Permissive role of cytosolic pH acidification in neurodegeneration: A closer look at its causes and consequences.

The maintenance of cytosolic pH in its physiological range is required for normal neuronal activity, and even minor alterations can have serious consequences. This Review summarizes the current understanding of the conditions that are associated with cytosolic pH disruption and that lead to abnormal cytosolic acidification. Oxidative stress results in cytosolic acidification, and this plays a crucial role in the emergence of apoptosis in protein misfolding and excitotoxicity, ultimately leading to irreversible neuronal damage. Through the identification of mechanisms by which intraneuronal pH acidification promotes neurodegeneration, we may identify new approaches for preventing and treating neurodegenerative disorders. © 2016 Wiley Periodicals, Inc.

Astrocytic and microglial nicotinic acetylcholine receptors: an overlooked issue in Alzheimer's disease.

It is increasingly recognized that astrocytes and microglia-associated dysfunction contribute to AD pathology. In addition, glial nicotinic acetylcholine receptors (nAChRs) play a role in AD-related phenomena, such as neuron survival, synaptic plasticity, and memory. From mechanistic point of view, the glial regulation of pro-inflammatory cytokines, as common contributors in AD, is modulated by nAChRs. Astrocytic and microglial nAChRs contribute to Aß metabolism, including Aß phagocytosis and degradation as well as Aß-related oxidative stress and neurotoxicity. These receptors are also involved in neurotransmission and gliotransmission through indirect interaction with N-Methyl-D-aspartate (NMDA) and a-amino-3-hydroxy-5-methyl-4 isoxazolepropionic acid (AMPA) receptors as well as gamma-aminobutyric acid (GABA) and intracellular calcium regulation. In addition, glial nAChRs participate in trophic factors-induced neuroprotection. This review gathers the most recent advances along with the previous data on astrocytic and microglial nAChRs role in AD pathogenesis.

Evolutionary concept analysis of health seeking behavior in nursing: a systematic review.

BACKGROUND: Although the research in health seeking behavior has been evolving, its concept remains ambiguous. Concept clarification, as a central basis of developing knowledge, plays an undeniable role in the formation of nursing sciences. As the initial step toward the development of theories and theoretical models, concept analysis is broadly used through which the goals can be used and tested. The aim of this study was to report an analysis of the concept of "health seeking behavior". METHOD: Employing a rigorous evolutionary concept analysis approach, the concept of health seeking behavior was examined for its implications, use, and significance in the discipline of nursing between 2000 and 2012. After applying inclusion and exclusion criteria, a total of 40 articles and 3 books were selected for the final analysis. RESULTS: The definition of attributes, antecedents, and consequences of health seeking behavior was performed through concept analysis. Core attributes (interactional, processing, intellectual, active, decision making based and measurable) were studied. The antecedents of concept were categorized as social, cultural, economic, disease pattern and issues related to health services. Health-seeking behavior resulted in health promotion and disease risk reduction. In addition, it led to predicting the future probable burden of the diseases, facilitation of the health status, early diagnosis, complete and effective treatment, and complication control. CONCLUSION: Health-seeking behavior, as a multi-dimensional concept, relies on time and context. An awareness of health-seeking behavior attributes antecedents and consequences results in promoting the status, importance and application of this concept in the nursing profession.

The effect of low-level laser therapy on knee osteoarthritis: prospective, descriptive study.

BACKGROUND: Osteoarthritis (OA) is one of the most common joint disorders in the elderly which could be associated with considerable physical disability. PATIENTS AND METHODS: In a descriptive, prospective study, 33 patients enrolled in the study from which 15 people were excluded due to incomplete course of treatment, leaving the total number of 18 patients with knee osteoarthritis. Gal-Al-As diode laser device was used as a source of low-power laser. Patients were performed laser therapy with a probe of LO7 with a wavelength of 810 nm and 50 mW output power in pulse radiation mode (F = 3,000, peak power = 80 W, Δt = 200 ns, density = 0.05 W/cm(2), dose = 6 J/cm(2), area = 1 cm(2)) and also a probe of MLO1K with a power output of 30 mW and a wavelength of 890 nm in pulse radiation mode (F = 3,000 Hz, peak power = 50 W, Δt = 200 ns, density = 0.017 W/cm(2), total dose = 10 J/cm(2)), and were given low-level laser therapy (LLLT) three times a week with a total number of 12 sessions. Data were analyzed using SPSS ver. 15, and the obtained data were reported as mean ± SD and frequency (%). To analyze the data, repeated measurement and marginal homogeneity approaches were used. RESULTS: In the current study, a significant reduction was observed regarding the nocturnal pain, pain on walking and ascending the steps, knee circumference, distance between the hip and heel, and knee to horizontal hip to heel distance at the end of the treatment course. CONCLUSIONS: In brief, the current study focuses on the fact that LLLT is effective in reducing pain in knee osteoarthritis.

