TANAFFOS
Year:2019 | Volume:18 | Issue:2|Papers Count:13

Dear Editor, I was searching for new modalities to prevent propofol injection pain (PIP) and I encountered and read with interest an article written by Akbari et al. in your journal (1). First of all, it seems that units used for injected ketamine and sodium thiopental is incorrect and they should be mg/Kg not ml/Kg. In our daily clinical practice as an anesthesiologist, we use 5% solution of sodium thiopental (50 mg/ml) and every anesthesia team member has experienced that injecting this concentration is per se painful in comparison to 2. 5% solution. As a routine practice, anesthesiologists used to administer propofol slowly via a large bore intravenous access or following injection of a minimal dose of lidocaine (1 to 2 ml of 2% solution) (2). The important issue regarding PIP is the importance of it. PIP is not an important problem and it is not a common source of bitter memories of surgery patients (3). From this point of view, adding unnecessary medications to the anesthesia regimen of an elective patient may expose him/her to unwanted risks. Propofol injection is painful and there is no doubt about it. But in clinical practice we should consider about costs and benefits of adding extra-drugs to usual regimens. If you suggest using combination of drugs such as ketamine or sodium thiopental, occurring unwanted events such as postoperative cognitive disorders or PONV are inevitable (4, 5).

Background: Mast cells play a critical role in the pathogenesis of various immunological and non-immunological diseases. It is now accepted that culturing primary mast cells considered as a tool for investigation role of mast cells in diseases. Development of various animal primary mast cells and their function could be used for the translational studies in the pathogenesis of human diseases. The aim of the study was to develop simple and cost-efficient method for differentiation and culture of rat mast cells from bone marrow by using rat and mouse spleen supernatant. Materials and Methods: Bone marrow cells from 10 to15-weeks-old male rats was obtained and cultured for three weeks on cell culture medium. After that, purity of cells was approved by FCԑ RI and CD117 antibodies, toluidine blue and Immunohistochemistry (IHC). Results: After 3 weeks continuous culturing, high purity of cells was found. CD117, CD34 expression and tryptase were 80. 1, 76. 89 and 87. 9%, respectively by rat splenic supernatant, whereas 85. 4, 83. 07 and 82. 1%, respectively with mouse splenic supernatants. Besides, rat spleen supernatant developed 91. 4% and mouse splenocyte supernatant developed 89. 7% mast cells based on surface markers. Conclusion: The data presented in this study indicated equal maturation and differentiation of bone marrow derived rat mast cells by using both spleen supernatants.

Background: Infection with Human Immune deficiency Virus (HIV) is a growing problem in developing countries. Among HIV infected cases, respiratory complications are common, dissimilar in different setting and their diagnosis is challenging. The aim of this study was to determine the spectrum of infectious and non-infectious pulmonary complications among HIV infected patients. Materials and Methods: The retrospective study was done among 710 HIV infected patients admitted in Masih Daneshvari Hospital, National Research Institute of Tuberculosis and Lung Diseases, Tehran, Iran from January 2003 to March 2017. Demographic, clinical, radiologic and laboratory data of 836 episodes of pulmonary complications were reviewed and final diagnosis were extracted. Results: Mean of CD4 cell count was 90± 131 x106 cells/L. Definite etiology was found for 653 episodes (78. 1%) of pulmonary complications. Infectious respiratory diseases were clearly more common than non-infectious etiologies, 86. 1 and 7. 6%, respectively. Pulmonary tuberculosis, as the leading cause, involved 542 cases (64. 8%) and Pneumocystis jiroveci (P. jiroveci) was the second infectious agent that was found in 111 cases (13. 2%). Among non-infectious causes, bronchiectasis and Chronic Obstructive Pulmonary Disease (COPD) exacerbation were on the top of the list, 21 of 64 (32. 8%) and 18 0f 64 (28. 1%), respectively. Many patients had more than one etiology. P. jiroveci had the highest tendency for dual infections (43 episodes). Conclusion: Pulmonary complications, especially infections are common among HIV cases in Iran, among them tuberculosis is the most common. Respiratory problems may be the first presentation of HIV infection. Clinicians should be aware about the risk of dual infections. Screening for HIV among all tuberculosis cases and vice versa is recommend.

