Iranian Red Crescent Medical Journal
Year:2019 | Volume:21 | Issue:8|Papers Count:11

Introduction: This report showed that clinically significant adductor muscle contraction can be possible even when the anterior and posterior branches of the obturator nerve are completely blocked. Case Presentation: A 66-year-old male patient visited Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea during the year 2016. He underwent transurethral resection of the bladder (TURB) of a bladder tumor under spinal anesthesia and obturator nerve block (ONB). ONB was performed at the right-side inguinal crease by an ultrasound-guided block of the anterior and posterior branches. At the beginning of surgery, he exhibited grade IV obturator reflex; therefore, general anesthesia was applied and the surgery completed. After the effect of neuromuscular blockade had been completely reversed, we confirmed twitching of the pectineus muscle by ultrasound using a nerve stimulator (stimulation current 0. 3 mA). Main branches of the right obturator nerve were still completely blocked when we rechecked the previously blocked-site (stimulation current 2 mA). Conclusions: The described case cautions that investigators must be aware more than two branches may pass adjacent to interfascial layers at the inguinal crease level and that a missed obturator nerve branch might result in severe adductor muscle contraction. We report this observation and suggest the possibility of an anatomical variant that requires the need for nerve stimulation and ultrasound for obturator nerve block verification.

Context: Postural stability is essential for performing everyday activities. The central nervous system (CNS) must modify balance control to provide stability to intrinsic and external perturbations. Methods considered as the main candidates for ultimate promotion of neural plasticity could be used for rehabilitation to enhance motor performance. The Transcranial Direct Current Stimulation (tDCS) as a non-invasive brain stimulation tool is applied over the cortex to accentuate and/or accelerate neural effects on network connectivity. Objectives: This study aimed to address the impact of tDCS intervention on balance recovery. We postulated that tDCS induces neuroplasticity that is fundamental for refining motor behaviors such as postural stability during rehabilitation. Methods: The present review discusses the tDCS application over the important areas of the CNS that are responsible for the sensorimotor processing of balance-relevant information. We searched ProQuest, PubMed, Science Direct, Cochrane, and Google Scholar for randomized, controlled trials that assessed the efficacy of tDCS intervention in improving balance impairment following neurologic disorders and enhancing postural stability in a healthy population. Results: Recent studies provide insights into the effects of tDCS on postural stability. Based on the defined criteria, there is a positive response to tDCS, but the underlying neural mechanisms are yet unknown. We suggest that interventions promoting more neural plasticity are crucial for better balance training outcomes and improved effectiveness of rehabilitation programs. Conclusions: Balance recovery after tDCS needs to be more investigated. The tDCS might be considered as an adjunct preventive strategy to provide functional recovery and reduce the adverse effects of balance impairment.

Background: Genotyping of Mycobacterium tuberculosis (M. tub) is an essential step for several purposes, including the epidemiological studies and the tuberculosis (TB) control programs. Golestan province in the Southeast of the Caspian Sea is the second Iranian high burden TB province. Objectives: This study aimed to determine the genetic diversity of M. tub isolates in Golestan province located in the north of Iran. Methods: In this cross-sectional study, all non-repetitive confirmed M. tub isolates, which were collected from patients with TB in Golestan province in 2016, were used for genotyping. After DNA extraction, PCR was done for 15 loci of mycobacterial interspersed repetitive unit-variable-number of tandem repeats (MIRU-VNTRs) for the 162 M. tub isolates. Then genetic diversity and genetic relationships between them were assessed by best match analysis using tools on MIRU-VNTRplus database. Antibiotic susceptibility patterns of M. tub isolates was determined by the proportional method. Statistical analysis was done by SPSS and R software. Results: Out of 162 M. tub isolates, 156 genotype patterns were obtained, which 150 of which were unique. Nine of 15 loci were highly discriminative. The clustering rates were 3. 7%. The prevalence of polyclonal infection was 2. 46%. Also, HGDI and AHGDI were 0. 999 and 0. 979, respectively. The New-1 (22. 2%) and Beijing (13. 6%) sub-lineages had the highest prevalence in this region. Although there was no significant correlation between demographic criteria and M. tub genotypes, still Beijing isolates showed more treatment failure (18. 2% vs. 0. 7%)andresistance to streptomycin (40. 9% vs. 7. 8%)comparedto others (P< 0. 05). The assessment of theminimum spanning tree showed that the members of the clonal complex were limited except for membersof Beijing. The PCA analysis showed that the combination of Qub11b and Mtub30 loci was diagnostic for Beijing sub-lineage. Conclusions: Owing to the high genotypic diversity of M. tub isolates in this region, relying on tuberculosis control program just based on close contact treatment is not sufficient, and we require to apply another approach.

