Crianças e adolescentes com necessidades especiais de saúde: o cuidado nos serviços de atenção domiciliar / Niños y adolescentes con necesidades especiales de salud: cuidado en los servicios de atención a domicilio / Children and adolescents with special healthcare needs: care in home care services

RESUMO Objetivo descrever o cuidado prestado às crianças com necessidades especiais de saúde nos Serviços de Atenção Domiciliar do estado de Mato Grosso do Sul. Métodos pesquisa quantitativa, descritiva e exploratória. Os participantes do estudo foram profissionais dos Serviços de Atenção Domiciliar do Mato Grosso do Sul. A coleta de dados se deu com a aplicação de dois formulários on-line, no período de 2019 a 2020. Um dos formulários tinha dados descritivos dos serviços e seus atendimentos; o outro se voltava para a validação de protocolo de fluxo de atenção domiciliar às crianças. Para análise de dados, utilizou-se a estatística descritiva. Resultados houve uma predominância de 25 crianças com paralisia cerebral, sendo que a maioria foi classificada como média complexidade, de acordo com a complexidade e as demandas de cuidados. Os profissionais realizam orientações, procedimentos e avaliação, além de serem responsáveis pelo treinamento da família. Os serviços não possuem protocolo de fluxo para atendimento das crianças. Conclusão Implicações para Prática embora os serviços apresentem capacidade de ampliação do atendimento e utilizem o Plano Terapêutico Singular, avanços na assistência às crianças e famílias ainda se fazem necessários. Recomenda-se a elaboração de protocolos de fluxo e propostas organizativas que auxiliem os profissionais em sua prática.

RESUMEN Objetivo Descrever a atención prestada a niños con necesidades especiales de salud en los Servicios de Atención Domiciliaria del Estado de Mato Grosso do Sul. Métodos investigação cuantitativa, descritiva e exploratoria. Los participantes del estudio fueron profesionales de los servicios de atención domiciliaria de Mato Grosso do Sul. La recolección de datos ocurrió a través de la aplicación de dos formularios en línea, de 2019 a 2020, uno con datos descriptivos de los servicios y su atención y el otro para la validación del protocolo para el flujo de atención domiciliaria a los niños. Se utilizó estadística descriptiva para el análisis de datos. Resultados hubo un predominio de 25 niños con parálisis cerebral. La mayoría clasificó como mediana complejidad de acuerdo a la complejidad y demandas de atención. The professionals carry out lineamientos, procedures, evaluation and are responsible for training the family. Los servicios no cuentan con un protocolo de flujo para la atención de niños. Conclusion Implications for Practice Although the services have the capacity to expand care and use the Singular Therapeutic Plan, advances in the care of the child and the family are still needed. The development of flow protocols and organizational proposals that help professionals in their practice are recommended.

ABSTRACT Objective to describe the care provided to children with special health needs in the Home Care Services of the State of Mato Grosso do Sul - Brazil. Methods research, descriptive and exploratory. Study participants were professionals from home care services in Mato Grosso do Sul. Data collection took place through the application of two online forms, from 2019 to 2020, one containing descriptive data of the services and their care and the other for validation of the home care flow protocol for children. It was used for data analysis and descriptive statistics. Results there was a predominance of 25 children with brain flexibility. Most classified as complex average according to the complexity and demands of care. Professionals and guidelines, procedures, assessment are responsible for training the family. The services do not have a flow protocol for the care of children. Conclusion Implications for Practice Services Present ability to deliver care and use the care plan and single use, advances in child care and solutions may still be presented. There is a practice of elaborating flow protocols and organization proposals that help professionals in their.

Detection of SARS-CoV-2 virus on the ocular surface of an asymptomatic health-care professional / Detecção do vírus SARS-CoV-2 na superfície ocular de um professional de saúde assintomático

ABSTRACT Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Its main form of transmission is through respiratory droplets. Case reports have described the presence of this virus in biological materials such as blood, feces, urine, and tears, which generate hypotheses about other means thereby the disease is transmitted. In this report, we describe a case of SARS-CoV-2 identified on the eye surface of an asymptomatic health-care professional. The nasopharyngeal reverse transcription polymerase chain reaction test, using a sample collected on the same day, and the serological test, performed 3 months later, did not reveal any evidence of SARS-CoV-2 infection. These results alert on the possibility of a false-positive reverse transcription polymerase chain reaction result for the ocular surface or the presence of the virus in the conjunctival mucosa in individuals without infection.