Contributions of Medieval Islamic physicians to the history of tracheostomy.

Tracheostomy was first described by Greco-Roman physicians, including Paulus of Aegina. Medieval Islamic clinicians extended the Greco-Roman ideas with substantial contributions to the field of surgery, including tracheostomy. Although Al-Zahrawi (936-1013 CE) stated that he had not heard or read of any Islamic physicians having performed tracheostomy, there is evidence that many prominent Islamic surgeons did practice this lifesaving procedure during medieval times. Throughout the Islamic Golden Age, Muslim physicians advanced the practice of tracheostomy with many modifications of the procedure, instrumentation, and adjuvant medicinal prescriptions.

Do pediatric patients undergoing cardiac surgeries require larger-size cuffed endotracheal tubes? A prospective study.

BACKGROUND: There is a controversy over using either smaller- or larger-size endotracheal tubes (ETT) in children undergoing cardiac surgery, and some anesthesiologists prefer to use ETT sizes different from the formula-based sizes. The aim of the present study was to compare proper-size cuffed ETT in children undergoing cardiac vs noncardiac surgeries. METHODS: In an observational prospective study, 80 children planned to undergo noncardiac elective surgeries (NCS group) and 80 children scheduled for cardiac surgeries (CS group) were recruited. For intubation, initial cuffed ETT size was calculated based on the following formula: Tube size (mm ID) = age (year)/4 + 3.5. The estimated ETT size for each age group and the size of final utilized tubes for each age range were recorded. RESULTS: Patients of tube sizes 4.5, 5, and 5.5 in the CS group were of lower age, weight, height, and body surface area compared with the patients of the same tube sizes in the NCS group (P < 0.05). The compatibility of the predicted vs actual required tube sizes was more in the NCS group compared to the CS group (72.5% vs. 56.2%; P = 0.02). Additionally, the cases with underestimated tube sizes were significantly more in the CS group compared with the NCS group (38.8% vs. 18.8%, P = 0.01). CONCLUSION: Children undergoing cardiac surgeries in relation to their age and body size do require larger-size ETTs compared with the children scheduled for noncardiac surgeries.

Effects of ginger (Zingiber officinale) on plasma glucose level, HbA1c and insulin sensitivity in type 2 diabetic patients.

The present study was aimed to evaluate the effects of Zingiber officinale on some biochemical parameters in type 2 diabetic (DM2) patients. In a randomized double-blind placebo controlled trial, 64 patients with DM2 were assigned to ginger or placebo groups (receiving 2 g/d of each). A 3 d diet record, anthropometric measurements and concentrations of fasting blood glucose (FPG), HbA1c, lipid profile (including total cholesterol, triglyceride, low density lipoprotein and high density lipoprotein) and also the homeostasis model assessment (HOMA) and quantitative insulin-sensitivity check index (QUICKI) were determined before and after 2 months of intervention. Ginger supplementation significantly lowered the levels of insulin (11.0 ± 2.3 versus 12.1 ± 3.3; p = 0.001), LDL-C (67.8 ± 27.2 versus 89.2 ± 24.9; p = 0.04), TG (127.7 ± 43.7 versus 128.2 ± 37.7; p = 0.03) and the HOMA index (3.9 ± 1.09 versus 4.5 ± 1.8; p = 0.002) and increased the QUICKI index (0.313 ± 0.012 versus 0.308 ± 0.012; p = 0.005) in comparison to the control group; while, there were no significant changes in FPG, TC, HDL-C and HbA1c (p > 0.05). In summary, ginger supplementation improved insulin sensitivity and some fractions of lipid profile in DM2 patients. Therefore it may be considered as a useful remedy to reduce the secondary complications of DM2.

