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Background. This paper reports a case where the patient developed Stevens - Johnson syndrome (SJS) following the use of phenytoin. Case description. The case was an 85-year-old male admitted to the 9-Dey Hospital in Torbat-Heydariyeh city, Iran with a diagnosis of cardiovascular accident (CVA). On Day 2 of hospitalization, phenytoin medication was started to control the patient’s seizures. On Day 10, the patient developed a 39.2°C fever and also a generalized rash starting from the upper limbs and spreading to the whole body. The dermatologist diagnosed SJS and recommended replacing phenytoin with an alternative drug for seizure control. From Day 15 onwards, his rashes started to decrease and almost entirely disappeared a week later. Conclusion. Considering the range and severity of the adverse effects of SJS, physicians need to be familiar with the symptoms of these reactions so that the drug can be replaced as soon as such symptoms emerge.

BACKGROUND: Pain management is very important for infants who are unable to express it verbally. Pain control is one of the nursing actions and part of their duties. This study attempted to determine the effects of breast milk odor on the physiological and behavioral responses caused by venipuncture pain in full-term infants at an educational hospital. MATERIALS AND METHODS: This randomized clinical trial study was carried out on 3–5 days' term and healthy babies with a gestational age of 34 weeks and later in the 9-Day Hospital of Torbet Heydariyeh, Iran, 2021. The sample size, taking into account the possibility of a 10% dropout of samples included 20 babies for each group and a total of 40 babies were selected by convenience sampling. To collect data, a checklist of demographic characteristics, a registration form for physiological responses, and the modified behavioral pain scale were used. RESULTS: The results of this study showed that breast milk odor has a positive effect on behavioral responses (P < 0.001) and also a significant relationship was observed between the effects of breast milk odor and physiological responses percentage of oxygen uptake and pulse (P < 0.001). However, no significant relationship was observed between breast milk odor and breathing variables (P > 0.05). CONCLUSIONS: According to the results, olfactory stimulation with breast milk during venous blood sampling showed positive effects on physiological responses and pain reduction in infants. Therefore, it is recommended to use soothing stimuli such as the smell of breast milk during painful procedures in babies.

Background: Pain relief during labour is one of the major concerns in obstetrics; severe labor pain causes fear of the next pregnancy, and interferes with the mother's family relationship. Objective: The aim of this study was to evaluate the analgesic effects of Entonox during labor on reducing the need for pethidine (Meperidine) and fetal-maternal complications. Methods: This double-blind randomized clinical trial was conducted on pregnant women who were candidates for vaginal delivery in Educational Hospitals of Mashhad University of Medical Sciences, Iran between January 2014 and November 2015. After entering into the inactive phase of labor, participants were randomly allocated to receive inhaled Entonox gas (n=200) or inhale Oxygen (n=200) as a control group. Mothers inhaled the gas at commencement of pain, and ceased as soon as the pain diminished, up to the end of the second stage of labor which was the neonate's birth. Main outcomes were pain score based on NRS (numerical rating scale), duration of delivery, required pethidine, maternal complications and satisfaction during labour. Chi-square and Independent T-test were used via SPSS for data analysis and P-value less than 0.05 was considered statistically significant. Results: Four-hundred pregnant women with a mean age of 26.4±5.9 years were studied. Complications such as nausea, vomiting, dizziness, and drowsiness were reported in 25% of the Entonox group and 23% in the control group (p=0.640). Mean of pain severity score during labor in the Entonox and control groups was 4.5±1.2 and 5.2±1.4, respectively (p

Introduction: Pulmonary embolism is one of the leading causes of mortality in patients.The mortality rate of this disease can be significantly reduced with appropriate treatment. Surgical intervention can be highly effective for the treatment of acute massive pulmonary embolism. This article presents a report on the experience of acute pulmonary embolectomy. Materials and Methods: Demographic data, rate of mortality, as well as surgical and post-operative complications were recorded and analyzed. Results: In general, 12 patients with mean age of 60±13.39 year were included in the study. None of the patients had significant arrhythmia during the surgery, but 25% suffered from post-operative arrhythmia. Moreover, electrical cardioversion was administered to 8% of the patients, 8% received pharmaceutical interventions, and the rest of the patients sustaining arrhythmia (9%) survived with specific metabolic correction. The diagnosis of acute pulmonary embolism was correct in 100% of the patients, with 33.3% of the cases suffering from this disease due to recent surgeries. In 41.6% of the patients, blood clots were observed in the pulmonary artery, right atrium, and right ventricle. The three-month follow-up of the patients showed that 83.3% of the cases were alive. There were two cases of mortality, one of which occurred at the end of surgical procedure and the other one happened in the intensive care unit. The results of independent t-test did not indicate any significant relation between mortality and ejection fraction of the patients (P=0.189). Moreover, there were not any significant differences between the patients’ pre- and post-operative laboratory tests (P˃0.05). Nonetheless, hemoglobin and hematocrit levels were significantly different pre- and post-operation (P=0.0001). Conclusion: Our data suggest that acute pulmonary embolism can be treated successfully with favorable outcome and a mortality rate of approximately 16.6%, if evaluation and diagnosis are done as soon as possible in patients who require surgical intervention.

