A. R. Dehpour, PharmD, PhD
A. Javadian, MD
Vol 55, No 2 (2017)
Arterial blood gas (ABG) sampling is a painful procedure with no perfect technique for quelling the discomfort. An ideal local anesthesia should be rapid, easy to learn, inexpensive, and noninvasive. This study was aimed to compare pain levels from ABG sampling performed with vapocoolant spray in comparison to placebo. We hypothesized that pretreatment with the vapocoolant would reduce the pain of arterial puncture by at least 1 point on a 10 point verbal numeric scale. We have evaluated the effectiveness of a vapocoolant spray in achieving satisfactory pain control in patients undergoing ABG sampling in this randomized placebo controlled trial. Eighty patients were randomized to 2 groups: group A, who received vapocoolant spray, and group B, who received water spray as placebo (Control group). Puncture and spray application pain was assessed with numerical rating scale (0, the absence of pain; 10, greatest imaginable pain) and number of attempts was recorded. The pain score during ABG sampling was not lower in group A compared with group B significantly (4.78±1.761 vs. 4.90±1.837; P:0.945). This study showed that while the spray exerts more application pain, the number of attempts required for ABG sampling was not significantly lower in group A compared with group B (1.38±0.54 vs. 1.53±0.68; P=0.372). Vapocoolant spray was not effective in ABG pain reduction, had milder application pain compared to placebo (P<0.05), but did not reduce sampling attempts. At present, this spray cannot be recommended for arterial puncture anesthesia, and further study on different timing is necessary.
Osteoporosis diagnosis is usually based on examination of the hip bone and vertebrae density; however, the radius bone has gained attention recently in terms of feasibility and accessibility as it is done by portable devices with proper precision. This study aims to compare hip and spine density with radius, knowing whether radius may be an appropriate alternative for osteoporosis diagnosis. 120 females who were referred to one Densitometry Center checked their skeletal status using a hologic unit for densitometry of spine, femoral neck, and one-third radius. The patients were divided into three groups of healthy, osteopenic and osteoporotic based on WHO’s protocol. Concordance analysis was done to investigate the degree of similarity of diagnosis. In the study, there were 40, 41, and 39 individuals with normal, osteopenic, and osteoporotic bone densities, respectively which obtained from hip bone or vertebrae using the T-score criterion T-score of radius bone density has a direct linear relationship with these result. Osteoporosis diagnosis can be made based on radius densitometry.
The present study aimed to compare the serum level of uric acid in patients with and without heart failure and also to determine the association between uric acid level and clinical status by Killip class in patients with STEMI. This case-control study was conducted on 50 consecutives as control group and 50 patients with acute heart failure, (20 patients had acute STEMI), who documented by both clinical conditions and echocardiography assessment. The mean plasma level of uric acid in the case group was 7.6±1.6 milligrams/deciliter (mg/dL) and in the control group was 4.5±1.5 respectively (P<0.001). These values in patients with STEMI was about 9.2±0.86, but in patients with acute heart failure in absence of STEMI was 6.5±1.04 (P<0.001). Moreover, there was significant difference among the level of uric acid and Killip classes (P<0.001). Also there was significant difference for uric acid level between HFrEF (HF with reduced EF) and severe LV systolic dysfunction (0.049). In STEMI patients with culprit LAD, mean uric acid was significantly higher than cases with culprit LCX [(9.7±0.98 versus 8.6±0.52 respectively) P=0.012]. Regarding treatment plan in patients with STEMI, mean level of uric acid in those considered for CABG was significantly higher than who were considered for PCI, 9.9±0.82 versus 8.9±0.76 respectively, P=0.029. In STEMI patients with higher killip class, higher level of uric acid was seen. Also, the severity of LV systolic dysfunction was associated with higher level of uric acid.
Maternal diabetes has teratogenic effects on the evolution of the fetal cardiovascular system; as a consequence, cardiovascular malformations are the most common anomalies in infants of diabetic mothers. The present study focuses on the association of all types of diabetes in mothers with the incidence of congenital cardiovascular malformations in their infants. In this retrospective case-control study performed between the years 2008 and 2010, 35 infants of diabetic mothers were selected as a case group, and another 35 infants of mothers with normal blood glucose levels were selected as a control group. Data has been extracted from patients’ files and registered. Finally, the association of data has been performed according to statistical analysis. According to the results, the prevalence of cardiovascular anomalies was significantly higher in infants of diabetic mothers (P=0.018). The most common malformations in the case group were PDA 10%, hypertrophic cardiomyopathy 9% and PFO 8%. Maternal diabetes type (overt or gestational diabetes), duration and control method did not correspond with any significant differences in the prevalence of cardiac anomalies. The results of this study indicate that diabetes in pregnant women plays an important role in the incidence of certain types of cardiac anomalies, such as PFO, HCMPT, and PDA. As a result, the performance of diagnostic procedures (like embryonic echo, before and after birth), provision of special prenatal care to diabetic mothers, and providing supportive and therapeutic care to symptomatic infants seems highly advisable in such cases.
