Shift work as an oxidative stressor

BACKGROUND: Some medical disorders have higher prevalence in shift workers than others. This study was designed to evaluate the effect of night-shift-working on total plasma antioxidant capacity, with respect to the causative role of oxidative stress in induction of some of these disorders. METHODS: Two blood samples were taken from 44 workers with a rotational shift schedule, one after their day shift and one after their night shift. The total plasma antioxidant capacity of each worker was measured through the FRAP method. The impacts of age and weight were also assessed. RESULTS: The total plasma antioxidant capacity was measured in 44 shift-workers with a mean age of 36.57 years (SD: 10.18) and mean BMI of 26.06 (SD: 4.37) after their day and night shifts. The mean reduction of total plasma antioxidant capacity after the night shift was 105.8 μmol/L (SD: 146.39). Also, a significant correlation was shown between age and weight and total plasma antioxidant capacity. Age and weight were found to be inversely related to total plasma antioxidant capacity; as age and weight increased, the total plasma antioxidant capacity decreased. CONCLUSION: Shift work can act as an oxidative stressor and may induce many medical disorders. Aging and obesity in shift workers makes them more sensitive to this hazardous effect

Thoracoscopic Congenital Diaphragmatic Hernia repair in neonate: The First Experience of Iranian Group

Background: Congenital diaphragmatic hernia (CDH) occurs due to a failure in closing pleuroperitoneal membrane thus resulting in an incomplete diaphragm formation1, which allows passage of the abdominal viscera into the thorax.1,3 Until 1995, the standard method for treatment of CDH was performed by open surgery through the abdomen or thoracic cavity. Minimally invasive approach via thoracoscopy or laparoscopy is applicable for treatment of CDH since 1995.4 Now a day’s thoracoscopic repair of CDH (T’Scopy CDH) is performed in many centers. In this paper, we present our experience of T’Scopy CDH repair from Iran.Patients and Methods: From 2011 to 2015, 74 patients with CDH were admitted to Pediatric Surgery Department of Dr. Sheikh (Sarvar) Pediatric Hospital. Twenty one patients (28%) met our inclusion criteria and underwent T’Scopy CDH repair. The median age at the time of repair was 5 days (2-daysold to 4-years-old patients). Inclusion criteria were weight over 2 kg and stable hemodynamics and arterial blood gas. Fourteen cases were intubated before entering the operating room. The defect was in the left side except in two cases. In 8 cases, we used thoracic wall as part of repair. Also, mesh support was utilized in 8 cases even in cases were primary repair of diaphragm was possible in order to reinforcing the repair (5 cases). Of these 8 cases, in 3 patients, whole repair was accomplished by mesh due to presence of a large defect.Results: The mean time of operation was 80 minutes (40-230 minutes). Intraoperative mortality was zero. In hospital, mortality occurred in two cases due to septicemia in one and respiratory and cardiac failure in another. Conversion to open surgery was required in 6 cases. Late recurrence was observed in 2 cases. The mean time of follow up was 14.6 months (3-36 months).Conclusion: It seems that appropriate case selection and liberal use of thoracic wall and mesh as a part of repair may cause better results and decreased chance of early and late recurrence

Controlled vs Spontaneous Ventilation for Bronchoscopy in Children with Tracheobronchial Foreign Body

Introduction Tracheobronchial foreign body aspiration is a common life-threatening condition in children. There are controversies in the management of this condition, including the type of ventilation during bronchoscopy.  This study aims to compare anesthesia with controlled ventilation versus spontaneous ventilation in rigid bronchoscopy in children with foreign body aspiration.  Materials and Methods: Patients who were candidates for rigid bronchoscopy due to foreign body aspiration were randomly assigned to either anesthesia with spontaneous ventilation or controlled ventilation. End tidal CO2 (ETCO2), electrocardiogram (ECG), heart rate (HR), oxygen saturation (SpO2), non-invasive blood pressure (NIBP) and complications and accidents during the surgery and recovery were recorded for each patient. Surgeon comfort during the procedure was also evaluated for each patient. A 20% change in HR or NIBP was considered significant. SpO2 values under 90% are considered desaturation.  Results: Fifty-one patients (31 male and 20 female) entered the study. The mean age was 26.76 months, ranging from 6 to 100 months. Choking and cough were present in 94% and 96.1% of the patients, respectively. Nuts were the most common foreign body (76.9%). The controlled ventilation group had significantly fewer complications, and surgeon comfort was significantly higher in this group. Oxygen desaturation was significantly more prevalent in the spontaneous ventilation group during laryngoscopy and bronchoscopy (

