The Effect of Premedication With Oral Acetaminophen on the Prevention of Localized Pain Resulting from Intravenous Propofol Injection: A Randomized Double Blind Placebo Clinical Trial

Background: Propofol is one of the most widely used medications in anesthesia and intensive care. Propofol Intravenous injection is painful for patients at the injection site. The aim of this study was to determine the effect of premedication with oral acetaminophen in prevention of local pain caused by intravenous injection of propofol. Methods: This study was a double-blind randomized controlled trial. Data were collected from July 2020 to July 2021 in Shariati Hospital. All stages of premedication and induction of anesthesia were the same in all three groups of patients. Pb, P500 and P1000 groups (patients with oral placebo, 500 or 1000 mg of oral paracetamol, respectively) received the medication 1 hour before transfer to the operating room. Results: In this study, 150 patients were included. 44.7% were men, 55.3% women, and mean age of patients was 36.82 ± 10.24. The highest severity of reported pain was in the group of patients receiving placebo. Patients receiving 1 gram of acetaminophen had the lowest reported pain. Patients receiving 500 mg of acetaminophen reported significantly less pain than patients receiving placebo and more pain than patients in the group receiving 1 g of acetaminophen. Age, gender and weight did not have any significant effect on the pain severity. Conclusion: When compared to placebo, the use of oral acetaminophen as a premedication considerably lowers discomfort induced by intravenous propofol infusion. A dosage of 1 g of oral acetaminophen is more effective than 500 mg in decreasing pain. The level of pain and acetaminophen's pain-relieving effects were not affected by age, gender or weight

Technical Quality of Root Canal Treatment Performed By Undergraduate Dental Students

INTRODUCTION: This study was carried out to evaluate the technical quality of root canal treatment (RCT) performed by undergraduate dental students at the Islamic Azad University in Tehran, Iran. MATERIALS AND METHODS: Four-hundred records of patients who had received RCT at faculty of dentistry, between the years 2004-2006 were evaluated. For each treated tooth at least three periapical x-rays were assessed: preoperative, working length measurement, and postoperative. Evaluation of root canal filling was based on two variables: length and density. The filling length was recorded as adequate, under- or overfilled. Density of filling was recorded as poor or adequate. Fillings with adequate length and density were recorded as acceptable. Detected iatrogenic errors were: ledge formations, root perforations, furcation perforations, strip perforations and presence of fractured instruments. Results were evaluated statistically using one-way ANOVA and Chi-square analysis. RESULTS: Out of the 400 teeth, 50.5% had at least one of the mentioned errors. Acceptable filling was observed in 32.5% of all studied teeth. Ledge was found in 17.5% of the teeth. Canal curvature was the most important factor associated with ledge formation (P<0.05). CONCLUSION: The technical quality of RCT performed by undergraduate dental students using step-back preparation and cold lateral condensation was classified as acceptable in 32.5% of the cases

Plethysmography Variability Index as a Guidance for Intraoperative Fluid Management in Cesarean Section Delivery under Spinal Anesthesia: A Pilot Study

Background: Plethysmography variability index (PVI) is a measure of the dynamic changes in the perfusion index (PI) that occur during one or more complete respiratory cycles. This study was designed to investigate the accuracy of PVI in guidance of fluid management in parturient undergoing cesarean section surgery under spinal anesthesia.Methods: This randomized clinical trial was performed on 21 consecutive patients who were candidate for cesarean section surgery under spinal anesthesia at Shariati Hospital in Tehran, Iran, between April 2015 and April 2016. The patients were randomly assigned to one of the PVI or conventional group. In all patients, serum level of lactate, mean arterial pressure (MAP), total amount of infused intraoperative fluids, urine output, and duration of surgery were recorded.Results: In total, 21 patients (10 in PVI group and 11 in control group) were assessed. The trend of the change in MAP was significantly different between the two groups with a downward trend in PVI group and a fluctuated trend in the conventional group (P = 0.003). The mean amount of infused fluid was 2565.00 ± 563.74 ml in PVI group that was significantly lower than control group (3122.73 ± 321.99 ml) (P = 0.011). Although urine output was numerically higher in PVI than in control group (425.00 ± 274.12 ml vs. 322.00 ± 121.82 ml), it was not statistically significant (P = 0.292). In PVI group, the primary value of PVI was 23.80 ± 6.93 that reached to 12.20 ± 1.75 at the end of surgery indicating a significant reduction (P < 0.001).Conclusions: Regarding clinical and hemodynamic stability as well as fluid therapy responsiveness (less requiring fluids within surgery), PVI monitoring seems to be superior to the conventional method