Background: Ischemic brain damage can be explained by the emergence of acute focal or global neurological findings caused by vascular occlusions or hemorrhages. Even in non-fatal cases, stroke is an important pathologic condition with a severe impact on the quality of life, and patients require considerable assistance in the daily lives. Objectives: The purpose of this study was to investigate the effect of rifampicin on malondialdehyde (MDA) levels and neurological examination of the hippocampal region in rats with transient cerebral ischemia. Methods: This experimental study has been performed in a university-affiliated animal lab, Trabzon, Turkey, in 2016. Thirty-eight Sprague Dawley rats weighing 220-280 g were used. In this two-vessel occlusion and hypotension ischemia-reperfusion model, the bilateral carotid arteries were temporarily clipped (30 minutes), and blood was withdrawnup to 3mLof intracardiac volume before the induction of hypotension. After 30 minutes, the clips were removed, and a reperfusion medium was created. One group of 12 rats received intraperitoneal injections of 30 mg/kg of rifampicin every day, and after a 30-minute bilateral carotid artery clipping and hypotension (10 mL/kg). Another group of 12 rats underwent a 30-minute bilateral carotid artery clipping and hypotension (10 mL/kg). The third group consisting of 7 rats underwent skin laceration only. The final group of 7 rats received anesthesia for only 15 minutes. Neurological examinations were performed at the end of days 1, 4, 7, and 10 in all groups. At the end of the 10th day, the animals were euthanized, and their brain tissues were removed. The hippocampi were removed from the brains for biochemical analysis and stored at-76° C in a deep freeze. Ischemic changes in the brain were assessed biochemically by measuring MDA levels in both blood and brain tissue. Results: There was no statistically significant difference between the groups in terms of the mean tissueMDA levels (P = 0. 112), but a significant difference was determined in the mean serum MDA values (P = 0. 033). Serum MDA values significantly differed between the Group 1 and Group 2 (P = 0. 030), but not between Group 1 and Group 3 (P = 0. 58). Serum MDA values were also significantly different between Group 2 and Group 3 (P = 0. 019), and between Group 2 and Group 4 (P = 0. 035). Conclusions: Rifampicin could exhibit a neuroprotective effect on cerebral ischemia-reperfusion injury.

Background: Although thermal therapy is recently suggested as a safe promising adjuvant therapy for insulin resistance and diabetes, its combination with oxymel has been claimed more effective by Traditional Persian Medicine (TPM). Objectives: This study was to examine the effect of thermal therapy plus oxymel on insulin resistance and Langerhans islands in diabetic rats. Methods: This experimental study was performed in the Experimental Animal Unit of Qom University of Medical Science in Iran in 2018. Sixty-four male rats were divided into 8 groups (using block randomization): fourNormal(Nl), Diseased without treatment (D), Oxymel (OXM) and Sauna (Sauna) groups and one major SINA group (oxymel plus sauna) subdivided into four groups of different intervention frequency of 1 (SINA1d), 3 (SINA3d) and 5 days (SINA5d2m) a week for 8 weeks and 5 days a week for 4 weeks (SINA5d1m). Diabetes was induced using a high-fat diet (milk butter) and low-dose streptozotocin. Measurement of serum levels of glucose, insulin, lipid profile, and glycosylated hemoglobin and histological examination of liver, pancreas, heart, and kidney was done at the end of the study. Results: The count of Langerhans Islands significantly increased in the groups of SINA3d (6. 25 0. 94), (P = 0. 05) and SINA5d2m (7  0. 36), (P = 0. 008) in comparison to the D group (4  0. 44), and cell organization became nearly normal, but serum insulin and glucose levels did not change. On the other hand, despite the high-fat diet, lipid profile and histological findings did not support fatty deposition and insulin resistance context. Conclusions: Sauna-oxymel combination (SINA) therapy, which was derived from TPM philosophy to increase systemic and pancreatic blood perfusion, was shown significantly effective in inducing regeneration of Langerhans Islands, but owing to the lack of adequate ectopic fat accumulation, its effect on insulin resistance and beta-cell functions remain uncovered. More suitable studies are needed to approve or disapprove the idea.

