Search

Purpose: To determine the keratometry measurement agreement using Sirius corneal topography and Scheimpflug camera, Tomey corneal topography, Topcon autokeratorefractometer, and Tomey OA-2000 optical biometry in eyes with different severity of keratoconus., Methods: In this retrospective study 115 eyes in different stages of keratoconus were divided into 2 groups of mild (stage 1), and moderate to severe keratoconus (stages 2, 3), according to the Amsler-Krumeich classification. Keratometry measurements were obtained using Sirius corneal topography and Scheimpflug camera (phoenix V3.7.01.08), Tomey corneal topography (Tms SW22C-200S-200), Topcon autokeratorefractometer (KR8900), and Tomey optical biometry (OA-2000 Opt-Meas V.4E)., Results: In group 1 All devices demonstrated fair agreement in average keratometry values (95% LoA range > 1 D). However, it was poorer for group 2 (95% LOA range > 3 D). In group 1 Bonferroni test revealed statistically significant difference in average K readings among (Topcon autokeratorefractometer 8900 and Tomey OA-2000 biometry, p < 0.01), and between (Tomey topography and Topcon autokeratorefractometer, p < 0.05). Also in group 2 significant difference was observed in the average keratometry of the most instruments (p < 0.01) except for the (Tomey topography and Topcon autokeratorefractometer) and (Tomey topography and Tomey OA-2000 biometry., Conclusions: According to our investigation in mild, moderate and severe keratoconus the agreement in K reading between Topcon autokeratorefractometer, OA-2000 optical biometry, Sirius topography and Tomey topography was poor. The agreement declines especially in the steep meridian and it was not acceptable clinically. These devices should not be applied interchangeably., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Incidences of disease, dieback, decline or mortality, some of which induced or enhanced by climate change, threaten the sustainability of forest stands in many ecosystems. Spatially explicit prediction of disease onset remains challenging, however, due to the involvement of several causative agents. In this paper, we developed a generic framework based on machine-learning algorithms and spatial analyses for landscape-level prediction of oak disease outbreaks caused by the charcoal fungus Biscogniauxia mediterranea in a mixed-oak forest of Mediterranean climate. For prediction, we used a set of fifteen causative factors as a cross-function of soil, site and stand-related predictors. A total of 80 sample plots, including 1134 affected trees, were surveyed and used for the modeling process at the 5600-ha landscape level of the southern Zagros, Iran, where the disease occurs in roughly 25% of forest lands. Ten machine learning algorithms were explored and the performance of each algorithm to predict oak disease outbreak was evaluated. The modeling framework used maximum entropy to remove the least influential variables and build the status-quo management scenario to which the results of the prediction models were compared. Results showed that the random forests algorithm (AUC = 0.96: Precision = 0.71: Accuracy = 0.90: F-Measure = 0.70) achieved significantly better results than the status-quo management (Precision = 0.13: Accuracy = 0.67: F-Measure = 0.12) and any other algorithm. Soil chemical properties (NPK, organic carbon and EC) and landform predictors (slope, distance to roads, and TWI) were major forecasters of oak disease outbreak identified by the random forest algorithm. Geostatistical analysis enabled the creation of a map that identified sites at higher risk of infestation, allowing epidemiologists and forest managers to find sites likely to be infested. Consequently, financial resources can be allocated and management practices such as sanitation felling treatments applied across large forest landscapes to minimize the risk of spread and severity to uninfested high-value trees on nearby or adjacent land zones that are in the early stage of epidemics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The burden of five main air pollutants, including CO, O3, NO2, SO2, and PM2.5, on the emergency department visits (EDVs) during January 2016-December 2019 due to all cardiovascular diseases was assessed in Tehran by using a time-series model. The pollutants data were collected from Iran Department of Environment including 10 air pollution monitoring stations for the period of our study. Cumulative relative risk and attributable number/fraction were calculated for each pollutants by a Quasi-Poisson time-series regression and distributed lag non-linear model (DLNM). The maximum lag was set to 14 days because harvesting effect is more likely happened during few days. We used percentile 25 as reference value in order to calculate cumulative relative risk and attributable fraction. About 69,000 patients with cardiovascular symptoms have been admitted into the hospital during 4 years. The cumulative relative risk during the 14 days was 1.13 (1.01, 1.26), 1.15 (1.02, 1.29), and 1.08 (1.01, 1.18) for CO, NO2, and PM2.5, respectively. The numbers attributed to all values of CO were more than others; about 3800 EDVs were significantly attributed to CO, of which over 3000 were significantly attributed to high values of the pollutant. Low values of all pollutants were, not surprisingly, responsible for low number of EDVs. PM2.5, CO, and NO2 were responsible to considerable attributable number of EDVs. Our study emphasizes the need for local authorities to establish a program to reduce the air pollution in Tehran., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: In health care institutions, safety culture is defined as the integrity of individual and group efforts to reduce the harms for the patients. This is possible through interactions, attitudes, and understanding of safety matters. On the other hand, one of the indicators of the safety culture is the safety climate. Objective: The aim of this study is to investigate the interaction between safety climate and safety culture using structural equation modeling in personnel of cancer treatment centers in Iran. Methods: In this study, 680 personnel of Iran’s hospitals were chosen in a random manner. Demographic (9 questions), safety culture (42 questions) and safety climate (37 questions) questionnaires were filled. The data were inserted in SPSS 20 software. Descriptive statistics method and Pearson’s correlation coefficient were used to describe the data and evaluate the relation between the variables, respectively. Structural equations model was developed using AMOS 22 software and fitness of the model was tested by χ2, RMSEA, GFI and NFI statistics. Results: The scores of safety climate and safety culture were 3.61 and 3.30, respectively, which imply that they are suiTable. The overall fitness of the model was accepTable. In this model, χ2 = 8637.17, df = 2964, χ2/df = 2.914, RMSEA = 0.058, NFI = 0.912, GFI=0.907, and CFI=0.875. In the regression analysis, there were positive significant relationships between safety climate and safety culture, safety climate and any of its components, and safety culture and any of the components. Conclusion: It was found that the safety climate and the safety culture had a positive impact on each other; so that with increasing safety climate, the safety culture also increases, and vice versa. Also, the level of education has a positive impact on safety culture and safety climate. So appropriate training can promote both variables in cancer treatment hospitals., (Creative Commons Attribution License)

