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Correlation of dysoxia metabolism markers with trauma scoring systems in multiple trauma patients admitted to the emergency department: A cross-sectional observational study
Get PDFBackground: All the trauma scoring systems (TSSs) have some limitations, and none is useful for patient monitoring. Recently, investigators have tried to modify the TSSs to improve their use. Aims: This study was conducted to determine whether any correlation exists between dysoxia metabolism markers (DMMs), including venous base deficit (BD) and HCO3level with different TSSs. Materials and Methods: In this cross-sectional study, all multiple trauma patients admitted to the emergency department were eligible. Blood samples for venous blood gas analysis were taken at the onset of resuscitation process. TSSs, including trauma index (TI), abbreviated injury score (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma Score-ISS (TRISS), were calculated for the patients. Spearman's rank correlation coefficient test was applied to find the association between the independent variables. Results: A total of 285 patients with a mean age of 33.37 ± 15.29 fulfilled the inclusion criteria, of which, 211 cases (74.0) were male. Statistical analysis revealed that there was a correlation between TI and HCO3level (P = 0.0001, r = 0.37) and also TI and BD (P = 0.0001, r = 0.47). Furthermore, there was an indirect correlation between AIS and ISS with HCO3and BD levels and the direct correlation between RTS and TRISS with HCO3and BD levels. Conclusion: It is likely that there is a statistical correlation, although weak, between TSSs with DMMs, including HCO3and BD level
Bilateral sacroiliac joint dislocation treated by posterior instrumentation case report and literature review
Get PDFSacroiliac joint dislocation is an uncommon and potentially life-threatening injury secondary to high-energy trauma. Given that bilateral sacroiliac joint dislocation has rarely been reported, its management constitutes a clinical challenge. The aim of this study was to review the literature available about sacroiliac joint dislocation management and to show an effective and reliable method to treat this kind of injury. Case report. We present a 15-year-old female patient who suffered a complete bilateral sacroiliac joint dislocation. The definitive treatment consisted of bilateral L4-iliac assembly plus right sacroiliac screw assisted by an O-arm navigation system. Surgical instrumentation allowed mobilization and full-weight-bearing a few days after surgery. At the 2-year follow-up, the patient remained asymptomatic. The triangle fixation technique stabilizes the sacroiliac joint and binds the lumbar spine to the pelvis. This method could represent a good option that allows early mobilization and weight-bearing
Are stainless steel elastic nails the solution to heavier children with femoral shaft fractures?
Get PDFBackground: The use of titanium elastic intramedullary nails for the treatment of femoral shaft fractures, in children weighing 45 kg, has been questioned due to the increased rates of malunion. Our aim was to see if the mechanical properties of stainless steel elastic nails provided enough fracture stability to justify their use in heavier children. Materials and Methods: Twenty pediatric femoral Sawbones®, fixed with titanium or stainless steel elastic nails, were tested. The bending stiffness and moments of the constructs were calculated at increasing loads, along with the angle of fracture deformation. From these estimates of maximum permitted body weight for each nail type were extrapolated. Results: Steel nails created significantly stiffer constructs than titanium in both the coronal and sagittal planes (P P P = 0.457). The estimated body weights extrapolated in the sagittal plane were 45 and 61 kg, in titanium and steel, respectively. In the coronal plane, they were 42 and 44 kg. Discussion: As steel has nearly twice the Young's modulus of titanium, it seems logical that fractures fixed with steel nails would be stiffer and fail at higher loads. However, it is unclear why steel did not outperform titanium in the coronal plane. A theory was proposed that unequal nail slip from the insertion sites might be a contributing factor to these findings. Conclusion: Pediatric femoral shaft fractures fixed with elastic steel nails provide significantly stiffer constructs than those fixed with titanium. However, there is an increased risk of malunion in the coronal plane, in children weighing 45 kg, regardless of material used, possibly due to unequal nail slip at the distal entry points
Development and domestication of a clinical guideline for pharmacological pain management of trauma patients in prehospital setting
