Iranian Red Crescent Medical Journal
Year:2018 | Volume:20 | Issue:5|Papers Count:11

Dear Editor, Hepatopulmonary syndrome (HPS) is commonly a pulmonarymanifestation described as the triad of liver disease, arterial hypoxia, and intra-pulmonary vasodilatation. Dyspnea and cyanosis are the most common complaintsof patients with HPS (1). The pathogenesis of HPSis not well known, but the treatment procedure is basedon four pathophysiological mechanisms including inactivationof endothelin-1 (ET-1), inhibition of pulmonary angiogenesis, blockage of nitric oxide synthesis, and inhibitionof bacterial translocation. Currently, liver transplantationis the only certain treatment of HPS (2).

Isoniazid (INH) and rifampicin (RFP) are primary antituberculosisdrugs. Hepatotoxicity is one of the most criticalside effects of these drugs (1). Cessation of INH and RFP, due to hepatotoxicity in patients with tuberculosis, maylead to treatment failure. Therefore, we need novel protectiveagents against the hepatotoxic side effects of INH andRFP.

Background: Patients have a significant role in controlling and treating hypertension. Improving patients’ Knowledge, Attitude, and Practice (KAP) is a crucial step in controlling hypertension. Objectives: This study aimed to examine the effect of training based on the Expanded Chronic Care Model (ECCM) on KAP in patientswith hypertension residing in Isfahan, Iran. Methods: The clinical trial was conductedon 190 hypertensive patients aged 36 to 80 in 2015-2016. Patients were randomly assignedtoaninterventionanda controlgroup. The intervention plan basedonECCMwasfour 2-hour education sessions for the interventiongroup and a family member. Then, follow-ups were done by a phone call for six months. Meanwhile; there was no intervention inthe control group. The data collection was done using KAP (a valid researcher-made questionnaire), before and after interventionin both groups. Results: In the intervention group, there was a statistically significant difference between the mean score of KAP before and sixmonths after the ECCM training (P < 0. 05). No significant differences were observed in the control group. The two groups were notsignificantly different in terms of the Mean  SD of KAP scores before the intervention. Six months after implementing the caremodel, however, the Mean SD of KAP scores were significantly higher in the intervention group compared to in the controls (P <0. 05). Conclusions: Based on the results, a training program based on the ECCM is effective in improving the knowledge, attitude, andpractice of patients. The ECCM could therefore be used as a framework for designing educational interventions for patients withhypertension.

Background: Polycystic ovary syndrome (PCOS)-induced oligomenorrhea can leave psychological and non-psychological impactson women. Among the proposed strategies for its treatment, herbal medications are of importance due to favorable effect profiles. Objectives: We planned a study to compare the effects of Celery and Anise combination (CAC) and metformin (met. ) on oligomenorrheain PCOS patients. Methods: We conducted a triple-blind, Randomized clinical trial on 72 patients that were randomly allocated into two equal groupsto receive six capsules of either CAC (750mgeach) or met. (250mgeach) at three separate doses for 15 days beginning from the follicularphase. If the bleeding occurred, three capsules of either placebo or met. would be administered daily during the menstruationphase, and then the follicular phase step with six capsules would be repeated. If the bleeding did not occur, three capsules of eitherplacebo or met. would be administered each day for 15 days. The regularity of menstrual bleeding as the primary outcome, as wellas testosterone, luteinizing hormone/follicular stimulating hormone ratio (LH/FSH), and complications, was assessed before andafter the three cycles. Results: The mean age standard deviation of patients was 26. 5 6. 1. The mean Body Mass Index was 26. 4 3. 5. CAC significantlyimproved oligomenorrhea (58. 3% vs. 25%, P < 0. 01), increased bleeding episodes (P = 0. 003), and reduced testosterone (mean difference: 0. 16 vs.-0. 02, P = 0. 005) and LH/FSH (mean difference: 0. 75 vs.-0. 08, P = 0. 002) without any major side effects compared tomet. Conclusions: We showed that Celery and Anise combination could regulate menstrual cycles and improve oligomenorrhea in polycysticovary syndrome patients superiorly to metformin.

