Safety and efficacy of lidocaine plus epinephrine on intraoperative bleeding in abdominal myomectomy: A double-blind clinical trial.

Background: Uterine fibroid is a common benign pelvic tumor and abdominal myomectomy may cause excessive intraoperative bleeding, which may lead to adverse outcomes. Objective: This study was planned to evaluate the effectiveness of the injection of lidocaine plus epinephrine to reduce intraoperative bleeding in abdominal myomectomy. Methods: During October 2019 and May 2020, 60 eligible women with uterine fibroids were enrolled in a randomized controlled trial. Our patients were divided into two groups of lidocaine plus epinephrine defined as Group L and placebo defined as Group P. In group L, lidocaine 3 mg/kg plus 0.5 ml of adrenaline which reached to 50 cc with saline solution and in group P, 50 ml of normal saline was used. Both the combined solution and normal saline were infiltrated to the serous and myometrium above and around the fibroid before incision. Patients' demographic data, total operative time, hemoglobin changes, and the degree of surgical difficulty were evaluated and compared between the two groups. Results: There was no significant difference between the two groups in terms of demographic data. Hemoglobin changes (p < 0.0001) and the degree of surgery difficulty (p = 0.01) were significantly lower in Group L compared with Group P. In each group the drop in hemoglobin levels from baseline to 4 h postoperatively was significant (p < 0.0001). A significantly meaningful correlation was reported between hemoglobin changes and the degree of surgery difficulty with the size of the uterine and fibroids (p < 0.05). While a negative correlation was found regarding gravidity and surgery difficulty (r = -0.413, p = 0.02). Surgery duration was longer in Group P compared with Group L 70.66 ± 19.85 versus 66.16 ± 14.48, respectively, but with no significant difference (p = 0.32). No significant adverse reaction or serious complication was reported in the two groups. Hemodynamic parameters were kept in the normal range throughout the surgery. Conclusion: A combination of lidocaine plus epinephrine during abdominal myomectomy appears to be a safe and effective method in reducing blood loss.

The Effect of an Empowerment Program on the Health-promoting Behaviors of Iranian Women Workers: A Randomized Controlled Trial.

OBJECTIVES: The workplace is an ideal place for encouraging health-promoting behaviors. Therefore, the aim of the present study was to determine the effect of an empowerment program on the health-promoting behaviors of women workers. METHODS: This randomized clinical trial was conducted with 80 women workers employed at a food packaging facility in 2020. The subjects were selected using convenience sampling and were classified into intervention and control groups using block randomization. An empowerment program for women workers was conducted across 6 sessions based on an empowerment model. Data collection tools included a demographic questionnaire and the Health Promoting Lifestyle Profile-II, which participants completed both before the program and 8 weeks after the last session. Data analysis was performed in SPSS version 16 using descriptive analysis and inferential statistics. RESULTS: There were no significant differences between the 2 groups in various health-promoting behaviors before the program. However, the intervention group's scores for nutrition (34.92±1.09 vs. 27.87±4.23), physical activity (24.40±2.94 vs. 17.40±5.03), stress management (26.35±2.60 vs. 23.05±4.27), spiritual growth (34.02±3.00 vs. 30.22±5.40), interpersonal relationships (30.82±2.38 vs. 27.60±4.61), and health responsibility (31.60±2.71 vs. 28.22±4.59) were significantly higher than the control group's 8 weeks after the program had ended. Moreover, there was a significant difference in the total score of health-promoting behaviors for the intervention group compared to the control group (179.00±9.22 vs. 151.42±20.25, p=0.001). CONCLUSIONS: An empowerment program for women workers led to significant improvements in the health-promoting behaviors of the participants. Similar programs can ultimately improve women's health in the workplace.

Whole genome sequence of Pantoea agglomerans ANP8, a salinity and drought stress-resistant bacterium isolated from alfalfa (Medicago sativa L.) root nodules.

