The effect of chamomile on flatulence after the laparoscopic cholecystectomy: A randomized triple-blind placebo-controlled clinical trial

OBJECTIVE

Flatulence is one of the main post-operative Ileus-related complications, especially in abdominal surgeries, which can be largely due to the effects of anesthesia. There are various kinds of therapeutic methods used for their treatment though sometimes their effects are limited. Thus, it is essential to find alternative treatments to decrease the implications of the disease. The present study is aimed to investigate the effect of Chamomilla recutita on flatulence after Laparoscopic cholecystectomy.

METHODS

This randomized controlled trial was carried out in 2020 at Isfahan in Iran. Patients randomly fell into either chamomile (n = 32) or placebo groups (n = 32). The intervention was performed 1 h before the operation. The severity and the frequency of flatulence were recorded using a visual analog scale in both groups in three stages before the operation, after the operation in recovery, and 2 h after the operation.

RESULTS

The flatulence was not observed before the operation and on arrival in the recovery room. Before leaving the recovery room, the frequency of flatulence was the same in both the groups. However, in the surgical ward, the frequency of flatulence in the chamomile group was significantly lower than in the placebo group. The mean of flatulence severity has significantly increased in both groups over time but in the chamomile group, this increase was significantly lower than in the placebo group.

CONCLUSION

These results suggest that chamomile has a potential therapeutic effect on the gastrointestinal and can reduce flatulence. In laparoscopic surgeries, using chamomile drops as a preventive drug seems to be effective in reducing the incidence of postoperative flatulence.

The Effectiveness of Training Based on Rational-Emotional-Behavioral Therapy on Career Decision-Making Self-Efficacy

Background: Career decision-making is a complex process and one of the most critical decisions of an individual which has long-lasting consequences on life in areas of psychological wellbeing, physical health, and financial status. The present research was designed and conducted by the aim of investigating the effectiveness of training based on rational-cognitive-behavioral therapy (REBTbased training) on career decision-making self-efficacy among personnel of Petroleum Company. Methods: The present research was conducted by the quasi-experimental method and used a pretestposttest-follow up with control group design. The statistical population of the current research was included all the organizational personnel of Pipelines and Telecommunication Company, north region, in the second half of 2017. The sample of the present research included 30 individuals from this population who, after their obtained scores in the questionnaire and on inclusion/exclusion criteria of the study, were selected by available sampling method and they were assigned into experiment and control groups (15 individuals per group) by random assignment method. The research tool was the Career Decision-Making Self-Efficacy Scale of Betz, Klein, and Taylor, which was completed by all participants in pretest, posttest, and one-month follow up stages. REBT-based training was provided for the experiment group subjects in eight 90-minute sessions, while the participants of the control group received no intervention until the end of the follow-up stage. The research data were analyzed by covariance analysis with repeated measurements and Bonferroni post hoc test through SPSS version 20. Results: Findings indicated that REBT-based training had a positive and significant effect on career decision-making self-efficacy and all its components (self-appraisal, career information, goal selection, planning, and problem-solving) in posttest and follow up stages (P<0.001). Conclusion: According to the study results, it recommended that an REBT-based training package would provide for the personnel of organizations and institutions to improve their career decisionmaking self-efficacy.

Is the ovarian reserve influenced by vitamin D deficiency and the dress code in an infertile Iranian population?

Background

In the recent years, vitamin D has become a topical subject and a focus of research not only in reproductive medicine but across many medical disciplines. In reproductive medicine, studies have identified an association between vitamin D status in women and ovarian reserve. In humans, exposure of the skin to sunlight is the main important source of vitamin D. A dress code of wearing concealing clothing is a risk factor for vitamin D deficiency. The objective of this prospective observational study was to evaluate the correlation between vitamin D deficiency and ovarian reserve in a population of infertile women in Iran. As part of the basic fertility assessment of study participants, blood tests were taken to measure vitamin D concentration and transvaginal ultrasound scans were performed on day 2–5 of the cycle to determine antral follicle count (AFC). All study participants were assessed by a reproductive medicine specialist and consultant dermatologist to classify their skin types according to the Fitzpatrick classification. In addition, the dress code of each study participant was recorded noting the percentage of exposed skin not covered by concealing clothing.

