[Blood loss and need for transfusion assessment in open reduction and internal fixation of femoral shaft fractures]

Background and Objective: A high percentage of patients with multiple traumas sustained at least from an orthopedic problem. One of the high frequent lesions was femoral shaft fracture. The aim of this study was to determine the amount of bleeding and the need for blood transfusion in femoral shaft fractures and risk factors

Methods: This descriptive, retrospective study was done on 84 patients with femoral shaft fractures whom were operated in Imam Khomeini Hospital in, Sari, in northern Iran during 2012-15. Age, sex, comorbidities, type of fracture, hospitalization period, pre and post-operative hemoglobin and blood unit's loss were recorded for each patient

Results: In 43 patients [51.19%] plate and in 41 patients [48.80%] intramedullary naling were used for treatment of fractures.13 [15.47%], 33 [39.28%] and 37[44.04%] of patients were received one, two and three blood units, respectively. There was no significant relationship between energy intensity and age. There was significant relationship between the intensity and the type of fracture [P<0.05]. A significant correlation existed between blood unit transfusion with sex, fracture type, hemoglobin before surgery and fracture energy intensity [P<0.05]

Conclusion: Based on the results of this study, it is recommended for hip fracture at least 3 units of blood should be reserved

[Histopathological findings in necrotic spaces developed with doxorubicin and 150 kHz ultrasound at low intensity and a combination of these two methods on adenocarcinoma tumor breast cancer in BALB/c mice]

Background: breast cancer is the most commonly diagnosed cancer in women. One in eight women will be diagnosed with breast cancer in their lifetime. Chemotherapy works on active cells. Active cells are cells that are growing and dividing into more of the same type of cell. Cancer cells are active, but so are some healthy cells. Also, scientists work constantly to develop ways of providing treatment with fewer chemotherapy side effects

Objectives: the aim of this study was antitumor effect of simultaneous low-intensity, 150 kHz ultrasound, in combination with the reduced dose of anticancer drug Doxorubicin [DOX] on breast adenocarcinoma using murine model [BALB/c]

Methods: twenty-five female BALB/c mice were used in this study. The tumor was implanted under the breast skin of mice. Mice were divided into five groups, namely control, sham, drug [IV injected of 2 mg/kg of DOX], drug [IV injected of 1 mg/kg of DOX] + US [150 kHz for 15 minutes] and exposure to ultrasound [150 kHz for 15 minutes] alone. The data were analyzed employing ANOVA using SPSS software V.13 and complementary test of Tooki was done

Results: it was shown that, after injection of DOX, exposure to ultrasound at 150 kHz the necrotic spaces in adenocarcinoma tumors compared to control and sham groups have meaningful variance [p<0.001]. There was also a significant difference [the bigger the necrotic spaces] between the drug+US group and drug treated group [p<0.05], It should be mentioned that the dose of DOX in drug+US group was reduced to 1mg/kg

Conclusions: the co-administration of DOX and low-intensity ultrasound provided a more effective treatment than the drug alone in murine adenocarcinoma breast cancer. The combined treatment appeared to produce synergistic effects that could prove potentially useful in reducing the side effects of DOX by lowering the required effective dose of the drug while increasing the efficiency of the therapy as a whole

Identification and characterization of the antigens expressed on the surface of human erythrocytes infected with plasmodium falciparum

Molecules expressed on the surface of infected erythrocytes [IE] with Plasmodium falci-parum play important roles in malaria pathogenesis and immune evasion. Some of these molecules are specific adhesive ligands mediating adhesion of IE to the vascular endothelium. In the current study, the antigens exposed on the surface of IE with different isolates and various binding subpopulations of P. falciparum were studied. A pooled hyper immune serum [HIS] from Malawian adults and eluted antibodies from the surface of the homologous and heterologous parasites were used. The parasite surface molecules were analyzed by Immuno-Gold-Silver enhancement [IGSE] and Western blotting. Mini-column cytoadherence method was used to select various parasite-binding subpopulations. Surface antigens of all the isolates were recognized by HIS and high recognition of antigens was observed in all isolates with homologous eluted antibodies. Western blot analysis showed that the eluted antibodies reacted with a small subset of antigens compared with HIS. Three bands, PfEMP-1, were detected in the Triton X- insoluble fraction of the ICAM-1 binding subpopulation. Another interesting band was tilde 52-55 kDa in various isolates of P. falciparum. This molecule as defined by its low molecular weight, Triton X-100 solubility, surface location and sensitivity to 1 mg/ml trypsin. The IE's surface antigens differed in parental population compared with the selected subpopulations. These molecules could induce isolate-specific immunity. Antibodies purified from the surface of IE can be used as specific reagents to investigate parasite-derived proteins expressed on the surface of IE.

