Burden of traffic accidents among pedestrians of Fars province, southern Iran;estimate of years of life lost in a sample of Iranian population from 2009 to 2013

Purpose: Traffic injuries are among the leading causes of mortality and morbidity worldwide. Pedestrians have been considered as a high-risk group among road users, especially in middle- or low-income communities. This study attempted to determine the burden of pedestrians'' fatalities in Fars, the southern province of Iran using years of life lost (YLL) approach. Methods: The data used in this study were retrieved from Fars Forensic Medicine Organization database on pedestrian traffic accidents. The YLL from 2009 to 2013 was estimated using the method presented by World Health organization. Some epidemiological characteristics of pedestrians'' fatalities were analyzed by SPSS. Results: Although YLL among 1000 male pedestrians decreased from 2.5 in 2009 to 1.5 in 2013, it increased from 0.9 to 2.1 among 1000 females during the same period. Higher proportion of death was found in female, illiterate, and married pedestrians (p < 0.001). In addition, mortality was higher in pedestrians living the cities, during daytime, at home, and in hospitals (p < 0.001). Conclusion: Consistent with the global trends, burden of pedestrian accidents in Fars was also exceptionally high. Considering the national and cultural aspects of different countries, improving the safety of pedestrians demands a multi-dimensional approach with interventional factors concerning policies, rules, pedestrians, motor vehicles and environmental conditions taken into consideration.     

Thermosensitive Depot-Forming Injectable Phosphatidylcholine Blends Tailored for Localized Drug Delivery

A thermosensitive depot-forming system was developed for sustained and localized delivery of the anticancer drug, paclitaxel. The formulation is injectable as a melt slightly above the body temperature and forms a solid depot upon cooling to 37°C. The thermosensitive system was prepared by blending various combinations of phosphatidylcholines at specific weight ratios solubilized in laurinaldehyde. Of the blends investigated, distearoyl–phosphatidylcholine (DSPC) and egg–phosphatidylcholine (ePC) were found to be most miscible. A liquid-to-gel phase transition temperature (T_C) of 39°C was observed for the 70:30 (w/w) DSPC–ePC blend and a T_C of 38.4°C with the addition of paclitaxel. Blends containing higher concentrations of ePC had a greater degree of swelling and weight loss. Furthermore, microscopy revealed an increase in porosity and erosion as the amount of ePC was increased in blends incubated in biologically relevant media. DSPC–ePC blends provided sustained release of paclitaxel over a 30-day period and the rate of drug release increased as the amount of ePC increased. Overall, the relationships established between the composition and properties of the blend may be employed to tailor the thermosensitive injectable formulation for localized chemotherapy of solid tumors. © 2013 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 102:3623–3631, 2013     

Effect of hypnosis on induction of local anaesthesia,pain perception,control of haemorrhage and anxiety during extraction of third molars: A case–control study

IntroductionSystemic conditions are considered limiting factors for surgical procedures under local anaesthesia in the oral cavity. All the pharmacological methods to control pain in patients have some disadvantages, such as side effects and extra costs for rehabilitation. Therefore, in such cases alternative treatment modalities are considered, such as hypnosis in dentistry. The aim of the present study was to evaluate the effect of hypnosis on haemorrhage, pain and anxiety during the extraction of third molars.Materials and methodsIn this case–control study, 24 female and male volunteers were included. The subjects had been referred to the Department of Oral and Maxillofacial Surgery, Kerman University of Medical Sciences, for extraction of third molars. Demographic data for all the subjects were recorded. Patients with chronic medical conditions were excluded. The patients were used as their own controls, with the third molars on one side being removed under hypnosis and on the opposite side under local anaesthetic.Hypnosis was induced by one of the two methods, either fixing the gaze on one point or Chiasson's technique; both these methods are appropriate for patients in the dental chair. The Spielberger State-Trait Anxiety Inventory was used to determine patient anxiety levels before hypnosis and anaesthesia. Pain was scored using VAS (visual analogue scale). After surgery the patient was asked to bite on a sterile gauze pad over the surgical site for 30 min when haemorrhage from the area was evaluated. If there was no haemorrhage the patient was discharged. If haemorrhage persisted, the gauze pad was left in place for another 30 min and the area was re-evaluated. Any active oozing from the area after 30 min was considered haemorrhage. Haemorrhage, anxiety and pain were compared between the two groups. Data was analyzed using the t-test, McNemar's test and Wilcoxon's signed rank test using SPSS 18 statistical software.ResultsTwenty-four patients were evaluated; there were 14 males (58.3%) and 10 females (41.7%). The mean age of the subjects was 24.1 ± 2.7 years (age range = 18–30 years). A total of 48 third molars were extracted. In each patient, one-third molar was extracted under hypnosis and the other under local anaesthesia. All the patients were in the ASA 1 category (normal) with no significant medical history.Of the subjects who underwent hypnosis, only two subjects (8.3%) reported pain after induction of hypnosis. In the local anaesthetic group, 8 subjects (33.3%) reported pain. There was a significant difference between the two groups. The results of the study showed that patients in the hypnosis group had less pain during the first few hours post-operatively. Anxiety scores in the two groups were very close to each other and no statistically significant differences were observed in general and when each person was compared with himself or herself. Pain intensity in the two groups at 5- and 12-h post-operatively exhibited significant differences. In the hypnosis group, 10 patients (41.7%) took analgesic medication; in the local anaesthesia group, 22 patients (91.7%) took the analgesic medication (P = 0.0001). In other words, patients reported less pain when they were under hypnosis.ConclusionThe results of the study showed that hypnosis can effectively reduce anxiety, haemorrhage and pain. More studies are necessary to collect data on the effect of hypnosis on oral and maxillofacial surgeries.     

Relapse Associated with Active Disease Caused by Beijing Strain of Mycobacterium tuberculosis

The role of microbial factors in outcomes of tuberculosis treatment has not been well studied. We performed a case–control study to evaluate the association between a Beijing strain and tuberculosis treatment outcomes. Isolates from patients with culture-positive treatment failure (n = 8) or relapse (n = 54) were compared with isolates from randomly selected controls (n = 296) by using spoligotyping. Patients with Beijing strains had a higher risk for relapse (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.0–4.0, p = 0.04) but not for treatment failure. Adjustment for factors previously associated with relapse had little effect on the association between Beijing strains and relapse. Beijing strains were strongly associated with relapse among Asian–Pacific Islanders (OR 11, 95% CI 1.1–108, p = 0.04). Active disease caused by a Beijing strain was associated with increased risk for relapse, particularly among Asian–Pacific Islanders.