Introduction of a handmade vacuum-assisted sponge drain for the treatment of anastomotic leakage after low anterior rectal resection

Purpose@#Anastomotic leakage, a known major postoperative complication, potentially leads to readmission, reoperation, and increased mortality rates in patients, such as rectal cancer patients following a low anterior resection (LAR). Currently, vacuum-assisted closure, as featured by B-Braun (B-Braun Medical B.V.), is already being used for the treatment of gastrointestinal leakages and fistulas. The main aim of this study was to introduce a novel method for creating a vacuum-assisted drain for the treatment of anastomotic leakage after LAR. @*Methods@#All 10 patients, who underwent LAR surgery from 2018 to 2019, were diagnosed with anastomotic leakage and had received neoadjuvant chemotherapy prior to surgery. Therefore, patients were treated with a handmade vacuum-assisted drain and were revisited every 5 to 7 days for further evaluations and drain replacement until leakage resolution. Physical features of cavity, time of diagnose, and duration of treatment were analyzed correspondingly. The handmade vacuum-assisted sponge drain was prepared for each patient in each session of follow-up. @*Results@#Eight out of 10 patients experienced complete closure of the defect. The mean delay time from the day of operation to the diagnosis of anastomotic leakage was 61.0±80.4 days while the mean time for leakage closure was 117.6±68.3 days. Eventually, 7 cases underwent ileostomy reversal with no complications during a 3-month follow-up. @*Conclusion@#In this study, we evaluated the healing process of anastomotic leakage after the usage of a handmade vacuum-assisted sponge drain in a case series method. In our trial, we provided an innovative cost-benefit method easily applicable in the operating room.

Effect of Helicobacter Pylori eradication on patients with ITP: a meta-analysis of studies conducted in the Middle East

Background@#Immune thrombocytopenia (ITP) is a bleeding disorder. Helicobacter Pylori is a Gram-negative bacterium that is presumed to be associated with ITP and therapeutic response of patients. To evaluate the effect of H. Pylori eradication on platelet count of ITP patients, we analyzed the studies conducted on the association between H. Pylori infection and response to therapy in ITP patients in Western Asia focusing on the Middle East region. @*Methods@#A systematic search of databases (PubMed/Medline, ISI Web of Science, Cochrane Central) and Google Scholar search engine results was conducted up until January 2020. The keywords included in the search were Helicobacter Pylori and/or H. Pylori, ITP and/or immune thrombocytopenia. @*Results@#Seven studies comprising a total of 228 H. Pylori -infected patients (193 with successful eradication) were included in this study. The association between H. Pylori eradication and ITP was expressed as odds ratios (OR) and 95% confidence intervals (CI). The findings showed that patients who received eradication treatment for H. Pylori infection had significantly higher OR (OR, 8.83; 95% CI, 2.03‒38.35; P =0.004) than those in the non-eradicated group. @*Conclusion@#Our results indicate a significant therapeutic effect of H. Pylori eradication on the platelet count of patients with chronic ITP. Given the inherent limitations of this study, including the small number of patients, further studies with more patients are recommended.

Short-course versus long-course neoadjuvant chemoradiotherapy in patients with rectal cancer: preliminary results of a randomized controlled trial

Purpose@#Colorectal cancer is becoming an increasing concern in the middle-aged population of Iran. This study aimed to compare the preliminary results of short-course and long-course neoadjuvant chemoradiotherapy treatment for rectal cancer patients. @*Materials and Methods@#Patients in group I received three-dimensional conformational radiotherapy with a dose of 25 Gy/5 fractions in 1 week plus concurrent XELOX regimen (capecitabine 625 mg/m2 from day 1–5 twice daily and oxaliplatin 50 mg/m2 on day 1 once daily). Patients in group II received a total dose of 50–50.4 Gy/25–28 fractions for 5 to 5.5 weeks plus capecitabine 825 mg/m2 twice daily. Both groups underwent delayed surgery at least 8 weeks after radiotherapy completion. The pathological response was assessed with tumor regression grade. @*Results@#In this preliminary report on complications and pathological response, 66 patients were randomized into study groups. Mean duration of radiotherapy in the two groups was 5 ± 1 days (range, 5 to 8 days) and 38 ± 6 days (range, 30 to 58 days). The median follow-up was 18 months. Pathological complete response was achieved in 32.3% and 23.1% of patients in the short-course and long-course groups, respectively (p = 0.558). Overall, acute grade 3 or higher treatment-related toxicities occurred in 24.2% and 22.2% of patients in group I and II, respectively (p = 0.551). No acute grade 4 or 5 adverse events were observed in either group. Within one month of surgery, no significant difference was seen regarding grade ≥3 postoperative complications (p = 0.333). @*Conclusion@#For patients with rectal cancer located 5 cm above the anal verge, short-course radiotherapy with concurrent and consolidation chemotherapy and delayed surgery is not different in terms of acute toxicity, postoperative morbidity, complete resection, and pathological response compared to long-course chemoradiotherapy.

Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study

PURPOSE: Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD.METHODS: A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study.RESULTS: Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group.CONCLUSION: Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

Anti-Mucin1 aptamer-conjugated chitosan nanoparticles for targeted co-delivery of docetaxel and IGF-1R siRNA to SKBR3 metastatic breast cancer cells

Background: Targeted co-delivery of siRNA and a chemotherapeutic drug is an attractive approach to cancer drug design and treatment. This study was carried out to design an anti-Mucin1 aptamer [Apt]-conjugated chitosan nanoparticle [NP] for targeted co-delivery of insulin-like growth factor receptor 1 [IGF-1R] Silencer siRNA and docetaxel [DTX] to SKBR3 cells

Methods: Characterization of nano-drugs, cellular uptake of NPs, cell viability, and gene expression studies were evaluated based on metastatic breast cancer cells

Results:The results of this study showed that NPs had spherical and smooth morphology with 110-118 nm in size and had positive zeta potential [12-14 mV]. siRNA and DTX were considerably loaded into NPs. The appropriate conjugation of the Apt to the NPs was affirmed by gel electrophoresis. The Apt-conjugated NPs were observed to enhance the cellular uptake of NPs into the SKBR3 cells. Although the combination treatment significantly decreased the cell viability of SKBR3 cells, the augmentative effect was observed when Apt was conjugated to NPs. Furthermore, Apt-conjugated NPs dramatically reduced the genetic expression of IGF-1R, signal transducers and activators of transcription 3 [STAT3], matrix metalloproteinases [MMP9], and vascular growth factor [VEGF]

Conclusion: The targeted NPs may augment the targeting of pathways involved in tumorigenesis and metastasis of breast cancer. Therefore, more animal model experiments are needed to further clarify the efficacy and safety of this functionalized nanodrug

Probability of Publication Bias in Published Articles Resulting from Dental Dissertations of Medical Sciences Universities in Iran

Abstract Objective: To evaluate the association of publication bias with obtaining positive or negative results in the Doctoral thesis of Iranian dental schools. Material and Methods: In this cross-sectional study firstly we collected all the abstracts of Doctoral and post-doctoral thesis belonging to electronic archives of five Iranian dental schools there after the analytic abstracts were included and in the second phase, we try to search resulting articles with searching in Google Scholar. Data were analyzed using descriptive statistics and a Chi-squared test, Pearson's correlation coefficient, Fisher's exact test, and Logistic Regression Results: Out of 483 reviewed thesis abstracts 269 cases were included (55.7%) 153 of which were accessible as papers (56.9%). In 67.7% of the reviewed thesis, positive results were obtained. There were significant relationships between publishing and publishing in international journals with two variables: Study type and field (p<0.05). In vitro studies, clinical trials and studies in the field of oral diseases and periodontics had a higher rate of publication in the form of articles. Retrospective studies and those in the fields of endodontics and oral pathology had a higher rate of publication in journals with international indexes. Using regression logistic model showed that the probability of publishing positive data was greater (18-31%) than negative data. It was shown that the specialty field affected the relationship between the chance of publication of the article and the positive/negative results (p=0.008), increasing the chance of publication to 31% Conclusion: There was publication bias in reviewed dental articles.