This article published in Cell J (Yakhteh), Vol 20, No 2, Jul-Sep 2018, on pages 267-277, four affiliations (1, 4, 5, and 10) were changed based on authors request., Competing Interests: There is no conflict of interest in this study., (Copyright© by Royan Institute. All rights reserved.)

Objectives: The regenerative potential of bone marrow-derived mononuclear cells (MNCs) and CD133+ stem cells in the heart varies in terms of their pro-angiogenic effects. This phase II/III, multicenter and double-blind trial is designed to compare the functional effects of intramyocardial autologous transplantation of both cell types and placebo in patients with recent myocardial infarction (RMI) post-coronary artery bypass graft., Materials and Methods: This was a phase II/III, randomized, double-blind, placebo-controlled trial COMPARE CPM-RMI (CD133, Placebo, MNCs - recent myocardial infarction) conducted in accordance with the Declaration of Helsinki that assessed the safety and efficacy of CD133 and MNCs compared to placebo in patients with RMI. We randomly assigned 77 eligible RMI patients selected from 5 hospitals to receive CD133+ cells, MNC, or a placebo. Patients underwent gated single photon emission computed tomography assessments at 6 and 18 months post-intramyocardial transplantation. We tested the normally distributed efficacy outcomes with a mixed analysis of variance model that used the entire data set of baseline and between-group comparisons as well as within subject (time) and group×time interaction terms., Results: There were no related serious adverse events reported. The intramyocardial transplantation of both cell types increased left ventricular ejection fraction by 9% [95% confidence intervals (CI): 2.14% to 15.78%, P=0.01] and improved decreased systolic wall thickening by -3.7 (95% CI: -7.07 to -0.42, P=0.03). The CD133 group showed significantly decreased non-viable segments by 75% (P=0.001) compared to the placebo and 60% (P=0.01) compared to the MNC group. We observed this improvement at both the 6- and 18-month time points., Conclusions: Intramyocardial injections of CD133+ cells or MNCs appeared to be safe and efficient with superiority of CD133+ cells for patients with RMI. Although the sample size precluded a definitive statement about clinical outcomes, these results have provided the basis for larger studies to confirm definitive evidence about the efficacy of these cell types (Registration Number: NCT01167751)., Competing Interests: There is no conflict of interest in this study., (Copyright© by Royan Institute. All rights reserved.)

