pooya rostami

 Colorectal cancer (CRC) is the third most frequent type of cancer in the world. In this explanation, genetic variation is associated in all cancers, particularly CRC, and modifications of numerous genes, such as CDX2, CTNNBIP1, and FAT4, are linked to tumorgenesis in CRC. As a result, this research was conducted in order to determine changes in the expression of these genes.

 After obtaining patient consent and pathology department approval, from72 individuals with confirmation of pathology report,were provided and bought from the Bio banks. Real-time PCR was used to examine the expression of CDX2, CTNNBIP1, and FAT4 genes in tumoral and non-tumoral tissues. These genes' histological associations with grading and staging for upregulation and downregulation were examined.

 CDX2 (P = 0.01) and CTNNBIP1 (P = 0.03) expression were highly increased, whereas FAT4 (P= 0.05) expression was downregulated. Similarly, there was no evidence of a link between CDX2 and CTNNBIP1 overexpression and grade, stage, lymphnode metastasis, or distant metastasis. Furthermore, FAT4 expression was linked to  highe stage, high grade, distant metastasis and lymphnode metastasis (P 0.05).

 CTNNBIP1 and CDX2 genes were upregulated in tumoral tissues, while FAT4 genes were downregulated. Finally, changes in the expression of these genes can be used as a CRC biomarker.

 Colorectal cancer (CRC) is the third most frequent type of cancer in the world. In this explanation, genetic variation is associated in all cancers, particularly CRC, and modifications of numerous genes, such as CDX1, CYLD, and CDKN2B, are linked to tumorigenesis in CRC. As a result, this research was conducted in order to determine changes in the expression of these genes.

 Specimens of CRC from 72 individuals with confirmation of pathology report, were provided and bought from the Biobanks. Real-time PCR was used to examine the expression of CDX1, CYLD, and CDKN2B genes in tumoral and non-tumoral tissues. These genes' histological associations with grading and staging for upregulation and downregulation were examined.

 The expression of CYLD (P = 0.01) and CDKN2B (P = 0.02) were upregulated significantly, but the CDX1 (P = 0.03) gene expression was decreased. Correspondingly, there was no significant association between CDX1 downregulation and CDKN2B upregulation with grade, stage, lymph‐node metastasis (P= 0.02) and distant metastasis. Moreover, the CYLD expression was also significantly associated with high grade (P = 0.03), high stage (P = 0.03), lymph‐node metastasis (P= 0.05) and distant metastasis (P= 0.05).

 The upregulation of CYLD and CDKN2B genes and downregulation of CDX1 gene in tumoral tissues were impressive. Conclusively, the alteration of these genes expression can be considered as a colorectal cancer biomarker.

Percutaneous nephrolithotomy (PCNL) is the preferred surgical treatment in many cases of kidney stones which is performed in different positions such as prone, lateral, and supine. This study was designed to evaluate whether patient position (lateral versus . prone) has an effect on the need for analgesia and onset of pain after surgery.

Patient with confirmed kidney stones (size ? 2 cm) who were candidates for PCNL were enrolled in this study. The required biochemical analyses were performed preoperatively. All patients  underwent spinal anesthesia by the same anesthesiologists and then were randomly divided into two separate groups as lateral (L) and prone (P) positions. The operations’ start and end time, required time for proper access into target calyces, additional need for analgesic or cardiac drugs, duration of analgesia, and onset of pain after PCNL were carefully recorded and then compared between the two groups.

In total, 51 patients were evaluated of whom 39 were men and 12 were women. Mean duration of analgesia after PCNL surgery in P group (173 ± 8 min) was significantly longer than in L group (147±12 min) (P = .001). Furthermore, the amount of ephedrine usage in L group (3.6 ± 1.5mg) was significantly lower than in the P group (16.4 ± 12mg), suggesting more hemodynamic variations in the P group during the operation.

Our randomized control trial study shows that choosing the optimal position in the PCNL technique depends on  patient's condition. If hemodynamic control is of matter to the anesthesiologist, then lateral position is more appropriate. However, if control of pain and longer time of analgesia are important,  prone position may be preferred.

Sturge-Weber syndrome (SWS) is a neurocutaneous disorder, characterized by leptomeningeal angiomas involving the oral cavity, trachea, larynx, and face. Herein, we present a case of vitrectomy in a seven-year-old boy with SWS. The patient showed hemangioma on the left side of his face, as well as mental retardation and epilepsy. Preoperative examination revealed no apparent hemangioma in the oral cavity, pharynx, larynx, or trachea. However, he was predicted to have difficult airway intubation, as the oral cavity was smaller than the normal size. The minimum Mallampati score was 3-4 due to macroglossia. First, we applied awake intubation, but he failed to follow the commands. We proceeded to general anesthesia with propofol and did not use any muscle relaxants to maintain spontaneous breathing. A laryngeal mask airway was inserted to minimize any harm to possible oral angiomas. The patient was hemodynamically stable and extubated without any complications, such as bleeding or respiratory problems.