[Kamil as-sina a attibbiyyah - an undated little-known medical book]

After Zakaryaye Razi [author of Al-Havi] and before Avicenna [author of the Canon of Medicine], Ali-ibn Abbas-al-Majusi was one of the great physicians and best known for his Kitab Kamil as-sina a attibbiyyah [the perfect book of medical art], also called al-Kitab al- Malaki [the royal book]. This book together with Al-Havi and the Canon of Medicine constitute the great medical encyclopedia of Islam and Iran. Working in Adhudi Hospital in Bagdad, Ali-ibn Abbas served as court physician and dedicated his book to king Adhud al-Dawlah Dailami [died in 983 A.D]. In the Author's critical view about old and new physicians, comprehensiveness of this book on diseases and their treatment, sensitivity of the author over education method and style of writing have made this book one of the pillars of traditional medicine, so that it had been the textbook of medicine for several centuries after being translated into Latin, and had been used widely in Persia, Arabic countries and also in many parts of Europe. Ali-ibn Abbas died in Baghadad or Shiraz in 994 AD. Three volumes of kamil as-sinaaattibbiyyah had been translated into persian by the corresponding author of this article and published by Institute of Islamic Studies of Tehran University-Mc Gill University Press. This descriptive article is about kamil as-sinaaattibbiyyah and its translation is useful to anyone interested in the history of medicine and traditional medicine

[ effect of dietary Aloe vera gel extract supplementation on lipid peroxidation of broiler breast fillets during frozen storage]

To improve the oxidative stability of meat products, the use of the dietary form of natural additives, especially those with plant origin is increasing. Aloe vera plant, the in vitro antioxidant effect of which has been previously discussed, is a potential candidate for this purpose. This study was designed to evaluate the effects of feed supplementation with Aloe vera gel extract on lipid peroxidation of broiler breast fillets during frozen storage. Fifty-four 1-day old broilers were allocated into three groups [basal diet as control, basal diet supplemented with 100 and 300 mg/kg methanol extract of Aloe vera gel] and fed for 6 weeks. In the term, chicks were slaughtered and their breast fillets were stored at -20[degree sign]C for 9 months. Lipid peroxidation was assessed after 1, 3, 6 and 9 months of frozen storage using chemical [PV and TBARS] and sensory evaluations. Results indicated that incorporation of 300 mg/kg Aloe vera gel methanol extract in broiler diets caused the delay of lipid peroxidation in raw breast meat [with 9.6 meq/kg, 92.67 micro g/kg and 6.3 in PV, TBARS and Sensory evaluations, respectively] in comparison with control sample [with 15.2 meq/kg, 139.33 micro g/kg and 3 in mentioned evaluations] at the last day of the experiment [p<0.05]. This study showed that methanol extract of Aloe vera gel can be considered as a dietary supplementation substance in chicken diet and can delay the oxidative spoilage of chicken breast fillets during frozen spoilage

Plasmodium falciparum: adhesion phenotype of infected erythrocytes using classical and mini-column cytoadherence techniques