Preoperative short course radiotherapy with concurrent and consolidation chemotherapies followed by delayed surgery in locally advanced rectal cancer: preliminary results

PURPOSE: This study aimed to assess complications and outcomes of a new approach, that is, combining short course radiotherapy (SRT), concurrent and consolidative chemotherapies, and delayed surgery. MATERIALS AND METHODS: In this single arm phase II prospective clinical trial, patients with T3-4 or N+ M0 rectal adenocarcinoma were enrolled. Patients who received induction chemotherapy or previous pelvic radiotherapy were excluded. Study protocol consisted of three-dimensional conformal SRT (25 Gy in 5 fractions in 1 week) with concurrent and consolidation chemotherapies including capecitabine and oxaliplatin. Total mesorectal excision was done at least 8 weeks after the last fraction of radiotherapy. Primary outcome was complete pathologic response and secondary outcomes were treatment related complications. RESULTS: Thirty-three patients completed the planned preoperative chemoradiation and 26 of them underwent surgery (24 low anterior resection and 2 abdominoperineal resection). Acute proctitis grades 2 and 3 were seen in 11 (33.3%) and 7 (21.2%) patients, respectively. There were no grades 3 and 4 subacute hematologic and non-hematologic (genitourinary and peripheral neuropathy) toxicities and perioperative morbidities such as anastomose leakage. Grade 2 or higher late toxicities were observed among 29.6% of the patients. Complete pathologic response was achieved in 8 (30.8%) patients who underwent surgery. The 3-year overall survival and local control rates were 65% and 94%, respectively. CONCLUSION: This study showed that SRT combined with concurrent and consolidation chemotherapies followed by delayed surgery is not only feasible and tolerable without significant toxicity but also, associated with promising complete pathologic response rates.

Glioblastoma Multiforme: an Advanced Analysis of 153 Patients and Review of the Literature

Objective Glioblastoma multiforme (GBM) is an aggressive primary tumor with frequent recurrences that leaves patients with a short survival time and a low quality of life. The aim of this study was to review the prognostic factors in patients with glioblastoma multiforme. Material and Methods The focus of this retrospective study was a group of 153 patients with supratentorial GBM tumors, who were admitted to a tertiary-care referral academic center from 2005 to 2013. The factors associated with survival and local recurrence were assessed using the hazard ratio (HR) function of Cox proportional hazards regression and neural network analysis. Results Out of the 153 patients, 99 (64.7%) weremale. The average age of the patients was 55.69 15.10 years. The median overall survival (OS) and progression-free survival (PFS) rates were 14.0 and 7.10 months respectively. In the multivariate analysis, age (HR » 2.939, p < 0.001), operative method (HR » 7.416, p < 0.001), temozolomide (TMZ, HR » 11.723, p < 0.001), lomustine (CCNU, HR » 8.139, p < 0.001), occipital lobe involvement (HR » 3.088, p < 0.001) and Karnofsky Performance Status (KPS, HR » 4.831, p < 0.001) scores were shown to be significantly associated with a higher OS rate. Furthermore, higher KPS (HR » 7.292, p < 0.001) readings, the operative method (HR » 0.493, p » 0.005), the use of CCNU (HR » 2.047, p » 0.003) and resection versus chemotherapy (HR » 0.171, p < 0.001) were the significant factors associated with the local recurrence of the tumor. Conclusion Our findings suggest that the use of CCNU and TMZ, the operative method and higher KPS readings are associated with both higher survival and lower local recurrence rates.

Objetivo Glioblastoma multiforme (GBM) é um tumor primário agressivo com recorrências frequentes que deixam pacientes com uma curta sobrevida e baixa qualidade de vida. O objetivo deste estudo é rever fatores de prognóstico em pacientes com glioblastoma multiforme. Material e Métodos O foco deste estudo retrospectivo foi um grupo de 153 pacientes com tumores GBM supratentoriais, os quais deram entrada em um centro acadêmico de atendimento de referência de 2005 a 2013. Fatores associados com a sobrevivência e a recorrência local foram avaliados usando a razão de risco (RR) da regressão de risco proporcional de Cox e análise de redes neurais. Resultados Dos 153 pacientes, 99 (64,7%) eram homens. A média de idade foi de 55,69 15,10 anos. A sobrevida geral (SG) mediana e a sobrevida de livre progressão (SLP) foram 14,0 e 7,10 meses, respectivamente. Na análise multivariada, idade (RR » 2,939, p < 0,001), método operatório (RR » 7,416, p < 0,001), temozolomida (TMZ, RR » 11,723, p < 0,001), lomustina (CCNU, RR » 8,139, p < 0,001), envolvimento do lobo occipital (RR » 3,088, p < 0,001) e Índice de Desempenho de Karnofsky (IDK, RR » 4,831, p < 0,001) foram identificados como significativamente associados a uma SG maior. Além disso, leituras maiores de IDK (RR » 7,292, p < 0,001), o método operatório (RR » 0,493, p » 0,005), o uso de CCNU (RR » 2,047, p » 0,003) e ressecção versus quimioterapia (RR » 0,171, p < 0,001) foram fatores significativos associados à recorrência local de tumor. Conclusão Nossos resultados sugerem que o uso de CCNU e TMZ, o método operatório e leituras maiores de IDK estão associados tanto à maior sobrevida quanto à menor recorrência local.

