Evaluating the effect of montelukast tablets on respiratory complications in patients following blunt chest wall trauma: A double-blind, randomized clinical trial / 中华创伤杂志(英文版)

PURPOSE@#Patients with multiple traumas are at high risk of developing respiratory complications, including pneumonia and acute respiratory distress syndrome. Many pulmonary complications are associated with systemic inflammation and pulmonary neutrophilic infiltration. Leukotriene-receptor antagonists are anti-inflammatory and anti-oxidant drugs subsiding airway inflammation. The present study investigates the effectiveness of montelukast in reducing pulmonary complications among trauma patients.@*METHODS@#This randomized, double-blind, placebo-control trial was conducted in patients with multiple blunt traumas and evidence of lung contusion detected via CT scan. We excluded patients if they met at least one of the following conditions: < 16 years old, history of cardiopulmonary diseases or positive history of montelukast-induced hypersensitivity reactions. Patients were allocated to the treatment (10 mg of montelukast) or placebo group using permuted block randomization method. The primary measured outcome was the volume of pulmonary contusion at the end of the trial. The secondary outcomes were intensive care unit and hospital length of stay, ventilation days, multi-organ failure, and the in-hospital mortality rate.@*RESULTS@#In total, 65 eligible patients (treatment = 31, placebo = 34) were included for the final analysis. The treatment group had more pulmonary contusion volume (mean (SD), mm3) at the right (68726.97 (93656.54) vs. 59730.27 (76551.74)) and the left side (67501.71 (91514.04) vs. 46502.21 (80604.21)), higher initial C-reactive peptide level (12.16 (10.58) vs. 10.85 (17.87)) compared to the placebo group, but the differences were not statistically significant (p > 0.05). At the end of the study, the mean (SD) of pulmonary contusion volume (mm3) (right side = 116748.74 (361705.12), left side = 64522.03 (117266.17)) of the treatment group were comparable to that of the placebo group (right side = 40051.26 (64081.56), left side = 25929.12 (47417.13), p = 0.228 and 0.082, respectively). Moreover, both groups have statistically similar hospital (mean (SD), days) (10.87 (9.83) vs. 13.05 (10.12)) and intensive care unit length of stays (mean (SD), days) (7.16 (8.15) vs. 7.82 (7.48)). Of note, the frequency of the in-hospital complications (treatment vs. control group) including acute respiratory distress syndrome (12.9% vs. 8.8%, p = 0.71), pneumonia (19.4% vs. 17.6%, p = 0.85), multi-organ failure (12.9% vs. 17.6%, p = 0.58) and the mortality rate (22.6% vs. 14.7%, p = 0.41) were comparable between the groups.@*CONCLUSION@#Administrating montelukast has no preventive or therapeutic effects on lung contusion or its complications.

Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims / 中华创伤杂志(英文版)

PROPOSE@#In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.@*METHODS@#All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.@*RESULTS@#In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.@*CONCLUSION@#We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.

Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran / 中华创伤杂志(英文版)

PURPOSE@#Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloids, which has both benefits and complications. The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics, coagulation profiles, and blood gases in such patients.@*METHODS@#In this cross-sectional study, patients were divided into two groups: femoral fracture group and non-femoral group. The hemodynamic status, coagulation profile, and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later. Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test.@*RESULTS@#A total of 681 trauma patients (605 men and 76 women) participated in this study, including 69 (86.3%) men and 11 (13.8%) women in femoral fracture group and 536 men (89.2%) and 65 women (10.8%) in non-femoral group. The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later. Blood gases decreased in the fracture group despite fluid therapy (p < 0.003), and the coagulation profile worsened although the change was not statistically significant.@*CONCLUSION@#The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine. If there is evidence of clinical shock, excessive crystalloid infusion (limited to 1 L) should be avoided, and blood and blood products should be started as soon as possible.

Immunogenicity of glycine nanoparticles containing a chimeric antigen as Brucella vaccine candidate