Background: Several studies show that mesenchymal stem cells (MSCs) possess anti-tumor properties, while other studies showthat MSCs may promote cancer. Extracellular vesicles (EVs) are identified as novel mediators to communicate among cells, whichmay be used as vehicles to transfer the MSC information to the target cells. Objectives: The current study aimed at investigating whether the human umbilical cord mesenchymal stem cell (HUSCMSC) derivedextracellular vesicles (EVs) inhibits or promotes tumor cell growth in K562 chronic myelogenous leukemia cell line. Methods: In the current experimental study, trypan blue exclusion and 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide(MTT) assay were performed to investigate the cell viability and metabolic activity. Additionally, flow cytometry was employedto assess cell cycle and apoptosis of K562 cells after 72 hours exposure to EVs. Results: The obtained results showed that no doses of EVs inhibited the tumor growth (mean  standard deviation (SD) of cellviability at the day 10 was 94. 4 2. 60, P > 0. 05) and metabolic activity in three days (mean SD at the day 3 was 97. 27 2. 46, P >0. 05). Furthermore, EVs also did not change the apoptosis rate (mean SD at the day 3 was 3. 17 2. 34 for annexin positive cells, and3. 36 1. 91 for annexin/propidium iodide (PI)-positive cells, P > 0. 05). Conclusions: In conclusion, no significant changes in tumor cell growth were observed after treating K562 cells with MSCs-derivedEVs.

Background: Ovarian Cancer is one of the most fatal female neoplasms associated with high mortality. Finding of the new mechanismsinvolved in the development of ovarian cancer will help us to better diagnosis and effective treatment. Objectives: The current bioinformatics study aimed at investigating the relationship between messenger RNA (mRNA) and longnon-coding RNA (lncRNA) in ovarian cancer through the LncRNAs2Pathways method. Methods: The genome-wide lncRNA andmRNAdata obtained from 185 ovarian cancer and healthy control samples originated fromMichigan Medical School were downloaded and pretreated from European bioinformatics institute (EMBL-EBI) database. The interactionsbetween miRNA and mRNA, and the intersections between lncRNA and miRNA were identified with starBase version 2. 0. Along non-coding RNA-mediated ceRNA network (LMCN) was constructed by integrating lncRNA-mRNA and lncRNA-mRNA intersections. Then, the lncRNAs were mapped to the network, and these lncRNAs were regarded as source nodes, and the random walk withrestart (RWR) algorithm was also applied to evaluate the effect of source nodes on protein-coding genes. Finally, the Kolmogorov-Smirnov-like statistics weighted by the propagation score was used to evaluate the enrichment value of each functional pathway. Results: After preliminary screening, the gene expression profile including 12, 437 genes was obtained. The LMCN network including11 lncRNA and 367 mRNA were identified. A total of 11 differentially expressed lncRNAs between the normal and ovarian cancersamples by the LCMN network were identified. The LncRNAs2Pathways screened six functional pathways (P < 0. 05) coregulated bylncRNAs related to ovarian cancer. Conclusions: A total of six functional pathways related to lncRNA and mRNA interactions in ovarian cancer were identified. Thisfinding is beneficial for effective diagnosis of patients with ovarian cancer, and also provides a new insight into the treatment ofthis disease.