Cytoadherence of Plasmodium falciparum- infected erythrocytes to host cells is an important trait for parasite survival and has a major role in pathology of malaria disease. Infections with P. falciparum usually consist of several subpopulations of parasites with different adhesive properties. This study aimed to compare relative sizes of various binding subpopulations of different P. falciparum isolates. It also investigated the adhesive phenotype of a laboratory P. falciparum line, A4, using different binding techniques. Seven different P. falciparum isolates [ITG, A4, 3D7 and four field isolates] were cultivated to late trophozoite and schizont and then Cytoadherence to cell differentiation 36 [CD36], intercellular cell adhesion molecule-1 [ICAM-1], and vascular cell adhesion molecule [V-CAM] and E-selectin were examined. The relative binding sizes of parasite subpopulations to human receptors were measured by mini-column Cytoadherence method. The adhesion phenotype of P. falciparum-A4 line was evaluated by in vitro static, flow-based and mini-column binding assays. The relative binding size of ITG, A4 and 3D7 clones to a column made with CHO/ICAM-1 was 68%, 54% and 0%, respectively. The relative binding sizes of these lines to CHO/CD36 were 59.7%, 28.7% and 0%, respectively. Different field isolates had variable sizes of respective CD36 and ICAM1-binding subpopulations. A4 line had five different subpopulations each with different binding sizes. This study provided further evidence that P. falciparum isolates have different binding subpopulations sizes in an infection. Furthermore, measurement of ICAM-1 or CD36 binding subpopulations may practical to study the Cytoadherence phenotypes of P. falciparum field isolates at the molecular level

Malaria in Mazandaran, Northern Iran: passive case finding during 1997-2012

Malaria is one of the most important parasitic diseases in tropical and temperate regions. The aim of this study was to determine the trend of malaria in Mazandaran Province, northern Iran during 1997-2012. This retrospective study was conducted from 1997 to 2012. The population's study was individuals who registered at health centers of Mazandaran Province. Peripheral blood smear were prepared for each case, stained with Giemsa and examined by light microscope. In addition to demographic data, other parameters including Slide Positive Rate [SPR], Annual Parasite Incidence [API] and Annual Blood Examination Rate [ABER] were analyzed. In total, 844 cases of malaria were reported. Plasmodium vivax was predominant species with 821 cases [97.4%]. The number of malaria cases increased from 1997 to 2005 and then decreased to 3 cases in 2011. Some cities had not reported any cases during last three years. The highest infection rate, 163[20.07%], was seen in 2001-02. The SPR had the highest value [0.54%] in 2004-05. The maximum API and ABER were observed in 2001-02 and 1997-98. 641[75.9%] of cases were imported from hyperendemic areas such as Afghanistan and South-eastern Iran and 94 [11.1%] malaria patients were recorded as introduced cases. The highest infection rate of malaria [21.3%] was seen in Babolsar. Extensive malaria control should be continued to Mazandaran to become malaria-free region and in prevention of re-introduction stage

Increased nuchal translucency and pregnancy outcome

To study the outcome of cases with nuchal translucency [NT] >/= 95th centile in the first trimester of pregnancy. This cross sectional study was performed at Iranian Fetal Medicine Foundation [FMF] between January 2009 and December 2011. Totally, 186 cases with NT >/= 95th centile who attended for the first trimester screening were studied. All cases with increased NT including those with normal karyotype were followed up with anomaly scan at 18-22 weeks and fetal echocardiography at 22-24 weeks. Pregnancy outcome was extracted from delivery records and pediatrics notes and telephone interviews. Of screened cases, 186 fetuses had an NT >/= 95th centile, of them 19.8% were abnormal karyotype, including 29 cases of trisomy 21, three of trisomy 18, two of trisomy 13, three of Turner syndrome. 77.8% did not show any abnormalities on follow-up examinations. 4.6% of cases were found to have malformation antenatally and 4% cases postnatally. 11.4% women elected termination of pregnancy without further follow up. There were 4.6% fetal loss and 1.3% hydrops fetalis. In this unselected population, the study showed one out of four fetuses with enlarged NT had an adverse pregnancy outcome [miscarriage, fetal loss, and fetal abnormalities], however the chance of having a normal child after exclusion of chromosomal abnormalities and adverse pregnancy outcome was 95%

Mini-column for cytoadherence: a new method for measuring the relative size of binding subpopulations in Plasmodium falciparum isolates

