Comparing the Quality and Complications of Tube Thoracostomy by Emergency Medicine and Surgery Residents; a Cohort Study

Introduction: Tube thoracostomy complications depend on the operator’s skill, patients’ general condition and the place in which the procedure is done. The present study aimed to compare the quality and complications of tube thoracostomy carried out by emergency medicine residents (EMRs) and surgery residents (SRs).Methods: This cohort study was conducted on 18-60 years old trauma patients in need of tube thoracostomy presenting to two academic emergency departments. Quality of tube placement and its subsequent complications until tube removal were compared between SRs and EMRs using SPSS 20.Results: 72 patients with the mean age of 37.1±14.1 years were studied (86.1% male). 23 (63.8%) cases were complicated in SRs and 22 (61.1%) cases in EMRs group (total= 62.5%). Chest drain dislodgement (22.2% in SRs vs. 22.2% EMRs; p>0.99), drainage failure (19.4% in SRs vs. 16.7% EMRs; p=0.50), and surgical site infection (11.1% in SRs vs. 19.4% EMRs; p=0.25) were among the most common observed complications. The overall odds ratio of complication development was 0.89 (95% CI: 0.35-2.25, p = 0.814) for SRs and 1.12 (95% CI: 0.28-4.53, p = 0.867) for EMRs.Conclusion: The findings of the present study showed no significant difference between SRs and EMRs regarding quality of tube thoracostomy placement and its subsequent complications for trauma patients. The rate of complications were interestingly high (>60%) for both groups

Digesters in traditional Persian medicine

Background: Functional gastrointestinal diseases are common in general populations and comprise more than 40% visits to gastroenterologists. Treatment options of gastrointestinal diseases have been limited. There are a few medications for functional gastrointestinal diseases and some of medications are not available in the market or in the place where the patient lives. Traditional Persian medicine (TPM) is a branch of alternative and traditional medicine based on individual viewpoint and humoral theory, focuses on lifestyle modification and uses natural products to manage the patients. Methods: In this study, a set of compound drugs known as digesters (jawarishes) and other applications are described based on main TPM text books. Results: Jawarishes have different formulations containing various medicinal herbs used for better food digestion and improved gastric functions and also used for other disorders including reinforcing the brain, heart, liver and some therapeutic approaches. Conclusions: By reviewing medieval Persian pharmaceutical manuscripts, we can conclude that many herbs are effective in different systems of the body and improve gastric functions. Zingiber officinalis and Piper nigrum are mixed together to get various formulations. The variety of jawarishes formulations and their different clinical applications can indicate continuity of their use

The weight of Mizaj (temperament) indices in Persian Medicine: A Delphi study

Background: Mizaj is an individualized viewpoint in Persian Medicine (PM) that is used for the prevetion of diseases and also treatment. Evaluating Mizaj in the two domains of hotness-coldness, and wetness-dryness, 10 criteria have been introduced, most of them are qualitative. To achieve valid and reliable questionnaires, the weight of these criteria must be determined in assessing the Mizaj. Methods: In a cross-sectional study with Delphi method, 10 indices were extracted from PM references and sent to PM experts via e-mail. They were asked to score the weight of each index in determining the Mizaj from 0 to 10. The scores ranked and comparing previous preliminary studies, criteria of major and minor were proposed. Results: Out of 147 invited PM experts, 122 completed the tables. Based on scores, physical functions, physique, and responsiveness of organs obtained the highest scores in the field of hotness-coldness. In wetness-dryness muscle/fat mass and sleep/wakefulness received the highest scores from the viewpoint of experts. Conclusion: Physical functions, physique (Anthropometry), responsiveness of organs and psychic function can be used as major criteria in Mizaj assessment methods in the hotness-coldness field. In the field of wetness-dryness, muscle/fat mass, sleep/wakefulness, tactile condition and physique (anthropometry) can be considered as major criteria

Mizaj assessment and data analysis methods in Amirkola health and aging project (AHAP cohort)

