Comparison of the effect of oral diclofenac potassium (Cataflam) with diclofenac sodium suppository on postoperative cesarean section pain; a randomized clinical trial

Background and aims: Postoperative pain after cesarean section is one of the important issues in gynecology. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are two of the drugs that are used for cesarean pain management. Considering the adverse effects of opioids in the mother and the baby, NSAIDs are preferred in the post-cesarean pain management. This study was designed to compare the effect of oral diclofenac potassium (Cataflam) with diclofenac sodium suppository on postoperative cesarean pain.Materials and Methods: This randomized clinical trial was conducted on patients who underwent cesarean section in Taleghani Hospital during 2019. Patients were randomly divided into two groups based on flipping coin. The first group received 100 mg of oral diclofenac potassium every 6 hours and the second group received 100 mg of diclofenac sodium suppository every 6 hours. The pain was assessed 30 minutes, 2 hours, 6 hours, 12 hours, 18 hours and 24 hours after the intervention using visual analogue scale (VAS) before and after analgesics.Results: Eighty-four patients were included in the final analysis. The mean of VAS during the intervention in the diclofenac sodium suppository group and in the Cataflam group was 3.42 ± 2.1 and 1.93 ± 2.4 respectively (P value = 0.011). Twenty-eight among 46 patients who received opioids due to severe pain (66.7%) were in the diclofenac suppository group and 18 of them (42.9%) were in the Cataflam group (P value = 0.021).Conclusion: Diclofenac potassium tablets and diclofenac sodium suppository can reduce the post cesarean pain. The efficacy of diclofenac potassium tablets (Cataflam) is significantly higher than the diclofenac suppository; however, the complication rate was not significantly different

Evaluation of demographic features of acute drug poisoning with Benzodiazepines; a cross – sectional study

Background: Poisoning is one of the important social problems in developing countries, and acute poisoning due to suicide by drug overdose or toxins is one of the most common cases of poisoning that requires emergency care. This study was aimed to determine the demographics of benzodiazepines poisoned patients in one of the referral centers for poisoning in Iran.Materials and Methods: This cross-sectional study was conducted on patients who referred to the poisoning emergency ward of Loghman Hakim Hospital from April 2015 to March 2016. Among 10624 patients who referred to the hospital at the study period, 2543 of them were poisoned by benzodiazepines. A total of 263 patients were selected randomly and were assessed for age, gender and the type of the benzodiazepine. The data were analyzed by version 15 of SPSS software.Results: Among 263 patients, 127 were males (48.2%) and 136 were females (51.7%). The mean age of patients was 31 years old with a range of 13 – 80 years old. In addition, most patients were in the age of between 18 to 35 years (n = 152). In this study, 91 patients (34.6%) were single-drug poisoned with benzodiazepines and 172 cases (65.4%) were poisoned by multi-drug regimens including benzodiazepines. Between different types of benzodiazepines, the most common type was Alprazolam and the least common benzodiazepine was Oxazepam. Almost 96% of patients (n = 252) were treated successfully and 8 patients (3%) got discharged with self-consent. Furthermore, the mortality rate was approximately 1% (n = 3).Conclusion: Benzodiazepines poisoning is common in younger patients; thus, close attentions are needed for the prescription of these drugs in young patients. Considering easy access to benzodiazepines in the community, periodic visits to psychiatrists may be useful for the reduction of benzodiazepine poisoning

Investigating Neurocranial Sizes And Cephalic Indices Of Male Newborns In North of Tehran Using Millimetric Cephalometry

Background: Anthropometric studies have been introduced as the second priority of research in the field of medical sciences in Iran. Information obtained from such studies are used in industry and medical sciences, including the manufacturing of prostheses, gas masks, and surgical instruments. Considering the effect of genetic, age, sexual, climatic, and geographical factors and their high importance on anthropometric sizes, the aim of the present project is to investigate the neurocranial sizes of the cephalic indices of one-day-old male newborns in north of Tehran.Materials and Methods: This cross-sectional descriptive study was carried out on 100 neurocranial sizes of one-day-old male newborns in Shohada-e-Tajrish Hospital in Tehran using millimetric cephalometry. Measurements were performed according to the protocol and by a ruler, cephalometer, and tape meter (0.5mm precision rate). The data were collected and recorded in the relevant forms and then processed and analyzed by a biostatistics software. Results: The present research showed that the mean head length, head width, ear height, head circumference, brain volume, brain weight, cephalic index, and the brain index was 118.2 mm, 94.3 mm, 71.3 mm, 348.5 mm, 415.1 ml, 429.2 g, 78.1%, and 12.8%, respectively. Frequency of different head phenotypes has been reported according to the cephalic index as follows: round head (65%), long head (20%), broad head (12%), and super-broad head (3%).Conclusion: The results of the present study showed that the cephalic index of one-day-old male newborns in Tehran was lower than those born in Kermanshah, Sistan and Baluchestan, and Qazvin, which can be explained by the impact of gender, climate, and geographical area on neurocranial dimensions and sizes