Results

189 infertility patients were included in this study. The mean concentration of vitamin D in this study population was 15.46 ng/ml, indicating severe vitamin D deficiency. A statistically significant negative correlation between age and vitamin D (p = 0.008) and age and AFC (p = 0.001) was identified. This study revealed a highly significant correlation between vitamin D concentrations and AFC (p < 0.001).

Conclusions

A concealing dress code is an independent risk factor for vitamin D deficiency due to a lack of skin exposure to sunlight. Our study suggests that the so caused severe vitamin D deficiency may play a crucial role in reduced ovarian reserve in the herein described group of an infertile female Iranian population.

Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

OBJECTIVE

This study aimed to compare two methods of controlled hypotension using labetalol and remifentanil in terms of capability to create controlled hypotension and to investigate the obtained complications, and satisfaction rate of surgeon and patient during functional endoscopic sinus surgery.

METHODS

In this prospective clinical trial, 62 patients underwent endoscopic sinus surgery in Al-Zahra and Ayatollah Kashani Hospitals of Isfahan were divided into two groups: in the first group, 20 mg bolus dose of labetalol and then infusion of it, at a rate of 0.5-2.0 mg/min and in the second group, remifentanil with dose of 0.5-1 μg/kg started and then 0.25-0.5 μg/kg/min were prescribed. Hemodynamic parameters during anesthesia and recovery time, surgeon and patient satisfaction, and recovery time were measured and recorded.

FINDINGS

Hemodynamics variable were comparable between two groups at different times of the study. The mean of bleeding and the frequency of side effects were higher in labetalol group (P = 0.033 and P < 0.0001, respectively). The median of surgeon satisfaction score in remifentanil group was statistically higher in labetalol group (P < 0.0001). Recovery time, fluid requirement, and pain score in labetalol group reported significantly more than remifentanil group. Richmond Agitation-Sedation Scale status at time points in the postanesthetic care unit showed differences between groups.

CONCLUSION

With infusion of labetalol and remifentanil after a bolus dose we can induce effective controlled hypotension under general anesthesia. Remifentanil is a short-acting narcotic drug; then, patient satisfaction was better and recovery time was shorter. From the economic aspect, labetalol prefers to remifentanil.

Comparison between paracetamol, piroxicam, their combination, and placebo in postoperative pain management of upper limb orthopedic surgery (a randomized double blind clinical trial)

Background:

Therapeutic superiority of a combination of Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) over either drug alone remains controversial. We evaluated the efficiency of a combination of Paracetamol and Piroxicam versus each drug alone and also placebo in the management of postoperative pain, in patients who had undergone elective upper limb orthopedic surgery under general anesthesia.

Materials and Methods:

A total of 100 patients were randomly divided into four groups to receive either intravenous (IV) infusion of Paracetamol, 15 mg/kg., intramuscular (IM) injection of Piroxicam 0.4 mg/kg., their combination or placebo. The pain scores were recorded at the first; second, fourth, sixth, twelfth, and 24 hours after Post Anesthesia Care Unit (PACU) admission. After the operation 0.1 mg/kg of morphine was administered, if the patient needed.

Result:

The means of the pain scores were 5.26 ± 1.53, 4.09 ± 0.88, 4.36 ± 1.48, and 4.11 ± 1.29, in groups A, B, C, and D, respectively, (Group A: received placebo; Group B: received both Paracetamol and Piroxicam; Group C received Piroxicam; Group D received Paracetamol). Except for differences between the mean pain scores in Groups B and D, the other differences were statistically significant (P value < 0.05). No adverse effect was reported in the four groups.

Conclusion:

IV infusion of 15 mg/kg Paracetamol used as a preventive may provide effective analgesia in comparison with IM 0.4 mg/kg Piroxicam or placebo. Addition of Piroxicam to Paracetamol has not much more benefit than Paracetamol alone, in reducing pain after upper limb orthopedic surgery.

Relationships between Serum Luteinizing Hormone Level, Endometrial Thickness and Body Mass Index in Polycystic Ovary Syndrome Patients with and without Endometrial Hyperplasia

Background

The endometrial hyperplasia measured by ultrasound in polycystic ovary syndrome (PCOS) women is strongly related to pathologic endometrial thickness, but there is no consensus on the relation between serum luteinizing hormone (LH) and either of these factors: pathologic endometrial hyperplasia and body mass index (BMI).

