Ryanodine receptor abnormalities has implicated in the generation and maintenance of seizure. Dantrolene, a selective ryanodine receptor antagonist, may be a potential drug for the prevention of seizure. Therefore, we aimed to clarify the protective effects of dantrolene against pentylenetetrazole seizure in mice. Male albino mice were received an intra-peritoneal injection of pentylenetetrazole (80 mg/kg) in seven separate groups (n=8). We used dantrolene (10,20 and 40 mg/kg), caffeine (200 mg/kg), dantrolene (40 mg/kg) + caffeine (200 mg/kg), diazepam (5 mg/kg as a positive control) and vehicle 30 minutes before the injection of pentylenetetrazole. Then, we registered the latency time of the first seizure, the severity of seizures and the incidence of seizure and death. Kruskal-Wallis test followed by Mann-Whitney and Fisher’s exact test were used to analyze the data. Dantrolene (10,20 and 40 mg/kg) significantly increased the latency time for the first seizure. Furthermore, dantrolene (20 and 40 mg/kg, but not 10 mg/kg) attenuated the severity of seizures in comparison to the vehicle group. Moreover, dantrolene only at the dose of 40 mg/kg prevented from tonic-clonic seizure and death in comparison to the vehicle group. In contrast, the addition of caffeine abolished the protective effects of dantrolene on the tonic-clonic seizure/death and inhibited the beneficial effects of dantrolene on the severity of pentylenetetrazol seizures. The acute dantrolene administration produced an anticonvulsant effect in the pentylenetetrazole-induced seizure. Moreover, caffeine prevented from dantrolene anticonvulsant effects. These results may imply about ryanodine receptors and intracellular calcium roles in the generation and control of pentylenetetrazole seizure.

Treatment of spinal cord injury by exogenous cells has brought both successful and unsuccessful results. Olfactory ensheathing cells and Schwann cells have been widely used for transplantation purposes. In this study, we investigated the effects of these cells on contused spinal cord by introducing cells into subarachnoid space. Fifty thousand Schwann cells or olfactory ensheathing cells or a mixture of both cell types were transplanted one week after a 3-second clip compression injury at T-9 spinal cord level in rats. Starting from the day one of spinal cord injury, animals were assessed for six months by BBB test and then were sacrificed for immunohistochemistry labeling of the spinal cord injury site. There was no locomotor recovery in any of the treatment groups including controls. Immunohistochemistry assessment indicated positive labeling of P75 and S100 markers in the cell-transplanted groups compared with control. Our data suggest that transplantation of Schwann cells and/or olfactory ensheathing cells into the subarachnoid space does not improve motor recovery in severely injured spinal cord, at least with the number of cells transplanted here. This, however, should not be regarded as an essentially negative outcome, and further studies which consider higher densities of cells are required.

Psoriasis is a chronic and inflammatory dermatologic disease. Psoriasis may predispose to cardiovascular disease and diabetes. However, the role of tumor necrosis factor (TNF) inhibitor in mediating this risk is controversial. Regarding frequent use of infliximab in psoriasis, and the hypothesis that anti TNF-α treatment may increase Body Mass Index (BMI) and alter lipid profile in these patients, the aim of this study was to assess changes in BMI and Lipid Profile and level of leptin in Psoriatic Patients under Treatment of Standard Protocol of Infliximab in a 24 week period. This study was accomplished as a before-after study. Twenty-seven psoriatic patients were included, and standard infliximab therapy was applied. All patients underwent 3 times of blood collection and in each session; LDL, HDL, Total Cholesterol, Triglycerides, Leptin, and PASI score were measured at the start of the study and at the 12th and 24th week of follow-up. Twenty-five patients consisted of 18 (72%) male and 7 (28%) female subjects were evaluated. The mean age of the patients was 36.91±13.31 years. PASI score demonstrated significant decrease after 24 weeks; however, BMI and HDL and leptin showed a significant increase during treatment. Significant negative correlation was seen between Leptin and PASI score changes (r=0.331, P=0.042). HDL and BMI had the most correlations with leptin (positive correlation) and PASI score (negative correlation). Results demonstrated a dramatic decrease in PASI, increase in BMI and HDL and increased in leptin; somewhat correlated to each other. These results suggest that patients taking infliximab should take more care of their weight and lipid profile, while on treatment.

