dr. farnaz hashemian

The quality of the surgical field during the surgery is impaired when bleeding occurs. This study compared the effect of tranexamic acid and dexmedetomidine on the rate of bleeding during endoscopic sinus surgery (ESS).

In this one-blind clinical trial, 72 patients with chronic rhinosinusitis who were candidates for ESS at Be’sat Hospital in Hamedan were randomly assigned to two groups. Group A received dexmedetomidine at a dose of 1μg/kg, and group B received tranexamic acid at a dose of 10mg/kg immediately after induction of anesthesia intravenously within 15 minutes. The two groups were evaluated and compared regarding the quality of the surgery field with the Boezaart scale, volume of intraoperative bleeding, hemodynamic changes, and complications up to 90 minutes after the beginning of surgery.

The mean volume of intraoperative bleeding in group A (181.67±86.66) was significantly higher than in group B (110.28±61.23) (P =0.000). At 15, 30, and 60 minutes, the quality of the surgical field in group B was better than group A (P =0.038), while at 90 minutes, there was no statistically significant difference (P =0.450). The mean arterial pressure in group A at 15 minutes was higher than in group B (P=0.003); at 60 and 90 minutes, it was lower, and the difference was statistically significant (P =0.01). On the other hand, in 30 minutes, the mean arterial pressure in group A was higher than in group B, without a significant difference (P =0.07). Moreover, there was no statistically significant difference between the average surgery time (P = 0.25) and the frequency of complications (P =0.405).

Based on the results, tranexamic acid is preferable to injectable dexmedetomidine to control and reduce bleeding during ESS.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a relatively common disease with serious impacts on patient quality of life. Recurrence of polyps after functional endoscopic sinus surgery (FESS) is a dilemma. Vitamin D3 (VD3) is known to inhibit the proliferation of nasal polyp-derived fibroblasts. The present study aimed to investigate the effects of oral VD3 on the recurrence of polyposis after FESS. This triple-blind placebo-controlled clinical trial was conducted on 40 patients with CRSwNP who did not respond to medical treatment and were candidates for FESS. In addition, the patients had VD3 insufficiency. Following the surgery, all the patients received routine treatment (i.e., fluticasone spray, irrigation, cefixime 400 mg daily for 10 days, and montelukast for a month). Moreover, the case group received oral VD3 tablets 4000 IU (single daily dose) for a month, and the control group received placebo in the same manner. The Sino-Nasal Outcome Test (SNOT-22) and Meltzer endoscopic grading scores were recorded at months 1, 3, and 6 after the study. In this study, 6 months following the intervention, the severity of polyposis was reported to be significantly lower in the VD3 group compared to the placebo group based on SNOT-22 (16.25±10.16 in the VD3 group vs. 47.45±13.55 in the placebo group; P<0.001) and Meltzer scores (0.50±0.60 in the VD3 group vs. 2.65±0.93 in the placebo group; P<0.001). No adverse effects were observed in the case group.                      This study showed the efficacy and safety of vitamin D supplementation in the reduction of polyposis recurrence after FESS in patients with CRSwNP.

Adenotonsillectomy is one of the most commonly performed surgical procedures in children. Although this surgery is technically easy, it can run a high risk of serious complications, such as laryngeal spasm, laryngitis, bleeding, pain, and nausea. The present study  aimed to assess the effect of preemptive dexamethasone on pediatric post tonsillectomy pain.

This triple-blinded clinical trial study involved a total number of  70 children within the age range of  3-15 years. They were candidates for adenotonsillectomy and were randomly assigned to two groups. One hour before the surgery, one group received intravenous dexamethasone (0.1 mg/kg) and the other group received distilled water intravenously. Patients' pain at 1, 4, 10, and 24 hours after the surgery, initiation of soft-diet feeding and the prevalence of nausea and vomiting were evaluated in both groups. Data were analyzed in SPSS software (version 16).

The total number of patients was 70 (35 in each group). Both groups were homogenous in terms of age and gender. In the intervention group, the mean score of pain in the first and fourth hours and the mean initiation time of soft- diet feeding were significantly lower, as compared to those of the control group (P <0.05). The mean score of the pain in the intervention group at hours 1,4,10, and 24 after tonsillectomy were obtained at 8.40, 5.74, 4.28, and 2.28, respectively. On the other hand, in the control group, the above mentioned mean scores were measured at 9.40, 6.80, 4.51, and 2.7 respectively (P<0.05). Nonetheless, it is noteworthy that no significant difference was observed between the two groups regarding the incidence of nausea and vomiting.