RESUMO A COVID-19 é uma doença infeciosa causada pelo SARS-CoV-2, sendo sua principal forma de transmissão através de gotículas respiratórias. Já existem relatos de caso descrevendo a presença desse vírus em materiais biológicos como sangue, fezes, urina e lágrima, o que gera hipóteses sobre outros meios de transmissão da doença. Neste estudo, descrevemos um caso de identificação do vírus SARS-CoV-2 na superfície ocular de um profissional de saúde assintomático. A transcrição inversa da reação em cadeia da polimerase da nasofaringe, coletada no mesmo dia, e o teste sorológico, realizado três meses após, não detectaram qualquer evidência de infecção pelo SARS-CoV-2. Esses dados alertam para a possibilidade de resultado falso positivo da transcrição inversa da reação em cadeia da polimerase da superfície ocular ou a presença do vírus na mucosa conjuntival sem infecção.

Compatibility of Clinical and Histopathological Diagnosis of Oral Lesions in Iranian Patients

Objective: To determine compatibility between clinical diagnosis and the pathological reports of biopsies from oral lesions. Material and Methods: In this descriptive study, 1146 clinical files of patients referring to Tabriz Faculty of Dentistry from 2004 to 2016 were retrieved and evaluated. The kappa coefficient was calculated for each file for compatibility of clinical and pathological diagnosis. Results: In relation to clinical (40.2%) and pathological (39.2%) diagnosis, irritational lesions of soft tissues exhibited the highest frequency. In 72.3% of cases, the clinical and pathological diagnosis were compatible and in 27.7% of cases these diagnosis were not compatible. The highest compatibility rates were detected for irritational lesions of soft tissues (81.5%) and mucocutaneous lesions (76.9%). There was no compatibility for osseous malignant tumors, inflammatory tissues, granulation tissues, metastatic lesions and hematologic disorders. Conclusion: Approximately one-third of clinical and histopathological diagnosis were not compatible. Therefore, to reach a correct diagnosis, the clinical, radiographic and histopathological views should be evaluated simultaneously.

Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia

@#Introduction: Trauma is a Global threat and the 5th highest cause of all-cause mortality in Malaysia caused predominantly due to road traffic accidents. Majority of trauma victims are young adults aged between 21-40 years old. In Malaysia, 24 out of 100,000 population die annually due to trauma, rating us amongst the highest in South East Asia. These alarming figures justify aggressive preventive and mitigation strategies. The aim of this paper is to promote the implementation of evidence-based interventions that will reduce the rate of preventable death because of trauma. Tranexamic acid is one of the few interventions in the early management of severe trauma with level-one evidence. Tranexamic acid has been proven to reduce all causes of mortality and mortality due to bleeding. Evidence proves that it is most effective when administered early, particularly within the 1st hour of trauma. This proposed guideline is formulated based upon quality evidence from multicentre studies, clinical practices in other countries and consideration of the local demographic factors with the intent of enabling an easy and simple pathway to administer tranexamic acid early in the care of the severely injured. Conclusion: The guideline highlights select pre-hospital criteria’s and the methods for drug administration. The authors recognise that some variants may be present amongst certain institutions necessitating minor adaptations, nevertheless the core principles of advocating tranexamic acid early in the course of pre-hospital trauma should be adhered to.

Insecticide susceptibility status and resistance mechanism of Anopheles cracens Sallum and Peyton and Anopheles maculatus Theobald (Family: Culicidae) from knowlesi malaria endemic areas in Peninsular Malaysia

Objective: To assess the insecticide susceptibility status of Anopheles cracens (An. cracens) and Anopheles maculatus (An. maculatus) from knowlesi malaria endemic areas in Peninsular Malaysia towards DDT, malathion and deltamethrin and to determine the resistance mechanism involved. Methods: Adult and larval mosquitos were collected for surveillance. Susceptibility status of Anopheles was determined using the standard WHO adult bioassay, larval bioassay and biochemical enzyme assay. Results: WHO adult bioassay results indicated An. cracens collected from Kampung Sungai Ular, Pahang was resistant towards 4% DDT, while An. maculatus collected from Kampung Sokor, Kelantan and Kampung Sungai Lui, Selangor exhibited resistance towards 4% DDT. However, the enzyme activity profiles varied according to strains and species. The resistance ratio of larval bioassay, showed that all strains and species tested were susceptible to malathion and temephos. Conclusions: Since only a few anopheline strains exhibited low level of insecticide resistance towards malathion, DDT and temephos. These insecticides are still considered effective for vector control program towards An. cracens and An. maculatus.

