The effect of hydroalcoholic extract of purslane (Portulaca oleracea L) on serum concentration of esterogen, progesterone, prolactin and gonadotropins in mature female rats

زمینه و هدف: گیاه خرفه اثرات مثبتی در کاهش کلسترول تام دارد و دارای تاثیرات مختلفی بر روی سیستم عصبی است؛ بنابراین ممکن است بر محور هیپوفیز-گناد تاثیرگذار باشد. در مطالعه­ی حاضر، تاثیرات احتمالی عصاره­ی هیدروالکلی گیاه خرفه ( Portulaca oleracea ) بر هورمون­های گنادوتروپین، استرادیول، پروژسترون و پرولاکتین مورد ارزیابی قرار گرفته است. روش بررسی: در این پژوهش تجربی 40 سر موش صحرایی ماده بالغ و باکره از نژاد ویستار با وزن تقریبی 2 ± 189 گرم در 5 گروه 8 تایی مورد مطالعه قرار گرفتند. گروه کنترل بدون تیمار دارویی، گروه شاهد که روزانه 2/0 میلی­لیتر آب مقطر به عنوان حلال دریافت نمود و گروه­های تجربی 1 تا 3 به ترتیب، مقادیر 200، 400 و 800 میلی­گرم بر کیلوگرم وزن بدن، عصاره­ی هیدروالکلی گیاه خرفه به صورت خوراکی به مدت 21 روز دریافت کردند. در پایان روز 21 از همه‏ی گروه­ها خونگیری شد و میزان هورمون­ها اندازه­گیری گردید. داده ها با کمک آزمون تجزیه و تحلیل واریانس یک­طرفه، مورد ارزیابی قرار گرفتند. یافته­ها: نتایج نشان داد که میزان هورمون استرادیول در گروه تجربی 3 و وزن بدن در گروه تجربی 2، کاهش معنی­داری (05/0 > P ) را نسبت به گروه شاهد و کنترل دارد. اختلاف معنی­داری در میزان هورمون­های گنادوتروپین ( FSH, LH ) ، پروژسترون و پرولاکتین مشاهده نشد (05/0 < P ). نتیجه‌گیری: نتایج این مطالعه­ بیانگر تاثیر وابسته به دوز عصاره گیاه خرفه در کاهش وزن بدن در مدت 21 روز است. همچنین این گیاه با دارا بودن ترکیبات آنتی‏استروژنیک و آنتی‏آروماتازی، غلظت استرادیول را در دوز حداکثر کاهش می‏دهد؛ بنابراین مصرف طولانی مدت آن می‏تواند باعث اختلالات هورمونی و کاهش قدرت باروری گردد

Intravenous Lidocaine versus Morphine Sulfate in Pain Management for Extremity Fractures; a Clinical Trial

Introduction: Considering the existing contradictions regarding effectiveness of intravenous (IV) lidocaine, especially in emergency department (ED), the present study was designed to compare the analgesic effect of IV lidocaine and morphine sulfate in pain management for extremity bone fractures. Method: In this triple blind clinical trial, 15 to 65 year-old patients with extremity fractures and in need of pain management were randomly allocated to either IV lidocaine or morphine sulfate group and were compared regarding severity of pain 5, 10, 15, 20, 25, and 30 minutes after infusion via intention to treat analysis.  The absolute risk reduction, number needed to treat and relative risk of IV lidocaine after 30 minutes were 0.40 (95%CI: 0.25 – 0.64), 7 (95%CI: 3.7 – 23.1), and 20.71 (95%CI: 10.91 – 30.51), respectively. Results: 280 patients with the mean age of 32.50 ± 12.77 years were randomly divided into 2 equal groups of 140 (73.9% male). The 2 groups had similar baseline characteristics. 15 minutes after injection success rate was 49.28% in lidocaine and 33.57% in morphine sulfate group (p = 0.011), and after 30 minutes it reached 85.71% and 65.00%, respectively (p &lt; 0.001). Conclusion: Based on the results of the present study, IV lidocaine could be considered as a reasonable alternative choice for pain management in ED.