Materials and Methods

In this observational cross-sectional study, three hundred fifty infertile PCOS women were involved in this research. An endometrial biopsy was taken by using a pipelle instrument, regardless of menstrual cycle’s day and all samples were reported by the same pathologist. Basal serum LH level was compared between two subgroups (hyperplasia and non-hyperplasia). The intended population was divided into three groups according to BMI and basal serum LH, later on the comparison was made in three groups. Chi-square test was applied to compare nominal variables between groups. Mann-Whitney U, and one way ANOVA tests were used to compare means on the basis of the result of normality test.

Results

The frequency of endometrial hyperplasia was 2.6%. Endometrial thickness in the patients with endometrial hyperplasia was significantly higher than that of a normal endometrium (10.78 ± 3.70 vs. 7.90 ± 2.86 respectively, P=0.020). There was no relation between endometrial hyperplasia and serum LH (P=0.600). The ANOVA test showed serum LH levels were not the same among three BMI groups (P=0.007). Post hoc test was also performed. It showed that the LH level in normal BMI group was significantly higher than those of other groups (P=0.005 and P=0.004), but there was no statistical difference between overweight and obese groups (P=0.8). We found no relationship between BMI and endometrial thickness in PCOS patients (P=0.6).

Conclusion

Sonographic endometrial stripe thickness is predictive for endometrial hyperplasia in PCOS women. We could not find out any relationship between serum LH level and BMI with endometrial thickness in PCOS patients. However, our study confirmed a diverse relationship between serum LH level and BMI in PCOS patients.

Metabolic syndrome in infertile women with polycystic ovarian syndrome

OBJECTIVE

The aim of the present study was to determine the prevalence of metabolic syndrome (MS) in infertile Iranian women with polycystic ovary syndrome (PCOS) using the ATPIII criteria.

SUBJECTS AND METHODS

In this cross-sectional study, 624 women with PCOS were enrolled at a tertiary referral center in Tehran, Iran, between April, 2012 and March, 2013. Diagnosis of MS was according to ATPIII criteria. Also, we divided PCOS patients into following two main groups: (i) with MS (n = 123) and (ii) without MS (n = 501), and then compared variables between two groups.

RESULTS

The mean age, body mass index (BMI) and waist circumference were 28.6 ± 4.3 years, 26.7 ± 3.7 kg/m2 and 85.2 ± 8.7 cm, respectively. The prevalence of MS was 19.7%. Our findings showed that age, BMI, waist circumference and all metabolic parameters were higher in PCOS women with MS than related values in those without MS. The most and least prevalent forms of MS were low level of high density lipoprotein-cholesterol (HDL-C) and hypertension, respectively.

CONCLUSION

It seems the prevalence of metabolic syndrome in our country isn't as high as western countries. The prevalence rate of MS increased with age and BMI. One of the major cardiovascular risk factors, low level of HDL-C, is the most prevalent metabolic abnormality in our participants.

Ion microscopy based on laser-cooled cesium atoms

We demonstrate a prototype of a Focused Ion Beam machine based on the ionization of a laser-cooled cesium beam and adapted for imaging and modifying different surfaces in the few-tens nanometer range. Efficient atomic ionization is obtained by laser promoting ground-state atoms into a target excited Rydberg state, then field-ionizing them in an electric field gradient. The method allows obtaining ion currents up to 130pA. Comparison with the standard direct photo-ionization of the atomic beam shows, in our conditions, a 40-times larger ion yield. Preliminary imaging results at ion energies in the 1-5keV range are obtained with a resolution around 40nm, in the present version of the prototype. Our ion beam is expected to be extremely monochromatic, with an energy spread of the order of the eV, offering great prospects for lithography, imaging and surface analysis.

mRNA expression of VEGF and its receptors in fallopian tubes of women with ectopic pregnancies

BACKGROUND

Establishment of viable pregnancy requires embryo implantation and placentation. Ectopic pregnancy (EP) is a pregnancy complication which occurs when an embryo implants outside of the uterine cavity, most often in a fallopian tube. On the other hand, an important aspect of successful implantation is angiogenesis. Vascular endothelial growth factor (VEGF) is a potent angiogenic factor responsible for vascular development that acts through its receptors, VEGF receptor 1 (VEGFR1) and VEGFR2. This study aims to investigate mRNA expression of VEGF and its receptors in fallopian tubes of women who have EP compared with fallopian tubes of pseudo-pregnant women. We hypothesize that expression of VEGF and its receptors in human fallopian tubes may change during EP.