Creatinine Phosphokinase (CPK) Elevation in the Coexistence of Wilson's Disease and Autoimmune Hepatitis with Atypical Presentation: A Diagnostic Dilemma

Background: Wilson's disease (WD) is a genetic disorder with various clinical presentations due to excessive accumulation of copper in the liver and other organs. It can present as acute/chronic hepatitis, liver failure, extrahepatic and neuromuscular manifestations. Autoimmune hepatitis (AIH) is a necroinflammatory disease of the liver, which affects a lot of people particularly the children population. AIH has a broad clinical presentation that is similar to WD. Coexistence of WD with elevated creatinine phosphokinase (CPK) and AIH, may be a diagnostic dilemma. Case Report: We presented a 6 years old boy with dysarthria, aggressive behavior, weak attention, concentration and weight loss with abnormal physical examination. Laboratory, histochemical, genomic studies, muscle/liver biopsy and atomic absorption test confirmed the diagnosis of both WD and AIH in the boy. Conclusion Although CPK and liver enzyme elevation is a rare presentation of chronic hepatitis with dominant feature of WD and AIH; however, simultaneous therapy with immunosuppressive drugs and Penicillamine may have superior benefit with a significant response

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Extraembryonic Mesenchymal Stromal/Stem Cells in Liver Diseases: A Critical Revision of Promising Advanced Therapy Medicinal Products

Liver disorders have been increasing globally in recent years. These diseases are associated with high morbidity and mortality rates and impose high care costs on the health system. Acute liver failure, chronic and congenital liver diseases, as well as hepatocellular carcinoma have been limitedly treated by whole organ transplantation so far. But novel treatments for liver disorders using cell-based approaches have emerged in recent years. Extra-embryonic tissues, including umbilical cord, amnion membrane, and chorion plate, contain multipotent stem cells. The pre-sent manuscript discusses potential application of extraembryonic mesenchymal stromal/stem cells, focusing on the management of liver diseases. Extra-embryonic MSC are characterized by robust and constitutive anti-inflammatory and anti-fibrotic properties, indicating as therapeutic agents for inflammatory conditions such as liver fibrosis or advanced cirrhosis, as well as chronic inflammatory settings or deranged immune responses

Extraembryonic Mesenchymal Stromal/Stem Cells in Liver Diseases: A Critical Revision of Promising Advanced Therapy Medicinal Products

Liver disorders have been increasing globally in recent years. These diseases are associated with high morbidity and mortality rates and impose high care costs on the health system. Acute liver failure, chronic and congenital liver diseases, as well as hepatocellular carcinoma have been limitedly treated by whole organ transplantation so far. But novel treatments for liver disorders using cell-based approaches have emerged in recent years. Extra-embryonic tissues, including umbilical cord, amnion membrane, and chorion plate, contain multipotent stem cells. The pre-sent manuscript discusses potential application of extraembryonic mesenchymal stromal/stem cells, focusing on the management of liver diseases. Extra-embryonic MSC are characterized by robust and constitutive anti-inflammatory and anti-fibrotic properties, indicating as therapeutic agents for inflammatory conditions such as liver fibrosis or advanced cirrhosis, as well as chronic inflammatory settings or deranged immune responses

The Relationship Between Prenatal Hydronephrosis and Vesicoureteral Reflux in Children With a History of Prenatal Hydronephrosis in the Third Trimester of Pregnancy