Lactoferrin inhibits E. coli O157: H7 growth and attachment to intestinal epithelial cells

Enterohemorrhagic Escherichia coli (EHEC) serotype O157:H7 strains are associated with haemorraghic colitis and haemolytic uremic syndrome (HUS) in humans. Cattle are a reservoir of E. coli O157:H7. We studied the ability of bovine and human lactoferrin, two natural antimicrobial proteins present in milk, to inhibit E. coli O157:H7 growth and attachment to a human epithelial colorectal adenocarcinoma cell line (Caco-2). The direct antibacterial effect of bLF on E. coli O157:H7 was stronger than that of hLF. Nevertheless, both lactoferrins had bacteriostatic effects even at high concentrations (10 mg/ml), suggesting blocking of LF activity by a yet undefined bacterial defence mechanism. Additionally, both lactoferrins significantly inhibited E. coli O157:H7 attachment to Caco-2 cells. However, hLF was more effective than bLF, probably due to more efficient binding of bLF to intelectin present on human enterocytes leading to uptake and thus removal of bLF from the extracellular environment. Inhibition of bacterial attachment to Caco-2 cells was at least partly due to the catalytic effect of lactoferrins on the type III secreted proteins EspA and Esp

Vaccination against EHEC : insights from model in sheep

Enterohaemorrhagic Escherichia coli O157:H7 are zoonotic pathogens associated with haemorrhagic colitis (HC) and the haemolytic uremic syndrome (HUS). Ruminants are the main reservoir of this organism and most outbreaks of E. coli O157:H7 infections are food borne. Food contamination by ruminant manure has been reported as the primary source of human infection, therefore inhibition of E. coli O157:H7 colonization and shedding in ruminants could control the risk of human exposure to this pathogen. In the present study a vaccine based on the translocon proteins EspA and EspB and the outer membrane adhesion factor intiminγ significantly reduced faecal shedding of E. coli O157:H7 by orally infected sheep

A Comparative Study of Intra-Articular Knee Injection of Leukocyte-Poor Platelet-Rich Plasma Compared to Corticosteroids and Local Anesthetics in Patients with Knee Osteoarthritis

Background: Knee osteoarthritis (OA) is the most common reason for orthopedic secondary care referral. And it is one of the main causes of disability in adults worldwide. It is estimated to affect between 10 to 25% of patients over the age of 60. Intra-articular corticosteroid injection (IA CS) and physical therapy were the two choices in an attempt to provide symptomatic management or deferred surgery. There is a growing trend is intra-articular platelet-rich plasma (IA PRP) injection to reduce pain and improve function in OA patients. PRP is divided into two types: leukocyte-poor platelet-rich plasma (LP-PRP) and leukocyte-rich platelet-rich plasma (LR-PRP). It was shown that LR-PRP increases pro-inflammatory factors and also decreases anti-catabolic mediators, and LP-PRP has the opposite aspect. Methods: In our research 40 patients were divided into two equal groups, IA corticosteroid and leukocyte-poor platelet-rich plasma (LP-PRP) 40 cc of blood from the basilic vein of the upper limb is used with two step centrifugation. The final samples were 4 millilitres product injected intra-articular. group two (corticosteroid (CS)) received an intra-articular injection of triamcinolone acetate (Kenalog) 40 mg/ml along with 4 ml of lidocaine 0.02% (Abureyhan Co.) for a total of 5 ml. The needle used is a 22-gauge pencil-point Quincke needle (Dr. Japan Co, Ltd), which is performed with the Sonosite Edge II ultrasound guide and in an anterior-lateral manner in the knee joint. Pain was assessed on a visual analogue scale (VAS range 0-10 points) before, one week, one month, two month and 3 months after the operation. The WOMAC questionnaire was also filled before injection and three months following injection and other variables were examined. Results: There were no significant differences between the groups across all the baseline parameters including age, sex, body mass index and comorbidities including high blood pressure, diabetes and smoking. Both injection groups were effective in reducing patients' pain from one week to three months after injection. The level of pain in the first week after injection was significantly lower in the corticosteroid group than in the PRP group. In the first month and the third month after the injection, the pain reduction according to mean scores of VAS was the same in both groups. Conclusion: In short, one injection of PRP can reduce the pain of patients with osteoarthritis of the knee as much as corticosteroids during a three-month treatment process. Considering the possible side effects of corticosteroids, this alternative treatment can be considered with further investigation