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There is little evidence regarding pyrethroid poisoning manifesting with cardiac problems in the literature. Many authors, however, adopted that pyrethroids have a direct effect on heart tissue and can cause cardiotoxicity. Interestingly, no experimental studies have yet determined its mechanism of toxicity on cardiac muscle cells. This letter aims to describe the probable cause of clinical manifestations attributed to piperonylbutoxide, an ignored ingredient in pesticide poisoning, which is added to many pesticide products to increase their insecticidal potency. We think that cardiac manifestations in some cases of pyrethroid poisoning are due to the concomitant piperonylbutoxide toxicity and its possible effect on norepinephrine release from adrenal gland, which might explain changes in cardiac findings. Thus, it is necessary for all clinical toxicologists to determine suspicious ingredients when they are facing a doubtful manifestation.

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Methods and Materials: This parallel randomized clinical trial was conducted on 120 CCNs in Shahroud by the census sampling method. Inclusion criteria included suffering from restless leg syndrome and having no wound or inflammation over the organ. The participants were assigned into two groups by the use of quadruple blocks. The intervention group received the warm compress for 12 sessions lasting 4 weeks and the control group did not receive an intervention. Data were collected using multidimensional fatigue inventory (MFI) and the Restless Legs Syndrome Scale and then analyzed using descriptive and inferential statistics (chi-squared test, independent sample t-test, and pair sample t-test). Results: The two groups were homogeneous in terms of demographic characteristics. Prior to the intervention, the two groups of warm compression and control did not have a significant difference in terms of mean fatigue and restless leg syndrome scores; however, after the intervention, a significant reduction was observed in the intervention group (p < 0.001). Conclusion: According to the results of the current study, the use of warm compression is an effective intervention in alleviating fatigue and restless leg syndrome, so it is recommended to implement this intervention as a nonpharmacological strategy among CCNs. Clinical Trial Registration Number. IRCT20190723044316N1.

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Since the beginning of the COVID-19 pandemic, efforts have been made to design safe and effective vaccines against SARS-CoV-2. Numerous vaccines have been designed and tested in limited clinical trials in various countries. Among them, the Sputnik V vaccine has shown a relatively safe profile and, to our knowledge, has no associated major side effects. We describe the case of a 40-year-old female healthcare worker who developed severe persistent eczematous lesions on the second day after she received the first dose of the Sputnik vaccine. The eczematous lesions were refractory to an antihistamine and persisted at the 1 month follow-up. Severe persistent eczematous lesions should be viewed as a potential side effect of vaccination with the Sputnik V vaccine. Moreover, a severe allergic reaction to a COVID-2019 vaccine may indicate the vaccine is ineffective in the recipient. LEARNING POINTS: Vaccination against COVID-19 may be accompanied by rare complications.Eczematous lesions can be a side effect of the Sputnik V vaccine.A severe allergic reaction to a COVID-19 vaccine may result in decreased vaccine effectiveness in the recipient.

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BACKGROUND: Pituitary adenomas impose a burden of morbidity on patients and characterizing the molecular mechanisms underlying its pathogenesis received remarkable attention. Despite the appealing role of necroptosis as an alternative cell death pathway in cancer pathogenesis, its relevance to pituitary adenoma pathogenesis has yet to be determined that is perused in the current study. METHODS: The total number of 109 specimens including pituitary adenomas and cadaveric healthy pituitary tissues were enrolled in the current study. Tumor and healthy pituitary tissues were subjected to RNA extraction and gene analysis using Real-Time PCR. The expression levels of necroptosis markers (RIP1K, RIP3K and, MLKL) and their association with the patient's demographic features were evaluated, also the protein level of MLKL was assessed using immunohistochemistry in tissues. RESULTS: Based on our data, the remarkable reduction in RIP3K and MLKL expression were detected in nonfunctional and GH-secreting pituitary tumors compared to pituitary normal tissues. Invasive tumors revealed lower expression of RIP3K and MLKL compared to non-invasive tumors, also the attenuated level of MLKL was associated with the tumor size in invasive NFPA. The simultaneous down-regulation of MLKL protein in pituitary adenoma tissues was observed which was in line with its gene expression. While, RIP1K over-expressed significantly in both types of pituitary tumors which showed no significant correlation with patient's age, gender and tumor size in GHPPA and NFPA group. Notably, MLKL and RIP3K gene expression was significantly correlated in the GHPPA group. CONCLUSIONS: According to our data, the reduced expression of necroptosis mediators (RIP3K, MLKL) in pituitary adenoma reinforces the hypothesis that the necroptosis pathway can be effective in regulating the proliferation and growth of pituitary tumor cells and tumor recurrence.

