Effects of routine repetitive transcranial magnetic stimulation on the sleep duration of patients with treatment-resistant depression: A prospective cohort study.

Aim: The aim of this study was to evaluate the short-term and long-term effects of routine repetitive transcranial magnetic stimulation (rTMS) on the sleep duration, depressive symptoms, and quality of life of patients with treatment-resistant depression (TRD). Methods: In this prospective cohort study, 25 participants with TRD were assessed using the Insomnia Severity Index (ISI) and four sleep duration components of the Pittsburgh Sleep Quality Index (PSQI). Depression severity was measured with Hamilton's Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI-II), and patient-perceived quality of life with the 36-Item Short-Form Survey (SF-36). All of these measures were evaluated at baseline (T0), and immediately (T1), 6 weeks (T2), and 12 weeks (T3) after the end of intervention. Results: At T1 endpoint, HDRS, BDI, SF-36, ISI, and three PSQI items (time to wake up, time taken to fall asleep, and Real Sleep Time) significantly improved, though these gains were reduced at follow-up endpoints (T2 and T3). Adjusting for confounders (age, sex, occupational status, BMI, and hypnotic medication) revealed that only improvements in HDRS, BDI, and time taken to fall asleep at T1 remained statistically significant. Linear regression analyses showed no significant association between reduced time taken to fall asleep and depression symptoms, suggesting rTMS can independently enhance this parameter, irrespective of depression resolution. Conclusion: Routine rTMS therapy can potentially enhance sleep duration in TRD individuals, alongside improved depressive symptoms and quality of life. However, these benefits tend to decrease over long-term follow-up, emphasizing a more pronounced short-term efficacy of rTMS.

Neoadjuvant Chemotherapy in Patients with HER2-Negative Breast Cancer: A Report from Clinical Breast Cancer Registry of Iran.

BACKGROUND: Neoadjuvant chemotherapy (NCT) has become an increasingly popular approach in management of breast cancer (BC). This study was conducted to evaluate the pathologic response and 36-month recurrence and survival rates of patients with human epidermal growth factor receptor 2 (HER2)-negative BC treated with different NCT regimens. METHODS: A total of 163 female patients with HER2-negative BC who received NCT during 2017-2020 were identified from the Clinical Breast Cancer Registry of Iran and entered the study. The prescribed NCT regimens included 4 cycles of doxorubicin plus cyclophosphamide, 4 cycles of doxorubicin plus cyclophosphamide followed by 4 cycles of paclitaxel, 4 cycles of doxorubicin plus cyclophosphamide followed by 4 cycles of docetaxel or 6 cycles of doxorubicin plus cyclophosphamide plus docetaxel (TAC). RESULTS: Thirty-two patients (19.6%) experienced pathologic complete response (pCR). TAC regimen, triple negative-BC and ki67>10% were significantly associated with increased pCR. The recurrence, overall survival (OS) and disease-free survival (DFS) rate at 36 months for all patients were 16.6%, 84.7% and 79.8%, respectively. Type of neoadjuvant regimen as well as age, hormone receptor status, Ki67, grade, clinical stage, type of surgery and pathologic response to chemotherapy did not significantly influence the survival and recurrence; however, TAC results in improved recurrence, OS and DFS rates. CONCLUSION: This study provides further evidence that NCT is a viable treatment option for patients with HER2-negative BC. The TAC regimen resulted in a significantly higher pCR rate compared to other regimens, but did not result in a significant improvement in recurrence, OS and DFS and rates.

Efficacy and Safety of Preoperative Embolization in Glomus Jugulare Tumors: A Systematic Review and Meta-analysis of Clinical Outcomes and Complications.

