مجله دانشکده پزشکی اصفهان
پیاپی 619 (هفته سوم خرداد 1400)

Hepatic fibrosis is often attributed to activation of hepatic stellate cells (HSCs) and excessive scar formation in the liver. Because these cells overproduce extracellular matrix, the advanced stages of the disease often lead to liver cirrhosis and hepatocellular carcinoma. In this study, the role of cholesterol in the activation of hepatic stellate cells was investigated.

Cells were cultured in Dulbecco's modification of Eagle’s medium (DMEM) with 10% Fetal Bovine Serum (FBS), and treated with 25, 50, 75, and 100 μM cholesterol concentrations for 24 hours. Then, gene expression transforming growth factor beta (TGF-β) and collagen1α, as well as Smad3C protein level were measured to assess liver fibrosis.

The expression of TGF-β and collagen1α genes increased significantly compared to the control group at 75 and 100 μM cholesterol concentrations. In addition, Smad3C protein level increased significantly compared to the control group after 4 hours of cell treatment with a concentration of 100 μM cholesterol.

Cholesterol increases the major proteins involved in the production of extracellular matrix, including collagen1α, by increasing the level of the Smad3C protein and activating the TGF-β signaling pathway. As a result, cholesterol can lead to the development of liver fibrosis.

Emergency Medical Service (EMS) has an important role in the management of patients with opioid poisoning. Proper administration of naloxone is life-saving in these patients. We performed a study to compare the correlation between naloxone prescribed by the EMS and poisoning emergency physician in hospital for patients with opioid poisoning.

Patients with opioid poisoning referred by EMS to the poisoning emergency room of Khorshid Hospital affiliated to Isfahan University of Medical Sciences, Iran, from April 2016 to March 2017 were evaluated for toxico-epidemiological factors and outcome.

Out of 340 patients studied, 80% were men. Poisoning with methadone (33.3%) and opium (23.2%) were the most opioid poisoning. 47.9% of patients were drowsy after administration of naloxone by EMS, 35.9% were fully conscious, and 3.5% were restless. There was a significant difference in blood oxygen saturation between the two groups receiving and not receiving naloxone by EMS (P = 0.02). The mean age of patients receiving naloxone by EMS and hospital emergency service was higher than patients not receiving naloxone. There was a strong correlation between naloxone administration by EMS and in the hospital (r = 0.77; P < 0.001). Kind of opioid (opium) and patient’s age (more than 40 years) predicted the naloxone administration by EMS and in the hospital. All patients recovered completely.

There was a strong correlation in naloxone administration between EMS and emergency service in hospital. Due to the high average age of patients receiving naloxone, more attention to prevent possible side effects of naloxone is recommended.

Congenital heart diseases (CHDs) are the most common type of birth defect. Success in the early detection of critical congenital heart diseases (CCHDs) using pulse oximetry technology depends on a large extent on physicians’ awareness of neonatal clinical examinations. The aim of this study was to investigate physicians’ awareness of newborn pulse oximetry screening for early detection of CCHD in Isfahan City, Iran.

A total of 65 physicians participating in the meeting at the continuing education programs at Isfahan University of Medical Sciences were enrolled in this descriptive-analytical, cross-sectional study in 2019-2020. Data were collected by a questionnaire, developed by the researchers, which validity and reliability were confirmed. Data analysis was conducted using SPSS software.

Of physicians participated to this study, 51 were pediatricians (78.5%). The most physicians (49.2%) had a moderate level of awareness of neonatal screening at birth by pulse oximetry. The results of linear regression analysis showed that only the doctors' workplace (hospital or office) was significantly associated with their awareness of neonatal screening at birth by pulse oximetry (P = 0.01, β = -0.31). In total, 7% of the variations in physicians’ awareness about neonatal screening at birth by pulse oximetry were predicted by this variable.

Physicians, particularly pediatricians, as the first line of health care providers to the newborns at birth, need more knowledge about the neonatal pulse oximetry screening, for early detection and referral of neonates with CHDs.