Upper endoscopy is a common procedure for the diagnosis and treatment of upper digestive tract diseases. The increasing number of pediatric gastrointestinal procedures has led to increasing attention on the safety and efficacy of medications used for sedation during the procedure. This randomized blinded interventional study was designed to compare the effect of oral midazolam with intravenous (IV) midazolam as a sedative medication in 119 children undergoing endoscopy. The mean time to sedation was 2.2±0.7 in IV midazolam group and 30.9±0 in oral midazolam group which was statistically significant difference between two groups. Separation from parents in oral midazolam group was as follow: 2 patients were high resistant (3.5%), 2 patients were resisted first and then relaxed (3.5%) and 55 patients were separated from their parents without any resistance (93%); whereas in IV midazolam group, 8 patients were high resistant (13.3%), 29 patients were relatively resistant (48.3%) and 23 patients were separated from their parents without any resistance (38.3%) that shows significant differences between the two groups. In terms of patient comfort during endoscopy, there was also a significant difference between the two groups. In oral midazolam, group parents were more consent, compared with the other group. The present study showed that oral midazolam is a safe and effective sedation during upper endoscopy in pediatrics. Oral midazolam reducing patients' anxiety during separation from parents leads the easy use of endoscopy and comfort of patients during endoscopy as compared with IV midazolam. Oral or IV midazolam were not able to put most patients in deep sedation level.

The genus Centaurea with an extensive background in Iranian traditional medicine represents more than 70 species in Iran that some of them are endemic to Iran. A variety of secondary metabolites has been isolated from this genus thus far. Sesquiterpene lactones and flavonoids have been reported as main compounds of C.bruguierana. Methanolic extract and different fractions of the whole fruiting samples of Centaurea bruguierana ssp.belangerana (Asteraceae) were examined for cytotoxicity against various cell lines using MTT cytotoxicity assay in order to identify active fraction(s). The chloroform and ethyl acetate fractions of plant have demonstrated significant cytotoxicity against colon adenocarcinoma and breast ductal carcinoma cell lines, which chloroform fraction, exhibited the most potent in vitro cytotoxic activity against colon adenocarcinoma cell line, and therefore, can be considered as the potential fraction through main compounds of plant against the adenocarcinoma colon cancer cell line. Moreover, only chloroform fraction was moderately active against Swiss embryo fibroblast cell lines while the other fractions were nontoxic. To summarize, the chloroform fraction of C.bruguierana demonstrated better cytotoxic activity against all of the tested cell lines compared with the other fractions; and promisingly in some cases represented moderate to very good cytotoxicity that suggests more investigations about its phytochemical properties.

Critically ill patient transfer is potentially risky and may be lead to morbidity and mortality. Physicians' skill is very important for safe transport. We want to evaluate the effect of clinical course teaching on the promotion of physicians' abilities in the transport of critically ill patients. In an interventional study, 320 interns, male and female, were taught about patient transfer in two groups include in one day clinical course as the small group system (n=160) and other group the lecture base learning (n=160). In the clinical course, each participant under observation of an anesthesiologist in the operation room and ICU was acquainted with mask ventilation, intubation and learned to work with a defibrillator, infusion pump, portable ventilator and pulse oximeter. In lecture group, the anesthesiologist explained the topics by video and dummy. At the end of education course, the interns’ abilities were evaluated based on checklist method and scored by the project colleague in all educational items. Three hundred twenty interns, 122 males, and 198 females; were enrolled, two groups. The clinical course training caused improvements in the interns’ knowledge and abilities in intubation and use of the defibrillator and portable ventilator vs.lecture group significantly (P<0.005). The males were better than females in laryngoscopy, but the progress of the females was significantly better than males (P=0.003). The rate of adverse events was reduced significantly after clinical course teaching (P=0.041) Clinical course teaching could promote interns' clinical competencies in the transport of critically ill patients.

Nurses are full partners with other health care professionals. Until fairly recently the scope of nurses potential in entrepreneurship has not been widely recognized. The present study tries to evaluate entrepreneurship psychological characteristics among nurses. The survey instrument included scales measuring entrepreneurship psychological characteristics including locus of control, need for achievement, risk taking propensity, ambiguity tolerance, and innovation, among nurses in the Shahid Sadoughi Hospital, Yazd, Iran in 2013. In this study average of entrepreneurship psychological characteristics of nurses which are higher than standard mark. The majority of the nurses have average entrepreneurship (20.4%). It means that they have some strong entrepreneurship. The result show that average of the need for achievement is 34.5%, the locus of control 33.8%, risk taking propensity 33.2%, ambiguity tolerance 34.2%, and innovation 41.6%. The results indicate that the 4 dimensions of the need for achievement, risk taking, Ambiguity Tolerance, and Innovation were significant. However, the locus of control is not significant at a 0.05 significance level. In terms, entrepreneurially nurses are comparatively more innovative, have risk taking attitudes, need for achievement, Ambiguity Tolerance, and Innovation. Results largely support significant positive relationships between psychological traits and entrepreneurial orientations.