Get PDFIntroduction: Inadequate management of acute traumatic pain in the prehospital stage is a fact, which has many physical and mental adverse effects. No clinical guideline for the pain management of prehospital trauma patients in Iran has been published yet. Aims: This study aimed at development and domestication of a clinical guideline for pharmacological management of pain in prehospital trauma patients. Materials and Methods: A multistage evolutionary study method was used. First, a systematic review of articles, books, and guidelines for prehospital acute pain management with a comprehensive approach was carried out, then clinical guidelines with the most relevance to the topic were selected, and their quality was evaluated with AGREE tools. Finally, the initial guideline was developed based on the recommendations of the most comprehensive ones. The Delphi method and experts panel were used to summarize the information and finalize the clinical guidelines recommendations. Results: A total of 38 clinical guidelines and 150 related articles were found, of which five more comprehensive clinical guidelines and the most relevant topics were identified and reviewed. The recommendations that were agreed on by the Delphi stage were considered as the final recommendations, and others were reviewed again in the panel of experts by making the necessary changes. Finally, the domestic clinical guideline with 52 recommendations in three areas (general, assessment, and drug recommendations) was developed. Conclusions: Iran prehospital emergency organizations can use the recommendations of this clinical guideline to improve the quality of care, satisfaction, and protect patients' right
A systematic review of clinical applications of polymer gel dosimeters in radiotherapy
Get PDFAbstract:
Radiotherapy has rapidly improved because of the use of new equipment and techniques. Hence, the appeal for a feasible and accurate three-dimensional (3D) dosimetry system has increased. In this regard, gel dosimetry systems are accurate 3D dosimeters with high resolution. This systematic review evaluates the clinical applications of polymer gel dosimeters in radiotherapy. To find the clinical applications of polymer gel dosimeters in radiotherapy, a full systematic literature search was performed on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in electronic databases up to January 31, 2017, with use of search-related terms in the titles and abstracts of articles. A total of 765 articles were screened in accordance with our inclusion and exclusion criteria. Eventually, 53 articles were included in the study. The findings show that most clinical applications of polymer gel dosimeters relate to external radiotherapy. Most of the gel dosimeters studied have acceptable dose accuracy as a 3D dosimeter with high resolution. It is difficult to judge which is the best polymer gel dosimeter to use in a clinical setting, because each gel dosimeter has advantages and limitations. For example, methacrylic acid–based gel dosimeters have high dose sensitivity and low toxicity, while their dose response is beam energy dependent; in contrast, N-isopropylacrylamide gel dosimeters have low dose resolution, but their sensitivity is lower and they are relatively toxic.
Keywords: Polymer gel dosimetry Clinical application
Radiotherapy Brachytherapy Neutron capture therap
Induction of protective immune response to intranasal administration of influenza virus-like particles in a mouse model
Get PDFHuman influenza A viruses (IAVs) cause global pandemics and epidemics, which remains a nonignorable serious concern for public health worldwide. To combat the surge of viral outbreaks, new treatments are urgently needed. Here, we design a new vaccine based on virus-like particles (VLPs) and show how intranasal administration of this vaccine triggers protective immunity, which can be exploited for the development of new therapies. H1N1 VLPs were produced in baculovirus vectors and were injected into BALB/c mice by the intramuscular (IM) or intranasal (IN) route. We found that there were significantly higher inflammatory cell and lymphocyte concentrations in bronchoalveolar lavage samples and the lungs of IN immunized mice; however, the IM group had little signs of inflammatory responses. On the basis of our results, immunization with H1N1 influenza VLP elicited a strong T cell immunity in BALB/c mice. Despite T cell immunity amplification after both IN and IM vaccination methods in mice, IN-induced T cell responses were significantly more intense than IM-induced responses, and this was likely related to an increased number of both CD11b high and CD103 + dendritic cells in mice lungs after IN administration of VLP. Furthermore, evaluation of interleukin-4 and interferon gamma cytokines along with several chemokine receptors showed that VLP vaccination via IN and IM routes leads to a greater CD4 + Th1 and Th2 response, respectively. Our findings indicated that VLPs represent a potential strategy for the development of an effective influenza vaccine; however, employing relevant routes for vaccination can be another important part of the universal influenza vaccine puzzle. © 2019 Wiley Periodicals, Inc