Methicillin-resistant Staphylococcus aureus (MRSA) has been one of the most important antibiotic-resistant pathogen in many parts of the world over the past decades. This cross-sectional study was conducted to investigate MRSA isolated between July 2013 and July 2014 in Karaj, Iran. All tested isolates were collected in teaching hospitals from personnel, patients, and surfaces and each MRSA was analyzed by SCCmec and spa typing. Antibiotic susceptibility testing was accomplished by disk diffusion method. Out of 49 MRSA isolates from the Karaj's teaching hospitals, 82%, 10%, and 6% of the isolates were SCCmec types III, II, and I, respectively. The main spa type in this study was spa t030 with frequency as high as 75.5% from intensive care unit (ICU) of the hospitals and high rate of resistance to rifampicin (53%) was found in MRSA isolates. In conclusion, high frequency of spa t030 with SCCmec type III and MRSA phenotype illustrated circulating of one of the antibiotic-resistant strains in ICU of Karaj's teaching hospitals and emphasizes the need for ongoing molecular surveillance, antibiotic susceptibility monitoring, and infection control.

Purpose: To compare central corneal thickness (CCT) and specular microscopic indices in active unilateral anterior uveitis with the same indices 1 week after the initiation of treatment., Methods: This study included 30 eyes with active unilateral idiopathic anterior uveitis. CCT and specular microscopic indices were compared before and after 1 week of the treatment with topical medications., Results: At the first visit, mean CCT was significantly greater in affected eyes (mean ± standard deviation: 514.0 ± 23.0) than in fellow eyes (493.2 ± 10.6) (p < 05). There was a significant decrease in CCT of the involved eye 1 week after start of treatment to 494.1 ± 23.1 μm (p < 05). No significant differences were observed in the specular microscopic indices between the affected and fellow eyes before treatment and 1 week after the treatment., Conclusion: We found that eyes with unilateral active anterior uveitis had increased CCT in comparison to their healthy fellow eyes without a change in the specular microscopic indices.

Statement of the Problem: The success of metal- ceramic- restorations (MCR) depends on the presence of strong bond between porcelain and metal substructure., Purpose: The purpose of this study was to evaluate the effect of hot pressing technique on the bond strength of a metal-porcelain composite in comparison to layering technique., Materials and Method: Thirty Nickel-Chromium specimens were produced by two methods; conventional porcelain layering on metal and hot pressing (n=15). Bond strengths of all specimens were assessed by the means of three-point bending test according to ISO 9693: 1999 (E) instructions. The data were analyzed using Students t-test (p< 0.001)., Results: The mean ± SD bond strength of conventional and hot pressing technique was 48.29 ± 6.02 and 56.52 ± 4.97, respectively. Therefore, the conventional layering technique yielded significantly lower mean bond strength values than hot pressing technique (p< 0.001)., Conclusion: This study showed that it is possible to improve metal-porcelain bond strength significantly by applying an overpressure during porcelain firing.

Background: Recently, we have reported the induction of apoptosis by 2-amino-4-(3-nitrophenyl)-3-cyano-7-(dimethylamino)-4H-chromene (3-NC) in HepG2, T47D and HCT116 cells with low nano molar IC50 values. In this study, anti-proliferative effects of modified 4-aryle-4H-chromenes derivatives; 2-amino-4-(3-bromophenyl)-3-cyano-7-(dimethylamino)-4H-chromene (3-BC), 2-amino-4-(3-trifluoromethylphenyl)-3-cyano-7-(dimethylamino)-4H-chromene (3-TFC) and 2-amino-4-(4,5-methylenedioxyphenyl)-3-cyano-7-(dimethylamino)-4H-chromene (4, 5-MC) were investigated in three human cancer cell lines. Compared to 3-NC none of the compounds displayed better anti-proliferative effect, although 3-BC appeared somewhat similar. Therefore 3-NC was selected for further studies., Methods and Results: Treatment of HepG2, T47D and HCT116 cells with this compound induced apoptosis as visualized by fluorescence microscopic study of Hoechst 33258 stained cells. Induction of apoptosis was quantified by Annexin V/PI staining using flow cytometry. Western blot analysis also revealed that 3-NC down-regulated the expression of anti-apoptotic protein Bcl2 and up-regulated pro-apoptotic protein Bax, in all of the cell lines. Nonetheless, HepG2 cell line was the most responsive to 3-NC as Bax and Bcl2 showed the most dramatic up and down regulation., Conclusion: Our previous finding that 3-NC down regulates Inhibitor of Apoptosis Proteins (IAPs) and the present observation that Bax is upregulated and Bcl2 is down regulated upon 3-NC treatment, this chromene derivative has the potential to overcome chemotherapy resistance caused by up regulation of these proteins.

