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Ventilator-associated-pneumonia (VAP) is characterized by morbidity, mortality, and prolonged length of stay in intensive care unit (ICU). The present study aimed to examine the effect of N-acetyl-cysteine (NAC) in preventing VAP in patients hospitalized in ICU. We performed a prospective, randomized, double-blind, placebo-controlled trial of 60 mechanically ventilated patients at high risk of developing VAP. NAC (600 mg/twice daily) and placebo (twice daily) were administered to NAC group (n = 30) and control group (n = 30), respectively, through the nasogastric tube in addition to routine care. The clinical response was considered as primary (incidence of VAP) and secondary outcomes. Twenty-two (36.6%) patients developed VAP. Patients treated with NAC were significantly less likely to develop clinically confirmed VAP compared with patients treated with placebo (26.6% vs. 46.6%; P = 0.032). Patients treated with NAC had significantly less ICU length of stay (14.36 ± 4.69 days vs. 17.81 ± 6.37 days, P = 0.028) and less hospital stay (19.23 ± 5.54 days vs. 24.61 ± 6.81 days; P = 0.03) than patients treated with placebo. Time to VAP was significantly longer in the NAC group (9.42 ± 1.9 days vs. 6.46 ± 2.53 days; P = 0.002). The incidence of complete recovery was significantly higher in the NAC group (56.6% vs. 30%; P = 0.006). No adverse events related to NAC were identified. NAC is safe and effective to prevent and delay VAP, and improve its complete recovery rate in a selected, high-risk ICU population.

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Background: There is a strong need to identify simple and cost-effective biomarkers for multiple sclerosis (MS). Objectives: To evaluate the serum levels of receptor for advanced glycation end products (RAGE) ligand, the high-mobility group box (HMGB) 1 and its correlation with changes in the physical and psychological indicators in MS patients. Methods: During the 12-month follow-up, the serum level of HMGB1, expanded disability status scale (EDSS) score, rate of clinical relapse, quality of life, and other psychological indicators were assessed at baseline, after 6 months, and after 12 months and compared between 60 newly diagnosed MS patients with 60 healthy controls (HCs). Data were analyzed using t-test and Mann–Whitney U test, two-way repeated measures analysis of variance (ANOVA) and Spearman's rank correlation coefficient. Results: A significant decrease was observed in the EDSS score (P < 0.001) and a significant increase in the serum level of HMGB1 in all MS patients (P = 0.009). The serum level of HMGB1 was higher in MS patients, compared with HCs (baseline: 65.8%, P = 0.007; six-month follow-up: 73.9%, P = 0.004; and 12-month follow-up: 77.6%, P = 0.021). There were significant positive correlations between the serum level of HMGB1 and scores of MS impact scale-psychological subscale (MSIS-PS) (r = 0.59, P < 0.001), Beck depression inventory (BDI) (r = 0.491, P = 0.031), and Pittsburgh sleep quality index (PSQI) (r = 0.471, P = 0.035). Conclusion: The serum level of HMGB1 could predict the patients' psychiatric status better than their physical status.

Background & Objective: Although giving birth is quite a natural process in a woman's life; it is very painful. Different people, however, experience this pain on different levels. In fact, one's perception of labor pain is determined by physiological, cultural, social, mental, and psychological factors. The present study aims to investigate the relationship between personality traits and one's perception of labor pain. Materials & Methods:This study is a descriptive-analytical correlational study. Two questionnaires were used for Gathering information: one on personality traits and the other on labor pain. One hundred participants were chosen according to their demographic information from a pool of pregnant women at the Persian Gulf Hospital maternity ward in Bandar Abbas City. The data was analyzed using descriptive and analytical measures such as the Pearson Factor.Results: Meaningful positive relationship between labor pain and Neuroticism (P=0.000, r=0.448), Openness (P=0.000, r=0.517) and Agreeableness (P=0.003, r=0.296). While Consciousness (P=0.047, r=-0.199) is found to have a meaningful negative relationship, extraversion shows no correlation with labor pain. Conclusion:Good Childbirth Counseling and proper training, based explicitly on a mother's personality traits, could significantly help provide an enjoyable childbirth experience and reduce the unnecessary demand for C-section operations.