Background: Modified Ultrafiltration (MUF) has been used in Cardiopulmonary Bypass (CPB) operations to prevent hemodilutionand remove pro-inflammatory cytokines. It has been studied in pediatric operation settings. However, evidence exists regarding itsapplication in adults’ Coronary Artery Bypass Grafting (CABG) operation. Objectives: The present study investigated MUF and its effects on inflammatory cytokine response, hemodilution and rotationalthromboelastometry outcomes in adults’ CABG operation. Methods: In a randomized controlled trial, 56 elective CABG patients that had referred to the Rajaie Cardiovascular Medical andResearch Center (Tehran, Iran) during year 2017 were randomly assigned to two groups, including control and MUF groups. Preoperativeand postoperative clinical parameters were recorded. Serum level of inflammatory cytokines after clamp removal, afterCardiopulmonary Bypass (CPB) (MUF in the MUF group) and 24 hours after Intensive Care Unit (ICU) entrance, and RotationalThrombo-elastometry (ROTEM) indices, pre-operation, and post-operation, were measured. Results: The two groups were similar in clinical perioperative parameters, including hemodynamics, transfusions, ROTEM indices, mechanical ventilation and CPB time, and ICU stay. The levels of inflammatory mediators were significantly increased after CPB inboth groups. Interleukin (IL)-6,-8 and-10 measures were equal between the two groups in all trial measurement points. The MUFgroup demonstrated a significantly lower level of Tumor Necrosis Factor (TNF)- compared with the control group after CPB (1. 55 0. 29 versus 1. 77  0. 35 log10 pg/mL, respectively; P = 0. 031). Hemoglobin (9. 55  0. 96 versus 8. 29  0. 57 g/dl, P < 0. 001) andhematocrit % (29. 96 3. 23 and 24. 72 1. 62, P < 0. 001) levels were significantly higher in the MUF group compared with the control, after CPB. Conclusions: Modified Ultrafiltration eliminates extra liquids and TNF- from circulation in adults CABG operation, without affectingthe hemostatic indices and improves hemoglobin level. It does not remove anti-inflammatory cytokine IL-10 from circulation.

Background: As personalized medicine is developing, similar concepts in Persian medicine need standardization. Objectives: The aim of this study was to compare the correlation of ten criteria of Mizaj assessment with Mizaj determined byexperts. Methods: In this cross-sectional methodological research, 74 medical student volunteers were examined by ten expert raters. Theagreement between every ten indices and total Mizaj were assessed with the Spearman’ s correlation coefficient (r) and weighted bythe Kappa coefficient (wk). Results: Among ten indices, the largest agreement was observed amongst indices of psychic function, impressibility, physical functionand physique with total warm or cold Mizaj and thus amongst indices of muscle and fat mass, touch, and physique with totalwet or dry Mizaj, respectively (k 0. 4). Conclusions: The four mentioned indices in assessing warmness-coldness and three in wetness-dryness are major criteria. Otherindices, such as hair condition, skin color, quality of waste matter (stool, urine, and sweat), and sleep/wakefulness have a minoreffect in Mizaj identification.

Background: Clinical Decision Making (CDM) is the foremost aspect of caring for patients. Storytelling can enhance skills such asjudging, and problem-solving among people, especially in clinical education environments. Objectives: The current study aimed at investigating the impact of tacit knowledge transfer through storytelling onCDMby nurses. Methods: The current quasi-experimental study was conducted on 61 nurses. The participants were selected by convenience samplingmethod and randomly assigned into experimental and control groups. An eight-hour storytelling session was held for theexperimental group, but not for the control group. The assessment tool was the Jenkins’ CDM in nursing scale. Results: The mean scores of CDM pre-intervention were 146. 80 12. 68 and 138. 42 12. 64 in the experimental and control groups, respectively (P = 0. 012). The mean scores of CDM post-intervention were 163. 43  18. 45 and 139. 10  11. 78 for the experimental andcontrol groups, respectively (P < 0. 001). The gain scores were 28. 74 38. 90 and 0. 78 3. 84 in the intervention and control groups, respectively. The difference was statistically significant (P < 0. 001). Conclusions: The obtained results showed that the transfer of knowledge and experiences through storytelling significantly enhancedCDM score.

