Chronic rhinosinusitis is a common inflammatory condition in western countries. Nasal polyposis has different symptoms such as nasal obstruction, anterior or posterior nasal drip, reduced sense of smell, and facial pain. Medical and endoscopic treatments are the two main treatments for nasal polyposis. Our aim was to compare the efficacy of different methods on olfactory function. This is a non-randomized clinical trial study that was done on 60 patients who were divided into two groups (medical and surgical). Patients were matched based on age, history of smoking, and the severity of obstruction. The radiologist score of Lund-Mackay staging system was used to match patients in two arms of the trial based on the severity of nasal obstruction. Patients in surgery groups underwent functional endoscopic sinus surgery under general anesthesia and then received Fluticasone propionate nasal spray for 8 weeks (400 mcg bd). Patients in the medical group were only prescribed with Fluticasone propionate with the same duration and same dose as mentioned. As a result of treatment protocol, both medical and surgical group experienced improvement in olfactory function but statistical analyses revealed that surgery resulted in better resolution of symptoms. Our observation revealed that combined treatment had a better effect than medical treatment in restoring olfaction in patients with nasal polyposis.
BackgroundConcomitant knee injury is a common finding in femoral fractures but can be easily missed during early management of the initial trauma. Degrees of damage to the articular structures vary considerably; from only a mild effusion to complete ligamentous and meniscal tears. Since previous reports were mostly from developed societies, this study was designed to look into characteristics of associated knee injury in a sample from Iran, to represent a developing country perspective.Materials and methodsConsecutive patients admitted to an orthopedic ward of Baqiyatallah hospital (Tehran, Iran) with diagnosis of femoral fracture were enrolled in this study between October 2008 and September 2009. In patients who met the inclusion criteria of the study, arthroscopic or open surgical examination of the knee, ADT, Lachman test, varus and valgus stress tests under anesthesia were carried out to determine the incidence of knee injury.ResultsForty patients with ipsilateral and two patients with bilateral femoral fractures were studied. Arthroscopy revealed medial meniscus injury in 12 (27 %) knees. Three (7 %) lateral meniscus injuries, 18 (40.9 %) ACL injuries and 2 (4.5 %) PCL injuries were also found. In varus and valgus stress tests, 15 (34 %) MCL and 4 (9 %) LCL laxities were noticed. The Lachman test was positive in 3 (6 %), and ADT was positive in 2 (4.5 %) patients.ConclusionsBased on our observations, concomitant ligamentous and meniscal knee injury is a common finding in femoral shaft fractures and rates of these injuries are generally in concert with reports from developed nations.
Purpose: Glioma cell infiltration, in which the glioma tumor cells spread long distances from the primary location using white matter (WM) or blood vessels, is known as a significant challenge for surgery or localized chemotherapy and radiation therapy. Following the World Health Organization (WHO), the glioma grading system ranges from stages I to IV, in which lower-grade gliomas represent benign tumors, and higher grade gliomas are considered the most malignant. Materials and Methods: We gathered magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) data for seven patients with right precentral gyrus-located tumors and six age-and sex-matched healthy subjects for analysis. Tract-Based Spatial Statistics (TBSS) was utilized to evaluate whole-brain WM implication due to probable tumor infiltration. Also, along-tract statistics were used in order to trace the implicated WM tracts. Finally, for cortical evaluation of probable tumor cell migration, voxel-based morphometry (VBM) was utilized, which allowed us to do whole-brain cortical estimation. Results: The TBSS results revealed significantly higher fractional anisotropy (FA) and lower mean diffusivity (MD) in the left side superior corona radiata. Also, higher FA was observed in the right corticostriatal tract. Along-tract statistics were also compiled on the corpus callosum (CC), which is anatomically known as a hub between hemispheres. The body of the CC, which connected with the superior corona radiata anatomically, showed significantly higher FA values relative to healthy subjects, which are in line with the TBSS results. Consistent with these results, whole-brain gray matter changes were analyzed via VBM, which showed significant hypertrophy of both sides of the brainstem. Conclusion: In future investigations, focusing on the genetic basis of the glioma patients in line with imaging studies on a larger sample size, which is known as genetics imaging, would be a suitable approach for tracing this process.