PURPOSE: This study aims to provide a comprehensive review of the clinical benefits, complications, and safety profile associated with preoperative embolization in Glomus jugulare tumors (GJTs). MATERIALS AND METHODS: A comprehensive search in PubMed, Embase, and Web of Science was conducted for English articles published up to March 2023, focusing on GJTs and preoperative embolization. Included studies involved patients over 18 with GJTs. We excluded studies that explored embolization methods other than the standard endovascular approach, as well as studies involving paragangliomas that did not provide specific data related to GJTs. Key variables such as hemorrhage volume and surgical time, as well as clinical outcomes, were analyzed. Data were analyzed using a random-effects model meta-analysis, assessing heterogeneity with the I2 statistic. RESULTS: This review encompasses 19 studies with a total of 328 patients. The studies incorporated into our meta-analysis display considerable differences and inconsistencies in their data. The findings of the meta-analysis show a mean hemorrhage volume of 636 ml (95% confidence interval (CI) 473-799) following preoperative embolization, and a mean surgical duration of 487 min (95% CI 350-624). The study also notes potential complications: facial nerve deficits occurred in 20% of cases (95% CI 11-32%), and vagal nerve deficits in 22% (95% CI 13-31%). CONCLUSION: This study suggests that preoperative embolization could decrease surgery duration and blood loss, but emphasizes the importance of evaluating risks like nerve damage. However, the generalizability of these findings is restricted due to the diversity of available data.

Evaluation of Association Between Adenomyosis and Cesarean Scar Defect.

PURPOSE: This study aims to investigate and compare quantitative factors of the cesarean scar defect (CSD) in symptomatic patients with and without uterine adenomyosis. METHOD: This study was conducted as a case-control study. Patients who met the inclusion criteria were divided into two groups: with adenomyosis (case) and without adenomyosis (control). The demographic data, medical history, and sonohysterography findings were extracted from the patient's documents and archived images. RESULT: During 2 years, 310 symptomatic women with a history of previous cesarean section underwent sonohysterography. Among them, 204 patients met the inclusion criteria. The most common chief complaints were post-menstrual bleeding (34.3%) and prolonged bleeding (27%). Cesarean scar depth and width significantly differed between these two groups, and patients with underlying adenomyosis had significantly larger defects (P-value of .009 and .005, respectively). Mean RMT/AMT ratio was 31.83% in the case group and 42.88% in the control group. In our study, RMT/AMT ratios were significantly lower in the case group (P-value of .001). In addition, we performed analysis on a subgroup of patients with one prior cesarean section. Similar results were achieved with a lower RMT/AMT ratio in case group (mean of 31.20% in case group and 46.47% in control group; P-value of .000). CONCLUSION: Our study showed a strong association between the presence of adenomyosis and larger clinically more significant CSDs. To establish a causative relationship, we suggest a prospective cohort study to follow up the patients and compare the evolution of CSD in patients with and without adenomyosis.

Characteristics and outcomes of COVID-19 patients during the BA.5 omicron wave in Tehran, Iran: a prospective observational study.

BACKGROUND: Omicron (B.1.1.529) is the fifth variant of concern of SARS-CoV-2, which has several subvariants. Clinical features of BA.1 and BA.2 infections have been described in the literature, but we have limited information about the clinical profile of BA.5, which caused the seventh wave in Iran. METHODS: A prospective observational study was conducted on the BA.5 confirmed patients referred to Imam Khomeini Hospital Complex, Tehran, Iran, from 11th to 31st August 2022. The patients were divided into the two groups of outpatients and hospitalized patients, and their clinical, radiological, and laboratory data and outcomes were recorded and analyzed. RESULTS: We included 193 patients with confirmed BA.5 infection, of whom 48 patients (24·8%) were hospitalized. The mean age of the patients was 45·3 ± 16·5 years, and 113 patients (58·5%) were female. The mean number of days patients had symptoms was 6·8 ± 2·4 days. The most common symptoms were weakness (69·9%), sore throat (67·4%), myalgia (66·3%), hoarseness (63·7%), headache (55·4%), fatigue (54·9%), and dry cough (50·3%). Fever and dyspnea were significantly more observed in the hospitalized patients (p < 0·0001). The COVID-19 vaccination rate was significantly lower in hospitalized patients than in outpatients (35/48-72·9% vs. 140/145 - 96·6%, p < 0·0001). The most common underlying diseases were hypertension (16·1%), diabetes mellitus (9·8%), and cardiovascular diseases (9·8%), all of which were significantly more common in hospitalized patients. Lung opacities were observed in 81·2% of hospitalized patients. By the end of our study, 1·5% of patients died despite receiving critical care services. CONCLUSIONS: Our findings suggested that BA.5 symptoms are more non-respiratory and usually improve within 7 days. Although the proportion of hospitalized patients is still significant, very few patients require intensive care. COVID-19 vaccination is effective in reducing the hospitalization rate. TRIAL REGISTRATION: Not applicable. This study is not a clinical trial.