While studies have shown the disastrous effects of post-partum depression (PPD) on children's behaviors, there is relatively lack of reliable data in Asian countries. This study examined the relative significance of maternal PPD in children's developmental disabilities at age four. In a longitudinal study design (2009), 1801 pregnant women attending in primary health centers of Mazandaran province in the north of Iran provided self-reports of depression from two to twelve postpartum weeks using Edinburgh Postnatal Depression Scale (EPDS). Approximately four years later, the women experiencing PPD and twice as the ones who did not experience this disorder were considered as case (N=204) and control (N=467) groups. The association between maternal depression at different times and childhood developmental disabilities based on Ages and Stages Questionnaire (ASQ) and other health problems reported by the child were analyzed using two-sample t-test, chi-square test, and logistic regression models. The presence of PPD only was not a predictor of child's developmental disabilities at age four. Childhood developmental disabilities in communication, gross motor and personal-social domains of ASQ were associated with the current and concurrent maternal depressive symptoms (OR=2.59, 95% CI=1.16-5.78; OR=4.34, 95% CI=2.10-8.96; OR=5.66, 95% CI=1.94-16.54 and OR=3.35, 95% CI=1.31-8.58; OR=4.15, 95% CI=2.72-13.87; OR=6.17, 95% CI=1.95-19.53 respectively). PPD, the current depressive symptoms, and depression at both occasions were associated with more health problems in children. Childhood developmental disabilities in some domains of ASQ were significantly related to the maternal depression chronicity or recurrence. Also, child's difficulties were more prevalent in association with maternal depression regardless of onset time.
This cross-sectional study aimed to determine the reliability of static control evaluation with Synapsys Posturography System (SPS, Marseille, France) and to compare the static postural control of deaf children with typically developing children. This study was conducted in 2 phases on 81 children of 7 to 12 years old in Tehran schools. The first phase examined the reliability of static balance evaluation with SPS. In this phase, a total of 12 children with typical development were evaluated and then do a re-test 1 week later. In the second phase, 30 children with profound sensorineural hearing loss (SNHL) and high risk in their balance (selected from Baghcheban Schools for the Deaf) as the experimental group, and 37 children with typical development (selected randomly from 2 primary schools for girls and boys in District 12 of Tehran Department of Education) as control group were enrolled in the study. They were all placed under sensory organization test evaluation. Based on the results of intraclass correlation coefficient (ICC), the unilateral random effects model, test-retest reliability in different sensory conditions, the moderate to excellent results were obtained (ICC between 0.68 and 0.94). Also, the mean displacement of pressure center in all sensory conditions, the limits of stability (LOS) area, the overall balance scores, and scores for balance sensory ratio (except the somatosensory ratio) of children with typical development were better than the deaf peers (P˂0.05). The SPS has acceptable reliability to evaluate static posture in children between the ages of 7 and 12 years. Furthermore, deaf children as compared to children with typical development had a lower static postural control in all sensory conditions. This finding confirms the need to examine the postural control for identifying the extent of sensory deficit that has caused poor balance function, and also the need for early intervention to address the balance deficit in deaf children.
Meniere’s disease is the disorder of inner ear characterized by vertigo, tinnitus and sensorineural hearing loss. The vestibular evoked myogenic potential (VEMP) test could be useful in the analysis of saccular function, and diagnosis of Meniere’s disease. In this study, we’ve analyzed the saccular function, using VEMP test in different groups of Meniere’s disease. Patients were categorized as possible, probable or definite Meniere’s disease groups according to the guideline of American Academy of Otolaryngology-Head and Neck Surgery. The exclusion criteria were neuromuscular system diseases, diseases of central nervous system, inner ear disorders, conductive hearing loss, a history of ototoxic drug consumption, being a drug abuser and a positive history of inner ear surgery or manipulations. The VEMP test is the recording of positive and negative waves from sternocleidomastoid muscle that is made by an auditory click to the ear. From the total of 100 patients, the waves of VEMP test was seen in 59 patients which 19 patients had abnormal amplitude, and latency and 40 patients were with normally recorded waves. There was a significant relationship between the severity of hearing loss and a VEMP test without any recorded waves. Most of the cases with ‘no wave recorded’ VEMP test, were patients with severe hearing loss. However, there wasn’t any relation between the pattern of hearing loss and ‘no wave recorded’ VEMP test. VEMP test could be a valuable diagnostic clue especially in patients with definite Meniere’s disease.
