Effects of Zizyphus jujube Extract on Memory and Learning Impairment Induced by Bilateral Electric Lesions of the Nucleus Basalis of Meynert in Rat

Alzheimer's disease (AD) is a common neurodegenerative condition that affects the elderly population. Its primary symptom is memory loss. The memory dysfunction in AD has been associated with cortical cholinergic deficiency and loss of cholinergic neurons of the nucleus basalis of Meynert (NBM). Zizyphus jujube (ZJ) activates choline acetyltransferase and may have beneficial effects in AD patients. This study investigates the effect of ZJ extract in intact rats and in rat model of AD. 49 male Wistar rats were divided into seven equal groups (1-control, without surgery, received water), 2-AD (bilateral NBM lesion, received water), 3 and 4-AD + ZJ (NBM bilateral lesion, received ZJ extract 500 and 1,000 mg/kg b.w. per day for 15 days), 5-sham (surgery: electrode introduced into NBM without lesion, received water), 6 and 7-without surgery and lesion, received ZJ extract-the same as groups 3 and 4). The learning and memory performance were assessed using passive avoidance paradigm, and the memory cognition for spatial learning and memory was evaluated by Morris water maze. In shuttle box test ZJ extract (500 and 1,000 mg) significantly increased step-through latency in AD + ZJ groups compared with AD group. In Morris water maze test (in probe day), both AD + ZJ groups receiving extract (500 and 1,000 mg) demonstrated significant preference for the quadrant in which the platform was located on the preceding day as compared with AD group. Our results suggested that ZJ has repairing effects on memory and behavioral disorders produced by NBM lesion in rats and may have beneficial effects in treatment of AD patients

Establishing an online editorial and publishing system: One-year experience with the Journal of Research in Medical Sciences

Although numerous published materials recommend journals to become online, few of them mention the transitional period, and to our knowledge none of them propose a rational evidence based approach to overcome the difficulties inherent in this time period. Studying the experiences of different journals during their transition into online business may help to delineate prominent factors affecting the whole process and its final outcome. In this article the story of a particular medial journal (Journal of Research in Medical Sciences) to change into an online practice is presented hoping to share experiences with other journals around the world

Predicting efficiency of post-induction mask ventilation based on demographic and anatomical factors

Background: Failure to ventilate patients by mask leads to serious complications especially if associated with difficult intubation. Previous studies have used subjective and indirect measures to evaluate difficulty in mask ventilation, which are associated with high inter-observer discrepancies. In this study, we have defined and used efficiency of mask ventilation (EMV) as an objective and direct surrogate for ease of mask ventilation in patients undergoing GA and mask ventilation using neuromuscular relaxation. Materials and Methods: 1050 adult patients prospectively were evaluated with respect to different patients demographic and physical factors and EMV. EMV was defined as the ratio of minute ventilation via anesthesia mask to that via tracheal tube expressed as percentage. Edentolous patients were ventilated using lip-over-mask techniques. Separate analyses were done for edentolous and non-edentolous patients. Results: EMV in edentolous patients (n=269) using the lip-over-mask method was relatively high (90.9 ± 14.3%, 60.14-128.57 range). The result of multiple regression analysis in patients with normal denture determined receded chin, presence of beard, male gender, high Mallampati classes, high neck circumference, low inter-incisors gap, and old age as independent factors for estimating EMV. A regression formula for predicting EMV was developed which had an acceptable R-square value with a good model fit. Conclusions: Using EMV is an easy and reliable tool for measuring efficiency of mask ventilation. Based on the result of this study, EMV can be estimated from patient′s demographic and physical factors. In edentolous patients, using the lip-over-mask method results in adequate ventilation of lungs

Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: A clinical trial

Background: A retrospective study has shown lesser days of hospital stay in patients with increased levels of intra-operative end-tidal carbon dioxide (ETCO 2 ). It is probable that hypercapnia may exert its beneficial effects on patients′ outcome through optimization of global hemodynamic and tissue oxygenation, leading to a lower rate of post-operative complications. This study was designed to test the hypothesis that higher values of intra-operative ETCO 2 decrease the rate of post-operative complications. Materials and Methods: In this randomized, double-blind clinical trial, 78 adult patients scheduled for percutaneous nephrolithotomy (PCNL) were prospectively enrolled and randomly divided into three groups. ETCO 2 was set and maintained throughout the procedure at 31-33, 37-39 and 43-45 mmHg in the hypocapnia, normocapnia and hypercapnia groups, respectively. The rates of post-operative complications were compared among the three groups. Results: Seventy-five patients completed the study (52 male and 23 female). Ten (38.5%), four (16%) and two (8.3%) patients developed post-operative vomiting in the hypocapnia, normocapnia and hypercapnia groups, respectively (P = 0.025). The nausea score was significantly lower in the hypercapnic group compared with the other groups (3.9 ± 1.8, 3.2 ± 2.1 and 1.3 ± 1.8 in the hypocapnia, normocapnia and hypercapnia groups, respectively; P = 0.000). Time to return of spontaneous respiration and awakening were significantly decreased in the hypercapnia group compared with the other groups (P < 0.01). Conclusion: Mild intra-operative hypercapnia has a protecting effect against the development of post-operative nausea and vomiting and decreases the duration of emergence and recovery from general anesthesia