The effects of microRNAs in activating neovascularization pathways in diabetic retinopathy
No full textDiabetic retinopathy (DR) is one of the major complications of diabetes mellitus that causes diabetic macular edema and visual loss. DR is categorized, based on the presence of vascular lesions and neovascularization, into non-proliferative and proliferative DR. Vascular changes in DR correlate with the cellular damage and pathological changes in the capillaries of blood-retinal barrier. Several cytokines have been involved in inducing neovascularization. These cytokines activate different signaling pathways which are mainly responsible for the complications of DR. Recently; microRNAs (miRNAs) have been introduced as the key factors in the regulation of the cytokine expression which plays a critical role in neovascularization of retinal cells. Some studies have demonstrated that changing levels of miRNAs have essential role in the pathophysiology of vascular changes in patients with DR. The aim of this study is to identify the effects of miRNAs in the pathogenesis of DR via activating neovascularization pathways. © 2018 Wiley Periodicals, Inc
Melatonin and non-small cell lung cancer: New insights into signaling pathways
Get PDFNon-small-cell lung cancer (NSCLC) is a type of malignancy with progressive metastasis having poor prognosis and lowered survival resulting from late diagnosis. The therapeutic approaches for the treatment of this incurable cancer are chemo- and radiotherapy. Since current treatments are insufficient and because of drug-induced undesirable side effects and toxicities, alternate treatments are necessary and critical. The role of melatonin, produced in and released from the pineal gland, has been documented as a potential therapy for NSCLC. Melatonin prevents tumor metastasis via inducing apoptosis processes and restraining the autonomous cell proliferation. Moreover, melatonin inhibits the progression of tumors due to its oncostatic, pro-oxidant and anti-inflammatory effects. As a result, the combined treatment with melatonin and chemotherapy may have a synergistic effect, as with some other tumors, leading to a prolonged survival and improved quality of life in patients with NSCLC. This review summarizes the available data, based on the molecular mechanisms and related signaling pathways, to show how melatonin and its supplementation function in NSCLC. © 2019 The Author(s)
Comparison of the diagnostic value of the visual inspection with acetic acid (VIA)and Pap smear in cervical cancer screening
Get PDFObjective: This study aimed to compare the diagnostic value of VIA with Pap smear in screening for cervical cancer. Materials and methods: In this cross-sectional study, 440 women who had eligibility criteria, in Kashan city were assessed. All women underwent Pap smear test and then a visual inspection with acetic acid and colposcopy-biopsy (Gold Standard). Then, the diagnostic value indices including the specificity, sensitivity, positive and negative predictive values for the results of VIA and Pap smear were analyzed by SPSS V16 software. Results: Finding showed that 29.9 of women had abnormal Pap smear. The false positive rate of Pap smear was 40.2, and its false negative rate was 37.4. For VIA, the false positive and false negative rates were 21.2 and 4.6. The sensitivity, specificity, NPV and PPV of Pap smear was 29.7, 85.5, 59.8, 62.6, and these values for VIA was 94.6, 81.6, 78.8, 95.4 respectively. Combination of Pap smear and VIA showed the sensitivity of 97.3 and 100 in low grade and high grade cervical lesions. Conclusion: VIA has a higher sensitivity than Pap smear in detection of low and high grade cervical lesions, however, its specificity is less than Pap smears. Therefore it is recommended to use of VIA along with Pap smear to reach a higher sensitivity. © 201
Nurses' experiences of workplace violence in Kashan/Iran: A qualitative content analysis
Get PDFBackground: Nurses are at a high risk of workplace violence (WPV). This phenomenon is largely dependent on the sociocultural conditions. Objectives:This study explained the experiences of nurses about the WPV in medical, surgical, and emergency departments of a general hospital in Kashan, Iran, in 2017. Methods: In a qualitative content analysis, 13 nurses who had the experience of WPV were invited to participate in semi-structured interviews. The interviews were analyzed through conventional qualitative content analysis using the method suggested by Graneheim and Lundman. Results:Four themes were extracted from the interviews. The themes were: violent behaviors, antecedents of violence,violence management,and violence outcomes. Conclusion: WPV had many forms, antecedents, and consequences. Training the personnel and developing a committee for evaluating the incidents can prevent the occurrence of the violence