In the current study, we evaluated the effectiveness of uvulopalatopharyngoplasty (UPPP) in treatment of patients with obstructive sleep apnea (OSA) syndrome. All patients were previously received medical treatment but their symptoms did not resolve. A prospective study was conducted in Shahid Sadoughi Hospital in Yazd, Iran. Several sleep indices were evaluated using polysomnography (PSG) in all patients before performing UPPP and tonsillectomy. All patients were visited 6 months after surgery and PSG was repeated to assess the efficacy of surgical intervention. A total of 48 patients were enrolled and underwent UPPP and tonsillectomy. Six months after surgery, significant improvements were observed in all indices of sleep (apnea-hypopnea index, respiratory distress index, arterial oxygen saturation, and snoring index). The score of daytime sleepiness (assessed by Epworth score) was also improved. According to the result of this study, using UPPP surgery in patients with OSA can cause symptoms improvement in 64 % of cases. It seems thatMuller's maneuver test has assisted in briefly increasing success rate after surgery, though to prove this claim; other studies should be designed and performed in a randomized clinical trial.
Background & Aim:Nurse's mistakes usually have a strong effect on the patients trust and satisfaction in the health services systems, and it can also lead to stress and moral contradicts among nurses. This study has aimed to survey the rate of nurses’ mistakes, according to documents in the Isfahan Province during 2007-2012.Methods:The study was a descriptive cross-sectional study. The sample population consisted of all complaints concerning nursing services provided in hospitals, private clinics and other health service centers between 2007 and 2012, submitted to the Forensic Medicine Commission Office, in Isfahan. The data were collected by a cheklist and analyzed using SPSS version 16.0 software.Results:Out of 708 complaints, 70 (9.8%) cases were related to nurses. Twenty-four cases led to awards. The age range of nurses was 35-40 (25.7%). Out of 70 nurses with a record, 75% (53 people) were female and the rest were male. Sixty four nurses (91.4%) were working in hospitals. Negligence was the first basis of the court rulings (16 cases out of 24). Nurses’ recklessness in providing services was due to their convictions among 66.7% of the casesConclusion:Although efforts to reduce and control nurses’ faults and mistakes depends on using a system for studying and removing the factors which lead to faults, human error is inevitable in every occupation and a 100% accurate operation is unreachable.
Neurofibromatosis type 1 (NF1) is associated with peripheral and central nervous system tumors. It is noteworthy that the regions in which these tumors frequently arise are the optic pathways (OPs) and the brainstem. Thus, we decided to trace the procedure of diffusion Magnetic Resonance Imaging (dMRI) alterations along with Short-Wavelength Automated Perimetry (SWAP) examinations of the OPs after surgery and chemotherapy over 1 year, which enabled us to evaluate chemotherapy's efficacy in an NF1 patient with an OP tumor. In this study, a 25-year-old woman with NF1 and left optic radiation (OR) glioma underwent surgery to remove the glioma. Immunohistochemistry (IHC) revealed a Pilocytic Astrocytoma (PA) WHO grade I. Post-operation chemotherapy done using nine treatment cycles of administering Temozolomide (TMZ) for 5 days every 4 weeks. Applying the region of interest (ROI) differential tractography method and SWAP four times every 3 months allowed us to follow the patient's visual acuity alterations longitudinally. The differential deterministic tractography method and statistical analyses enabled us to discover the white matter (WM) tracts anisotropy alterations over time. Furthermore, statistical analyses on the SWAP results along time illustrated possible alterations in visual acuity. Then, we could compare and associate the findings with the SWAP examinations and patient symptoms longitudinally. Statistical analyses of SWAP tests revealed a significant improvement in visual fields, and longitudinal differential tractography showed myelination and dense axonal packing in the left OR after 1 year of treatment. In this study, we examined an old hypothesis suggesting that chemotherapy is more effective than radiotherapy for NF1 patients with OP gliomas (OPGs) because of the radiation side effects on the visual field, cognition, and cerebrovascular complications. Our longitudinal clinical case study involving dMRI and SWAP on a single NF1-OPG patient showed that chemotherapy did not suppress the OP myelination over time. However, it should be noted that this is a clinical case study, and, therefore, the generalization of results is limited. Future investigations might focus on genetic-based imaging, particularly in more cases. Further, meta-analyses are recommended for giving a proper Field Of View (FOV) to researchers as a subtle clue regarding precision medicine.
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