Tehran University Medical Journal

Background: Burns are one of the most devastating forms of trauma worldwide. In the elderly, flame and scald burns, or scalds alone, are the major causes of burns, occur at home, particularly in the kitchen and bathroom. Because elderly burned patients suffer from greater morbidity and mortality than younger patients with similar burn extents, preventing burns is paramount to continuing functionality and quality of life. Burns are largely explainable by characteristics of both the individual and the physical environment. Our study aims to analyses the epidemiologic characteristics of burn in the elderly (above 60 years old) in Iran.
Methods: Records of elderly patients (aged 60 and older) admitted with acute burns to the Burn Center of the Shahid Motahari Hospital, Tehran, Iran, between March 2007 and March 2014 was carried out. Patient demographics, etiology of burn, mechanism of injury, burn extent, mortality, severity of burn, length of stay in hospital, and outcomes were reviewed. The information was analyzed by SPSS software, version 18 (SPSS Inc., Chicago, IL, USA). T-test, oneway anova and K square were used.
Results: A total of 374 elderly patients were admitted. Majority of the patients were men 231 (61.8%) and the number of women were 143(38.2%). The most common etiologies were scalds (20.3%) and (oil-benzine-gasoline) (19.8%). The mean age of the patient was 71.5 years, which was average in women (72) and men (70.5 years). There was a statistically significant difference between the mean age in both male and female groups, so that the mean age of women was significantly higher than men (P=0.004). There was a significant correlation between gender and (etiology, hospital stay-mortality) and between treatment outcome and (etiology and motivation) and between motivation and etiology (P<0.001).
Conclusion: Boiling water was the main cause of burning in older women. Diminished senses, concentration disorders, slower reaction time, reduced mobility, and bedridden states may decrease elder's ability to identify fire and also to escape harm.

Background: Sesame oil can be used to treat cardiovascular diseases, such as atherosclerosis, by reducing the levels of fibrinogen and factor VII. The aim of this study is to prepare a microemulsion containing sesame oil as a drug nanocarrier for improving the aqueous solubility and therapeutic effects of this vegetable oil on the reduction of the fibrinogen and factor VII levels in animal model.
Methods: This experimental study was performed for microemulsion preparation and animal test at Ferdowsi University of Mashhad and Cardiovascular Research Center of Mashhad University of Medical Sciences, Mashhad, Iran, respectively, from April 2015 to January 2017. To prepare the microemulsion samples, Tween 80 and span 80 were selected as surfactant couple and surfactant ratios of 8:1, 9:1 and 10:1 were determined for construction of pseudo-ternary phase diagrams. The Zealand white rabbits were categorized in three groups: receiver of base diet group, high cholesterol diet and high cholesterol diet plus microemulsion.
Results: The average particle size of the samples was in the range of 16.64±0.1 to 21.16±0.2 nm with a uniform particle size distribution. Zeta potential was in the range of -10.7 to 18.4 mV, refraction index was approximately 1.39. Electrical conductivity coefficient was in the range of 297 to 311 μz and pH of all the samples were approximately 6.42 for all samples. All of the microemulsion samples were physically stable and the prepared sample with 9:1 surfactant ratio was selected to investigate the animal test due to the higher oil percentage in comparison with the other samples that be stable over 6 months. Significant decrease in the levels of fibrinogen and factor VII in the third group of rabbits was observed compared to the other groups.
Conclusion: The results of this study showed the effective performance of nanostructured drug delivery systems in the form of microemulsion to improve the aqueous solubility and therapeutic effects of hydrophobic compounds such as vegetable oils.

Background: Hypoglycemia is a condition when blood glucose level is lower than 70 mg/dl in people without diabetes. The symptoms of hypoglycemia include tachycardia, sweating, pallor, pupillary dilatation. Hypoglycemia is a non-lethal and often preventable clinical problem in non-diabetic patients that can occur during fasting or after dining.
Case presentation: A 52 years old man referred to Shohada-e-Tajrish Hospital, Tehran, with diagnosis of kidney stones candidate for percutaneous nephrolithotomy (PCNL). The patient underwent general anesthesia and after 40 minutes, the surgeon requested injection of tranexamic acid because of bleeding, but unintentionally the patient received 100 unites of crystalline insulin by nurse anesthesia. Vital signs were stable, the patient's blood glucose was 85 mg/dl and he had no sweat. Then the therapeutic intervention consisted of administering a bolus dose of 50 cc 50% dextrose water (DW) and then infusion of 50% dextrose water over that time. The patient was monitored for 10 hours in recovery and also received 1 mg of glucagon. The blood glucose was checked frequently. Fortunately, there were not any detectable hypoglycemic attacks (blood glucose less than 70 mg/dl) during that time. Throughout the first three hours in ICU, he suffered from severe hypoglycemic episodes and treated by DW 50% (bolus stat and infusion) and after stabilization of vital signs he transferred to ward.
Conclusion: The mortality of iatrogenic hypoglycemia is lower than other causes of hypoglycemia. However, on time diagnosis and aggressive treatment can prevent serious complications. In addition, proper communication between health care providers and precise checking of drugs labels before injection can dramatically decrease these events.