Nerve Stimulator versus Ultrasound-Guided Femoral Nerve Block; a Randomized Clinical Trial

Introduction: Pain control is the most important issue in emergency department management of patients with femoral bone fractures. The present study aimed to compare the procedural features of ultrasonography and nerve stimulator guided femoral nerve block in this regard.Method: In this randomized clinical trial, patients with proximal femoral fractures presenting to emergency department were randomly divided into two groups of ultrasonography or nerve stimulator guided femoral block and compared regarding success rate, procedural time, block time, and need for rescue doses of morphine sulfate, using SPSS 20.Results: 50 patients were randomly divided into two groups of 25 (60% male). The mean age of studied patients was 35.14 ± 12.95 years (19 – 69). The two groups were similar regarding age (p= 0.788), sex (p = 0.564), and initial pain severity (p = 0.513). In 2 cases of nerve stimulator guided block, loss of pinprick sensation did not happen within 30 minutes of injection (success rate: 92%; p = 0.490). Ultrasonography guided nerve block cases had significantly lower procedural time (8.06 ± 1.92 vs 13.60 ± 4.56 minutes; p &lt; 0.001) and lower need for rescue doses of opioid (2.68 ± 0.74 vs 5.28 ± 1.88 minutes; p &lt; 0.001).Conclusion: Ultrasonography and nerve stimulator guided femoral block had the same success rate and block duration. However, the ultrasonography guided group had lower procedure time and lower need for rescue doses of morphine sulfate. Therefore, ultrasonography guided femoral block could be considered as an available, safe, rapid, and efficient method for pain management of femoral fracture in emergency department.

Which came first, the risk of migraine or the risk of asthma? A systematic review

Objectives We conducted this review to systematically assess the association and risk of the migraine in the patient with asthma and vice versa. Methods We systematically searched publishes articles indexed in PubMed, Scopus, Cochrane library, PsycINFO, CINAHL, ISI Web of Science, Science Direct from inception, and Embase databases until June 2017. The quality assessment of the involved studies was done using the Newcastle-Ottawa Scale (NOS). Results Eight studies with 389,573 participants were reviewed and selected for data extraction. Among the selected studies, 5 were reported the association between migraine with asthma risk, and the rest three studies reported the risk of asthma in patient with migraine compared to non-moraine individuals. Odds ratio (OR) of migraine for patient with asthma as compared with non-asthmatic individuals was 1.62 (95% CI 1.43–1.82). Data pooling using a random-effect model showed that migraine was associated with a significant increased risk of asthma (relative risk (RR): 1.56; 95% CI: 1.51–1.60; p &lt; .00001). Besides, sub-group and sensitivity analyses supported the positive association between asthma and migraine, and risk of asthma in migraine patients. Conclusion Now it is unknown if control of the asthma will impact the severity of migraines or vice versa, but it is necessary to perform more research to further explain the mechanisms through which asthma increases the frequency of migraine or vice versa. If two conditions linked, once an individual undergo better control of asthma symptoms, might the excruciating migraine ease, too

Comparison of Oral Midazolam and Promethazine with Oral Midazolam alone for Sedating Children during Computed Tomography

Introduction: Both midazolam and promethazine are recommended to be used as sedatives in many studies but each have some side effects that limits their use. Combination therapy as an alternative method, may decreases these limitations. Therefore, this study aimed to compare midazolam with midazolam-promethazine regarding induction, maintenance, and recovery characteristics following pediatric procedural sedation and analgesia. Methods: Children under 7 years old who needed sedation for being CT scanned were included in this double-blind randomized clinical trial. The patients were randomly divided into 2 groups: one only received midazolam (0.5 mg/kg), while the other group received a combination of midazolam (0.5 mg/kg) and promethazine (1.25 mg/kg). University of Michigan Sedation Scale (UMSS) was used to assess sedation induction. In addition to demographic data, the child’s vital signs were evaluated before prescribing the drugs and after inducing sedation (reaching UMSS level 2). The primary outcomes in the present study were onset of action after administration and duration of the drugs’ effect. Results: 107 patients were included in the study. Mean onset of action was 55.4±20.3 minutes for midazolam and 32.5±11.1 minutes for midazolam-promethazine combination (p&lt;0.001). But duration of effect was not different between the 2 groups (p=0.36). 8 (7.5%) patients were unresponsive to the medication, all 8 of which were in the midazolam treated group (p=0.006). Also in 18 (16.8%) cases a rescue dose was prescribed, 14 (25.9%) were in the midazolam group and 4 (7.5%) were in the midazolam-promethazine group (p=0.02). Comparing systolic (p=0.20) and diastolic (p=0.34) blood pressure, heart rate (p=0.16), respiratory rate (p=0.17) and arterial oxygen saturation level (p=0.91) showed no significant difference between the 2 groups after intervention. Conclusion: Based on the findings of this study, it seems that using a combination of midazolam and promethazine not only speeds up the sedation induction, but also decreases unresponsiveness to the treatment and the need for a rescue dose

