Tehran University Medical Journal

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Background: percutaneous dilatational tracheostomy was invented by ciaglia in 1985. With advent of various instruments, various methods such as Fantoni, Grigges and etc, it became a widesepreadly used method of tracheostomy, especially in intensive care unit wards. In our country this was began in 2005, along with many work shops conducted by anesthesiology department of Tehran University of Medical sciences, with help of specialist from Turin University from ITALY.

Case report: In this report two patients who underwent percutaneous dilatational tracheostomy are presented, and are compared with patients who had undergo surgical tracheostomy. Their long and short term complications such as bleeding, injury extents, and recovery was studied and presented.

Conclusion: Tracheostomy is an opening in front of neck, in to the trachea, through which breathing is made possible. Percutaneous Dilatational Ttracheostomy (PDT) is a method of tracheostomy, in which the need for surgery and transfer of patient to operation room is alleviated. Dispite various benefits, PDT has a few short term and long term drawbacks, which are cartilage fracture, injury to vital structures, perforation of posterior wall, sever bleeding displacement of tube, tracheo-esophageal fistula and trache-oinnominate fistula. Incidence of these complications are lower than surgical tracheostomy. Global reports, especialllly from countries with large scale experiences present a different statistic regarding its success as an alternative method for patients with long surveillance and under mechanical ventilation.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Occult hepatitis B infection (OBI) is a form of hepatitis in which despite absence of detectable HBsAg, HBV-DNA is present in peripheral blood of patients. The responsible mechanisms for progression of OBI yet to be clarified, but some investigators believed that the genetics and immunological parameters are different in resistant individuals and patients. Vitamin D3 and its receptor interaction could be involved in anti-viral immune response. The aim of this study was to investigate the association between polymorphisms in intron 8 of VDR with OBI.
Methods: In this experimental study, the plasma samples of 3700 blood donors were collected and tested for HBsAg and anti-HBs by ELISA. The HBsAg negative and anti-HBc positive samples were selected and screened for HBV-DNA using PCR. HBV-DNA positive samples were assigned as OBI cases and PCR-RFLP was performed to examine the polymorphisms in intron 8 of VDR genes.
Results: Results of current study indicated that 352 (9.5%) of 3700 blood samples were HBsAg^- and anti-HBc⁺. HBV-DNA was detected in 57/352 (16.1%) of HBsAg^- and anti-HBc⁺ samples. Our results showed that no significant difference was observed in Apa-1 polymorphisms of intron 8 of VDR and OBI patients.
Conclusion: Our results demonstrated that there are not any association between Apa-1 detected alleles and OBI, hence, it can be concluded that these alleles are not associated with OBI and other researchers should evaluate relation between other polymorphisms of VDR with OBI.

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Background: Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009.

Methods: In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups.

Results: The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups (P<0.05). Except in the first and thirtieth minutes, the changes in heart rate (HR) were significantly different throughout the study between the two groups (P<0.04) and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position (P<0.04) and the use of fluid was significantly larger in the sitting group (P<0.05).

Conclusion: According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb.

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Background: Surgeons and anesthesiologists working in orthopedic operating theatres are exposed to significant noise pollution due to the use of powered instruments. This may carry a risk of noise-induced hearing loss. The present study was designed to quantify the noise pollution experienced by anesthesiologists at Imam Khomeini Hospital which is one of the largest Iranian hospitals. Methods: Prior to beginning of any operation a sound level meter was worn by the anesthesiologist at the level of chest pocket. Basal sound level was recorded. All changes in the sound level of 25 operation rooms and two related pass ways were recorded and the mean sound level along with maximum sound level were noted. These data were analyzed by SPSS version 17. For comparing the mean values, the One way ANOVA and Post-Hoc analysis was used. Noise exposures were compared with occupational health guidelines. Results: Our comparative data showed that orthopedic operation room had the highest level of noise, indicating that orthopedic operation room is significantly suffered by the most types of noise with the P value of 0.002. This is contrast to the sound levels at the other operation rooms which were at same range and were not significantly different. Comparison of the maximum sound level between these 27 places showed that orthopedic and one of general surgery room had top two maximum sound levels. Conclusion: Overall total noise dose during all types of surgeries was measured as twice of permitted dose and also orthopedic and general operation rooms experience brief periods of noise exposure in excess.

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Background: Multiple sclerosis (MS) is a chronic inflammatory disorder of the CNS characterized by destruction of the myelin sheath, gliosis and progressive neurological dysfunction. The regulatory T (Treg) cells play a major role in the control of the autoimmunity and inflammation. The forkhead box p3 (FOXP3) is a central molecule in the function of Treg cells that play an important role in the immunoregulation. The aim of this study was to investigation single nucleotide polymorphism (SNP), rs2232365, in FOXP3 gene in patients with multiple sclerosis.

Methods: In a case-control study, peripheral blood samples were collected from 90 patients with MS (46 men and 94 women with different patterns of disease) from January 2014 to April 2015 in the Afzalipoor Hospital, Kerman (a city located in the southeast of Iran). In a total, 90 healthy subjects were also enrolled into the investigation as a control group. The healthy subjects were recruited among blood donations of the Kerman Transfusion Organization and interviewed regarding CNS disease, and none of them had any history of CNS diseases or other relevant disorders. The SNP rs2232365 in FOXP3 gene was assessed by single specific primer-polymerase chain reaction (SSP-PCR) method. Finally, statistical analysis was performed using SPSS version 22 (Chicago, IL, USA).

Results: In both patients and healthy control groups, there was significant difference among subjects with GG, AG, and AA genotypes at rs2232365 in FOXP3 gene. The frequencies of AA and AG genotypes at rs2232365 in the FOXP3 gene were significantly higher in MS group as compared with healthy subjects (P<0.002). Moreover, the frequency of GG genotype was significantly lower in the MS group in comparison with healthy control subjects (P<0.002). The frequency of A allele was significantly higher whereas the frequency of G allele was significantly lower in MS patients as compared with healthy subjects (P<0.001).

Conclusion: The results of the present study suggest that SNP rs2232365 may influence the susceptibility to multiple sclerosis. Therefore, SNP rs3761548 may directly or indirectly alter the level of the FOXP3 protein expression in Treg cells.