Background: The present study aimed to assess the efficacy of folic acid (FA) on withdrawal following nicotine (Nic) administration in adolescent male rats., Aims and Methods: Adolescent male rats were divided into two groups: (1) vehicle and (2) Nic (Nic-2 mg/kg), and were under treatment from 21 to 42 days of age. After that, they continued the experiment without treatment and returned to a regular diet, except for one of those who received Nic. The rats were divided into four groups where they were treated with different doses of FA (5, 10, and 15 mg/kg) and bupropion (Bup) by oral gavage, and the final group included normal rats that received only FA (15 mg/kg) from 42 days of age for three weeks during which withdrawal occurred., Results: Results showed that adolescent Nic exposure exacerbated the behavioral indices of anxiety- and depression-like behaviors, while FA attenuated the effects of Nic withdrawal on anxiety and depression as well as Bup. In support, the biochemical results demonstrated a balance between oxidant and antioxidant mediators in addition to the increase and decrease of serotonin and monoamine oxidase (MAO) activity in cortical tissue. TNF-α as an inflammatory agent was decreased, whereas IL-10 as an anti-inflammatory parameter was increased., Conclusions: The present findings suggest anxiety and depression caused by Nic withdrawal were attenuated by FA more likely through the reduction activity of MAO, the important enzyme responsible for serotonin metabolism along with balance between oxidant/antioxidant and pro-inflammatory/anti-inflammatory mediators. However, various mechanisms might be involved, which requires further investigation., Implications: Nic withdrawal-induced depression and anxiety like behavior in rats followed by neuro-oxidative damage and neuro-inflammation. FA supplementation as well as Bup improved cognitive disorders induced by Nic withdrawal by increasing neuro-inflammation and neuro-oxidative damage., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Believability and thoughts are considered as the pillars of behaviors over time, and anxious feelings are a risk factor for mental disorders, especially during the coronavirus disease (COVID-19) pandemic. This study aimed to explore the thought believability and anxious feelings of COVID-19 among infected and healthy families., Methods: In this hospital-based matched case-control study, health surveillance files of COVID-19 patients were collected from January to June 2021 and were analyzed statistically. In this study, two questionnaires of demographic characteristics and the Believability of Anxious Feelings and Thoughts (BAFT) were used. Data were analyzed using the One-way ANOVA., Results: Of 600 participants, 300 (50%) were PCR-confirmed and 300 (50%) were non-infected. Overall, 163 (54.33%) of infected people were male, 146 (48.67%) single, and 156 (52.00%) government employees. The results showed that the mean scores of physical anxiety (PA) and negative evaluation (NE) in the case group is significantly higher than the control group ( P = 0.001); while emotional regulation (ER) in the control group was significantly higher than the case group ( P = 0.001)., Conclusion: Having high believability to the risks of COVID-19 may be a predictor of preventive behaviors in individuals. Worrying about COVID-19 can increase the perceived risk of a pandemic in societies and consequence, increase the general public health., Competing Interests: The authors declare that they have no competing interests., (© 2023 Iran University of Medical Sciences.)

Background: Human T-cell lymphoma/leukemia virus type 1 (HTLV-1) infection is relatively common in northeast Iran. It is important to understand which factors play a role in the pathogenesis of this virus. Blood group antigens may act as a receptor for various infectious agents. This study was performed to detect any association between Rh blood group antigens and HTLV-1 infection in northeast Iran., Methods: In this case and control study, Rhesus blood group antigens (D, C, c, E and e) were determined within 24 hours of blood collection by commercial antibodies in 100 HTLV-I infected individuals and 332 healthy blood donors at the Khorasan Blood Transfusion Center, Mashhad, Iran, in 2011. The results of HTLV-I positive subjects and the control group were compared using SPSS software., Results: The frequencies of Rh blood group antigens in the case group were D in 88%, C in 72%, c in 68%, E in 27%, and e in 94%. In the control group the frequencies were D in 91%, C in 75.5%, c in 72.9%, E in 28.6% and e in 98.2%. Chi-square test showed a significant difference between the two groups for the frequency of e antigen (p = 0.03)., Conclusions: Our study showed that e antigen expression is associated with a decreased risk of HTLV-I infection in northeast Iran.