Friedreich’s ataxia (FRDA) is a rare autosomal recessive spinocerebellar ataxia which in the majority of cases is associated with a GAA-trinucleotide repeat expansion in the first intron of Frataxin gene located on chromosome 9. The clinical features include progressive gait and limb ataxia, cerebellar dysarthria, neuropathy, optic atrophy, and loss of vibration and proprioception. Ataxia with ocular motor apraxia type 1 (AOA1) is another autosomal recessive cerebellar ataxia which is associated with oculomotor apraxia, hypoalbuminaemia, and hypercholesterolemia. Here we describe two siblings (13- and 10-year-old) display overlapping clinical features of both early-onset FRDA and AOA1. Almost all of laboratory test (including urinary analysis/culture, biochemistry, peripheral blood smear, C-reactive protein level, erythrocyte sedimentation rate-1h) results were within the normal range for both patients. Due to the normal laboratory test results; we concluded that the diagnosis was more likely to be FRDA than AOA1. Therefore, neurologists should bear in mind that clinical presentations of FRDA may vary widely from the classical phenotype of gait and limb ataxia to atypical manifestations such as oculomotor apraxia.
Pneumonia is considered as the main cause of abdominal pain in children whereas it presents mostly by respiratory symptoms in adults. Here we present a 71-year-old Iranian female who complained specifically of abdominal pain on admission to our emergency department. We had found nothing as an etiology in our first evaluations. After several hours chest pain was added to the symptoms and the following chest, X-Ray showed a consolidation in the right lung base. She was treated by pneumonia antibiotic regimen and discharged after seven days in a good clinical condition. In conclusion, pneumonia should be considered as a differential diagnosis of abdominal pain in adults as well as in children.
Desmoids tumors, characterized by monoclonal proliferation of myofibroblasts, could occur in 5-10% of patients with familial adenomatous polyposis (FAP) as an extra-colonic manifestation of the disease. FAP can develop when there is a germ-line mutation in the adenomatous polyposis coli gene. Although mild or attenuated FAP may follow mutations in 5΄ extreme of the gene, it is more likely that 3΄ extreme mutations haveamore severe manifestation of thedisease. A 28-year-old woman was admitted to the Cancer Institute of Iran with an abdominal painful mass. She had strong family history of FAP and underwent prophylactic total colectomy. Pre-operative CT scans revealed a large mass. Microscopic observation showed diffuse fibroblast cell infiltration of the adjacent tissue structures. Peripheral blood DNA extraction followed by adenomatous polyposis coli gene exon by exon sequencing was performed to investigate the mutation in adenomatous polyposis coli gene. Analysis of DNA sequencing demonstrated a mutation of 4 bpdeletions at codon 1309-1310 of the exon 16 of adenomatous polyposis coli gene sequence which was repeated in 3 members of the family. Some of them had desmoid tumor without classical FAP history. Even when there is no familial history of adenomatous polyposis, the adenomatous polyposis coli gene mutation should be investigated in cases of familial desmoids tumors for a suitable prevention. The 3΄ extreme of the adenomatous polyposis coli gene is still the best likely location in such families.
Kaposi᾽s sarcoma (KS) can develop in 0.06% to 4.1% of kidney transplant recipients. Here we describe a case of 50-year-old man who developed KS a few months after kidney transplantation. After transplantation, he had delayed graft function and was managed by anti-thymocyte globulin (ATG) for five days. At the discharge, his immunosuppressive therapy was prednisolone 20 mg/day, tTacrolimus (Pprograf®) 4 mg/day, and mycophenolate mofetil (MMF) 2 gr/day, while he also took Vvalcyte and diltiazem. Once diagnosed with KS, the Prograf® (tacrolimus) was replaced by prednisolone (5 mg/day) and sirolimus (2 mg/day). Gradually the skin nodule on the patient arm disappeared, and the others nodule on the right his leg was decreased. It seems that the examination of skin should be a part of regular follow-up and dermatologist examination is recommended every 6 months.
|All the work in this journal are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|