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Immobilized microalgae are a promising approach to incorporate microalgae in recirculating aquaculture system (RAS) for water purification. In the present study, two types of biosorbents including sodium alginate-immobilized Scenedesmus spp. and Chlorella spp. beads (algal beads) and sodium alginate beads without microalgae (alginate beads) were prepared. In the first experiment (static test), the potential of two biosorbents to remove different concentrations of total ammonia nitrogen (TAN) and total phosphorus (TP) from water was investigated. In the second experiment, two prepared biosorbents were used as biofilter in a RAS for rearing African cichlid (Labidochromis lividus) for 30 days. The survival rate and growth indices of fingerling fish and removal efficiency of two biosorbents for TAN, NO3-N, and TP were determined. The results of static test showed that the removal efficiency and uptake capacity of the two biosorbents for TAN and TP increased during 30 days of the experiment, and these values for the algal beads were higher than the alginate beads. The TAN removal efficiency of the two biosorbents increased with increasing TAN concentration from 0.5 to 5 mg L-1. The application of algal beads in the RAS improved the survival rate, final weight, final length, weight gain, and daily growth index (DGI%) indices of fish compared to those cultured in the RAS containing the alginate beads and the control (P<0.05). The algal and alginate beads decreased the TAN concentration by 42.85% and 28.57% compared to the control after 30 days of cultivation period, respectively. The uptake of nitrate was not observed by the two biosorbents during cultivation period. The TP removal efficiency of algal beads reached 44.90% after 30 days. The findings of this study indicated that the sodium alginate-immobilized microalgae could be considered as a suitable biofilter to be incorporated into a RAS to improve water quality and consequently enhance the growth and health of fish.

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BACKGROUND: The critical care unit is inherently stressful due to its complexity, leading to fatigue and consequences such as restless legs syndrome (RLS). This study aimed to investigate the prevalence of RLS and its relationship with fatigue in critical care nurses. PATIENTS AND METHODS: This cross-sectional study was performed with 200 nurses of critical care units of Shahroud hospitals in 2019 using the census sampling method. Data collection tools included the RLS questionnaire and the Multidimensional Fatigue Inventory. Data analysis was performed using descriptive and inferential statistics (multiple linear regression analysis). RESULTS: The results showed that 72% of the subjects had moderate to high RLS, and their mean fatigue was 55.31 ± 10.53. By increasing one point in the score of RLS and 1 year of critical care nursing experience, the fatigue score increases by 0.3 and 0.71. CONCLUSIONS: Considering the relationship between fatigue and RLS in critical care nurses, supportive interventions seem necessary to reduce the effects of these two components. HOW TO CITE THIS ARTICLE: Ameri M, Mirhosseini S, Basirinezhad MH, Ebrahimi H. Prevalence of Restless Legs Syndrome and Its Relationship with Fatigue in Critical Care Nurses. Indian J Crit Care Med 2021;25(11):1275-1279.

