Reviews in Clinical Medicine
Volume:3 Issue: 1, Winter 2016

Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by recurrent apnea during sleep. Nocturnal laboratory-based polysomnography (PSG) is the gold standard test for diagnosis of OSA. The sufferers may complain from daytime sleepiness, snoring or occasional headaches. Serious consequences such as cardiovascular complications, stroke or symptoms of depression may complicate the syndrome. Headache prevalence due to sleep apnea is estimated 1%-2% in general population and affects 2%-8% of middle age population. Morning headache is more common in the OSAS patients. OSAS patients present with various characteristics of morning headache. Treatment with continuous positive airway pressure usually reduces headache. The pathophysiologic background for a relation between obstructive sleep apnea and morning headache is multifactorial. Some theories have been proposed for OSAS-related headaches such as changing oxygen saturation during sleep, cerebral vasodilation and increased intracranial pressure due to cerebral vasodilation, sleep disruption and depression but the definite cause of headaches in OSAS patients is not yet clear.

The activation of oculucardiac reflex (OCR) is common during the strabismus surgeries. OCR is known as a trigemino-vagal reflex, which leads to the various side effects including bradycardia, tachycardia, arrhythmia, or in some cases cardiac arrest. This reflex could be activated during intraorbital injections, hematomas, and mechanical stimulation of eyeball and extraocular muscles surgeries. The incidence of OCR varies in a wide range, from 14% to 90%, that depends on anesthetic strategy and drug used for the surgery. The efficacy of various anticholinergic and anesthetic agents on declining the OCR reflex has been evaluated in different studies, especially in children. Although the detection of OCR goes back to 1908, its exact effect is not well recognized during strabismus surgery. In this review, we aimed to summarize the studies investigated the efficacy and potential of various anesthetic medications on inhibiting the OCR in children undergoing strabismus surgery.

Overnight polysomnography is the gold standard for the detection of obstructive sleep apnea-hypopnea syndrome (OSAS). However, it is expensive and needs attending personnel. The study of simplified sleep apnea monitoring is one of the recent trends for sleep medicine research. The proposed clinical prediction rules employ the vital and social statistics, symptoms, craniofacial traits, and obesity-related measures for initial screening of OSAS in an ambulatory setting. However, most of them are partially or completely clinical and not home-based. One disadvantage of this sort of screening methods is their inability to asses OSAS severity. Another approach of initial OSAS screening is a usage of just one or two physiological signals such as electrocardiography (ECG), pulse oximetry, snoring, nasal airflow, or even speech sound. In this study, we aimed to review the different strategies and to compare their performances, reported by means of their sensitivity–specificity and accuracy for OSAS incidence and severity. OSAS severity is determined by apnea-hypopnea index (AHI) value. Based on the data obtained from the related articles, the most accurate methods of AHI estimation exploit ECG and pulse oximetry signals.

Cystic fibrosis is one of the most common autosomal recessive diseases that affects sweat glands and mucosa. CF is a hereditary disease with annual incidence of about 2500 new cases in United Kingdom. Insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 levels decrease in CF. The aim of this study was to assess the role of growth peptides in patients with CF.
We searched PubMed, Google scholar, IranMedex, and Scientific Information Database (SID) in September 2012 to April 2014. We included clinical studies with available abstracts and full texts that were in English or Persian languages. Manual searching was conducted within the reference lists of articles. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data.
The earliest study was published in 1997 and the most recent one was in 2014. Study participants were adults in 3 studies (20%) and 12 studies (80%) were conducted in children. Patients with CF have lower levels of IGF-1 and there is a significant correlation between IGF-1 levels and growth index in patients with CF.
IGF-1 decreases in children with CF and might be the cause of poor growth and low body mass index in these children.

The role of magnesium supplement to prevent primary and/or secondary kidney stones has not been fully determined. The aim of this study is to evaluate the effects of magnesium supplement in modifying urinary risk factors of recurrent kidney stones. We searched MEDLINE, Scopus, and Google Scholar databases on December 7, 2014 and reference lists of systematic reviews and randomized, controlled trials. Among the initial 282 articles found by our search strategy and hand searching, we found eight English-language studies were eligible for our study. Magnesium supplementation could be beneficial in nephrolithiasis prevention through increasing urinary magnesium, citrate, and calcium while declining urinary oxalate. In pediatric patients, the results were more prominent and could decline urinary oxalate up to 90% of the baseline. Magnesium supplementation could be beneficial, especially with potassium-citrate combination. However, due to the low number of well-designed randomized controlled trials, especially in pediatrics, the conclusions of this study need further confirmation.

