Iranian Red Crescent Medical Journal
Year:2018 | Volume:20 | Issue:8|Papers Count:10

Introduction: Abdominal aorta injury is a rare yet lethal condition, particularly in patients at first-line hospitals, which usually lackin experience with the treatment of major vascular injuries. In this setting, the patient should initially be treated with the intent toprolong survival and enable the consultation of a physician at a tertiary hospital. Case Presentation: This report describes a case, in whommassive blood transfusion and aortic compression with gauze were combinedto maintain hemodynamics for approximately one hour successfully. The case was a 40-year-old patient with a penetratingabdominal aorta injury. This patient was admitted to the People’ s Hospital of Jingyan County in Leshan, People Republic of China, during May 2017. During the resuscitation process, this patient experienced a blood loss of 12 000 mL (equivalent to 2. 5 folds that ofa male with a 60-kg body weight) and received an approximate total volume of 9000 mL of transfused blood and blood products. Conclusions: Although supermassive hemorrhages and transfusions approximated to 2. 5 times and 2 times, respectively, blood volumeof a 60-kg man are extremely rare. This study demonstrates that the simple intervention combined with a massive transfusionwith gauze-based aortic compression can effectively prolong the time window, during which an abdominal aorta repair is possible. Therefore, massive transfusion and gauze-based compression are one of the most effective rescue measures to life-threateninghemorrhages.

Background: There is a growing body of literature on the effectiveness of family-based interventions in bipolar disorder (BD). Objectives: The present study aimed to determine the effectiveness of a family-based intervention on expressed emotion, copingstyles of family and symptoms severity of bipolar patients. Methods: An experimental design using pretest, posttest, and a three-month follow-up was used. The population comprised familymembers of patients with one type of bipolar disorder spectrum who were hospitalized in a referral Psychiatric Hospital in Tehran, Iran, during the second half of 2017. Sixty-two patients were selected randomly and assigned randomlyinto two groups of experimentaland control. Then, the main caregiver of their family was invited for participation in the research. They had no diagnosis inaxis I and they were eager to participate in the study. 12 sessions of family-focused therapy (FFT) based on the Micklowitz protocolwith some adaptation for Iranian families were used for the experimental group. The control group was on the waiting list andreceived no intervention. The following measurement tools were used: the Young Mania Rating Scale (YMRS), Coping Inventory forStressful Situations (CISS), and Emotional Expressiveness Questionnaire (EEQ). Data were analyzed via repeated measures analysisof variance test. Results: The results showed that there was a significant difference between the two groups in coping styles and expressed emotion(P = 0. 023). The symptoms severity was 46. 4 5. 9 in patients and 54. 5 6. 9 in controls (P = 0. 038). The results remained at follow-up(P = 0. 041). The effect size of 0. 8 indicated a high promotion after treatment. Conclusions: The family-focused therapy was effective in decreasing emotion expression in families and improving coping stylesof family members. It led to an improvement in symptoms severity in patients. Therefore, it is recommended as supplementary topharmacotherapy in patients with bipolar disorder and their families.

Background: Nitrate (NO3-) is one of the inorganic anions produced from the oxidation of nitrogen. The organic or inorganicnitrogen may act as a carcinogen depending on the reduction of nitrate to nitrite and the subsequent reactions of nitrite with othermolecules, leading to the formation of N-nitroso compounds. Objectives: This study aimed to determine the effects of nitrate and Vitamin C on oxidative stress in the renal tissue of rats. Methods: This experimental study was conducted in Iran during the 2017-2018. The sample size was estimated to include 55 Wistarmale rats using Morgan’ s table and Cochran’ s formula. In total, 49 rats were selected and divided into seven groups of: (1) NO3 = 0mg/L (control), (2)NO3 = 10 mg/L, (3)NO3 = 45 mg/L, (4)NO3 = 200 mg/L, (5)NO3 = 10 mg/L + Vitamin C 20 mg/100 gBW(BodyWeight), (6) NO3 = 45 mg/L + Vitamin C 20 mg/100 g BW, and (7) NO3 = 200 mg/L + Vitamin C 20 mg/100 g BW. Blood samples were obtainedto determine blood urea nitrogen (BUN) and creatinine. An autopsy was performed on the renal tissue to evaluate oxidative stressindicators including malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH). Results: In this research, the fourth group showed a significant increase in the level of creatinine (50. 14 2. 6, 43. 14 1. 21, P = 0. 01)and BUN (0. 72 0. 04, 0. 57 0. 11, P = 0. 003) compared to the control group. On the other hand, a significant increasewas observedin the level of MDA in the fourth group compared to the control group (P = 0. 01), whereas a significant reduction was found in thelevels of CAT (P = 0. 001), SOD (P = 0. 02), and GSH (P = 0. 02). In addition, the levels of creatinine and BUN significantly reduced in theseventh group compared to the fourth group (P < 0. 05). Furthermore, the use of Vitamin C resulted in a significant reduction inMDA and an increase in SOD, CAT, and GSH in the seventh group compared to the fourth group (P < 0. 05). Conclusions: According to the results of the study, nitrate in drinking water and the prescription of Vitamin C had no significanteffect in the presence of nitrate doses of 10 and 45 mg/L. However, a 200 mg/L dose of nitrate significantly affected BUN, serumcreatinine, and oxidative stress indicators, causing the kidney disease.

