JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2009 | Volume:27 | Issue:95|Papers Count:10

Background: This study was designed to compare the length of ICU and hospital stay, need to ventilation support, and nosocomial pneumonia, in sever head injury patients, between early and late tracheostomy.Methods: A randomized clinical trial was done. In a period of 2 years, tracheostomy (20 early and 20 late) was did in 40 patients with sever head injury (GCS£8), without lung disease or severe chest injuries, which was hospitalized in Al-Zahra or Ayatollah Kashani hospitals of Isfahan city. Tracheostomy was defined as early if performed in 4th day of reception. The length of ICU and hospital stay, need to ventilation support, and occurrence of pneumonia was registered. P value<0.05 considered to indicate statistical significance.Findings: The mean duration of ICU stay in early and late tracheostomy groups was respectively 20.58 and 28.15 days (P=0.015), and for hospital stay was respectively 30.25 and 36.55 days (P=0.042). The mean duration need to ventilation support was respectively 8.90 and 12.25 days (P=0.049). The pneumonia was occurred in early and late tracheostomy in 8 and 19 cases, respectively (P<0.001). The sex, age, and patient’s GCS in time of reception to ICU or release of it was not associated with kind of tracheostomy.Conclusion: Early tracheostomy is associated with shorter lengths of stay in ICU and hospital, and need to ventilation support and lower nosocomial pneumonia than in late tracheostomy among patients with severe head injury.

Background: Zinc was suggested as an antioxidant and immunomodulator trace element in parallel with other trace elements and antioxidant enzymes. Recently selenium deficiency was indicated in Behcet disease. In this study, we evaluated the correlation of serum zinc level and Behcet disease.Methods: In a cross-sectional, descriptive study serum level of zinc was measured in 49 cases satisfying International Study Group criteria and 51 controls. Serum zinc level was measured by atomic absorption spectrometry and compared the mean of serum selenium levels in both case and control and was analyzed by t-test statistical test.Findings: Serum zinc level (mean±SD) in patients (66.4±15.38) were significantly (P<0.0005) lower than healthy controls (86.87±17.18). When considering Global Physician Assessment, there was not significantly difference between active (67.47±14.3) and non-active (69.53±13.65) patients. A significant decrease in Zinc level was present in ocular involved patients (P<0.001).Conclusion: Our results showed that serum zinc level is lower in patients than healthy control group. It is not clear that zinc is a predicting factor of exacerbation or activity of disease. More studies are needed for understanding the precise relationship between zinc and Behcet etiopathology.

Background: Laryngoscopes are the potential cause of cross-contamination between patients. A considerable way to prevent this problem is to use of disposable laryngoscope’s blades. This study was designed to evaluate laryngoscopic conditions in pediatrics with disposable and metallic Macintosh blades.Methods: 152 children scheduled for elective surgery aged 3-12 years were enrolled in this randomized clinical trial. After induction of anesthesia, anesthesiologist intubated the patients with one of two kinds of laryngoscope’s blades (disposable or metalic Macintosh). During laryngoscopy and tracheal intubation, glottic view, brightness of laryngoscopic field, time of intubation and satisfaction degree of anesthesiologist was recorded.Findings: All patients were successfully intubated. There was significant difference between disposable and metalic Macintosh blades with respect to time of intubation and brightness of laryngoscopic field. Grade I of laryngoscopy was more frequent in metalic group compared to disposable group (83% vs. 49%) Anesthesiologist satisfaction was significantly improved during laryngoscopy with metalic Macintosh blade.Conclusion: With respect to successful tracheal intubation of all patients in this trial and the usefulness of disposable laryngoscopes to prevent crosscontamination between patients and regardless of significant difference in laryngoscopic conditions between disposable and metallic blades, disposable laryngoscopes can be used under normal intubating conditions in pediatrics.

Background: Propolis is a resinous material collected by bees from the buds or other parts of plants. It is known for its biological, antibacterial, antifungal and healing properties. Antifungal activity of propolis was studied in several studies. In this study, the effects of propolis on the 21 strains of 3 species of dermatophytes, including Trichophyton mentagrophytis, T. rubrum and T. verrucosum was studied.Methods: First the alcoholic extract of propolis was provided and then this extract was added to SCC medium in different dilutions. Then the fungus was inoculated in the center of medium containing of propolis and the growth rate of fungus was measured based on the colony diameter at ten days and Minimum Inhibitory Concentration (MIC) of the extract was determined.Findings: Alcoholic extract of propolis showed antifungal activity against of these three species. MIC of Alcoholic extract of the propolis in each milliliter of medium was 0.00625 for T. verrucosum, 0.0125 for T. mentagrophytis and 0.05 for T. rubrum.Conclusion: It seems that propolis of Iranian bees as a natural product has a good antifungal activity.