Background: Antimicrobial resistance of Streptococcus pneumoniae (S. pneumoniae) has shown major changes in recent years. On the other hand, macrolide antibiotics are being increasingly used in clinical practice. Several studies have reported increased resistance to this group of antibiotics, while there is no comprehensive information in this area. Accordingly, the present study was designed to estimate the resistance of S. pneumoniae to macrolides in Iran. Materials and Methods: In this review, articles (2000-2017), evaluating the level and type of S. pneumoniae resistance to macrolides in Iran, were extracted by searching different databases, and the results were analyzed. Results: A total of 25 relevant articles were retrieved and analyzed. Overall, 2723 cases had been recruited in these studies. The mean percentage of resistance to macrolides was estimated at 48. 43% (CI, 38. 8-57. 9%). In the majority of reported cases, the resistance mechanisms included ribosomal methylation (i. e., ermB mutation), dual resistance, and efflux-mediated resistance. Conclusion: Based on the findings, the resistance rates are considerable in different cities of Iran. Therefore, without determining the type of drug resistance in clinical samples, use of macrolides is not recommended for treatment purposes. In addition, considering the type of resistance mechanisms in Iran, use of higher drug doses is probably ineffective.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of mortality and morbidity throughout the world. Although the cause of COPD exacerbations can be bacterial or viral, use of antibiotics in exacerbations remains controversial. Procalcitonin serum level dramatically increases in bacterial infections, but not in viral or noninfectious febrile diseases. The aim of this study is to investigate whether the measurement of procalcitonin can be used to differentiate bacterial from non-bacterial causes of COPD exacerbations. Materials and Methods: Sixty-eight COPD patients admitted to the emergency department of Masih Daneshvari Hospital due to COPD exacerbation were studied. At admission and before prescribing antibiotics, we obtained sputum and blood samples for sputum gram staining and culture and measured serum C-reactive protein and procalcitonin. All results were analyzed by SPSS software version 22. Results: A total of 68 patients including 51 males and 17 females were studied. From 38. 2% of patients a respiratory pathogen was isolated from their sputum and 23. 5% of patients had elevated serum procalcitonin values. Using Fisher exact test, we found strong correlation between elevated procalcitonin levels above 0. 5 ng/ml and sputum culture results (P < 0. 01). We also found strong correlation between elevated procalcitonin levels above 0. 5 ng/ml with abnormal C-reactive protein levels in a group of patients with positive sputum culture, using Fisher exact test (P <0. 01) Conclusion: As sputum culture and microbiologic studies are time consuming and sometimes expensive, it seems that procalcitonin could be a reliable marker of bacterial infection in COPD exacerbation, although we recommend a larger study with larger sample to consolidate the finding of this study.

Background: Streptococcus pneumoniae (S. pneumoniae) is one of the most common causes of human diseases in young children. Macrolides are commonly antibiotics used for empirical treatment of community-acquired respiratory infections. The purpose of this study was to determine antibiotic resistance pattern as well as the relationship between macrolide resistance and the major mechanisms of resistance in pneumococci isolated from healthy children. Materials and Methods: In this cross-sectional study, 43 isolates of S. pneumoniae were collected from healthy children in Ardabil. Resistance pattern against tested antibiotics was determined using the disk diffusion method. The Minimum Inhibitory Concentration (MIC) of erythromycin was determined using the E-test strips. The mefA/E and ermB gene were detected in erythromycin-resistant isolates using the specific primers and Polymerase Chain Reaction (PCR) technique. Results: According to antimicrobial susceptibility testing, 74. 4 % of the isolates were resistant to erythromycin, 95. 3 % to penicillin, 81. 3 % to co-trimoxazole, 72 % to azithromycin, 41. 8 % to tetracycline, 27. 9 % to clindamycin, and 16. 2 % to chloramphenicol. All isolates were susceptible to levofloxacin and vancomycin. In the case of rifampin, 95. 3% of the isolates were sensitive and 4. 6% semisensitive. The MIC of erythromycin for resistant isolates was between 1. 5 and ≥ 256 μ g/ml. PCR results revealed that 100% of erythromycin-resistant isolates contained mefA/E gene and 81. 25 % contained both the ermB and mefA/E genes. Conclusion: The prevalence of antibiotic-resistant strains of S. pneumoniae, especially resistance to macrolides, was high among healthy children in Ardabil. According to the results of this study, we suggest using levofloxacin, rifampin and vancomycin antibiotics as an appropriate prophylactic regimen in pneumococcal infections.

