Comparison of 0.5% Bupivacaine and 0.5% Ropivacaine epidurally in lower limb orthopaedic surgeries

Background: Ropivacaine in equi-potent concentrations with bupivacaine, the degree of motor blockade is less pronounced with ropivacaine, and there is a greater propensity for blocking pain transmitting A-delta and C fibres rather than A-α motor fibres. It appears to have most of the blocking characteristics of bupivacaine. So we have undertaken the study to compare ropivacaine 0.5% (20ml) and bupivacaine 0.5% (20ml) for epidural anaesthesia in patients undergoing lower limb orthopaedic surgeries.Methods: This double-blind, randomized study involves 60 patients who were undergone orthopaedic surgery, having ASA-I or ASA-II physical status. Out of 60, 30 patients received 20 ml of 0.5% ropivacaine and 30 patients received 20 ml of 0.5% bupivacaine at the L3, 4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, peak time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset.Results: Epidurally, Ropivacaine in comparison to Bupivacaine provides quicker onset, early peak effect and prolonged duration of sensory block and shorter duration of motor block. Ropivacaine provides prolonged effective analgesia. It reduces requirement of rescue analgesics and related side effects.Conclusions: Ropivacaine 0.5% is safer and effective alternative to Bupivacaine in epidural anaesthesia and post operative pain relief

Acceptability of HIV Rapid Testing in Diverse Clinical Settings in Iran

Introduction: Rapid HIV testing in clinical settings can identify previously undiagnosed persons and link them to care, as well provide patients with knowledge of their serostatus and risk reduction counseling. We conducted a survey to characterize factors affecting the acceptance or declining of rapid HIV testing among Iranian patients.Methods: This cross-sectional survey was conducted from October 2014 to December 2014 with patients in three different health care centers (an emergency department in an urban hospital, a rural health centre, a voluntary counseling and testing centre (VCT) within Imam Khomeini Hospital, Tehran, Iran and a rural health centre). Participants completed a semi-structured face-to-face questionnaire and were tested by an HIV rapid test (Chembio Sure Check).Results: Of 222 participants, 25 participants were from the urban emergency department, 40 from the urban VCT program, and 157 from the rural health care centre. All did the rapid HIV test; all were HIV negative. HIV-related risk profiles found the urban emergency department patients more likely to have multiple partners (26%, P<0.01) and history of sexually transmitted diseases (27%, P<0.001) compared to VCT patients (9% and 3%, respectively) and rural clinic patients (4% and 1%, respectively). Emergency department patients were also more willing to pay for a HIV rapid test (44%, P<0.01), doing a rapid self-test at home (84%,P=0.01), preferring pharmacies as a place for providing rapid tests (80%, P=0.001). Also level of participants’ awareness was considerably different between mentioned centres (median=11, 12, 10 for emergency department, VCT and rural Health care centre respectively; P=0.012).Conclusions: Increasing knowledge about HIV rapid testing, its availability, and keeping costs low can expand the desire to use the test and ultimately prevent the spread of HIV through lack of knowing one’s serostatus and lack of treatment. Emergency departments in urban Iran may be an opportunity to test persons at high risk for HIV infection

Holomorphic maps and the complete 1/N expansion of 2D SU(N) Yang-Mills

We give a description of the complete 1/N expansion of SU(N) 2D Yang Mills theory in terms of the moduli space of holomorphic maps from non-singular worldsheets. This is related to the Gross-Taylor coupled 1/N expansion through a map from Brauer algebras to symmetric groups. These results point to an equality between Euler characters of moduli spaces of holomorphic maps from non-singular worldsheets with a target Riemann surface equipped with markings on the one hand and Euler characters of another moduli space involving worldsheets with double points (nodes).Comment: 17 pages + 8 (Appendices) ; 4 figure

Sex-specific risk factor profile in oesophageal adenocarcinoma

A nationwide Swedish case–control study of 388 men and 63 women with adenocarcinoma of the oesophagus and gastro-oesophageal function and 676 men controls and 140 women investigated whether sex differences in aetiology contribute to male predominance. Compared with men, women seemed more vulnerable to reflux (odds ratio (OR)=4.6, 95% confidence interval (CI)=2.0–10.5 vs OR=3.4, 95% CI=2.5–4.6), obesity (OR=10.3, 95% CI=2.6–42.3 vs OR=5.4, 95% CI=2.6–10.8) and smoking (OR=5.3, 95% CI=2.0–14.1 vs OR=2.8, 95% CI=1.9–4.2), less harmed by low intake of fruit and vegetables (OR=0.9, 95% CI 0.3–2.4 vs OR=1.6, 95% CI=1.1–2.2) and less protected by Helicobacter pylori infection (OR=0.5, 95% CI=0.3–0.8 vs OR=1.6, 95% CI=0.5–5.4)