Cytoadherence of Plasmodium falciparum- infected red blood cells to endothelial cells is an important mechanism for parasite survival and a major trigger for diseases pathology. Here, we describe a new adhesion assay in which different cell types [CHO, CHO/CD36 and CHO/ICAM-1] are attached to Cytodex beads in a mini-column format to measure the relative sizes of various binding subpopulations as a percentage of the total population. Relative size of CD36 and ICAM-1-binding subpopulations of erythrocytes infected with P. falciparum were measured by amount of parasitemia before and after passing the infected erythrocytes through a particular column. The mini-column adhesion assay was a suitable method as parasitemia always reduced after passing through a particular column in independent experiments. For example, in a typical experiment using P. falciparum ITG line, 75% of the parasites are retained on a CHO/ICAM-1 while 0% of clone 3D7 is retained. This work introduced and validated a method for measuring the relative size of parasite binding subpopulations and the selection of them. Also, the mini-column method is of value for assessments of cytoadherence and can be used as tool for different applications

Trialling diagnosis-related groups classification in the Iranian health system: a case study examining the feasibility of introducing casemix

This paper examines the quality of routinely collected information in an Iranian hospital in a trial of casemix classification. Australian Refined Diagnosis Related Groups [AR-DRG] were used to classify patient episodes. There were 327 DRGs identified, of which 20% had only 1 case. The grouper program identified invalid records for 4% of total separations. Approximately 4.5% of cases were classified into error DRGs and 3.4% were ungroupable. No complication and comorbidity effects were identified with 93% of total cases. R[2] [variance in length of stay explained] was 44% for untrimmed cases, increasing to 63%, 57% and 58% after trimming by L3H3, IQR and 10th-95th percentile methods respectively

impact of diabetes on early and midterm outcome of patients undergoing coronary artery bypass grafting surgery

Diabetic patients constitute about 25% of patients undergoing coronary artery bypass graft surgery [CABG]. The impact of diabetes on the results of this operation, especially in Asian patients is not well understood. The present study aims to evaluate the effect of this important risk factor on the early and midterm outcome following CABG. This study was performed in Shahid Madani Heart Hospital, Tabriz, Iran from April 1998 to April 2003. Considering our inclusion and exclusion criteria, 1269 patients available for follow up were enrolled and evaluated for their early [30 days] and midterm mortality. Diabetic patients constituted 332 [26.2%] of our patients. Female gender, hypertension, hyperlipidemia and peripheral arterial disease [PAD] were more prevalent in diabetics. Early mortality was not significantly different between two groups [6.6% in diabetics vs. 5% in non-diabetics, P=0.300] and this was true for early cardiac death [6.3% in diabetics vs. 4.7% in nondiabetics, P=0.200]. However, in midterm follow up of 4.1 +/- 1.6 years, diabetic patients had significantly higher mortality [18.7% in diabetics vs. 11.2% in nondiabetics, P<0.001]. Also total mortality was significantly higher in diabetics [25.3% in diabetics vs. 16.2% in non-diabetics, P<0.001]. In univariate regression analyses diabetes was an independent risk factor for midterm mortality. Diabetes may not be an independent risk factor for early death following CABG. However, it is an important predictor of midterm mortality

outcome of tricuspid regurgitation after mitral balloon valvutomy for severe mitral stenosis

Severe mitral stenosis is occasionally associated with significant tricuspid regurgitation [TR] and this association has an adverse impact on morbidity and mortality in patients undergoing mitral valve intervention. However, the effect of successful mitral balloon valvotomy [MBV] on significant TR is not fully elucidated. The aim of this study was to investigate the course of TR after MBV in patients with severe mitral stenosis with TR. The present study was performed in Tabriz Madani heart center from March 2007 to February 2008. Among 110 patients with mitral stenosis who were candidates of MBV, 68 cases with more than mild TR were selected and the fate of TR after MBV and its predictors were evaluated. Among 68 patients who were enrolled in this study, 58 individuals [85.3%] were female with mean age of 36.85 +/- 14.32 years. Before intervention, 48 patients [70.6%] had severe TR and 20 [29.4%] cases had moderate TR. After intervention, 14 patients suffered from mild TR, 22 from moderate TR and 32 patients from severe TR [P<0.05]. There were significant changes in mitral valve area [MVA] [from 0.82 +/- 0.22 to 1.70 +/- 0.21 cm[2]; P<0.0005] and pulmonary artery systolic pressure [PASP] [from 53.00 +/- 12.04 to 34.91 +/- 11.26 cm2; P<0.0005] and right ventricle dimension [RVD] varying from 2.97 +/- 0.64 to 2.20 +/- 0.58 cm; P<0.0005]. This study showed significant relationship between MVA, RVD, and PASP as TR regression determinants. In 6-month follow up no patient needed mitral valve surgery or repeated MBV. There was no procedure related mortality and no death was seen in 6 months follow up in the study group. Significant decrease of symptoms was observed in almost all patients after intervention which persisted during follow up period. Significant number of patients with severe MS and moderate or severe TR showed TR regression following MBV which persisted during 6 months follow up. Severity of MS, PASP and RVD were most important predictors of this regression