Norwegian scabies - rare case of atypical manifestation

Abstract Human scabies affects all social classes and different races around the world. It is highly contagious, but the exact figures on its prevalence are unknown. A 19-year-old male patient was admitted to the emergency room reporting fever (38°C) and multiple lesions throughout the body, except face, soles, and palms. Lesions were non-pruritic, which hampered the initial diagnostic suspicion. Skin biopsy was performed, and the final diagnosis was crusted scabies (Norwegian). It was concluded that human scabies is a significant epidemic disease, due to its different clinical manifestations, and because it is extremely contagious.

Sedation in colonoscopy by using three different propofol infusion methods and analysis of plasma concentration levels: a prospective comparative study / Sedação em colonoscopia: utilização do propofol em estudo comparativo entre três diferentes modos de administração

ABSTRACT Background: The propofolemia becomes directly linked to the clinical effects of this anesthetic and is the focus for studies comparing propofol clinical use, in different administration methods routinely used in endoscopy units where sedation is widely administered to patients. Aim: To evaluate the effects of three different regimens of intravenous propofol infusion in colonoscopies. Methods: A total of 50 patients that underwent colonoscopies were consecutively assigned to three groups: 1) intermittent bolus infusion; 2) continuous manually controlled infusion; 3) continuous automatic infusion. Patients were monitored with Bispectral IndexTM (BIS) and propofol serum levels were collected at three different timepoints. The development of an original dilution of propofol and an inventive capnography catheter were necessary. Results: Regarding clinical outcomes, statistical differences in agitation (higher in group 1, p=0.001) and initial blood pressure (p=0.008) were found. As for propofol serum levels, findings were similar in consumption per minute (p=0.748) and over time (p=0.830). In terms of cost analysis, group 1 cost was R$7.00 (approximately US$2,25); group2, R$17.50 (approximately US$5,64); and group 3, R$112.70 (approximately US$36,35, p<0.001). Capnography was able to predict 100% of the oxygen saturation drop (below 90%). Conclusion: The use of propofol bolus administration for colonoscopies, through continuous manually controlled infusion or automatic infusion are similar regarding propofolemia and the clinical outcomes evaluated. The use of an innovative capnography catheter is liable and low-cost solution for the early detection of airway obstruction.

RESUMO Racional: A propofolemia está diretamente relacionada com os efeitos clínicos desse anestésico e é foco de diversos estudos comparando os usos clínicos do propofol e os diferentes métodos de administração, como realizado amplamente nos centros de endoscopia. Objetivo: Avaliar os efeitos de três diferentes regimes de infusão de propofol intravenoso em colonoscopias. Métodos: Ao todo 50 pacientes que foram submetidos à colonoscopia foram consecutivamente divididos em três grupos: 1) infusão em bolus intermitente; 2) perfusão contínua controlada manualmente; 3) infusão automática contínua. Os pacientes foram monitorados com Bispectral IndexTM (BIS) e os níveis séricos de propofol foram coletados em três momentos diferentes. Foi necessário a preparação de uma diluição específica de propofol e o desenvolvimento de um cateter de capnografia original manufaturado para a realização do estudo. Resultados: Em relação aos desfechos clínicos, houve diferença estatística na agitação (maior no grupo 1, p=0,001) e pressão arterial inicial (p=0,008). Com relação aos níveis séricos de propofol, os resultados foram semelhantes no consumo por minuto (p=0,748) e ao longo do tempo (p=0,830). Em termos de análise de custo, no grupo 1 o custo foi de R$ 7,00 (aproximadamente US$ 2,25); grupo 2, R$ 17,50 (aproximadamente US$ 5,64); e grupo 3, R$ 112,70 (cerca de US$ 36,35, p<0,001). A capnografia foi capaz de diagnosticar 100% das dessaturações de oxigênio (abaixo de 90%). Conclusão: O uso de propofol em bolus para colonoscopias, por meio de infusão contínua controlada manualmente ou infusão automática são semelhantes quanto à propofolemia e os resultados clínicos avaliados. Além disso, o uso de um cateter de capnografia inovador é solução de baixo custo para a detecção precoce da obstrução da via aérea.

