Epidemiology and Prognostic Factors in Cases of Near Hanging Presenting to a Referral Hospital in Arak,Iran

Background

Hanging is a common method of suicide in many countries, and it has a higher success rate than other commonly employed modes of attempted suicide, such as self-poisoning.

Study Objectives

The aim of this study was to determine the epidemiology and characteristics of near-hanging patients admitted to the main referral hospital in Arak, Iran.

Methods

All patients with the diagnosis of hanging admitted between January 2000 and 2009 were included in the study. Data regarding demographics, radiographic studies, injuries, Glasgow Coma Scale score (GCS) on arrival, and outcomes, were examined.

Results

During the 9-year study period, 43 cases of near hanging were identified. All patients were male, with a mean age of 24.2 years (range: 12–38 years). The median GCS at presentation was 6 (range: 3–12), and 83.8% of patients had a GCS of 8 or less. Cervical spine fracture of C2 was observed in two cases (4%). The imaging studies revealed that 62.7% of patients had an abnormal brain computed tomography scan, with brain edema being the most common finding (n = 16, 37.2%), followed by subdural hematoma (n = 10, 23.3%). Ophthalmologic examination demonstrated retinal bleeding in 24 patients (55.8%). There were four inpatient deaths among the study group, and 39 patients survived to discharge, yielding a mortality rate of 9.3%. Findings on presentation associated with subsequent mortality included a systolic blood pressure < 90 mm Hg, GCS < 5, retinal bleeding, and pulmonary edema.

Conclusion

Mortality among patients who present alive to the hospital after near hanging is low, including those with a low GCS on arrival. Ophthalmoscopic examination, as well as radiological examination of the brain and cervical spine, should be performed in cases of near hanging.     

Alkaloid and flavonoid rich fractions of fenugreek seeds (Trigonella foenum-graecum L.) with antinociceptive and anti-inflammatory effects

The seeds of fenugreek (Trigonella foenum-graecum L.) have medicinal uses as hypoglycemic, antinociceptive and anti-inflammatory agents. We aimed to evaluate the antinociceptive and anti-inflammatory effects of the major fractions of fenugreek seeds. The methanolic extract of the plant seeds was partitioned using a liquid–liquid extraction procedure to give six major fractions. Following phytochemical screening of isolated fractions, the total extract and each fraction were evaluated for their antinociception and anti-inflammatory effects using formalin and carrageenan-induced paw edema tests respectively. The methanolic extract exhibited both antinociceptive and anti-inflammatory effects at a dose of 100 mg/kg. Among the tested fractions, alkaline chloroform fraction (AKC), which was alkaloid positive in screening tests, showed the most anti-nociceptive effect in a dose-dependent manner. AKC fraction was as effective as morphine (5 mg/kg) in this regard. Both aqueous and acidified chloroform fractions (ACC) could significantly inhibit paw edema at a different dose. The latter fraction dose-dependently inhibited carrageenan-induced paw edema. The results of phytochemical screening tests confirmed the presence of flavonoids in both ACC and aqueous fractions. It can be concluded that the alkaloid and flavonoid content of fenugreek seeds can be responsible for antinociception and anti-inflammatory effects of the plant respectively.     

Induction of DNA double-strand breaks by monochlorophenol isomers and ChKM in human gingival fibroblasts

Phenol has been traditionally used in dental treatment as a sedative for the pulp or as disinfectant for carious cavity and root canal. However, phenol is regarded as a mutagenic and carcinogenic agent and its use in dental practice is now therefore restricted. Monochlorophenols are derivatives of phenol, which are still used clinically as root canal disinfectants, they are even more active antiseptics/disinfectants than phenol, and the so-called Walkhoff (ChKM) solution makes use of monochlorophenol for root canal disinfection. Ingredients in the ChKM solution are the monochlorophenol compound 4-chlorophenol (4-CP), camphor, and menthol. In literature, the use of the ChKM solution is controversial because of a possible DNA toxicity of the ingredient 4-CP. However, it is unknown whether ChKM can really induce DNA damage in human oral cells. In this study, the induction of DNA double-strand breaks (DSBs) by ChKM and monochlorophenol compounds (2-chlorophenol, 2-CP; 3-chlorophenol, 3-CP; and 4-chlorophenol, 4-CP) was tested in human gingival fibroblasts (HGFs). DNA DSBs (foci) induced in HGFs unexposed and exposed to monochlorophenols or ChKM solution were investigated using the γ-H2AX DNA focus assay, which is a direct marker for DSBs. DSBs result in the ATM-dependent phosphorylation of the histone H2AX. When cells were exposed to medium or medium?+?DMSO (1?%) (negative controls), an average of 3 foci per cell were found. In positive control cells (H(2)O(2)?+?medium, or H(2)O(2)?+?medium?+?DMSO (1?%), an average of 35 foci each were found. About 20 DSB foci per cell were found, when HGFs were exposed to 2-CP (4?mM), 3-CP (2.3?mM), 4-CP (2.1?mM), or ChKM (corresponding to 1.5?mM 4-CP). Our results show increasing DNA toxicities in the order of 2-CP?相似文献   

