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Background & objectives: Endoscopy is an invasive and painful procedure. The use of sedatives, especially in children, is expanding. The aim of this study was to compare the sedative effects of ketofol and the combination of midazolam-ketamine in upper endoscopy in children aged 1 to 14 years who referred to Taleghani Hospital in Gorgan. Methods: In this study, 55 children entered the study 1 to 14 years after obtaining parental consent. They were then divided into two groups, ketamine-propofol (KP) and ketamine-midazolam (KM), by simple randomization. At all stages of the work, patients underwent cardiac and respiratory monitoring. All hemodynamic parameters and ramsy sedation score (RSS) were recorded for all participants in the 5 time periods before, during and after endoscopy. ANOVA test and bonferroni tracking test were used in spss software to analyze and compare data. Results: 54.5% were male patients. The ANOVA test showed that the scores of the two groups at the time of the study had a statistically significant difference (p=0.02). In the KM group, the mean blood pressure and heart rate of patients increased at all times compared to before the intervention (p=0.005). Blood pressure in the KP group had a steady trend over time (p

Background: Cervical cancer affects women in the time that they are critical to economic and social stability. Objective: The aim of this narrative review to assess the socio-economic consequences of cervical cancer. Methods: In this review, Pubmed, Scopus, ISI web of science, Conferences databases and Iranian databases were searched. In order to search related articles, researchers used the following terms: “Uterine cervical neoplasms” OR ‘cervical cancer”; Costs and cost analysis; costs of illness, burden, socioeconomic. After the primary search, some records were obtained from 1960 to 2018. After studying titles, abstracts, and in some cases the full texts, 48 relevant articles were included in this research. Results: Hospitalization costs were the highest direct costs. However, total social costs are higher than health and medical costs. There is a dramatic increase in direct costs with the increase in age and stage of the disease. The costs are less for people aged 75 and up and for stage 4 because of less invasive treatment received by older women and the limited choice of treatment in advanced stages. The costs for persons who were screened 6 months to 5 years before diagnosis were lower. Conclusion: The burden of the disease is high. Early detection of cancer can save lives and reduce health care costs. Studies evaluating the costs associated with cervical cancer as well as virusrelated diseases in developing countries, calculating indirect costs and the impact of the disease on family members, relatives, and especially the spouse of the affected women are recommended.

Background Nursing Delirium Screening Scale (Nu-DESC) is a new instrument for determining delirium by nurses. The study aimed to investigate the psychometric properties of Nu-DESC and determined the sensitivity and specificity of it. Methods Two evaluators assessed delirium by Nu-DESC in nonintubated patients admitted to intensive care unit (ICU) wards of Ardabil educational and medical centers. For determining psychometric properties of the instrument, the methods of determining content validity, structural validity, criterion validity (the DSM-5 criteria was used as a standard tool), internal consistency, and inter-rater reliability were used. Results Ninety-six participants were assessed two times using the Nu-DESC. The mean age of the participants was 58.84, and 51 (53.1%) of them were male. Due to the high correlation of the Nu-DESC with the study criterion (DSM-5), the criterion validity of the instrument is confirmed. By using DSM-5 instrument, the cutoff score of 2 shows the best sensitivity and specificity. The kappa and alpha coefficients were obtained as r = 0.96 and α = 0.86, which indicate a good agreement between the evaluators and acceptable consistency. Conclusion Nu-DESC can be used as an efficient and reliable instrument by nurses in the ICU. It was also found that taking medical history can help nurses to better interpret the Nu-DESC score at diagnosing delirium. How to cite this article Amirajam Z, Noran EA, Molaei B, Adiban V, Heidarzadeh M, Darghah MH. Psychometric Properties of Nursing Delirium Screening Scale in Patients Admitted to Intensive Care Units. Indian J Crit Care Med 2021;25(6):680–684.

Cinnamon (Cinnamomum zeylanicum), fenugreek (Trigonella foenum-graecum), shallot (Allium hirtifolium Boiss), and clove (Syzygium aromaticum) are well-known and widely used medicinal plants in the world. There is some experimentally proven evidence demonstrated the beneficial effects of these herbs on metabolic disorders like diabetes. Despite the fact that there are limited studies in the field of herb-herb interactions, some of the diabetic patients prefer to use these herbs in a combination form. The aim of this study was to evaluate the possible effects of an equal mixture of these plants (named Tetraherbs) in streptozotocin (STZ)-induced diabetic rats. Severe diabetic rats (FBS above 350 mg/dL) were treated orally with ethanolic extracts of cinnamon (EEC), fenugreek (EEF), shallot (EES), and clove (EECL) separately at the dose of 75 mg/kg, or in equal combination formula (Tetraherbs) at doses of 100–300 mg/kg once per day for 28 days. At the end of the study, their effects on glucose levels, plasma lipids, liver enzymes activity, and histology of pancreas were evaluated. The blood glucose lowering activity, as well as pancreatic β cell regeneration of Tetraherbs, was significantly higher than the plants when they used separately. However, there was no significant difference in lipid-lowering and hepatoprotective potentials of the herbs whether used singly or in combination. In conclusion, the results of the present study provide evidence show combination form of the studied plants increased their glucose-lowering activity by positive interaction.