Effificacy of autologous platelet-rich plasma combined with fractional ablative carbon dioxide resurfacing laser in treatment of facial atrophic acne scars: A split-face randomized clinical trial.

Background: Autologous platelet-rich plasma has recently attracted signifi cant attention throughout the medical fi eld for its wound-healing ability. Aims: This study was conducted to investigate the potential of platelet-rich plasma combined with fractional laser therapy in the treatment of acne scarring. Methods: Sixteen patients (12 women and 4 men) who underwent split-face therapy were analyzed in this study. They received ablative fractional carbon dioxide laser combined with intradermal platelet-rich plasma treatment on one half of their face and ablative fractional carbon dioxide laser with intradermal normal saline on the other half. The injections were administered immediately after laser therapy. The treatment sessions were repeated after an interval of one month. The clinical response was assessed based on patient satisfaction and the objective evaluation of serial photographs by two blinded dermatologists at baseline, 1 month after the fi rst treatment session and 4 months after the second. The adverse effects including erythema and edema were scored by participants on days 0, 2, 4, 6, 8, 15 and 30 after each session. Results: Overall clinical improvement of acne scars was higher on the platelet-rich plasma-fractional carbon dioxide laser treated side but the difference was not statistically signifi cant either 1 month after the fi rst treatment session (P = 0.15) or 4 months after the second (P = 0.23). In addition, adverse effects (erythema and edema) on the platelet-rich plasma-fractional carbon dioxide laser-treated side were more severe and of longer duration. Limitations: Small sample size, absence of all skin phototypes within the study group and lack of objective methods for the evaluation of response to treatment and adverse effects were the limitations. Conclusion: This study demonstrated that adding platelet-rich plasma to fractional carbon dioxide laser treatment did not produce any statistically signifi cant synergistic effects and also resulted in more severe side effects and longer downtime.

The Evaluation of Laparoscopic Orchiopexy on the Treatment of Non-palpable Undescended Testes .

Objectives: Cryptorchidism is the most frequent birth anomaly in boys with 2-5% prevalence in full term infants. This anomaly is associated with an increased risk of testicular cancer and infertility as well as hernia, testicular torsion, and psychological distress. Surgery is the main treatment for this anomaly. This study aimed to evaluate the therapeutic efficacy of laparoscopic orchiopexy in the treatment of non-palpable undescended testis. Methods: Forty patients with a non-palpable testis were evaluated by laparoscopic orchiopexy in a hospital in Hamedan city, Iran, during 2006 to 2009. The average age of patients was 19±12.16 months old. The patients were followed up after the surgery and three months later to assess the response to treatment and the testicular atrophy. Results: Thirteen patients did not have a testis in the laparoscopic investigation and six patients had testis located in the inguinal canal. So they were excluded from the analysis. Seventeen patients were treated by one-staged laparoscopic orchiopexy while four patients were treated by two-staged Fowler-Stephens laparoscopic orchiopexy. The success rate for the treatment was 100%. Conclusion: Laparoscopic orchiopexy is a safe and effective method for the treatment of non-palpable undescended testis.

Antimicrobial effect of Malaysian vegetables against enteric bacteria

Objective: To investigate the antibacterial activities of green vegetables (pennywort, mint, garlic, parsley and celery) against four common enteric bacteria [Salmonella enterica (ATCC 25957) (S. enterica), Shigella flexneri (ATCC 12022) (S. flexneri), Escherichia coli (ATCC 43889) (E. coli) and Enterobacter cloacae (ATCC 13047) (E. cloacae)] as an alternative medicine for controlling food borne diarrhea disease and the synergistic effect of green vegetables against those bacteria. Methods: Five common vegetables (pennywort, mint, garlic, parsley and celery) were purchased and extracted. The antimicrobial activities of these extracts were tested against four common enteric bacteria (S. enterica, S. flexneri, E. coli and E. cloacae). Ten different concentrations of the extracts (from 640 to 1.25 mg/mL) were prepared and used for the study. The minimal inhibitory concentration (MIC) was determined by the broth dilution method. The antimicrobial activities were assessed by using both well diffusion and disc diffusion methods. Results: Garlic extract showed excellent inhibitory effects on all enteric bacteria. Other plants (parsley, celery, mint and pennywort) were not effective against enteric bacteria. The MIC of garlic against S. flexneri and E. cloacae was 40 mg/mL. The MIC of S. enterica and E. coli were 20 and 10 mg/mL, respectively. The performance of the well diffusion method was better than that of the disc diffusion method with clear and sharp inhibition zones of tested bacteria against plant extracts. Conclusions: Garlic had excellent antimicrobial effects against enteric bacteria and was recommended to be given to patients with gastroenteritis. The other vegetables (pennywort, mint, parsley and celery) showed no inhibitory effects on enteric bacteria but still can be used for its richness in vitamins and fibers. The performance of the well diffusion method was better than that of the disc diffusion method in detecting the antibacterial effects of green vegetables.