Cedecea davisae bacteremia in a neutropenic patient with acute myeloid leukemia

Cedecea are the new members of Enterobacteriacea. Because of their inherent resistance to some antibiotics, the clinical response could be unpredictable making management of Cedecea infection in immunocompromised patients challenging. We report a case of acute myeloid leukemia with central line-related Cedecea bacteremia.     

The impact of one session resistance exercise on plasma adiponectin and RBP4 concentration in trained and untrained healthy young men

We designed this study, to investigate the predicting effect of a single resistance exercise session on serum level of RBP4 and adiponectin in trained and untrained subjects and to evaluate whether regular training may affect the response of these adipokines to exercise. Thirty four healthy young male students including 19 trained and 15 untrained participated in this study; each group was then randomly assigned to intervention and control groups. The exercise session prolonged 120 minutes intensive resistance program at 70%-80% of 1RM. The blood samples were collected just before the start of training program and 4 hours post exercise to evaluate concentration of adiponectin, RBP4 and CRP as well as other metabolic markers. The serum level of adiponectin, RBP4 and CRP was not significantly different between trained and untrained groups at baseline. More over four hours post exercise adipokines concentration and CRP didn't differ between groups. Adjusted regression model showed, basal adiponectin (β=0.59, p=<0.001) and HDL cholesterol (β=0.28, p=0.09) were the main predictors of post exercise adiponectin concentration. In addition, the basic level of RBP4 appeared to be the only predictor of after exercise RBP4 concentration (β=0.46, p=0.02). Neither one session of high intensity resistance exercise nor long term training had predicting effect on post exercise adiponectin and RBP4 concentration in healthy young men. In the other hand, the beneficial effect of acute resistance exercise training may not be reflected by changes in adiponectin, RBP4 and CRP concentration in healthy young individual no matter they trained or untrained.     

Efficacy of ‘Itrifal Saghir’, a combination of three medicinal plants in the treatment of obesity; A randomized controlled trial

Background

Herbal combination of Itrifal Saghir (triphala) has been widely used in traditional medicine. And brings health benefits such as antioxidant effect and scavenger of hydroxyl radicals and nitric oxide radicals activity and substantiated in traditional medicine a anti-obesity.

Material and method

In this study we aimed to assess the efficacy of this herbal medicinal on reduction of weight and body mass index (BMI) of simple obese subjects in comparison with placebo. Obese subjects aged between 16 and 60 years were selected for 12-week, double-blind, randomized, placebo-controlled trial using a parallel design. Subjects were randomly assigned to take 5 grams of either the Itrifal Saghir (n = 31) or placebo (n = 31), 2 times daily for 12 weeks. Measures of body weight, BMI, waist circumference (WC), hip circumference (HC), were assessed at baseline and once every four weeks during the 12 week treatment period. The safety was evaluated by means of measuring the liver and kidney function. Homeostasis model of insulin resistance (HOMA-IR) was calculated as [fasting insulin (μU/mL) × fasting glucose (mmol/L)/22.5].

Results

Compared to placebo group, in treatment group the mean difference of effective weight loss was 4.82Kg (CI95% 3.52 - 6.11, ρ < 0.001), the mean of decrease in waist circumference was 4.01 cm (CI 95% 2.13 - 5.90, ρ < 0.001), and the mean decrease in hip circumference was 3. 21 cm (CI 95% 1.96 - 4.45, ρ < 0.001) in treated subjects. No adverse effects or significant changes in liver and kidney function tests were observed in both placebo and treated groups.

Conclusions

Itrifal Saghir appears to produce a positive effect on weight loss in obese subjects.     

The effect of semelil (angipars?) on bone resorption and bone formation markers in type 2 diabetic patients

Background and purpose of the study

Diabetes mellitus has been recognized as a major risk factor for osteoporosis in which bone turnover is affected by different mechanisms. As the morbidity, mortality and financial cost related to osteoporosis are expected to rise in Iran in coming years, and considering the efficacy of Angipars® for improvement of different ulcers which made it a new herbal drug in diabetic foot ulcer, there is a need to evaluate the effect of this new drug on different organs including bone resorption and bone formation markers.

