مجله پزشکی بالینی ابن سینا
سال بیست و ششم شماره 3 (پیاپی 93، پاییز 1398)

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.

This study aimed at comparing the results of refractive cataract surgery in patients undergoing sequential surgeries in both eyes. Considering the preoperative refraction and final refraction of the first eye, it is possible to correct the refrative result of cataract surgery using the adjustment of the second eye intraocular lens (IOL) power.

This study was conducted based on a matched-pair clinical-trial design. Regarding the final result of the first eye refraction,  the adjustment of the second eye IOL power was determined by 50% of uncorrected refractive error. Finally, the mean spherical equivalent (SE) of the first and second eyes were determined, and the differences were analyzed using a paired t-test at a significant level of 95%.

A total of 470 candidates who underwent bilateral sequential cataract surgery were investigated in this study.  The refractive errors ranged from -8.25 to + 6.50 and from -6.75 to +7.25 for the first and second eyes, respectively. The mean values of SE for the first and second eyes were 2.55 and 2.48 preoperatively, and 1.13 and 0.47 postoperatively, respectively. Moreover, there was a significant difference between the two groups (P<0.001). 

The adjustment of IOL power for the second eye by 50% of uncorrected refractive error of the first eye led to acceptable outcomes.

Psoriasis is one of the most common skin diseases affecting 2-4% of the population. Based on the related literature, patients with psoriasis are at increased risk of developing type 2 diabetes. The present study aimed to compare the patients with psoriasis to healthy individuals in terms of prevalence of diabetes.

This cross-sectional case-control study was carried out in Sina Hospital, Hamadan, Iran. A total of 35 patients with psoriasis were allocated to the case group and 35 healthy subjects who were comparable in terms of age and gender were assigned to the control group. All participants were examined concerning fasting plasma glucose (FPG) and body mass index. In both groups, the FPG≥126 mg/dl indicated diabetes. The collected data were analyzed in SPSS software (version 16.0; SPSS Inc. Chicago, IL). A p-value less than 0.05 was considered statistically significant.

In each group, 19 individuals (54.3%) were male. Mean age in case group was 43±11.5 and in controls was 45.1±12.8 (p-value=0.481). The mean Psoriasis Area and Severity Index (PASI) of the patients was 20.6±12.7 (1.4 to 49.8). The most frequent severity of psoriasis regarding PASI was moderate including 16 patients (45.7%). The mean FPG in the patients was 108±33.6 and in controls 99.6±20.5mg/dl (P=0.755).Eight patients (22.9%) had diabetes while only 3 healthy controls (8.6%) had it (P=0.188). Multivariate logistic regression analysis demonstrated that psoriasis patients with the same gender, BMI and age have almost 4- fold increased risk of developing diabetes rather than healthy controls (P=0.08). As evidenced by the obtained results, eight patients with psoriasis (22.9%) suffered from diabetes, whereas only three (8.6%) of them had diabetes in the control group (P=0.188). Multivariate logistic regression analysis demonstrated that patients with psoriasis had almost 4-fold increased risk of developing diabetes, compared to healthy people (P=0.08).

Based on the findings of the current study, the probable association between type 2 diabetes and psoriasis should be taken into account given hyperglycemia in patients with psoriasis.

Oral candidiasis is often caused by Candida albicans, followed by C. dubliniensis, C. parapsilosis, and C. glabrata. The present study aimed to investigate the antifungal effects of Rosa damascena (R. damascena) essential oil, mixed mouthwash of R. damascena essential oil and grape vinegar, as well as nystatin against various standard Candida species.

This descriptive study was performed on 5 standard strains of various Candida species. The anti-Candida effects of R. damascena and mixed mouthwash against various Candida strains were assessed using well diffusion and broth macrodilution methods. Nystatin was utilized as a positive control drug.