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Background: Using morphologic features of the bones is the basis of gender determination in anthropology and forensic medicine. In this study, we evaluated the calcaneus diameters for gender determination in the Iranian population. Methods: This cross-sectional study was conducted on Iranians referring to Hazrat-e Rasool Hospital's radiology ward for plain lateral X-ray of the foot. Lateral foot X-rays from 100 men and 100 women were gathered and evaluated for calcaneal indexes. These patients aged between 18 and 80 years old who did not suffer major trauma to the calcaneus bone were recruited. Using a picture archiving and communication system (PACS), four variables were calculated for each X-ray graph: Maximum anterior-posterior length of the calcaneus (MAXL), Maximum height of the bone (MAXH), Height of the cuboid facet (CFH) and Height the calcaneal body (BH). Cut off points for each index were calculated using the area under curve (AUC) in ROC curves. Results: Lateral foot X-rays from 100 men and 100 women were gathered and evaluated for calcaneal indexes. The means of the four indexes were compared between the sexes which showed all four means are significantly different p value <0.001. AUC for MAXL in differentiating the genders was 0.824, which showed 86.8 as the cut off with a sensitivity of 80% and specificity of 69.0%. Cut off point for MAXH was set at 59.8 with sensitivity and specificity of 78.0% and 60.0%, respectively. For BH, 49.5 was set as the cut off point with a sensitivity of 79.0% and specificity of 64.0%. The best cut off point for CFH was 27.8 with 76.0% sensitivity and 63.0% specificity. Conclusion: It can be concluded that the calcaneal diameters are reliable criteria for sex determination. Although the cutoff points are different between various races and populations, it is evident that these diameters can be used for sex determination in general.

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BACKGROUND: An oscillating bone saw is rarely used to perform laminectomy. The purpose of this study was to describe a relatively quick and harmless technique for multilevel laminectomy in patients with lumbar spinal stenosis (LSS) using an oscillating bone saw to find out how this instrument affects the time of surgery and rate of complications. METHODS: This prospective study was conducted on 45 patients with LSS who required multilevel laminectomy. The bones were cut using an oscillating sagittal saw equipped with a fine 1-cm blade. Posterolateral fusion was performed if any evidence of spinal instability occurred, or the correction of deformity was addressed. The time spent for laminectomy from initial cutting to the whole bone removal (T1) and the duration of laminectomy (i.e., from initiation to the end of decompression; T2) were recorded for the corresponding level. The volume of harvested autograft was also measured, and any dural injuries were reported. RESULTS: Posterolateral fusion was performed on 32 (71.1%) patients. The mean T1 and T2 per level were estimated at 70.5±5.4 and 157.5±12.1 sec, respectively. In addition, the mean volume of harvested autograft per level was obtained as 3.5±1.2 cc. No durotomy was observed during laminectomy using an oscillating bone saw. However, a dural tear occurred in one patient when a Kerisson punch was utilized for ligamentum flavum removal and foraminotomy. CONCLUSION: Based on the findings, it can be concluded that laminectomy by means of the oscillating bone saw is a safe procedure that provides a sufficient volume of harvested autograft for fusion. This technique could also induce a remarkable reduction in the time of surgery.

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Aluminium (Al) water pollution is an increasing environmental problem and comprehensive analysis of toxic responses of aquatic primary producer organisms is imperative. We characterized the antioxidant response of Scenedesmus sp. microalga to Al-induced oxidative stress. After 72 h of exposure to Al (0, 10, and 100 µM) in a modified Bold Basal Medium (pH 5.0), we observed cell aggregation and alterations in the subcellular structure, strong lipid peroxidation and oxidative stress induction (detected with the fluorescent probe 2',7'-dichlorodihydrofluorescein diacetate) in parallel with Al accumulation in cells. At the same time, Al toxicity caused depletion of important macronutrients like Ca, which is important for cell-wall structure. Analysis of antioxidant enzymatic activities in Al-treated Scenedesmus cells revealed that catalase, ascorbate peroxidase, as well as different isoforms of superoxide dismutase were inhibited especially at the highest Al dose (100 µM), cells that accumulated the highest concentration of Al. On the other hand, glutathione reductase activity increased at that Al concentration. Immunodetection after Western-blotting confirmed that only ascorbate peroxidase inhibition was apparently due to a decrease in enzyme levels. However, the inhibition of catalase and activation of glutathione reductase activities seemed related with post-translational modifications in protein function as protein expression decreased or increased, respectively under Al stress. Our results may help to understand toxic mechanisms triggered by Al in freshwater microalgae, which in turn could aid to select suitable biomarkers of Al contamination in aquatic ecosystems.