Survey for Correlation between Biofilm Formation and Virulence Determinants in a Collection of Pathogenic and Fecal Enterococcus faecalis Isolates

BACKGROUND: Enterococcus faecalis is an opportunistic pathogen that causes most of the enterococcal infections. Among the different factors implicated in the pathogenesis of these organisms, biofilm formation and antibiotic resistance are the most important. The ability for biofilm formation has been attributed to the presence of some virulence genes. However, no definite correlation has been found. This study aimed to detect biofilm formation and antibiotic resistance patterns in E. faecalis isolates collected from clinical and fecal samples, and to investigate possible correlation between some virulence genes (esp, cyl, gelE) and biofilm formation. MATERIALS AND METHODS: A collection of 123 E. faecalis isolates were investigated for antibiotic resistance and production of hemolysin, gelatinase, and biofilm using phenotypic methods. The esp, gelE and cyl genes were detected using polymerase chain reaction. RESULTS: Thirty-eight pathogenic isolates (37%) were positive for biofilm formation. Additionally, the gelE, esp, and cyl genes were detected in 74 (71.8%), 79 (76.7%) and 42 (40.8%) isolates, respectively. In the fecal samples, 18 (90%) isolates were biofilm producers and 11 (55%), 17 (85%) and 8 (40%) isolates were positive for gelE, esp, and cyl, respectively. There were significant differences in biofilm production between pathogenic and fecal isolates (P <0.001). Multidrug resistance (MDR) was found among 32% (n = 33) and 15% (n = 3) of the clinical and fecal isolates, respectively. However, no significant difference was seen between MDR and biofilm formation. Five pathogenic and two fecal isolates were negative for all investigated genes while they were they were biofilm producers. In contrast, 22 pathogenic isolates and 1 fecal isolate were positive for the tested genes, but did not form any biofilm. No significant differences were observed between biofilm formation and the presence of the esp, gelE and cyl genes in the pathogenic and fecal isolates (P ˃0.05). CONCLUSION: The presence of the esp, gelE and cyl genes might not be determining factors for biofilm formation in enterococci and other mechanisms might be involved in this process.

Estimating Tuberculin Skin Test Reactions among Children and Teenagers Who Received the Bacillus Calmette-Guerin Vaccination at Birth: A Meta-analysis

OBJECTIVES: Tuberculin skin reaction size is one indicator of bacillus Calmette-Guérin (BCG) vaccine efficacy and a way to diagnose latent infection. Several primary studies have examined this issue. Combining the results of these studies using a meta-analysis will provide reliable evidence regarding this indicator for policymakers. This study aimed to estimate the total frequency of different tuberculin skin test reactions among Iranian children and teenagers who received the BCG vaccination at birth. METHODS: National and international databanks were searched using relevant keywords. After the search strategy was restricted and duplicates were excluded, the titles and abstracts of the remaining papers were screened. All included studies included healthy children who received the BCG vaccine without confirmed tuberculosis exposure. Heterogeneity of the results was assessed using the Cochrane test and I² index showed the random effects model as the best model for estimating the pooled results. RESULTS: We combined the results of 14 primary studies including purified protein derivative reaction test measures of 26,281 Iranian children. The frequencies (95% confidence intervals) of the reactions were 8.5% (6.2–10.8) for patients with a reaction size ≥ 10 mm, 29.9% (22.3–37.4) for a reaction size of 5–9 mm, and 60% (48.9–71.1) for a reaction size < 5 mm. CONCLUSION: Our study showed that large numbers of Iranian children and teens have no positive BCG vaccine reaction and a considerable number of children have been exposed to Mycobacterium tuberculosis.