Coughing is an airway complication that could affect the outcome of surgery following general anesthesia in adults. In this systematic review, we aimed to study the efficacy of applying laryngeal airway mask (LMA) compared with endotracheal tube (ETT) in reducing the postoperative cough in adults under general anesthesia. PubMed was searched for the relevant articles. Inclusion criteria were all the randomized controlled clinical trials, which used LMA and ETT in adults under general anesthesia. Only English language articles were included in this study with no time limitation. Overall, 15 articles were retrieved, which were relevant with the purpose of this study. Efficacy of LMA in reducing coughing was significantly different with ETT in adults under general anesthesia in various types of surgeries. Calculated number needed to treat (NNT) showed that using LMA would significantly reduce coughing even in one adult patient. Coughing has shown various adverse effects on postoperative main results in some surgeries such as cataract, cranial, etc. Applying LMA could positively decrease postoperative coughing in adults.

Intraocular pressure (IOP) can be influenced by several factors including corneal thickness, gender, refractive error, and the presence of diabetes mellitus. In the present study, we systematically reviewed published literature to find association between variations of IOP due to strabismus surgery. PubMed and Scopus were systematically searched with the following search terms: (intraocular pressure OR IOP) AND (strabismus) for the articles in which the fluctuation of IOP before and after strabismus surgery had been evaluated. All types of articles including case series, cross-sectional, clinical trials, and cohort studies with no time limitation were included in this study. Systematically searches, selection of articles, and the extraction of data were performed by two reviewers independently. 1617 out of 1674 articles were excluded due to duplication or irrelevancy. After step by step process of article selection, 57 relevant articles were included for further evaluation. However, only 8 articles met the inclusion criteria. The results of this report showed that IOP may vary due to strabismus surgery, and it decreases after the surgery.

Cardiopulmonary bypass is associated with high risk of mortality and morbidity which should be investigated regarding the major risk factors related to this surgery. Temperature management can have a significant role on post operation cerebral and neurological complication; however the optimum temperature for cardiopulmonary surgery is not certainly detected. This systematic review investigated the difference between hypothermia and normothermia regarding postoperative mortality. PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding patients in-hospital death which were provided in each article mostly within 30 days after the surgery are extracted and compared based on specific effect size including: relative risk reduction, absolute risk reduction, number needed to treat. Totally 28 articles are retrieved and extracted from PubMed as the most relevant articles. In 8/28 articles no mortality incidence was occurred in each group and the effects sizes could not be calculated. No significant difference was obtained between two studied groups. Similar patients death prevalence observed between hypothermia and normothermia might be due to the studies sample size, or the following cars performed the intensive care units which assist to reduce the postoperative mortality rate. According to the obtained results these to procedure might be as safe as each other regarding the patients mortality rate.

There are many internal and external factors that are considered as the main causes of nasal infections and inflammation in chronic rhinosinusitis (CRS) leading to polyposis. It is suggested that bacterial and fungal elements have an important role in the development of these diseases. Scopus and PubMed were searched thoroughly on 1 February 2015 with the following search terms: (fungal biofilms) AND (nasal polyposis) to find the articles in which the prevalence of fungal biofilms had been evaluated in patients with nasal polyposis. Only English language articles with no time limitation were included in this study. Of 48 records found by initial search, only 10 articles met the inclusion criteria. Data showed that the presence of biofilms is associated with nasal polyposis in 110 of 303 patients and 13 of controls. The results of studies confirm that the fungal biofilms play an important role in the pathogenesis of chronic rhinosinusitis with nasal polyposis. According to the results of included studies, there is a close association between the presence of fungal biofilm and different types of nasal disorders including nasal polyposis.

Urinary tract infection (UTI) that can affect any part of the urinary tract and may subsequently lead to kidney infection is linked with variety of causative factors such as oxidative stress. In this study, we aimed to systematically review the literatures to evaluate the effects of oxidative stress on UTI.
PubMed and Google scholar were searched systematically using the key terms, “oxidative stress” and “urinary tract infection” in the title, keywords, and abstract on February 2015 to find articles in which the oxidative stresses had been evaluated in children with urinary tract infection (UTI). Papers were excluded if they were unrelated to the purpose of this study, or in language other than English. Full texts of the relevant documents were fully reviewed for data extraction.
Of overall 50 articles from PubMed, and 6 records found in Google scholar, only 8 articles met the inclusion criteria for further assessment. Additionally, three papers were omitted due to full texts unavailability or language irrelevancy, and five articles, which fully met the inclusion criteria, were used for data extraction. The results showed that the level of antioxidant decreases significantly in patients with UTI, while the markers of oxidative stress increases.
The results of the studies showed that the level of antioxidants decreases in patients with UTI, while lipid peroxidase and the level of oxidative stress biomarkers such as malondialdehyde and reactive oxygen species increase. These findings are suggestive of an association between oxidative stress and UTI. The role of oxidative stress in pediatric urinary tract infections: a systematic review.