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Acute purulent mediastinitis with sequential bilateral pleural empyema caused by neck trauma: A unique occurrence, a case report
Get PDFBackground: Descending necrotizing mediastinitis (DNM) due to blunt trauma is very rare form of mediastinitis that can rapidly progress to septicemia and multi organ failure, in spite of optimal surgical management. Case presentation: We report a 28-year-old patient, previously healthy man, with acute descending necrotizing mediastinitis and late sequential bilateral pleural empyema, caused by blunt neck trauma. Although after admission, the course of his illness was complicated with septic shock, homodynamic instability, renal and pulmonary insufficiency, however he survived with on time diagnosis, aggressive surgical intervention, appropriate antibiotics administration and optimal management in the intensive care unit (ICU). Conclusions: Descending necrotizing mediastinitis due to blunt neck trauma is a rare occurrence, but can lead to late sequential bilateral empyema even after 18 days. With early diagnosis, aggressive drainage and antibiotic therapy, the patient life can be saved. The lesson we took from this case is that: 1- blunt neck trauma rarely leads to descending necrotizing mediastinitis and late sequential empyema (even after 18 days). 2- If the patient does not recover from sepsis, despite optimal surgical management, contra lateral empyema or pericarditis should be considered. © 2019 The Author
Morphological and molecular detection of dicrocoelium dendriticum isolated from domestic animals based on genetic ND1 marker in Markazi Province
No full textBACKGROUND: Dicrocoeliasis is one of the commonest parasitic diseases of the bile ducts and gallbladder in a wide range of mammals including ruminants and sometimes human being. The disease is really important in medicine, economy, and veterinary medicine. Annually, slaughter house loses a huge amount because of losing a great deal of valuable proteins in people daily diets. In order to bring the disease under control, morphological and molecular analysis of parasite in endemic districts is essential. OBJECTIVES: The present study was conducted to determine the morphological as well as molecular characterization of cattle, sheep and goats isolated from Dicrocoelium by applying ND1 genetic marker in the Markazi province, Iran. METHODS: In this cross-sectional study 480 fresh adult worms were collected from livers of 120 cattle, sheep and goats slaughtered in abattoirs in Markazi province. To diagnose the species of parasite, morphometric indices of mature worms were calculated based on standard parameters. Then DNA of 60 isolates with different morphometric characteristics was extracted and PCR reaction was performed for a part of ND1 (mtDNA). PCR was purified and its sequence was defined, the percentage of genetic similarity was compared to cases registered by GenBank and the exact species of parasite was recognized. RESULTS: The morphometric analysis in all isolates was as follows: testicles were sequential, the length and the width of the worm for all cattle, sheep and goat isolates were 7994±967µm, 6844±100µm, 6570±110µm (P<0.0001) and 1649±339µm, 1490±221µm and 1430±252µm (P<0.0001) respectively. The proportion of the length to the width was 4.87±0.641, 4.58±0.625, and 4.64±0.622 respectively. All the results mentioned above confirmed Dicrocoelium dendriticum in the hosts of the district under investigation. The analysis of the gel electrophoresis in all isolates showed the existence of band 200pb.The percentage of genetic similarity to the registered items, cases were determined by the Gen bank between 97 and 99 percent. CONCLUSIONS: Molecular identification and morphometric assays clearly showed that D. dendriticum is the only agent of Dicrocoeliasis among cattle, sheep and goats in the Marakazi province, Iran. Molecular diagnosis of parasite by applying genetic marker of the nucleus is recommended. © 2019 University of Tehran. All rights reserved
The study of relationship between serum levels of soluble fms-like tyrosine kinase-1 and soluble fibrinogen-like protein 2 with delayed graft function after kidney transplantation
Get PDFDelayed graft function (DGF) is a transplant complication which means a need to dialysis throughout the first week after transplantation. This study aimed to ascertain the relationship between the two immunomodulatory factors of soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble fibrinogen-like protein 2 (sFGL-2) with DGF after transplantation. This case-control study was done in 2 groups of 58 kidney transplant patients with and without DGF. The control group included the patients who didn't show DGF symptoms. Then, serum levels of sFlt-1and sFGL-2 in all blood samples were measured by ELISA. Serum sFlt-1 and sFGL-2 levels were significantly higher in the DGF group compared to those in the control group (p�0.001). sFlt-1 and sFGL-2 serum levels significantly affect DGF (p<0.001) in such a way that they may be diagnostic factors of DGF. This study showed a significant relationship between sFlt-1 as well as sFGL-2 and DGF. Therefore, plasma levels of sFlt-1 and sFGL-2 may be used as diagnostic tools to determine the risk of DGF. © August 2019, Iran J Allergy Asthma Immunol
Effects of fluoride versus amorphous calcium phosphate solutions on enamel microhardness of white spot lesions: An in-vitro study
