An 85-year-old Woman with Altered Mental Status and Hypotension

An 85-year-old female patient was brought to emergency department (ED) from a nursing home with altered mental status (GCS: 12/15) and hypotension (90/60 mmHg). Bilateral fine crackles in lungs and severe cachexia were obvious in her physical examination. The ECG showed only sinus tachycardia. Several attempts at peripheral vein cannulation failed due to poor visualization of severely atrophied and contracted subcutaneous veins. Therefore, on two attempts, a central venous catheter (CVC) was inserted into the right internal jugular vein (IJV) using the Seldinger technique. After securing and taping the central line, fluid infusion started with no difficulty and a portable chest x-ray was ordered

First report of simultaneous assessment of hepatitis A virus and hepatitis E virus seroprevalence among soldiers in Iran

Hepatitis E virus (HEV) and Hepatitis A virus (HAV) have been considered as common causes of viral hepatitis to military service members since their discovery. Although Iran has been recognized as an endemic country for HAV and HEV there is no study about HAV and HEV simultaneous prevalence among Iranian soldiers. The purpose of this study was to assess anti-HAV and anti-HEV antibodies in Iranian soldiers concurrently. In this cross-sectional study, a total of 400 serum samples were collected by simple random sampling for detection of anti-HAV and anti-HEV IgG by commercial HEV enzyme-linked immunosorbent assay (ELISA) kit. Out of 400 individuals, all participants were male with ages ranging from 18 to 26 years. Totally, 12% and 0.5% of the tested specimens were positive for anti-HAV and anti-HEV respectively. There were no significant differences between the subjects grouped according to age groups. Our finding presented a dramatic decrease in seropositivity against HAV. Therefore, vaccination for HAV should be reevaluated for military services in Iran

Immunoinformatics and Similarity Analysis of House Dust Mite Tropomyosin

Background: Dermatophagoides farinae and Dermatophagoides pteronyssinus are house dust mites (HDM) that they cause severe asthma and allergic symptoms. Tropomyosin protein plays an important role in mentioned immune and allergic reactions to HDMs. Here, tropomyosin protein from Dermatophagoides spp. was comprehensively screened in silico for its allergenicity, antigenicity and similarity/conservation.Materials and Methods: The amino acid sequences of D. farinae tropomyosin, D. pteronyssinus and other mites were retrieved. We included alignments and evaluated conserved/ variable regions along sequences, constructed their phylogenetic tree and estimated overall mean distances. Then, followed by with prediction of linear B-cell epitope based on different approaches, and besides in-silico evaluation of IgE epitopes allergenicity (by SVMc, IgE epitope, ARPs BLAST, MAST and hybrid method). Finally, comparative analysis of results by different approaches was made.Results: Alignment results revealed near complete identity between D. farina and D. pteronyssinus members, and also there was close similarity among Dermatophagoides spp. Most of the variations among mites' tropomyosin were approximately located at amino acids 23 to 80, 108 to 120, 142 to 153 and 220 to 230. Topology of tree showed close relationships among mites in tropomyosin protein sequence, although their sequences in D. farina, D. pteronyssinus and Psoroptes ovis are more similar to each other and clustered. Dermanyssus gallinae (AC: Q2WBI0) has less relationship to other mites, being located in a separate branch. Hydrophilicity and flexibility plots revealed that many parts of this protein have potential to be hydrophilic and flexible. Surface accessibility represented 7 different epitopes. Beta-turns in this protein are with high probability in the middle part and its two terminals. Kolaskar and Tongaonkar method analysis represented 11 immunogenic epitopes between amino acids 7-16. From comparative analysis of predicted probable consensus epitope regions by machine learning approaches these epitopes were gained: AA23-48, AA59-80, AA91-110, AA114-143, AA154-168, AA182-200, AA208-225, and AA254-272. Prediction of allergenic proteins by AlgPred server showed 10 matches for IgE epitope, and prediction by hybrid approach showed that IgE epitope is undoubtedly the major allergen.Conclusion: Immunoinformatic approaches in allergenic protein analysis are now reliable tools for explanation/interpretation of clinically observed complexities. Results of present study, would help in HDM immunotherapy against several species of parasites as a wide range epitopic desensitization or prevention (vaccine) regime

Comprehensive phylogenetic, similarity and allergenicity analysis of Boophilus genus tick Tropomyosin protein