MATERIALS AND METHODS

This was a case-control study. The case group consisted of women who underwent salpingectomy because of EP. The control group consisted of women with normal fallopian tubes that underwent hysterectomy. Prior to tubal sampling, each control subject received an injection of human chorionic gonadotropin (hCG) to produce a state of pseudo-pregnancy. Fallopian tubes from both groups were procured. We investigated VEGF, VEGFR1 and VEGFR2 mRNA expressions in different sections of these tubes (infundibulum, ampulla and isthmus) by reverse transcription polymerase chain reaction (RT-PCR) and quantitative PCR (Q-PCR).

RESULTS

RT-PCR showed expressions of these genes in all sections of the fallopian tubes in both groups. Q-PCR analysis revealed that expressions of VEGF, VEGFR1 and VEGFR2 were lower in all sections of the fallopian tubes from the case group compared to the controls. Only VEGFR2 had higher expression in the ampulla of the case group.

CONCLUSION

Decreased expressions of VEGF, VEGFR1 and VEGFR2 in the EP group may have a role in the pathogenesis of embryo implantation in fallopian tubes.

Comparison of two dimensional and live three dimensional ultrasounds for the diagnosis of septated uterus

BACKGROUND

Traditionally, septate uterus was diagnosed with invasive method like hysterosalpingography and hysteroscopy. Nowadays transvaginal ultrasonography was reported to be a sensitive tool for detection of septate uterus too.

OBJECTIVE

The objective of the present study was to evaluate the application of two dimensional ultrasound (2-DUS) and real time three dimensional ultrasound (3-DUS) in differentiating various type of septated uterus. Hysteroscopy confirmation was assigned as the gold standard.

MATERIALS AND METHODS

This retrospective study was performed among 215 infertile women with suspected septate uterus from October 2008 to July 2012. An inclusion criterion was septated uterus based on HSG or experiencing abortion, preterm labor, or recurrent IVF failure. Fusion anomalies were excluded from the study (unicornuate, bicornuate and didelphys anomalies). The results of 3D and 2D sonographies were compared, while they were confirmed by hysteroscopy result in detection of septated uterus. Kappa index for agreement between 2DUS and hysteroscopy, as well as 3-DUS and hysteroscopy in detection of septate uterus was carried out. By receiver operating characteristic (ROC) curve, cut off points for predicting the kind of anomalies were proposed.

RESULTS

The women were evaluated by 2-DUS (n=89) and (II) 3-DUS (n=126). All women underwent hysteroscopy, following 2-DUS and 3-DUS at the same or subsequent cycle. The results of kappa (K) index were 0.575 and 0.291 for 3-DUS and hysteroscopy, as well as 2-DUS and hysteroscopy, respectively. Also, the cutoff points were 27% for arcuate and subseptate, and 35% for differentiating septate and subseptate.

CONCLUSION

Real time 3-DUS has better ability for visualization both uterine cavity and the fundal uterine, so it has higher agreement in detection of septate uterus than 2-DUS.

The effect of intravenous infusion of paracetamol before anesthesia induction on the core and peripheral temperature changes and post-operative shivering in patients undergoing general anesthesia

Background:

Post-operative shivering is an unpleasant complication that various drugs are used to prevent and treat. It is tried to advice a suitable drug with the least side-effects. This study was carried out to examine the effect of intravenous Apotel on the post-operative shivering and core and peripheral body temperature.

Materials and Methods:

This clinical trial conducted in Al Zahra and Kashani Hospitals in Isfahan in 2012 on 64 patients undergoing upper limbs surgery with general anesthesia, which divided in two equal groups. In the first group, before induction, 15 mg/kg and up to 1 g paracetamol was infused in 100 cc normal saline within 20 min and control group was infused 100 cc normal saline during 20 min. Post-operative shivering and pain were recorded in the same time in addition to the core and peripheral temperature. The results were analyzed by SPSS ve.20 software.