Dexamethasone added to bupivacaine prolongs duration of epidural analgesia.

BACKGROUND: Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind, controlled clinical trial to evaluate the effect of dexamethasone added to bupivacaine-fentanyl on the duration of postoperative analgesia via epidural catheterization. METHODS: Seventy two adult patients scheduled for elective abdominal or thoracic surgery under epidural anesthesia were randomly allocated into two groups to receive either bupivacaine (0.5%) - fentanyl (50 microg) and dexamethasone (8 mg) in lumbar or thoracic epidural anesthesia (Dexa group, n=36), or bupivacaine-fentanyl and saline normal (control group, n=36) via epidural catheter. Duration of analgesia, postoperative pain score and IV analgesic use at first 24 hours were recorded and compared. RESULTS: Two patients were excluded (one in each group) due to unsuccessful blockade. Age, gender and duration of surgery were similar in the two groups (p>0.05). The duration of analgesia (372< or = 58.1 vs. 234.6+/- 24.3 min) was significantly longer and pain score and pentazocine use were less in the Dexa than the control group (37.1+/- 19.7 mg v.s. 73.1 +/- 17.6 mg, respectively; p=0.001). CONCLUSIONS: This study revealed that dexamethasone added to bupivacaine-fentanyl solution in epidural analgesia prolongs the duration of analgesia in abdominal or thoracic surgery.

Effectiveness of intravenous dexamethasone versus propofol for pain relief in the migraine headache: a prospective double blind randomized clinical trial.

BACKGROUND: There are many drugs recommended for pain relief in patients with migraine headache. METHODS: In a prospective double blind randomized clinical trial, 90 patients (age ≥ 18) presenting to Emergency medicine Department with Migraine headache were enrolled in two equal groups. We used intravenous propofol (10 mg every 5-10 minutes to a maximum of 80 mg, slowly) and intravenous dexamethasone (0.15 mg/kg to a maximum of 16 mg, slowly), in group I and II, respectively. Pain explained by patients, based on VAS (Visual Analogue Scale) was recorded at the time of entrance to ED, and after injection. Data were analyzed by paired samples t test, using SPSS 16. P < 0.05 was considered to be statistically significant. RESULTS: The mean of reported pain (VAS) was 8 ± 1.52 in propofol group and 8.11 ± 1.31 in dexamethasone group at presenting time (P > 0.05). The VAS in propofol group was obviously decreased to 3.08 ± 1.7, 1.87 ± 1.28 and 1.44 ± 1.63 after 10, 20 and 30 minutes of drug injection, respectively. The VAS in dexamethasone group was 5.13 ± 1.47, 3.73 ± 1.81 and 3.06 ± 2 after 10, 20 and 30 minutes of drug injection, respectively. The mean of reported VAS in propofol group was less than dexamethasone group at the above mentioned times (P < 0.05). The reduction of headache in propofol group, also, was very faster than dexamethasone group (P < 0.05). There were no adverse side effects due to administration of both drugs. CONCLUSIONS: Intravenous propofol is an efficacious and safe treatment for patients presenting with Migraine headache to the emergency department. TRIAL REGISTRATION: Clinical Trials IRCT201008122496N4.

Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department.

