مجله دانشکده پزشکی اصفهان
پیاپی 637 (هفته اول آبان 1400)

The aim of this study was to evaluate the effect of intracameral lidocaine injection on hemodynamic parameters and pain intensity during and after cataract surgery under intravenous sedation and topical anesthesia.

This clinical trial included 62 patients randomly divided into two groups of 31; the intervention group received intracameral lidocaine with topical tetracaine, and the placebo group received intracameral sterile balance sodium solution (BSS) with topical tetracaine. Baseline and intraoperative and postoperative hemodynamic variables were recorded, and pain intensity were recorded and analyzed upon entering recovery and at different intervals up to 24 hours after the surgery.

Reported pain intensity decreased significantly In both groups over time (P < 0.050). Patients’ pain in the intervention group was significantly lower in comparison to the control group (P < 0.050); but no significant difference was observed between the hemodynamic variables in two groups (P > 0.05)

The present study shows that intracameral lidocaine is effective in controlling postoperative pain in patients undergoing cataract surgery without any considerable hemodynamic side effects.

Age-related macular degeneration (AMD) is one of the disorders in the retina that causes central vision disorders. Optical coherence tomography (OCT) images are used to diagnose this disease, and given the changes in the disease caused by elevations in the retinal pigment epithelium (RPE) layer of the retina, the complication is diagnosed.

In the proposed method, the starting point of the RPE layer was labeled by the user on a limited number of OCT slides to eliminate the possibility of mistaking other layers such as the retinal nerve fiber layer (RNFL). The graph-based algorithm was then applied to the image in low width parts; an algorithm was used to maintain the continuity of the parts to eventually estimate the location of the RPE layer. With a similar algorithm, the bruch layer was also located at each scan, and by estimating the distance of the two layers, PED elevations were identified.

The proposed method was evaluated on three datasets with 35, 15, and 10 patients. Compared to the graph-based method in the first, second, and third datasets, respectively, the unsigned error in the RPE layer improved from 4.3392 to 2.7827, 3.3340 to 2.1623, and 6.4842 to 2.3924 pixels, and the bruch layer improved from 5.7576 to 4.8473, 4.3353 to 2.6023, and 6.67 to 2.5446 pixels, respectively.

The proposed method is valid in PED images, and can be effective in diagnosing AMD.

Cryptococcal meningitis is a chronic fungal meningitis caused by Cryptococcus neoformans or Cryptococcus gattii. Acquired immunodeficiency syndrome (AIDS) and the use of immunosuppressive drugs are the main underlying factors of the disease. In this case report, we present a patient with cryptococcal meningitis who left the hospital after three months of unsuccessful monitoring and treatment.

The patient was a 20-year-old woman who underwent a kidney transplant three years before, and was referred to Alzahra hospital in Isfahan, Iran, with generalized headache, diplopia, photophobia, phonophobia, weight loss, vomiting, and Kernig's sign. By isolating the yeast from the cerebrospinal fluid, fluconazole was prescribed for her. After 18 days, the antifungal drug regimen was changed to amphotericin B deoxycholate. Due to no improvement in symptoms, the patient left the hospital after three months with personal consent. Molecular identification of the fungus was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. For this purpose, ITS1-5.8S-ITS2 region was amplified and cut with HpaII restriction enzyme and Cryptococcus neoformans was identified as the causative agent of infection using the digested band pattern (127 and 428 bp).

Patients taking immunosuppressive drugs are at risk for invasive fungal infections. Due to the emergence of resistant clinical isolates to antifungal agents, evaluation of drug susceptibility of fungi in specialized laboratories in parallel with clinical treatment of patients is recommended to prevent mortality and impose side effects of antifungal drugs on these patients.