There seems to be a close relationship between hippocampal N-methyl-D-aspartic acid (NMDA) and GABAA receptors with respect to the modulation of behavior that occurs in the CA1 region of the hippocampus. This study investigated the possible involvement of the CA1 GABAA receptors in anxiolytic-like effects induced by (+)-MK-801 (a noncompetitive antagonist of the NMDA subtype of the glutamate receptor). Male Wistar rats were subjected to the elevated plus-maze apparatus and open arm time (%OAT), and open arm entries (%OAE) for anxiety-related behaviors, and closed arm entries that correspond to the locomotor activity were assessed. An intra-CA1 injection of (+)-MK-801 (2 μg/rat) and muscimol (0.5 μg/rat; a GABAA receptor agonist) increased %OAT and %OAE by themselves while not altering the closed arm entries, indicating an anxiolytic-like effect of these drugs. Injection of bicuculline (0.1, 0.25, and 0.5 μg/rat; a GABAA receptor antagonist) did not alter any of the anxiety-related parameters. An intra-CA1 injection of a subthreshold dose of muscimol (0.1 μg/rat) or bicuculline (0.5 μg/rat), 5 min before injection of subthreshold and effective doses of (+)-MK-801 (0.5, 1 and 2 μg/rat), increased and decreased the anxiolytic-like effect of (+)-MK-801, respectively. The isobologram analysis of these findings suggested a synergistic anxiety-like effect of intra-CA1 (+)-MK-801 and muscimol. In conclusion, the CA1 GABAA receptors appear to be involved in anxiolytic-like behaviors induced by (+)-MK-801.

Background: Cardiovascular diseases (CVDs) are the number one cause of death in the world. In most analyses of health problems, environment plays a significant and modifiable role in causing the problem either directly or indirectly through behavior., Objectives: This study aims to understand the patients and healthcare providers' experiences about the environmental determinants of CVD risk factors based on the Precede Model., Patients and Methods: This qualitative study conducted over six months in 2012 at Diabetes Units of Health Centers associated with Alborz University of Medical Sciences and Health Services which is located in Karaj, Iran. The data were collected based on individual semi-structured interviews with 50 patients and 12 healthcare providers. Data analysis was performed simultaneous with data collection using the content analysis directed method., Results: Lack of behaviors like stress control, healthy eating and physical activity were the roots of the risk factors for CVD. The environmental factor is one of the barriers for conducting these behaviors. The environmental barriers included of structural environment including "availability and accessibility of health resources", "new skills", and "law and policies" which are located in enabling category and social environment including "social support", "motivation to comply" and "consequences of behavior" which are located in reinforcing category. The most barriers to performing health behaviors were often structural., Conclusions: The environmental factors were barriers for doing healthy behaviors. These factors need to be considered to design health promotion interventions. Policymakers should not only focus on patients' education but also should provide specific facilities to enhance economic, social and cultural status.