Background: Multiple sclerosis (MS) is an autoimmune and multifactorial disease, and its pathogenesis is associated with manygenetic and environmental factors. Long Non-coding RNA (lncRNAs) are a group of genes that have recently been identified as predisposinggenetic factors for the development of many cancers. Objectives: This is a case– control study to evaluate the expression of two lncRNAs including Urothelial Carcinoma Associated 1(UCA1) and Cancer-Associated Transcript 2 (CCAT2) in Relapsing-Remitting Multiple Sclerosis (RRMS) patients compared to healthycontrol group. Methods: In this case-control study, the expression of UCA1 and CCAT2 was evaluated in 50RRMSpatients (37 females, 13 males with amean age of 36. 2 2. 9 years) compared to 50 healthy controls (38 females, 12 males with a mean age of 35. 3 2. 1), using the TaqManreal-time PCR technique. This study was conducted during 2017 and 2018 at Shahid Beheshti University of Medical Sciences, Tehran, Iran. Results: There was no significant difference between the overall expression of UCA1 (P = 0. 282) and CCAT2 (P = 0. 983) among the caseand control groups. However, there was a significant difference in the expression of UCA1 in female patients older than 40 years incomparison with healthy age-matched females (P = 0. 013). In addition, there was a significant correlation between the expressionof UCA1 and CCAT2 (P < 0. 0001). Conclusions: These results suggest the synergistic effects of UCA1 and CCAT2 on pathogenic aspects of MS, by affecting cellularsignaling pathways such as WNT and NF-kB.

Background: Functional dyspepsia is one of the most common and disturbing symptoms that affect many patients visiting healthcare centers. Objectives: This study was intended to examine the efficacy of honey and diet education in functional dyspepsia symptoms. Methods: This randomized clinical trial was conducted on 60 patients with functional dyspepsia symptoms in two groups. Patientsfrom both groups received necessary education provided by a gastroenterology subspecialist for modifying their dietary patterns. Experimental group patients also received a teaspoon of honey per day, 30 minutes before each meal for 30 days. The severity ofeach symptom was measured using the Visual Analogue Scale. Results: A total of 30 patients in each group were assessed. Patients’ mean age was 35. 07  12. 24 and 40. 22  11. 43 years in theexperimental and control groups, respectively. There was no significant difference between the groups in terms of demographiccharacteristics (P 0. 05). There were significant differences in the signs of functional dyspepsia before and after the interventionin both groups (P < 0. 05). Mann-Whitney U test showed no significant differences between the experimental and control groups inany of the symptoms after the intervention (P 0. 05). Conclusions: The consumption of honey alone was unable to affect gastrointestinal factors in patients with functional dyspepsia. However, the improvement of symptoms in both groups due to the dietary pattern education is worth considering.

