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Background: Hyperbilirubinemia is one of the most common causes of neonatal re-hospitalization; using transcutaneous bilirubin (TCB) measurement nomogram, the aim of this study was to determine the risk of severe hyperbilirobinemia in term and near-term Iranian neonates at discharge time. Methods: 450 healthy newborn infants, with the gestational age of + 35 weeks, weight of + 2 kg, and the age of 12 to 140 hours were enrolled in this randomized-descriptive practical study. Before being discharged, the infant's bilirubin was measured using Bilichek that was placed on their chest and between two nipples. After being discharged, the newborn infants were followed up. According to the discharge time transcutaneous bilirubin level, the infant's age (in terms of hour), and based on bilirubin nomogram, the newborns were divided into four groups of low-risk, low-medium-risk, high-mediumrisk, and high-risk. In following up the infants, if they were suffering hyperbilirobinemia, the bilirubin was measured again. Findings: According to discharge time transcutaneous bilirubin level and the infant's based-on-hour age, 20% of the subjects were included in the low-risk group, 33.1% in low-medium-risk group, 32.2% in high-medium-risk group, and 14.7% in high-risk group. The risk of severe hyperbilirobinemia in followed-up newborns was 1.4%, 6.9%, 13.6%, and 32.8%, in groups 1 to 4, respectively. During this time, 11.9% of the newborns were found to have sever hyperbilirubinemia (more than 95th percentile. Conclusion: By providing bilirubin nomogram, based on transcutaneous bilirubin level and the infant's age (in terms of hour), the severity of future hyperbilirobinemia can be estimated in Iranian healthy newborns. The transcutaneous bilirubin method with bilichek, that is a non-invasive method, can be recommended for all newborns at discharge time. [ABSTRACT FROM AUTHOR]

Background: Interleukin-6 (IL6) gene polymorphism is an important inflammatory cytokine. It may play a major role in complications observed after CABG surgery. Therefore, the present study was designed to study the relationship between IL6 174G>C gene polymorphism and complications after CABG. The aim of this study was to investigate any probable relationship between IL6 174 G >C polymorphism and complications observed after CABG surgery. Methods: In this case-control study, whole blood samples were obtained from all patients hospitalized for CABG surgery in Sina Hospital, Isfahan. Subject were divided into two groups of patients with (POC) or without (NPOC) complications. Information such as age, sex, degree of hemorrhage after the surgery, time spent in the intensive care unit (ICU), ventilation time, and inotropic support after the surgery was collected. Statistical analysis of the obtained data was performed using t-test and chi-square test. Findings: We did not find a correlation between IL6 gene polymorphism and complications after CABG surgery (P = 0.126). However, a significant difference was observed. This difference for GG was P = 0.05 and for GC was P = 0.035 between two groups. Conclusion: GG genotype may play a role for the inflammation and complications after CABG. Further studies with larger number of patients are recommended. [ABSTRACT FROM AUTHOR]

Background: Paraquat poisoning is one of the most common lethal poisonings in Isfahan, the central province of Iran. Due to the lower price and widespread usage of this potent herbicide for agricultural purposes, this kind of intoxication occurs almost frequently in this region. Paraquat is available here as a concentrated liquid, aerosol form or water soluble granules with different brand names. The toxicity of this poison is due to the creation of superoxide radicals through the electron transport system involved in intracellular conversion of NADPH to NAD. Superoxide anions and other free radicals are very toxic for the cell membrane. Paraquat poisoning affects the respiratory, cardiovascular, central nervous, endocrine, digestive, skin and almost all body systems, depending on the amount of ingestion. Toxic signs and symptoms of its poisoning would be appeared with the ingestion of at least 20 mg/kg or more in adults. Serum levels of 0.2 µg/ml 24 hours and 0.1 µg/ml 48 hours after ingestion, is usually associated with a fatal outcome. Immediate treatment is important for survival of patients. Supportive care, prevention of absorption of ingested poison, elimination measures and administration of antioxidants are all considered as the cornerstone of its treatment. There is no specific antidote for this toxin. High mortality rate of up to 75% in paraquat poisoning may be related to the amount of ingested toxin and the quality of medical care. Therefore, acute care physicians are supposed to have enough knowledge and skills for the supportive care and treatment of paraquat poisoning. [ABSTRACT FROM AUTHOR]