Background: The PRECEDE model is a useful tool for planers to assess health problems, the behavioral and environmental causes of the problems, and their determinants. This study aims to understand the experiences of patients and health care providers about the behavioral causes of cardiovascular diseases (CVDs) risk factors and their determinants., Methods: This qualitative study utilized content analysis approach based on the PRECEDE model. The study was conducted for over 6 months in 2012 at the diabetes units of health centers associated with Alborz University of Medical Sciences, which is located in Karaj, Iran. Data were collected using individual semi-structured interviews with 50 patients and 12 health care providers. Data analysis was performed simultaneously with data collection using the content analysis directed method., Results: Stress, unhealthy eating, and physical inactivity were the behaviors, which predict the risk factors for CVD. Most of the patients considered stress as the most important underlying cause of their illness. In this study, 110 of the primary codes were categorized into seven subcategories, including knowledge, attitude, perceived susceptibility, severity, perceived benefits, barriers, and self-efficacy, which were located in the predisposing category of the PRECEDE model. Among these determinants, perceived barriers and self-efficacy for the mentioned behaviors seemed to be of great importance., Conclusion: Identifying behavioral determinants will help the planners design future programs and select the most appropriate methods and applications to address these determinants in order to reduce risky behaviors.

Bacteremia continues to result in significant morbidity and mortality, particularly among neonates. There is scarce data on neonatal bacteremia in among Iranian neonates. In this study, we determined neonatal bacteremia isolates and their antibiotic resistance pattern in neonatal insensitive care unit at Beasat hospital, Sanandaj, Iran. During one year, all neonates admitted to the NICU were evaluated. Staphylococcal isolates were subjected to determine the prevalence of MRS and mecA gene. A total of 355 blood cultures from suspected cases of sepsis were processed, of which 27 (7.6%) were positive for bacterial growth. Of the 27 isolates, 20 (74%) were Staphylococcus spp as the leading cause of bacteremia. The incidence of Gram negative bacteria was 04 (14.8%). The isolated bacteria were resistant to commonly used antibiotics. Maximum resistance among Staphylococcus spp was against Penicillin, and Ampicillin. In our study, the isolated bacteria were 7.5 % Vancomycin and Ciprofloxacin sensitive. Oxacillin disk diffusion and PCR screened 35% and 30% mec a positive Staphylococcus spp. The spectrum of neonatal bacteremia as seen in NICU at Beasat hospital confirmed the importance of pathogens such as Staphylococcus spp. Penicillin, Ampicillin and Cotrimoxazol resistance was high in theses isolates with high mecA gene carriage, probably due to antibiotic selection.

Background: Apical Membrane antigen 1 (AMA-1) is positioned on the surface of merozoite and it may play a role in attack to red blood cells. The main aim of present study was to determine the genetic variation, as well as, to detect of selection at domain I of AMA-1 gene Plasmodium vivax isolates in Iran., Methods: Blood samples were collected from 58 patients positive for P. vivax, mono infection and the domain I of AMA-1 gene was amplified by nested PCR and then sequenced., Results: A total 33 different haplotypes were identified among 58 Iranian sequences. The 23 new haplotypes were determined in this study that was not reported previously in other regions of the world. There were totally observed 36 point mutations at the nucleotide level in the analyzed sequences. Sequences analyses indicated 25 amino acid changes at 20 positions in which 5 sites demonstrated thrimorphic polymorphism and the others were dimorphic in the domain I of the Iranian PvAMA-1 isolates., Conclusion: Our findings indicated relatively high level of allelic diversity at the domain I of PvAMA-1 among P.vivax isolates of Iran. Since, PvAMA-1 is considering as vaccine candidate antigen, these data provide valuable information for the development of a PvAMA-1 based malaria vaccine.

The use of local anesthesia with lidocaine containing epinephrine in patients with cardiac disease is controversial in the literature. The aim of our study was determining the safety of use the local anesthesia contain epinephrine in patients with ischemic heart disease that undergoing reconstructive surgery. Thirty two patients that had known ischemic heart disease and candidate to undergo reconstructive surgery for skin tumor enrolled in this study.  All patients continued their medication for cardiac disease till morning of the operation. 10 ml lidocaine 2% containing 1:100,000 epinephrine was injected in patients for local anesthesia. The hemodynamic changes and electrocardiographic variables before injection were compared with them after injection, during surgery and till 6 hours postoperation period. A 12 lead electrocardiogram was recorded in all our cases for detection of myocardial ischemic changes. The mean age, weight and height were 58.2±10.4, 74.8.±14.4 kg and 164.5± 8 cm respectively. Twelve patients (37.5%) were diagnosed with systemic hypertension and 10 patients with diabetes (31.2%). The comparison of change of systolic, diastolic and mean blood pressure between baseline, during procedure and after operation defined that our subjects did not have any significant disturbance in blood pressure in perioperative period. The comparison of baseline heart rate with heart rate after injection, during procedure and in postoperation period indicated a significant changes in this variable (P=0.044). The heart rhythm during the perioperative period also failed to exhibit alterations. The ischemic change was not recorded in our patients before injection compared to after injection. None of our patients have any early complications because of infiltration of local anesthetic containing epinephrine in our patients. The use of 10 ml 2% lidocaine with epinephrine 1:100,000 in patients with cardiac disease represent a safe anesthetic procedure. These patients experienced a more profound anesthesia with hemodynamic stability and without myocardial ischemic changes.