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BACKGROUND: Pituitary adenoma accounts as a complex and multifactorial intracranial neoplasm with wide range of clinical symptoms which its underlying molecular mechanism has yet to be determined. The bioactive lipid mediators received attentions toward their contribution in cancer cell proliferation, progression and death. Amongst, 15-Lipoxygense (15-Lox) enzymes and products display appealing role in cancer pathogenesis which their possible effect in pituitary adenoma tumor genesis is perused in the current study. METHODS: The 15-Lipoxygenses isoforms expression level was evaluated in tumor tissues of prevalent functional and non-functional pituitary adenomas and normal pituitary tissues via Real-Time PCR. The circulating levels of 15(S) HETE and 13(S) HODE as 15-Lox main products were assessed in serum of patients and healthy subjects using enzyme immunoassay kits. RESULTS: Our results revealed that 15-Lox-1 and 15-Lox-2 expression levels were elevated in tumor tissues of pituitary adenomas comparing to normal pituitary tissues. The elevated levels of both isoforms were accompanied with 15(S) HETE and 13(S) HODE elevation in the serum of patients. The 15-Lox-1 expression and activity was higher in invasive tumors as well as tumors with bigger size indicating the possible pro-tumorigenic role of 15-Lox-1, more than 15-Lox-2 in pituitary adenomas. The diagnostic value of 15-Lipoxygense isoforms and products were considerable between patients and healthy groups. CONCLUSION: The possible involvement of 15-Lipoxygense pathway especially 15-Lox-1 in the regulation of pituitary tumor growth and progression may open up new molecular mechanism regarding pituitary adenoma pathogenesis and might shed light on its new therapeutic strategies.

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BACKGROUND: Pregnancy and postpartum are critical periods for patients with neurological complications. In this study, we aimed to evaluate the clinical characteristics and outcome of pregnant women with neurological conditions. MATERIALS AND METHODS: This cross-sectional study reviewed pregnant women with neurological signs and symptoms, who were registered in the Medical Care Monitoring Center (MCMC) database of Shiraz University of Medical Sciences 2013-15. A questionnaire was designed to record each patient's information including demographic variables, past medical history, clinical presentation, obstetric profile, and fetal/maternal outcomes. RESULTS: Totally, 332 mothers were registered in the database. The main neurological complaints in our population were headache, seizure, unilateral neurological symptoms, multiple sclerosis, neuromuscular disorder, and brain tumor. More than half of the patients (54%) experienced headache during the pregnancy and postpartum period. CONCLUSION: Evaluating the neurological disorders separately, based on the time of symptom onset indicates the importance of follow-up of mothers during peripartum. Our findings suggest that decisions for pregnancy in women with neurological disorders should be based on risks outweighing for the mother and the fetus, particularly regarding the pharmacological side effects.

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BACKGROUND: Growing rods are increasingly used for treatment of early onset scoliosis (EOS) worldwide. Beside promising outcomes, some authors are concerned about high rates of complications. In the current clinical trial, complications of EOS surgery using dual growing rods were investigated. METHODS: Between June 2006 and February 2017, twenty-two consecutive patients with a coronal curve >45 degrees underwent serial surgical correction using dual growing rods at Shafa Orthopedic hospital, Tehran, I.R. Iran. The rods were secured using hooks or screws or both. The patients were followed for 5.2 ± 1.7 years on average. Wilcoxon test was utilized to compare the pre- and post-operative values. P < 0.05 was considered significant. RESULTS: The scoliotic and kyphotic curves decreased significantly from 52 ± 24° to 38 ± 19° and from 78 ± 22° to 60 ± 17°, respectively (P < 0.001). Total rate of implant-related complications (IRCs) and surgical site complications (SSCs) were 54.5% (12 patients) and 22.7% (5 patients), respectively. Malpositioned pedicular screw was found in 2 patients. CONCLUSION: EOS can be effectively corrected using dual growing rods, however, considerable rates of IRC are of concern (54.5%). It seems necessary to compare the efficacy and complication rate of newer devices with those of growing rods in future studies.

