Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran

Background and objective

Pressure ulcer (PU) is one of the important and frequent complications of hospitalization, associated with high treatment costs. The present study was conducted to determine the incidence of PU and its direct treatment costs for patients in intensive care unit (ICU) in Iran.

Bradykinin receptors of cerebral microvessels stimulate phosphoinositide turnover.

We examined by ligand binding methods whether bradykinin (BK) receptors exist in rat and pig cerebral microvessels, and in the cerebral cortex from which the microvessels were isolated. We found a high-affinity and saturable BK receptor site in both rat and pig cerebral microvessels, but not in their cerebral cortex. The maximal density of binding and the dissociation constant were 8.0 +/- 4.1 and 6.8 +/- 1.5 fmol/mg of protein and 47 +/- 24 and 150 +/- 8 pM (mean +/- SD) in cerebral microvessels of the pig and rat, respectively. The high-affinity specific binding of BK was effectively displaced by des-Arg0[Hyp3-Thi5-8,D-Phe7]BK, a specific B2 receptor antagonist, but not by des-Arg9[Leu8]BK, a specific B1 antagonist. We also demonstrated that BK increases phosphatidylinositol hydrolysis in cerebral microvessels of the rat and pig. This effect was also blocked by the B2, but not by the B1, antagonist. Increased phosphatidylinositol hydrolysis was manifested by a rapid transient increase in inositol trisphosphate and the later slow accumulation of inositol bisphosphate and inositol monophosphate. Preincubation of microvessels with phorbol ester, stable GTP analogs, pertussis toxin, or in Ca(2+)-free buffer did not influence BK activation of phosphatidylinositol hydrolysis. These results demonstrate the existence of BK receptors of the B2 subtype in brain microvessels, which may play an important role in modulation of the brain microcirculation, probably via increased phosphoinositide turnover.     

The MTT assay for chemosensitivity testing of human tumors of the central nervous system

In this study we assessed the influence of patient- and drug-specific parameters in the short-term MTT-chemosensitivity assay in 150 primary cell cultures derived from human brain tumors. In 45 patients the MTT assay was directly compared with the CFA (Colony Forming Assay). Resistance was 10-20% higher in the MTT assay than in the CFA, but there was a good agreement in both assays, that more malignant gliomas had a higher in vitro chemosensitivity against ACNU and BCNU. Overall the results demonstrate, that there is no uniform correlation between the in vitro chemosensitivity and the histopathological classification of the tumors, which corresponds well to the clinical situation. On the basis of this study we suggest prospective clinical trials with the MTT assay in human brain tumors.     

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran

Purpose: Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. Methods: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset. Results: The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003). Conclusion: Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.     

Diagnosis and surgery of brachial plexus injuries

The surgical outcome of traumatic injuries of the brachial plexus (BP) depends on the following parameters: 1) accurate preoperative diagnosis of cervical root avulsion; 2) time interval between injury and surgery; 3) delicate handling of the nerve tissue; and 4) postoperative physiologic training. This report is based on a 15-year experience in brachial plexus surgery and is supported on the grounds of two major studies. In a prospective study, the authors controlled for the reliability of preoperative radiologic diagnosis by myelo-CT and MRI scans for 40 patients, to evaluate the integrity of the intraspinal cervical roots after brachial plexus injury. Surgical inspection via a cervical hemilaminectomy proved the accuracy of 85 percent and 52 percent of CT myelography and MRI, respectively. Retrospective statistical analyses were carried out of the long-term surgical results of 54 patients with traumatic injuries of the BP who received a grafting procedure between cervical roots C5 or C6 and the musculocutaneous nerve. Patients operated on up to 6 months after trauma showed a better result than patients operated on later than 12 months after trauma (p<0.05). In contrast, grafting between cervical root C5 or C6 and the use of different sural-graft sizes to reconstruct the musculocutaneous nerve demonstrated no statistically significant difference in the final outcome.     

N-nitro- -arginine methylester is protective against ethanol-induced gastric damage in cholestatic rats

In this study the effect of nitric oxide (NO) synthesis inhibition on ethanol-induced gastric damage was evaluated in bile duct-ligated, sham-operated and unoperated rats. The animals were injected intraperitoneally with saline, -arginine (200 mg/kg) or N^G-nitro- -arginine methylester ( -NAME) in doses of 5, 15 and 30 mg/kg, 30 min before ethanol administration. The animals were killed 1 h after ethanol administration and their stomachs were removed for measurement of gastric mucosal damage. The results showed that -NAME significantly enhanced the development of gastric mucosal lesions in sham-operated and unoperated rats, while in bile duct-ligated animals, -NAME decreased and -arginine enhanced the potentiation of ethanol-induced gastric mucosal damage. The plasma level of nitrite and nitrate was also measured and was significantly higher in bile duct-ligated rats than in control groups. The results suggest that inhibition of NO synthase with -NAME has different effects on ethanol-induced gastric damage in cholestatic groups and in normal rats and that these effects can be explained by overproduction of NO in bile duct-ligated animals.     

A Three-Dimensional Developmental Measurement of the Temporomandibular Joint

This article presents an anthropologic study of the growth and developmental changes that occur within the bony components of the temporomandibular joint. The material used was provided by the Department of Physical Anthropology of the Smithsonian Institution Museum of Natural History, Washington, D.C.

Based on a Class I normal occlusion, the authors selected a total of 100 skulls with mandibles from the Aleutian Islands collection. These skulls, which were from 2-to 20-year-old subjects, were divided into four age groups. The approximate age of each skull was determined by charts based on eruption sequence, the number of permanent teeth present, and suture closure.

Anatomic landmarks and anthropologic techniques were used to make direct linear measurements on the bony components of the 200 temporomandibular joints. Three-dimensional measurements were made on the condyles, fossae, and articular eminences of each skull.

Several variables were chosen for statistical analysis: (1) The size of the individual components of the TMJ within each age group. (2) The changes with age in the anteroposterior, medial-lateral, and vertical dimensions of the individual TMJ components. (3) Asymmetries in size between the right and the left TMJ components. (4) The interrelationship of the individual TMJ components as seen in their growth changes.

The results obtained from the various measurements used in this study were compared to the findings of a number of earlier studies.