Background: This study was designed to evaluate the correlation of superficial, low grade, unifocal bladder TCC recurrences and the level of tumor markers P53 and CD44 in the tumor tissue.Methods: In 95 patients with primary diagnosis of unifocal superficial TCC of the bladder TURBT was done. Sixty patients (M=49, F=11) with unifocal, superficial (stage Ta or T1), low grade (grade 1 or 2) papillary TCC of the bladder without carcinoma in situ were enrolled to the study and completed it. Tumor tissue sections were immunohistochemically stained for P53 and CD44 separately. Follow up cystoscopy was performed every 3 months for the first year and every 6 months for the second year. Recurrence rate of tumor was compared between P53 positive and p53 negative groups and between CD44 positive and CD44 negative groups.Findings: The mean age of the patients was 59.7 years. The overall recurrence rate was 53%. It was 64.5% in P53 positive and 41.2% in P53 negative group (P=0.07). Recurrence rate in CD44 positive and CD44 negative group was 72% and 40% (P<0.02) and recurrence rate in both positive marker (CD44 and P53) groups was 87.5% and in both negative marker groups was 40 % (P<0.02).Conclusion: Our results suggest that there is a remarkable relationship between CD44 positive group, specially CD44 and P53 positive group and recurrence rate in low risk superficial TCC, but the relationship between P53 positive group and recurrence is not statistically significant.

Background: Acute myeloblastic leukemia (AML) is the most common form of acute leukemia in adults. One of the major problems in this disease is the emergence of leukemic blast cells that are resistant to anticancer drugs. This phenomenon is termed multidrug resistance (MDR). One cause of the MDR is the expression of the MDR1 gene and its product, P-glycoprotein (Pgp). In this study, we tried to inhibit the MDR phenotype with MDR1/mRNA/Pgp in the leukemic cells using short interfering RNA (siRNA) and two nano particles as non-viral vectors.Methods: The Pgp expressing cell line was established from a parental K562 cell line with increasing concentration of doxorubicin and named KDI/20. In order to reverse the MDR phenotype due to pgp expression, siRNA against MDR1/mRNA was synthesized. siRNA was used on the KDI/20 cells in combination with two nano particles as non-viral vectors: (1) Fugene 6 transfection reagent (cationic lipid) and (2) polyethylenimine (cationic polymer). The effect of these complexes was assessed at the cellular level by flowcytometry (for Pgp detection) and molecular level by Real Time-PCR.Findings: The result showed 79% reduction in Pgp by siRNA /Fugene 6 and 86% reduction in the Pgp by siRNA/PEI at the cellular level in flowcytometry. Also 62% reduction in the MDR1/mRNA by siRNA /Fugene 6 and 74% reduction in the MDR1/mRNA by siRNA /PEI at the molecular level by Real Time-PCR.Conclusion: siRNA could be an efficient method in order to post transcriptional gene silencing and there were no significant differences between two nano particles in gene silencing in this study.

Background: Sickle cell disease is the most common hemoglobinopathies that affect a specific intracellular protein named as hemoglobin. This disease has several clinical manifestations including, CNS involvement. Stroke is one of the most important manifestations of this disease. Diagnosis of high risk patient and necessary intervention as transfusion can reduce its complications, but its effects on TCD parameters remain undefined. The aim of this study was to show the efficacy of hydroxyurea in decreasing of velocity parameter in sickle cell disease.Methods: 25 Sickle cell Patients who had indication of hydroxyurea treatment were selected for the study and at the first of the study, total hemoglobin, hemoglobin s, hemoglobin F and peak systolic velocities of middle cerebral and internal carotid arteries was measured and then repeated 6 month later.Findings: 25 Patients (18 male and 7 female) between 3 to 47 years old and by the mean of ages 16.5 years old were evaluated. Our data showed significant changes of mean hemoglobin, hemoglobin S, hemoglobin F and peak systolic velocities of middle cerebral and internal carotid arteries before and after 6 month hydroxyurea treatment (P<0.05).Conclusion: Our Study Suggests that hydroxyurea can improve hemoglobin state and reduce peak systolic velocities of middle cerebral and internal carotid arteries.

Background: First year of life especially is important in providing of a foundation for health and improvement of the life quality. In recent years Infants Mortality Rate has been decreased in our country but still is higher than the developed countries.Methods: In our study data was collected in a questionnaire for 2004-2005 year dead infant in Birjand hospitals. This study was a case – control for each case, two controls, who matched one to one considering variable of residency and age were chosen.Findings: 79.7 percent of infant mortality was in neonatal period. The most important causes of death in neonatal were prematuity and low birth weight (54.3%) and in post neonatal period were congenital abnormality (33.3%). In this study logistic regression analysis showed that few variables such as father's education, history of prior death child, interval between two births, high risk mother's in pregnancy, type of delivery, gestational age and weight of birth had the significant relationship with infant mortality. Prematurity and low birth weight was highly associated with mortality.Conclusion: Special care for premature and low birth weight infant and strengthening health care programs and emphasizing the need to identify high risk groups should be priorities.