Background: In patients undergoing Cardiopulmonary Bypass (CPB) with extracorporeal circulation, the rapid restoration ofblood flow to the ischemic tissue induces cardiac damage termed as myocardial Ischemic Reperfusion (I/R) injury. Objectives: In the current study, the researchers hypothesized that Dexmedetomidine (DEX) modulates I/R injury in CoronaryArtery Bypass Graft Surgery (CABG) with Cardiopulmonary Bypass (CPB). Methods: This randomized, double-blind, clinical trial took place in a university affiliated Hospital, Gilan, Iran. From April 2016to March 2017, 114 eligible patients undergoing elective and isolated CABG were randomized to receive either DEX infusion 0. 3 to0. 5  g/kg/hour before induction of anesthesia till 12 hours postoperatively (group D) or normal saline as placebo (group C). Theendpoints were used to assess creatinine phosphokinase-MB (CKMB) and cardiac troponin I (CTnI) levels at four measurement timepoints, including baseline (T0) and 6, 12, 24, and 48 hours after the operation (T0-T4). Results: Overall, 114 patients’ data were analyzed; group D (n = 58) and group C (n = 56). No significant differences were foundbetween the two groups, in view of baseline characteristics. Following CPB, a marked increase in CKMB and CTnI plasma levels wasobserved in both groups compared with baseline (P = 0. 0001). Serum CKMB levels increased from 2. 27 0. 59 to 7. 81 1. 39, and 2. 22 0. 64 to 7. 46  1. 25 and CTnI levels from 10. 22  0. 17 to 4. 89  1. 1, and 0. 27  0. 28 to 4. 5  1. 4 in groups C and D, respectively (P= 0. 0001). According to CKMB, there was a significant difference between the two groups at T2 (P = 0. 002) and T3 (P = 0. 0001), andbased on CTnI at T2 (P = 0. 004) and T3 (P = 0. 0001). However, no significant difference was observed at the other measurement pointtimes. No adverse effect was recorded due to this intervention. Conclusions: Perioperative DEX in cardiac surgery appears safe, with properties to alleviate I/R injury. Obviously, future standardtrials are required to find optimal intervention strategies.

Background: Coronary artery bypass grafting (CABG) is one the most common heart operations, in which blood vessels from otherparts of the body, like the saphenous vein, are grafted to the blocked arteries. Due to the widespread use of vasoactive drugs inthe course of surgery, and renal complications of these drugs, we aimed to determine the effect of norepinephrine on the renalfunction of patients with CABG, visiting the cardiac surgery ward of a university affiliated hospital in Ardabil, Iran, with the purposeof maintaining renal perfusion and preventing renal dysfunction in patients undergoing CABG. Objectives: This research aimed to determine and compare the effects of vasopressin and norepinephrine on the renal function ofpatients undergoing CABG. Methods: This study was a randomized clinical trial. A total of 120 candidates for CABG in a governmental hospital, Iran, duringyears 2016-2017, were randomly assigned into two groups. The patients’ conditions across the two groups were compared regardinghemodynamics during surgery and post-surgical complications, e. g., renal function (Bun, Cr, and CLCr), using a researcher madequestionnaire. Results: The results of our study showed that according to repeated measures test, there was no statistically significant differenceduring the intervention (P value > 0. 05). However, the Independent t-test revealed a statistically significant difference betweengroups following CABG, which related to the clearance creatinine level. It indicated higher clearance creatinine level in the norepinephrinegroup (72. 83 25. 03 and 78. 16 27. 31) than the vasopressin group (64. 33 17. 47 and 86. 33 30. 54) (P < 0. 05), however, the groups did not vary significantly from each other in other items. Conclusions: According to the results of the study, it could be stated that probable renal complications during operation can bereduced to some extent in patients undergoing CABG using inotrope and vasopressor drugs such as norepinephrine.

