Demographic data of patients with β-thalassemia major recorded in the electronic system in the north of Iran, 2016

Background: Major thalassemia prevention project in Iran began in 1997. Mazandaran Province in northern Iran took effective steps in preventing the birth of patients with thalassemia major in the country. We report on the demographic status of patients with thalassemia major registered in the electronic system of Mazandaran Province in Iran.Methods: The web-based application of the Mazandaran Thalassemia Registry (THRegistry) was designed based on the Net Framework platform in VB.Net and the 2014Sql Server database. The information source included clinical records in 14 thalassemic wards of the Mazandaran province hospitals. Epidemiological data of patients and date of transfusion, blood group, educational status, employment, marital status and having children were recorded.Results: The study population was 1,725 patients including 889 (51.5%) women and 836 (48.5%) men with a mean age of 30±9.6 years. A total of 188 patients born have been identified after the launch of the country's disease prevention plan in 1997. Prenatal diagnosis (PND) services were not used in 99 cases, PND result was mistaken in 6 other cases and in the remaining 5 cases PND was performed. A total of 1,314 patients (76.2%) were blood transfusion dependent thalassemia (TDT). Mean haemoglobin level in male and female patients was 9.4±6.3 and 9.01±5.1/100 g/dl, respectively. The mean age of onset of transfusion was 4±6.3 years. A total of 382 cases (22.1%) of married patients had a child of their own.Conclusions: The system is a good resource to design descriptive and cohort studies, survival studies, therapeutic planning, and observation of the success of the major thalassemia prevention project

Potential Effects of Silymarin and Its Flavonolignan Components in Patients with β

Major β-thalassemia (β-TM) is one of the most common inherited hemolytic types of anemia which is caused as a result of absent or reduced synthesis of β-globin chains of hemoglobin. This defect results in red blood cells lysis and chronic anemia that can be treated by multiple blood transfusions and iron chelation therapy. Without iron chelation therapy, iron overload will cause lots of complications in patients. Antioxidant components play an important role in the treatment of the disease. Silymarin is an antioxidant flavonoid isolated from Silybum marianum plant. In the present study, we reviewed clinical and experimental studies investigating the use of silymarin prior to September 1, 2015, using PubMed, ISI Web of Knowledge, Science Direct, Scopus, Ovid, and Cochrane Library databases and we evaluated the potential effects of silymarin on controlling the complications induced by iron overload in patients with β-TM. Based on the results of the present study, we can conclude that silymarin may be useful as an adjuvant for improving multiple organ dysfunctions

Does high-dose metformin cause lactic acidosis in type 2 diabetic patients after CABG surgery? A double blind randomized clinical trial

Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Student’s t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used

Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients

Iron-overload-associated cardiomyopathy has been one of the primary causes of mortality in thalassemia patients with iron burden. There is growing evidence citing the beneficial effects of ebselen as an antioxidant selectively blocking the divalent metal transporter 1 (DMT-1) to deter iron ingress into cardiomyocytes, raising internets in viewing this component in this population in order to treat and even prevent cardiomyopathy occurring from iron surplus. In this article, we reviewed the potential advantageous effects of ebselen in thalassemia patients who suffer from iron excess, susceptible to cardiomyopathy induced by iron overload. A systematic search in several databases, including PubMed, Scopus, and Web of Science, was conducted to explore the role of ebselen in controlling iron-overload-related cardiomyopathy in thalassemia patients by the keywords of Ebselen AND iron. The inclusion criteria were English-written preclinical and clinical studies investigating the efficacy and side effects of ebselen in an iron-overload context. After searching the databases, 44 articles were found. Next, of 19 published articles, 3 were included in this article. After reviewing the references of the included studies, no articles were added. In conclusion ebselen can be a promising adjuvant therapy in patients with thalassemia alongside the standard treatment with iron chelators, particularly in severe cases with cardiomyopathy, due to falling iron inflow by inhibiting DMT-1 and increasing ferroportin-1 expression and antioxidant properties. However, clinical studies need to be carried out to reach a definite conclusion

Factors Associated with Incidence and Severity of Acute Poisoning in Aged People: A Retrospective Cross-Sectional Study in North of Iran, 2013-2020