A novel approach to lower rectal anastomosis: technique innovation and the preliminary report of twenty cases / Uma nova abordagem para a anastomose retal mais baixa: inovação técnica e relatório preliminar de cinte casos

Background and aims: To describe a practical technique innovation (transanal 'Pull-through' approach) as a feasible, safe and effective alternative to the conventional transabdominal stapler low rectal anastomosis in lesions of minimal anatomical distinction from the adjacent intact mucosa. Material and methods: Prospective case-series of patients with low rectal cancers, familial adenomatous polyposis (FAP) and ulcerative colitis undergoing Pull-through transection and very low rectal anastomosis using linear TA-90 noncutting stapler and circular stapler-cutter. Results: In this series, twenty patients (11 men and 9 women) underwent proctectomy by the transanal Pull-through technique. Barring one of the patients that developed a pelvic abscess in the immediate postop follow-up, surgical procedure and the long-term follow-up period was uncomplicated with no critical findings of leakage, stenosis and bleeding. The postop rate of infection and fecal incontinence was not significantly different between genders and different age groups of the study. The mean operative time was calculated 169.9 ± 11.1 minutes. Conclusion: Pull-through transection procedure using the TA-90 non-cutting stapler is a safe, efficient and economically sound technique implicated in low-lying rectal lesions. The transanal 'Pull-through' approach is particularly helpful in situations where the direct visualization of lower rectal mucosa changes the prognosis through determining the marginal extent of intact/involved mucosa (e.g., FAP, villous adenomas, rectal polyps and post-neoadjuvant chemoradiotherapy tumors).

Experiência e objetivos: Descrever uma inovação técnica prática (abordagem transanal pull-through) como uma alternativa viável, segura e eficaz à anastomose transabdominal retal baixa convencional com grampos em lesões com mínima diferenciação anatômica com respeito à mucosa intacta adjacente. Material e métodos: Estudo prospectivo de série de casos de pacientes com cânceres retais baixos, polipose adenomatosa familiar e colite ulcerativa submetidos à transecção pull-through e a uma anastomose retal muito baixa com o uso de um grampeador linear não cortante TA-90 e um grampeador cortante circular. Resultados: Nesta série, 20 pacientes (11 homens, 9 mulheres) foram submetidos a uma proctectomia pela técnica transanal pull-through. À exceção de um dos pacientes, que apresentou um abcesso pélvico no seguimento pós-operatório imediato, não ocorreram complicações com o procedimento cirúrgico e ao longo do prolongado período de seguimento, nem houve achados críticos de vazamento, estenose ou sangramento. O percentual de infecção e incontinência fecal no pós-operatório não foi significativamente diferente entre gêneros e nas diferentes faixas etárias dos pacientes envolvidos no estudo. O tempo cirúrgico médio foi de 169,9 ± 11,1 minutos. Conclusão: O procedimento de transecção pull-through com o uso do grampeador não cortante TA-90 é técnica segura, eficaz e economicamente confiável para uso em lesões retais baixas. A abordagem transanal pull-through tem particular utilidade em situações nas quais a visualização direta de alterações na mucosa retal mais baixa muda o prognóstico, mediante a determinação da extensão marginal da mucosa intacta/envolvida (p. ex., FAP, adenomas vilosos, pólipos retais e tumores pós-quimiorradioterapia neoadjuvante).

Fatal idiopathic hypereosinophilic syndrome presenting with refractory ascites: case report study

Hypereosinophilic syndromes were a group of divergent disorders united by overproduction of eosinophils and the several organ damages ascribed to this persistent eosinophilia. Among all the presenting symptoms, gastrointestinal symptoms were the least common. We were reporting a 21 year old man with a 2 year history of refractory ascites, hepatomegaly, portal and hepatic veins thrombosis and cutaneous lesions. Bone marrow aspiration and biopsy revealed granulocytic hyperplasia with marked eosinophilia. After ruling our common causes of eosinophilia, a diagnosis of idiopathic hypereosinophilic syndrome was made. The patient was treated with corticosteroids and imatinib but due to the advanced progression of the disease, resulted in a fatal outcome. Since early diagnosis and treatment is the key for improving the prognosis of HES patients, a high clinical suspicion is necessary in the diagnosis of this condition

Fever ,weight loss and early satiety due to gastric inflammatorymyofibroblastic tumor; case report and literature review