Background: Lumbar back pain is a common disease, which reduces life quality. Caudal epidural steroid injection (CESI) is frequentlypreferred to relieve lumbar back pain. However, various major complications can be observed due to CESI. A new techniqueof needle angle should be improved to prevent complications such as intraosseous, intrathecal or intravascular injection duringCESI. Objectives: Caudal epidural steroid injection is one of the methods frequently used to treat chronic lumbar back pain. The currentstudy aimed at examining the anatomy of the sacral hiatus and determining the optimal angle of the needle for CESI. Methods: The current clinical trial was performed in Diyarbakı r Selahaddin Eyyü bi State Hospital from January to June in 2017. Thestudy included 150 adult patients (first group = 92 males (%61. 3), second group = 58 females (%38. 7) aged 18-78 years applied to theAlgology Polyclinic with ASA-PS classes I and II (the American Society of Anesthesiologists (ASA) physical status classification system). Measurements were taken during the CESI applied under ultrasonography (USG) guidance of the intercornual distance, the sacralspace, and the optimal needle entry angle. Results: The intercornual distance was significantly higher in group one (mean standard deviation (SD): 16. 6 2. 04) than grouptwo (mean SD: 15. 8 2. 51) (P < 0. 049). No difference was observed between group one (mean SD: 4. 49 0. 75) and group two(mean SD: 4. 45 0. 88) with respect to sacral space (P > 0. 79). The most appropriate entry angle for the needle in the applicationof CESI was mean 71. 04° in the whole patient group, as 71. 9° in group one and 69. 7° in group two. There was no significant differencebetween the genders in terms of themeanoptimal angle (P> 0. 091). Also, nosignificant difference was observedamongthe patientsin terms of the demographic data (P > 0. 05). Conclusions: The results of the current study revealed that the optimal needle angle for CESI applied under USG guidance was71. 04° , different from traditional method and the injection procedure could be safely made directly to the epidural space withoutchanging the angle after entry of the needle to the epidural space.

Background: Leukemia Inhibitory Factor (LIF) is largely used in stem cell researches for the maintenance of Embryonic Stem Cells(ESCs) in a pluripotent state. However, the relatively high costs of LIF is a potential limit of such researches. Objectives: The aim of this study was prokaryotic expression and purification of the recombinant hexahistidine-tagged human LIF(His6-hLIF) fusion protein and assessment of its ability to maintain a pluripotent or undifferentiated state of ESCs. Methods: Encoding the DNA sequence of mature hLIF was codon optimized for expression in Escherichia coli and chemically synthesizedand cloned in the expression vector pET-28a (+). Immobilized Metal Affinity Chromatography (IMAC) was performed topurify the recombinant His6-hLIF. Then, His6-hLIF was tested for its ability to maintain mESC by comparison with commercial LIF asa control. Results: The yield for the recombinant His6-hLIF was assessed to be approximately 1. 7 mg from one liter of culture. There were nostatistically significant differences in expression of two pluripotency gene markers, oct-4 and Nanog, between mESCs treated withHis6-hLIF and those with commercial hLIF (P = 0. 09 and P = 0. 13, respectively). Besides, morphological characteristics (round cellularmorphology) were similar between them. Conclusions: Collectively, the findings showed that the ability of the recombinant His6-hLIF protein in maintaining pluripotentstate of ESCs was comparable to commercial hLIF, providing evidence that the presence of the N-terminal hexahistidin tag does notinfluence biological activities of hLIF.

Background: Theory-based individual counseling interventions targeting physical activity that produce glycemic control in patientswith type 2 diabetes mellitus are warranted. However, little is known about how caregivers should support patients with type2 diabetes to achieve and sustain a physically active lifestyle. Objectives: The aim of the present study was to determine the effect of theory-based individual counseling on promoting physicalactivity and glycemic control in type 2 diabetic patients. Methods: This quasi-experimental study was conducted from March to September 2016 in Tonekabon, Iran. Using a simple randomsampling method, 80 patients, with type 2 diabetes, who were members of the Iranian Diabetes Association were assigned to experimentaland control groups. The patients in the experimental group participated in a four-week educational program that includeda 90-minute general education session and a 40-minute individual counseling session. The control group did not receive any trainingprogram. All the patients were evaluated at a base time, 12 and 24 weeks follow up for demographic data, clinical measures, stages of Change Scale, and a seven-day Physical Activity Recall Questionnaire (PAR). Results: Individual counseling interventions showed statistically significant increases in HBA1C of patients in the experimentalgroup (from 8. 54 1. 35 to 7. 73 1. 25) compared to those in the control group (from 8. 57 1. 38 to 8. 51 1. 43) at 24-weeks follow-up(P < 0. 001). There was a significant increase in the physical activity of patients in the experimental group (From 224. 6 19. 7 to 244. 6 12. 9) compared to those in the control group (from 226. 3 17. 4 to 231 11. 1) at 24-weeks follow-up (P < 0. 001). Conclusions: This study confirmed that education based on the Stages of Change Model and individual consulting can be used asa framework to increase physical activity and improve metabolic profile in type 2 diabetic patients.