Casemix in the Islamic Republic of Iran: current knowledge and attitudes of health care staff

Casemix is a tool that classifies patients according to their clinical similarity and the homogeneity of resources required. A descriptive study was conducted to assess the level of knowledge and attitude toward the casemix-based funding system among staff working in the Iranian Social Security Organization in Tehran. The survey showed that knowledge of casemix and diagnosis-related groups [DRG] was poor among the study group and any attempt to implement the casemix system-which about three-quarters of high-level staff had never heard of would be likely to fail. This highlights the necessity for creating awareness of the casemix and DRG systems among the hospital staff before any action takes place

Evaluation of toxicity of heavy metals for Escherichia coli growth

Iron is essential to virtually all organisms but it can be toxic in excess. High concentration of iron and other trace elements could restricted bacterial growth and modify their metabolic pattern as well. However, this study aimed to find out the influence of iron, chromium, cadmium and synergism or antagonism between these elements on growth of a gram negative bacterium. In the series of experiments, E. coli has been cultured in a nutrient broth which supplemented with Fe[+2], Fe[+3], Cr[+3], Cd[+2] alone or in combination with together, at 37°C for 5 h. Bacterial growth was measured every half an hour using spectrophotometer. Findings obtained from this study indicated that bacterial growth reduced at presence of 1 mM/L concentration of Fe[+3] and 0.5 mM/L Fe[+2] in comparison with control. Growth of the bacteria was completely inhibited by 1 mM/L concentration of iron [II]. Chromium has also inhibitory effects on growth of the bacteria and cadmium is very toxic. Cr[+3] and Cd[+] have antagonism effect with iron on the growth of bacteria. This work suggested that trace elements could interact in their metabolism in bacteria. It has also concluded that toxic effects of trace element could be another view against pathogenic bacteria particularly in complex with antibacterial activity of various antibiotics

outcome of pregnancies associated with intrauterine contraceptive devices

In this retrospective study we sought to determine the outcome of pregnancies associated with intrauterine contraceptive devices. Medical records of 2000 women, who used IUCD, were reviewed in detail. All IUCDs were inserted either post menstrual, post delivery or post miscarriage. 1196 [60%] IUCDs were inserted by doctors and the remaining 804 [40%] by midwives. The cohort was divided to four groups on the basis of their age. There were 300, 950,300 and 450 women in 18-22,23-27,28-32 and 33-37 years groups respectively. They were also divided to three groups on the basis of their parity with 300 Para 1 women, 1100 Para 2-4 women and 600 Para 5 or more. 37 [1.85%] unintended pregnancies occurred, including 35 intrauterine pregnancy and 2 ectopic pregnancies. 9 [3%] of these pregnancies occurred in 18-22 year group, 16 [1.68%] in 23-27 age group, 8 [2.67%] in 28-32 age group and 4 [0.89%] in 33-37 age group [Figure 1]. 19 [1.59%] of the pregnancies occurred in women whose IUCDs were inserted by medical staff and 18 [1.51%] in those whose IUCDs were inserted by midwives. The outcome of intrauterine pregnancies included 19 [51%] term pregnancies, 9 [24%] miscarriages, no septic abortions, 7 [19%] Preterm labour including 2, 26-28 weeks and 5 29-32 weeks. No puerperal sepsis or congenital abnormalities were reported [Figure 2]