Environmental abiotic stress conditions, especially drought and salinity, are currently the major factors that reduce crop yields worldwide. It has been reported that plant-associated beneficial bacteria, especially strains resistant to abiotic stresses that could maintain their efficiency under environmental challenging conditions, can contribute to alleviate abiotic stresses of host plants. In this study, we presented the assembly of the whole genome of Pantoea agglomerans ANP8, a plant growth-promoting bacterium resistant to salinity and drought stresses. The draft genome assembly contained 4,713,172 bp with 4586 predicted genes. A primary draft genome with a total of 5,115,548 bp and 1916 contigs was obtained (longest contig length being 485,272 bp and smallest contig being 112 bp). Following assembly upgrades, 68 scaffolds and 70 contigs with lengths ≥ 500 bp and an N50 = 209,657 bp were obtained. Number of 5554 and 5472 open reading frames longer than 50 codons were observed in the direct strand and in the reverse strand, respectively. Due to the multiple plant growth-promoting characteristics of this bacterium, genes involved in various indole-3-acetic acid production pathways, e.g., indole-3-pyruvic acid and indole-3-acetamide pathways, were found in the bacterium's genome. In addition, multiple copies of the gcd gene, most important enzymes involvement in the solubilization of phosphates, glucose dehydrogenase, were also observed in this genome. The study provides new genomic information to help understanding the way of action of a stress-tolerant plant growth-promoting bacterium.

Mining alfalfa (Medicago sativa L.) nodules for salinity tolerant non-rhizobial bacteria to improve growth of alfalfa under salinity stress.

There are fewer reports on plant growth promoting (PGP) bacteria living in nodules as helper to tolerance to abiotic stress such as salinity and drought. The study was conducted to isolate rhizobial and non-rhizobial drought and salinity tolerant bacteria from the surface sterilized root nodules of alfalfa, grown in saline soils, and evaluate the effects of effective isolates on plant growth under salt stress. Based on drought and salinity tolerance of bacterial isolates and having multiple PGP traits, two non-rhizobial endophytic isolates and one rhizobial endophytic isolate were selected for further identification and characterization. Based on partial sequences of 16 S rRNA genes, non-rhizobial isolates and rhizobial isolate were closely related to Klebsiella sp., Kosakonia cowanii, and Sinorhizobium meliloti, respectively. None of the two non-rhizobial strains were able to form nodules on alfalfa roots under greenhouse and in vitro conditions. Co-inoculation of alfalfa plant with Klebsiella sp. A36, K. cowanii A37, and rhizobial strain S. meliloti ARh29 had a positive effect on plant growth indices under salinity stress. In addition, the single inoculation of non-rhizobial strains without rhizobial strain resulted in an increase in alfalfa growth indices compared to the plants non-inoculated and the ones inoculated with S. meliloti ARh29 alone under salinity stress, indicating that nodule non-rhizobial strains have PGP potentials and may be a promising way for improving effectiveness of Rhizobium bio-fertilizers in salt-affected soils.

The Effect of Parental Medical History on the Prevalence of Cerebrovascular Diseases in Their Children in an Iranian Population.

INTRODUCTION: Still a controversial issue, family history is known as a risk factor for the development of Cerebrovascular Diseases (CVD). In this study, we aimed to evaluate the relationship between parental history and risk of CVD in their offspring in Iranian population. METHODS: Isfahan Cohort Study (ICS) included total 6504 healthy participants which were randomly selected through a two-stage cluster sampling method from three districts. The participants were followed prospectively for 10 years. The diagnosis of CVD were confirmed by expert panelist. Clinically validated history of CVD was established for definition of parental history of CVD. Types of history were categorized into paternal, maternal, both parents, and no history. RESULTS: The prevalence of CVD is generally higher among female offspring compared with male ones (P<0.001). The relative risk of CVD with maternal history was not significant (95%CI=0.95-2.29). By adjusted model analysis, history of CVD in both parents affected the risk of CVD in their male children (RR=2.13, P=0.033, 95%CI). By crude model analysis, maternal history of CVD (P=0.047), history of CVD in both parents (P=0.032), and maternal history of hypertension (P=0.005) were determined as risk factors of CVD in offspring. Indeed, the mean age of CVD in offspring decreases based on this order: history of hypertension in parents, paternal history of CVD in both parents, maternal history of CVD, and no history (P<0.001). CONCLUSION: Early and regular screening for CVD development is necessary in female offspring of the families with the present history of CVD from maternal side. This group are at risk and should be considered as the target group for screening and taking preventive measures.

The sustainability of interventions of a community-based trial on children and adolescents' healthy lifestyle.