Objective The Critical-Care Pain. Observation Tool is one of the instruments developed to assess pain in patients who are unable to communicate verbally. The study aimed to survey the psychometric properties of Critical-Care Pain. Observation: Tool in four groups of non-verbal patients according to their Richmond Agitation Sedation Score (RASS). Study design and methodology 65 critically ill patients (medical, surgical, trauma) were assessed using the critical care pain observation tool on six occasions (before, during and after nociceptive and non-nociceptive procedures). Patients were divided into four groups according to their RASS score: 1. All patients (RASS −3 to +2), 2. Sedated patients (RASS −3 to −1), 3. Restless patients (RASS +1), 4. Agitated patients (RASS +2). Results Discriminant and criterion validity, confirmatory factor analysis and internal reliability showed good validity and reliability in the critical care pain observation tool in all groups except agitated patients. The results showed that, in general, the CPOT has good version of the critical care pain observation tool has good psychometric properties to evaluate pain in non-verbal patients admitted to intensive care units who have a RASS score ranging from −3 to +1, but it is not a good tool to evaluate pain in patients who are agitated according to RASS.

Background There is a variety of experimentally proven medicinal plants having antidiabetic properties but data on herb-drug interaction are very limited. Earlier studies indicated that aqueous extract of turnip leaf (AETL) has hypoglycemic potential in diabetic animals. The present study was conducted to evaluate co-administration effects of AETL and metformin, a commonly used antidiabetic drug, in diabetic rats. Methods Metformin at the two different doses (50,100 mg/kg) and AETL at the dose of 400 mg/kg (separately or concurrent with metformin) were orally given to streptozotocin-induced diabetic rats for 4 weeks daily. Fasting blood glucose (FBG) was measured at the times 0, 7, 14, 21 and 28 days after investigation. At the end of study, liver enzymes activity [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] as well as liver histopathology were evaluated. Results Both treatments could significantly decrease FBG levels when they administrated separately. Interestingly, co-administration of AETL and metformin in a dose dependent manner significantly improved hypoglycemic activity of metformin. While neither metformin nor AETL could ameliorate liver alterations alone, but in concomitant therapy they efficiently attenuated liver enzymes elevation and histological damages. Conclusion The results of the present study demonstrate that combination of metformin with AETL enhance the prior effectiveness and reduced the latter adverse effects by a synergistic interaction., Graphical abstract Image 1

Today, global interest in the use of herbal medicine is increasing and evaluation of their efficacy have become more important .There are several evidence that suggest some herbal extracts have beneficial effects on diabetic nephropathy. The present study has been designed to examine protective role of edible parts of turnip (leave and root) on alloxan-induced diabetic rats. Diabetic rats were intragastrically treated either with aqueous extract of turnip leave or root (AETL or AETR) at concentrations of 200, 400 mg/kg/d for consecutives 8 weeks. The effects of AETL and AETR on fasting blood glucose (FBG) and kidney functional markers including: urine volume, 24-hour urine total protein (UTP), blood urea nitrogen (BUN), plasma creatinine (Cr) and quantitative morphometric analysis of glomeruli including; mesangial matrix expansion (MME), urinary space, tuft-to capsule adhesion, Bowman’s capsule (BC) thickening, glomerulosclerosis, capillary dilatation, and hyalinosis were monitored by routine measurements, biochemically and pathologically. Our results showed that AETL significantly decreased FBG levels, urine volume, UTP, BUN and plasma Cr in diabetic rats. Moreover, AETL with a dose dependent manner remarkably decrease glomerular lesions such as MME, tuft-to-capsule adhesion and BC thickening. However, treatment of AETR had undistinguishable effects on these parameters in diabetic rats. In conclusion, the biochemical and pathological assessed indicators showed varying degrees of improvement in AETL treated diabetic nephropathy rats. The results obtained in this work indicate that turnip leaf may be considered as an easily accessible dietary source for diabetic nephropathy patients.

Objective: The present study has been carried out to evaluate the diuretic and antioxidant properties of pine herb in an animal model. Materials and Methods: 45 adult male rats were randomly divided into nine groups including: groups I (the negative control), groups II (positive control, furosemide 10 mg/kg), groups III to VIII (treatment groups received 100, 200, 400 mg/kg of the aqueous extracts of bark and fruit) and group IX received the combination of aqueous extract of bark (100 mg/kg) and the fruit (100 mg/kg). The urine output, glomerular filtration rate (GFR), electrolytes, urea, and creatinine levels were evaluated. Furthermore, the phenolic content and antioxidant activity of both extracts were also assessed using 2, 2-diphenyl-1-picrylhydrazyl (DPPH), ferric reducing antioxidant power (FRAP) and Folin–Ciocalteu methods. Results: The aqueous extracts of the pine bark and fruit increased the urinary output in a dosedependent manner. The combination of the two extracts compared to the other extracts alone significantly increased the serum potassium level. This study also showed each extract increase creatinine clearance in a dose-dependent manner (p Conclusion: The pine bark and fruit can be useful in the prevention and treatment of kidney stones due to the high diuretic properties and antioxidant activity.