     Boophilus genus ticks are responsible for transferring some pathogens and reducing production factors in cattle. Tropomysin (TPM) protein has actin regulator activity and playing important role in immune and allergic reactions. The main goal is to determine different aspects of phylogenetic, similarity, homology, structure and allergenicity of TPM protein. In prior study, we identified TPM by using Mass-spectrometry in Boophilus anulatus larva proteins extraction. Analysis by NCBI and Mascot software showed complete similarity of this protein with Boophilus microplus. TPM Blasting, invertebrates TPM sequences retrieval, aligning and analyzing of conserved and variable regions along sequences were next steps. Also, construction the phylogenetic tree, overall mean distances estimation, homology protein secondary structure, allergencity analysis was achieved. The most similar sequences to Boophilus genus TPM are Haemaphysalis sp., Scolopendra sp. and etc., respectively. The multiple sequence alignment showed that conserved and variable regions stretched in different part of TPM. The close relationships in Phylogenetic tree between Ticks and Mites were seen, although the TPM sequences in ticks are more similar to each other than to mites and assume as the nearest relatives. Insects TPM like worms, located in two separated clades, and Trichinella spiralis in worm clades are more related taxa to members of ticks and mites groups. Furthermore, overall mean distances over sequence pairs reflects TPM conservation during speciation. TPM has high homology in different species and has two domain of α-helix that cannot form disulfide bonds. Finally, allergenicity analysis by separated and hybrid approach showed it undoubted is allergen and candidates some peptides as responsible for allergenicity of TPM. The comprehensive analysis of TPM has never been easy, especially when we attempt to make statements from different aspects about this protein.  Our study revealed the some unique and valuable aspects of TPM protein of Boophilus genus, and will help to further studies on mentioned protein

An 85-year-old Woman with Altered Mental Status and Hypotension

An 85-year-old female patient was brought to emergency department (ED) from a nursing home with altered mental status (GCS: 12/15) and hypotension (90/60 mmHg). Bilateral fine crackles in lungs and severe cachexia were obvious in her physical examination. The ECG showed only sinus tachycardia. Several attempts at peripheral vein cannulation failed due to poor visualization of severely atrophied and contracted subcutaneous veins. Therefore, on two attempts, a central venous catheter (CVC) was inserted into the right internal jugular vein (IJV) using the Seldinger technique. After securing and taping the central line, fluid infusion started with no difficulty and a portable chest x-ray was ordered

Effect of Combined Use of Calcium and Vitamin B6 on Premenstrual Syndrome Symptoms: a Randomized Clinical Trial

Introduction: Premenstrual syndrome is one of the most common disorders in women, which includes a group of psychological and physical symptoms. The aim of this study was to examine the impact of combined use of calcium and vitamin B6 on premenstrual syndrome symptoms. Methods: This double blind randomized controlled was carried out on 76 students of Hamadan University of Medical Sciences. Students were randomly allocated to two groups. (38 people in each group). Student in intervention groups received calcium tablet (500mg) and vitamin B6 (40 mg) and student in intervention groups received only vitamin B6 twice a day for two consecutive months. The symptoms were assessed by Beck depression inventory (BDI) and daily symptom records (DSR) questionnaires. Analyses were carried out by test-retest method, Chi-square, Mann-Whitney, Independent t-test, and paired t-test using SPSS software ver.13. Results: The result showed that although the severity of symptoms decreased in both groups, but this reduction was more significant in the combined calcium and vitamin B6 group. Conclusion: According to the result, using of combination of calcium and vitamin B6 leads to better controlling of the premenstrual syndrome symptoms. Therefore it is recommended for women who suffer from these syndromes

The Effect of Inhalation Aromatherapy with Lavender Essence on Pain Intensity and Anxiety in Burn Patients: A Clinical Randomized Trial

Introduction: Pain is one of the common problems in burn patients. Inhalation aromatherapy is one of the nurses' methods for pain management. However, there is not much information available about the effect of these methods on pain in burn patients. This study aimed to evaluate the effect of inhalation aromatherapy with Lavender essence on the pain intensity in burn patients.   Methods: The present study was a single-blind, three-group clinical trial. The research population consisted of patients with burns in one of Hamadan hospitals. One hundred and twenty patients were selected using convenience sampling and randomly assigned into three groups of lavender, placebo and control groups. The intervention included inhalation of 10 drops of lavender extract in the examiation group, 10 drops of distilled water in the placebo group, for one hour before wound dressing, and routine care in the control group. Pain in patients was evaluated before, immediately after intervention (before dressing), and after dressing using a visual analogue scale. The data were analyzed using SPSS 21 and one-way and repeated measures ANOVA with significant level of P<0.05.   Results: Demographic variables were similar in all three groups. There was a significant difference between the mean pain intensity in the groups after intervention (P<0.05), which was significant between the lavender group with placebo and control group (P<0.05). There was not a statistically significant difference between the control and placebo groups (P=0/443).   Conclusion: The use of lavender aroma can reduce short-term pain of burn patients. Therefore, the use of lavender aroma is recommended in short term pain by medical staff and nurses