Background: One of the principles of Persian medicine (PM) is the individualized approach that is presented with the concept of Mizaj. In this viewpoint, Mizaj is determined for every person based on 10 criteria, which is a result of the Mizaj of the main organs, including the brain, liver, and heart. There is no standard diagnostic tool for Mizaj assessment in the elderly. The purpose of this study is to explain the method of Mizaj assessment and data analysis in the elderly in the second phase of the Amirkola health and aging project (AHAP) in Iran. Methods: In this study, a novel Mizaj assessment method in two phases is presented. In the first phase, 1541 elderly were assessed by a PM expert and typical diagnoses were determined. At the second phase, an expert panel including 5 PM experts evaluated the cases. The paraclinical and metric data of the elderly whose Mizaj agreed in the expert panel was used to assess its correlation with Mizaj. Conclusion: In the lack of valid and reliable questionnaires to assess the personalized viewpoint of PM, a new expert-based method has been introduced that can be used in similar studies. The result of the Mizaj assessment in this way will be used to obtain objective values for the Mizaj assessment

Management of Patients with Refractory Cardiogenic Shock and Cardiointestinal Syndrome with Impella 5.5 as Bridge to Decision: Case Series

Patients with advanced heart failure require multi-system management as a majority succumb to end-organ dysfunction, including gastrointestinal sequelae. Temporizing measures, such as early mechanical circulatory support, can assist in the recovery of patients with acute cardiogenic shock. The temporary support can improve patient characteristics to enable future definitive heart failure therapies such as durable left ventricular assist devices and orthotopic heart transplantation. We present two cases of cardiogenic shock that were successfully bridged with an Impella 5.5 (Abiomed). The management enabled the patients to recover from reversible cardiointestinal syndrome and undergo successful definitive therapies

Age-Specific Distribution of Intraocular Pressure in Elderly Iranian Population and Its Associated Factors

Background: The purpose of this study was to determine the distribution of intraocular pressure (IOP) and assess its association with age, sex, systemic blood pressure, diabetes mellitus, body mass index (BMI) and tobacco smoking in Iranian elderly population. Methods: This cohort-based, cross-sectional study assessed elderly individuals aged 60-90 years in Amirkola, northern Iran, in 2016-2017. Past medical history, blood pressure, diabetes mellitus, BMI and tobacco smoking were recorded through an interview and physical examination. IOP was assessed using non-contact tonometry. Results: Total of 1377 individuals participated in this study, out of which 1346 IOP measurements were included for the final analysis. The mean age of participants was 69.4 ± 7.1 years and mean IOP was determined to be 16.7 ± 3.2 mmHg. Majority of the participants were males (56.1 vs 43.1), 73.8 of participants were overweight or obese, 6.1 smoked tobacco, 28.9 had diabetes mellitus and 84.9 had higher than normal blood pressure. Through multiple regression analysis, it was determined that age (β=-0.132, p<0.001) was negatively associated with IOP, and the presence of diabetes mellitus (β=0.118, p<0.001), systolic blood pressure (β=0.101, p<0.001), and BMI (β=0.020, P=0.020) were positively associated with IOP. Conclusion: Mean IOP of individuals in this study was higher than average based on other studies. Age, was negatively and systemic blood pressure, BMI and presence of diabetes mellitus were positively associated with mean IOP of elderly Iranian population. Sex and tobacco smoking were not correlated with IOP. &#160

