Motor and Sensory Outcomes of Infantile Exotropia: A 10-Year Study (2008–2017)

Purpose@#We aimed to determine the long-term motor and sensory outcomes of patients with infantile exotropia. @*Methods@#In this longitudinal retrospective (historical cohort) study, the records of 76 patients with infantile exotropia were Studied. Subjects with constant exotropia manifesting before the age of 1 year who were at least 5 years old at recruitment time between 2008 and 2017 were included. @*Results@#The medical records of 26 patients were excluded due to not participating in follow-up examinations or having incomplete records. In total, 54 infantile exotropic patients (51.9% male) with a mean age of 11.1 ± 6.8 years and follow-up of 4.99 ± 3.58 years were studied. Postoperative sensory outcomes (central stereopsis [3,000 sec/arc]) were observed in 38.9%, 38.9%, and 21.2% of patients, respectively. In terms of postoperative motor outcomes, 69%, 24%, and 7% were achieved as orthophoria, residual exotropia, and consecutive esotropia, respectively. Patients with a higher surgical age (p = 0.022) and better visual acuity (p = 0.004) had significantly better sensory outcomes, while higher preoperative deviation resulted in more suppression (p = 0.039, rs = 0.218). @*Conclusions@#With rates of 69% for motor success and 78.8% for sensory success, surgical outcomes of infantile exotropic patients seems to be favorable. Further studies are recommended to verify our findings.

new approach to an old concept for reducing shoulder pain caused by gynecological laparoscopy

Background: The purpose of this study was to introduce a technique to extract the remaining peritoneal gas in order to improve the post-laparoscopic shoulder pain

Methods: This study included 12 patients undergoing laparoscopic gynecologic procedures between February and March 2016 in Minimally Invasive Techniques Research Center, Pars Hospital, Tehran, Iran. For complete suction of the air from abdominal cavity, the air was first vacuumed from the pelvic cavity in Trendelenburg position and then the patients were put in anti-Trendelenburg position. In this position, as the remaining gas was shifting toward subdiaphragmatic area, the suction tube was shifted to a position next to the camera canal and the remaining air was suctioned. A 10 point visual analogue scale was used to measure the severity of patients' post-operative shoulder pain

Results: The mean VAS for shoulder pain was 0.8+/-1.7 4 hr post-surgery. At 12 hr post-surgery, the mean VAS was 0.8+/-1.5. At 24 hr post-surgery, the mean VAS for shoulder pain was 0.3+/-0.8. Finally, 48 hr post-surgery, the VAS score for all patients was zero

Conclusion: Our approach for emptying the abdominal cavity from residual gas after laparoscopic procedures seems to be useful in preventing post-operative shoulder pain among patients undergoing gynecological laparoscopic surgeries. Further studies are suggested to compare the effect of our proposed method with other methods

rare case of gestational gigantomastia with hypercalcemia: the challenges of management and follow up

Background: Gigantomastia is a breast disorder marked by exaggerated rapid growth of the breasts, generally bilaterally. Since this disorder is very rare and has been reported only in sparse case reports its etiology has yet to be fully established. Treatment is aimed at improving the clinical and psychological symptoms and reducing the treatment side effects; however, the best therapeutic option varies from case to case

Case Presentation: The present report described a case of gestational gigantomastia in a 30-year-old woman, gravida 2, parity 1, 17 week pregnant admitted to Pars Hospital, Tehran, Iran, on May 2014. The patient was admitted to hospital at week 17 of pregnancy, although her breasts initially had begun to enlarge from the first trimester. The patient developed hypercalcemia in her 32nd week of pregnancy. The present report followed this patient from diagnosis until the completion of treatment

Conclusion: Although gestational gigantomastia is a rare condition, its timely prognosis and careful examination of some conditions like hyperprolactinemia and hypercalcemia is essential in successful management of this condition

Vision therapy/orthoptics among three to seven year old children

Vision Therapy/Orthoptics [VT/O] is a package of treatments that enables patients to achieve the maximum level of visual performance. The aim was to determine the effect of three months vision therapy/orthoptics on best corrected visual acuity [BCVA], fusion, stereopsis and ocular alignment in 3-7 year old children. In this randomized clinical trial study, 80 children with amblyopia and/or nonparalytic horizontal deviations were randomly divided into intervention and control groups. Intervention group was treated by vision therapy/orthoptics for three months. These modalities included patch, red filter, sector patch, over minus lens, prism and synoptophore exercises. Controls were treated by only patching for the same period. Pre and post-treatment BCVA, fusion, stereopsis and alignment were compared. Visual performance was classified as excellent [BCVA >/= 20/30, deviation /= 20/30, deviation 10pd and no stereopsis]. A total of 80 cases [56 girls and 24 boys] with the mean age of 5.6 +/- 1.4 years entered the study. Although more improvement of fusion and stereopsis was seen in the intervention group [P<0.001 for both groups], there was no significant differences in BCVA and alignment between two groups. Also the difference of visual performance was not statistically significant between two groups, whereas the improvement was significant in each group [P<0.001, for both groups]. Vision therapy/orthoptics treatment can be effective for improving sensory status in 3 to 7 year old children with amblyopia and/or strabismus. Further studies with larger sample sizes and focusing on accommodation and fusional amplitude are warranted

