Journal of Advances in Medical and Biomedical Research
Volume:32 Issue: 150, Jan-Feb 2024

Tympanoplasty is a widely performed surgical procedure for chronic otitis media (COM), and efforts are being made globally to establish standardized surgical techniques. This study sought to compare the postoperative outcomes of endoscopic and microscopic approaches in COM patients.

This randomized clinical trial of an open-label design was performed on 34 patients who were candidates for tympanoplasty surgery due to chronic otitis media in Urmia Imam Khomeini hospital from April to December 2022. Patient allocation was performed by grouping participants according to odd or even numbers, with half assigned to the endoscopic group and the remaining half assigned to the microscopic group.  Demographic data, pain severity, operation duration, and graft success rate preoperatively and 3 and 6 months postopera tively were evaluated. Independent samples t-test, Chi-square test, and SPSS version 21were used to analyze data. A P-value ˂0.05 was considered statistically significant.

No significant difference was reported in terms of pre and postoperative pure tone audiometry conditions between the two groups. Significantly lower operation time (65.83 ± 11.6 minutes) was reported in the endoscopic group compared to the microscopic group (P=0.001). The graft success rate in the microscopic and endoscopic groups was 77.8% and 75%, respectively, which was not statistically significantly different (P = 0.84). A significant difference was observed between microscopic and endoscopic groups in the pain score of patients immediately after surgery (5.66 ±18.1 and 3.75 ± 1, retrospectively) and one day after surgery (5.50 ± 1.9  and 3.62 ± 0.95, respectively) (P < 0.001).

Endoscopic tympanoplasty technique has demonstrated comparable efficacy in improving hearing loss as the conventional method. However, its advantages in terms of reduced operating time and postoperative pain suggest that it may emerge as the preferred approach for tympanoplasty surgery.

Toll-like receptors (TLRs) are proteins that play key roles in inflammation. METH and buprenorphine (BUP) both modulate pain, but the exact mechanism underlying their antinociceptive effects is unknown. As a result, the expression of TLR1 and TLR2 genes was examined in METH rats that had been treated with or without BUP.

A total of 77 rats were classified into 11 subtypes (n = 7): control (saline), BUP 6 or 10 mg/kg, METH (10 mg/kg), METH+BUP 6 or 10 mg/kg, or withdrawal groups. The treatments were intraperitoneally administered for 5 or 14 days. RT-PCR evaluated genes expressed in the brain stem area.

The results showed that TLR1 gene expression in the METH group (10 mg/kg; 5 days) considerably improved compared with the control group. Furthermore, BUP injection (10 mg/kg) acutely decreased TLR2 gene expression compared with the METH group. In the METH + BUP (10 mg/kg; 14 days) group, TLR1 expression was higher than in the METH group. The coadministration of METH+BUP (10 mg/kg) acutely decreased TLR2 gene expression compared with METH.

There are limited changes in these genes, and their role in METH consumption and inflammation is unclear. Due to the presence of these two genes in the inflammatory pain and addiction signaling pathways, they may have more clear roles in other parts of the nervous system.

Heart failure (HF), as the final stage of cardiovascular disease, is a prevalent cause of mortality, disability, and recurrent hospitalization. Effective treatment of systolic HF is crucial for reducing patient disability and preventing repeated hospital admissions. In this context, we aimed to conduct a comparative study of spironolactone at doses of 25 mg and 50 mg in patients with systolic HF.

This randomized clinical trial was performed on 100 patients with systolic HF. The patients were randomly divided into two treatment groups receiving 25 and 50 mg of spironolactone. Subsequently, changes in ejection fraction, frequency of hospitalization, performance capacity, quality of life, and electrolyte disorders were examined.

There was no significant difference between the groups in terms of age, sex, cardiovascular risk factors, history of cerebrovascular accidents, readmission rate, and EF changes (P>0.05). At the end of the study, the mean scores of performance capacity and quality of life in patients receiving 50 mg of spironolactone were 204.3±28 and 32±3.1, respectively. These values were statistically higher than those reported in patients receiving 25 mg of spironolactone (178.9±30 and 36.7±3.3, respectively) (P<0.001). In patients who received 50 mg of spironolactone, the average levels of potassium and blood urea nitrogen were 0.68±0.08 and 6.1±1.4, respectively. These levels were significantly higher compared to those in patients receiving a 25mg dose, where the levels were 0.39±0.17 and 4.7±2.8, respectively (P<0.05). However, it is important to note that the maximum values observed did not exceed the normal range for these parameters.

Compared to the 25mg dose, the 50mg dose of spironolactone was observed to enhance both the quality of life and performance capacity in patients with systolic HF. Therefore, it can be prescribed as the initial daily dosage for managing patients with HF.

Sexual function significantly affects the quality of life in women with premature ovarian insufficiency (POI). This study aimed to identify predictors of sexual function considering psychological and socio-demographic factors.