Background: The prevalence of ventricular fibrillation after removal of the aortic cross-clamp in patients undergoing coronaryartery bypass surgery is about 74%-96%. Defibrillation shock and different types of agents are used to treat ventricular fibrillation(VF). Objectives: This study was aimed to compare the effects of combining Lidocaine + Magnesium Sulfate with Amiodarone + MagnesiumSulfate in the prevention of reperfusion-induced ventricular fibrillation. Methods: This randomized, double-blinded clinical study included 74 ASA class II and III patients undergoing coronary artery bypassgrafting (CABG) in a university-affiliated hospital, Bandar Abbas, Iran, in the years 2015-2016. Patients were divided into twogroups based on a random sample table of the lock. Both groups received Magnesium Sulfate through the cardiopulmonary bypasspump. Lidocaine 2% (100 mg) and Amiodarone (300 mg) were injected respectively to group Lidocaine + Magnesium Sulfate (LM)and group Amiodarone + Magnesium Sulfate (AM) patients before aortic cross-clamp release. The incidences of arrhythmias wererecorded within 30 minutes after release of the aortic cross-clamp (ACC). Additionally, the defibrillation shocks (frequency andlevel of Joules delivered), amount of inotrope agent, and the hemodynamic and arterial blood gas parameters were recorded up to24 hours postoperatively. Results: There was no significant difference between the two groups in terms of demographic characteristics, ejection fraction, andASA class. The prevalence of ventricular fibrillation (VF) and atrial fibrillation (Af) 30 minutes after ACC release were 46. 7% and 53. 3%(P = 0. 240) vs. 33. 3% and 66. 7% (P > 0. 999); while, up to 24 hours post-operatively were 60% and 20. 0% vs. 0. 0% and 0. 0% in groupsLM and AM respectively. The number of defibrillations in the Lidocaine + Magnesium Sulfate group was significantly higher; 57. 9%vs. 25% in groups LM and AM respectively (P = 0. 004). Conclusions: The use of Amiodarone + Magnesium Sulfate reduces the number of defibrillation following the release of the Aorticcross-clamp compared with Lidocaine + Magnesium Sulfate.

Background: Trauma is the main cause of death in all age groups, as well as the 7th leading cause of fatality among the elderly. Compared to the youth, the risk of mortality and length of hospital stay are higher in elderly patients experiencing similar traumaand injury severity. Objectives: The present study aimed to identify the risk factors for mortality in the elderly. Methods: This was a cross-sectional study conducted on 65304 trauma patients who were referred to Shahid Rajaee (Emtiaz) Hospitaltrauma referral center, Shiraz, Iran 2011-2016. Information such as age, gender, injured body region, length of hospital stay, injury severity score (ISS), injury mechanism, nosocomial infection, and mortality was recorded. Injury severity scores and injuredbody regions were determined based on a conversion of international classification of diseases, the 10th revision (ICD-10) injurycodes to Abbreviated Injury Scale (AIS-98) severity codes using a domestically developed electronic algorithm. The binary logisticregression was used to determine the partial effects of independent risk factors. Results: Patients over 60 had a mean age of 70. 79 8. 83. Mortality rates were 4. 7% (330) and 1. 05% (614) among patients over andunder 60, respectively. The most important risk factors for geriatric mortality included age over 75 [OR = 1. 91, 95% CI (1. 28-2. 85)], nosocomial infection [OR = 10. 56, 95% CI (6. 52-17. 10)], ISS (16-24) [OR = 12. 51, 95% CI (7. 28-21. 490)], head injury [OR = 13. 17, 95% CI(5. 83-29. 77)], and pedestrian accidents [OR = 1. 47, 95% CI (1. 47-1. 95)]. Aging led to increased mortality due to nosocomial infection. Among the elderly patients, males had a higher mean injury severity score compared to females. Conclusions: According to our results, mortality rates increased by age in geriatric trauma patients. With similar severity of injuries, there was a greater risk of mortality for trauma patients with very old age compared to old patients. Aging, gender (males), nosocomial infection, ISS, and head injury were the most significant predictors of mortality in the elderly.