Perspectives of Iranian Medical Nurses about Do-Not-Resuscitate (DNR) Orders

Objective: To study the attitudes of Iranian medical nurses towards the do-not-resuscitate (DNR) decision.Methods: In this cross-sectional study, 200 nurses working in Imam Khomeini Hospital, (affiliated to Tehran University of Medical Sciences, Tehran, Iran) were enrolled. They answered to a questionnaire with two sections: the first one consisted of demographic questions (age, sex, and level of education), and the second included questions about DNR orders derived from a previously conducted study by Hosaka et al.Results: A total of 168 questionnaires returned (response rate (RR=85%)). About 61% felt that DNR order is sporadically necessary. Near 66% had participated in DNRs in their practice and the most case was the patient with terminal cancer. The most common person who decided DNR orders were physicians. Sixty seven percent believed that DNR cards are useful for establishing in clinical settings.Conclusion: As DNR is not routine in Iran, enrollment of nurses in this decision should be clearly defined

Dynamics of PEGylated-dextran-spermine nanoparticles for gene delivery to leukemic cells.

Leukemic cells are hard-to-transfect cell lines. Many transfection reagents which can provide high gene transfer efficiency in common adherent cell lines are not effective to transfect established blood cell lines or primary leukemic cells. This study aims to examine a new class of cationic polymer non-viral vector, PEGylated-dextran-spermine (PEG-D-SPM), to determine its ability to transfect the leukemic cells. Here, the optimal conditions of the complex preparation (PEG-D-SPM/plasmid DNA (pDNA)) were examined. Different weight-mixing (w/w) ratios of PEG-D-SPM/pDNA complex were prepared to obtain an ideal mixing ratio to protect encapsulated pDNA from DNase degradation and to determine the optimal transfection efficiency of the complex. Strong complexation between polymer and pDNA in agarose gel electrophoresis and protection of pDNA from DNase were detected at ratios from 25 to 15. Highest gene expression was detected at w/w ratio of 18 in HL60 and K562 cells. However, gene expression from both leukemic cell lines was lower than the control MCF-7 cells. The cytotoxicity of PEG-D-SPM/pDNA complex at the most optimal mixing ratios was tested in HL60 and K562 cells using MTS assay and the results showed that the PEG-D-SPM/pDNA complex had no cytotoxic effect on these cell lines. Spherical shape and nano-nature of PEG-D-SPM/pDNA complex at ratio 18 was observed using transmission electron microscopy. As PEG-D-SPM showed modest transfection efficiency in the leukemic cell lines, we conclude that further work is needed to improve the delivery efficiency of the PEG-D-SPM

Evaluation of work-related accidents among Hamadan construction workers

Introduction: construction is one of the most important industries in which many workers start on activity. Sometimes, these industries workers are victims of different occupational accidents and injuries. Therefore, the aim of this study was to determine the frequency and underlying reasons in construction accidents. Materials and methods: In this descriptive - analytical study, all construction workers (n = 347) who encountered with occupational accident were studied in Hamadan city, west of Iran. The data were extracted from health profiles of injured workers by checklist. Data were analyzed with SPSS 16 by applying of Chi square and Logistic regression tests at the significant level of P < 0.05. Results: During 2007-2010, 347 workers encountered with construction accidents and seven of them were died. Finding showed that fall and slip were cause of 36.59% of accidents. Also, carelessness was major predictor factor related to 80.96% of accidents. According to the results, 36.02% of these accidents were happened at 15.00 and 18.00 PM. Conclusion: Develop and discussion about organizing public policies is suggested to implement work safety programs for construction workers

Sexual Function in Women with Multiple Sclerosis

Multiple sclerosis (MS) is an inflammatory disease of central nervous system (CNS) and sexual dysfunction (SD) is one of the most common disabilities of MS women. The aim of this study was to determine sexual function of women with MS (multiple sclerosis). One hundred definite MS patients MS patients and fifty age-matched healthy controls were enrolled. Demographic data (sex, age), duration of the disease and disease pattern extracted from patient's  files and Kurtzke Expanded Disability Status Scale (EDSS) recorded for each patient by an expert neurologist. Participants were asked to answer the valid and reliable Persian version of Beck depression inventory (BDI) and Female Sexual Function Index (FSFI) questionnaires. The total FSFI score and subscale scores differed significantly between the MS patients and the controls. There was a significant negative correlation between EDSS and FSFI scores (rho=-0.44, P<0.001) and significant positive correlation between EDSS and BDI (rho=0.36, P<0.001) in patients. Mean BDI and all subscales of FSFI differed significantly between patients with total FSFI score higher and lower than 26.55. Sexual dysfunction should be considered in women with multiple sclerosis

Comparison of Sleep Quality in Women with Migraine Moreover, Multiple Sclerosis

Multiple sclerosis (MS) and migraine are two common neurological disorders affecting women more than men. Sleep quality impairment has been reported in both diseases. The goal of this study was to compare sleep quality and depression between women with MS and migraine. Seventy women with migraine and 75 women with MS were enrolled in this study. Participants were asked to fill-out valid and reliable Persian versions of Pittsburg Sleep Questionnaire (PSQI) and Beck Depression Inventory (BDI). Mean age and duration of disease for MS group was 31.1 ± 7.6, 4.8 ± 5 and for second group 31.4 ± 5.6, 5.2 ± 4 years, respectively. Mean BDI score and number of patients with poor sleep (PSQI ≥5) were significantly higher in patients with migraine. There was significant positive correlation between PSQI and BDI scores in all participants (r=0.32, P<0.001), while correlation coefficient was 0.39, P=0.001 in patients with migraine and 0.35, P=0.002 in MS cases. Multiple linear regression analysis between the PSQI as a dependent variable and age, BDI and education level as independent variables showed that BDI is the independent predictors of PSQI in both groups. This study shows that patients with migraine suffer from poor sleep and depression more frequently than MS cases

