A Comparison between Pre-Incisional and Intraoperative Lidocaine Infiltration on Post-Incisional Surgical Pain in Microdiscectomy Surgery: A Randomized Clinical Trial Study.

Objectives: Effective postoperative pain control in microdiscectomy surgery is crucial to managing the disease and improving the patient's quality of life. Therefore, this study aimed to assess the potential effectiveness of 2% lidocaine in reducing pain immediately after discectomy surgery. Methods: A total of 60 patients who underwent microdiscectomy surgery were enrolled in this randomized clinical trial study. They were randomly assigned to three groups: one group received lidocaine just before the incision, another group received lidocaine just before closing the incision, and the third group served as the control. Pain scores were measured at 1, 2, 3, 4, 8, and 12 h after the surgery using a Visual Analogue Scale. Results: The demographic and clinical characteristics of the study population, including age, weight, length of surgery, gender, and history of diabetes, hypertension, and previous surgery, were comparable across all three groups (P>0.05). There was a significant reduction in pain scores over time in the groups that received lidocaine before (P<0.001) and during surgery (P=0.002). Moreover, there were significant differences in pain scores at all time points among the three groups. Both groups receiving lidocaine showed significantly lower pain scores than the control group (Pbefore surgery=0.005 and Pduring surgery<0.001). However, no significant difference was observed between the groups receiving lidocaine (P=0.080). Conclusion: These findings highlight the effectiveness of a local injection of 2% lidocaine either before or during the surgery in managing post-incisional surgical pain after discectomy.

The Epidemiological, Clinical, Mycological, and Pathological Features of Rhino-cerebral Mucormycosis: A Systematic Review.

Cerebral mucormycosis (CM) is a life-threatening manifestation of mucormycosis, an angioinvasive fungal infection caused by Mucorales. We sought to systematically review all available case reports to describe epidemiologic features, clinical manifestations, predisposing factors, and diagnostic and treatment strategies of CM. A systematic search was conducted using a combination of the following keywords: "Mucor", "Zygomycetes", "mucormycosis", "cereb*", "brain", "central nervous system", and "intracranial", separately and in combination until December 31st 2018. Data sources included PubMed, Scopus, EMBASE, Web of Science, Science Direct, and Proquest without limiting the time of publication. We included 287 articles corresponding to 345 cases of CM. Out of the 345 cases, 206 (60%) were male with a median age of 44 years; 130 (38%) were reported from North America; 87 (25%) from Asia; and 84 (24%) from Europe. The median time from onset of symptoms to presentation was 3-7 days (65/345, 65%). The highest mortality was observed among patients with diabetes mellitus (P=0.003). Debridement of infected brain tissue was associated with improved survival in CM cases (OR 1.5; 95% CI 01.3-1.8; P<0.0001). The use of liposomal amphotericin B (L-AMB) was significantly associated with patients' recovery (OR 2.09; 95% CI 1.2-3.4; P=0.003). The combination of L-AMB and posaconazole (12.5%) was more effective than the monotherapy treatment of CM cases (P=0.009). Clinicians should consider DM as an important risk factor for CM. Moreover, surgical debridement and antifungal combination therapy could be an effective approach in the management of CM patients.

Giant Cerebral Hydatid Cyst: A Rare Case Report.

The diagnosis of hydatid cyst should be considered in children with seizure in endemic regions.

Breaking HIV News to Clients: SPIKES Strategy in Post-Test Counseling Session.

Breaking bad news is one of the most burdensome tasks physicians face in their everyday practice. It becomes even more challenging in the context of HIV+ patients because of stigma and discrimination. The aim of the current study is to evaluate the quality of giving HIV seroconversion news according to SPIKES protocol. Numbers of 154 consecutive HIV+ patients from Imam Khomeini Hospital testing and counseling center were enrolled in this study. Patients were inquired about how they were given the HIV news and whether or not they received pre- and post-test counseling sessions. Around 51% of them were men, 80% had high school education, and 56% were employed. Regarding marital status, 32% were single, and 52% were married at the time of the interview. Among them, 31% had received the HIV news in a counseling center, and only 29% had pre-test counseling. SPIKES criteria were significantly met when the HIV news was given in an HIV counseling and testing center (P.value<0.05). Low coverage of HIV counseling services was observed in the study. SPIKES criteria were significantly met when the HIV seroconversion news was given in a counseling center. The need to further train staff to deliver HIV news seems a priority in the field of HIV care and treatment.

Fatal cutaneous mucormycosis after kidney transplant.

Mucormycosis is an uncommon opportunistic infection that is caused by Mucorales from the Zygomycetes class. Patients with severe immunodeficiency admitted to the hospital are at greatest risk for developing this infection. Mucormycosis usually is transmitted in humans by inhalation or inoculation of spores in the skin or mucous membranes. A 66-year-old man developed a surgical wound infection at 1 week after kidney transplant that did not improve despite broad-spectrum antibiotics and debridement. He was transferred to our hospital 45 days after transplant and had fever and a large purulent wound that was surrounded by a black necrotizing margin. Immunosuppressive drugs were discontinued and the dosage of prednisolone was decreased. Massive debridement was performed but was incomplete because he had full-thickness abdominal wall necrosis. Histopathology showed broad fungal hyphae without septation, consistent with the diagnosis of mucormycosis. Despite antifungal therapy with amphotericin B and additional debridement, the patient died of septic shock at 52 days after kidney transplant. Cutaneous fungal infections should be considered in the differential diagnosis of any nonhealing infected wound that does not respond to broad-spectrum antibiotics, especially in patients with predisposing risk factors such as transplant.