Results:

In patients receiving Apotel, the core and peripheral temperature were significantly lower (P < 0.05). At 10 min after entering in recovery, 10 patients in the control group and 2 in the intervention group suffered from shivering (31.2% vs. 6.2%), which was significantly different (P = 0.02). Nineteen patients (29.7%) suffered from shivering in recovery (14 patients in the control group and 5 patients in the intervention group (43.8% vs. 15.6%)). In Apotel receiving group, the incidence of shivering in recovery was significantly lower (P = 0.014).

Conclusion:

Given the beneficial effects of Apotel in post-operative shivering and pain reduction, using the drug as a pre-drug is recommended in patients undergoing surgery with general anesthesia.

Prophylactic administration of haloperidol plus midazolam reduces postoperative nausea and vomiting better than using each drug alone in patients undergoing middle ear surgery

Aims:

The efficacy of using midazolam or haloperidol for prevention of postoperative nausea and vomiting (PONV) has been investigated before. The main object of the present study was to evaluate the anti-emetic effects of combining administration of intravenous haloperidol with intravenous midazolam on PONV in patients underwent middle ear surgery in comparison with using each drug alone.

Methods:

Study design was randomized, double-blind, placebo-controlled. 80 patients, aged 18-60 years, scheduled for middle ear surgery in Kashani Hospital Medical Center under general anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. Patients were divided into 4 groups of 20 each and received haloperidol 2 mg i.v. (Group H); midazolam 2 mg i.v. (Group M); haloperidol 2 mg plus midazolam 2 mg i.v. (Group HM); saline i.v. (Group C). The incidences of PONV and complete response were evaluated at 0-2 hours after arrival to the PACU and 2-24 hours after arrival to the ward in 4 groups.

Results:

Patients in group HM had significantly lower incidence of PONV compared with groups H, M, and C throughout 0-24 h (P<00.5). The HM group had the lowest incidence of PONV (0-2, 2-24, and 0-24 h) and the highest incidence of complete response. Postoperative anti-emetic requirement was significantly less in group HM compared with group M or H (P<0.05).

Conclusion:

Combine administration of haloperidol 2 mg plus midazolam 2 mg significantly reduced PONV better than using each drug alone in patients underwent middle ear surgery under general anesthesia.

Expression and characterization of Escherichia coli derived hepatitis C virus ARFP/F protein

Genome of the hepatitis C virus (HCV) contains a long open reading frame encoding a polyprotein that is cleaved into 10 proteins. Recently, a novel, so called "ARFP/F", or "core+1", protein, which is expressed through a ribosomal frame shift within the capsid-coding sequence, has been described. Herein, to produce and characterize a recombinant form of this protein, the DNA sequence corresponding to the ARFP/F protein (amino acid 11-161) was amplified using a frame-shifted forward primer exploiting the capsid sequence of the 1b-subtype as a template. The amplicon was cloned into the pET-24a vector and expressed in different Escherichia coli strains. The expressed protein (mostly as insoluble inclusion bodies) was purified under denaturing conditions on a nickel-nitrilotriacetic acid (Ni-NTA) affinity column in a single step with a yield of 5 mg/L of culture media. After refolding steps, characterization of expressed ARFP/F was performed by SDS-PAGE and Western blot assay using specific antibodies. Antigenic properties of the protein were verified by ELISA using HCV-infected human sera and by its ability for a strong and specific interaction with sera of mice immunized with the peptide encoding a dominant ARFP/F B-cell epitope. The antigenicity plot revealed 3 major antigenic domains in the first half of the ARFP/F sequence. Immunization of BALB/c mice with the ARFP/F protein elicited high titers of IgG indicating the relevance of produced protein for induction of a humoral response. In conclusion, possibility of ARFP/F expression with a high yield and immunogenic potency of this protein in a mouse model have been demonstrated.

A randomized evaluation of intravenous dexamethasone versus oral acetaminophen codeine in pediatric adenotonsillectomy: emergence agitation and analgesia

BACKGROUND

Adenotonsillectomy is the most frequently performed ambulatory surgical procedure in children. Post operative agitation and inadequate pain control, for children undergoing adenotonsillectomy, can be a challenge. The aim of this study was to assess the effect of intravenous dexamethasone and oral acetaminophen codeine on emergence agitation and pain after adenotonsillectomy in children.