Treatment of recurrent corneal epithelial defect by autologous serum eye drop

The aim of the present study was to evaluate the efficacy of autologous serum eye drop in treatment of recurrent corneal epithelial defect. Fourteen patients with recurrent corneal epithelial defect were studied. Autologous serum was prepared from the patients and diluted in 20% normal saline. The patients were instructed to use the autologous serum every six hours. Patients were followed for a mean period of 18 months. Four males [28.6%] and 10 females [71.4%] entered the study. Four patients stopped the treatment after three months with complete satisfaction from treatment. Patients reported a reduction in frequency and severity of attacks 4.6 +/- 2 weeks after the start of treatment. The mean number of attacks before the procedure was 7.6 +/- 0.9 per year which was reduced to 2.2 +/- 0.9 per year after treatment [p<0.001]. The main side effects in patients were eye pruritus and redness which were well tolerated by patients. Autologous serum application seems to be a safe and effective method to treat recurrent corneal epithelial defect

Treatment results of high dose cabergoline as an adjuvant therapy in six patients with established severe ovarian hyper stimulation syndrome

The beneficial role of cabergoline as a prophylactic agent to prevent ovarian hyper stimulation syndrome [OHSS] among high-risk patients has been demonstrated in previous studies. But data for its role as a treatment for established severe OHSS is still limited. We represent the treatment results of high dose oral cabergoline in management of six patients after the syndrome is established. High-dose oral cabergoline [1 mg daily for eight days] was prescribed as an adjuvant to symptomatic treatment for six hospitalized patients with established severe OHSS following infertility treatment cycles. In two cases OHSS resolved rapidly despite the occurrence of ongoing pregnancy. Considering the treatment outcomes of our patients, high dose cabergoline did not eliminate the need for traditional treatments, but it was a relatively effective and safe therapy in management of established severe OHSS, and prevented the increase in its severity following the occurrence of pregnancy

Resistance to clopidogrel among Iranian patients undergoing angioplasty intervention

To study the resistance to standard dosage of clopidogrel among Iranian patients following percutaneous coronary intervention measured by platelet aggregation test

Patients undergoing percutaneous coronary intervention in Imam Hussein Medical center, Tehran, Iran, who were under treatment with aspirin, but had no history of clopidogrel usage, entered the study. Patients received standard dosage of clopidogrel [Plavix®, Sanofi, France, 600 mg loading dose and 75 mg/day afterward]. Platelet aggregation was measured using light transmission aggregometer. The response to the drug was categorized as complete resistance [platelet aggregation decreased less than 10%], intermediate resistance [platelet aggregation decreased between 10 to 30%] and complete response [platelet aggregation decreased to 30% or more]. All patients were evaluated for major adverse cardio vascular events one month after the angioplasty based on MACE criteria by phone contact

Thirty-one patients with a mean age of 59 +/- 13 entered the study. Sixty-five percent of patients showed complete response to clopidogrel [95% CI: 45% to 81%], 22% showed intermediate resistance [95% CI: 10-41%] and 13% showed complete resistance [95% CI: 4-30%]. One month after the angioplasty, no major adverse cardiovascular event was recorded

Based on our findings, it seems that there is no major difference between Iranian population and other studies regarding the resistance to clopidogrel. Due to the limited number of participants in our study, further investigations with higher number of patients are recommended to more precisely calculate the percentage of resistance among Iranian patients

T2-star [T2*] magnetic resonance imaging for assessment of kidney iron overload in thalassemic patients