Get PDFBackground: Development of white spot lesions around orthodontic fixed orthodontic appliances is a common finding, especially in patients with poor oral hygiene. One of the conservative interventions for regression of these lesions is using chemical solutions. The current study aimed to compare the effectiveness of fluoride and amorphous calcium phosphate (ACP) on microhardness improvement of affected enamel. Materials and Methods: Forty-five intact human incisor teeth were selected and randomly divided into 3 groups of 15. Fluoride group, ACP group and artificial saliva group (control group). Inducing of white spot lesion was done by PH-cycling model. Samples of the first and second group were submerged into 0.05 fluoride and 0.05 ACP solutions respectively for one minute a day. The rest of the time, all specimens were put in artificial saliva, which was incubated in 37 °c temperature. Microhardness of specimens was assessed by Vickers microhardness test in three stages: 1: Baseline microhardness assessment that was done before induction of white spot lesion, 2: Secondary microhardness assessment that was done after induction, 3: Final microhardness assessment that was done after chemical treatment. The SPSS 11.5 software was used for statistical analysis and p < 0.05 was considered as significant. Results: Microhardness of specimens in the fluoride and ACP groups had significantly improved after the treatment (between secondary assessment and final assessment). In the control group, no significant improvements were observed. In final assessment, there were significant differences between the ACP and control groups, but no significant differences were found neither between the fluoride and ACP, nor the Fluoride and control groups. Conclusions: According to the current study, both 0.05 ACP and 0.05 fluoride solutions enhanced enamel micro- hardness in treatment of white spot lesion. © Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488
A system approach on safe emergency evacuation in Subways: A systematic literature review
Get PDFBackground: Due to the extensive use of subway transportation in high- and middle-income countries, the safety of passengers has become one of the important challenges in emergency management of subway station. Therefore, the present systematic review aimed to identify environmental and organizational management factors that affect the safe emergency evacuation in subway stations. Materials and Methods: In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Google Scholar, Iran Medex, Magiran, and Scientific Information Database from 1990 to 2019 were searched to identify effective emergency management factors in safe emergency evacuation of the subways. A thematic content analysis was employed for data analysis. Results: Of 763 publications retrieved from the searches, 149 studies were included for data analysis. According to the findings, effective environmental and organizational management factors in safe emergency evacuation were discussed in eight subcategories, including infrastructure properties, evacuation-assisting resources, prevention of injuries and mitigation, preparedness for emergency evacuation, emergency response and reconstruction, and maintenance of evacuation facilities. Conclusion: The design of an optimal route for emergency evacuation is the main theme of most studies focusing on environmental factors. While a system approach for designer is needed for effective subway emergency evacuation, human-related factors focusing on injury prevention are also crucial
Pattern of meniscal tear in patients with anterior cruciate ligament injury at a rural tertiary care center of Central India: A prospective study
Get PDFBackground: Various studies have reported the incidence of meniscal injuries in anterior cruciate ligament (ACL)-deficient knee. It is responsible for the development and progression of knee osteoarthritis (OA) in patients with ACL injury and concomitant meniscal tear. Objective: The objective of this study is to find out an occurrence of meniscal tear and its pattern in patients with ACL injury. Materials and Methods: We studied 124 patients diagnosed with ACL injury by arthroscopy at a rural tertiary care center of Central India region. The study was conducted from July 2016 to June 2018. Standard protocol was used to collect information for sociodemographic characteristics. Condition of the injury was assessed at the time of arthroscopic procedure and noted. Data were collected and analyzed by Epi Info software. Results: We diagnosed 124 patients with ACL injury, out of which 106 (85.5) were male and 18 were female (14.5). The mean age of the patients was found to be 28.7 years (±10.7), with a range of 14-59 years. The present study observed the incidence of medial meniscus tear in 30 (24.2) and lateral meniscal tear in 18 (14.5) study participants. Conclusion: The present study showed a substantial number of cases with meniscal damage. Hence, it is imperative to screen patients with ACL tear clinically and radiologically and even during arthroscopic procedure so that chances of OA association can be minimized by early intervention
Productivity and years of life lost due to fatal traffic injuries in Shiraz Shahid Rajaei Hospital during 2009-2013
