Surface fluids effects on the bladder tissue characterisation using electrical impedance spectroscopy

The electrical impedance of the human urinary bladder in both benign and malignant areas can be measured using an electrical impedance spectroscopy system (EIS). Glycine is usually used in the bladder surgery in the theatre to make an insulation medium for electro-surgery and the extension of the mucosa. In addition, a saline solution is usually used to wash the inside of the bladder after bladder surgery and it is used to extend the bladder tissue mucosa. Therefore, the effect of glycine and the saline solution that fills the bladder is important, because it was expected that the application of common surface fluids (air, saline solution and glycine solution) in the bladder epithelium would affect the measured electrical impedance of the urothelium, to differentiate the malignant area from the normal bladder tissue. In this study, bladders were removed from the patients' bodies and then were moved from theatre to the histopathology department immediately after excision. These bladder samples were then opened and pinned to a corkboard to take the impedance readings, using the impedance spectroscopy system. Following this, the bladder and corkboard were completely submerged in a saline solution and readings were taken at about 1cm from the sutures. Subsequently, this procedure was repeated with the bladder submerged in glycine and then air, respectively. According to the statistical work, these fluids were found to have a significant effect on the measured impedance of the bladder tissue in benign and malignant areas. Furthermore, the best fluid between air, glycine and saline, to measure the impedance of the urinary bladder, is air (P<0.0001).     

Gender-specific differences in the association of adiponectin gene polymorphisms with body mass index

OBJECTIVE: Adiponectin gene polymorphisms are associated with obesity, metabolic syndrome and type 2 diabetes (T2D). The study evaluated possible associations of +45T/G and -11391G/A adiponectin gene polymorphisms with body mass index (BMI), waist circumferences (WC), and blood pressure in diabetic and non-diabetic Iranians. METHODS: This cross-sectional study involved two groups of subjects: 243 diabetic patients and 173 non-diabetic subjects recruited from Rafsanjan city in the south-east of Iran. RESULTS: No significant association was found between +45T/G and -11391G/A adiponectin gene polymorphisms and systolic or diastolic blood pressure. However, male carriers of the TT genotype of +45T/G had a significantly higher mean BMI than male GG homozygotes (p = 0.018). Also, male carriers of the GG genotype of -11391G/A had significantly higher mean BMI than male GA or AA homozygotes (p = 0.041). Female carriers of the GG genotype of -11391G/A had significantly higher mean WC than female GA or AA homozygotes (p = 0.038). CONCLUSIONS: We observed a significantly higher BMI in women, and GA or AA carriers of -11391G/A polymorphism. Also, there was a significantly lower WC in females and GG carriers of +45T/G. These results point to a gender-specific impact of the studied genotypes on BMI and WC.     

Gastrointestinal malformations in Gorgan,North of Iran: epidemiology and associated malformations

The aim of this prospective study was to evaluate the prevalence and pattern of gastrointestinal malformations (GIM) among Iranian newborns in Gorgan, North of Iran. From 1998 through 2003, 37,951 live births in Dezyani hospital in Gorgan, North of Iran, were screened for gastrointestinal malformations. Clinical and demographic factors of diagnosed cases were recorded in a pre-designed questionnaire for analysis; sex, ethnicity, type of GIM and associated anomalies. The overall prevalence rate of gastrointestinal malformations was 10 per 10,000 births. The imperforate anus (5 per 10,000) was the commonest birth defect in gastrointestinal tract. The prevalence rate of GIM was 8.2 per 10,000 in males and 10.7 per 10,000 in females. According to the parental ethnicity, the prevalence rates of GIM were 6.7, 15.8 and 17.6 per 10,000 in Fars, Turkman, and Sistani, respectively. There were eight cases (21%) with associated anomalies. The prevalence rate of GIM in North of Iran is not similar to the previous studies in Iran and Middle East and ethnic background may be a causative factor in the rate of GIM in this area.     

Effects of Vitamin E and Zinc Supplementation on Antioxidants in Beta thalassemia major Patients

Objective

In beta thalassemic patients, tissue damage occurs due to oxidative stress and it happens because of the accumulation of iron in the body. This study was conducted to determine the effect of zinc and vitamin E supplementation on antioxidant status in beta-thalassemic major patients.

Methods

This double blind randomized clinical trial was carried out on 120 beta thalassemic patients older than 18 years. Patients were randomly categorized in four groups. Zinc (50mg/day) and vitamin E (400mg/day) supplements were administered for former and latter group, respectively. In the third group both supplements were administered in similar doses. The fourth (control) group received no supplement. The effect of supplementations on serum zinc and vitamin E, superoxide dismutase (SOD), glutathione peroxidase (GPX), total antioxidant capacity (TAC) and body mass index (BMI) were measured at the beginning and the end of the study.

Findings

Serum zinc levels in group 1 and 3 were significantly increased (P<0.007 and P<0.005, respectively). Serum vitamin E levels in group 2 and 3 were also increased significantly (P<0.001). Mean GPX activity in group1, 2 and 3 decreased significantly (P<0.015, P<0.032 and P<0.029, respectively). Mean SOD activity and TAC did not show significant change after supplementation. BMI had significant increase in all treated groups (P<0.001).