Improved survival in thalassemic patients has lead to the manifestation of morbidities such as renal dysfunction. This involvement suggests the need for a reliable and non-invasive method to assess the degree of kidney iron overload. We conducted the present study to evaluate the relationship between serum ferritin levels, liver, heart, and kidney MRI gradient echo [T2*] relaxation times in thalassemic patients, as a step to evaluate the feasibility of using MRI T2* to assess the degree of kidney iron overload. This was a prospective study of 120 [60 males, 60 females] regularly transfused thalassemic patients [mean age: 25.9 +/- 9 years] who suffered from major and intermediate thalassemia. Patients attended an adult thalassemia clinic located in Tehran, Iran. Cardiac, hepatic and renal MRI T2* were performed. Serum ferritin levels were measured. Our results indicated a moderate correlation between kidney MRI T2* relaxation time and serum ferritin [r = -0.446, P < 0.001]. Kidney MRI T2* relaxation time weakly correlated with liver MRI T2* relaxation time [r = 0.388, P < 0.001] and cardiac MRI T2* relaxation time [r = 0.338, P = 0.023]. The moderate correlation between kidney MRI T2* relaxation time and serum ferritin, and its weak correlation with liver and heart T2* relaxation times indicate that relying on liver and heart MRI T2*, as well as serum ferritin levels to predict the exact condition of kidney iron overload might not be a reliable approach. Our findings suggest the use of kidney MRI T2* as a noninvasive method for evaluating renal iron overload in thalassemic patients. Further studies to investigate the relation between kidney MRI T2* relaxation times and renal function, as well as the cost benefit of using this method, are suggested

Intranasal midazolam compared with intravenous diazepam in patients suffering from acute seizure: a randomized clinical trial

Acute seizure attack is a stressful experience both for health care personnel and parents. These attacks might cause morbidity and mortality among patients, so reliable methods to control the seizure preferably at home should be developed. This study was performed to measure the time needed to control seizure attacks using intranasal midazolam compared to the common treatment [intravenous diazepam] and to evaluate its probable side effects. This study was conducted as a not blind randomized clinical trial among 60 patients coming to Imam Ali Hospital, Zahedan, Iran. The patients were 2 months to 15 years old children coming to our emergency department suffering from an acute seizure episode. Intranasal midazolam was administered 0.2 mg/kg equally dropped in both nostrils for case group and intravenous diazepam was administered 0.3mg/kg via IV line for control group. After both treatments the time needed to control the seizure was registered by the practitioner. Pulse rate and O[2] saturation were recorded at patients' entrance and in minutes 5 and 10 after drug administration. The time needed to control seizure using intranasal midazolam [3.16 +/- 1.24] was statistically shorter than intravenous diazepam [6.42 +/- 2.59] if the time needed to establish IV line in patients treated by intravenous diazepam is taken into account [P<0.001]. The readings for O[2] saturation or heart rate did not indicate a statistically significant difference between two groups of patients either at entrance or 5 and 10 minutes after drug administration. Considering the shorter time needed to control acute seizure episodes compared to intravenous diazepam and its safety record, intranasal midazolam seems to be a good candidate to replace diazepam, as the drug of choice, in controlling this condition

Clinical osteoporosis probability scoring system: selection of menopausal women for bone densitometry screening

To formulate a clinical scoring system for evaluating people at risk of osteoporosis before ordering Bone Mass Densitometry. Eighty two probable clinical osteoporosis related factors were checked in 325 females referred for Bone Mass Densitometry testing in Hamadan province, Iran. The statistical modeling resulted in a clinical osteoporosis probability [COP] scoring system based on 9 factors including: fracture history, drug therapy with thyroid hormone, corticosteroids, estrogen, ca-VitD, number of children, age, BMI and the number of menopausal years. Osteoporosis was found in 62.2%. The osteoporosis probability scoring system cutoff value of 26.8 was selected with 89% sensitivity, 63% specificity, Youden factor of 0.53 and LR=2.4. In this score, osteoporosis probability was 98%. Area under the curve in Roc curve of osteoporosis probability scoring system was 81.4%. Clinical Osteoporosis Probability scoring system with a 26.8 cutoff value is suggested for osteoporosis prescreening using Bone Mass Densitometry test

[Comparison of intraoperative hemodynamic parameters and post operative analgesia of gabapentin and tizanidine in patients with tibial fractures]

Preoperative consumption of some drugs can control intra operative and post operative pain. Gabapentin and Tizanidine analgesic effects have been studied but a comparison between analgesic effects of these two drugs has not been studied before. We studied 60 patients with tibial fractures between 15 to 80 years. They were divided into two groups: 30 patients were given 300 mg Gabapentin orally 1 hour before operation [Group G], and 30 patients were given 8 mg Tizanidine by oral route 1 hour before operation [Group T]. Pain was assessed 1 hour before until 12 hours post operation using Visual Analogue Scale [VAS]. All patients had general anesthesia. Vital signs and fentanyl consumption during Surgery, the first time morphine was needed and the total dose of Morphine after operation were assessed. Systolic, diastolic blood pressure and heart rates during operation between two groups were not statistically significant. intra operative fentanyl dose in group G was significantly less than group T[P = 0.001]. The first time morphine was needed in group G was significantly longer than group T [P = 0.001] and total dose of Morphine Consumption during 12 hours after operation in group G was significantly less than group t [P = 0.003]. VAS was only different between two groups 12[th] hours. After operation. Preoperative oral consumption of Gabapentin compared to Tizanidine might facilitate better analgesia and more opioid saving during and after operation