Background: One of the most common methods of suicide is acute poisoning. The association of anemia with psychiatric disorders and psychiatric disorders with suicidal behavior has been know previously. Due to the lack of study on relationship of anemia with suicide, anemia and related factors in intentional suicidal attempts were performed. Methods: A cross-sectional descriptive-analytic study was performed in Noor general hospital. 601 patients with attempted suicide self poisoning were evaluated. χ2 and logistic regression analysis was performed for data analysis. Findings: Prevalence of anemia was 33.8%. Frequency of anemia in patients according to age, sex and bipolar disorder showed significant differences. Logistic regression analysis showed the probability of suicide in women anemic patients was more than men (P = 0.022). Risk of suicide in anemic patients with bipolar disorder was 2.32 times the patients without bipolar disorder (P = 0.01). With increasing age of patients by age 60 relationship of anemia associated intentional poisoning would be increased. Conclusion: Gender, age and bipolar disorders are the related factor in patients with anemia and suicide. [ABSTRACT FROM AUTHOR]

Background: Regarding increasing tramadol toxicity in recent years due to usage of tramadol as a drug for suppression of withdrawal symptoms and high availability of this drug, we did a survey on the frequency of tramadol intoxication symptoms, duration of admission, therapeutic measurements, tramadol dosage, and prognosis of the patients. Methods: We conducted a cross sectional study, in which information of every patient with tramadol toxicity admitted in Noor hospital ward of toxicology (Isfahan, Iran) were gathered and analyzed. Finding: From 184 cases, 141 (76.6%) were men. The mean age of the patients was 24 ± 7 years. Forty percent of patient had positive history of substance abuse. Eighty four cases (45.6%) were with coingestion. Thirty four percent of patients had chronic ingestion of tramadol. The most common chief complaint was central nervous system (CNS) depression (57%) followed by seizure (25%), bradypnea (18%), tachycardia (25%), and hypertension (7%). Active charcol (89%), gastric lavage (81%), naloxane (25%), anti convulsants (11%), and intubation and ventilation (5%) were done as therapeutic acts. The most common complication in patients was aspiration pneumonia. Two (1.1%) patients died. There were significant relationships between tramadol dose and seizure (P = 0.036), ataxia (P = 0.002), and outcome (P < 0.001). Conclusion: Tramadol overdose frequently cause CNS depression, respiratory depression, tachycardia, hypertension, and seizure; these symptoms could be from both effects of tramadol either on mu receptor or inhibition of monoamine reuptake. [ABSTRACT FROM AUTHOR]

Background: Hyperreactio Luteinalis (HL) is a rare condition during spontaneous pregnancy characterized by bilaterally, or in rare cases, unilaterally enlarged ovaries containing multiple selflimited theca lutein cysts, usually associated with high maternal serum levels of human chorionic gonadotropin (HCG) and hyperandrogenic state. Most of the patients require surgical intervention during their pregnancy because of ovarian torsion, preeclampsia, syndrome of hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP), or to rule out ovarian malignancy. However, we can avoid unnecessary surgical intervention with accurate diagnosis of HL by means of laboratory tests and magnetic resonance imaging (MRI). Case Report: A 27-year-old pregnant woman with gestational age of 27 weeks was admitted with labor pain and complicated with HELLP syndrome. In ultrasonography, bilateral and multiple ovarian cysts were seen. Conclusion: Reviewing this case suggests a relationship between HL and HELLP syndrome and may help to explain the underlying causes of preeclampsia; HL may be a predictor of preeclampsia and HELLP syndrome in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Preterm premature rupture of membrane (PPROM) is the rupture of the membrane before labor and prior to the 37th week. PPROM is a common complication of pregnancy with numerous adverse effects on both the mother and the infant. Identifying the risk factors for PPROM and methods for its early diagnosis and treatment will dramatically decrease the side effects. This study aimed at evaluating the outcome of pregnancies complicated by PPROM. Methods: This descriptive, analytic, cross-sectional study lasted for six months. It included 57 patients who were admitted to Shahid Beheshti Hospital (Isfahan, Iran) due to rupture of membrane in 28th-34th weeks of pregnancy. Patients were physically examined and asked for their history and symptoms. The collected data was analyzed with chi-square tests. Findings: The prevalence of PPROM, cesarean section, tachycardia, fever, and more than 15000/ml leukocytosis was 2.3, 52.7, 74.0, 95.0, and 66.0 percent, respectively. Distress, sepsis, and death were observed in 21.0, 3.0, and 1.7 percent of the neonates, respectively. No cases of pneumonia or hyaline membrane disease were detected. There was not a significant relationship between sex and PPROM. Conclusion: Our findings were similar to those of previous research. However, considering the importance of PPROM, larger studies in different areas are required for diagnosis and treatment of PPROM to prevent preterm birth. [ABSTRACT FROM AUTHOR]