BACKGROUND: Despite the fact that numerous medications have been introduced to treat renal colic, none has been proven to relieve the pain rapidly and thoroughly. In this study, we aimed at comparing the effects of intravenous lidocaine versus intravenous morphine in patients suffering from renal colic. METHODS: In a prospective randomized double-blind clinical trial performed in the emergency department of Imam Reza educational hospital of Tabriz, Iran, we studied 240 patients, 18-65 years old, who were referred due to renal colic. Patients were divided into two groups. In group I (120 people) single-dose intravenous lidocaine (1.5 mg/kg) was administered and in group II (120 people) single-dose intravenous morphine (0.1 mg/kg) was administered slowly. Visual Analogue Pain Scale (VAS) was recorded while admission, 5, 10, 15 and 30 minutes after injection. Statistical data and results were studied using descriptive statistics as percentage and Mean ± SD. To compare the response to treatment, Mann-Whitney U-test was used in two groups. Consequently, the data were analyzed using the SPSS16 software. RESULTS: Pain score measured in two groups five minutes after the injection of lidocaine and morphine were 65 % and 53 % respectively (95% CI 0.60 - 0.69, CI 0.48 - 0.57, p = 0.0002).108 (90 %) patients (95 % CI 0.84 - 0.95) from group I and 84 (70%) patients (95 % CI 0.62 - 0.78) from group II responded appropriately at the end of the complete treatment. The difference was statistically significant (p = 0.0001). CONCLUSIONS: Changing the smooth muscle tone and reducing the transmission of afferent sensory pathways, lidocaine causes a significant reduction in pain. TRIAL REGISTRATION: Clinical Trials IRCT138901042496N3.

Effect of hyperglycemia treatment on complications rate after pediatric cardiac surgery.

Introduction: The goal of this study was to elucidate harmful complications of intraoperative hyperglycemia following children cardiac surgery and benefits of insulin administration for accurate blood sugar controlling. Methods: this study is a Randomized clinical trial. We conducted this study in the operating room of shahid madani hospital. Fifty patients who were children under 12 years old undergone cardiac surgery using cardiopulmonary bypass (CPB). Intraoperative insulin infusion was administered intravenously targeting blood sugar levels of 110-140 mg/dL. Blood sugar and arterial blood gas (ABG) were measured every 30 min during operation. Results: Inotropes were used less in the study than the placebo group during surgery. The means of hospitalization and extubation time were more in the placebo group than the study group(P =0.03) and (P =0.005), respectively. However, the mean time of hospitalization in the ICU ward did not differ significantly between the two groups. Conclusion: Hyperglycemia has a relation with long time of intubation and hospitalization in ICU. These findings suggest the positive effect of accurate blood sugar control on reducing complication and hospitalization time in children undergoing cardiac surgery.

Role of anesthesiology curriculum in improving bag-mask ventilation and intubation success rates of emergency medicine residents: a prospective descriptive study.

BACKGROUND: Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The purpose of our study was to determine success rates of bag-mask ventilation and tracheal intubation performed by emergency medicine residents before and after completing their anesthesiology curriculum. METHODS: A prospective descriptive study was conducted at Nikoukari Hospital, a teaching hospital located in Tabriz, Iran. In a skills lab, a total number of 18 emergency medicine residents (post graduate year 1) were given traditional intubation and bag-mask ventilation instructions in a 36 hour course combined with mannequin practice. Later the residents were given the opportunity of receiving training on airway management in an operating room for a period of one month which was considered as an additional training program added to their Anesthesiology Curriculum. Residents were asked to ventilate and intubate 18 patients (Mallampati class I and ASA class I and II) in the operating room; both before and after completing this additional training program. Intubation achieved at first attempt within 20 seconds was considered successful. Successful bag-mask ventilation was defined as increase in ETCo2 to 20 mm Hg and back to baseline with a 3 L/min fresh gas-flow and the adjustable pressure limiting valve at 20 cm H2O. An attending anesthesiologist who was always present in the operating room during the induction of anesthesia confirmed the endotracheal intubation by direct laryngoscopy and capnography. Success rates were recorded and compared using McNemar, marginal homogeneity and paired t-Test tests in SPSS 15 software. RESULTS: Before the additional training program in the operating room, the participants had intubation and bag-mask ventilation success rates of 27.7% (CI 0.07-0.49) and 16.6% (CI 0-0.34) respectively. After the additional training program in the operating room the success rates increased to 83.3% (CI 0.66-1) and 88.8% (CI 0.73-1), respectively. The differences in success rates were statistically significant (P = 0.002 and P = 0.0004, respectively). CONCLUSIONS: The success rate of emergency medicine residents in airway management improved significantly after completing anesthesiology rotation. Anesthesiology rotations should be considered as an essential component of emergency medicine training programs. A collateral curriculum of this nature should also focus on the acquisition of skills in airway management.