Background: Multiple studies have suggested that chronic spontaneous urticaria (CSU) may be an autoimmune condition occurred in a substantial proportion of cases, but it is important to identify the potential triggers of the disease. There is no study in which the authors tried to answer the question of whether patch testing to common contact urticariogens should be routinely done in patients with CSU. Objectives: We assessed urticarial, eczematous, and dual contact reactivity in patients with CSU to common contact urticariogens, the frequency and etiology, and compared with patients suffering from atopic dermatitis (AD) and healthy non-atopic persons. Methods: All consecutive patients with chronic urticaria (CU) orADreferred to us fromVojvodina province (Serbia) betweenNovember 2015 and May 2017, and healthy volunteers were recruited. Contact reactivity was defined as a positive patch-test to at least one of 15 well-known contact urticariogens. Results: During the study period, 155 patients with CU and 100 patients with AD were referred, and 100 healthy control volunteers were also recruited. Among them, 90 patients with CU, 75 with AD and 70 healthy volunteers gave their written informed consent. Moreover, those who did not fulfill the proposed criteria were excluded. Finally, the patients were divided into three groups: the CSU group included 28 patients with current CSU selected from 73 patients with CU; the Group A included 60 persons with current extrinsic AD, and the Group C included 50 healthy non-atopic persons. In all groups, benzoin, cinnamic acid, benzoic acid, and Peru balsam were among the top five allergens in contact-urticarial response, whereas nickel and cinnamic acid were among the top three in eczematous response. The rates of urticarial, delayed, anddual contact reactivity to at least one allergen did not significantly differ [( 2-boot = 1. 410; P = 0. 480). ( 2-boot = 1. 341; P = 0. 527) and ( 2-boot = 0. 316; P = 0. 907), respectively] among different groups. The difference was detected to benzoin urticarial reactivity ( 2-boot = 8. 487; P = 0. 016): in the CSU or AD groups, it was significantly higher than the C group (P = 0. 025 and 0. 010, respectively). A significant difference was detected in female urticarial reactivity to benzoin ( 2-boot = 6. 998; P = 0. 031): in the group AD, it was higher than the C group (P = 0. 018). Conclusions: This could be of the first studies in which the researchers tried to answer the question of whether patch testing to common contact urticariogens should be routinely proposed in patients with chronic spontaneous urticaria. The authors suggest that more investigations have to be designed through multicentric research.

Dear Editor, Natural disasters affect children’ s health enormously with various examples studied globally (1). It is defined as “ A serious disruption of the functioning of a community or a society, leading to one or more of the following: human, material, economic and environmental losses, and impacts” (1). This definition includes natural disasters and humanitarian emergencies. ...

Background: Chronic recurrent TMJ dislocation adversely affects patients’ lives. Various surgical and non-surgical methods have been used for treating recurrent TMJ dislocation. Some non-surgical methods include physiotherapy, occlusal splint, and avoidance of activities causing large-mouth-opening, and autologous blood or Platelet-Rich Plasma-injection to the Temporomandibular Joint (TMJ). Objectives: This experimental study aimed to compare the histopathological evaluation of Platelet-Rich Plasma (PRP) injection and autologous blood (AB) injection to the Temporomandibular Joint. Methods: This experimental study was conducted in an animal lab affiliated to the Gazi University of Medical Sciences, Ankara, Turkey, in 2016. Bilateral TMJs from 12 young New Zealand White rabbits were assessed in the study. The animals were divided into two experimental groups with equal numbers (n = 6) including PRP and AB injection groups. For the experimental groups, 1mLwas injected into the upper joint space and 0. 5 mL to the pericapsular tissue. The injections were administered unilaterally. Moreover, 1 mL of isotonic saline was injected into the contralateral sides of TMJ upper joint space and 0. 5 mL into the pericapsular tissue to serve as controls for both groups. One month after the experimentation, the animals were sacrificed, and histological analyses were performed for fibrosis and tissue reactions. Results: Collagen fibers and adipose tissue production in the retrodiscal ligament were more in the PRP group than in the AB group. According to the fibrosis classification, similar fibrotic changes were observed in the AB and PRP-injected tissue samples compared to controls. No cartilage degeneration was seen in either of the two groups. Conclusions: Considering the limitations of this study, PRP injection may be an alternative to AB injection for treating chronic mandibular dislocation. Clinicians could safely use the PRP injection technique to increase the success rate of the treatment.