Gastric inflammatory myofibroblastic tumor [IMT] is a rare tumor with and unpredictable prognosis usually find in young adults. We present an 18-year-old man with gastric IMT. He complained of epigastric pain, intermittent fever and night sweating associated with weight loss since two years ago. Physical examination showed anemic and cachestic features with mild abdominal tenderness in palpitation as well as an abdominal mass in epigastrium. Abdominal CT scan revealed a huge mass that was arising from the stomach. Upper endoscopy revealed a submucosal lesion in fundus of stomach of approximately 8cm. Endoscopic ultrasound showed a large sub-mucosal non homogenous fundal mass with areas of calcification. The patient underwent laparoscopic partial gastrectomy. Histopathologyand immunohistochemistryevaluation revealed an IMT

Cisternostomy for management of intracranial hypertension in severe traumatic brain injury; case report and literature review

Main goal in the management of patients with severe traumatic brain injury [TBI] is control of intracranial pressure [ICP]. Decompressive craniectomy is an accepted technique for control of refractory intracranial hypertension in patients with severe TBI. Because of high complication rate after decompressive craniectomy, new techniques such as basal cisternostomy have developed. We herein report a case of severe TBI in a 13-year-old boy treated by cisternostomy. The patient was admitted following a motor vehicle accident. Brain CT scan showed diffuse brain edema, left frontal contusion and posterior interhemispheric subdural hematoma. The patient underwent ICP monitoring. Subsequently, with 26 mmHg mean-value of ICP, he was treated surgically by cisternostomy technique. A progressive improvement of the neurological conditions in the following hours. After 5 days the boy was discharged and in the 3-months follow-up he was completely recovered. Cisternostomy could be an appropriate alternative to decompressive craniectomy for management of intracranial hypertension in patietns with sever TBI

Helping HSE team in learning from accident by using the Management Oversight and Risk Tree [MORT] analysis Method

Introduction: The effects of accidents vary from minor injuries to fatalities and from insignificant damage to very severe damage to the environment and property

In order to prevent accidents in the work place, the root causes of and events should be identified using a systematic method and the results should be published. The current study aims to investigate the given causes of an accident in order to implement preventive actions in accidents and similar organizations

Methods: In this case study, after choosing the main event; to analyze the accidents, at first a set of questions in MORT were answered. By answering the questions, the final events, and the inappropriate management risks [color-coded red] followed by the leading causes of the accident were identified

Results: After analyzing the given accident, 22 inappropriate final events [color-coded red] and 4 assumed risks were identified. Of the total 12 identified basic causes, about 75% were classified as the management policies and decision makings group, 17% as the individual factors, and 18 % as the environmental factors group

Conclusion: The analysis using MORT method helped the organization with learning lessons from the accident especially at the management level. In order to prevent the similar and dissimilar accidents, the inappropriate informational network within the organization, inappropriate operational readiness, lack of proper implementation of work permit, the inappropriate and lack of updated technical information systems regarding equipments and working process, and the inappropriate barriers should be considered in a special way

effect of Migri-Heal on nitric oxide production in an in vitro inflammatory model of primary microglial cells

Background: Recently, much attention has been directed towards considering activated microgelial cells as putative targets for treatment of neurological disorders. MigriHeal as a novel herbal remedy was introduced for the treatment of migraine headaches. The previous researches has shown that MigriHea extracts can decrease NO in an in vitro inflammatory model. The aim of this study was to investigate the effect of MigriHeal on NO generation from LPS- stimulated microglia cells

Materials and Methods: Neonatal rat primary microglial cells were isolated from the mixed glial cultures and the purity of the cultures was determined by immunocytochemistry. Microglial cells were pretreated with Migri-Heal and activated by 1microg/ml LPS. Subsequently, NO levels in the culture supernatants were measured by a griess reaction. Our results showed that Migri-Heal 50microg/ml significantly reduced NO level in inflamed microglia in a dose-dependent manner

Results: The results showed that different concentrations of Migri-Heal had no prominent effect on cell viability in presence of LPS as compared with the control group. In addition, the pretreatment of microglia cells with Migri-Heal can prevent from a morphological changes of the cells into the round and phagocytic shape

Conclusion: Our study demonstrated that MigriHeal might have NO scavenging properties. Integrative studies are warranted to uncover the novel pharmacological insights of this herbal remedy as an putative therapeutic approach against diseases -associated with inflammation

Risks and Pitfalls of Epidural Injections during Management of Lumbar Disc Herniation: Few Comments

No abstract available.