A survey of physicians' opinions about the treatment of subsegmental pulmonary embolism.

Introduction: The aim of this study was to survey the attitudes of internists, cardiologists, and pulmonologists regarding treatment or no treatment of isolated subsegmental pulmonary embolism (ISSPE) with anticoagulant drugs. Methods: Qualified physicians were asked to select their management options from a questionnaire that included a patient scenario with subsegmental pulmonary embolism (SSPE) and negative past medical history of thromboembolism. Results: A total of 113 physicians responded to the survey. Of these, 8.8% preferred not to treat patients without further evaluation; 15% decided not to treat, but follow-up the patient with a serial lower-limb colour Doppler ultrasonography; 1.7% preferred anticoagulant treatment only during hospitalization and follow-up without medication; 5% preferred anticoagulant treatment for less than 3 months; and 34.5% chose a 3-6-month treatment with anticoagulation. Furthermore, 24% of physicians opted for anticoagulant treatment for more than 6 months, and 9.7% left the decision up to the patient. Opting not to treat was an option selected by more board-certified faculty members specialized in cardiology, internal medicine, and pulmonology compared with residents (p = 0.038). Willingness to provide anticoagulant therapy in the internal medicine, cardiology and pulmonology groups was 56.6%, 37.3% and 6%, respectively (p = 0.007). Conclusion: The majority of physicians surveyed prefer anticoagulant therapy in patients with SSPE.

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.

Effect of green tea consumption in treatment of mild to moderate depression in Iranian patients living with HIV: A double-blind randomized clinical trial / 中草药·英文版

Objective: Depression affects people living with HIV (PLWH) compliance leading to poor control infection. Previous observational studies showed an anti-depression effect of green tea extract (GTE). The therapeutic effect of GTE on depression were investigated in PLWH receiving antiretroviral therapy (ART). Methods: Fifty PLWH on ART with diagnose of mild to moderate of depression, participated in a double-blind, placebo-controlled trial and underwent 12 weeks of treatment with either 400 mg GTE capsules or placebo twice daily. The Hamilton depression scale of patients was measured before, 6 weeks and 12 weeks after treatment in two groups. The primary outcome measure was performed to evaluate the efficacy of GTE in improving depressive symptoms. Results: The mean of Hamilton score showed a significant difference between the two groups after 12 weeks (P = 0.035). Repeated measures ANOVA test showed a significant effect for time × treatment interaction on the Hamilton mean score between the two groups (P = 0.000). Conclusion: It seems the use of GTE capsules in PLWH on ART is safe and could lead to greater and more rapid improvement in depressive symptoms than placebo. Thus it can be considered as an alternative therapy for mild to moderate depression. Further studies with higher sample size and longer follow-up and comparisons with other antidepressive drugs are warranted.

Psychometric evaluation of Azeri version of the head and neck cancer specific quality of life questionnaire (EORTC QLQ-H&N43).

BACKGROUND: Oral cancer surgery can have a deep effect on the quality of life in the patient both in terms of functional and psychological aspects. This study aimed to translate and validate the European Organization for Research and Treatment of Cancer head and neck cancer specific quality of life questionnaire (EORTC QLQ-H&N43) in Azerbaijan. METHODS: Forward-backward translation was applied in order to translate the EORTC QLQ-H&N43 from English into Azeri. Then, a sample of patients with oral cancer attending a teaching hospital affiliated to Azerbaijan Medical University completed the EORTC QLQ-C30 (the core cancer specific questionnaire), and the EORTC QLQ-H&N43. To evaluate psychometric properties of the QLQ-H&N43, known groups validity, convergent and divergent validity was performed. Internal consistency reliability was examined by estimating the Crornbach's alpha coefficient. RESULTS: Ninety-six patients with confirmed diagnosis of oral cancer were entered into the study. The mean age of patients was 59.6 (SD = 10.7) years and 36 patients (37.5%) diagnosed as having stage IV and 10 patients (10.5%) were metastatic. The results obtained from comparing quality of life scores among these patients showed that the questionnaire was able to differentiate among patients who differed in stage and metastasis lending support to its validity. In addition convergent and divergent validity showed satisfactory results. The internal consistency of the multi-item scales as assessed by the Cronbach's alpha coefficient showed acceptable results (alpha ranging from 0.66 to 0.78). CONCLUSION: The findings suggest that in general the Azeri version of EORTC QLQ-H&N43 has satisfactory internal consistency reliability and validity, but additional psychometric evaluation is needed to draw firm conclusions.

