Benefits of using intrathecal buprenorphine

Background: General anesthesia draws attention to the most commonly used modalities for post cesarean delivery pain relief in systemic administration of opioids, while the administration of small dose of intrathecal opioid during spinal anesthesia can be a possible alternative. The aim of this study was to evaluate the effects of buprenorphine on cesarean section prescribed intrathecally. Methods: This double blind randomized clinical trial study was conducted in patients for cesarean section under spinal anesthesia. The patients were randomly divided into case and control groups. Case group (208 patients) received 65-70 mg of 5% lidocaine plus 0.2 ml of buprenorphine while the same amount of 5% lidocaine diluted with 0.2 ml of normal saline was given to 234 cases in the control group. Hemodynamic changes and neonatal APGAR scores (Appearance, Pulse, Grimace, Activity, Respiration) were recorded. Pain score was recorded according to the visual analog scale. This study was registered in the Iranian Registry of clinical Trials; IRCT2013022112552N1. Results: The mean age of case and control groups was 24.4±5.38 and 26.84±5.42 years, respectively. Systolic blood pressure was not significantly different until the 45th minute but diastolic blood pressure showed a significant difference at the 15th and the 60th minutes (P<0.001). Heart rate changes were significantly different between cases and controls at the initial 5th, 15th and after 60th minutes (P<0.001). Pain-free period was significantly different between two groups (1.25 h versus 18.73 h) (P<0.001). Conclusion: The results show that prescription of intratechal buprenorphine prolongs the duration of analgesia without any significant considerable side effects

Transfusion-related acute lung injury in multiple traumatized patients

Background: Many of the multiple traumatized patients who refer to the hospital need transfusion. Transfusion-related acute lung injury (TRALI) is a serious clinical syndrome associated with the transfusion of plasma-containing blood components. In the article, we present a case of TRALI following transfusion of packed red blood cells Case Presentation: A 24 year old male referred to Shahid Beheshti Hospital due to multiple trauma with left femoral and humerus fractures. Due to severe anemia he received 3 units of packed red blood cells. The symptoms of TRALI began 2 hours after transfusion. He was transferred to intensive care unit (ICU) due to metabolic acidosis and severe hypoxia. The TRALI was confirmed after ruling out the other probable pulmonary diseases. He recovered and was discharged. Conclusion: Transfusion related acute lung injury should be considered in any case receiving transfusion of plasma containing blood components

Age structure and growth rate of (Squalius cephalus Linnaeus, 1758) in Tuji tributary from Talar River, Mazandaran Province

A structure and growth pattern of Squalius cephalus (Linnaeus, 1758) in Tuji tributary of Talar River, Mazandaran Province, was studied during the period from August 2008 till August 2009. In total, 298 fish were caught by electrofishing and fixed in 10% formalin. The weight and length of fish were measured and the age was determinated by scallometric method. The age data showed that fishes were between 0+ to 4+ age groups. Pauli`s applied growth pattern showed a positive alometric for male and female and total fish and a negative isometric for unmature fishes. The average instantaneous growth rate of European Chub showed that the age groups 2+ and 3+ with 1.1 had the fastest growth compare to 3+ and 4+ age groups with 0.89. Condition factor of specimens showed that the highest one with 1.58 (r2 = 0.983) belong to females and the lowest with 1.17 (r2 = 0.901) belong to unmature fishes. The total sex ratio (123 males to 115 females) showed no significant differences between them

The Genes Responsible for Maple Syrup Urine Disease, Molecular Pathomechanisms and Causative Mutations in Iranian Population

BACKGROUND AND OBJECTIVE: Maple syrup urine disease is a rare inborn metabolic inherited disorder caused by deficiency of branched chain α-keto acid dehydrogenase complex and leading to accumulation of branched chain amino acids in body fluid. The incidence of MSUD is higher in populations with high consanguineous marriage. BCKD is a mitochondrial complex which is encoded by four nuclear genes (BCKDHA, BCKDHB, DBT, and DLD) and MSUD can be caused by mutation within any of these four genes. Accumulation of metabolic is associated with impairment of energy metabolism, provoke apoptosis, dysfunctional neurotransmitter synthesis and neuropathological defects such as seizure, psychomotor delay and coma. In the present study, we investigated the incidence of MSUD in Iran, compiled previously reported mutations in Iranian population and also explained molecular pathomechanisms underlying MSUD. METHODS: To compile MSUD mutations, we systematically reviewed PubMed and magiran databases to find related articles in English and Persian language, respectively. The key words "MSUD" and "Iran" was used as query. FINDINGS: Until 9th December 2018, twenty four MSUD mutations were collected from Iranian population of which 18 mutations have been only identified in Iran and were not reported in other populations yet. Likewise, because of high consanguineous marriages, the incidence of MSUD were higher than worldwide average in different provinces. CONCLUSION: Identification and compiling of MSUD mutations in Iranian population can be useful for prenatal genetic diagnosis in at risk families and play crucial role in early diagnosis and also treatment before starting neurological symptoms in newborns

Demographic characteristics and the first program of colorectal cancer (CRC) screening in north of Iran (2016)

Background: Colorectal cancer (CRC) is one of the most common types of gastrointestinal cancers. This study aimed to determine the demographic characteristics and their relationships with the results of the first screening program for CRC in people over 50 years old in northern Iran. Methods: This cross-sectional study was conducted in 2016 on 924 eligible people over 50 years old. Initial screening was done by IFOBT and then colonoscopy was performed if the results were positive. The demographic characteristics of individuals including age, sex, place of residence, marital status, body mass index (BMI) and education level were investigated with the results of the colonoscopy and the test results. Results: The mean age of participants was 59.38 years, and the participation of women (57.0) and rural residents (54.2) were higher in the screening program. According to the demographic variables, age was considered as a strong independent predictor variable, so that the prevalence of positive test results was more than 2 times higher in subjects older than 70 compared with subjects aged �60 (OR =2.05; 95 CI, 1.18-3.55, P=0.010). Also, the chance of positive test result in the age group �55 years old was 23, with an increase of 64 in the age group above 75 years (P<0.001). Among the positive test subjects, 118 cases underwent colonoscopy. Conclusions: The prevalence of IFOBT positivity was increased with age. Therefore, given the aging population of the country, it is recommended to emphasize on the screening of older people in the general population. ©Journal of Gastrointestinal Oncology

