Shiraz E-Medical Journal
Year:2020 | Volume:21 | Issue:6|Papers Count:8

Dear Editor, Proton pump inhibitors (PPIs) block gastric acid secretion by inhibiting the hydrogen/potassium adenosine triphosphatase enzyme system. These drugs are used to treat gastric ulcers, esophagitis, duodenal ulcers, Zollinger-Ellison syndrome, Barrett’ s esophagus, and gastroesophageal reflux disease. Although PPIs have acceptable safety, their administration can result in allergic and anaphylactic reactions. Although these reactions, either immediate or delayed, are unusual, they can be life threatening. A number of publications have reported anaphylactic reactions after administration of PPIs. The actual rate of adverse reactions to these drugs is unknown (3-5). We describe a case of anaphylactic reaction to an intravenous administration of pantoprazole in a patient treated for a presumed peptic ulcer. A 45-year-old male was presented to our Emergency Department complaining of four days of increasing epigastric pain. The pain was limited to the epigastric area without radiation. The pain was improved immediately after eating meals, however, it intensified 30 minutes afterwards. The patient had defecated twice daily without melena and hematochezia. He did not have any vomiting. He was mildly tender to the palpation of the epigastric region. The patient and her family had no history of allergic diseases and drug hypersensitivity. In addition, the patient declared that he had consumed nothing before taking Pantazole.

Background: Pregnancy may be the only time that a woman presents for medical care and when an opioid use disorder can be identified and treated. Objectives: The aim of this study, determination of maternal and neonatal outcomes in mothers using opioids. Methods: This prospective cohort study was carried out on 159 pregnant women who used opioids and 474 healthy subjects in Kamali Hospital in Karaj from 2014 to 2017. The data were collected using a checklist, containing social, midwifery, obstetric, and neonatal data. Data were analyzed by SPSS 19. Results: In the present study, there were no significant differences between the two exposed and non-exposed groups in terms of mean age, pregnancy/maternal characteristics; however, there were significant differences in terms of weight gain and care services (P < 0. 001). The frequency of all kinds of drugs; Methamphetamine with 27. 7%; heroin with 25. 8%; and opium with 24. 5% were the most consumed drugs. Among the newborns in the two groups, the first and fifth minutes of Apgar score, weight, and admission were significant (P < 0. 001). The prevalence of infants less than 2500 in the group faces 21. 4% in contrast to 3. 4% in the non-exposed group. Conclusions: Given the increasing number of mothers consuming Opioids within pregnancy and the irreparable side effects of these drugs, it is important to pay attention to this and to provide coping strategies.

Background: The rapid spreading of corona virus disease 2019 (COVID-19) worldwide results in pneumonia and acute respiratory distress syndrome in many patients, which can be the major cause of death in cases with COVID-19. It has been reported that chloroquine (CQ) has improved COVID-19-induced pneumonia in clinical trials. Objectives: Since CQ and its derivatives are proved to exhibit anti-autophagy properties based on previous studies, autophagy can be introduced as a possible mechanism of respiratory complications. Methods: In the current study, we reviewed papers of Google Scholar database with no time limitation. Results: It was revealed that autophagy has an important role in the manifestation of COVID-19 respiratory complications Conclusions: Autophagy is triggered by SARS-CoV2 virus for its replication and autophagy inhibitory treatments might be considered promising therapeutics.

The current study aimed at validating the 26-item Suinn-Lew Asian Self-Identity Acculturation scale (SL-ASIA) using confirmatory factor analysis (CFA) in first-generation young adult Middle Eastern (ME) migrants, and also exploring the agreement between the outcomes of linear and orthogonal approaches of acculturation using SL-ASIA. The CFA and convergent and discriminant validity measures were employed to validate the original linear SL-ASIA and the subsequently designed orthogonal SL-ASIA for first-generation young adult ME migrants in Australia (n = 382). Cohen’ s Kappa coefficient was used to measure the agreement between classifications obtained by the linear and orthogonal methods of measuring acculturation. The CFAs of the initial six-factor 21-item linear scale and the two-factor five-item orthogonal scale indicated poor fits. However, after model specification and validation, satisfactory fit and validity indices were achieved for the modified scales. The validated linear SL-ASIA comprised five factors and 15 items, and the validated orthogonal SL-ASIA comprised two factors and four items. The Kappa coefficient showed a high level of consistency between the linear and orthogonal models of acculturation, confirming that the use of either scale can lead to similar research outcomes. The study also supports the use of the validated linear and/or orthogonal scales to measure acculturation. This finding responds to the existing gap in the literature that until now, no acculturation scale is validated for ME migrants, and also no study is conducted to validate the orthogonal SL-ASIA.