BACKGROUND: Sustainability is the core of a successful health-related intervention program. This study was conducted to evaluate the sustainability of interventions of the Heart Health Promotion from Childhood (HHPC) project, one of the 10 interventional projects of the Isfahan Healthy Heart Program. METHODS: The evaluation of HHPC included administrating surveys to 500 elementary and middle, and 500 high school students. The study participants were randomly selected from all schools in Isfahan. The questionnaires were administered by interviews to evaluate the sustainability of interventions. RESULTS: The results of interviews showed that interventions were sustainable in 100% of elementary school, 99% of middle school, and 87% of high school students. Training of healthy lifestyle behaviors was significantly higher in all-girls middle schools (P < 0.001). Daily morning exercise was more frequent in girls high schools (P < 0.001), while selling unhealthy food was more frequent in boys high schools (P < 0.001). The participants attributed the success of the program mostly to students' agreement and cooperation. CONCLUSION: Even though 5 years have passed since the end of the HHPC project, many of the interventions have been continued at the schools, often because healthy behaviors have become institutionalized in the target population. However, now all schools have the same level of sustainability, especially the middle and high schools, and all-boys schools. Therefore, it is important for future projects to place additional emphasis on these institutions for future school-based interventions.

Is the association between salt intake and blood pressure mediated by body mass index and central adiposity?

OBJECTIVE: To assess the amount of salt intake among normotensive (NT) and prehypertensive (PHT) subjects and to determine whether the association between salt intake and blood pressure is correlated with body weight and waist circumference (WC) or is independent. METHODS: A total of 806 NT and PHT subjects from Isfahan Healthy Heart Program (IHHP) were enrolled in the study. A standard questionnaire was used to assess sociodemographic characteristics. The amount of salt intake was measured by the 24-hour urine collection method. Blood pressure, height, weight, and WC were measured based on standard protocols. RESULTS: The mean ages (± SD) of NT and PHT subjects were 35.9 (± 11.9) and 44.7 (± 12.5) years, respectively (P < 0.001). The mean values of body mass index (BMI) and WC were greater among PHT than NT subjects (BMI: 27.9 ± 3.8 vs. 25.1 ± 4.3 kg/m2; P < 0.001 and WC: 90.2 ± 8.6 vs. 81.2 ± 11.2 cm; P < 0.001, respectively). PHT subjects had higher amount of salt intake than NT ones (10.3 ± 6.2 vs. 12.7 ± 7.1 g/d, respectively; P = 0.003). Odds ratio (OR) for being PHT increased significantly across the tertiles of salt intake in crude model and sociodemographic- adjusted model. Further adjustment for BMI and WC values weakened the OR for being PHT and showed nonsignificant trend (OR (and 95% CI) for BMI across tertiles of salt intake: 1, 1.26 (0.59 - 2.69), 1.89 (0.93 - 3.81); P = 0.063 and OR (and 95% CI) for WC across tertiles of salt intake: 1, 1.22 (0.58 - 2.57), 1.79(0.89 - 3.56); P = 0.082). CONCLUSION: The findings of this study suggest that the association between salt intake and blood pressure is related to body weight and WC.

Does significant weight reduction in men with coronary artery disease manage risk factors after cardiac rehabilitation program?

BACKGROUND: Vast majority of cardiac patients who refer to cardiac rehabilitation program (CRP) are obese and obesity is associated with coronary heart disease (CHD). So, the aim of this study is to investigate the effects of CRP on obesity indexes, lipid profiles, and functional capacity (FC) in obese men with CHD and to explore whether significant weight reduction affected these risk factors and FC or not. MATERIALS AND METHODS: In an observational study, we evaluated 536 patients, including 464 non-obese men and 72 obese men. All participants completed CRP for 2 months; then, obese patients were divided into two groups: patients with weight reduction ≥ 5% and patients who didn't have significant weight reduction. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes independent t-tests and paired t-tests were used. RESULTS: Results showed following CRP, non-obese men had significant improvement in obesity indexes (P = 0.00), lipid profiles (P < 0.05), and FC (P = 0.00) and in obese men, favorable improvement were seen in obesity indexes (P = 0.00), FC (P = 0.00), and total cholesterol (P = 0.02). Comparing two groups revealed that there were significant differences in obesity indexes, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. In addition, comparing subgroup of obese patients revealed that there were significant differences in FC (P = 0.00) and low-density lipoprotein cholesterol/ high-density lipoprotein cholesterol ratio (P = 0.04). CONCLUSION: CRP has more advantage in management of obesity, FC, and lipid profiles in both obese and non-obese patients. Also, weight reduction may cause greater improvement in FC and fitness levels in obese men with CHD.