The study was conducted in Tabriz, 2021, with 130 women who had POI. Data were collected using the female sexual function index (FSFI), perceived stress scale (PSS), Spielberger state-trait anxiety inventory (STAI), Rosenberg self-esteem scale (RSES), Beck depression scale (BDI), and socio-demographic characteristics questionnaire. The Pearson correlation test was used to determine the correlation between psychological variables and the total sexual function score. Additionally, the general linear model was used to identify the predictors of sexual function.

 The mean (SD) score of sexual function was 13.8 (6.7). There was a significant negative correlation between stress (r=-0.22, p=0.018), state anxiety (r =-0.13, p=0.153), trait anxiety (r=-0.26, p=0.005), depression (r=-0.39, p<0.001) with total sexual function score. On the other hand, self-esteem had a positive correlation (r= 0.34, p<0.001) with sexual function score. Moreover, variables such as desire to pregnancy and type of pregnancy were predictors of sexual function. Sexual function score was significantly higher in women who wanted to become pregnant than in ones who did not (p=0.012) and in women who became pregnant naturally than in women who became pregnant through assisted reproductive techniques (ART) (p=0.002).

The study findings indicate that the sexual function of women with POI is influenced not only by psychological factors but also by their desire to become pregnant and the type of pregnancy they have. Given the intricate interplay between psychological and physical factors and sexual function among infertile women, further research is warranted in this area.

  Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by changes in bowel movements and abdominal pain in the absence of structural disorders. Although effective treatment for irritable bowel syndrome is not yet available. One of the treatments is the low-dose antidepressants, depending on the type and severity of the disease. This study was performed to compare the effect of selective serotonin-norepinephrine reuptake inhibitors including duloxetine and imipramine from a tricyclic antidepressant.

forty-eight definitively diagnosed IBS patients (based on Rome III criteria) were examined in 2 groups of men and women. Patients in the control group were treated with Dicyclomine and Imipramine while the case group received dicyclomine and duloxetine. The outcomes were measured before and 3 months after treatment to determine and compare the improvement in responses (mainly diarrhea).

Duloxetine could significantly improve the symptoms such as abdominal pain in females (P-value: 0.01) and males (P-value: 0.001), bloating in females (P-value: 0.004) and incomplete defecation in females (P-value: 0.001) and in males (P-value: 0.007). The side effects of this drug were, however, higher than Imipramine. The introduction of more appropriate treatment requires further studies on a larger sample size to assess the symptoms and the side effects.

 Based on the effect of duloxetine on this clinical results, it is recommended as an effective treatment in controlling of abdominal pain, bloating, and incomplete defecation.

Acute kidney injury (AKI) is a rapid loss of kidney function that is associated with high morbidity and mortality. Oxidative hazard, inflammation, mitochondrial deterioration and depletion of cellular energy stores, which terminate in organ dysfunction, are the major hallmarks of AKI. The current experimental investigation attempted to evaluate the effects of selenium (Se), a pivotal micronutrient, on the ischemia/reperfusion (IR)-induced kidney damage emphasizing on the biogenesis of mitochondria.

Male Wistar rats (n = 18) were randomly allocated into three groups: sham, IR, and Se + IR. Rats in the last group 1 h before IR induction, were treated with Se (0.5 mg/kg) intraperitoneally. Six hours after reperfusion blood and kidney tissue samples were collected, and animals were euthanized. In addition to the evaluation of biochemical factors and histopathology, the protein levels of sirtuin1 (SIRT-1), and peroxisome proliferator-activated receptor-gamma coactivator 1-α (PGC-1α) of the kidney tissues were determined via western blotting.

Pre-treatment with Se could significantly improve IR-induced kidney function markers (creatinine and BUN) as well as the pathological alteration in comparison with the IR group (P < 0.05). Moreover, in the Se + IR group, a substantial surge of the Sirt-1 and PGC-1α at the protein level was recorded compared to the IR group.

The results proposed that Se displays a protective role against renal IR injury via up-regulating proteins involved in mitochondrial biogenesis. Due to the pivotal role of mitochondria in renal tubules, these results offer insight into the plausible preventative and/or therapeutic effects of Se against AKI after further studies.

Bisphenol A [BPA; 2,2-bis-(4 hydroxyphenyl) propane] is an environmental estrogenic and endocrine-disrupting compound that exerts its destructive effects through increasing oxidative stress, but the mechanisms underlying this effect have not yet been fully explained. This study evaluates BPA toxicity in muscle cells and the therapeutic potential of adiponectin (APN) and quercetin (QUER).

Confluent L6 rat muscle cells were exposed to BPA (50 and 100 μM) with APN (10 and 100 ng/ml) and QUER (10 and 25 mM) for 24 and 48 hours. Cell viability, pro-oxidant/antioxidant balance (PAB), catalase (CAT) activity, and KEAP1/Nrf2 gene expression were analyzed using desired methods.