As evidenced by the obtained results, preemptive dexamethasone reduces the post tonsillectomy pain in the first four hours after pediatric adenotonsillectomy. Moreover, it was revealed that it accelerates the initiation of soft-diet feeding without exerting any effect on nausea and vomiting.

Regarding the high frequency of drug errors and its importance in increasing financial costs and health of the patients, this study was conducted with the aim of determining the prevalence and types of drug errors among medical and nursing team.

In this cross –sectional study, of 903 medical errors, 385 reported drug errors were recorded in safety unit and mortality and morbidity committee of Besat Hospital in Hamadan during 2014-2015. The data were gathered in a checklist, including the types of drug errors, the wards and time of occurrence.

Of the 903 reported  medical errors totally, only 385 drug errors was reported (42.6%). The most errors were in dose of medicines (22.8%) and false timing of drug delivery (19.7%). The highest rate of drug error was reported in surgical (11.6%) and pediatrics (9.8%) wards.

The results showed that improving pharmacologic knowledge of nurses and physicians is important on of the patients’ safety. It is required to implement credit scales by the management team to lower incidence of drug errors.

The deviated nose is a common deformity encountered in rhinoplasty, and yet it is the most challenging pathology to treat, because multiple internal and external structures have deformity, so there is a need to be corrected. 
METHODES
The intermediate short osteotomy has been applied as a technique to correct severe nasal bony deviations. Eleven patients with severe deviated nose who had been operated by the senior author from 2013 through 2016 were included in the study (follow-up period of 6-24 month). Intermediate short osteotomy was performed after medial and before lateral osteotomy. Surgical outcomes were assessed by another otolaryngologist based on review of pre- and post-operative (6 to 24 months after surgery) photographs. The post-operative outcome in terms of deviation correction was classified as excellent, good, fair, or no change.
Of all 11 cases, 6 (54.5%) were accepted as excellent, 4 (36.4%) as good, and 1 (9%) as no change.
Intermediate short osteotomy can be considered as a modification of intermediate osteotomy that eliminates nasal dorsal deviation more completely. This osteotomy is very simple and need only 1 to 2 minutes and use of this method is recommended for correction of severe deviated bony noses.

Halitosis and foreign body sensation are two common and disturbing symptoms of chronic caseous tonsillitis (CCT). The aim of this study was to compare the efficacy and safety of temperature-controlled radiofrequency (TC-RF) tonsil ablation with CO2-laser cryptolysis (CO2-LC) in the treatment of patients with halitosis caused by CCT.
Sixty-two patients who suffered from halitosis and/or foreign body sensation due to CCT were enrolled in the present randomized clinical trial, and were randomly assigned into two groups. Group A underwent TC-RF tonsil ablation and Group B received CO2-LC. The severity of symptoms including halitosis and foreign body sensation was reported 7 days, 1 month, and 6 months after the procedure. Patient pain levels and amount of bleeding were evaluated as safety outcome measures. Pain levels were evaluated during the intervention, and at Day 1, 3, and 7 following the procedure using a visual analog scale (VAS).
Mean rank of pain score in the RF tonsil ablation group was found to be higher than in the CO2-LC group at all measured timepoints following the procedure. The amount of bleeding in the LC group was found to be significantly less than in the RF group (P Both procedures were found to be effective and safe in the treatment of CT-associated halitosis. However, LC showed better results based on lower pain levels, lower incidence of bleeding, and faster progression to a routine diet.

Although effective strategies have been presented for preventing the spread of antibiotic resistance in Iran, recent reports have revealed increasing antibiotic resistance among children and adults.. In the present study, we tried to provide a clear view of the antibiotic resistance status of aerobic organism as the most prevalent organism in patients with rhinosinusitis in Hamadan, Iran..Patients and A cross-sectional study was conducted on 216 consecutive patients referred to otolaryngology clinics of Imam Khomeini and Besat University hospitals in Hamadan with clinical and radiological manifestations of chronic rhinosinusitis. Two specimens were taken from each patient; one from the affected maxillary sinus by aspiration and another from the middle meatus and nasopharynx by swabbing. Antibiotic susceptibility was tested by Kirby Bauer’s method; distributions of the isolates from middle meatus, nasopharynx and sinus were determined and the results of susceptibility test were analyzed.. Among the aerobic organism from meatus and oropharynx, the most frequent isolated strains were alpha-hemolytic Streptococcus (15.4%), followed by coagulase-negative Staphylococcus (14.6%), and Branhamella catarrhalis (13.2%), and the most prevalent isolated strains from sinus were S. aureus (19.1%), Klebsiella pneumonia (16.4%), and B. catarrhalis (15.6%), respectively. The highest antibiotic susceptibility was detected to ciprofloxacin and ceftriaxone in most of the strains; susceptibility to ciprofloxacin ranged from 76.7% (for Pseudomonas aeruginosa) to 100% (for Escherichia coli and Haemophilus influenza); susceptibility to ceftriaxone ranged from 71.4% (for Acinetobacter baumannii) to 100% (for S. pneumonia, Corynebacterium diphtheria, and H. influenza). Besides, regardless of strain, the highest resistance was mostly detected to penicillin (ranging from 33.3% to 91.7%), and to ampicillin (ranging from 38.4% to 83.7%).. Our study showed that resistance to some antimicrobial agents including penicillin subgroups was considerably high for managing sinusitis. Therefore, public health policies should be more focused on minimizing the misuse of these subgroups as well as limiting the inappropriate use of other agents with high susceptibility..

