Demographic data of patients with β-thalassemia major recorded in the electronic system in the north of Iran, 2016

Background: Major thalassemia prevention project in Iran began in 1997. Mazandaran Province in northern Iran took effective steps in preventing the birth of patients with thalassemia major in the country. We report on the demographic status of patients with thalassemia major registered in the electronic system of Mazandaran Province in Iran.Methods: The web-based application of the Mazandaran Thalassemia Registry (THRegistry) was designed based on the Net Framework platform in VB.Net and the 2014Sql Server database. The information source included clinical records in 14 thalassemic wards of the Mazandaran province hospitals. Epidemiological data of patients and date of transfusion, blood group, educational status, employment, marital status and having children were recorded.Results: The study population was 1,725 patients including 889 (51.5%) women and 836 (48.5%) men with a mean age of 30±9.6 years. A total of 188 patients born have been identified after the launch of the country's disease prevention plan in 1997. Prenatal diagnosis (PND) services were not used in 99 cases, PND result was mistaken in 6 other cases and in the remaining 5 cases PND was performed. A total of 1,314 patients (76.2%) were blood transfusion dependent thalassemia (TDT). Mean haemoglobin level in male and female patients was 9.4±6.3 and 9.01±5.1/100 g/dl, respectively. The mean age of onset of transfusion was 4±6.3 years. A total of 382 cases (22.1%) of married patients had a child of their own.Conclusions: The system is a good resource to design descriptive and cohort studies, survival studies, therapeutic planning, and observation of the success of the major thalassemia prevention project

Does high-dose metformin cause lactic acidosis in type 2 diabetic patients after CABG surgery? A double blind randomized clinical trial

Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Student’s t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used

The Role of Oral Care in Prevention of Ventilator Associated Pneumonia: A Literature Review

Introduction: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection reported among mechanical ventilation patients in intensive care units(ICU). Ventilator-associated pneumonia is associated with increased morbidity, mortality hospital, length of stay and health care costs. Oral health can be compromised by critical illness and by mechanical ventilation and thus, it deteriorates over time. A relationship exists between oral health status and VAP that is influenced by nursing care. Oropharynx colonization is the main risk factor for the development of VAP. Also dental plaques can provide a habitat for microorganisms responsible for VAP. Oral care in critically ill patients is an important issue and nurses of intensive cares play a key role in preventing VAP. Educations for all nurses of intensive cares should focus on the risk factors for VAP as well as onthe preventive interventions. The aim of the present study was to review the literature focusing on oral care in prevention of VAP

Comparison of the antibacterial effects of Persica, Matrica and chlorhexidine gluconate mouthwashes and normal saline in mechanically ventilated ICU patients: A clinical trial

Background: Bacterial colonization in the pharynx is one of the most important risk factors for ventilator-associated pneumonia. The aim of this study was to determine and compare the anti-bacterial effects of different mouthwashes in mechanically ventilated patients. Materials and Methods: In this double-blind randomized clinical trial, 80 patients were selected from the intensive care units (ICUs) of Imam Khomeini Hospital in Sari City, Iran, during 2010-2011, and were divided into four groups of 20 cases. The first intervention group was administered with chlorhexidine gluconate (CHX) 0.2 mouthwash, the second group Persica herbal 10 mouthwash, the third group was administered with Matrica 10 and finally in the fourth group, normal saline was used. In order to culture Staphylococcus aureus and Streptococcus pneumoniae, oropharynx samples were obtained without any stimulation prior and 6 min following oral rinsing. Results: Bacterial colonies were decreased significantly after the intervention in all four groups (P<0.001). Chlorhexidine gluconate, Persica and Matrica mouthwashes caused to decrease the Staphylococcus aureus (P<0.001, P<0.008 and P=0.01, respectively) and Streptococcus pneumoniae (P<0.001) positive cultures after the intervention. Conclusion: Herbal oral mouthwashes including Persica and Matrica are effective in decreasing Staphylococcus aureus and Streptococcus pneumoniae colonized in the oropharynx of mechanically ventilated patients. Therefore, after further investigations, they can serve as suitable alternatives for CHX in ICU settings

Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients

Iron-overload-associated cardiomyopathy has been one of the primary causes of mortality in thalassemia patients with iron burden. There is growing evidence citing the beneficial effects of ebselen as an antioxidant selectively blocking the divalent metal transporter 1 (DMT-1) to deter iron ingress into cardiomyocytes, raising internets in viewing this component in this population in order to treat and even prevent cardiomyopathy occurring from iron surplus. In this article, we reviewed the potential advantageous effects of ebselen in thalassemia patients who suffer from iron excess, susceptible to cardiomyopathy induced by iron overload. A systematic search in several databases, including PubMed, Scopus, and Web of Science, was conducted to explore the role of ebselen in controlling iron-overload-related cardiomyopathy in thalassemia patients by the keywords of Ebselen AND iron. The inclusion criteria were English-written preclinical and clinical studies investigating the efficacy and side effects of ebselen in an iron-overload context. After searching the databases, 44 articles were found. Next, of 19 published articles, 3 were included in this article. After reviewing the references of the included studies, no articles were added. In conclusion ebselen can be a promising adjuvant therapy in patients with thalassemia alongside the standard treatment with iron chelators, particularly in severe cases with cardiomyopathy, due to falling iron inflow by inhibiting DMT-1 and increasing ferroportin-1 expression and antioxidant properties. However, clinical studies need to be carried out to reach a definite conclusion