The Role of Insulin-Like Growth Factor-1 and Pregnancy-Associated Plasma Protein-A in Diagnosis of Acute Coronary Syndrome and Its Related Morbidities.

INTRODUCTION: Pregnancy-associated plasma protein-A (PAPP-A) is a metalloproteinase that plays a role in atherosclerotic plaque destabilization. In recent studies, insulin-like growth factor-1 (IGF-1) has been introduced as a mediator of atherosclerosis. PAPP-A and IGF-1 level may be important diagnostic indicators of acute coronary syndrome (ACS). OBJECTIVE: The present study tried to assess the diagnostic role of IGF-1 and PAPP-A biomarkers in ACS spectrum. METHODS: The serum level of IGF-1, PAPP-A and troponin I was determined in 121 consecutive patients with ACS. Relationships were assessed by t-test, ANOVA and the non-parametric equivalent. Accuracy of biomarkers was measured by the area under the ROC curve (AUC) and optimal cut-off points to diagnose STEMI and NSTEMI using Youden index. RESULTS: In patients with acute ST segment elevation myocardial infarction (STEMI), all of these three biomarkers were significantly higher than those in patients with unstable angina (P= 0.028 for IGF-1, P<0.001 for PAPP-A and Troponin-I). Mean level of IGF-1 in patients with renal failure was significantly higher than that in patients without renal failure (137.9±35.1 vs 105.1±46.9, P=0.003), but PAPP-A and serum Troponin-I level had no significant difference in renal failure groups (P>0.05). ROC curve analysis showed that after Troponin-I, PAPP-A was a good discriminator between patients with STEMI and patients with unstable angina (AUC=0.79). Optimum cut-off value for PAPP-A was found to be 89.2 ng/ml, with sensitivity and specificity of 66.7% and 83.8%, respectively. CONCLUSION: PAPP-A can be a novel biomarker for both identification of patients with STEMI and risk stratification in patients with ACS.

Prevalence of Non-Celiac Gluten Sensitivity in Patients with Refractory Functional Dyspepsia: a Randomized Double-blind Placebo Controlled Trial.

Refractory functional dyspepsia (RFD) is characterized by symptoms persistence in spite of medical treatment or H. pylori eradication. No study has yet investigated the presence of gluten-dependent RFD as a clinical presentation of Non-Celiac Gluten Sensitivity (NCGS). Patients with RFD, in whom celiac disease, wheat allergy and H. pylori infection had been ruled out, followed a six weeks long gluten-free diet (GFD). Symptoms were evaluated by means of visual analogue scales; patients with ≥30% improvement in at least one of the reported symptoms after GFD underwent a double-blind placebo controlled gluten challenge. Subjects were randomly divided in two groups and symptoms were evaluated after the gluten/placebo challenge. GFD responders were further followed on for 3 months to evaluate the relationship between symptoms and gluten consumption. Out of 77 patients with RFD, 50 (65%) did not respond to GFD; 27 (35%) cases showed gastrointestinal symptoms improvement while on GFD; after blind gluten ingestion, symptoms recurred in 5 cases (6.4% of patients with RFD, 18% of GFD responders) suggesting the presence of NCGS. Furthermore, such extra-intestinal symptoms as fatigue and weakness (P = 0.000), musculo-skeletal pain (P = 0.000) and headache (P = 0.002) improved in NCGS patients on GFD. Because of the high prevalence of NCGS among patients with RFD, a diagnostic/therapeutic roadmap evaluating the effect of GFD in patients with RFD seems a reasonable (and simple) approach.