The results of the well diffusion assay of  R. damascena essential oil and mixed mouthwash were 17 and 6 mm regarding C. albicans strains, respectively, and 15 mm and 0 regarding other Candida strains, respectively. With respect to the results obtained from broth macrodilution test, the minimum inhibitory concentration of R. damascena essential oil and mixed mouthwash were found to be 8 and 6 µg/ml, 124 and 12 µg/ml, 31 and 12 µg/ml, as well as 62 and 25 µg/ml for C. albicans, C. dubliniensis, C. glabrata , and C. parapsilosis, respectively. Moreover, C. albicans was the most sensitive Candida species to R. damascena essential oil and the mixed mouthwash.

The results showed that R. damascena essential oil and mixed mouthwash remarkably led to the inhibition of Candida species growth causing oral candidiasis.

This study investigated the difference between patients with mild cognitive impairment and healthy controls using Optical Coherence Tomography (OCT) regarding Retinal Nerve Fiber Layer (RNFL) thickness.

In total, 20 patients with mild cognitive impairment and 20 healthy controls were subjected to neurological examination in this case-control study. The examinations included Minimal Mental State Examination test, comprehensive examination of the eye, and OCT using SPECTRALIS®. The data were analyzed to evaluate the thickness of RFNL through descriptive and analytical statistics. Both eyes were selected for analysis, and the patients with mild cognitive impairment were compared with the healthy controls regarding the RFNL thickness.

The mean age of the patients was 61.4±3.4 years (age range: 53-65 years), and the mean RNFL thickness in patients was 100±10.1 μm. Moreover, the mean values of RNFL thickness in the lower, upper, nasal, and temporal quadrants were 128±18.9, 119±12.2, 87±14.06, and 68±10.3 μm, respectively. There was no difference between females (99±13.2) and males (103±5.6) regarding the RNFL thickness. In addition, no significant difference was observed between the male and female age groups in terms of the RNFL thickness. Additionally, there was no significant difference between the patients (100±10.1) and control group (104±8.7) regarding the RNFL thickness. The chance of developing mild cognitive impairment is increased by 1.45 times with increasing age. It should be noted that this relationship was statistically significant (P<0.001).

The results of this study indicate that patients with mild cognitive impairment had reduced RNFL thickness, compared to healthy controls. However, since this difference was not significant, it cannot be regarded as a proper approach for diagnosis and follow up of the patients.

Cataract is one of the most common causes of blindness in the world, and posterior capsular opacification (PCO) is the most common complication after cataract surgery. Nd: YAG laser posterior capsulotomy is a standard method for the treatment of PCO. The aim of this study was to investigate the effects of Yas laser capsulotomy on anterior segment parameters and lenticular astigmatism.

In this randomized clinical trial study, a total of 37 eyes from 30 patients with posterior capsular opacity after uneventful phacoemulsification were enrolled and underwent Nd: YAG laser capsulotomy. Full ocular examination, including intraocular pressure and refractive errors, was performed on the samples. The AC depth, volume, and angle were measured by Pentacam before capsulotomy and 3 months following that.

Mean visual acuity improved preoperatively (0.505±0.276) and 3 months after capsulotomy (0.646±0.268); )P<0.001). Mean values of spherical equivalent and cylindrical powers were 1.304±0.268 and -1.142±0.881 dioptre before the procedure and 1.285±0.152 and -1.027±0.807 dioptre 3 months following the surgery, respectively. The difference in cylindrical and spherical errors was not statistically significant after the procedure. Mean scores of lenticular astigmatisms were 0.902±0.735 and 0.621±0.326 dioptre before and after capsulotomy, respectively, which was statistically significant (P=0.018). The changes in the Anterior Chamber depth, angle, volume, and mean central corneal thickness were not statistically significant after capsulotomy.

Laser capsulotomy decreased lenticular astigmatism and improved visual acuity. The changes in the AC depth might be a clue for associated complications, such as the changes in refractive errors, intraocular lens position, and intraocular pressure.

Bacterial agents are the most common causes of urinary infection with Escherichia coli as the major causative organism. Accordingly, the current study aimed to determine the antibiotic resistance among Escherichia coli isolates from human urinary infection cases.