Comparison of the Modified QuEChERS Method and the Conventional Method of Extraction in Forensic Medicine to Detect Methadone in Post-Mortem Urine by GCMS

Background:Extraction of drugs is one of the biggest concerns and the most important part of preparation and determination in forensic medicine. The lack of an easy, efficient and fast extraction method is the most important and most difficult problem despite the development of forensic centers and their being equipped with new diagnostic devices. In the present study, a comparison was conducted between extraction of methadone in post-mortem urine (Autopsy), using modified QuEChERS method and conventional liquid-liquid extraction method in forensic medicine. Method: Methadone extraction from the Post-Mortem urine sample was performed using QuEChERS extraction method, which is a simple and fast micro-extraction method in tube. In this method, the analyte was extracted using MgSO4, NaCl salts and ethyl acetate solvent, and detected by Gas Chromatography-Mass Spectrometry (GCMS). Results: The recovery level of methadone analyte in the urine sample obtained was equal to 67% (N = 15) in QuEChERS method, and 49% (N =1 5) in LLE method. In this center, the LOD and LOQ of the methadone were determined, using GC-MS device, to be equal to 29.1ng/mL and 97ng/mL, respectively. According to the results obtained, there was a significant difference between QuEChERS and LLE methods, in terms of methadone test in post-mortem urine. Conclusion: Cheap, fast, effective, and green QuEChERS, improved with better recovery, could replace the LLE method in detecting methadone in Post-Mortem urine

The Carotid Artery Thrombosis Following Blunt Neck Trauma; a Case Report

Introduction: This case emphasizes on the importance of detecting thrombosis and carotid artery injuries and the need for rapid treatment of blunt neck traumas.&nbsp;Case presentation: A 43-year-old male motorcyclist rider, rode into a rope and suffered blunt neck trauma. At admission to the emergency department (ED), he was fully conscious with Glasgow coma scale of 15. The biochemical tests and X-rays were normal, but initial examination revealed paresthesia in the right-hand fingertips, which exacerbated over the first 24 hours of admission. Doppler ultrasound of the neck arteries and computed tomography (CT) angiography reports showed thrombosis of the right common carotid artery, which spread to the right subclavian and vertebral arteries. Treatment was initiated with heparin injection followed by daily administration of oral warfarin, and seven days later, symptoms were relatively improved.&nbsp;Conclusion: Considering possible vascular injuries following blunt neck trauma should be kept in mind when dealing with such patients, and necessary physical examination required to rise the impression. By reviewing the literature, it seems that although CT angiography is usually used in screening carotid injuries, this modality appears to have poor sensitivity in this regard, and digital subtraction angiography (DSA) is still considered the gold standard for detecting carotid artery injury

The Carotid Artery Thrombosis Following Blunt Neck Trauma; a Case Report

Introduction: This case emphasizes on the importance of detecting thrombosis and carotid artery injuries and the need for rapid treatment of blunt neck traumas.&nbsp;Case presentation: A 43-year-old male motorcyclist rider, rode into a rope and suffered blunt neck trauma. At admission to the emergency department (ED), he was fully conscious with Glasgow coma scale of 15. The biochemical tests and X-rays were normal, but initial examination revealed paresthesia in the right-hand fingertips, which exacerbated over the first 24 hours of admission. Doppler ultrasound of the neck arteries and computed tomography (CT) angiography reports showed thrombosis of the right common carotid artery, which spread to the right subclavian and vertebral arteries. Treatment was initiated with heparin injection followed by daily administration of oral warfarin, and seven days later, symptoms were relatively improved.&nbsp;Conclusion: Considering possible vascular injuries following blunt neck trauma should be kept in mind when dealing with such patients, and necessary physical examination required to rise the impression. By reviewing the literature, it seems that although CT angiography is usually used in screening carotid injuries, this modality appears to have poor sensitivity in this regard, and digital subtraction angiography (DSA) is still considered the gold standard for detecting carotid artery injury