Purpose@#Brucellosis as a worldwide zoonotic illness affect domestic animals and humans doesn’t have any vaccine for the prevention of infection in humans yet. The aim of this study was to evaluate the specific immune response following the administration of glycine nanoparticles as adjuvant and delivery system of a chimeric antigen contained trigger factor, Omp31, and Bp26 in murine model. @*Materials and Methods@#The chimeric antigen of Brucella was cloned and expressed in Escherichia coli (E. coli) BL21 (DE3). Purification and characterization of recombinant protein was conducted through Ni-NTA (nickel-nitrilotriacetic acid) agarose, SDS-PAGE (sodium dodecyl sulfate-polyacrylamide gel electrophoresis), and Western blot. Nanoparticle characteristics including morphology, particle size distribution, zeta potential, protein retention rate, and release rate were measured in vitro. Subsequently, nanoparticle contained antigen was administered to mice and blood sample was taken to measured the antibody level. @*Results@#The protein retention in the nanoparticles was successfully done and the nanoparticle characteristics were appropriate. The average size of glycine particles containing antigen was about 174 nm, and the absorption of protein was approximately 61.27% of the initial value, with a release rate of approximately 70% after 8 hours. Enzyme-linked immunosorbent assay result proved that the immunized sera of mice which were administered with nano-formula contains high levels of antibodies (immunoglobulin G) against recombinant chimeric antigen and also a high level of mucosal antibody (immunoglobulin A) in the oral group, which showed a desirable immunity against Brucella. @*Conclusion@#The results showed that chimeric antigen-loaded glycine nanoparticles can act as a vaccine candidate for inducing the cellular and humoral immune response against brucellosis.

[Evaluation and reconstruction of Alzahrawi's puncturing instruments]

Abu al-Qasim Khalaf Ibn-e-Abbas Zahrawi [936-1013 A.D.], known as Albucasis in west, was one of the greatest physicians in the Islamic world. To many historians, he was considered as the father of modern surgery. His book, Al-Tasrif, e.g., written in 30 chapters, was, in fact, a medical encyclopedia of that era. It was used as one of the main references in medical academic centers for centuries. The 30th chapter of this weighty book was dedicated to surgery. In this chapter, Zahrawidescribed many surgical procedures and introduced about 200 instruments invented for those procedures. In addition to drawing some of the instruments, he explained their size, shape, and application, as well. In the second section of this chapter, named "surgery and instruments", he explained about the functions of various surgical instruments, used for spliting, piercing and phlebotomizing, including Gamaneh, surgical blade, Makhda', Nishtar and experiment rod, all of which were available for the surgeon to choose from as needed. The aim of this study, was to describe, design and evaluate the functional quality of a hypothetical module of the instrument "experiment rod", used for piercing, as presented in Al-Tasrif

Clinical and histopathologic investigation of periapical actinomycosis with cutaneous lesion: a case report

Management of an extra-radicular infection is a challenging procedure that requires surgical intervention. This report describes a patient with discharging cutaneous lesion that required apical surgery. A 40-year-old woman was referred to the Department of Endodontics, Shiraz Dental School with chief complaint of a cutaneous sinus tract. She had been treated by a dermatologist and an otolaryngologist. The patient had also received orthograde root canal treatment of tooth #16. Yet, the lesion was still discharging and the patient was scheduled for surgery. Histopathologic analysis of the lesion showed actinomycosis infection. A 36-month follow-up revealed clinical and radiographic healing

Antibacterial activity of ethyl acetate and aqueous extracts of Mentha longifolia L. and hydroalcoholic extract of Zataria multiflora Boiss. plants against important human pathogens

Objective: To determine the potential antibacterial activity of ethyl acetate and aqueous extracts from Mentha longifolia L. (M. longifolia) and hydroalcoholic extract of Zataria multiflora Boiss. (Z. multiflora) against important human pathogens. Methods: Pseudomonas aeruginosa, Shigella dysenteriae, Klebsiella pneumoniae (K. pneumonia). Enterobacter cloacae, Salmonella typhi, Proteus mirabilis, Serratia marcescens, Bacillus cereus, Staphylococcus saprophyticus and Staphylococcus aureus were kinds of pathogenic bacteria to determine the antibacterial effect of aqueous and ethyl acetate extracts of M. longifolia and hydroalcoholic extract of Z. multiflora using broth microdiluation method. Results: The lowest minimum inhibitory concentration and minimum bactericidal concentration values for K. pneumonia and Pseudomonas aeruginosa (1.25 and 2.5 mg/mL) were observed by the hydroalcoholic extract of Z. multiflora and the lowest minimum inhibitory concentration and minimum bactericidal concentration values for K. pneumonia and Serratia marcescens (2.5 and 5 mg/mL) were observed by the aqueous extracts of M. longifolia. Conclusions: In conclusion, it seems that Z. multiflora and M. longifolia extracts could inhibit the growth of all of the mentioned bacteria.