Conclusion

Our results suggest that beta thalassemic patients have enhanced oxidative stress and administration of selective antioxidants may preclude oxidative damage.     

Selective Toxicity of Persian Gulf Sea Cucumber (Holothuria parva) and Sponge (Haliclona oculata) Methanolic Extracts on Liver Mitochondria Isolated from an Animal Model of Hepatocellular Carcinoma

Background:

Natural products isolated from marine environments are well known for their pharmacodynamic potential in diverse disease treatments, such as for cancer or inflammatory conditions. Sea cucumbers are marine animals of the phylum Echinoderm and the class Holothuroidea, with leathery skin and gelatinous bodies. Sponges are important components of Persian Gulf animal communities, and the marine sponges of the genus Haliclona have been known to display broad-spectrum biological activity. Many studies have shown that sea cucumbers and sponges contain antioxidants and anti-cancer compounds.

Objectives:

This study was designed to determine the selective toxicity of Persian Gulf sea cucumber (Holothuria parva) and sponge (Haliclona oculata) methanolic extracts on liver mitochondria isolated from an animal model of hepatocellular carcinoma, as part of a national project that hopes to identify novel potential anticancer candidates among Iranian Persian Gulf flora and fauna.

Materials and Methods:

To induce hepatocarcinogenesis, rats were given diethylnitrosamine (DEN) injections (200 mg/kg i.p. by a single dose), and then the cancer was promoted with 2-acetylaminofluorene (2-AAF) (0.02 w/w) for two weeks. Histopathological evaluations were performed, and levels of liver injury markers and a specific liver cancer marker (alpha-fetoprotein), were determined for confirmation of hepatocellular carcinoma induction. Finally, mitochondria were isolated from cancerous and non-cancerous hepatocytes.

Results:

Our results showed that H. parva methanolic extracts (250, 500, and 1000 µg/mL) and H. oculata methanolic extracts (200, 400, and 800 µg/mL) increased reactive oxygen species (ROS) formation, mitochondrial membrane potential (MMP), mitochondrial swelling, and cytochrome c release in the mitochondria obtained from cancerous hepatocytes, but not in mitochondria obtained from non-cancerous liver hepatocytes. These extracts also induced caspase-3 activation, which is known as a final mediator of apoptosis, in the hepatocytes obtained only from cancerous, not non-cancerous, rat livers.

Conclusions:

Our results suggest that H. parva and H. oculata may be promising therapeutic candidates for the treatment of HCC, following further confirmatory in vivo experiments and clinical trials.     

The role of clinical pharmacist to improve medication administration through enteral feeding tubes by nurses

Background As a common practice, medications are given in addition to nutrients through enteral catheters especially in critically ill patients. Nurses are primarily responsible to administer medications in this manner. The correct drug delivery via enteral tubes requires special skills. Objective This study was designed to evaluate effectiveness of clinical pharmacist-led educational program in progressing nurses' knowledge and practice regarding medications delivery via enteral catheters. Setting This study has been performed in two teaching hospital affiliated to Tehran University of Medical Sciences. Methods This is a case-control, interventional study. At first, a knowledge and practice questionnaire regarding drug administration trough enteral feeding tube by intensivist nurses was prepared. This questionnaire was filled by each nurse at pre-intervention phase of the study. Then, the clinical pharmacists provided educational programs including preparing evidence-based booklet and classes for case group nurses. Nurses in case and control groups were evaluated again after 3?months. At pre- and post-intervention phases nurses were observed regarding their practice to administer drugs via enteral tubes as well. Main outcomes Mean scores of knowledge and practice questions as well as percent of nurses with correct answers were compared between pre- and post-intervention phases in case and control groups. Results The mean scores of knowledge and practice questions significantly increased in the case group but decreased or remained unchanged in the control group. In contrast to control group, the percent of nurses with correct answers to each domain of knowledge and practice questions increased significantly in the case group. Conclusion This study showed that nurses did not have sufficient baseline knowledge about rules of drug administration via enteral feeding tubes; however, integrated educational program by clinical pharmacists that focus on promoting correct administration of drugs via enteral feeding catheters significantly improved knowledge and practice of nurses. A theory-practice gap was found in this study that may be related to the authority of physicians not nurses in ordering rules for medication administration through enteral catheters.     

Global and regional prevalence of strabismus: a comprehensive systematic review and meta-analysis

ABSTRACT

Purpose: Despite the importance of information on the prevalence of strabismus, which can be effective in planning preventive and curative services, no study has addressed its prevalence comprehensively. In this study, a systematic search was done to estimate the regional and global prevalence of strabismus in different age and sex groups and factors affecting prevalence heterogeneity.

