Antinociceptive and Antihyperglycemic Effects of Melissa officinalis Essential Oil in an Experimental Model of Diabetes

Objective

The efficacy of oral administration of Melissa officinalis essential oil (MOEO) on hyperalgesia was investigated using the formalin test in streptozotocin (STZ)-induced diabetic rats.

Materials and Methods

Animals were divided into control, MOEO-treated control (0.01, 0.02 and 0.04 mg/day), diabetic and MOEO-treated diabetic (0.01, 0.02 and 0.04 mg/day) groups. Nociceptive testing was performed on male adult Wistar rats 4 weeks after the onset of hyperglycemia. At the end of the experiment, all rats were weighed and plasma glucose measurements were performed.

Results

Diabetes was associated with significant hyperalgesia during both phases of the formalin test. MOEO (0.04 mg/day) completely reversed hyperalgesia in diabetic rats, while MOEO (0.02 and 0.04 mg/day) caused less intensive nociceptive behaviors during both phases of the test in control rats. MOEO at both high doses restored euglycemia and reduced the body weight of treated diabetic animals compared to untreated diabetic animals. The 0.01-mg dose of MOEO did not alter pain responses in the control or diabetic groups compared to their respective controls.

Conclusions

This study shows that chronic administration of MOEO displays efficacy in an experimental model of diabetic hyperalgesia. MOEO may therefore show promise as a treatment for painful diabetic neuropathy.Key Words: Hyperalgesia, Diabetes, Melissa officinalis, Rats     

Clinical and obstetric characteristics of pregnant women with Covid-19: A case series study on 26 patients

ObjectiveTo evaluate the clinical characteristics and outcomes of pregnant women with Covid-19.Materials and methodsThis case series study was performed to investigate demographic, clinical and obstetric characteristics of 26 pregnant women with COVID-19 referring to a university hospital of Kashan during the epidemic of COVID-19 (March to May 2020).ResultsThe mean gestational age of the patients at admission and delivery was 31.8 ± 5.2 and 36.3 ± 3.4 weeks, respectively. The most common symptoms were fever (96.2%) followed by dyspnea and cough (30.8%). The findings of lung CT scan showed abnormalities confirming the pneumonia in 22 patients (84.6%). Cesarean section was performed in 69.2% of the mothers. The most common maternal–fetal outcome was preterm delivery (38%). Two mothers were transferred to the ICU due to deterioration in clinical condition and they underwent mechanical ventilation without any maternal death. The most common neonatal outcomes were prematurity (38%) and low birth weight (34.6%). No cases of confirmed COVID-19 were observed in the neonates.ConclusionClinical manifestations and laboratory and radiographic findings in pregnant women with COVID-19 are similar to the general population. Common outcomes of pregnancy and delivery in mothers included increased rate of preterm delivery and cesarean section. The most prevalent neonatal outcomes included prematurity and LBW. Careful monitoring of pregnant women with COVID-19 is recommended.     

Bacterial Analysis of Peri-implantitis and Chronic Periodontitis in Iranian Subjects

Chronic periodontitis (CP) and peri-implantitis (PI) are multifactorial diseases of tooth and implant supporting apparatus. Bacterial invasion and consequent host immune response seem to play a role in relevant pathogenesis. The structural differences between tooth and implant pose preferential biofilm colonization. This study was aimed to compare the prevalence of bacteria in CP and PI. Clinical and radiographic examination performed over 69 individuals referred to Shahid Beheshti Dental School (Tehran, Iran) and four groups categorized: CP (n=22), HP (n=21), PI (n=13) and HI (n=13). The mean age was 45.6 years, 55% of participants were female and 45% were male. Bacterial samples were collected by paper point method and transferred to Institute of Odontology, University of Gothenburg (Gothenburg, Sweden) for checkerboard DNA-DNA hybridization. Kruskal-Wallis and Mann-Whitney U tests were used to compare distribution of bacteria in four groups. Significant differences were observed for T. forsythia, P. intermedia, C. rectus, P. endodontic, P. gingivalis, T. denticola and P. tannerae (P<0.05). The most prevalent bacteria in CP and PI were T. forsythia and P. gingivalis, respectively. In conclusion, bacterial prevalence differs significantly between tooth and implant. The most prevalent bacteria in Iranian subpopulation do not necessarily bear a resemblance to other populations. The type of implant surface may influence the biofilm. Other studies should be conducted to corroborate these findings.     

