Pulmonary thromboembolism with transthoracic ultrasound and computed tomography angiography

Evaluation of biochemical parameters in operating room staff exposed to radiation and anesthetic gases

Background

Exposure to ionizing radiations and other hazardous agents such as anesthetic gases pose serious risks to the health of healthcare workers. This study aimed to evaluate the changes in blood and biochemical parameters of the operating room staff exposed to ionizing radiations and remnants of anesthetic gas.

Methods

This cross-sectional study was performed at (Ayatollah Taleghani Hospital). The control group was selected from different parts of the hospital that were not exposed to ionizing radiations and anesthetics, including the office, services, and treatment. The case group included all operating room personnel. Hematopoietic parameters such as complete blood count and WBC differential, and parameters of liver function such as serum activity of liver enzymes (ALT, AST, ALP, LDH) and serum bilirubin levels, fasting blood sugar, serum lipid profile, level of vitamin D and magnesium were measured for the exposed and referent subjects. Additionally, a checklist was used to gather data regarding the occupational variables and medical histories of the studied subjects.

Results

The mean values of Hb, Hct, Vitamin D, and MCHC, as well as the RBC count, were significantly lower in the exposed individuals than in the referent subjects. In contrast, the proportion of smokers was significantly higher in the exposed group than in the referent group. No significant differences were noted between exposed and unexposed groups as far as other parameters were concerned. However, no significant differences were noted between the case and control groups as far as other measured parameters were concerned. Likewise, no significant differences were noted between exposed and referent groups as far as blood types, history of underlying diseases, work history, working hours per month, number of morning and evening shift hours, type of diet, consumption of a high-fat diet a day before blood sampling, X-ray in the recent year, history of radiotherapy, and therapeutic agents use was concerned.

Conclusions

Exposure of operating room staff to ionizing radiations and waste anesthetics gases is associated with subtle, subclinical prepathologic decreases in some hematopoietic parameters such as hemoglobin, hematocrit and MCHC levels, RBC count as well as vitamin D levels.

Comparative study of the effect of two different doses of remifentanil on bleeding control in lumbar fusion surgery: A randomized clinical trial

Objectives

Spinal fusion surgery completely prevents movement or friction between the two vertebrae. Remifentanil, a selective drug agonist, suppresses and decreases the vasomotor system upon release of histamine. In this study, the efficacy of remifentanil infusion at doses of 0.1 and 0.3 μg/kg/min in the control of low blood pressure was compared.

Methods

In this randomized clinical trial, 110 candidates for selective spinal fusion surgery were entered and randomized into 2 groups. The first group received 0.1 μg/kg/min and in the second group 0.3 μg/kg/min remifentanil. The systolic and diastolic blood pressure, pulse rate, SPO2, and surgeon's satisfaction were measured and compared between groups.

Results

the systolic blood pressure was significantly lower in patients receiving 0.3 μg of remifentanil by the time 30, 45, 60, and 90 min during the surgeries (P < 0.05). No significant difference was observed in terms of PR (P = 0.19) and SPO2 (P = 0.41) between the two groups. We also observed significantly higher duration of surgeries (P = 0.002), duration of anesthesia (P = 0.009), significantly higher bleeding volume (P < 0.001), higher fluid intake (P = 0.01) and higher transfused blood (P = 0.01) in patients that received 0.1 μg remifentanil compared to other patients.

Conclusion

Here we showed that administration of 0.3 μg/kg/min remifentanil was associated with significantly lower systolic blood pressure during the surgeries. On the other hand, patients that received 0.1 μg/kg/min remifentanil had significantly higher duration of surgeries, duration of anesthesia, significantly higher bleeding volume, higher fluid intake, and also higher transfused blood.

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Spinal fusion surgery completely prevents movement or friction between the two vertebrae.

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Remifentanil, a selective drug agonist, suppresses and decreases the vasomotor system.

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0.3 μg/kg/min remifentanil was associated with significantly lower systolic blood pressure.

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Patients that received 0.1 μg/kg/min remifentanil had significantly higher duration of surgeries.

Carotid intima-media thickness measurements in patients with multiple sclerosis

Objectives

The goal of this study was to evaluate the mean carotid intima-media thickness (CIMT) in patients with Multiple Sclerosis (MS).

Methods

In this cross-sectional study, 100 patients with MS were enrolled. Carotid intima-media thickness was measured by Doppler Ultrasonography. The mean CIMT was then compared between different groups of sex, age, body mass index (BMI), medications, and site of the MS plaques in the brain and cervical MRI. In addition, disease duration, annual relapse rate, and Expanded Disability Status Scale (EDSS) were compared between high and normal CIMT groups.

Results

Among 100 patients, Sixty-two percent of the patients were female. The mean age was 35.95 ± 9.32 years. Mean CIMT was 0.38 ± 0.2 mm, and 22% of the patients had abnormal CIMT measures. CIMT was significantly associated with higher age (P = 0.01) and prolonged disease duration (P < 0.001). CIMT was not associated with other disease factors or types of the disease-modifying drug (P > 0.05).