Background and purpose: Mortality rate due to intentional and unintentional poisoning is higher in vulnerable older adults than the general population. This study was performed to determine the prevalence of acute poisoning and factors associated with the incidence and severity of this condition in aged people. Materials and methods: A retrospective cross-sectional study was conducted using the medical records of all older adults (> 60 years old) admitted to Qaemshahr Razi Hospital, Mazandaran province due to acute intentional or unintentional poisoning during 2013-2020. Demographic characteristics, poisoning motive, occurrence and type of substance leading to poisoning, clinical signs, and treatment outcome were studied. Data were analyzed using STATA14. Results: There were 200 cases (mean age: 69.84±8.40 years) with poisoning, including 64.5% men. Unintentional poisonings were seen in 77.5% of the cases. Opium and its derivatives were the most common causes of poisoning. The most common toxins were opium and alcohol. Gastrointestinal poisoning was reported in majority of patients (76.5%). Only 0.5% were discharged after outpatient treatment. The mean duration of hospitalization was 2.2 days and this period was longer in patients poisoned due to concomitant use of several drugs or drug abuse. Intubation, ICU hospitalization, and emergency dialysis were required in 1.5%, 4.5%, and 1.5%, respectively. Death occurred in 0.5% of the patients during hospital stay.  Conclusion: Unintentional poisoning accounts for a significant proportion of older age poisoning. Further studies are recommended to investigate indirect mortality rates, such as death due to complications after discharge, and socioeconomic burden of poisoning in aged people

The Assessment of Correlation between Blood Products Injection with Ventilator- Associated Pneumonia in Trauma Patients under Mechanical Mentilation in ICU

Abstract Background: Ventilator-associated pneumonia (VAP) is one of the most important causes of mortality in intubated traumatic patients admitted in ICU. The aim of current study was to determine correlation between blood products transfusion with incidence of VAP in traumatic patients under mechanical ventilation in ICU. Materials and Methods: This study was a prospective descriptive-analytical study. Current study was carried out on traumatic patients under mechanical ventilation admitted to Imam Khomeini hospital ICU wards of Sari city, from September 2015 to September 2016. In addition to demographic data, patients' clinical information were daily recorded. Results: Of total of 2304 patients admitted to ICU, 186 traumatic patients under mechanical ventilation longer than 48 hours were reviewed and analyzed. Among patients infected with VAP, 36 persons(87.8%) had transfusion of blood products before VAP incidence. Blood products transfusion (before and / or after 48 hours) had the highest adjusted risk ratio in the incidence of VAP (Odds ratio; OR=3.58). Also, amount of injected Packed Red Blood Cells and platelet were significantly higher in patients infected with VAP (p<0.005). Conclusion: Considering remarkable increase in incidence of VAP following blood products transfusion and its correlation with injected PRBC and platelet, considering these modifiable risk factors for controlling and preventing the incidence of VAP in traumatic patients under mechanical ventilation in ICU is necessary and reasonable

Combination iron chelation therapy with deferiprone and deferasirox in iron-overloaded patients with transfusiondependent β-thalassemia major

There are few papers on the combination therapy of deferiprone (DFP) and deferasirox (DFX) in iron-overloaded patients with transfusion-dependent β-thalassemia major (β-TM). A total of 6 patients with β-TM (5 males and 1 female) with a mean age of 23.8±5.8 years (ranging from 17 to 31) used this treatment regimen. The mean doses of DFP and DFX were 53.9±22.2 and 29.3±6.8 mg/kg/day, respectively. The duration of treatment was 11.5±4.6 months. Their serum ferritin levels were measured to be 2800±1900 and 3400±1600 ng/mL before and after treatment, respectively (p<0.6). Their cardiac magnetic resonance imaging (MRI) T2* values were 16.69±15.35 vs 17.38±5.74 millisecond (ms) before and after treatment, respectively (p < 0.9). Although there was no significant difference between their cardiac MRI T2* values before and after treatment statistically, the values improved after combination therapy with DFP and DFX in most of the patients. Liver MRI T2 * values were changed from 2.12±0.98 to 3.03±1.51 ms after treatment (p < 0.01); Further, their liver T2* values and liver iron concentration (LIC) were improved after treatment. Our study found that cardiac MRI T2* values, liver MRI T2* values, and LIC were improved after combination therapy with DFP and DFX in β-TM patients and that DFP and DFX combination therapy could be used to alleviate cardiac and liver iron loading