Background: Most of patients with Obstructive Sleep Apnea (OSA) are at risk of metabolic syndrome. The treatment of choice for OSA patients is the Continuous Positive Airway Pressure (CPAP). Reports about the effect of CPAP on metabolic parameters are controversial. So, we aimed to evaluate the effect of CPAP therapy on blood pressure, Fasting Blood Sugar (FBS), and serum lipids including: Triglycerides (TG), total cholesterol (Chol), High Density Lipoproteins (HDL), and Low Density Lipoproteins (LDL). Materials and Methods: This study included 35 OSA patients. Initially, their baseline demographic and clinical characteristics were recorded. Then, the patients underwent CPAP therapy on average 4-7 hours for 8 weeks. The level of FBS, TG, Cholesterol, HDL, LDL, and blood pressure were measured and recorded before and after treatment. Finally, the collected data were analyzed with SPSS version 22. Results: This study included 35 OSA patients [24 men (68. 6%)], with mean age of 45. 58± 8. 02 years. Results indicated that CPAP therapy led to decrease of 9. 76 and 3. 49 mmHg in systolic and diastolic blood pressures, respectively. Also, LDL decreased to 6. 27mg/dl and HDL increased to 0. 75 mg/dl (P<0. 001) with treatment. The changes of other variables were not significant (P>0. 05). Conclusion: Treatment of OSA with CPAP has beneficial effects on blood pressure and some items of lipid profile. Regarding the importance of metabolic disturbances in OSA complications, choosing an appropriate treatment for OSA patients can play an important role in improvement of patients status as well as prevention of these complications.

Background: Respiratory allergies are among the most common allergies in the world with an increasing number of people affected in recent decades. Determination of allergens prevalence in each area is considered as the first step in prevention of allergic diseases and developing novel and more effective immunotherapies. The aim of this study was to determine the prevalence of the most common allergens among patients with respiratory allergies in Mashhad, Iran Materials and Methods: This cross sectional study included 1246 people who were referred to Allergy Clinic of Mashhad University of Medical Sciences with respiratory allergic symptoms from 2012 to 2017 in which a questionnaire containing demographic information was completed and Skin Prick Test was performed for each patient. Results: Among 1246 patients with respiratory symptoms, there were 1084 patients with allergic rhinitis (87%), 69 patients with allergic asthma (5. 5%), 14 patients with allergic rhinoconjunctivitis (1. 1%) and 79 patients with both allergic rhinitis and asthma (6. 3%) with an overall male to female ratio of 1. 18. Rhinorrhea (86. 3%), sneezing (81. 1%) and itchy eyes (68. 4%) were the most common symptoms in patients with respiratory allergic disorders in this study and the highest rate of sensitivity was to pollens including Salsola kali (82. 3%), pigweed mix (65. 1%), tree mix (51. 7%) and ash (49. 8%), respectively. Conclusion: Generally, Salsola kali seems to be the main allergen in different respiratory allergies including allergic rhinitis, asthma and rhinoconjunctivitis in semi-arid climate of Mashhad, Iran.

Background: One of the most worrying aspects of medical area in developing countries is the Intensive Care Unit (ICU). This study aimed to evaluate the acceptability of the clinical dashboard by the users, prior to final use and their attitude towards this technology, as well as to examine the specific needs that Tele-ICU technology can cover in the form of a clinical dashboard. Materials and Methods: This study was conducted at Shahid Bahonar Hospital of Kerman, Southeastern Iran, with three ICUs, the first, second, and third sections of which had 10, 12, and 24 beds, respectively. Taking survey and need assessment of care providers, qualitative and quantitative analyses were undertaken to identify key positive and negative themes. The data were analyzed by SPSS software version 18. Results: About 82% of care providers in the ICU participated in this survey. The number of participants based on the groups in the survey was 98 (81. 7%) of the nurses and respiratory therapists group, 20 (80%) from the group of anesthesiologists and 20 (87%) from the group of anesthesiologist assistants who participated in the survey. About 51% of the survey participants completed the description section either partially or totally. On average, among all groups, the group of anesthesiologists had the most and the nurses had the least knowledge about telemedicine and Tele-ICU, whereas the anesthesiologist assistants had the most and the nurses and respiratory therapists group had the least knowledge about clinical dashboards. Conclusion: This study showed that the level of knowledge and awareness of care providers, especially nurses and respiratory therapists in the ICU in terms of telemedicine and Tele-ICU is low and care providers are in doubt that telemedicine technology could have a positive or negative impact on human resource shortages, yet agreed that it would have a negative effect on the privacy of the patients and care providers. In addition, the ICU care providers agree that Tele-ICU can positively affect the quality of patient care, staff satisfaction, reduce the cost of care, and ease and reduce the time for patient counseling. This suggests the need for further research and education of system impact beyond patient outcomes related to this new technology.

