ABSTRACT
Time of day can affect the outcome of medical procedures and surgical operations. The current study was designed to assess whether time of day can influence the quality of breast cancer surgery or not. Patients who underwent breast cancer surgery and axillary lymph node dissection in Tehran, Iran between March 2012 and March 2013 were enrolled. Surgeries were categorized into two group based on the time of initiation [before and after 1 pm]. We considered the number of dissected lymph node as an indicator of operation quality. In this way, dissection of at least six lymph nodes was considered as an adequate number of lymph node examinations. A total of 134 patients were enrolled. Median start time of surgery was 11 am. Surgeries were performed before and after 1 pm in 105[78.4%] and 29[21.6%] patients, respectively. The association between time and the number of dissected lymph nodes was significant when they were considered either as a categorical [P = 0.002] or continuous variables [P = 0.039]. Based on our results, it can be suggested that breast surgeries with later start time might have lower quality
ABSTRACT
A 3-year-old boy was admitted to the emergency department with right lower limb pain, edema, and livedoid discoloration that occurred immediately after intramuscular injection of benzathine penicillin. The patient was diagnosed with Nicolau syndrome, a rare complication of intramuscular injection presumed to be related to the inadvertent intravascular injection. It was first reported following intramuscular injection of bismuth salt, but it can occur as a complication of various other drugs. Fasciotomy was carried out due to the resultant compartment syndrome and medical therapy with heparin, corticosteroid, and pentoxifyllin was initiated
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A young male patient used fixed dose combinations of different fluoroquinolones and nitroimidazoles several times in the last few years for self-treating repeated episodes of diarrhea and loose motion. Each time, he experienced fixed drug eruptions that increased in number and severity on subsequent occasions. Suspecting association between the drug and the rashes, the patient each time discontinued the treatment prematurely, and preferred to switch to a similar formulation next time, but with different molecules of fluoroquinolone [ciprofloxacin or ofloxacin] and nitroimidazole [tinidazole or ornidazole]. He could not however avoid the rash. This time the patient presented with multiple, round-to-oval, well-defined, hyperpigmented cutaneous patches of different dimensions, all over the body. He appeared to have run out of options and therefore consulted us seeking advice on how he should treat himself next time he suffered from diarrhea. Causality assessment by Naranjo's algorithm revealed a definite relationship between the cutaneous adverse reaction and the offending drug. He was counselled regarding medication in general and advised, in particular, to avoid the tendency to self-treat any future episode of diarrhea
ABSTRACT
Background: Skin metastases occur in 1-5% of solid tumors and are rarely the presenting sign of internal malignancies. Certain features in skin lesions raise suspicion of metastasis from solid tumors. Case Presentation: In this article a 61-year-old woman is presented with erythematous skin nodules in upper abdomen and chest. Histopathological evaluation of lesions suggested metastatic carcinoma and a thorough search found stomach signet cell adenocarcinoma and breast lobular carcinoma. Immunohistochemical staining confirmed diagnosis of lobular carcinoma with metastasis developed in skin and stomach. Conclusions: Clinicians must be aware that malignancies can present by skin metastases. Since breast and stomach cancer can both metastasize to skin, immunohistochemistry evaluation is of great importance to diagnose the primary tumor
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Anticoagulation drugs are frequently used to prevent deep vein thrombosis in high-risk patients. Subcutaneous low molecular weight heparin [LMWH] is increasingly used in both hospitalized patients and outpatient settings. This necessitates familiarity of both health care providers and patients with such treatment and vigilance on possible complications. Here we present a case of hematoma of rectus sheath that occurred following subcutaneous injection of enoxaparin and was successfully treated with conservative management
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Localization of sources in patients with focal seizure has recently attracted many attentions. In the severe cases of focal seizure, there is a possibility of doing neurosurgery operation to remove the defected tissue. The prosperity of this heavy operation completely depends on the accuracy of source localization. To increase this accuracy, this paper presents a new weighted beamforming method to precisely localize the focal seizure sources from the electroencephalogram [EEG] signals. First, synchronization value is determined just between each two adjacent channels, and the channel with maximum average in synchronization index is selected as the nearest channel to the dominant focal sources. Next, weight of each channel is determined based on its Euclidean's distance to the selected channel. The determined weights act as a prior knowledge, incorporating in multiple signal classification [MUSIC] and some other beamforming methods to localize the exact place of seizure source. Next, the effect of estimated source is removed from the signals repeatedly to find the second focal source. This process continues till all focal sources being determined. To verify and validate the proposed scheme, 65 channels EEG signals were simulated and a linear weighting was applied to the three groups based on some sources. The proposed scheme and some known beamforming methods such as conventional beamformer, MUSIC, Weighted MUSIC, Capon's, Eigenvector and also SLORETA were applied to the simulated epileptic signals to find the location of sources. Experimental results reveal the superiority of the proposed method to the rival schemes in terms of localization accuracy, both in clean and noisy environments
ABSTRACT
Premature and critically sick infants frequently experience several interventions, including blood transfusions, parentral nutrition, and prescriptions during hospitalization that could affect the result of thyroid function test. This study aims to investigate the correlation between thyroxine level and clinical short term outcome among the newborn infants in the neonatal intensive care unit [NICU]. We assessed serum levels of thyroxine and thyroid stimulating hormone of 99 neonates who were admitted in the NICU from September 1[st] 2004 to March 30[th] 2005. Number of patients with low thyroxin level [less than 6.5 micro g/dl] was determined and the relation between serum total thyroxine level and birth weight, gestational age, duration of hospitalization, clinical diagnosis, and final outcome was investigated. Short term outcome was considered as duration of hospitalization and discharge alive from hospital. Prevalence of hypothyroxinemia was 26 percent. Later assessment of thyroxine level within 3 weeks revealed normal level of this parameter [8.12 micro g/dl +/- 1.36]. Patients with lower gestational age and lower birth weight had lower thyroxine level [7.15 micro g/dl +/- 2.56, and P=0.03, 6.72 micro g/dl +/- 3.03, and P=0.08]. Low thyroxine level was not associated with adverse short-term clinical outcome [mortality rates; 3[11%] and 9[12%], and duration of hospitalization among 17.7 +/- 9.8 vs 16.7 +/- 13.0 in patients with hypothyroxinemia and low thyroxine level respectively]. Hypothyroxinemia has considerable prevalence in neonatal intensive care setting and is related with lower birth weight and gestational age. Whether thyroxin levels are a marker or mediator of short term clinical outcome remains to be determined by further studies