Amplitude changes in otoacoustic emissions after exposure to industrial noise

Noise-induced hearing loss (NIHL) is a frequent problem in industrial settings, especially where a high noise level is present. It is permanent, and irreversible, but preventable. Routine audiometry (an objective and time consuming) test is used for NIHL screening. Otoacoustic emissions (OAEs) are recently proposed as a more sensitive test for early diagnosis of NIHL. In this study, we aimed to compare the results of pure tone audiometry (PTA) with OAE in the diagnosis of NIHL. In a cross-sectional study on 120 workers (in three groups: Not exposed to noise, exposed to noise without NIHL and exposed to noise with NIHL), we compared the results of PTA and OAE. OAE can detect some changes in the function of hearing system in subjects exposed to noise, and these changes are apparently prior to hearing loss, which is diagnosed by PTA. OAE is a more sensitive method for the early diagnosis of cochlear damage than PTA, and can be performed in industrial settings for NIHL screening

Evaluation of the return to work and its duration after myocardial infarction

BACKGROUND: The evaluation of the ability for return to work among patients after myocardial infarction (MI) is subject to controversy. Understanding various factors, which may affect return to work process, will help in promoting effective communication between physicians and patients. Return to work is dependent on such factors as patients&rsquo; functional capacity, MI expansion, cardiac muscle function, some psychiatric variables, job satisfaction, economic status, and age. In this study, we aimed to assess the frequency of return to work after first MI attack, and factors affecting it. METHODS: This was a follow-up study performed in Yazd, Iran from September 2007 until September 2010 on 200 patients suffering from their first MI attack. Patients were assessed 6 months and 1-year after MI regarding their cardiac function. Job satisfaction was evaluated by Direct Support Professional job satisfaction questionnaire. RESULTS: Seventy-seven percent of MI patients returned to work after 1-year. Mean time for return to work was 46.00 &plusmn; 4.12 days. Sixty percent of patients returned to work during the first 50 days after MI and 50% of them during 40 days after MI. The most common reason for not returning to work was patient&rsquo;s decision. CONCLUSION: This study showed that a considerable numbers of patients returned to work after 1-year. The only factors which affected the rate of return to work were left ventricular function after MI and job satisfaction. &nbsp; Keywords: Myocardial Infarction, Return to Work, Left Ventricular Function, Job Satisfaction&nbsp;</p

SD1000: High Sustained Viral Response Rate in 1361 Patients With Hepatitis C Genotypes 1, 2, 3, and 4 Using a Low-cost, Fixed-dose Combination Tablet of Generic Sofosbuvir and Daclatasvir: A Multicenter, Phase III Clinical Trial

Background. The combination of sofosbuvir and daclatasvir is a potent, pangenotypic regimen suitable for mass-scale hepatitis C treatment, especially in resource-limited countries where newer, expensive combinations are not available. This combination has been widely tested on genotype 4. However, Phase III trials of this combination in other genotypes have been cost prohibitive. With the introduction of generic, low-cost sofosbuvir and daclatasvir, large-scale studies in resource-limited countries are now possible. Methods. Sofosbuvir at 400 mg and daclatasvir at 60 mg were coformulated into a fixed-dose combination (FDC) tablet (Sovodak, Rojan Pharma, Tehran, Iran). Patients from 46 centers were dosed for 12 or 24 weeks with or without ribavirin, in line with existing guidelines. Responses to treatment were evaluated 12 weeks after the end of treatment (for a sustained virological response at Week 12; SVR12). Results. There were 1361 patients recruited. Overall, the patients were 21% female, with a mean age of 50 years; 39% were cirrhotic; 22% were treatment-experienced; 47% were genotype 1, 41% were genotype 3, and 2% were other genotypes. The genotype was not known in 10% of the patients. The intention-to-treat and per-protocol SVR12 rates were 94.7% and 98.8%, respectively. The safety profile was unremarkable, treatment was well tolerated, and compliance with the single-tablet regimen was excellent. Conclusions. The treatment with FDC of sofosbuvir and daclatasvir achieved high SVR12 rates, equivalent to those seen in Phase III trials of other pangenotypic options, and has been conducted at a similar scale in a representative, real-world population at a cost of under $100 per patient, which makes this combination suitable for elimination protocols in resource-limited countries. Keywords:sofosbuvir; daclatasvir; Hepatitis C; sustained virological response; generic drug