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BACKGROUND: Suicide ranks among the top ten causes of death in all age groups all over the world. There are many methods for committing suicide including self-poisoning, firearm and hanging. The aim of the present study was to provide an overview of self-poisoning related suicidal deaths with special focus on forensic toxicology analysis results in Tehran, Iran from 2011 to 2015. METHODS: All suspicious cases with the the history of self-poisoning were investigated to define the cause and manner of death under the supervision of forensic medicine practitioners. Postmortem samples were analysed in forensic toxicology laboratory to confirm the presence of drugs in cadaver of suicidal cases. Drugs and poisons were analysed using thin layer chromatography, high performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography and gas chromatography equipped with nitrogen phosphorus detector. Demographic data were collected from autopsy reports of all cases with confirmed self-poisoning suicidal cause of death. RESULTS: Results showed that 674 cases of self-poisoning deaths were investigated during a five-year study period, of which 68.55% were male. The most often used suicide method was self-poisoning in young population. Phosphine gas liberated from aluminum phosphide tablets was the most toxic substance detected in postmortem samples (619 cases) followed by opioids, methamphetamine, organophosphates, cyanide and strychnine. CONCLUSION: In conclusion self-poisoning suicidal death was predominant in young male population in Tehran, Iran. It seems that free access to suicide means such as drugs and poisons should be restricted by national and health authorities. TRIAL REGISTRATION: Not applicable.

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Fatty liver disease (FLD) is the most prevalent form of liver disease worldwide. Overnutrition can induce nonalcoholic fatty liver disease (NAFLD), a spectrum of conditions ranging from simple steatosis [or nonalcoholic fatty liver (NAFL)] to nonalcoholic steatohepatitis and cirrhosis. Some of the epidemiological and pathological studies have also suggested an association between the presence of fatty liver and sudden death. A 37-year-old man was found dead when he was asleep in the bed at home. According to his family, he was single and a costermonger. He was not an athlete, and there was no history of any physical and mental disorder. He was not addicted and did not use any drugs or alcohol. The positive points, in this case, were: a large heart with mild coronary stenosis and steatohepatitis in autopsy and sudden death. Since steatohepatitis did not have any complication such as fat embolism, it can be concluded that the combination of steatohepatitis and cardiovascular disorder led to sudden unexpected death. Heart more than 450 gr is susceptible to arrhythmia, and fatty liver disease can cause cardiovascular changes.

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In some relationships, pregnancy is a risk factor for intimate partner violence (IPV). We present a case of a 34-year-old, 28-week-pregnant woman who was admitted to the emergency department with multiple traumas due to IPV. Her husband had hit her with a power cable after abusing methamphetamine. There were multiple ecchymoses and lacerations on her body. On questioning, the patient revealed a low socioeconomic status. The couple had been married for five years, and the abuse began 11 months earlier, after the husband became addicted to methamphetamines. In this instance of abuse, the husband was suspicious of the wife's pregnancy and believed that the child had been fathered by another man. Her husband's methamphetamine abuse had resulted in previous incidences of non-physical IPV, but, in the present incident, the combination of abuse coupled with partner jealousy resulted in physical abuse. During admission, there were no significant changes to the patient's health, and the fetus was deemed to be healthy and unharmed. After discharge, the patient decided to divorce her abusive husband. Screening and counseling for interpersonal and domestic violence is especially recommended during pregnancy to protect the mother and her fetus. In Iranian civil law, IPV is regarded as "osr-o-haraj" or severe and intolerable hardship, and women may cite it as grounds for divorce in cases such as spousal drug addiction and certain forms of spousal abuse. When intimate partner assault is repeated and petition for khula is presented to the courts, the court can order the man to divorce his wife and, if he refuses, the court judge can grant the khula without the husband's consent.