Investigation of caspase-1 activity and interleukin-1β production in murine macrophage cell lines infected with Leishmania major

Objective: To investigate the caspase-1 dependent inflammatory pathway activity and interleukin-1β (IL-1β) secretion in murine macrophage cell lines J774G8 infected with Leishmania major (L. major) using caspase-1 activity assay and ELISA. Methods: Novy-MacNeal-Nicolle biphasic medium was applied to produce promastigote form of L. major. Metacyclic promastigotes in the stationary phase were applied to infect macrophage. Caspase-1 activity and IL-1β secretion were assessed by the CPP32/caspase-1 fluorometric protease assay and ELISA IL-1β kits, respectively, with time intervals of 6, 18 and 30 h. Results: Our study showed an increase in caspase-1 activity and IL-1β secretion in infected samples compared to non-infected macrophages. The highest increase in IL-1β production was observed after 6 h of infection. Conclusions: These results arise that the activation of inflammasome pathway could be one of the innate immunity pathways against L. major.

Investigation of caspase-1 activity and interleukin-1β production in murine macrophage cell lines infected with Leishmania major

OBJECTIVE@#To investigate the caspase-1 dependent inflammatory pathway activity and interleukin-1β (IL-1β) secretion in murine macrophage cell lines J774G8 infected with Leishmania major (L. major) using caspase-1 activity assay and ELISA.@*METHODS@#Novy-MacNeal-Nicolle biphasic medium was applied to produce promastigote form of L. major. Metacyclic promastigotes in the stationary phase were applied to infect macrophage. Caspase-1 activity and IL-1β secretion were assessed by the CPP32/caspase-1 fluorometric protease assay and ELISA IL-1β kits, respectively, with time intervals of 6, 18 and 30 h.@*RESULTS@#Our study showed an increase in caspase-1 activity and IL-1β secretion in infected samples compared to non-infected macrophages. The highest increase in IL-1β production was observed after 6 h of infection.@*CONCLUSIONS@#These results arise that the activation of inflammasome pathway could be one of the innate immunity pathways against L. major.

Antibacterial activity of ethyl acetate and aqueous extracts of Mentha longifolia L. and hydroalcoholic extract of Zataria multiflora Boiss. plants against important human pathogens

OBJECTIVE@#To determine the potential antibacterial activity of ethyl acetate and aqueous extracts from Mentha longifolia L. (M. longifolia) and hydroalcoholic extract of Zataria multiflora Boiss. (Z. multiflora) against important human pathogens.@*METHODS@#Pseudomonas aeruginosa, Shigella dysenteriae, Klebsiella pneumoniae (K. pneumonia), Enterobacter cloacae, Salmonella typhi, Proteus mirabilis, Serratia marcescens, Bacillus cereus, Staphylococcus saprophyticus and Staphylococcus aureus were kinds of pathogenic bacteria to determine the antibacterial effect of aqueous and ethyl acetate extracts of M. longifolia and hydroalcoholic extract of Z. multiflora using broth microdiluation method.@*RESULTS@#The lowest minimum inhibitory concentration and minimum bactericidal concentration values for K. pneumonia and Pseudomonas aeruginosa (1.25 and 2.5 mg/mL) were observed by the hydroalcoholic extract of Z. multiflora and the lowest minimum inhibitory concentration and minimum bactericidal concentration values for K. pneumonia and Serratia marcescens (2.5 and 5 mg/mL) were observed by the aqueous extracts of M. longifolia.@*CONCLUSIONS@#In conclusion, it seems that Z. multiflora and M. longifolia extracts could inhibit the growth of all of the mentioned bacteria.

[Evaluation of antibacterial and antifungal effects of marine algae [gracilariaarcuata] of chabahar coasts, Iran]

Considering the increasing rate of drug-resistant strains among microorganisms, finding antimicrobial and antifungal compounds from natural materials, which certainly havefewer side-effects, has long been of interest to researchers. Hence, this study aimed to evaluate antibacterial and antifungal effects of ethanolic extract of red algae Gracilariaarcuata of Chabahar Coasts. After sampling, antimicrobial and antifungal effects of ethanolic extract of red algae Gracilariaarcuata against 5 bacterial strains of Proteus vulgaris, Vibrio cholera, Escherichia coli, Staphylococcus aureus, Listeria monocytogenes and one fungal species, Aspergillus flavus, were studied and the results were compared with standard antibiotics. Independent sample t-test and one-way ANOVA were used for comparison between groups, and Duncan test was used to assess differences between means. V. cholera had the highest sensitivity to red algae with an inhibition zone diameter of 11.25 +/- 0.35, so that there was a statistically significant difference compared to commercial antibiotic neomycin [p<0.05]. E. coli showed the highest resistance against ethanolic extract of the test algae. Red algae Gracilariaarcuata from Chabahar coasts has high antibacterial and antifungal properties