The most frequent and important events that threaten patient safety in intensive care units from the perspective of health-care professionals'

Background: Patient safety is a priority in all health-care centers across the world. This study aimed to determine the frequency of events that threaten patient safety and the grade threating of events from the perspective of the health-care professionals in the intensive care units (ICUs). Materials and Methods: This cross-sectional study was conducted in 2016. The participants were 306 members of health-care professionals (physicians and nurses) with at least 1 year of work experience in ICUs of educational hospitals affiliated to Isfahan University of Medical Sciences. Data were collected using a three-section self-made questionnaire. Data analysis was done using descriptive statistics (frequency distribution and percentage) and version 16 of SPSS software. Results: A total of 306 questionnaires were completed out of 320 questionnaires handed out among participants. During the last month, 91.2% of the participants had reported at least a case of medication error, 75.6% had reported at least a case of ventilator-associated pneumonia, and 74.2% had reported at least a case of catheter-induced urinary infection in ICUs. Conclusion: The occurrence of events threatening the patient safety in ICUs warrants proper planning by administrators of health-care centers. Medication error was the most frequent and important event of threat to patient safety and falling was the least frequent event of threat to patient safety in ICUs. Considering the frequency and magnitude of medication error in ICUs, a well-adjusted preventive plan should be designed and implemented to improve the patient safety

Effect of ondansetron on prevention of post-induction hypotension in elderly patients undergoing general anesthesia: A randomized, double-blind placebo-controlled clinical trial

Background: Elderly patients are susceptible to post-induction hypotension. Volume loading and vasopressors for prevention of hypotension in elderly patients may increase perioperative cardiovascular risks. Ondansetron by blocking Bezold-Jarisch reflex (BJR) through inhibition of serotonin receptors has been effective in the prevention of post-spinal hypotension, and bradycardia. Bradycardia frequently accompanies post-induction hypotension in elderly patients, which signifies a possible preventing role for ondansetron. No previous study has evaluated the prophylactic effects of ondansetron for the prevention of post-induction hypotension. Materials and Methods: In this randomized placebo-controlled clinical trial, ondansetron 4 mg was given intravenously to 65 elderly patients, 20 min before induction of general anesthesia, and the rate of post-induction hypotension defined as 25% or more reduction in mean arterial blood pressure, compared with a placebo groups. Results: A total of 114 patients completed the study (58 in ondansetron and 56 in the placebo group). Proportions of post-induction hypotension were 9 (16%) and 25 (45%) in ondansetron and placebo groups, respectively, (P = 0.001). Forty-five patients (40%) developed bradycardia. Rates of bradycardia were not significantly different between two groups. Conclusions: The results of this study show the effectiveness of intravenous ondansetron for prevention of post-induction hypotension in elderly patients. The mechanism of this effect largely is unknown. Role of ondansetron for prevention of post-induction hypotension may not fully understandable by its interaction with BJR, as has been shown in post-spinal hypotension

Tracheal sound analysis for automatic detection of respiratory depression in adult patients during cataract surgery under sedation

Background: Tracheal sound analysis is a simple way to study the abnormalities of upper airway like airway obstruction. Hence, it may be an effective method for detection of alveolar hypoventilation and respiratory depression. This study was designed to investigate the importance of tracheal sound analysis to detect respiratory depression during cataract surgery under sedation. Methods: After Institutional Ethical Committee approval and informed patients' consent, we studied thirty adults American Society of Anesthesiologists I and II patients scheduled for cataract surgery under sedation anesthesia. Recording of tracheal sounds started 1 min before administration of sedative drugs using a microphone. Recorded sounds were examined by the anesthesiologist to detect periods of respiratory depression longer than 10 s. Then, tracheal sound signals converted to spectrogram images, and image processing was done to detect respiratory depression. Finally, depression periods detected from tracheal sound analysis were compared to the depression periods detected by the anesthesiologist. Results: We extracted five features from spectrogram images of tracheal sounds for the detection of respiratory depression. Then, decision tree and support vector machine (SVM) with Radial Basis Function (RBF) kernel were used to classify the data using these features, where the designed decision tree outperforms the SVM with a sensitivity of 89% and specificity of 97%. Conclusions: The results of this study show that morphological processing of spectrogram images of tracheal sound signals from a microphone placed over suprasternal notch may reliably provide an early warning of respiratory depression and the onset of airway obstruction in patients under sedation