Methods: A comprehensive and systematic search was done in different international databases, including Web of Science, Scopus, PubMed, Embase, etc. to find published articles on the total prevalence of strabismus and the prevalence of exotropia and esotropia. A binomial distribution was used to calculate the prevalence and 95% confidence interval (CI). The Cochran’s Q-test and I² were applied to evaluate heterogeneity and a random-effects model was used to assess the pooled prevalence. The Begg’s test was administered to investigate publication bias and finally, a meta-regression method was applied to determine the factors affecting the heterogeneity among studies.

Results: Of 7980 articles, 56 articles with a total sample size of 229,396 were analyzed. Many of these articles (n = 14) were from the Regional Office for the Americas. The estimated of pooled prevalence (95% CI) of any strabismus, exotropia, and esotropia was 1.93% (1.64–2.21), 1.23% (1.00–1.46), and 0.77% (0.59–0.95), respectively. The heterogeneity in prevalence of strabismus and its subtypes according to I² was above 95% (p value <.001 for all). Age had a direct effect on heterogeneity in the prevalence of exotropia (b: 3.491; p: 0.002). Moreover, WHO region had a significant direct effect on heterogeneity in the prevalence of strabismus (b: 0.482; p < .001) and esotropia (b: 0.168; p: 0.027), and publication year had a significant direct effect on heterogeneity in the prevalence of exotropia (b: 0.059; p: 0.045). Sample size and publication year did not have any association with strabismus nor with other variables. There was no publication bias according to the Begg’s test.

Conclusion: The prevalence of strabismus varies widely in the world. As for factors affecting heterogeneity in the prevalence of strabismus, the results showed that age affected heterogeneity in the prevalence of exotropia, WHO region affected heterogeneity in the prevalence of strabismus and esotropia, and publication year affected heterogeneity in the prevalence of exotropia. Information about the global prevalence of strabismus can help health care planners design interventions and prioritize resource allocation.     

The effect of orally administered ketamine on requirement for anesthetics and postoperative pain in mandibular molar teeth with irreversible pulpitis

Achieving successful anesthesia and pain control in a predictable, efficient manner is a challenge in the endodontic treatment of vital inflamed lower molars. The aim of this study was to evaluate the effect of oral ketamine on the dosage of local anesthetics required and postoperative pain management for irreversibly inflamed mandibular molars. In this randomized double-blind placebo-controlled clinical trial, 36 patients with irreversibly inflamed mandibular molars were randomly divided into two groups of 18. Ten mg of ketamine dissolved in 20 ml of fruit juice was administered orally to patients in the experimental group. The control group was given 20 ml of fruit juice alone as a placebo. After 30 min, inferior alveolar nerve block (IANB) anesthesia was induced using one cartridge of 2% lidocaine and 1:100000 epinephrine. Teeth were tested after 5 to 10 min using an electrical pulp tester. In patients showing a positive response, another IANB injection was applied, and the total number of anesthetic cartridges used was recorded. Postoperative pain was evaluated using a visual analogue scale (VAS). In addition, use of analgesic in the first 24 h after treatment was monitored using a questionnaire. Data were analyzed by t test using SPSS software. There were no significant differences in age or gender between the two groups. The number of anesthetic cartridges used in the ketamine group was significantly less than that in the control group (P = 0.003). Furthermore, postoperative pain in the ketamine group was significantly lower (P = 0.019). Also the number of analgesic tablets taken in the ketamine group was significantly lower (P = 0.011). It can be concluded that a low dose of ketamine might be beneficial for enhancing the effect of local anesthetics.     

Maternal Folate and Vitamin B12 Status and Neural Tube Defects in Northern Iran: A Case Control Study

Objective

This study was conducted to determine the serum level of folic acid and vitamin B12 in neural tube defects pregnancies (NTD) and healthy controls in Northern Iran.

Methods

This case-control study was performed on women with neural tube defects pregnancies and controls with unaffected pregnancies in Northern Iran during 2006. Twenty three pregnant women whose pregnancies were diagnosed as NTD by a second-trimester ultrasonographic examination were recruited as cases. The control group (n=23) consisted of women who were selected among socio-economic status (SES) matched women who had a normal targeted ultrasound during the second trimester with documented normal fet al outcome. Fetal NTD was suspected with targeted second-trimester ultrasound during the 16^th week of gestation and confirmed with high maternal serum α-fetoprotein levels. Folate, vitamin B₁₂, homocysteine and alpha fetoprotein were evaluated after target ultrasonography.

Findings

Serum alpha fetoprotein level (mean±SD) in cases and controls was 120.2±64.1 and 50±33.5 iu/ml, respectively (P<0.05). The mean±SD folate in cases and controls was 8.4±4.2 versus 9.3±4.2 ng/ml, respectively. This difference was not significant. Folate deficiency was found in 30.4% of the cases and 13% of the controls (OR=2.9, 95%: 0.54–19.8). Vitamin B12 deficiency was found in 13% of cases and 17.7% of the controls (OR=0.7, 95%: 0.1-4.9).

Conclusion

This study showed that the probability of having a newborn with NTDs in maternal folate deficiency is three times higher than with normal folate in Northern Iran.