BPA in high doses (100 mM) significantly reduced the viability of the muscle cells, while APN and QUER increased cell survival in a time-dependent manner. The effect of QUER also was dose-dependent, while APN in high doses decreased the viability of the muscle cells. APN and QUER also reduced BPA-associated oxidative stress. These changes were significant in the case of QUER. The CAT activity was reduced in BPA-treated cells, which was notably increased with APN and QUER treatment. A decrease in Nrf2 gene expression of BPA-treated muscle cells improved by treatment with QUER and APN in a dose-dependent manner.

Our results hinted that APN and QUER could modulate BPA-induced oxidative stress in muscle cells through KEAP1/Nrf2 pathways. Accordingly, it can also be concluded that APN in low doses and QUER may significantly reduce muscle toxicity caused by BPA.

Colonoscopy serves as a diagnostic and therapeutic tool for children. However, the process of bowel preparation presents a considerable challenge. This study aimed to compare the effectiveness of a clear liquid diet (CLD) versus a low-residue diet (LRD) in bowel preparation for colonoscopy among children aged 2-14 years.

In this single-blind clinical trial, a total of 110 children aged 2-14 years undergoing colonoscopy were randomly assigned to two groups: the CLD group and the LRD group. Along with their assigned diets, all participants received 2 g/kg of polyethylene glycol in two or three divided doses, as well as a single dose of 5-mg bisacodyl prior to colonoscopy. The primary outcome was the adequacy of bowel cleansing for colonoscopy, evaluated using the Boston Bowel Preparation Scale (BBPS) in both groups. The secondary outcomes included the tolerability of bowel preparation diets and adverse effects.

According to the physician’s assessment, the CLD group had favorable BBPS scores (BBPS ≥5) in 96.5% (55/57) of cases, while the LRD group had favorable scores in 98.1% (52/53) of cases. There were no significant differences between the two groups in terms of the mean BBPS score, regimen tolerability, and adverse effects. 

This study demonstrated that both CLD and LRD regimens were effective in bowel preparation and were well-tolerated by children aged 2-14 years.

 A supraclavicular brachial plexus block (SCBPB) is a safe alternative to general anesthesia in upper limb surgeries. We compared the effect of adding magnesium sulfate (MS) and low-dose dexamethasone (LDD) to ropivacaine in SCBPB in elective upper limb surgeries. 

 The ultrasound-guided SCBPB was done on 55 candidates for elective upper extremity surgeries in 3 groups by using 200 mg MS + 24 mL ropivacaine 0.5% (MS Group), 4 mg dexamethasone + 24 mL ropivacaine 0.5% (LDD Group), and 1 mL normal saline + 24 mL ropivacaine 0.5% (NS Group). The sample was investigated for the sensory and motor block onset, motor and sensory block duration, analgesia duration, total opioid consumption, and the Visual Analog Scale (VAS) during sensory return.

 The onset of motor and sensory block was faster in the MS group compared to the LDD and NS group (P<0.05). The sensory block duration was longer in the LDD group compared to the MS and NS groups. The duration of motor block and analgesia in the LDD group was significantly longer than the NS group (P<0.05). However, this difference was not significant regarding the MS group (p>0.05). The LDD and MS groups were not different in terms of total opioid consumption and VAS at the time of sensory return. However, both groups had significant differences with the NS group (P<0.05).

 The LDD prolonged the motor and sensory block duration and analgesia compared to MS.

Investigating multidrug resistance and TEM and SHV broad-spectrum beta-lactamase genes in Escherichia coli bacteria isolated from patients with urinary tract infections is very useful to improve the treatment of infection and prevent the failure of treatment of urinary tract infections.The aim of this study was to investigate multidrug resistance and TEM and SHV broad-spectrum beta-lactamase genes in Escherichia coli bacteria isolated from patients with urinary tract infections.

In this study, 188 strains of Escherichia coli, which cause urinary tract infections in Alborz province, were studied. Urine samples were cultured on EMB and Blood Agar media. Differential tests were performed for final identification. ESBL-producing strains were identified, PCR was performed to survey the abundance of ESBL-producing genes.

Based on the results of the disk diffusion and Double-disk synergy testS, 82 (43.6%) strains were determined as the final producer of ESBL. out of these isolates, the frequency of SHV, TEM, and CTX genes measured 64.3%, 55.9%, and 21.4%, respectively. These results showed that 12 (14.28%) of Escherichia coli isolated have all genes, 26 (30.95%) had 2 genes and 36 (42.85%) had one gene.

According to the results, it was found that imipenem with the lowest resistance is the best drug in the treatment, and carbapenems are the best drug for treating diseases caused by Escherichia coli. The results of the current study may be useful in replacing ESBL enzyme resistance screening with more modern sensitivity measurement methods such as MIC and Etest.