Background: Insulin therapy refusal among type 2 diabetic patients is most challenging for healthcare providers. Objectives: This study aimed to evaluate the type 2 diabetic patients’ attitude and compliance with the initiation of insulin therapy. Methods: A cross-sectional study was conducted on 100 type 2 diabetic patients at the Endocrinology Clinic of Loghman Hakim Hospital, Tehran, Iran. A questionnaire was prepared to assess the attitudes toward the onset of insulin therapy. Positive and negative attitudes toward insulin injection were compared between the two groups of accepting and rejecting insulin therapy. Results: In this study, 62% of patients with type 2 diabetes tended to start insulin therapy. There was a statistical difference between the total positive and negative attitude items toward insulin therapy (agree/disagree) and acceptance of insulin therapy (P < 0. 05). The most agreements related to a positive attitude in the two groups of accepting and rejecting insulin therapy belonged to statements “ Insulin injection prevents complications of diabetes (micro and macrovascular)” as 100% (P < 0. 001) and “ Insulin injection helps improve my diabetes” as 96. 8% (P < 0. 001). The most agreements related to negative attitudes in the two groups of accepting and rejecting insulin therapy belonged to statements “ Insulin injection causes my dependence on it” as 72. 6% (P = 0. 001) and “ I can control my diabetes with oral medication and diet without insulin injection” as 97. 4% (P < 0. 001). Conclusions: As 38% of patients with type 2 diabetes refused to initiate insulin therapy, it seems that effective communication between physicians and patients and continuous follow-ups by health care providers can increase positive attitudes toward insulin injection.

Background: Laparoscopic ovarian drilling (LOD) is recommended for the treatment of women with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate. Objectives: This study aimed to evaluate the effect of ovarian drilling on the serum levels of anti-mullerian hormone (AMH), androgens, and the number of antral follicles. Methods: This was a pre-and post-clinical trial performed on 30 infertilewomenwith PCOS resistant to clomiphene citrate. Patients underwentstandard laparoscopic ovarian drilling. Serumlevels of AMHandandrogensandantral follicle count (AFC)weresurveyed before LOD and three and six months after LOD. The ovarian ovulation rate in each month was also monitored for six months. Then, the association between changes in these parameters, especially the level of AMH, and postoperative ovulation was investigated. A P < 0. 05 was considered statistically significant. Results: The number of antral follicles three (3. 00 8. 00) and six months (7. 73 4. 14) after ovarian drilling showed a significant decrease compared to preoperative values (12. 40 4. 02) (repeated-measures ANOVA, P < 0. 001). The mean AMH (6. 78 1. 08 versus 12. 25  1. 35; P = 0. 005) and the antral follicle count (7. 71  0. 54 versus 12. 29  0. 67 and P < 0. 001) were lower in ovulation than in non-ovulation patients. The significantly more AMH reductions were seen in pregnant women (3. 63  5. 61) than in non-pregnant women (3. 63 1. 24) (P = 0. 01). Conclusions: It may be possible to use the changes in AMH and AFC to predict the success rate of LOD.

Background: Despite huge advances in science, technology, and medical equipment, numerous concerns grow over healthcare workers (HCWs) since they are exposed to a wide range of biological hazards due to the nature of their work. Objectives: The current study aimed at developing and validating an index to assess the risk of occupational safety and health (OSH) in hospitals and healthcare settings. Methods: In the current cross-sectional study, anindex called the hospital occupational safety, andhealth risk assessment(HOSHRA) was developed and validated through the face and content validity as well as internal consistency and inter-rater reliability. Ultimately, the developed index was utilized to assess OSH risks in 36 teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Results: The mean score of the HOSHRA index among the selected hospitals was 71. 53 5. 93, indicating that the OSH risks were at a moderate level. According to the HOSHRA action levels, OSH risk level for ergonomic hazards was high, but it was moderate for physical, chemical, ergonomic, and psychological ones. In terms of physical hazard subcategories, the risk of electrical hazard, as well as fire and explosion, was high, but it was moderate for fall and slip, and radiation. Conclusions: The developed observation-based method showed an acceptable content validity and reliability for OSH risk assessment of hospitals. The HOSHRA index could also be used for hospitals as an applicable measure to improve their OSH.

Background: Bariatric surgery has resulted in body weight loss, which claimed by surgery removal specific parts of the stomach with enzyme or sleeve gastrectomy. Objectives: The aim of this study is to determine weight loss and endocrine changes by 12-week fundus resection and sleeve gastrectomy in rabbits. Methods: Twenty-one rabbits, weighing 2. 5-3. 5 kg, were divided into three groups (n = 7): sleeve gastrectomy, experimental fundus resection, and sham group. The weight of rabbits and total ghrelin and leptin levels in the plasma before and after surgery were measured in 12 weeks. Statistical analyses were performed using the Kruskal-Walis test for comparison of the means between the groups, and the difference after months in one group was assayed by Friedman test. Results: The results showed sleeve gastrectomy had a significant weight loss after one month when compared to fundus resection and sham-operated controls (P = 0. 008). There was no significant difference in the ghrelin levels after these surgeries, but leptin levels decreased significantly after the fundectomy (P = 0. 025). Conclusions: Sleeve gastrectomy is more efficient than the fundus resection in weight loss. It could be suggested as a new option in metabolic disorders due to the high level of leptin.