Comparing Two Different Doses of Intravenous Midazolamin in Pediatric Sedation and Analgesia

Introduction: Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard. Methods: The present clinical trial was performed to compare 0.1 and 0.3 mg/kg doses of IV midazolam in induction of sedation for head trauma infant patients in need of brain computed tomography (CT) scan. Conscious infants under 2 years old, with stable hemodynamics were included. Onset and duration of action as well as probable side effects were compared between the two groups using SPSS version 22. Results: 110 infants with the mean age of 14.0 §5.9 months (range: 4–24) and mean weight of 9.7±2 kg (range: 5–15) were randomly allocated to one of the 2 study groups (54.6% female). Success rate in 0.1 and 0.3 mg /kg groups were 38.2% (21 patients)and 60% (33 patients), respectively (p=0.018). Overall, 56 (50.9%) patients did not reach proper sedation and were sedated receiving ketamine (22 patients) or another dose of midazolam (34 patients, mean additional dose needed was 2.1±1.1 mg). Conclusion: The results of the present study demonstrated the higher success rate and longer duration of action for 0.3 mg /kg midazolam compared to 0.1 mg /kg. The groups were equal regarding onset of action, effect on vital signs and probable side effects

Ketamine Associated Vomiting in Children Requiring Sedation: A Prospective Randomized Open Trial Study

Background In recent years, ketamine has been the most used sedative in Emergency Department (ED) procedures for pain management. Therefore, this study evaluated ketamine associated vomiting (KAV) in children requiring sedation. Materials and Methods This is a prospective, randomized, and open trial study carried out on children of ages 3 months to 13 years requiring sedation for medical diagnostic or treatment procedures. The patients were randomized into 1 mg/kg IV, 2 mg/kg IV, 3 mg/kg IM and 5 mg/kg IM groups. Results A total of 190 patients were enrolled for this study. In total, 17.37% of the children were reported to have vomited after ketamine administration. In the IV group, 21.69% of the children vomited, while in the IM group, 14.02% vomited (p= 0.18). In the 1 mg/kg IV group, 22.72% of the children vomited compared to 20.51% (p= 0.51) in the 2 mg/kg IV group.  In the 3 mg/kg IM group, 14.54% of the children vomited as against 13.46% in the 5 mg/kg IM group (p= 0.54). There were no significant differences between sex and dose group on the incidence of vomiting (p= 0.40). Conclusion This study showed that the administration of ketamine via IV and IM in a standard dose is a safe method for sedating children. However, there is need to study the combination of ketamine with anti-vomiting agents in different injection routes, as well as to review the combination with tranquilizer to minimize the rate of vomiting in children requiring sedation in the ED

Effective Factors in Severity of Traffic Accident-Related Traumas; an Epidemiologic Study Based on the Haddon Matrix