We describe the surgical management of a free-floating thrombus in the aortic arch in a patient with severe mitral stenosis, a left atrial appendage (LAA) clot, and an iliac artery thrombus. A 60-year-old woman complaining of dyspnea and pain in her right leg was referred to our multidisciplinary clinic. After a brief history was taken, an electrocardiography evaluation showed atrial fibrillation. Color Doppler sonography of the lower limb arteries showed decreased blood flow in distal branches of the internal iliac artery of the right leg. Transthoracic and transesophageal echocardiography evaluations revealed severe mitral stenosis, a large LAA clot, and a large mobile mass (2 × 1.5 × 1.5 cm) in the distal aortic arch. Additional investigations with computed tomographic angiography revealed that the thrombus extended from the aortic arch to the subclavian artery. Another bulky thrombus in the right iliac artery was also found. Given this complicated medical situation, emergency cardiac surgery was performed, and the clot was removed. The stenotic mitral valve was replaced with a prosthetic valve, The LAA was closed after clot removal, and the bulky thrombus was extracted from the right iliac artery. Transesophageal echocardiographic data were obtained postoperatively, and the patient's course in the intensive care unit was favorable. She was discharged from the hospital in good condition on warfarin, digoxin, aspirin, and metoprolol.

Background: Coronary artery bypass graft (CABG) is a treatment strategy to relieve the symptoms of coronary artery disease (CAD). Based on determining the long term outcome of CABG using SF-36 Health Related Quality Of Life (HRQOL) questionnaire, the present study was conducted in our center to determine the CABG results one-year after the operation., Methods: Between March 2005 and August 2009, 112 patients with coronary heart disease (CHD) who underwent coronary artery bypass graft (CABG) were enrolled. Patients completed SF-36 HRQOL general health status questionnaire. Stepwise multiple linear regression models were used to detect independent variables predicting changes in each eight subscales of SF-36 questionnaire., Results: The mean age of patients was 61.4±0.9 years and most of them were male with three vessel diseases that were on pump CABG. The mean physical and mental component summary scores were 59.5±0.9 and 60.2±0.9, respectively. Physical functioning (PF) and role physical (RP) improved in males. Regression models showed that there were some statistical models with low R-square to predict role emotional (RE), general health (GH), PF and RP according to ejection fraction after surgery, diabetes, pump type of CABG and male gender., Conclusion: CABG has led to higher and more satisfactory outcomes for PF, RP and RE but lower in other scales comparing with normative data of the society and one-year post-operative scores of other studies. It could mostly be attributed to unmodified risk factors and progression of existing comorbidities.

Introduction: This study aimed to evaluate the response rate, clinical efficacy and onset of action of sublingual captopril in patients diagnosed with hypertensive urgency., Methods: In this cross-sectional study, 101 (67 female and 34 male) patients with a diagnosis of hypertensive urgency (systolic pressure greater than or equal to 180 mmHg and/or diastolic pressure greater than or equal to 110 mmHg, and no findings of target organ damage) were included. Sublingual captopril (25 mg) was administered and the blood pressure was measured during a follow-up period of 120 minutes., Results: After 60 minutes, an ideal decrease (25 percent of the initial blood pressure) was detected in 54 patients (53.5 percent). An additional 25 mg of sublingual captopril was administered to the remaining 47 patients (46.5 percent). Of these, 19 (18.8 percent) did not respond even to the second dose of sublingual captopril. These non-responders consisted of patients who were taking multidrug antihypertensive regimens before presentation due to hypertensive urgency. No serious side effect was recorded during the study period., Conclusion: Sublingual captopril can be used as an effective, easily applicable and safe treatment in the management of hypertensive urgency for 120 minutes for those who do not receive multidrug antihypertensive regimens.

