مجله پزشکی بالینی ابن سینا
سال بیست و نهم شماره 3 (پیاپی 105، پاییز 1401)

The injection site in spinal anesthesia is one of the factors that can affect the height of the sensory block. This clinical trial study aimed to compare the effect of spinal anesthesia at L3-L4 and L4-L5 on the level of sensory-motor block and hemodynamic status in cesarean section.

Seventy patients undergoing elective cesarean section and receiving spinal anesthesia (10 mg of 0.5% bupivacaine plus 2.5 μg of sufentanil) were randomly divided into two groups of 35 with spinal anesthesia at L3-L4 (group 1) or L4-L5 (group 2). The two groups were compared concerning demographic data, hemodynamic status, level of sensory block, degree of motor block, time to return the sensory level to T10, complications of spinal anesthesia, and neonate Apgar score.

There was no significant difference between the two groups in the mean age (P=0.329). In the first group, 22.9%, and in the second group, 40% of the patients had the level of anesthesia at the eighth thoracic vertebra (T8). None of the patients had zero or one score in both groups. Hypotension (82.9% vs. 8.6%), bradycardia (34.3% vs. 8.6%), and intraoperative nausea and vomiting (65.7% vs. 11.4%) were higher in the first group than in the second group (P<0.001).

Performing spinal anesthesia in L4-L5 lumbar space, compared to L3-L4 space, in addition to creating a sufficient level of anesthesia, is associated with fewer complications, such as hypotension, bradycardia, as well as nausea and vomiting, in cesarean section.

 Noninvasive treatments are preferred for tooth enamel remineralization, and metal nanocomposites could be used for this purpose. The present study investigated the effect of boron nanocomposites doped on the hydroxyapatite-chitosan surface on the microhardness of demineralized tooth enamel.

 In this laboratory study, boron nanocomposites doped on the hydroxyapatite-chitosan surface were made by the sol-gel method. A total of 45 healthy human teeth were selected and divided into buccal and lingual halves. The demineralization cycle of the samples was performed for 14 days to demineralize the tooth enamel surface. The samples were randomly divided into three equal groups based on the use of remineralizing materials, G1:hydroxyapatite-chitosan nanocomposites; G2:boron nanocomposites doped on the hydroxyapatite-chitosan surface, and G3:control group without nanocomposite. Nanocomposites were applied on the surface of the teeth for 28 days (twice a day). The microhardness of the samples was performed by the Vickers test at three points. The SPSS software (version 19), one-way analysis of variance, and Tukey's test were used for statistical analysis of the data (α=0.05). The surface morphology of the groups was examined by SEM[A1] .

 There was a statistically significant difference between the three studied groups (P<0.001). The highest mean was first observed in the G2(368.12) and then in the G1(342.62). Moreover, the lowest mean was related to the control group(267.53). Pair-by-pair comparison of groups showed that there was a significant statistical difference between groups 1 and 2, 1 and 3 as well as 2 and 3 (P<0.05).

 Both HApC and B@HApC compounds improve remineralization and increase the microhardness of tooth enamel; however, this increase was greater in the presence of a boron-containing compound.

In this study, the thickness of the retinal nerve fibers layer(RNFL) was compared among patients with mild cognitive impairment, Alzheimer's dementia, and healthy individuals (controls) using Optical Coherence Tomography (OCT) device.

This case-control study was conducted on 30 patients diagnosed with mild cognitive impairment and 31 healthy subjects undergoing neurological examination. The examinations included minimal mental state examination a comprehensive assessment of ophthalmology and performance of OCT using a Spectralis device. Both eyes were selected for analysis, and the differences in the thickness of retinal nerve fibers layer between patients with mild cognitive impairment and healthy subjects were investigated.

In this study, the mean age scores of the patients and healthy individuals were 66.00±8.56 and 60.25±7.50 years, respectively. According to the results of the ordinal logistic regression model, after controlling the effects of other variables, the severity of cognitive impairment increased by 1.26 times in the right eye and by 1.30 times in the left eye (P<0.001). Similarly, for each micrometer increase in the thickness of the retinal nerve layer in the superior quadrant of the right and left eyes, the severity of the cognitive impairment decreased by 4% and 5%, respectively.

These results indicated that superior and inferior retinal nerve fiberslayer thickness was reduced in patients with mild cognitive impairment and Alzheimer's dementia, compared to the healthy subjects, and it can be an element to detect and track this pathology.

Vitamin D deficiency in humans is a major health problem worldwide. This study aimed to investigate the effect of vitamin D supplementation in reducing mortality and complications after intertrochanteric fracture of the hip joint.

In this clinical trial, 100 patients over 60 years of age with hip fractures and serum levels of vitamin D less than 20 ng/ml referring to Besat Hospital in Hamadan, Iran, were selected and randomly assigned to one of the intervention or control groups. The intervention group was given vitamin D in a vial of 600,000 units IM. Data were analyzed using SPSS software (version 23).

The mean age of the patients in the intervention and control groups were 78.04±8.50 and 79.40±7.30 years, respectively (P=0.430). Regarding gender, 54% of the patients in the intervention group and 60% in the control group were men. Mean serum levels of vitamin D were 15.48±4.03 and 14.23±3.28 ng/ml, respectively. The frequencies of mortality within one year after surgery were 8% and 18% (P=0.137), and the frequencies of complications were 4% and 14% (P=0.160).

The injection of vitamin D supplement in the form of a single dose of 600,000 muscle units in patients over 60 years of age with vitamin D deficiency and intertrochanteric fracture of the hip joint reduced one-year mortality and complications. However, this reduction was not significant compared to the control group.