There are suspended fungal spores in the air and in the nasal mucosa of adults, especially in areas with a humid climate. Several studies have revealed the role of fungi in the pathogenesis of chronic rhinosinusitis (CRS) in recent years but it is a topic of controversy, especially in regions with low humidity. The aim of this study was to evaluate the prevalence of fungal species in intraoperative specimens from patients who underwent functional endoscopic sinus surgery (FESS) for CRS in Hamadan, a high altitude region of Iran. In this prospective cross-sectional study specimens were obtained from 62 patients with a diagnosis of CRS according to clinical and computed tomography criteria who underwent endoscopic sinus surgery. During the functional endoscopic sinus surgery, specimens were collected from the nose and sinuses of patients and preserved in conical centrifuge tubes containing Sputolysin and chloramphenicol. The specimens were then plated on Sabouraud dextrose agar, Mycosel agar, Niger seed agar, and Chrom Agar/Candida plates and incubated at 30°C for up to 1 month. At the end of the incubation period the samples were evaluated microscopically to detect fungi and identify their genera and species. The fungal cultures were positive in 16 out of 62 patients with CRS (25.8%). In order of frequency the fungal genera and species were: Aspergillus fumigatus (9), Aspergillus niger (3), Candida albicans (2), Penicillium sp. (1) and Cladosporium sp. (1). The percentage of positive cultures collected was higher in winter but the difference was not statistically significant compared to the rest of the year. Our data show that 25.8% of patients tested positive for the presence of fungi. The results strengthen the theory regarding the role of fungi in the pathogenesis of CRS even in areas with low humidity. Aspergillus was the most commonly isolated fungus.

To report a case of retained silicone tube Case report : We report a case of 48-year-old Iranian lady who referred to the department of otolaryngology with 18 years history of epiphora and intermittent mucopurulant discharge from the left lacrimal canaliculi. She had external dacryocystorhinostomy (DCR) with silicon stenting for epiphora 18 years ago but epiphora had continued after surgery. Preoperative irrigation test revealed partial obstruction and in diagnostic nasal endoscopy the previous rhinostomy site was patent. She was operated with revision endoscopic DCR approach and an impacted 15 millimeters piece of silicon tube was removed from lacrimal sac. This case should alert surgeons to the possibility of foreign bodies as a cause of persistent epiphora after DCR surgery.

The aim of the present study was to determine the effects of adenotonsillectomy on height, weight and body mass index (BMI) in children under 12 years old, with or without airway obstruction and evaluation of the risk of overweight in them. In this case-control study, 120 children with the age of 2-12 years old were studied; 60 children as case group who underwent adenotonsillectomy and 60 healthy children as control group. After collecting the data related to appetite status and sleep breathing disorder of the case group, height, weight and BMI have been measured for all children in two stages; preoperatively and 6 months later. Also in the case group, BMI percentiles, pre and postoperatively have been calculated. Patients with Low appetite in the initiation and at the end of the study in the case group were 80% and 8.3% respectively (P=0.01). Mean of height, weight and BMI variation after 6 months were significantly different between case and control groups (P<0.05). BMI percentiles in the case group preoperatively were: 20% underweight, 67% healthy weight, 10% at risk of over weight, 3% over weight. Postoperatively, after 6 months BMI percentiles in order of above frequency were: 10%, 57%, 22% and 11% (P=0.02). Analysis of the results showed that adenotonsillectomy can lead to increase of height, weight, BMI and appetite not only in the children with low weight due to airway obstruction but also in the normal weight and over weight children. Therefore risk of overweight should be mentioned as a probable undesirable outcome of adenotonsillectomy.