مجله دانشکده پزشکی اصفهان
پیاپی 653 (هفته اول اسفند 1400)

The prevalence of asthma and allergic diseases in the world has increased in recent decades, and it is necessary to identify allergens in different regions. The aim of this study was to evaluate the frequency of allergens in patients with atopic and non-atopic asthma in Dazyani Asthma and Allergy Clinic, Gorgan City, Iran in 2020.

This cross-sectional descriptive study was performed on 96 children with asthma aged 1 to 16 years. Diagnosis of asthma was based on the patient's clinical signs, life-saving medications used, activity limitation established, and pulmonary function tests. Accordingly, the definitive diagnosis of asthma was a 15% increase in forced expiratory volume-1 (FEV1) after inhalation of 2 puffs of salbutamol. Children were divided into two groups of atopic and non-atopic based on experiments. In this study, if immunoglobulin E (IgE) levels were high and Prick test was positive, they were in the atopic group, otherwise they were in the non-atopic group. Serum levels of eosinophils and immunoglobulin E were analyzed by type of asthma and severity of asthma.

Among the studied children, 54.17% had atopic and 45.83% non-atopic phenotype. A total of 71.78% of children with asthma were at least allergic to one of the allergens tested. There were also significant relationships between the severity of asthma and being atopic, immunoglobulin E, and eosinophil count.

Asthma is more severe in children with atopic asthma than non-atopic asthma. The mean of immunoglobulin E and eosinophils in atopic asthma is higher than non-atopic. Immunoglobulin E and eosinophil levels are also directly related to the severity of asthma.

Readmission is a hospital quality and outcome measure. The aim of this study was to investigate the rate of readmission and its causes and costs in inpatient wards of a university hospital in Iran.

One-year data from a 320-bed training center were extracted to determine readmission, admission, final diagnosis, and costs. According to a specialized study, readmission cases were classified into one of 20 groups, and one of the 10 causes of the disease. Data analysis was performed using chi-square and logistic regression tests via SPSS software.

Out of a total of 17,542 hospitalizations, 1214 (6.92%) were readmitted, accounting for 8.27% of the total hospitalization costs. Among the classes of causes of readmission, unrelated complications of disease and recurrence of the disease were the most common causes of readmission, respectively. Among the inpatient wards, the highest percentage of readmission was related to the gynecology ward. The results of multiple logistic regression showed that the chances of readmission in the age groups between 15 to 65 years and under 15 years, was respectively 32.3% [confidence interval (CI): 0.78-0.58; odds ratio (OR) = 0.67] and 58.1% (CI: 0.51-0.32; OR = 0.41) lower than the age group over 65 years (P < 0.050). The chance of readmission in patients covered by social security, accidental, health and miscellaneous insurance was respectively 35.0% (CI: 0.50-0.84; OR = 0.65), 37.8% (CI: 0.43-0.89; OR = 0.62), 23.1% (CI: 0.98-0.59; OR = 0.76) and 68.9% (CI: 0.89-0.11; OR = 0.32) lower than patients with armed insurance coverage (P < 0.050).

The results of the study indicate the importance of monitoring the rate, process, and costs of readmission as one of the key indicators of hospital performance quality.

Cochlear implantation (CI) is usually performed through mastoidectomy and posterior tympanotomy (PT) to access the cochlea. This surgical procedure can expose the surgeon to possible complications or misplacement of the electrode. Alternative techniques for cochlear implantation with endomeatal or suprameatal approach without posterior tympanotomy have been described. Here, we report a 4-year-old patient, a candidate for cochlear implantation, for whom due to the difficulty of accessing the round window, we used the combined approach to reach the cochlea.

In this particular patient, there was no restriction on mastoid pneumatization; so, we began surgery with a posterior tympanotomy approach to access the round window. But after opening the mastoid and facial recess, because the lateral semicircular canal was not developed well, the oval window and the stapes were displaced posteriorly. Moreover, because of posterior displacement, the round window was not visible through the facial recess. Therefore, by adding the trans-canal approach, we could access the round window, and the prosthesis was successfully inserted. No complication occurred, and six months after surgery, the patient had acceptable auditory and speech performances.

Familiarity and having experience in different approaches to the cochlea is a prerequisite for a cochlear implant surgeon to be able to use alternative methods in cases of difficulty in accessing the round window or finding a proper site for cochleostomy.