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BACKGROUND: Peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) is a rare neoplasm that typically presents as generalized lymphadenopathy. PTCL, NOS presenting as malignant ascites is rare. METHODS: A 61-year-old African-American man with past medical history of HCV, cryoglobulinemia, and cryptococcal pneumonia was admitted for dyspnea on exertion over a period of 1 month and new onset of abdominal distension. RESULTS: Ascites, splenomegaly, hepatomegaly and extensive lymphadenopathy were found by imaging. Paracentesis obtained 1.3 liter of abdominal fluid, the cytologic evaluation showed a monomorphic population of intermediate-sized lymphoid cells with irregular to convoluted nuclear contours. Fluid sent for flow cytometry showed an abnormal T-lymphocyte population expressing CD4, weak surface CD3 and absence of CD7. PCR studies of ascitic fluid detected a clonal T-lymphocyte population with T-cell receptor gamma gene rearrangement. Serologic testing for human T lymphotropic virus (HTLV) was positive for HTLV-II. Subsequent bone marrow biopsy revealed lymphomatous involvement. CD30 and ALK-1 immunostaining were negative. This case was classified as PTCL, NOS. CONCLUSIONS: PTCL, NOS can have unusual clinical presentation such as ascites and pleural effusion, and may also occur as a complication of immunodeficiency state. Further studies are needed to determine if HCV or HTLV-II viral infection is associated with PTCL.

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Motor vehicle and falling down are responsible for the most number of traumatic injuries. This study aimed to compare the characteristics of traumatic brain injury among accident and falling down cases. In this analytical cross-sectional study, data were collected from the records of cadavers who died due to accident or falling down and referred to Kahrizak dissection hall, Tehran forensic medicine organization during 2013. A total of 237 subjects (183 (77.2%) accident and 54 (22.8%) falling down) with a mean age of 35.62 (SD=15.75) were evaluated. A number of 213 (89.9%) were male. From accident group, scalp injury was seen in 146 (79.8%), scalp abrasion in 122 (66.7%), scalp laceration in 104 (56.8%), sub skull bruising in 176 (96.3%), skull fracture in 119 (65%), hemorrhage in 166 (90.7%), Subdural hemorrhage (SDH) in 155 (84.7%), Subarachnoid hemorrhage (SAH) in 161 (88%), Epidural hemorrhage (EDH) in 41 (22.4%), contusion in 140 (76.5%), and skull base fracture in 140 (76.5%) of cases. In falling down group scalp injury was seen in 42 (77.8%) cadavers, scalp abrasion in 38 (70.4%), scalp laceration in 30 (55.6%), sub skull bruising in 49 (90.7%), skull fracture in 39 (72.2%), Hemorrhage in 49 (90.7%), SDH in 43 (79.6%), SAH in 47 (87%), EDH in 10 (18.5%), contusion in 33 (61.1%), and skull base fracture in 39 (72.2%) of cases. There was no significant difference between these two groups (P Value> 0.05). Accident and falling down had no difference in terms of any injury or hemorrhage.

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INTRODUCTION: Clinical symptoms of female genital tract lymphoma are often non-specific, and mimic other more common gynecological malignancies. Diagnosis can only be confirmed by histology. CASE PRESENTATION: We report the case of a 48-year-old multiparous woman who underwent subtotal hysterectomy because of enlarged myomatous uterus and persistent heavy vaginal bleeding. "2 months later", postoperative pelvic and abdominal CT scan performed because of flank pain, revealed bilateral hydronephrosis. Pelvic and colposcopic exam and cervical biopsy under anesthesia showed benign histology, as reported by two pathologists. Referral to a third pathologist and immunohistochemical (IHC) exam revealed malignant lymphoproliferative disorder. CONCLUSION: Despite multiple negative pathology reports of the cervical biopsies, bimanual pelvic exam with deep biopsies by a gynecologist, allowed accurate final diagnosis of this unusual case.