الگوی اولویت‌بندی داروها در منابع طب سنّتی ایران

  In the medical world today, the searching process to find a new drug (drug discovery) is very expensive and time consuming. Although the principles of Iranian Traditional Medicine (ITM) differs from conventional medicine, including the viewpoints to drugs and its mechanisms of effectiveness, but it seems that it is possible to find ideas to produce new drugs matching with basics of conventional medicine. In this paper, we have tried to introduce a logical and repeatable manner to find the most effective material medica in ITM references for a definite disease or sign and symptom. This manner is explained in 9 steps including: accommodation of subject, arrange keywords, determine resources, giving a score to each book, search in the references, find synonyms and classification, re-monitoring, scoring and setting priorities. After setting priority based on literature review, recommendation of each materia medica for clinical trials should be done regarding to factors such as: availability, cost, being native, fewer complications, better tasting, easy to prepare and availability to maintain long-time.در دنیای پزشکی امروز جست‏وجو و کشف داروی جدید، فرآیندی پرهزینه و زمان‌بر است. اگرچه مبانی و دیدگاه طب سنّتی ایران با مبانی طب رایج غربی در بسیاری از موارد مانند چگونگی نگاه به دارو و مکانیسم‌های اثربخشی آن تفاوت اساسی دارد، شاید بتوان از انبوه علوم متراکم در کتاب‏های طب سنّتی برای جست‏وجو و یافتن دارو، حتی بر اساس مبانی طب رایج استفاده کرد. در مقاله حاضر سعی شده است روش جست‏وجو و اولویت‌بندی دارو در منابع طب سنّتی ایران برای یک علامت یا بیماری تعریف‎شده از دیدگاه طب رایج، با سیر منطقی ارائه شود تا علاوه بر یافتن حداکثر مفردات توصیه‌شده، این کار قابلیت تکرارپذیری نیز داشته باشد. شیوه جست‎وجو در متون، در 9 مرحله شامل: تطبیق موضوع، تعیین کلیدواژه‌ها، تعیین منابع، نمره دادن به کتاب‏ها، جست‎وجو در منابع، یافتن مترادفات، دسته‌بندی، بازبینی، نمره‎دهی و اولویت‌بندی، تنظیم و توضیح داده شده است. پس از اولویت‌بندی مفردات بر مبنای جست‎وجو در متون، توجه به مواردی مانند در دسترس بودن، ارزان بودن، بومی بودن، عارضه کمتر، مزه بهتر، قابلیت تهیه آسان و نگهداری طولانی‌مدت در توصیه مفردات برای انجام کار بالینی، مهم است

Digesters in traditional Persian medicine

Background: Functional gastrointestinal diseases are common in general populations and comprise more than 40% visits to gastroenterologists. Treatment options of gastrointestinal diseases have been limited. There are a few medications for functional gastrointestinal diseases and some of medications are not available in the market or in the place where the patient lives. Traditional Persian medicine (TPM) is a branch of alternative and traditional medicine based on individual viewpoint and humoral theory, focuses on lifestyle modification and uses natural products to manage the patients. Methods: In this study, a set of compound drugs known as digesters (jawarishes) and other applications are described based on main TPM text books. Results: Jawarishes have different formulations containing various medicinal herbs used for better food digestion and improved gastric functions and also used for other disorders including reinforcing the brain, heart, liver and some therapeutic approaches. Conclusions: By reviewing medieval Persian pharmaceutical manuscripts, we can conclude that many herbs are effective in different systems of the body and improve gastric functions. Zingiber officinalis and Piper nigrum are mixed together to get various formulations. The variety of jawarishes formulations and their different clinical applications can indicate continuity of their use

Modeling of Hepatocytes Proliferation Isolated from Proximal and Distal Zones from Human Hepatocellular Carcinoma Lesion.

Isolation of hepatocytes from cirrhotic human livers and subsequent primary culture are important new tools for laboratory research and cell-based therapeutics in the study of hepatocellular carcinoma (HCC). Using such techniques, we have previously identified different subpopulations of human hepatocytes and among them one is showing a progressive transformation of hepatocytes in HCC-like cells. We have hypothesized that increasing the distance from the neoplastic lesion might affect hepatocyte function and transformation capacity. However, limited information is available in comparing the growth and proliferation of human hepatocytes obtained from different areas of the same cirrhotic liver in relation to their distance from the HCC lesion. In this study, hepatocytes from 10 patients with cirrhosis and HCC undergoing surgical resections from specimens obtained at a proximal (CP) and distal (CD) distance from the HCC lesion were isolated and placed in primary culture. CP hepatocytes (CP-Hep) were isolated between 1 to 3 cm (leaving at least 1cm margin to avoid cancer cells and/or satellite lesions), while CD hepatocytes (CD-Hep) were isolated from more than 5 cm or from the contralateral-lobe. A statistical model was built to analyze the proliferation rates of these cells and we evaluated expression of HCC markers (Glypican-3 (GPC3), αSmooth Muscle Actin (α-SMA) and PCNA). We observed a significant difference in proliferation and in-vitro growth showing that CP-Hep had a proliferation pattern and rate significantly different than CD-Hep. Based on these data, this model can provide information to predict growth of human hepatocytes in primary culture in relation to their pre-cancerous state with significant differences in the HCC markers expression. This model provides an important innovative tool for in-vitro analysis of HCC