Get PDFBackground: Road traffic injuries (RTIs) are an important public health concern, and one of the main causes of death leading to loss of productive and effectual years of life. This study aimed to determine the economic burden of fatal crashes for about 5 years in Shahid Rajaei Hospital in Shiraz. Methods: In this cross-sectional study, cost and demographic data related to the people who died in the hospital due to RTIs, during 2009-2013, were obtained from medical records. Economic burden of traffic accidents that led to death was estimated using human capital as direct costs of treatment and potential years of life lost (PYLL) and lost productivity as indirect costs. Results: During 2009-2013, 989 individuals died from traffic accidents in Shiraz, imposing 1.58 million US dollars to hospital costs, 41,298 PYLL, and 67 million US dollars productivity lost. In this study, the mean age of the dead people was 43.3 ± 22.24, and the productivity lost per capita was 67,000 US. Conclusions: The economic burdens of traumatic brain injuries were high in fatal accidents in Fars Province equivalent to 0.0003 of Iran's gross domestic product in 2013. Thus, special attention should be directed toward prevention measures for fatal traffic accidents
The intensive care unit admission predicting the factors of late complications in trauma patients: A prospective cohort study
Get PDFBackground: Organ failure (OF) and sepsis are important causes of late death in trauma. Previous studies reported the methods that could predict OF at the time of patient arrival. However, most of the evidence is from high-income countries, where health-care systems were different from developing countries. This research aimed to identify the factors to predict late complications in trauma patients in surgical intensive care units (SICUs). Methods: This study was a secondary data analysis from the THAI-SICU study, which was a prospective cohort study in nine university-based-SICUs in Thailand. Late complications were defined as any OF or sepsis that occurred after 48 h of ICU admission. Multivariable logistic regression was conducted to identify the significant factors. Results: Three hundred and fourteen patients were eligible for the analysis. Late complications occurred in 60 patients (19). Patients who had complications had higher Acute Physiology and Chronic Health Enquiry (APACHE II) (15.8 vs. 12.4, P = 0.02) and Sequential OF Assessment (SOFA) scores on admission (6.7 vs. 3.8, P P = 0.04) and SOFA score on admission (OR = 1.2, 95% CI; 1.12-1.29, P P Conclusions: The incidence of late complications in trauma patients in the SICU was 19%. Current smoking and SOFA score might be valuable in future prediction of late complications during admission
Core and biological motif of self-assembling peptide nanofiber induce a stronger electrostatic interaction than BMP2 with BMP2 receptor 1A
No full textRecent studies suggest that nanotopography can trigger colocalization of integrins and bone morphogenetic protein 2 (BMP2) receptors (e.g., BMPR1A), thereby leading to osteogenesis. In this study, the bone marrow homing peptide 1 (BMHP1) motif was bound to a self-assembling peptide core to form a hydrogel-based nanofiber (R-BMHP1). The docking and molecular dynamic study revealed that the R-BMHP1 sequence induced a stronger electrostatic interaction than BMP2 through arginines in the RADA core sequence and through lysine24 in the BMHP1 motif with BMPR1A. Notably, decrease of polar solvation binding energy will enhance the total binding energy and increases bone regeneration even more than BMP2 The enhanced osteogenesis and bone repair potential of R-BMHP1 nanofiber might be related to its chemical interaction with BMPR1A, which triggered downstream signal transduction through osteogenic genes overexpression in osteo-differentiated mesenchymal stem cells (MSCs), as well as implanted critical-sized bone defects in rats. Following that, calcium deposition occurred by osteoblast-like cells, ALP activity increased in osteodifferentiation MSCs and rat serum, and calcium density improved in bone defects (X-ray). The nanofiber was biocompatible and enhanced the cell viability of MSCs, without multinuclear cell infiltration into the defect site. Taking everything into account, not only does nanotopography induce osteogenesis through colocalization of BMPRs and integrins, but also R-BMHP1 nanofibers (considering their chemical structure) induce cell proliferation, osteogenesis, and bone repair through strong electrostatic interaction with BMPR1A and downstream signaling. The entire outcome of this study manifests the plausibility of R-BMHP1 for spine and spinal cord injury repair. © 201
Association between miRNAs expression and signaling pathways of oxidative stress in diabetic retinopathy
No full textDiabetic retinopathy (DR) is a major cause of vision reduction in diabetic patients. Hyperglycemia is a known instigator for the development of DR, even though the role of oxidative stress pathways in the pathogenesis of DR is established. The studies indicate that microRNAs (miRNAs) are significant to the etiology of DR; changes in miRNAs expression levels may be associated with onset and progression of DR. In addition, miRNAs have emerged as a useful disease marker due to their availability and stability in detecting the severity of DR. The relationship between miRNAs expression levels and oxidative stress pathways has been investigated in several studies. The aim of this study is the examination of function and expression levels of target miRNAs in oxidative stress pathway and pathogenesis of diabetic retinopathy. © 2018 Wiley Periodicals, Inc