With the increase of cardiovascular diseases worldwide, diagnostic and therapeutic measures, particularly nuclear medicine technology, have also increased. A multiplicity of diagnostic procedures are used for treating many patients with cardiovascular diseases in Farshchian Cardiovascular Hospital, Hamadan, Iran; therefore, the staff of this hospital, especially non-intensive care workers, have encountered a large number of these patients and have fear and concerns caused by this exposure. In this regard, this study aimed to determine the exposure of staff working in non-intensive care units of this Cardiovascular Hospital to ionizing radiation, including gamma-ray.

This cross-sectional study was conducted in which 40 film badges (for radiation measurement) were attached to staff working in two separated inpatient wards (Ward A and Ward B) from non-intensive wards of Farshchian Cardiovascular Hospital in three separate shifts (morning, evening, and night) and in three occupational categories, including nurses, health workers, and service provider staff.[A1] The amount of radiation exposure of people (in mSv) was measured in two separate sections for four mounths (the first two months, the second two months) and SPSS version 26 software was used to analyze the data.

Exposure to ionizing radiation, including gamma-ray, in all three occupational categories of nurses, health workers, and service providers was less than 0.05 mSv in both wards, all below the risk threshold.

The results of this study showed that the exposure of nurses, health workers, and service providers working in the studied wards to ionizing radiation (e.g., gamma-ray) was within the permissible limit; therefore, the working environment of these employees is safe to take care of patients

One of the complications that can cause significant death and disability in cancer patients is thromboembolic events. Since gastrointestinal cancers are among the most common cancers in the world and Iran, and there is little information about thromboembolic events associated with gastrointestinal cancers in Iran, this study was conducted to determine the frequency of asymptomatic and symptomatic thromboembolic events in patients with gastrointestinal cancer.

In this cross-sectional study, the files of patients with gastrointestinal cancer in Shahid Beheshti Hospital and Imam Khomeini Clinic in Hamadan city, Iran, during 2017-2021 were examined.

In this study, 630 patients with gastrointestinal cancer were examined, and a total of 59 (9.4%) cases of thromboembolism were recorded. Most thromboses occurred in patients with stomach cancer (P>0.05). The relative frequencies of thrombosis in patients using and not using anticoagulants were 7.6% and 13.2%, respectively (P<0.05).

The occurrence of thrombosis in Iran is less than that in western societies and it is not related to the location of cancer, age, and gender. In the case of taking oral anticoagulants, the risk of thrombosis decreases. Most thromboembolic events occur during the first 6 months after cancer diagnosis and the first 3 months after the start of chemotherapy.

Swallowing disorders can occur in various diseases, primarily neurological ones. This study investigated the distribution pattern of swallowing disorders in different pathologies of patients and the related risk factors.

The 323 medical files of neurological patients of Sina Hamadan Specialized Hospital (Hamadan, Iran) in the first six months of 2016 were analyzed in terms of pathologies related to dysphagia and factors aggravating the disorder. Furthermore, the relationships between them were investigated using x2 and independent samples t-test.

According to the studied files, 46.1% of patients were hospitalized with stroke pathology involving the highest percentage of dysphagia. The most and least important risk factors related to dysphagia, intubation, and pathologies, other than stroke, were 100% and 10.9%, respectively (P<0.001).

Considering the high incidence of swallowing disorders in neurological patients, especially stroke, and also considering aphasia as one of the most important disorders along with dysphagia that can cause more complexity of the disorder, it is necessary to plan for team treatments with the presence of a swallowing therapist

Nowadays, it has been proven that the immune system plays a major role in the occurrence or treatment of some cancers. The PDL-1 proteins are among the components of the immune system, which are expressed in different body cells, including B cells and T cells. In this regard, the present study was conducted to determine the frequency of PDL-1 protein expression and its relationship with tumor histopathology in patients with gastric cancer.

In this case series study, 100 patients referred to the Oncology Clinic, located in Imam Khomeini Clinic, Hamadan, Iran, between 2016-2021, with the diagnosis of gastric cancer (confirmed by endoscopic biopsy pathology) were selected. Moreover, their PDL-1 protein expression (with IHC) and its relationship with age, gender, metastasis, stage, and grade of the tumor were evaluated.

The average age of patients was 65.53 ± 10.83 years, and 72% were male. The result of PDL-1 protein expression showed that 2 patients were negative, 25 patients were weakly positive and 73 patients were strongly positive. In addition, 69 Out of 100 patients had metastases, 69 cases had high grade and 68 were in stage 4 of the disease. A significant relationship was observed between PDL-1 expression with metastasis, higher grade, and higher stage of the tumor (P<0.05).

Most patients with gastric cancer had a strongly positive expression of PDL-1 protein. Expression of PDL-1 was significantly associated with the severity of gastric cancer (e.g., grade, higher stage, and metastasis); therefore, the PDL-1 biomarker could be used as a determinant of gastric cancer severity and prognosis

 Uterine perforation is a rare condition that occurs spontaneously and with less prevalence in intestinal diseases, including malignancies.

 A 61-year-old woman with a history of the rectal tumor was referred due to acute abdominal pain, and pyometra was detected caused by uterine-colon fistula. During surgery, uterine perforation was observed, and the patient was treated with antibiotics and drainage. The pathology examination confirmed the invasion of colon cancer into the uterus.

 Although uterine perforation caused by pyometra and uterine-colon fistula is a rare occurrence, in any patient with colorectal malignancy who presents with an acute abdomen, it should be considered one of the complications of cancer, and antibiotic treatment should be started on time.