Methemoglobinemia is a disorder characterized by the presence of a higher than normal level of methemoglobin. Prilocaine which is one of the oxidizing local anaesthetics is widely used in many local procedures. The first choice of treatment of complications due to the use of these local anaesthetics is methylene blue, while ascorbic acid is the alternative choice. The side effects of metilen blue restrict its usage in some special conditions. Ascorbic acid is a good alternative drug with limited experience in methemoglobinemia. We present a case of a methemoglobinemia treated with ascorbic acid successfully to emphasize the use of ascorbic acid as an alternative method..

The prevalence of DDH ranges from 1 per1000 to 3.4 per 100 live- births. One- and-one-half hip spica cast is the conventional technique of immobilization after the open reduction with or without osteotomy. In this study, we evaluated the preference of bilateral one-half spica cast over the one-and-one-half spica cast. Eight hips in five patients with developmental dislocation of the hip have undergone open reduction. Salter osteotomy, Pemberton osteotomy and femoral shortening were done on two, two and six hips, respectively. Bilateral one-half spica cast with trochanteric molding was applied for all of the hips. The patients’ age ranged from 1.5 to 7 years old. The only complications consisted of two osteonecrosis of the head and one superficial infection. No dislocation, graft displacement, nonunion and device failure was occurred. Bilateral one-half spica cast is sufficient after the open reduction with or without osteotomy in DDH patients and we can substitute the bilateral one-half spica cast above the knee cast for the conventional one and one-half spica cast.

Successful pregnancy is the ultimate goal of almost all couples. However, this pleasant event is usually accompanied psychological and behavioral changes and can result in stress in women, particularly women who pregnant by assisted reproductive technology methods (ARTs). This study aims to determine the anxiety level during pregnancy and its relation with infertility factors in women who has been pregnant by Assisted Reproduction Technology (ART) methods.Patients and A total number of 100 ARTs pregnant women who came to three infertility centers in Tehran from August to November 2009 participated in this descriptive cross sectional study. The rational for selecting the subjects was their availability to the researcher at the time of the research. Anxiety was measured by Beck Anxiety Inventory and for obtaining the infertility data, a questionnaire designed by the researcher was given to the subjects. Data were statistically analyzed using the inferential statistic of chi-square. Study results showed that 34 % of subjects were anxious (moderate and sever levels in total). There are significant relations between infertility duration, history of treatment failure and anxiety level (P = 0.03) (P = 0.02). There were no statistically significant relationships with regard to other variables. Infertility duration and history of treatment failure in ARTs pregnant women are two factors that affect the anxiety level during pregnancy.