The Azeri Version of European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30): Translation and Validation.

OBJECTIVE: Quality of life in cancer patients has become an important outcome measure. This study aimed to translate and validate the European Cancer Research and Treatment Core Quality of Life Questionnaire (EORTC QLQ-C30) in Azerbaijan. METHODS: Forward-backward procedure was applied to translate the EORTC QLQ-C30 from English into Azeri. Then a cross sectional study was conducted to validate the questionnaire in Azerbaijan. A sample of patients with confirmed diagnosis of oral cancer completed the Azeri version of the questionnaire from January 2017 to December 2018. Construct validity was assessed by performing know groups comparison and item-scale correlation matrix. Reliability was examined by estimating the Cronbach's alpha coefficient for internal consistency. RESULTS: In all 141 patients with oral cancer participated in the study. Known groups comparison indicated that the Azeri version of EORTC QLQ-C30 well differentiated between patients who differed in the disease stage. Those with higher stage reported lower functioning and higher symptoms. In addition item-scale correlation matrix showed a good correlation between items and its own hypothesized subscales as expected (Pearson correlation coefficient ranging from 0.735-0.978). The Cronbach's alpha coefficient ranged form 0.68 to 0.94 indicating acceptable results for the internal consistency of the questionnaire. CONCLUSION: This preliminary validation study proved that the Azeri version of EORTC QLQ-C30 is a valid measure of quality of life in cancer patients. However, studies with other cancer patients and stronger psychometric evaluations are recommended.

The Level of Knowledge, Attitude and Practice of the Physicians and Nurses About Suitable Healthcare Personnel (HCP) Attire in Hospitals of Tehran University of Medical Sciences.

Objective: The purpose of this study was to investigate the status of knowledge, attitude and practice of medical team about suitable " Healthcare personnel (HCP) attire". Materials and methods: This is a descriptive study that was approved by the Research Ethics Committee of Tehran University of Medical Sciences, and evaluated knowledge, attitude and performance of physicians and nurses about "Health care personnel (HCP) attire" by a questionnaire. In order to create the questionnaire a panel of experts' reviews was set and a questionnaire was made through Focus group discussion (FGD). The Variables included age, gender, work experience, type of employees' time, type of jobs, education level, type of employee. Results: This study was conducted on 441 physicians and nurses who were working in Tehran University of Medical Sciences. The mean percent of KAP score was 72.6 ± 14.3. The score of the questionnaire in general was 14.91 ± 70.99 for knowledge, 73.5 ± 13.3 for attitude and 73.7 ± 17.1 for performance. Conclusion: According to this survey, the questionnaire score in the general knowledge, attitude and performance about the "Healthcare personnel (HCP) attire" is low.

Evaluation of quality of life in patients with oral cancer after mandibular resection: Comparing no reconstruction, reconstruction with plate, and reconstruction with flap.

This cross-sectional study aimed to assess and compare quality of life in patients with advanced oral cavity tumors after mandibular resection in 3 groups (no reconstruction, reconstruction with plate, and reconstruction with flap) at the Cancer Institute, affiliated to Tehran University of Medical Sciences. Quality of life was measured using the European Organization for Research and Treatment of Cancer core quality of life questionnaire and European Organization for Research and Treatment of Cancer head and neck cancer-specific quality of life questionnaire-35 items. The comparison was tested using Kurskal-Wallis analysis. All 120 patients were entered into the study. The mean age of patients was 48.5 (standard deviation = 18.1) years. Patients presented with advanced stage of the disease and underwent mandibular resection with no reconstruction (n = 40), reconstruction with plate (n = 41), and reconstruction with flap (n = 39). The findings showed that in general, there were no statistically significant differences in quality of life among 3 groups except for speech problem (P = .4), dry mouth (P = .03), and feeling ill (P = .04). Although there were no significant differences in quality of life among patients in 3 groups, overall patients who received reconstruction with flap reported better functioning and fewer symptoms. Those who did not receive any reconstruction reported the worse conditions.

Bullying and Victimization among Students Bears Relationship with Gender and Emotional and Behavioral Problems.