Introduction: Traffic accidents are the 8th cause of mortality in different countries and are expected to rise to the 3rd rank by 2020. Based on the Haddon matrix numerous factors such as environment, host, and agent can affect the severity of traffic-related traumas. Therefore, the present study aimed to evaluate the effective factors in severity of these traumas based on Haddon matrix. Methods: In the present 1-month cross-sectional study, all the patients injured in traffic accidents, who were referred to the ED of Imam Khomeini and Golestan Hospitals, Ahvaz, Iran, during March 2013 were evaluated. Based on the Haddon matrix, effective factors in accident occurrence were defined in 3 groups of host, agent, and environment. Demographic data of the patients and data regarding Haddon risk factors were extracted and analyzed using SPSS version 20. Results: 700 injured people with the mean age of 29.66 ± 12.64 years (3-82) were evaluated (92.4% male). Trauma mechanism was car-pedestrian in 308 (44%) of the cases and car-motorcycle in 175 (25%). 610 (87.1%) cases were traffic accidents and 371 (53%) occurred in the time between 2 pm and 8 pm. Violation of speed limit was the most common violation with 570 (81.4%) cases, followed by violation of right-of-way in 57 (8.1%) patients. 59.9% of the severe and critical injuries had occurred on road accidents, while 61.3% of the injuries caused by traffic accidents were mild to moderate (p &lt; 0.001). The most common mechanisms of trauma for critical injuries were rollover (72.5%), motorcycle-pedestrian (23.8%), and car-motorcycle (13.14%) accidents (p &lt; 0.001). Conclusion: Based on the results of the present study, the most important effective factors in severity of traffic accident-related traumas were age over 50, not using safety tools, and undertaking among host-related factors; insufficient environment safety, road accidents and time between 2 pm and 8 pm among environmental factors; and finally, rollover, car-pedestrian, and motorcycle-pedestrian accidents among the agent factors

Correlation between self-esteem and perceived stress in pregnancy and ways to coping with stress

Background and Aim: Stress during pregnancy can have long-term negative consequences on both mother and fetus. Therefore, recognizing the factors that contribute to controlling stress can have a major role in pregnant women’s mental health. The current research was designed to determine the role of self-esteem on the level of stress during pregnancy and the ways to cope with it. Materials and Methods: In this regard, a cross-sectional study was conducted. The city of Tehran was divided into 4 geographic districts including north, south, east and west. A state hospital was elected for each district, and 450 pregnant women (24-32 of gestational week) were randomly chosen from the hospitals. After explaining the purpose of the study and obtaining an informed consent from the qualified pregnant women, they filled out the perceived stress, Rosenberg Self-Esteem and Coping Inventory for Stressful Situations (CISS) questionnaires. Data were analyzed using SPSS software version 19. The level of significance was considered p<0.05. Results: The age of the 450 participating pregnant women was 28.55 years, 78.9 percent had high school or lower education, and 90 percent were housewives. In this study, self-esteem was 21.918.33 and the perceived stress was 20.094.5, respectively. There was a significant inverse correlation between self-esteem and perceived stress. A significant difference was observed between individuals with different levels of self-esteem and the coping styles. ‍Conclusion: It appears that the level of self-esteem of pregnant women is effective on their level of stress and their coping style. By teaching techniques, which increase self-esteem, the level of stress can be decreased in pregnant women

Prevalence of Upper Extremity Musculoskeletal Disorders in Dentists: Symptoms and Risk Factors

Aim. The purpose of the present research was to examine the factors that lead to musculoskeletal disorders in dentists by assessing their posture using RULA method. Materials and Methods. In this cross-sectional study, 130 dentists (84 male and 46 female) participated. The posture of the subjects during their normal workload was recorded by using the RULA method, and the range of musculoskeletal pains by using the Nordic Musculoskeletal Questionnaire (NMQ), and individual and professional data was assessed by a demographics questionnaire. All tests were performed at the P<0.05 level. Results. Assessment of the physical status of the subjects showed that 82.8% of subjects were at high risk of musculoskeletal disorders. The majority of musculoskeletal pains were in the neck (55.9%) and the shoulder (43.8%). Moreover, 68.9% of the subjects had experienced pain at least once over the last year. Significant relationships were observed between musculoskeletal pain and daily work hours P=0.07 and number of patients P=0.02, but the pain was not significantly associated with BMI and experience. Conclusion. The present findings showed that unsuitable posture of dentists during work has a considerable effect on musculoskeletal disorders. Therefore, further investigation is required to avoid the detrimental effects of wrong posture