Introduction: Acute normovolaemic haemodilution (ANH) is a safe and cost-effective blood conservation strategy in procedures with great blood loss. It eliminates the risk of administrative errors and also contaminations that may occur whenever banked blood is used. Classically, haemodilution is regarded as causing coagulopathy. This study was designed to determine the effect of crystalloids on measured coagulation values and perioperative blood loss following ANH in patients undergoing elective coronary revascularization., Methods: Following a prospective case-control study one hundred candidates for CABG (50 cases in the ANH group and 50 in the control group) were included. Blood samples for coagulation testing haematocrit and platelet levels were collected before ANH, after cardiopulmonary bypass (CPB), and upon arrival at the intensive care unit (ICU). Differences were considered statistically significant with P values < 0.05., Result: There was no statistically significant difference between chest tube drainage in the two groups. The number of patients using PRBC (packed red blood cell) or FFP (fresh frozen plasma) was significantly higher in the control group in comparison to the ANH group (P < 0.05). The PT increased significantly after arrival in the ICU in both groups (P < 0.001) but there was no between-group difference (P = 0.22). aPTT not only did not change significantly in the ICU relative to the baseline pre ANH values in both groups (P > 0.05) but also did not show any between-group difference (P = 0.69). There was no statistically significant difference in the aCT of the control and the ANH group after arrival to the ICU (P = 0.09). Hct and Plt decreased significantly in both groups after CPB and arrival at ICU., Conclusion: ANH reduced the need for PRBC and FFP by 58% and 74%, respectively. Regarding the increase in PT and decrease in Plt count, we concluded that performing ANH with saline solution (SS) in patients undergoing CABG surgery may cause a non-clinically significant change in coagulation state.

Disseminated intravascular coagulation is a pathologic syndrome with different medical disorders. Diagnosis and treatment of this syndrome is one of the difficult managements in medical science. Thromboelastogram is the only guide for early diagnosis and precise management of this syndrome. We describe a patient who developed disseminated intravascular coagulation due to endocarditis and spleen abscess. She was diagnosed by thromboelastography and treated successfully.

Background: Upper gastrointestinal (UGI) symptoms are common in uremic patients, and higher serum levels of urea have been suggested to be related to Helicobacter pylori (HP) colonization and UGI mucosal inflammation., Aim: The aim of this study was to compare HP infection and UGI endoscopic findings between uremic patients, renal transplant (RT) recipients, and controls., Methods: A total of 474 subjects (71 chronic renal failure [CRF], 73 hemodialysis [HD], 25 Tx, and 305 controls) from Baqyiatallah Hospital, Tehran, Iran were recruited between April 2002 and March 2004 for evaluation of dyspepsia, excluding those receiving any HP-eradication therapy. All subjects were examined for esophagus, stomach and duodenum mucosa, and infection with HP on 2 distinct tissue samples of the anthral region., Results: Four groups of subjects (mean +/- 2 se; age, 45 +/- 1.6 years; 62.9% male) were studied. Duodenal ulcer in the uremic patients (CRF, 16.1%; HD, 13.7%) was more common than that in the RT-recipients (8%) and controls (6.5%); P=.038. Erosive gastritis and duodenal bulb deformity were also more common in the uremic subjects (CRF, 23.9%, 36.9%; HD, 30.1%, 20.5%, respectively) than those in the other subjects (RT recipients, 16%, 8%; controls, 8.2%; 0%, respectively); P<.001. HP infection was found to be higher in the uremic patients (CRF, 66.2%; HD, 63%) than in the RT recipients (40%) and controls (34.8%); P<.001., Conclusion: Higher rates of gastric and duodenal mucosal lesions and HP infection in the uremic patients in comparison with the subjects with normal renal function may have resulted from higher serum levels of urea, anemia, and fluctuations in the gastric blood supply in the CRF and HD patients. However, more tenable evidence from controlled trials is required for the eradication of HP in all uremic patients and transplantation candidates.