Distance learning is expanding and replacing the traditional academic medical settings. Managing trauma patients seems to be a prerequisite skill for medical students. This study has been done to evaluate the efficiency of distance learning on performing the initial assessment and management in trauma patients, compared with the traditional learning among senior medical students. One hundred and twenty senior medical students enrolled in this single-blind quasi-experimental study and were equally divided into the experimental (distance learning) and control group (traditional learning). All participants did a written MCQ before the study. The control group attended a workshop with a 50-minute lecture on initial management of trauma patients and a case simulation scenario followed by a hands-on session. On the other hand, the experimental group was given a DVD with a similar 50-minute lecture and a case simulation scenario, and they also attended a hands-on session to practice the skills. Both groups were evaluated by a trauma station in an objective structured clinical examination (OSCE) after a month. The performance in the experimental group was statistically better (P=0.001) in OSCE. Distance learning seems to be an appropriate adjunct to traditional learning.

Bronchiolitis obliterans (BO) is the most remarkable pulmonary sequels of war-related sulfur mustard inhalation. There is little if any data about long-term efficacy of associated BO treatment. Five years spirometric records of three groups of patients with obstructive pulmonary diseases (asthma, COPD, BO) and documented sulfur mustard inhalation were evaluated. The BO patients were treated with inhaled Seretide 125-250/25 (2 puffs BID), azithromycin (250 mg, three times/week) and N-acetylcysteine (1200-1800/day). Asthma and COPD patients were treated according to existing guidelines. Seventy-three (38 asthma, 16 COPD and 19 BO) patients completed the 5 years follow-up. Basal and final FEV₁ in BO patients (2.69±0.81 and 2.39±0.65 respectively) were not significantly different from COPD patients (2.46±0.56 and 1.96±0.76 respectively). There was also no significant difference between the yearly FEV₁ decline in BO patients compared to COPD patients (60±84 cc vs. 99±79 cc respectively, P=0.163). The non-significant difference of FEV1 decline in BO compared to COPD patients suggests the effectiveness of azithromycin, inhaled steroid and N-acetyl cysteine in BO patients. Considering safety and possible effectiveness, this treatment is recommended until more data is available from controlled clinical studies.

Cases with Hirschsprung’s disease show the functional intestinal obstruction. Obstruction in these patients may lead to bacterial overgrowth with stasis and inflammation of the colon. Bacterial overgrowth can cause hyperammonemia that makes lethargy and loss of conscious and finally admitting in ICU. The purpose of this case report is to present a case that had Hirschsprung’s disease and referred to Children’s Medical Center with serum hyper-ammonium caused by bacterial overgrowth that induced coma and altered level of consciousness then made her to admit to PICU. A 15-year-old female referred to Children’s Medical Center with lethargy and low grade diarrhea. She had hypocalcemia and hypoalbuminemia with high PT and INR. Because of loss of conscious, she admitted at PICU. Laboratory findings showed hyperammonemia in this case, but other criteria were normal. Administration of antibiotic and lactulose therapy was started that lead to a reduction in serum ammonium level and discharging of the case. Thirteen days later she referred again with mentioned symptoms, and clinical evaluations showed high serum ammonium level. This time because of loss of conscious she had to admit at PICU and used NG tube. Administration of lactulose syrup and sodium benzoate make her in a better condition. Narrowing rectum toward the sigmoid and highly enlarged intestinal lopes was on behalf of Hirschsprung’s disease. Finally, the patient with the acceptable situation and oral periodic metronidazole discharged. It is essential to check serum ammonium level in the cases with loss of conscious. The choice for controlling hyperammonemia is lactulose therapy.

Pituitary gland metastasis was seen in elderly patients, and the incidence of pituitary metastasis is 1% to 4% of all cancer patients. Renal cell carcinoma is a primary malignancy in only 2.6% of pituitary metastases. We reported a 50-year-old man with pituitary metastasis from renal cell carcinoma that had signs of diabetes insipidus. He had multiple lesions in both lungs, and bone scan involved L12 and L1 vertebrates. He was treated with combination bevacizumab 600 mg/month and sunitinib 50 mg/D for four weeks with two weeks rest for 6 months. Treatment with targeted drugs without surgery of pituitary or radiotherapy improved metastatic renal cell carcinoma in the patient.