Adopting and adapting clinical practice guidelines for timing of decompressive surgery in acute spinal cord injury from a developed world context to a developing region.

PURPOSE: The proper application of high-quality clinical practice guidelines improves trauma patients' care and outcomes. This study aimed to adopt and adapt guidelines on the timing of decompressive surgery in acute spinal cord injury (SCI) in Iranian clinical settings. METHODS: This study followed a systematic search and review of the literature to enter them into the selection process. The source guidelines' clinical suggestions were converted into clinical scenarios for clinical questions on the timing of decompressive surgery. After summarizing the scenarios, we prepared an initial list of recommendations based on the status of the Iranian patients and the health system. The ultimate conclusion was reached with the help of a national interdisciplinary expert panel comprising 20 experts throughout the country. RESULTS: A total of 408 records were identified. After title and abstract screening, 401 records were excluded, and the full texts of the remaining seven records were reviewed. Based on our screening process, only one guideline included recommendations on the topic of interest. All of the recommendations were accepted by the expert panel with slight changes due to resource availability in Iran. The final two recommendations were the consideration of early surgery (≤24 h) as a treatment option in adult patients with traumatic central cord syndrome and in adult patients with acute SCI regardless of the level of injury. CONCLUSION: Considering early surgery for adult patients with acute traumatic SCI regardless of the level of injury was the final recommendation for Iran. Although most of the recommendations are adoptable in developing countries, issues with infrastructure and availability of resources are the limitations.

Anti-atherosclerosis effect of different doses of CETP vaccine in rabbit model of atherosclerosis.

AIM: To evaluate atheroprotective effects of different doses of cholesteryl ester transfer protein (CETP) vaccine, three doses of Tetanus toxoid-CETP (TT-CETP) peptide including 10, 50 and 100/rabbit, termed FA10, FA50, FA100, respectively, were administered in rabbit model of atherosclerosis. METHODS: Animals were vaccinated subcutaneously (S.C.) with 100µl of vaccine in presence of complete Freund's adjuvant (CFA) for the first administration. Rabbits were boosted 4 times at 3 weeks intervals with the same peptide dose formulated in incomplete Freund's adjuvant (IFA). Animals were fed with diet supplemented with 2% cholesterol from week 11 to week 19. Anti-TT-CETP specific antibody and CETP activity in sera were determined. Therapeutic response was examined by tracking plasma lipoprotein levels (HDL-C, LDL-C and total cholesterol), and pathologic observation of intima/media thickness at the site of aortic lesions. RESULTS: All TT-CETP vaccine doses generated strong anti TT-CETP antibody response. CETP activity reduced in rabbits vaccinated with FA100 (P=0.031). FA100 showed significant increase in level of HDL-C rather than control group (P=0.006). However, no significant reduction were found in atherosclerotic lesion when compared to control. CONCLUSION: Inhibition of CETP activity and increased HDL-C were found with FA100, but the vaccine failed to prevent aortic lesion development in immunized rabbits when compared to control. Our result supports the hypothesis stated that CETP may not be an attractive therapeutic target for the prevention of cardiovascular disease.

Measurement of (226) Ra, (232) Th, (137) Cs and (40) K activities of Wheat and Corn Products in Ilam Province - Iran and Resultant Annual Ingestion Radiation Dose.

BACKGROUND: Natural background radiation is the main source of human exposure to radioactive material. Soils naturally have radioactive mineral contents. The aim of this study is to determine natural ((238) U, (232) Th, (40) K) and artificial ((137) Cs) radioactivity levels in wheat and corn fields of Eilam province. METHODS: HPGe detector was used to measure the concentration activity of (238) U and (232) Th series, (40) K and (137) Cs in wheat and corn samples taken from different regions of Eilam province, in Iran. RESULTS: In wheat and corn samples, the average activity concentrations of (226) Ra, (232) Th, (40) K and (137) Cs were found to be 1, 67, 0.5, 91.73, 0.01 and 0.81, 0.85, 101.52, 0.07 Bq/kg (dry weight), respectively. H ex and H in in the present work are lower than 1. The average value of H ex was found to be 0.02 and 0.025 and average value of H in to be found 0.025 and 0.027 in wheat fields samples and corn samples in Eilam provinces, respectively. The obtained values of AGDE are 30.49 mSv/yr for wheat filed samples and 37.89 mSv/yr for corn samples; the AEDE rate values are 5.28 mSv/yr in wheat filed samples and this average value was found to be 6.13 mSv/yr in corn samples in Eilam. Transfer factors (TFs) of long lived radionuclide such as (137) Cs, (226) Ra, (232) Th and (40) K from soils to corn and wheat plants have been studied by radiotracer experiments. CONCLUSION: The natural radioactivity levels in Eilam province are not at the range of high risk of morbidity and are under international standards.