Background: Ventilator-Associated Pneumonia (VAP) is one of the common causes of mortality and morbidity. Subglottic secretion suction decreases the incidence of VAP. In this study, the effect of 5% sodium chloride (NaCl) in subglottic area in addition to secretion suction in VAP prevention was investigated in patients who were admitted to the intensive care unit. Materials and Methods: All patients were intubated by an intubation tube with subglottic suction. In the intervention group, subglottic area was washed with 10 ml of 5% sodium chloride solution, and in the control group the subglottic area was washed with 10 ml distilled water. Patients were monitored for a maximum of two weeks, and the incidence of VAP was monitored by a Clinical Pulmonary Infection Score (CPIS). Results: There was no significant difference between the two groups in terms of age and sex. Four (27%) patients in the intervention group, and 7 (37%) in control group were diagnosed with VAP, which was not statistically significant between the two groups (P=0. 225). The duration of hospitalization, duration of intubation and mortality did not show any significant difference between the two groups. Conclusion: It was expected that in this study the rate of VAP became significantly lower with the intervention of using antimicrobial solution in addition to suction. Although the rate decreased clinically, it was not statistically significant, which may be due to the low number of patients.

Background: Although the main hazard in cement processing is dust, and its effects on pulmonary function constitute the most important group of occupational diseases in this industry, evidence for association between exposure to cement dust and pulmonary function has not been conclusive. This study was performed with the aim to evaluate the impact of cement dust in the workplace on decreasing pulmonary function parameters among the workers. Materials and Methods: In this cross-sectional study 283 workers were studied, of which 140 workers were considered as exposed group and 143 workers as non-exposed group. Fifty samples of respirable dust were collected from breathing zone of workers in different sections of cement factory. Visible absorption spectrophotometry was used according to the NIOSH Method 7601 to measure crystalline silica content of reparable dust samples. Spirometry test was also applied to assess workers’ pulmonary function parameters. Results: Respirable dust concentration was in the range of 1. 77 to 6. 12 mg/m3. The concentration of crystalline silica in all units was higher than the Threshold Limit Value (TLV) (0. 025 mg / m3). There were a significant difference in the Peak Expiratory Flow (PEF) parameter among workers in the two exposed and non-exposed groups to respirable dust (P= 0. 017). In other parameters of pulmonary function (FVC, FEV1, FEF 25-75, FEV1/FVC %), there were no significant differences between the two groups under study (P= 0. 45, P= 0. 14, P= 0. 29 and P= 0. 23, respectively). Conclusion: The findings of this study have provided an evidence to confirm the hypothesis that exposure to cement dust can cause complication in PEF parameter of cement industry workers.

Background: Tobacco smoke is toxic for cells and could be a damaging factor to skin. The purpose of this study was to compare the biophysical properties of skin in smokers and non-smokers. Materials and Methods: The study population consisted of 28 current smokers and 24 non-smokers. The hydration of the stratum corneum, trans epidermal water loss, pH, erythema, melanin content, sebum, friction and elasticity parameters (R0, R2, R5) of skin, epidermis and dermis thickness and echodensity were measured on middle forehead, right cheek and right inner arm of participants. Also volume, surface area and depth of right nasolabial folds were measured. The mean of these values in smokers were compared with nonsmokers by independent sample T-test. Results: Gross elasticity was significantly lower in smokers on forehead (p= 0. 048). Thickness of epidermis was higher in smokers in all measured sites but the differences were not statistically significant. Thickness of dermis was higher in smokers in all measured sites too, but only the difference on cheek was statistically significant (p= 0. 009). Density of epidermis was lower in smokers in all measured sites, but only the difference on forehead was statistically significant (p= 0. 019). Density of dermis was lower in smokers in all measured sites, but only the difference on arm was statistically significant (p= 0. 028). Volume and area of nasolabial folds were higher in smokers, but only the difference of area was statistically significant (p = 0. 031). Conclusion: Tobacco smoking could affect the biophysical parameters of skin, especially thickness and density of dermis and epidermis and nasolabial folds.

A 35-year-old man with a prior history of liver transplantation 18 months ago was admitted to our Intensive Care Unit (ICU) with fever and worsening dyspnea and was diagnosed with severe pneumonia leading to Acute Respiratory Distress Syndrome (ARDS). He had a prolonged hospitalization and was treated with empiric broad spectrum intravenous antibiotics, oseltamivir, trimethoprim/sulfamethoxazole, and subsequently caspofungin and ganciclovir. Blood, nasopharyngeal, as well as Bronchoalveolar Lavage (BAL) culture and Polymerase Chain Reaction (PCR) were negative for all viral, bacterial, and fungal causes of pulmonary infection except Enterovirus-Human Rhinovirus (EV-HRV) that was positive with high titers on BAL and swab specimens. Consequently, the diagnosis of EV-HRV pneumonia complicated by ARDS was established. The patient gradually improved and was discharged from the hospital after 3 weeks. This report highlights EV-HRV as a cause of ARDS in immunocompromised adults.