Demographic characteristics and the first program of colorectal cancer (CRC) screening in north of Iran (2016)

Background: Colorectal cancer (CRC) is one of the most common types of gastrointestinal cancers. This study aimed to determine the demographic characteristics and their relationships with the results of the first screening program for CRC in people over 50 years old in northern Iran. Methods: This cross-sectional study was conducted in 2016 on 924 eligible people over 50 years old. Initial screening was done by IFOBT and then colonoscopy was performed if the results were positive. The demographic characteristics of individuals including age, sex, place of residence, marital status, body mass index (BMI) and education level were investigated with the results of the colonoscopy and the test results. Results: The mean age of participants was 59.38 years, and the participation of women (57.0) and rural residents (54.2) were higher in the screening program. According to the demographic variables, age was considered as a strong independent predictor variable, so that the prevalence of positive test results was more than 2 times higher in subjects older than 70 compared with subjects aged �60 (OR =2.05; 95 CI, 1.18-3.55, P=0.010). Also, the chance of positive test result in the age group �55 years old was 23, with an increase of 64 in the age group above 75 years (P<0.001). Among the positive test subjects, 118 cases underwent colonoscopy. Conclusions: The prevalence of IFOBT positivity was increased with age. Therefore, given the aging population of the country, it is recommended to emphasize on the screening of older people in the general population. ©Journal of Gastrointestinal Oncology

Biallelic null variants in PNPLA8 cause microcephaly by reducing the number of basal radial glia.

Patatin-like phospholipase domain-containing lipase 8 (PNPLA8), one of the calcium-independent phospholipase A2 enzymes, is involved in various physiological processes through the maintenance of membrane phospholipids. Biallelic variants in PNPLA8 have been associated with a range of paediatric neurodegenerative disorders. However, the phenotypic spectrum, genotype-phenotype correlations and the underlying mechanisms are poorly understood. Here, we newly identified 14 individuals from 12 unrelated families with biallelic ultra-rare variants in PNPLA8 presenting with a wide phenotypic spectrum of clinical features. Analysis of the clinical features of current and previously reported individuals (25 affected individuals across 20 families) showed that PNPLA8-related neurological diseases manifest as a continuum ranging from variable developmental and/or degenerative epileptic-dyskinetic encephalopathy to childhood-onset neurodegeneration. We found that complete loss of PNPLA8 was associated with the more profound end of the spectrum, with congenital microcephaly. Using cerebral organoids generated from human induced pluripotent stem cells, we found that loss of PNPLA8 led to developmental defects by reducing the number of basal radial glial cells and upper-layer neurons. Spatial transcriptomics revealed that loss of PNPLA8 altered the fate specification of apical radial glial cells, as reflected by the enrichment of gene sets related to the cell cycle, basal radial glial cells and neural differentiation. Neural progenitor cells lacking PNPLA8 showed a reduced amount of lysophosphatidic acid, lysophosphatidylethanolamine and phosphatidic acid. The reduced number of basal radial glial cells in patient-derived cerebral organoids was rescued, in part, by the addition of lysophosphatidic acid. Our data suggest that PNPLA8 is crucial to meet phospholipid synthetic needs and to produce abundant basal radial glial cells in human brain development

Patient’s Satisfaction of Emergency Department Affiliated Hospital of Babol University of Medical Sciences in 2013 -14

BACKGROUND AND OBJECTIVE: Patient satisfaction in emergency departments is an indicator of healthcare quality, evaluation of which can promote awareness of the relevant authorities regarding its status. This study aimed to evaluate patient satisfaction in emergency departments in hospitals affiliated to Babol University of Medical Sciences. METHODS: This cross-sectional study was performed in patients admitted to emergency departments in hospitals affiliated to Babol University of Medical Sciences, Babol, Iran, during a period of eight months (2013-2014). The participants were chosen through convenience sampling. Information regarding hospital environment, facilities, and nursing team was collected using a standard questionnaire. Standard questionnaire responses were classified to” don’t happen, dissatisfied, low, medium and high satisfaction”. Then medium and high responses classified to favorable satisfaction (above average) and low or dissatisfied responses were classified to unfavorable satisfaction. In case the patients were unable to fill-out the questionnaire, their companion completed it for them. FINDINGS: Overall, 444 (87.9%) patients expressed optimum satisfaction. The highest rate of dissatisfaction (14.8%, n=74) was related to environment and services, while the highest rate of satisfaction (49.3%, n=246) was pertinent to nursing staff. The results indicated that the rate of satisfaction in residents of rural areas was 0.55 times higher than in urban residents (OR: 1.55, 95% CI: 1.12-2.70, p=0.02), 50% lower in patients compared to companions (OR: 0.55, 95% CI: 0.36-0.83, p=0.05),and  in the evening shift was 0.65 times higher than in those admitted in the morning (OR: 1.65, 95% CI: 1.06-2.58, p=0.03). Moreover, this rate in patients admitted at night shift was 0.74 times higher than in those admitted in the morning (OR: 1.74, 95% CI: 1.12-2.70, p=0.01). CONCLUSION: This study demonstrated optimum patient satisfaction in emergency departments in hospitals affiliated to Babol University of Medical Sciences