Oculocardiac reflex (OCR) is a life threatening, possible complication of corrective strabismus surgery and is more common among the pediatric patients. Sevoflurane and Propofol are the most commonly used agents in pediatric surgery. This study aimed to compare the effect of these two agents on oculocardiac reflex during corrective strabismus surgery in pediatrics patients. A total of 89 children were divided in two groups and no significant demographic data difference was between the two groups. Group 1 (n=45) received sevoflurane 6-8% as induction agent followed by 2-3% for maintenance, group 2 (n=44) was injected with propofol 3mg/kg as induction agent followed by 200µg/kg/min infusion as the maintenance dose, bispectral index (BIS) was kept 40-60 in both groups. Oculocardiac reflex was compared between the two groups. Incidence of OCR of group 1was showed a significant decrease. Sevoflurane reduced the incidence of OCR. Sevoflurane may be the agent of choice in corrective strabismus surgery, compared to propofol.

Delayed caustic injury complications are common, especially in developing countries, and several treatments have been proposed to prevent the resulting esophageal strictures so far. Although inflammatory nature of caustic injury makes the anti-inflammatory agents a viable option, few studies have investigated these agents. High-dose corticosteroids therapy for reduction of stricture formation in the esophagus after the ingestion of caustic material is still a controversial topic. In this regard, this study aimed to determine the impact of high doses of methylprednisolone in preventing esophageal stricture. A total of 112 patients with grade II esophageal caustic injury, diagnosed by esophagogastroscopy within 24 hours of injury, were enrolled in our study. The treatment group (n=44) received methylprednisolone (1 g/d for 3 days), pantoprazole, ceftriaxone, and metronidazole and the control group (n=58) received the same regimen excluding methylprednisolone. Endoscopic and radiologic findings were used to compare the severity of the damage to the esophagus and stomach between the two groups. After 8 months of follow-up, stricture development was observed in 3 (5.6%) patients in the treatment group and in 11 (19%) patients in the control group. The difference was statistically significant (P=0.038). The gastric outlet obstruction was observed in 4 (7.4%) patients in the treatment group and in 19 (32.7%) patients in the control group. Again, the difference was statistically significant (P<0.05). There were not any side effects due to the high doses of methylprednisolone in the study group. High doses of methylprednisolone can prevent the development of esophageal stricture in grade II of caustic injury.

Hydrogen peroxide poisoning can cause death. The chemical reactions in the body will produce complications, such as stroke, perforation of the gut, and embolism. These complications are most likely seen with high concentrations.

The patient was a 55-year-old female, who tried to commit suicide by ingestion of approximately 150 cc of hydrogen peroxide. She was brought to the emergency room for medical treatment. During the physical examination, the patient had air in the neck and mediastinum, which is a strong indication of acute mediastinitis. The patient was treated with esophagectomy and feeding jejunostomy. The pathology reported first degree burns of the esophagus without perforation. The patient underwent reconstructive surgery and treatment for eight weeks, yet she died during surgery as a result of low ejection fraction (EF).

In this case, the patient intentionally ingested a low concentration (15%) of hydrogen peroxide and as a result experienced first degree burns in the esophagus. The patient did not require surgery for treatment. The presence of white mucus and air around the esophagus and stomach was thought to be indicative of acute mediastinitis and mistakenly exposed the patient to major surgery.

Sulfur Mustard (SM) is an alkylating agent that has been used as a chemical warfare gas during World War II and by Iraqi army in the Iran-Iraq conflict between 1983 and 1988. SM can cause serious organ damages especially ocular, neurologic, coetaneous, bone marrow and pulmonary complications. On the other hand dexmedetomidine is a α2 agonist with sedative and analgesic effect with a short duration half-life. Considering these benefits, usage of dexmedetomidine would be a good choice in ophthalmic outpatient’s surgeries to keep the cognition state in an acceptable condition comparing with other available drugs especially in patients with concurrent chemical burn injury.
After informed consent, patients with inclusion criteria were randomly divided in to two groups: dexmedetomidine (group D, n=50) and Remifentanil (group R, n=50). Cardiovascular signs, Mini Mental State Examination (MMSE) score were recorded as baseline. Patients received respectively dexmedetomidine by infusion with a loading dose of 0.5µg/kg (during 10 minutes) in group D. The maintenance dose of 0.2µg/kg/hr was then started. Loading dose of remifentanil was given by 0.1µg/kg (during 10 minutes); 5 minutes before local anesthesia in group R and maintenance dose of 0.05µg/kg/min was then started. In Post Anesthesia Care Unit (PACU) after 120 minutes of stopping drug infusions n-back and MMSE tests were performed.
The MMSE score had no statistically difference between two groups before surgery (in subgroup age>=65 P= 0.5, and in subgroup age=65 and age=65 P The result of n-back and MMSE revealed that the cognition state improves better in patients receiving dexmedetomidine comparing with those of remifentanil. Dexmedetomidine is safe for protecting the cognition state especially in patients with borderline respiratory reserve due to chemical burn injury.