Antibacterial effect of myrtus communis hydro-alcoholic extract on pathogenic bacteria

Today, due to the changes in the form of the resistance of pathogenic bacteria, discovering new antimicrobial drugs is under study. So, the aim of this study is to evaluate the antimicrobial properties of the extract of the myrtle herb on some of pathogenic bacteria. Hydroalcoholic extract of the leaves of myrtle herb was evaluated at 4 concentrations including 10-80 mg/ml on four strains of pathogenic bacteria using penetrative dissemination method together with the measuring diameter of the growth inhibition zone; then the results were compared to four conventional antibiotics. The minimum inhibitory and bactericidal concentrations were studied using macro dilution method. Treatment by the concentration of 80 mg/ml extract of this herb showed the greatest effect on the bacterium Staphylococcus aureus and Vibrio cholera serotype Ogawa which had a significant difference with all other treatments and standard antibiotics [p< 0.05]. The extract showed no effect on the bacterium Pseudomonas aeruginosa and just concentration of 80 mg/ml showed a little effect on E. coli and other antibiotics had no significant effect except tetracycline which has little effect on this strain. Minimum inhibitory concentration was 0.2 mg/ml for bacterium Staphylococcus aureus [S. aureus] and the maximum for E.coli by 8 mg/ml. This study showed that under study bacteria were more resistant to the antibiotics and the extract of Myrtus communis leaves showed greatest antibacterial effect against S. aureus and V. cholerae cerotype Ogawa

[Study of antibacterial effect of Prosopis sp. hydro-alcoholic extract]

Increasing incidence of drug resistant microorganisms poses enormous threat to the human health and requires alternative sources of antimicrobial agents. Plants develop unique family of chemicals to protect themselves from various microbes. The aim of this study was to investigate antibacterial effect of Prosopis sp. hydro-alcoholic extract on some pathogenic bacteria. This study was conducted at Chabahar Maritime University. Leaf of Prosopis sp. was collected and the essence was extracted by hydro-alcoholic extraction method. The extract dried and 4 different concentrations of 10, 20, 40 and 80 mg/ml were prepared after autoclave. Extracts were examined on 4 different clinical bacteria by the Disc Diffusion Agar Method at 3 replicates. Minimum inhibitory concentration [MIC] and minimum lethal concentration [MLC] were determined by the serial dilution method. ANOVA and Duncan Multiple Range test was used to analysis data. Hydro-alcoholic extract showed antibacterial effect after autoclave. Concentrations of 40 and 80 mg/ml showed the best result on Staphylococcus aureus and had significant difference with other treatments and standard antibiotics [p<0.05]. Extracts didn't show any effect on Pseudomonas aeruginosa. Regarding Escherichia coli, concentration of 80 mg/ml had significant difference with other treatments and standard antibiotics [p<0.05]. Minimum MIC was 2 mg/ml for Staphylococcus aureus and Vibrio cholerae serotype ogava. MLC was in higher concentrations. This study showed that autoclave prepared new compounds which had antibacterial effect. Hospital acquired bacteria were resistance to common antibiotics. The Prosopis sp. extract had higher antibacterial effect on Staphylococcus aureus and Vibrio cholerae serotype ogava in comparison with antibiotics.

[ relationship between time management and academic achievements among bachelor and master students of Shiraz university and Shiraz university of medical sciences]

Introduction: The capability of applying time management skill, is an important factor in academic and non-academic achievements. This study was performed to investigate the relationship between time management and academic achievement of master and bachelor students of Shiraz University [SU] and Shiraz University of Medical Sciences [SUMS]

Methods: In this descriptive cross sectional study, 610 students were selected through cluster sampling. Data was gathered using a researcher-made questionnaire including items asking about individual skills, time management, and average score. The gathered information was analyzed by SPSS software using descriptive and inferential statistics

Results: The mean score of time management skill and also the average score was significantly higher among students of SUMS compared students of SU [p<0.001]. No significant difference was observed among male and female students considering time management skill but, in academic achievement, female students' scores were higher than male's [p<0.001]. MS students enjoyed a higher mean score considering individual skills of time management, all 4 aspects, and academic achievement [p<0.001]

Conclusion: The differences observed in time management skill was corresponding to differences in academic achievement scores. Therefore, it could be concluded that students' academic achievement is roughly related to time management and its application in academic life. It is recommended to plan for students' training on time management skills in order to enhance their accomplishments