Efficacy of clarithromycin containing bismuth-based regimen as a second-line therapy in helicobacter pylori eradication

The eradication of Helicobacter pylori infection, commonly prevailing in the stomach, has been important since its introduction. Adequate preparations should be made in finding alternatives when faced with first-line treatment failures. Currently, ideal second-line treatments are indistinct and varied among countries as result of different antibiotic resistance patterns. We aimed to evaluate the safety and efficacy of a clarithromycin-containing bismuth-based quadruple regimen as a second-line treatment. Forty-eight H.pylori-positive patients with proven gastric or duodenal ulcers and/or erosions who had previously failed to respond to furazolidone-containing regimens were enrolled. They received pantoprazole [40 mg-bid], amoxicillin [1gr-bid], bismuth subcitrate [240 mg-bid], and clarithromycin [500mg-bid] for 10 days. Eight weeks after treatment, a 14C-urea breath test was performed for the re-evaluation of H. pylori eradication. Forty-three patients completed the study. H.pylori eradication rates were 79.2% [95% CI=65.00-89.53] and 88.4% [95% CI=74.91-96.11] according to intention-to-treat and per-protocol analyses, respectively. All patients had excellent compliance to treatment and one did not continue therapy because of adverse effects. In developing countries such as Iran, a ten-day clarithromycin-containing bismuth-based quadruple regimen is encouraged as a second-line treatment because of the acceptable rate of eradication and low adverse effects

MTHFR Gene polymorphisms and susceptibility to Migraine Attacks

Background: Migraine consisting of migraine with aura [MA] and migraine without aura [MO] is a painful neurovascular disorder affecting approximately 16% of the general population. A combination of genetic and environmental factors is involved in the pathogenesis of migraine. The MTHFR enzyme is involved in homocysteine [Hcy] metabolism and it has been reported that 1298 A to C and 677 C to T mutations in the MTHFR gene are associated with an increased in plasma Hcy levels. Hcy is a highly reactive amino acid and causes endothelial injury. Because a plausible theory about vascular impairment in migraine, it is considered that mutations in MTHFR gene and folate metabolism are associated with migraine

Materials and Methods: in total, 75 patients with migraine [24 with MA and 51with MO] in accordance with the IHS criteria participated in this case-control study. Control group were 128 normal matched healthy subjecys who selected from same region without history of migraine or other neurologic disorder after interviewing and examining by a physician. Mean age at entry was 36.42+/-9.6 and 31.64+/-8.9 years old in migraine and control group respectively. MTHFR polymorphisms were investigated by PCR-RFLP

Results: genotypic results indicated that the prevalence of the MTHFR 677TT genotype in migraine subjects was higher than control [17.3% and 3.1% respectively, P<0.001]. Interestingly the risk of migraine was 6-fold higher in subjects possessing the MTHFR 677T homozygous variant [OR=6.5; CI95%: 2.03-20.76]. No significant difference in the prevalence of MTHFR A1298C genotypes was observed in migraine group when compared to controls [P>0.001]

Conclusion: it seems that MTHFR C677T is a potential genetic risk factor for migraine attacks, both in MA and MO subclasses in Iranian population. C677T and A1298C joint effect could amplify the potential influence of each SNPs

effect of rocker shoe on the ground reaction force parameters in patients with rheumatoid arthritis

Foot and ankle problems are common complications in rheumatoid arthritis disease. Gait pattern such as normal foot and ankle rocker is impaired in patients with rheumatoid arthritis. Rocker sole as an external shoe modification is commonly prescribed in this pathology. The aim of this study was to investigate the effect of rocker shoe on vertical ground reaction force parameters during walking in patients with rheumatoid arthritis. Sixteen female participants with rheumatoid arthritis were recruited in this study. All patients were prepared with a pair of high-top, heel-to-toe rocker shoe and were asked to wear the shoes for one month. Ground reaction force parameters including peak forces and peak force times were evaluated in the first session, and after seven days and thirty days follow up were carried on. First maximal vertical force was significantly increased with rocker shoe compared to barefoot after 7 days follow up. Walking with rocker shoe reduced the minimal vertical force after 7 days. The second maximal vertical force showed to be statistically lower with rocker shoe than barefoot after 7 and 30 days. Furthermore, stance time decreased with rocker shoe after one month. Results of this study revealed that vertical ground reaction force parameters changed in rheumatoid arthritis patients with heel-to-toe rocker shoe, both immediately and after one month follow up. This might suggest the effectiveness of rocker shoes in improving gait in rheumatoid arthritis patients