Background and Aim: Prenatal hydronephrosis is found in 1%-5% of pregnancies. Withoutwell-timed diagnosis and treatment, it can lead to irreversible outcomes. Because littleinformation is available on the indication of Vesicoureteral Reflux (VUR) regarding theantenatal diameter of the kidney pelvis, the current study aimed to determine the associationbetween prenatal hydronephrosis and the VUR.Methods: This cross-sectional study was conducted from 2011 to 2016 on 200 neonateswith hydronephrosis detected in fetal life ultrasounds in the third trimester of pregnancy.We assessed the prenatal and postnatal kidney ultrasonography of 400 kidneys and VoidingCystourethrogram (VCUG). We employed the Spearman correlation coefficient fordetermining the association between study variables. The obtained data were analyzed usingSPSS 16.0 software at a significance level of less than 0.05.Results: Of 200 infants, 71.5% were males and 28.5% were females. No significantrelationship was found between the degree of antenatal hydronephrosis and the VCUGseverity (r=0.098, P=0.106). Despite antenatal hydronephrosis, the degree of postnatalhydronephrosis and the VCUG severity was correlated (r= 0.255, P=0.001).Conclusion: There is no correlation between the severity of fetal hydronephrosis and VURseverity or the presence of a greater correlation between postnatal hydronephrosis anddegree of VUR. Thus in cases of mild prenatal hydronephrosis, we suggest urinary tractultrasonography three to seven days after birth and then cystography if postnatal sonographyshowed moderate or severe or progressive hydronephrosis

QTc interval measurement in patients with right bundle branch block: A practical method

Abstract Background and Aim Prolonging the QT interval in the right bundle branch block (RBBB) can create challenges for electrophysiologists in estimating repolarization time and eliminating the effect of depolarization changes on QT interval. In this study, we aimed to develop a practice formula to eliminate the effect of depolarization changes on QT interval in patients with RBBB. Methods This prospective study evaluated accidentally induced RBBB in patients undergoing electrophysiological study. Two expert electrophysiologists recorded the ECG parameters, including QRS duration, QT interval, and cycle length, in the patients. The formula was developed based on QT interval differences (with and without RBBB) and its proportion to QRS. Additionally, the Bazzet, Rautaharju, and Hodge formulas were used to evaluate QTc. Results We evaluated 96 patients in this study. The mean QT interval without RBBB was 369.39 ± 37.38, reaching 404.22 ± 39.23 after inducing RBBB. ΔQT was calculated as 34.83 ± 17.61, and the ratio of ΔQT/QRS with RBBB was almost 23%. Our formula is: (QTwith RBBB − 23% × QRS). Subtraction of 25% instead of 23% seems more straightforward and practical. Our formula could also predict the QTc interval in RBBB based on the Bazzet, Rautaharju, and Hodge formulas. Conclusion Previous formulas for QT correction were hard to apply in the clinical setting or were not specified for RBBB. Our new formula allows a rapid and practical method for QT correction in RBBB in clinical practice

Evaluation of gut microbiota of iranian patients with celiac disease, non-celiac wheat sensitivity, and irritable bowel syndrome: are there any similarities?

Abstract Background and aims Individuals with celiac disease (CD), non-celiac wheat sensitivity (NCWS), and irritable bowel syndrome (IBS), show overlapping clinical symptoms and experience gut dysbiosis. A limited number of studies so far compared the gut microbiota among these intestinal conditions. This study aimed to investigate the similarities in the gut microbiota among patients with CD, NCWS, and IBS in comparison to healthy controls (HC). Materials and methods In this prospective study, in total 72 adult subjects, including CD (n = 15), NCWS (n = 12), IBS (n = 30), and HC (n = 15) were recruited. Fecal samples were collected from each individual. A quantitative real-time PCR (qPCR) test using 16S ribosomal RNA was conducted on stool samples to assess the relative abundance of Firmicutes, Bacteroidetes, Bifidobacterium spp., and Lactobacillus spp. Results In all groups, Firmicutes and Lactobacillus spp. had the highest and lowest relative abundance respectively. The phylum Firmicutes had a higher relative abundance in CD patients than other groups. On the other hand, the phylum Bacteroidetes had the highest relative abundance among healthy subjects but the lowest in patients with NCWS. The relative abundance of Bifidobacterium spp. was lower in subjects with CD (P = 0.035) and IBS (P = 0.001) compared to the HCs. Also, the alteration of Firmicutes to Bacteroidetes ratio (F/B ratio) was statistically significant in NCWS and CD patients compared to the HCs (P = 0.05). Conclusion The principal coordinate analysis (PCoA), as a powerful multivariate analysis, suggested that the investigated gut microbial profile of patients with IBS and NCWS share more similarities to the HCs. In contrast, patients with CD had the most dissimilarity compared to the other groups in the context of the studied gut microbiota