The current experimental study was carried out on 50 specimens of positive cultures with urinary tract infection referred to Imam Reza Hospital Laboratory in Bojnord, Iran. The resistance and susceptibility of the isolates were assessed using disc diffusion method. Moreover, the presence of tetA, blaTEM, Sul1, aac(3)-IV, and aadA1 gens was examined using molecular methods with specific primers.

Prevalence of antibiotic resistance to ampicillin, cotrimaxazole, levofloxacin, nalidixic acid, ciprofloxacin, gentamicin, and nitrofurantoin was measured at 84%, 60%, 60%,52%, 44%, 22%, and 6%, respectively. in total, 50 E. coli strains were isolated were examined to determine blaTEM, aac(3)-IV, tetA, Sul, and aadA1 genes using polymerase chain reaction(PCR). Based on the obtained results, the frequency of blaTEM, aac(3)-IV, tetA, Sul1, aac(3)-IV, and aadA1 genes was reported as 24%, 12%,10%, 8%, and 14%, respectively.

Disk diffusion agar method can be used as a primary screening method to determine antibiotic susceptibility for Escherichia coli isolates separated from urinary tract infections. In addition, genotypic method can be implemented for the accurate evaluation of the resistance of the isolates.

Human immunodeficiency virus (HIV) infection in males not only causes physical, psychological, economic, and social problems for this population, it may also affect the physical and mental health of their spouses. This study aimed to compare the wives of HIV-positive husbands with a control group regarding depression, anxiety, and stress disorders.

This descriptive and cross-sectional study included 43 wives of HIV-positive husbands (case group) who referred to Counseling and Behavioral Centers in Hamadan and Malayer, Iran, during 2019 using census and convenience sampling methods. Subsequently, the case group was compared with a control group (i.e., 100 wives of HIV-negative husbands) in terms of depression, anxiety, and stress using Depression, Anxiety, and Stress Scale-21. The data were analyzed in SPSS software (version 21). A P-value less than 0.05 was considered statistically significant.

The mean values of depression, anxiety, and stress in the case and control groups were 17.44±12.32 and 5.82±7.29 (P<0.001), 13.20±10.42 and 6.56±5.75 (P<0.001), as well as 20.23±12.58 and 16.04±8.03, respectively (P=0.049). Out of 143 females under study, 38 (26.6%) cases were HIV-positive. Moreover, the mean values of depression, anxiety, and stress in HIV-positive and HIV-negative females were 17.47±12.64 and 6.36±7.81 (P<0.001), 16.82±5.88 and 13.36±10.87 (P<0.001), as well as 20.05±12.19 and 16.30±8.59, respectively (P=0.042).

The prevalence of depression, anxiety, and stress is high in females with HIV-positive husbands. According to the results, there is a significant relationship between depression and the level of education among these women. It can be concluded that HIV-infection correlated significantly with psychiatric disorders

Neurofibromatosis type1 (NF-1) is a hereditary autosomal dominant disease that is accompanied by complications, such as benign and malignant tumors and vascular involvement, including pulmonary hypertension, artery stenosis, and pulmonary artery aneurysm. Spontaneous hemothorax is a rare and lethal complication of NF-1 due to vasculopathy as stenosis or aneurysmal modifications of large intrathoracic vessels, and dysplastic alterations of small vessels in highly vascularized mesenchymal tumors. Most commonly, tumor-related hemothorax is due to neurofibroma, and the most frequently involved artery is the intercostal artery.

A 48-year-old male referred to our hospital with a chief complaint of dyspnea from a week ago. His symptoms began with pleuritic chest pain followed by dyspnea. The physical examination showed many neurofibromatosis lesions and café-au-lait macules on the skin. Thoracotomy was performed during the hemothorax examination. Moreover, inflammation of the pleura and fibrothorax were reported without any site of bleeding.

Vascular complications should be regarded in NF-1. Any patient presents with hemodynamic disorder or pleural effusion should be examined and treated promptly