Objective: Bullying and victimization are common and serious problems in schools resulting in development of emotional and behavioral disorders in adolescents. This study aimed at examining the prevalence of bullying behavior and some of its associated factors among students. Method : This was a cross sectional analytic study involving junior high schoolers in grades seven, eight and nine. This study was part of an international study that used a questionnaire as a tool for data collection. The questionnaire investigated some of the characteristics and qualities possessed by most juveniles and some occasional problems which they may experience. Also, it was used to examine participants' experiences with bullying and victimization. This questionnaire comprised of 15 sections on demographic characteristics, individual health, family status and types of bullying experiences at school and outside of school, along with the Strengths and Difficulties Questionnaire (SDQ), which is an instrument for screening emotional and behavioral problems in children and adolescents. A multistage cluster sampling from five regions, consisting of the north, south, west, east, and central regions of Tehran, was conducted and 1456 questionnaires were completed by the students. Results: According to the results of this study, prevalence rate for bullying and victimization was 17.4% and 25.8%, respectively. The results indicated that gender had a significant relationship with bullying and victimization, with boys being more likely to be bullies and also more prone to victimization than girls (p < 0.001). Other parameters such as emotional, behavioral, and environmental influence also had a significant relationship with bullying and victimization. Conclusion: Bullying is more prevalent in boys than in girls, and boys are more likely to be victimized as well. Emotional and behavioral problems are identified as risk factors, and future interventions should focus on these risk factors to develop preventive measures.

Chemotherapy effect on daytime sleepiness and contributing factors in older adults with cancer.

OBJECTIVES: The objective of this study was to determine the prevalence of excessive daytime sleepiness (EDS) among older Iranian patients with cancer and to analyze the effect of chemotherapy treatment on patients' sleep problems. The relationship between sleep disturbances and physical activity, psychological factors, and demographic data, are also explored. METHODS: This cross-sectional study consisted of interviews with 83 patients, >60 years old with a solid tumor, carried out in Cancer Institute of Iran once prior to receiving chemotherapy and the second time after the first cycles of chemotherapy. Questionnaires consisted of demographic data, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scales (HADS), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and Eastern Cooperative Oncology Group performance status (ECOG PS). Medical data were also gathered from hospital records. Logistic regression was used to identify predictors of excessive daytime sleepiness after chemotherapy. RESULTS: The results showed a significant association between EDS and receiving chemotherapy. 8.1% were initially experiencing EDS which increased to 21.6% after chemotherapy (P-value < .001). Anxiety before chemotherapy and number of regions of recurrence of cancer, if any, were identified as independent predictors of daytime sleepiness. CONCLUSIONS: As EDS prevalence increases after chemotherapy, and this can affect patients' quality of life and treatment outcomes; caregivers should bear in mind that senior patient with cancer, especially those suffering from anxiety and cancer recurrence, need special attention before starting treatment in order to manage EDS over the course of chemotherapy.

Normal Reference Interval of WBC Count After On - Pump Coronary Artery Bypass Graft; When Values Could Be Misleading.

BACKGROUND: Applying the cardiopulmonary pump produces inflammatory responses and induces leukocytosis. White Blood Cell (WBC) count has a diagnostic value for detecting different infections. In this study, we want to redefine the normal value reference intervals of WBC count in Coronary Artery Bypass Graft (CABG) patients, to prevent misdiagnose leukocytosis as a sign of infection. METHODS: In an observational study, 140 patients who underwent on - pump CABG were enrolled to find out normal values of the reference interval. WBC counts were evaluated for all of them one day before the operation, first 30 minutes of ICU entrance, after 24 hours, and 48 hours after operation. Normal values of reference intervals were calculated for each measurement by two different statistical methods. RESULTS: There were 102 men and 38 women with age average of 61 years. There was no significant difference between genders' WBC counts before operation (P = 0.151), ICU entrance (P = 0.391), 24 hours after surgery (P = 0.698), and 48 hours after surgery (P = 0.523). The mean values of WBC after surgery were higher than the normal range of reference interval and had an increasing trend in the first 48 hours after surgery. The WBC values were significantly different between pre and post operation (before operation and ICU admission (P = 0.001), ICU admission and 24 hours later (P = 0.001), 24 hours after surgery, and 48 hours after surgery (P = 0.001)). All post - operative reference values were significantly higher than the range for the general population. CONCLUSIONS: There is a significant increase in WBC count after on - pump CABG. The normal range of WBC should be revised and adjusted to prevent misinterpretation as a sign of infection.