The Relationship between Weight and CVD Risk Factors in a Sample Population from Central Iran (Based on IHHP).

BACKGROUND: Atherosclerosis is one of the leading causes of mortality all around the world. Obesity is an independent risk factor for atherosclerosis and cardiovascular diseases (CVD). In this respect, we decided to examine the effect of the subgroups of weight on cardiovascular risk factors. METHODS: This cross-sectional study was done in 2006 using the data obtained by the Iranian Healthy Heart Program (IHHP) and based on classification of obesity by the World Health Organization (WHO). In this study, the samples were tested based on the Framingham risk score, Metabolic Measuring Score (MMS) and classification of obesity. Chi-square and ANOVA were used for statistical analysis. RESULTS: 12514 people with a mean age of 38 participated in this study. 6.8% of women and 14% of men had university degrees (higher than diploma). Obesity was seen in women more than men: 56.4% of women and 40% of men had a Body Mass Index of (BMI) ≥ 25 Kg/m2. 13% of the subjects had FBS > 110 and13.9% of them were using hypertensive drugs. In this study, we found that all risk factors, except HDL cholesterol in men, increased with an increase in weight. This finding is also confirmed by the Framingham flowfigure for men and women. CONCLUSION: One of every two Americans, of any age and sex, has a Body Mass Index of (BMI) ≥ 25 Kg/m2. Obesity associated CVD and other serious diseases. Many studies have been done in different countries to find the relationship between obesity and CVD risk factors. For example, in the U.S.A and Canada they found that emteropiotic parameters, blood presser and lipids increased by age(of both sexes). Moreover, another study done in China, which is a country in Asia like Iran, shows that BMI has an indirect effect on HDL cholesterol, LDL cholesterol and triglyceride. This data is consistent with the results of the current study. However, In China they found that this relationship in men is stronger than women, but our study reveals the opposite.

The impact of a 6-year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: experiences from the Isfahan healthy heart program.

OBJECTIVES: We aimed to evaluate the changes over time in the prevalence, awareness, treatment, and control rate of hypertension in intervention and reference areas of a comprehensive community trial with reference area. METHODS: Data from independent sample surveys before and after implementation of the program (2001 vs.2007) were used to compare differences in the intervention and references areas over time. Hypertension was defined as blood pressure ≥140/90 mmHg in non-diabetic patients and ≥130/80 mmHg in diabetic individuals and or taking antihypertensive medications. Interventional activities included educational strategies at population level as well as for hypertensive patients, their families and health professionals. RESULTS: The study population of the baseline survey included 6175 (48.7% males) in the interventional area and 6339 (51.3% male) in the reference area. The corresponding figures in the post-intervention phase was 4717 (49.3% male) in the interventional area and 4853 (50.7% male) individuals in the reference area. The prevalence of hypertension had a non-significant decrease from 20.5%to 19.6%, in the interventional area whereas in the reference area, it increased from 17.4% to 19.6% (P = 0.003). If we consider Bp ≥ 140/90 in diabetic and non-diabetic patients as hypertension definition, the prevalence of hypertension in the interventional areas had a non-significant decrease from 18.9% in 2001 to 17.8% in 2007, whereas in the reference area, it had a significant rise from 15.7% to 17.9% (P = 0.002) respectively. Awareness, treatment and control rates of hypertension had better improvement in urban and rural part of the interventional area compared to reference area. The awareness, treatment, and control rates of hypertension increased significantly in the age groups of more than 40 years, as well as in all groups of body mass index in interventional areas without significant change in the reference area. Mean systolic blood pressure of study population in the interventional area decreased from 116.13 ±19.37 to 112.92 ± 18.27 mmHg (P < 0.001) without significant change in reference area. CONCLUSIONS: This comprehensive and integrated program of interventions was effective in tackling with the prevalence of hypertension, and may improve the awareness, treatment and control rates of this disorder in a developing country setting.