Introduction: Many of Medicinal plants have been investigated for possible anticancer properties. The correlation cytotoxic effect of herbs with antioxidant activity is unclear, yet. The aim of the present study was to examine the antioxidant contents and anticancer effects of 12 Iranian medicinal plants on proliferation of breast cancer, MCF-7, and epithelial normal, MCf-10A, cells. Methods: Free radical scavenging and total antioxidant capacities of herbal waters assessed by DPPH and FRAP methods, respectively. Their total phenolic contents and cell viability determined by Folin–Ciocalteu and MTT assays, respectively. Results: Among the herbs, group A which contained relatively highest total phenolics content, antioxidant and free radical scavenging activities inhibited significantly greater growth of breast cancer cells in a dose- and time-dependent manner as compared to other groups. These medicinal plants were not cytotoxic components against normal cells. Conclusion: Therefore our results indicated that anti proliferative effects of 12 selected Iranian herbs showed a direct correlation with antioxidant properties. The herbs as natural antioxidants with fewer side effects could potentially improve the outcome of human breast cancer therapy. These findings endorse further investigations on these plants to determine their active metabolites and mode of action.

Aims: Turnip is one of the most consumed medicinal plants that seem to have advantageous efficacy on hyperlipidemia. The present work was undertaken to evaluate the hypolipidemic activity of aqueous extract of Brassica rapa root on hyperlipidemic rats. Materials & Methods: In this experimental study 40 male Wistar rats were divided into 5 equal groups; normal control, hyperlipidemic control (1ml normal saline once a day), Atorvastatin (10mg/kg of body weight per day) and aqueous extract of Brassica rapa root groups (200 and 400mg/kg of body weight per day) were treated for 10 days. After 18h fasting in 11th day, hyperlipidemia was induced by a single intraperitoneal (IP) injection of triton WR1339 (300mg/kg of body weight) in all groups except normal control. 24 hours after injection, blood collection was done and plasma analyzed for lipid profiles. Data was compared between group s by ANOVA and Tukey tests in SPSS 18 software. Findings: Aqueous extract of Brassica rapa root inhibited the elevation of plasma total cholesterol level at the dose of 200mg/kg of body weight. The extract also decreased LDL cholesterol and triglyceride levels in hyperlipidemic rats significantly but in compare to normal control group these levels were significantly high (p

Cardioprotective effects of various plants are generally attributed to their antioxidant activity. The whole fruit extract of pomegranate (WFEP), Punica granatum L. (Punicaceae), has a potent antioxidant activity.To investigate cardioprotective effect of WFEP against doxorubicin (Dox)-induced cardiotoxicity in rats.Male Wistar rats were divided randomly into three groups of eight rats each: control (water, 5 mL/kg); Dox (10 mg/kg i.v.) and WFEP (100 mg/kg). Dox was administered in Dox and WFEP groups. After anesthetizing the animals on the last day, electrocardiogram was recorded and blood was analyzed for creatine kinase-MB isoenzyme (CK-MB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) activities. Determinations of superoxide dismutase (SOD), reduced glutathione (GSH), lipid peroxidation (LPO) and histopathology of the heart tissues were carried out.The WFEP group showed decreased QT and increase in heart rate (p 0.05) compared to the Dox group. Significant decrease in CK-MB (p 0.01), LDH (p 0.05) and no such significant decrease in AST were observed as compared to the Dox group. There was significant increase in the level of GSH (p 0.05), whereas inhibition of LPO and increase in SOD concentration was not significant in the WFEP group compared to the Dox group. Histopathological study of the WFEP-treated group showed slight protection against myocardial toxicity induced by Dox.Results indicate that WFEP has cardioprotective effect against Dox-induced cardiotoxicity in rats.

Ziziphus jujuba Mill. (Z. jujuba) is a traditional herb with a long history of use for nutrition and the treatment of a broad spectrum of diseases. It grows mostly in South and East Asia, as well as in Australia and Europe. Mounting evidence shows the health benefits of Z. jujuba, including anticancer, anti-inflammation, antiobesity, antioxidant, and hepato- and gastrointestinal protective properties, which are due to its bioactive compounds. Chemotherapy, such as with cis-diamminedichloroplatinium (CDDP, cisplatin) and its derivatives, is widely used in cancer treatment. It is an effective treatment for human cancers, including ovarian cancer; however, drug resistance is a major obstacle to successful treatment. A better understanding of the mechanisms and strategies for overcoming chemoresistance can greatly improve therapeutic outcomes for patients. In this review article, the bioactive compounds present in Z. jujuba are explained. The high prevalence of many different cancers worldwide has recently attracted the attention of many researchers. This is why our research group focused on studying the anticancer activity of Z. jujuba as well as its impact on chemoresistance both in vivo and in vitro. We hope that these studies can lead to a promising future for cancer patients.