Co-inheritance of hemoglobin D and beta-thalassemia traits in three Iranian families: clinical relevance

Here we report the result of three cases referred to our lab that had a combination of beta-thalassemia and hemoglobin D [Hb D] traits. These individuals had no symptoms of profound anemia and hematological indices were similar to that of a beta-thalassemia heterozygote. In all three cases, the Hb D level was elevated and no HbA was detected electrophoretically. The electrophoresis pattern suggested that all cases were homozygotes for Hb D. PCR followed by digestion with EcoRI and sequencing of the beta-globin gene confirmed the presence of Cd 121 GAA>CAA in the heterozygous form with another beta-globin mutation. In all cases, the mutations in the beta-globin gene were detected by ARMS PCR technique and they were either IVSII-I or IVSI-5. Hematological studies of the family members showed that thalassemia which caused the mutations and Hb D were in the Trans position

Pain relief methods after thoracotomy

Thoracotomy is one of the surgical operations which causes severe pain. In fact, this pain is one of the most excruciating pains caused by surgical operations. Different procedures are performed to decrease this pain which is associated with significant physiologic, mental and pathologic complications. Each of these procedures has its own advantage and disadvantages. In many centers, the most common treatment method used, is considered as the first choice. In this study, common methods of analgesia after thoracotomy were compared. During this meta-analysis, "Visual Analogue Scale" [VAS] of patients in epidural group was compared with those in four groups of systemic opioids, intercostal block, para- vertebral block and intrapleural infusion in the first 24 hours after surgery. Data obtained from 28 randomized clinical trials [RCT] which compared the procedures in 1697 patients after thoracotomy were gathered using random effect model, effect size index and the standardized difference average. Statistical values were evaluated and the results obtained using standard error, 5% maximum confidence limit and 5% minimum confidence limit. The obtained data were evaluated using studies performed between 1987 and 2005. After evaluating 314 titles and 185 abstracts, 28 articles were entered in the meta- analysis considering inclusion criteria. Four groups of epidural with systemic opioids, epidural with para-vertebral, epidural with intercostal and epidural with intrapleural analgesia were studied. It was noticed that the epidural method in total 24 hours with 95% CI= -0.9802 to -0.3844 was a better procedure compared with systemic opioids. Epidural method did not show any difference with intercostal method in 24 hours mean with 95% CI= -0.2171 to +0.5906. Epidural method was also better than intrapleural in 24 hours mean with 95% CI= -1.1166 to -0.0106. When comparing epidural with para-vertebral, epidural was better with 95% CI= +0.1744 to -0.4527. According to the evaluations performed, epidural method is recommended as the method of choice to reduce pain after thoracotomy