مجله دانشکده پزشکی اصفهان
پیاپی 374 (هفته دوم اردیبهشت 1395)

Paratracheal air cysts (PACs) are extraluminal collections of air mostly located adjacent to the right of the trachea at the level of the thoracic inlet. Although, PACs are usually asymptomatic, the lesions do occasionally cause complications such as chronic cough, difficult intubation, and right-sided recurrent laryngeal nerve palsy. The purpose of the present study was to demonstrate the appearance and prevalence of PACs through retrospective review of multidetector computed tomography (MDCT) of the chest.
In a cross sectional study, a total of 1054 chest MDCT scans of patients that referred to MDCT unit of Alzahra hospital in Isfahan from 2012 to 2013 were reviewed. Exclusion criteria were history of thoracic surgery, history of tracheostomy or tracheal intubation and presence of tracheal lesions. PACs were evaluated for size and the presence of visible communication with the trachea. Patient demographics, age and sex were also collected.
Findings: Of the 1054 patients evaluated, 112 (10.6%) of them had PACs. 103 (92%) patients had one PAC, and 9(8%) had two PACs. Age of the patients ranged from 6 to 91 years. In 43 (38.4%) of the patients, a direct communication with the trachea was seen. Sizes of the PACs ranged from 1 mm to 13/1 mm with mean ± SD of 3.89 ± 2.72 mm. PACs were 10 mm, in 86 (76%), 21 (20%), and 5 (4%) of the patients, respectively. PACs which had communication with trachea, were significantly larger than the cysts without communication (P = 0.01).
PAC is a common finding on CT examinations of the chest that occur in an expectable location. The exact pathogenesis of PAC is unclear but presence of these cysts in a wide age range may suggest congenital and acquired causes.

Suicide is one of the serious challenges facing mankind today. Considering that in our country a study to evaluate the use of mental health services and suicide by self-immolation is not carried out, determining the history of mental health services use in self-immolation suicide attempters seems logical and useful.
The study was conducted from November 2013 for one year in Shahid Motahari hospital, Tehran, Iran. During this time, participants with burn and suicide by self-immolation were identified and after obtaining an informed consent, mental health services access questionnaire during the last year was completed for each participant.
Findings: The average age of the participants in our study was 33.7 and the results of our study showed that over a year before the suicide attempt, 27.5% of those referred to a psychiatrist, clinical psychologist and a total of 20.0% to 37.0% of the patients at least achieved one of them. The most common causes of going to a psychiatrist were: sleep problems, family problems, aggression, addiction-related problems, symptoms of depression and anxiety, respectively. Also, 12.5% of participants over the years before the recent attempt of suicide had a history of psychiatric hospitalization. 57.5% of those were referred to other therapists during last year and in general, 62.5% were at least visited by a therapist or quasi-therapist.
The results of our study revealed a lack of awareness of suicidal mental health services and there are also myths about mental disorders and psychiatric medications recommended in these patients need for further information in the form of community mental health services. Community-based mental health services can be involved in many aspects of individual, family, social and educational at risk of suicide.

Sensorineural hearing loss (SNHL) is the most common sensory disorder and 1 in every 500-1000 newborns is affected. Non-syndromic SNHL accounts for 70% of hereditary hearing loss and 80% of SNHL cases have an autosomal recessive mode of inheritance (ARNSHL). The Purpose of the recent study is genetic linkage analysis to determine the prevalence of DFNB40 and DFNB48 loci in studying families with ARNSHL from the western provinces of Iran.
In this study, 60 families from 3 provinces of Iran involving Hamedan, Kohgiluyeh and Boyer-Ahmad and Chaharmahal and Bakhtiari with autosomal recessive non syndromic hearing loss were examined. The selected families in this study were consanguineous and had at least two patients. They also were negative for GJB2 mutations. Linkage analysis was performed by using 6 markers short tandem repeat (STR) for the DFNB40 locus and 7 markers STR for the DFNB48 locus.
Findings: After examining different families, it was revealed that none of them showed linkage to the DFNB40 and DFNB48 loci.
The recent study suggests that DFNB40 and DFNB48 loci might not play an important role in causing hearing loss in the mentioned provinces. However, further studies are necessary to determine more precisely the role of these loci in the Iranian population.

Pain is one of the major post-operative problems that patients encounter in lumbar discectomy surgery with usually a devastating effect on the patient's spirit within the first 24 hours after surgery. This study aimed to compare the effect of intrathecal injection an admixture containing Marcaine and magnesium Sulfate with that of Neostigmine and Fentanyl on the duration of analgesia, nausea and vomiting, urinary retention and the dose of analgesic in lumbar disc herniation.
This clinical trial study was conducted in Isfahan, Iran, Al-Zahra University Hospital in 2012 on patients with lumbar disc herniation undergoing surgery. Patients were randomly divided into three groups and were spinally anesthetized. Marcaine with Magnesium Sulfate were used for the first group, Neostigmine for the second group, and Fentanyl for the third group at the time of injection. After the surgery, a collection of patient's signs and symptoms including pain in surgical site, urinary retention, patient request for additional intravenous morphine and nausea and vomiting were assessed and recorded every 6 hours for 24 hours. The obtained findings were analyzed using SPSS software.
Findings: The mean pain intensity, nausea and vomiting and urinary retention had no significant difference in all three studied groups from 2 to 24 hours after the operation.
Adding Magnesium Sulfate, Neostigmine or Fentanyl had no effect on reducing the postoperative complications and all the three compounds had a similar effect on pain and other postoperative complications and given the patient conditions and comments of the anesthesiologist and surgeon, each drug can be used to control pain and reduce the postoperative complications.

The World Hypertension Day celebrates 17th of May of every year by concentrating on an important global health subject. For World Hypertension Day (WHD) 2014, they have chosen “Know your Blood Pressure “as the theme. Chronic kidney disease is a worldwide public health puzzle and hypertension is one the most important cause of damage to the kidneys. In fact by improved screening, diagnostic efforts and judicious use of antihypertensive using renoprotective agents, we will continue to reduce the incidence of strokes, heart failure and also heart attacks, hence our patients will be capable of enjoying their health.