Conclusion

Multiple Sclerosis might be associated with carotid atherosclerotic vascular disease.

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MS is a chronic inflammatory and immune-mediated disease.

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Atherosclerosis is a complex and chronic inflammatory disease, Which is a predictor of cardiovascular disease.

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Intima-media thickness as a marker of atherosclerotic vascular disease can be assessed in Multiple Sclerosis.

Complications in Patients with Cardiac Penetrating Trauma

BACKGROUND

Cardiac penetrating trauma is a medical emergency that mostly affects young people. Based on the type of injury and associated complications, it can present as a surgical challenge and can lead to mortality.

OBJECTIVE

The aim of this study is to evaluate the complications of penetrating heart trauma among patients referred to Shahid Madani Hospital.

METHODS

In this retrospective descriptive study, the data of penetrating cardiac trauma patients referred to Shahid Madani hospital, Karaj, Tehran, from 2016-2019, were investigated. Information, including age, sex, cause of trauma, traumatized area and complications, was extracted and recorded in a data collection form. The data were evaluated statistically using SPSS v18.

RESULTS

A total of 44 patients were included in the study, where the mean age of the patients was 25 years. 73.3% of these patients were men and 26.7% were women. Knife stab wounds were the most prevalent cause of the trauma, present in 93.3% of patients. 73.3% of the patients had cardiac tamponade and 20% had a pneumothorax. The right ventricle was the most common site of the injury in 46.7% of the patients. A mortality rate of 3.4% was reported in this study.

CONCLUSION

The results of this study showed that the highest penetrating heart rate trauma occurred among young people, and the most common cause of the trauma was a knife stab. The most common area of the injury was the right ventricular, and cardiac tamponade was the most common complication.

Early percutaneous tracheostomy in COVID19 patients with failed intubation: A case series

INTRODUCTION

COVID19 and pulmonary dysfunction leading to acute respiratory distress syndrome (ARDS).

CASE STUDY PRESENTATION

Herein we presented the cases of failed intubation that was replaced by early percutaneous dilational tracheostomy. The procedure is safe for the patients, doctors and clinical staff.

CONCLUSION

Additionally, we report mucormycosis after COVID19 treatment that was potentially due to immunosuppressive drugs.

Radical extrapleural pneumonectomy with bronchial fistula by pulmonary function test evaluation technique

Introduction

and importance: Pulmonary Function Tests (PFTS) is an important tool in the assessment of pulmonary pathologies and preoperative evaluation. Case presentation: A 54-year-old man with history of massive pleurisy in the left thorax, treated by placing chest tube and drainage of bloody effusion, was readmitted for epithelioid mesothelioma. He was then presented with pneumothorax due by a refractory bronchial fistula while having a plural catheter. Based on the consultation, the whole-body bone scan was conducted, and findings demonstrated epithelioid mesothelioma (stage 1) with the refractory fistula for which the patient was candidate for thoracic surgery. Decreased lung capacity was seen by Pulmonary Function Testing - PFTS.

Clinical discussion

The novel PFTS Evaluation Technique was designed to measure the true pulmonary capacities in order to evaluate the pulmonary post-operative tolerance. In this technique the chest tube was placed for 4 weeks until the patient reaches mediastinal fixation then the measurements by PFTS were carried out in two steps. First, using an open chest tube and second, using a clamped chest tube. In both steps, the pulmonary capacities were measured and provided to the pulmonologist for consultation.

Conclusion

In this case, after acquiring the approval of the specialist depended on PFTS after PFTS Evaluation Technique, the radical extra pleural pneumonectomy surgery was conducted, and the patient was discharged with a good general appearance and treated fistula.

Coronavirus case presentation in a patient with loss of consciousness due to dyspnea

INTRODUCTION AND IMPORTANCE

Severity of corona virus disease 2019 (COVID19) is presented with respiratory distress.

CASE PRESENTATION

We present a case of a 29-year-old male who was not presented with typical symptoms of COVID19 at the time of referral but loss of consciousness.

CLINICAL DISCUSSION

The importance of testing patients without typical symptoms for coronavirus infection and multi-system manifestation of the virus is presented in this case.

CONCLUSION

Severe drop in oxygen saturation in asymptomatic patients can lead to encephalopathy.

An idiopathic case of precordial deep T-wave inversion

Introduction and importance

One percent of the patients referred to cardiac intensive care unit (CICU) are presented with T-wave inversion.

Case presentation

We present a case of 78-year-old woman with chest pain and dyspnea. ECG showed precordial deep T-wave inversion.

Clinical discussion

Cardiomyopathies, ischemia and other pathologies were ruled out.

Conclusion

It is likely to be a first reported case of idiopathic deep T-wave inversion seen in the family without any cardiac or non-cardiac etiology.

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T-wave inversion is commonly presented in electrocardiogram (ECG) of infants.

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Precordial lead T-wave inversion is seen in infants and can be seen in childhood period as well.

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Familial clustering of this type of ECG was attractive.

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Genetic analysis of these findings can give more meaningful conclusions.