Sacroiliac Joint Intraarticular Injection in True Anteroposterior View: Description of a New C-Arm Guided Method.

BACKGROUND: The anatomic characteristics of the sacroiliac joint (SIJ) make it difficult to achieve intraarticular injection without radiologic guidance. The classic C-arm guided SIJ intervention technique is difficult. Here we describe a new and simple method for SIJ intraarticular intervention. OBJECTIVE: This study aims to introduce a new, simple approach for SIJ intraarticular intervention. STUDY DESIGN: An observational case series study. SETTING: The study was conducted at an academic medical center in a major metropolitan city. METHODS: This method of intervention was performed on 57 patients (a total of 73 joints) who were selected for diagnostic and therapeutic SIJ intervention. The procedure was done in anteroposterior (AP) view, without any C-arm angulation. The accuracy of the intraarticular injection was confirmed by using intraarticular contrast material. A numerical rating scale (NRS) score was recorded for each joint before and after the procedure; the number of x-ray exposures and number of attempts were recorded for each procedure as well. RESULTS: Successful intraarticular contrast spread was obtained in all SIJs. The number of x-ray exposures was about 9 ± 3, and there was not a remarkable difference between cases according to gender of the patient (P = 0.1) or side of the joint (P = 0.2). In 5 cases, the first needle placement was not correct; there were no differences between gender (P = 0.4) and side of the joint (P = 0.4) regarding the first successful attempt. The NRS pain scores decreased in all of the patients more than 50% after the procedure; the pain scores were similar to the results of classic methods of intraarticular interventions with successful contrast spread, and there were no remarkable differences considering gender (P = 0.5) or side of the joint (P = 0.8). LIMITATIONS: This is a very small, nonrandomized, and controlled study; further blinded clinical trials are needed to clarify the probable advantages of this method compared with conventional ones. CONCLUSION: This observational study introduces a new and simple approach for SIJ intraarticular intervention, with a high success rate. KEY WORDS: Low back pain, sacroiliac joint, C-arm, new technique, intraarticular, injection.

Sensorineural hearing loss in patients with chronic suppurative otitis media: Is there a significant correlation?

INTRODUCTION: Hearing loss as a sequel of chronic suppurative otitis media (CSOM) is often conductive, but recent studies have found an additional sensorineural component in these patients, thus demonstrating inner ear damage. The aim of the study was to determine the association between CSOM and sensorineural hearing loss (SNHL) and to assess the influence of patient's age, duration of disease, and presence of cholesteatoma and ossicular erosion on the degree of SNHL. METHODS: In a retrospective study, the medical records of 119 patients who underwent surgery was reviewed. Seventy patients met the inclusion criteria of unilateral otorrhea, normal contralateral ear on otoscopy, and age between 10-65 years with no history of head trauma or ear surgery or familial hearing loss. Bone conduction (BC) thresholds for affected and contralateral ear were measured at frequencies of 500, 1000, 2000, and 4000 Hz. Data analysis was performed using SPSS 13 with independent-samples t-test, Pearson correlation test, and two-tailed analysis. A p ≤ 0.05 was considered statistically significant. RESULTS: Significant higher BC thresholds were found in the affected ear than in the normal ear for each frequency (p < 0.001), which increased with increasing frequency (7.00 dB at the 500 Hz and 9.71 dB at the 4000 Hz). There was a significant correlation between age and degree of SNHL (r = 0.422, p < 0.001) but no significant correlation was in duration of the disease (r = 0.119, p > 0.05). There was no relationship between presence of cholesteatoma and ossicular erosion with SNHL (p > 0.05). CONCLUSION: These findings demonstrate that CSOM is associated with some degree of SNHL and cochlear damage, and higher frequencies are more affected. Aging can act as a precipitating factor in this pathological process.