Factors Associated with Discharge Against Medical Advice from Emergency Department, Universiti Kebangsaan Malaysia Medical Centre

Patients who self-discharge against medical advice (DAMA) are susceptible to life-threatening consequences. By understanding the factors associated with DAMA, healthcare centres can build strategies to assist patients to receive optimal medical care and prevent unfavourable outcome. The objective of this study was to determine the factors associated with DAMA from the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a prospective unmatched case control study conducted over a 4-month period. For every DAMA episode, two patients who were admitted on the same day were randomly selected as control. Following patient consent, data was collected using a standardized questionnaire. Patients were contacted by the investigator for information regarding hospitalization within two weeks of DAMA. Ninety three patients were recruited; 31 DAMA patients and 62 admitted patients. Payment method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01). The likelihood of self-paying patients to take DAMA was three times higher than those who had a guarantor letter from their employer or insurance provider. Other factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09- 15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6% DAMA patients were admitted to hospital within two weeks of the DAMA episode. Payment method significantly influences DAMA. Payment planning, social welfare services, non-governmental organization funds and the introduction of a national health policy scheme may aid hospital payment, alleviate financial limitation of patients and reduce DAMA episodes.

Usage of Mobile Applications in Diabetes Management: A Review / Jurnal Sains Kesihatan Malaysia

Peer-reviewed articles on the usage of mobile applications in the management of diabetes were reviewed. Studies using mobile device applications for diabetes interventions published between January 2007 and March 2013 were included in this review. Studies related to the developmental processes of the mobile applications were excluded. The characteristics of these studies and the outcomes of the methods used in the management of diabetes were gathered. We retrieved a total of 372 articles from ACM Digital library, PubMed and Proquest Medical Library. After applying the inclusion and exclusion criteria, 8 articles were eligible for further review. Most of the studies included in this review showed the effectiveness of mobile applications in diabetes management. Their major contribution comes from feedback functions of the systems that assist participants in the self-monitoring of their blood glucose and dietary intake. However, the majority of the studies showed the limited use of the mobile phone as a tool to input information into systems which would in turn convey a reminder message to the patient. In conclusion, with its features of portability and convenience, mobile application used in the management of diabetes has the potential to improve glycaemic control, resulting in significant clinical and financial benefits.

Conjugates of B-cells and platelet microparticles in the human peripheral blood

Background: Activated platelets shed microparticles [MPs] in vivo and certainly in vitro under storage. Like platelets, platelet-derived MPs contribute to hemostatic and inflammatory responses. We sought to determine the interactions between platelet MPs and peripheral B lymphocytes in the healthy blood circulation to propose a possible role for platelet MPs in the functioning of B cells

Materials and Methods: An enzyme-linked immunosorbent assay [ELISA] was established to determine the normal interactions between human peripheral blood B lymphocytes and platelet MPs. B cells were isolated and bound to the wells of microtiter plates using coated anti-CD19. Then the presence of attached MPs was surveyed. Also, platelet MPs were separated from human platelet concentrates and applied to confirm the new binding capacities of B cells for these microvesicles

Results: Platelet MPs were recognized in the wells of ELISA in which only B cells were isolated. So MPs were bound with peripheral blood B cells. Furthermore, using this method, the role of CD40/ CD40L interaction was displayed for the binding

Conclusion: It seemed that the binding of platelet MPs to B cells normally took place in vivo and a percent of B cells circulate in blood in connection with platelet MPs

Angiolipofibroma of the right colon: a rare type of submucosal polyp

Colorectal hamartomatous polyps originating from the submucosa represent a very small percentage of all colonic polyps. Mesenchymal hamartomatous polyps are formed by more than one type of mesenchymal tissue. We report the pathological findings of an unusual presentation of a polypoid proliferation of vascular, mature fatty and fibrous connective tissue. The histological findings support the diagnosis of a hamartoma rather than a true neoplasm