Background: Acute poisoning is one of the most threatening health problems around the world. The purpose of this study was to evaluate the prevalence of intentional and unintentional poisoning in vulnerable groups in order to assist in planning and implementation of preventive measures. Methods: This cross-sectional study included 786 patients in vulnerable groups (children, women of reproductive ages and the elderly) with acute poisoning who attended the Emergency Department of Noor Hospital in Isfahan, Iran, during 2012. Findings: In 89.5% of cases, poisoning was intentional and 20.1% of these patients had a history of previous suicide attempts. Women at the age 19-44 were the most suicidal cases (95.1%). The most common medications were psychiatric drugs (51.9%). No significant difference was found between sexes, ingested drugs, and outcome between intentional and poisoning group compared to unintentional poisoning. Majority of patients recovered and the mortality rate was 0.5%. Conclusion: Our results showed that the women of reproductive ages were the most vulnerable groups at risk of intentional poisoning in our society that commit suicide by using drugs especially with psychiatric drugs. More attention and support for this vulnerable group is suggested. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer among women. Genetic is a proven risk factor in this disease. As breast cancer genes (BRCA1 and BRCA2) affect the incidence of this type of cancer, identification of mutation carriers is important in reduction of the overall risk. The purpose of this study was to determine the prevalence of BRCA1 and BRCA2 mutations in patients with breast cancer using high resolution melting (HRM) analysis. Methods: Blood samples of 41 female patients with breast cancer and 20 healthy women were collected randomly. The studied mutations were 185delAG, 5382insC, 3889delAG and 1476delG in BRCA1 and 6174delT and 6033-34insGT in BRCA2. Genomic DNA was extracted from blood samples. Forward and reverse primers were designed for each mutation. DNA samples of healthy individuals were sequenced to make sure about the absence of the studied mutations. Real-time polymerase chain reaction (PCR) and HRM analysis were performed and HRM and melting curves were plotted for all samples. For each mutation, some random samples were sequenced. The curves in the case and control groups were compared for each mutation. Findings: The desired mutations were not observed in any samples of the case group. Sequenced samples confirmed the HRM results. Conclusion: Due to the low number of samples and lack of known native mutations, observation and identification of mutations seem to be impossible in studies such as the present one. However, this study can serve as a base for extensive and applied studies of native and non-native mutations in Iranian population. [ABSTRACT FROM AUTHOR]

Background: The relation between angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphism and cardiovascular diseases was reported previously but the role of this polymorphism and the occlusion of vein grafts in long-term post coronary artery bypass graft (CABG) surgery still has remained controversial. The aim of the present study was to investigate any probable relationship between ACE I/D polymorphism and the atherosclerotic occlusion of vein grafts. Methods: Patients who undergone CABG surgery more than five years ago, participated in this crosssectional study. Occlusion of vein graft was determined by angiography. The ACE I/D polymorphism was detected by polymerase chain reaction (PCR) based restriction analysis. Findings: A total of 102 patients (84 males) were enrolled to the study. The frequency distribution of DD, ID, and II polymorphisms were 23.6%, 62.7%, and 13.7%, respectively. There were no differences among genotypic groups regarding the number of occluded, diseased, and atherosclerosisfree vein grafts (P = 0.6, 0.7, and 0.18, respectively). Patients with II genotype had the same number of completely occluded vein grafts in a marginally significant shorter time after CABG (P = 0.06) compared with the other groups. Conclusion: Although the results of our study indicated no association of ACE I/D polymorphisms and the occlusion of vein grafts long-term post-CABG, ACE II genotype may accelerate the rate of occlusion in vein grafts. [ABSTRACT FROM AUTHOR]

Background: Poisoning is one of the medical emergencies. Poisoning with new Anticonvulsant drugs such as lamotrigine, sodium valproate, topiramate and gabapentin has been observed alone or in combination with other drugs in the last few years. Therefore this study was performed regarding the poisoning with new anticonvulsant drugs with respect to demographic, clinical manifestations, length of hospital stay, outcome and correlation between the outcome and different variables. Methods: This study was a descriptive-analytical and cross-sectional study. Simple sampling method was performed in the Noor and AliAsghar Hospital on poisoning cases with new anticonvulsant drugs. Need to intubation, connected to ventilator and aspiration pneumonia were considered as outcome Statisticial analysis was done by SPSS17 using ANOVA, Student t-test and logistic regression. Findings: Poisoning with Sodium valproate was more common than Lamotrigine, Topiramate and Gabapentin. The Mean (SD) age of study population was 27.67 (9.74) years old. The most important prediciting factors in outcome incidence were sex (male), seizure, cardiovascular and respiratory symptoms in poisoning with Sodium valproate and seizure in poisoning with Lamotrigine. One death occurred in poisoning with Sodium valproate. Conclusion: Average age of patient was about 27.67 years which may be due to the use of these drugs in the younger age groups. The higher length of hospital stay in patients with respiratory symptoms in Sodium valproate and Lamotrigine poisoning would be because of more complications (intubation, ventilation and aspiration penumonia) observed with these two drugs. [ABSTRACT FROM AUTHOR]