Soluble Flt-1 Gene Delivery in Acute Myeloid Leukemic Cells Mediating a Nonviral Gene Carrier

Vascular endothelial growth factor (VEGF) is a potent angiogenic factor involved in angiogenesis-mediated progression of acute myeloid leukemia (AML). Studies have reported the role of soluble form of fms-like tyrosine kinase (sFlT-1) delivery as an antitumor agent by inhibiting VEGF. is study investigates the outcome of delivery of a VEGF165 antagonist, soluble vascular endothelial growth factor receptor, namely sFLT-1, mediating lipofectamine 2000 in acute myeloid leukemic cells. A recombinant plasmid expressing sFLT-1 was constructed and transfected into the K562 and HL60 cells using lipofectamine 2000 transfection reagent. sFLT-1 expression/secretion in pVAX-sFLT-1 transfected cells was veri�ed by RT-PCR and western blot. MTS assay was carried out to evaluate the effect of sFLT-1 on human umbilical vein endothelial cells and K562 and HL60 cells in vitro. Treatment with pVAX-sFLT-1 showed no association between sFLT-1 and proliferation of infected K562 and HL60 cells, while it demonstrated a signi�cant inhibitory impact on the proliferation of H�VECs. e results of the current study imply that the combination of nonviral gene carrier and sFLT-1 possesses the potential to provide efficient tool for the antiangiogenic gene therapy of AML

Soluble Flt-1 Gene Delivery in Acute Myeloid Leukemic Cells Mediating a Nonviral Gene Carrier

Vascular endothelial growth factor (VEGF) is a potent angiogenic factor involved in angiogenesis-mediated progression of acute myeloid leukemia (AML). Studies have reported the role of soluble form of fms-like tyrosine kinase (sFlT-1) delivery as an antitumor agent by inhibiting VEGF. This study investigates the outcome of delivery of a VEGF165 antagonist, soluble vascular endothelial growth factor receptor, namely sFLT-1, mediating lipofectamine 2000 in acute myeloid leukemic cells. A recombinant plasmid expressing sFLT-1 was constructed and transfected into the K562 and HL60 cells using lipofectamine 2000 transfection reagent. sFLT-1 expression/secretion in pVAX-sFLT-1 transfected cells was verified by RT-PCR and western blot. MTS assay was carried out to evaluate the effect of sFLT-1 on human umbilical vein endothelial cells and K562 and HL60 cells in vitro. Treatment with pVAX-sFLT-1 showed no association between sFLT-1 and proliferation of infected K562 and HL60 cells, while it demonstrated a significant inhibitory impact on the proliferation of HUVECs. The results of the current study imply that the combination of nonviral gene carrier and sFLT-1 possesses the potential to provide efficient tool for the antiangiogenic gene therapy of AML

Comparison of Oral Midazolam With Intravenous Midazolam for Sedation Children During Upper Gastrointestinal Endoscopy

Upper endoscopy is a common procedure for the diagnosis and treatment of upper digestive tract diseases. The increasing number of pediatric gastrointestinal procedures has led to increasing attention on the safety and efficacy of medications used for sedation during the procedure. This randomized blinded interventional study was designed to compare the effect of oral midazolam with intravenous (IV) midazolam as a sedative medication in 119 children undergoing endoscopy. The mean time to sedation was 2.2±0.7 in IV midazolam group and 30.9±0 in oral midazolam group which was statistically significant difference between two groups. Separation from parents in oral midazolam group was as follow: 2 patients were high resistant (3.5%), 2 patients were resisted first and then relaxed (3.5%) and 55 patients were separated from their parents without any resistance (93%); whereas in IV midazolam group, 8 patients were high resistant (13.3%), 29 patients were relatively resistant (48.3%) and 23 patients were separated from their parents without any resistance (38.3%) that shows significant differences between the two groups. In terms of patient comfort during endoscopy, there was also a significant difference between the two groups. In oral midazolam, group parents were more consent, compared with the other group. The present study showed that oral midazolam is a safe and effective sedation during upper endoscopy in pediatrics. Oral midazolam reducing patients' anxiety during separation from parents leads the easy use of endoscopy and comfort of patients during endoscopy as compared with IV midazolam. Oral or IV midazolam were not able to put most patients in deep sedation level

Academic Performance, Sleep Disorders and Their Association in Middle School Students in Iran

Background: Although sleep disorders are common problems among families and they affect the learning, memory processes and academic performance of children, there is no evaluation of these disorders in Iran. The aim of this study was to assess the prevalence of sleep disorders and its association with academic performance of school age children.Materials and Methods: A cross-sectional study was conducted on 1,100 middle school students of Isfahan city of Iran during 2012-2013. Multi-stage random cluster sampling method was performed and five girl’s schools and five boy’s schools were selected. The data gathered with a validated questionnaire to evaluate the academic performance and sleep disorders.Results: The mean duration of nocturnal sleep was 8.38±1.17 which was significantly higher in the group with excellent academic performance (8.86±1.18 hours), than the other two groups (8.14±1.17 hours for average academic performance and 7.90±1.15 hours for poor academic performance). Academic performance was significantly associated with age, gender, parental occupation, nocturnal sleep time, sleep latency and sleep disorders (