Background: Pregnancy is a major event in a woman’ s life that is associated with conflicting emotions, joy, and anxiety. Objectives: The present study was conducted to assess the effect of Acceptance andCommitmentTherapy (ACT) on women’ s anxiety and quality of life during pregnancy. Methods: This randomized clinical trial was conducted in 2016 on pregnant women presenting to health centers in Arak, Iran. First, eligible women were identified by referring to the health centers. Sampling was done conveniently after obtaining informed consent. Finally, 44womenwererandomlyallocated toACTandcontrol groups usingtwo-armblocks “ A” and“ B” . Anxietyandquality of life were measured before the ACT, after ACT, and one month later in pregnant women using the Van den Bergh’ s Pregnancy-Related Anxiety Questionnaire and the 36-item Short-Form Health Survey (SF-36), respectively. The ACT group was followed up by telephone one month after the intervention. For the control group, we performed routine pregnancy care. Statistical analysis was done by the Kolmogorov-Smirnov test for normality of data distribution, followed by the chi-square test, independent t-test, and paired t-test. Results: Anxiety decreased after the intervention and increased one month later, although it was less than before intervention (P = 0. 001). On the other hand, the quality of life improved after intervention, but it worsened one month later (P = 0. 026). Conclusions: Counseling based on the ACT may be used for reducing anxiety in pregnant women; however, its effect on the quality of life remains to be explored further.

Background: Scabies is one of the most common itchy dermatoses in school students. The scabies incidence is dependent on personal hygiene and social factors. Objectives: This study aimed to determine the scabies prevalence and health literacy among high school students. Methods: This cross-sectional study was performed in 22 high schools of Accra, Ghana, from March to July 2018. School students voluntarily participated in the study. After obtaining the agreement of the relevant authorities, we gathered information regarding demographic characteristics and knowledge, attitude, and hygiene habits of 2, 766 students. Results: Overall, 2, 766 students consisting of 1, 171 from urban areas and 1, 595 from suburban areas of Accra were enrolled in this study. The scabies prevalence was 10. 3% in the high school students, ranging from 3. 7% in suburban students to 19. 4% in urban students. The risk of scabies was higher in females than in males (OR = 1. 57; 95%CI = 1. 18-2. 07; P = 0. 002) and in urban students than in suburban students (OR = 6. 90; 95%CI = 5. 05-9. 43; P < 0. 001). The knowledge level was good in 53. 4% of the students and moderate in 44. 1%. Almost 91. 3% of the students had a positive attitude toward scabies prevention. There were significantly higher knowledge and attitude scores in urban areas than in suburban areas (all P < 0. 001). Conclusions: According to the high prevalence of scabies in urban students in, it is necessary to perform more educational efforts and governmental/ non-governmental supports to limit the cases. It seems that high social class and urban residence do not guarantee the occurrence of scabies; thus, comprehensive prevention programs are required for all social classes.

Background: Urinary tract infections (UTI) are one of the common infections worldwide. Escherichia coli is the most common bacteria causing UTI. Objectives: The current study aimed at investigating the susceptibility pattern, biofilm formation, and the relationship between pap and sfa virulence genes and biofilm formation in E. coli strains isolated from patients with UTI from 2017 to 2018 in Yasuj City, Iran. Methods: In the current cross-sectional study, 130 E. coli strains were isolated from patients with UTI. Antimicrobial susceptibility testing was performed by disk diffusion method. The presence of pap and sfa genes was investigated by multiplex polymerase chain reaction (PCR). Biofilm formation was tested using microtiter plate assay and ELISA (enzyme-linked immunosorbent assay) reader for E. coli isolates. Results: Out of 130 E. coli strains isolated from UTI samples, 98 (75. 38%) were positive for the biofilm formation, (14% strong, 31% moderate, and 53% weak). The pap and sfa genes were detected in 50% and 29% of the isolates, respectively. Majority of the isolates were resistant against ampicillin (80%) and susceptible to amikacin and meropenem (100%); the pap and sfa genes were detected in 92. 85% and 85. 71% of the biofilm-forming isolates, respectively. These genes in Uropathogenic E. coli (UPEC) have a significant relationship with strong biofilm formation (P < 0. 0001). Conclusions: The obtained results indicated that the frequency of pap gene was higher than that of sfa in E. coli strains isolated from patients with UTI in Yasuj. The pap and sfa genes in E. coli strains had a significant relationship with strong biofilm formation. In addition, the frequency of biofilm formation in antibiotic-resistant E. coli was higher than that of antibiotic-sensitive strains. According to the results of the current study, it is recommended to administer Amikacin or Meropenem in Yasuj to treat UTI.