[Study of 15 system of short tendem repeats loci [STRs] in sample of Syrian population]

The aim of this study was to know the Allele frequencies for the 15 STR loci in the sample in Aleppo in Syria. Allele frequencies for the 15 STR loci included in the PowerPlex16 PCR Amplification Kit panel from [Promega, Madison, USA] according to manufacturer's instructions [D3S1358, TH01, D21S11, D18S51, PentaE, D5S818, D13S317, D7S820, D16S539, CSF1PO, PenyaD, vWA, D8S1179, T, POX, FGA] and several statistical parameters were estimated from a sample of 127 unrelated individuals representing all ethnic groups in Aleppo in Syria . DNA was extracted from blood samples using QIAmp1 DNA Mini Kit [QIAGEN, Hagen, Germany] according to manufacturer's instructions and the PCR products were typed using an ABI PRISM 310 Genetic Analyzer [Applied Biosystems, Foster City, CA, USA]]. The results were analyzed using GeneMapper ID v3.0 software [Applied Biosystems]. Several forensic and population parameters such as heterozygosity, polymorphic information content [PIC], power of discrimination [PD], power of exclusion [PE] and the paternity index [PI]] were calculated using Microsoft Excel-. A p-value of the 15 loci were estimated by using the statistical Microsoft Windows 2007 to verify whether the genotype distribution conformed to Hardy- Weinberg equilibrium predictions.We compared our data with other data sets from published studies of individuals from Turkey, Morocco and Iraq, our data indicate that standardized multilocus STR panels may be a useful forensic tool which can be applied for identification purposes also in the Syria population. Our Data may be a useful forensic tool which can be applied for identification purposes also in the Syria population

Students' Perceptions of the Educational Environment in a Northern Iran University of Medical Science.

Aim: This study aimed to evaluate the current situation of clinical departments in order to explore the viewpoint of interns and trainee according to the Dundee ready educational pattern (DREEM) in Mazandaran University of Medical Science. Design and Setting: the samples included all intern and externs of medical department who were studying in Mazandaran University of Medical Science. Methods and Materials: This was a cross sectional study which comprised students who selected by convenience methods. The standard questionnaire used to assess the view of students who were intern or trainer in Mazandaran University of Medical science during 2012. The questionnaire comprised four subscales i.e. learning (12 item), educational environment (12 item), teachers (11 item) and perceived ability (12). Statistical analysis: SPSS software was used to analysis the collected data. We employed ANOVA, Pierson and Structural Equation Modelbing. Results: the findings showed the mean is above 3 and significance level is belowe0.05 which implies the view of interns is average toward teacher efficacy, educational environment, learning condition and perceived self-ability. Conclusions: according to the findings, authors suggests to future researchers to explore the clinical departments situations in different cultures and regions with different medical educational related factors in order to provide better knowledge regarding gaps in health care systems.

Comparison of analgesic effect of femoral nerve block and continuous intravenous infusion pump, after anterior cruciate ligament reconstruction in first postoperative day

Incidence of anterior cruciate ligament [ACL] tearing is especially high in athletes, and reconstruction surgery is often required, associated with severe post-operative pain requiring active interventions. In the present study we compared the continuous intravenous morphine infusion technique with femoral nerve block regarding efficacy of pain management and patients' satisfaction, so that the best post-operative pain management for ACL reconstruction can be decided. We recruited 54 patients for this study and divided them randomly in 2 equal groups; Group-A [continuous intravenous morphine infusion] and Group-B [femoral nerve block]. Femoral block for coded subjects was performed at the end of the surgery right before shifting the patient. For patients in the other group, catheter was inserted for continuous infusion after extubation and transfer to recovery room. Pain intensity was assessed and recorded in recovery service and right after complete consciousness, and then every 4 hours by trained nurses of the department, using visual analogue scale [VAS]. After complete consciousness and every 12 hours, patients' satisfaction from post-operative analgesia was questioned and recorded, using five Likert scale items. Post-operative complication were recorded. The pain in Group-A [the continuous infusion pump group] at 20 and 24 hours after surgery was significantly lower than Group-B [nerve block group][p<0.05]. Post-operative complications [especially nausea] in femoral nerve block was lower. Analgesic degree of nerve block is comparable with the impact of continuous infusion pump at least during 20 hours after anterior cruciate ligament reconstruction surgery