Investigation of FIH-1 and SOCS3 expression in KRAS mutant and wild-type patients with colorectal cancer

Colorectal cancer (CRC) is a multistep process based on the accumulation of somatic mutations in genes such as APC and KRAS. Data on the presence of mutations in KRAS gene in CRC and its relationship with clinicopathological parameters and expression of genes involved in tumor progression are scarce. We unbiasedly examined the KRAS status in samples from 99 patients and its correlation with clinicopathological parameters such as age, sex, tumor location, lymph node metastasis, tumor stage, tumor grade, and vascular invasion. Consistent with reports of other researchers, 38.4 of our samples harbored KRAS mutation in their genomes with preferential mutation in codon 12 (89.4 ). Nevertheless, unlike previous reports, we were not able to correlate KRAS status with clinicopathological parameters (P > 0.05) except for vascular invasion. Patients with KRAS mutation have more vascular invasion compared with patient having wild-type KRAS. Next, we investigated the expression of two tumor suppressor genes, factor-inhibiting hypoxia-inducible factor 1 (FIH-1) and suppressor of cytokine signaling (SOCS3), in both KRAS mutant and wild-type groups and looked for any correlation between their expression and clinicopathological parameters. Although the expression of both genes was not regular, none of the clinicopathological parameters were associated with the expressions of FIH-1 and SOCS3 at mRNA level (P > 0.05). However, decline in FIH-1 expression at protein level in KRAS mutant group was correlated with stage IV and grade 2 of tumor (P � 0.05). Our results demonstrated that there is no or low correlation between KRAS status, FIH-1, and SOCS3 expression with epidemiologic and clinicpathological characteristics in CRC. © 2016, International Society of Oncology and BioMarkers (ISOBM)

Gendered Representations of Male and Female Social Actors in Iranian Educational Materials

This research investigates the representations of gendered social actors within the subversionary discourse of equal educational opportunities for males and females in Iranian English as a Foreign Language (EFL) books. Using critical discourse analysis (CDA) as the theoretical framework, the authors blend van Leeuwen’s (Texts and practices: Readings in critical discourse analysis, Routledge, London, 2003) ‘Social Actor Network Model’ and Sunderland’s (Gendered discourses, Palgrave Macmillan, Hampshire, 2004) ‘Gendered Discourses Model’ in order to examine the depictions of male and female social actors within this gendered discourse. The gendered discourse of equal opportunities was buttressed by such representations within a tight perspective in proportion to gender ideologies prevailing in Iran. Resorting to CDA, we can claim that resistance against such gendered discourse in Iranian EFL textbooks militates against such gender norms. These representations of male and female social actors in school books are indicative of an all-encompassing education, reinforcing that the discourse of equal opportunities is yet to be realized in the education system of Iran

Mid-esophagus unresectable cancer treated with a low cost stent. First experience

<p>Abstract</p> <p>Background</p> <p>In the cancer of the esophagus, with recent technologic advances, self-expanding metal stents (SEMS) are at the forefront of the armamentarium for re-establishing luminal patency. Weighed against the numerous advantages of stents are the import conditions and the cost. In light of this, we tested new low cost prostheses having the basic needs and characteristics to aim a significant benefit to poor people having advanced esophageal cancer, in a Brazilian regional public hospital.</p> <p>Methods</p> <p>This initial experience included fifteen patients (eleven men and four women, 55 ± 6.17 years old), presenting esophageal cancer, located at the medium third of the thoracic esophagus, extending for 5.5-8 cm long, not suitable for surgical procedure because they had been staged on fourth grade of the disease, two of them having fistula communicating esophagus to respiratory tree. The stents were placed under endoscopic and fluoroscopic guidance, after attempting an esophageal dilatation. An appropriate covered stent was then deployed, twelve of 10 cm and three of 13 cm in length. A chest X-ray was done 2 h after the procedure and a barium swallow was performed within 12 hours. Seven days and monthly until complete a six month follow-up after the procedure the patients were questioned about presence of pain, regurgitation, heartburn, cough, and their alimentary behavior.</p> <p>Results</p> <p>There were no severe complications and transient mild chest pain resolved until the seventh day after the stent deployment. Chest X-ray demonstrated expansion of the stent in all patients. In 2 cases of fistula, a barium swallow showed its complete sealing. The completion of the proposed follow-up was not achieved in three cases, limited by the patient's death until the third month, due to cancer progression. Recurrent dysphagia to paste food accounted for by tumor overgrowth proximal or distal to the stent and stent migration were not observed in the series.</p> <p>Conclusions</p> <p>The new low cost endoprostheses is effective and forthcoming increased experience and prospective trials including questionnaires to analyze quality of life will allow for more informed decisions tailoring to a particular patient situation or to unexpected complications.</p