Methods

In this randomized, double- blind clinical trial, 61 diabetic patients were included. The subjects were randomly divided into intervention and control groups. Subjects of intervention group received 100 mg of Angipars® twice a day. Laboratory tests including bone resorption and bone formation markers were performed at baseline and after 3 months.

Result

31 patients in study group and 30 patients in control group finished the study. The mean age of the study population and the mean disease duration was respectively 51.8 ± 6.2 and 7.5 ± 4.7 years with no significant differences between intervention and control patients. No statistically significant differences between patients and controls were observed in pyridinoline, osteocalcin, urine calcium, bone alkaline phosphatase and tumor necrosis factor (TNF-α). Only urine creatinine level significantly changed between two groups after 3 month of treatment (p-value: 0.029)

Conclusion

In conclusion, the findings of this study indicate that Semelil (Angipars®) had no beneficial or harmful effects on bone. It might be other effects of this new component on bone turnover process which need more studies and more time to be discovered.     

Juvenile Systemic Lupus Erythematosus associated with Klinefelter's syndrome: A case report

We present the first reported case of juvenile Systemic Lupus Erythematosus with Klinefelter's syndrome in a 14-year-old Iranian boy who had leg ulcers and arthritis. He had low level of testosterone accompanied with hypergonadotropic hypogonadism. This case emphasizes the importance of two X chromosomes as a risk factor for Systemic Lupus Erythematosus in women and men with Klinefelter's syndrome (47, XXY).     

Dose to tissue medium or water cavities as surrogate for the dose to cell nuclei at brachytherapy photon energies

It has been suggested that modern dose calculation algorithms should be able to report absorbed dose both as dose to the local medium, D(m,m,) and as dose to a water cavity embedded in the medium, D(w,m), using conversion factors from cavity theory. Assuming that the cell nucleus with its DNA content is the most important target for biological response, the aim of this study is to investigate, by means of Monte Carlo (MC) simulations, the relationship of the dose to a cell nucleus in a medium, D(n,m,) to D(m,m) and D(w,m), for different combinations of cell nucleus compositions and tissue media for different photon energies used in brachytherapy. As D(n,m) is very impractical to calculate directly for routine treatment planning, while D(m,m) and D(w,m) are much easier to obtain, the questions arise which one of these quantities is the best surrogate for D(n,m) and which cavity theory assumptions should one use for its estimate. The Geant4.9.4 MC code was used to calculate D(m,m,) D(w,m) and D(n,m) for photon energies from 20 (representing the lower energy end of brachytherapy for 1?3Pd or 12?I) to 300 keV (close to the mean energy of (1?2Ir) and for the tissue media adipose, breast, prostate and muscle. To simulate the cell and its nucleus, concentric spherical cavities were placed inside a cubic phantom (10 × 10 × 10 mm3). The diameter of the simulated nuclei was set to 14 μm. For each tissue medium, three different setups were simulated; (a) D(n,m) was calculated with nuclei embedded in tissues (MC-D(n,m)). Four different published elemental compositions of cell nuclei were used. (b) D(w,m) was calculated with MC (MC-D(w,m)) and compared with large cavity theory calculated D(w,m) (LCT-D(w,m)), and small cavity theory calculated D(w,m) (SCT-D(w,m)). (c) D(m,m) was calculated with MC (MC-D(m,m)). MC-D(w,m) is a good substitute for MC-D(n,m) for all photon energies and for all simulated nucleus compositions and tissue types. SCT-D(w,m) can be used for most energies in brachytherapy, while LCT-D(w,m) should only be considered for source spectra well below 50 keV, since contributions to the absorbed dose inside the nucleus to a large degree stem from electrons released in the surrounding medium. MC-D(m,m) is not an appropriate substitute for MC-D(n,m) for the lowest photon energies for adipose and breast tissues. The ratio of MC-D(m,m) to MC-D(n,m) for adipose and breast tissue deviates from unity by 34% and 15% respectively for the lowest photon energy (20 keV), whereas the ratio is close to unity for higher energies. For prostate and muscle tissue MC-D(m,m) is a good substitute for MC-D(n,m). However, for all photon energies and tissue types the nucleus composition with the highest hydrogen content behaves differently than other compositions. Elemental compositions of the tissue and nuclei affect considerably the absorbed dose to the cell nuclei for brachytherapy sources, in particular those at the low-energy end of the spectrum. Thus, there is a need for more accurate data for the elemental compositions of tumours and healthy cells. For the nucleus compositions and tissue types investigated, MC-D(w,m) is a good substitute to MC-D(n,m) for all simulated photon energies. Whether other studied surrogates are good approximations to MC-D(n,m) depends on the target size, target composition, composition of the surrounding tissue and photon energy.