METHODS

One hundred and five pediatric patients (3-7 years old), scheduled to undergo adenotonsillectomy under general anesthesia, were enrolled in the study. Thirty minutes before induction, patients were randomized to three groups. Group 1 received 0.2 mg/kg of intravenous dexamethasone and 0.25 ml/kg of oral placebo syrup. Group 2 received 20 mg/kg of oral acetaminophen codeine syrup and 0.05 ml/kg of intravenous saline. Group 3 received 0.25 ml/kg of oral placebo syrup and 0.05 ml/kg of intravenous saline. Emergence agitation and postoperative pain were assessed, recorded and compared.

RESULT

Agitation was less frequent in dexamethasone and acetaminophen codeine groups in comparison with placebo group, but there were not significant differences between the two groups. The pain frequencies in the three groups were not significantly different.

CONCLUSION

The results of this study suggest that the administration of intravenous dexamethasone (0.2 mg/kg) and oral acetaminophen codeine (20 mg/kg) thirty minutes before anesthesia can significantly decrease the incidence and severity of agitation but does not have an effect on postoperative pain.

Effects of adjunct intrathecal magnesium sulfate to bupivacaine for spinal anesthesia: a randomized, double-blind trial in patients undergoing lower extremity surgery

PURPOSE

The aim of this study was to evaluate the effect of additional magnesium sulfate (MgSO(4)) 100 mg to intrathecal (IT) isobaric 0.5% bupivacaine 3 ml on spinal anesthesia in patients undergoing lower extremity orthopedic surgery.

METHODS

In a double-blind randomized clinical trial, 79 American Association of Anesthesiologists (ASA) I or II adult patients undergoing lower extremity orthopedic surgery were recruited. The patients were randomly allocated to receive 100 mg MgSO(4) 5% (0.2 ml) plus 15 mg of bupivacaine 0.5% (MgSO(4) group) or 15 mg bupivacaine 0.5% combined with 0.2 ml normal saline (control group) intrathecally. Response to treatment was assessed as onset and duration of sensory block, the highest level of sensory block, time to complete motor block recovery, duration of spinal anesthesia, and postoperative analgesic requirement.

RESULTS

The onset of the sensory block was slower in the MgSO(4) group than in the control group (13.3 vs. 11.6 min, P = 0.04), and the duration of the sensory blockade was significantly longer in the MgSO(4) group than the control group (106.5 vs. 85.5 min, P = 0.001). Total analgesic requirements for 24 h following surgery were lower in the MgSO(4) group than in the control group (96.8 vs. 138.5 mg, P = 0.001). Mean duration of spinal anesthesia was not significantly different between two groups (178.0 vs. 167.4 min, P = 0.23).

CONCLUSION

In patients undergoing lower extremity surgery with spinal anesthesia, the addition of 100 mg IT MgSO(4) to 15 mg bupivacaine without opioid supplement, prolonged the duration of the sensory block, decreased postoperative analgesic consumption, and significantly prolonged the onset of spinal anesthesia.

Effect of black tea on enteral feeding tolerance in ICU patients

BACKGROUND

Tea consumption has been known mostly as a well-drink after water in the world. Tea drink can affect balance of fluids and renal function. In addition, it can cause loss of many viruses in the stomach and can increase or decrease gastrointestinal movements. This research was done to determine the effect of tea on increasing enteral feeding tolerance in ICU patients in Alzahra Hospital.

METHODS

In this clinical trial study, 45 patients were enrolled in two groups, tea consumption group and the standard method of nutrition as control group. Tea gavage was performed two times in the morning; 100 cc tea used for the study group and the same volume of water was used for the control group. Residual volume was measured before gavage. Data collected for one week. Information sheet had two pages; the first page described how to complete the form and the method of tea gavage and the second page was for data collection. Data were analyzed by t-student test, chi-square, and analysis of variance.

RESULTS

In two groups, 92% of patients tolerated liquid gavage. Their difference by chi-square test was not significant. Average urine volume after black tea gavage was 783.3 L in the study group and 802.2 L in the control group. ANOVA test showed no significant difference.

CONCLUSIONS

Although the difference was not statistically significant between the two groups, but in study group consumption of tea was acceptable by patients.