Representative drug susceptibility patterns for guiding design of re-treatment regimens for multidrug-resistant tuberculosis in Iran

Background and objective:   The prevalence of multidrug-resistant tuberculosis (MDR-TB) has increased substantially in the past 20 years, however, there are no data specific to Iran. This study investigated patients suspected to have MDR-TB, attending the TB referral hospital in Iran.
Methods:   All patients suspected of having MDR-TB on hospital admission in the period 2003–2005 were included in this study. Sputum from all patients was tested for smear and culture, and drug sensitivity testing was performed using the proportion method. Patients were categorized into three groups based on their history of medical treatment. Group I consisted of patients with CAT I regimen failure; Group II consisted of patients with a history of CAT II regimen failure and Group III comprised patients with a history of more than two courses of irregular CAT I anti-TB regimen.
Results:   There were 105 patients recruited; 32 in Group I, 53 in Group II and 20 in Group III. There were no significant differences between the three groups in their resistance to first-line anti-TB drugs. Fifty-five patients were diagnosed with MDR-TB. The prevalence of MDR-TB was 56% (18 cases) in group I, 49% (26 cases) in group II and 55% (11 cases) in group III. No significant difference in the pattern of drug resistance was observed between the three groups.
Conclusion:   The prevalence of MDR-TB was high in this study. The lack of response of MDR-TB patients to CAT II treatment indicates that antibiotic sensitivity testing is essential in patients with CAT I treatment failure.     

Comparison of the Accuracy and Reproducibility of Focused Abdominal Sonography for Trauma Performed by Emergency Medicine and Radiology Residents

We compared the diagnostic accuracy of emergency medicine residents (EMRs) and radiology residents (RRs) in performing focused abdominal sonography for trauma (FAST). The cohort in this prospective study comprised 200 unstable patients (163 males and 37 females; mean ± standard deviation of age, 34.3 ± 16.4 y) who presented with trauma. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. Patients with positive FAST results underwent further diagnostic procedures such as computed tomography, diagnostic peritoneal lavage and laparotomy. Those with negative FAST results underwent clinical follow-up for 72 h until their condition deteriorated or they were discharged. Sensitivity, specificity, positive and negative predictive values and accuracy in evaluating free intraperitoneal fluid were 80%, 95%, 57%, 98% and 94% when FAST was performed by EMRs and 86%, 95%, 59%, 98% and 94% when FAST was performed by RRs. The level of agreement between EMRs and RRs was moderate (κ = 0.525). FAST is a useful screening tool for initial assessment of free abdominal fluid in patients with trauma. Our results indicate that EMRs can perform sonography on trauma patients as successfully as RRs.     

Implementation of a protocol for integrated management of pain,agitation, and delirium can improve clinical outcomes in the intensive care unit: A randomized clinical trial

Background

Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes.

Materials and Methods

A total of 201 patients admitted to 2 mixed medical-surgical ICUs were randomly allocated to protocol and control groups. A multidisciplinary team approved the protocol. Pain was assessed by Numerical Rating Scale and Behavioural Pain Scale, agitation by Richmond Agitation Sedation Scale, and delirium by Confusion Assessment Method in ICU. The Persian version of the scales was prepared and tested for validity, reliability, and feasibility in a preliminary study. The patients in the protocol group were managed pharmacologically according to the protocol, whereas those in the control group were managed according to the ICU routine.

Results

The median (interquartile range) for the duration of mechanical ventilation in the protocol and control groups was 19 (9.3-67.8) and 40 (0-217) hours, respectively (P = .038). The median (interquartile range) length of ICU stay was 97 (54.5-189) hours in the protocol group vs 170 (80-408) hours in the control group (P < .001). The mortality rate in the protocol group was significantly reduced from 23.8% to 12.5% (P = .046).

Conclusion

The current randomized trial provided evidence for a substantial reduction in the duration of need to ventilatory support, length of ICU stay, and mortality rates in ICU-admitted patients through protocol-directed management of PAD.