[Mutation of STRs in paternity testing]

A study of the consecutive cases for STRs mutations has been performed during years from 2007 to 2010 in Laboratory for Research and Genetic Consultation at the Faculty of Medicine, which were 44 cases investigated ratios. 44 cases examined to confirm the ratios in the laboratory. DNA was extracted from blood samples. The PCR products were typed using an ABI PRISM 310 Genetic Analyzer [Applied Biosystems, Foster City, CA, USA]]. The results were analyzed using Gene Mapper ID v3.0 software [Applied Biosystems]. As was my case study to prove the existence of mutations rates and one of them associated boom in location A Locus in the HLA system where systems have been added sexual STRs on chromosome X to this case to confirm the descent. The study was conducted statistical cases containing mutations to calculate the probability of paternity W calculates the boom or not calculated. During the study found, 2 STRs mutations discoverers using STRs Systems in investigating cases of percentages in the following systems were D3S1358, D13S317, and in both cases were from the father's side, In paternity investigation cases, 2 STRs mutations have been detected in several loci. The final probability paternity value [after inclusion of mutations] and that the probability of paternity in cases calculates boom with the 15 systems of STRs with the addition of other systems was always >99.99%. Allowing to conclude confidently the presence of a mutation. we can expect to find paternity investigation cases with one or even two genetic incompatibilities that are non-exclusion cases

In silico experiment with an-antigen-toll like receptor-5 agonist fusion construct for immunogenic application to Helicobacter pylori.

BACKGROUNDS: Helicobacter pylori colonize the gastric mucosa of half of the world's population. Although it is classified as a definitive type I carcinogen by World Health Organization, there is no effective vaccine against this bacterium. H. pylori evade the host immune response by avoiding toll-like detection, such as detection via toll-like receptor-5 (TLR-5). Thus, a chimeric construct consisting of selected epitopes from virulence factors that is incorporated into a TLR-5 ligand (Pseudomonas flagellin) could result in more potent innate and adaptive immune responses. MATERIALS AND METHODS: Based on the histocompatibility antigens of BALB/c mice, in silico techniques were used to select several fragments from H. pylori virulence factors with a high density of B- and T-cell epitopes. RESULTS: These segments consist of cytotoxin-associated geneA (residue 162-283), neutrophil activating protein (residue 30-135) and outer inflammatory protein A (residue 155-268). The secondary and tertiary structure of the chimeric constructs and other bioinformatics analyses such as stability, solubility, and antigenicity were performed. The chimeric construct containing antigenic segments of H. pylori proteins was fused with the D3 domain of Pseudomonas flagellin. This recombinant chimeric gene was optimized for expression in Escherichia coli. The in silico results showed that the conserved C- and N-terminal domains of flagellin and the antigenicity of selected fragments were retained. DISCUSSION: In silico analysis showed that Pseudomonas flagellin is a suitable platform for incorporation of an antigenic construct from H. pylori. This strategy may be an effective tool for the control of H. pylori and other persistent infections.

[Effect of aerobic exercise on plasma vasoactive intestinal peptide, blood pressure and heart rate of elderly healthy persons and coronary artery patients]

Vasoactive intestinal peptide [VIP] plays an important role in modulating coronary blood flow and heart rate. The purpose of the present study was to investigate the effect of eight weeks of low intensity aerobic exercise on plasma levels of VIP hormone, blood pressure and heart rate in healthy elderly men and women, and patients with coronary artery disease [CAD]. In this study, 15 healthy women and 15 healthy men and 15 female and 15 male with CAD disease were randomly chosen as the experimental and control groups. Subjects did aerobic exercises tree days/week, for eight weeks, with the heart rate of 100 +/- 10 beats per minute. Blood samples were taken from each subject in three stages, [before, immediately after and 24 hours after the 8 weeks of exercising]. The results showed that there was a significant difference among plasma VIP levels in the four groups. Moreover, a significant difference was observed between the systolic blood pressure in the four groups [P=0.01] and the systolic blood pressure in male patients and healthy women [P=0.03] while there was no meaningful difference the systolic blood pressure in the two other groups. There was also a significant difference in the heart rate of the three rounds of sampling in the three of groups [P=0.002] but no significant difference was observed in healthy men. According to the above results, it seems that the duration and intensity of each workout should be considered to reach the VIP stimulation threshold. It may bring about considerable changes in VIP levels.