Canon Journal of Medicine
Volume:1 Issue: 3, Summer 2019

Adenocarcinoma is the most common malignancy in pancreas. Normally there is no squamous cell in pancreas. Pancreas Squamous Cell Carcinoma (SCC) is a rare tumor and its presentation is like adenocarcinoma and no specific symptom and sign is reported. Tumor markers are not helpful for this disease.

We report a 55 year-old female patient who had pancreas SCC. All investigations were normal and no other site of SCC, as a possible source for metastasis, was found.  The tumor was not operable and she received 3 cycles of cisplatin and 5-fluorouracil. Then she received radiotherapy up to 44 Gy. Although she had partial response, operation was not again possible and then she received chemotherapy. Unfortunately she developed liver metastasis and passed away 9 months after diagnosis.

pancreas SCC is a rare tumor and the role of surgery and radiotherapy is not well studied. Chemotherapy is better to be administered according to SCC of other sites. Despite aggressive treatment, this malignant disease has a poor prognosis.

The non-recurrent laryngeal nerve (NRLN) is an infrequent variant of inferior laryngeal nerve that takes an unusual course. Since this is a rare anatomic variation, operations on these patients carry a great risk of laryngeal nerve injury.

A 25-year-old woman with papillary thyroid carcinoma and cervical lymphadenopathy underwent total thyroidectomy and bilateral neck dissection levels II – VI. It was noted intraoperatively that right inferior laryngeal nerve was a NRLN and right common carotid artery originated directly from the aorta and right brachiocephalic artery was absent. The nerve was preserved and patient underwent an uneventful surgery. She was well in her follow-up visits, her voice was good and both of her vocal cords were mobile on indirect laryngoscopy examination.

Although NRLN is a rare anatomic variation, surgeons should always think twice about this finding whenever right recurrent laryngeal nerve cannot be found according to anatomical landmarks intra-operatively.

Cardiovascular diseases are the leading cause of death for people worldwide. The purpose of this study was to determine the diagnostic accuracy of acute coronary syndromes assessment by emergency medicine specialists with accordance to the latest guidelines in shariatic hospital of Isfahan.   This cross-sectional study involved all consecutive patients that assessed in Emergency Department because of cardiac symptoms throughout one year (April 2017 to January 2018). The raw data were analyzed with SPSS software version 23. One hundred and seventy-five patients were included in this study.  Moreover, pain radiation in the left shoulder (p-value=0.02), cold sweating (p-value=0.01), obesity (p-value=0.00), and chronic diseases (p-value=0.45) recorded more in ACS patients compared to control group. Result showed that the using of nitrate drug leads to significant reduction in pain intensity in ACS patients and make significant higher change in their electrocardiogram (ECG) in comparison to control group. Finally, results indicated that using the troponin test in the final diagnosis, ACS patients showed higher troponin levels compared to control group. Finally, results indicated that using the troponin test in the final diagnosis, ACS patients showed higher troponin levels compared to control group. Patients with a final diagnosis of ACS are older than the control group. Moreover, the retrosternal pain, chest pain, exertional dyspnea, radiating pain in left shoulder or hands and cold sweating were significantly more common in patients with ACS. Based on this, the quick actions relates to ACS should be implemented to improve the diagnostic accuracy in the future.

Hypotension and hypertension have the potential ability to injure the vital organs. Controlling blood pressure is necessary to stabilize the patient's hemodynamic situation. There are different blood pressure measurement methods such as invasive blood pressure measurement (IBP), noninvasive blood pressure measurement (NIBP) and auscultatory method. This cross-sectional study was conducted on 20 inpatients of angiography ward of Sina hospital, Isfahan, Iran. The measurement accuracy of IBP, NIBP and auscultatory method compared and the effective parameters in each technique discussed. The mean error and standard deviation of IBP and oscillometric in all patients was -4.06±8.9 for MAP, -3.64±10.3for systolic and -4.22±4.9 for diastolic. The mean error and standard deviation of oscillometric and auscultatory for all patients was -1.73±6.5 in systolic pressure and 0.42±4 in diastolic pressure. Based on gender, systolic pressure error in men was -3.3±4.2 and -0.78±3.6 in women; diastolic pressure error in men was -4.37±9.5 and -4.37±8.9 in women and MAP error reported -4.2±8.57 and -1.2±8.17 in men and women respectively. Findings showed that in the range of normal pressure and prehypertension, the accuracy of IBP, NIBP and auscultatory method was nearly the same but for hypertension grade 1 and 2, only the mean error and standard deviation of MAP is acceptable. Considering the effect of gender on blood pressure manifest that the error of systolic pressure, diastolic pressure and MAP for women is less than men.

Coronary arteries are the main vessels supplying the heart. Various factors can affect their performance, which causes coronary diseases and impaired blood supply and irreparable complications. Coronary artery disease (CAD) is one of the most common cardiovascular diseases with the highest mortality rate and disability among patients. The objective of this study is to investigate the epidemiological and anatomical characteristics of the atherosclerotic plaques in coronary arteries and their risk factors in Mazandaran Heart Center. This cross-sectional study with a census design performed on all patients with atherosclerotic plaque, who undergone atherectomy surgery, from November 2009 to January 2019. Patient’s information was extracted from their medical records archive with ethical points. SPSS 16.0 was used for statistical analysis. Out of 156 patients with atherosclerotic plaque, 60.9% were male. The mean age of patients was 61.58± 8.9 years. The most incidence of atherosclerotic plaques was seen in 50-80 age category. Atherosclerotic plaques were mostly found in the right coronary (RCA) (53.8%) followed by left anterior descending (LAD) (41%) arteries, which was more common in men. No significant relationship was observed between sex, age, the number of arteries involved and level of biochemical variables.   We found that gender, age, calcification, FBS, TG, TC, HDL, and LDL do not have significant effect on “site” of plaque in different coronary arteries which might due to same physiological and histological structure of these arteries. Further studies are being needed for etiology and mechanism involved.

Improper use of antibiotics increases the cost of treatment, incompetent therapy, longer hospitalization time, more visits to the doctors, and improper treatment of the patients, lack of infection control, and the development and spread of antibiotic resistance. The objective of this study was the evaluation of antibiotic misuse and overuse in hospitalized patients with nosocomial infections in BuAli Sina hospital, in the north of Iran. This retrospective cross-sectional study was performed by census methods on all nosocomial infections patients hospitalized in BuAli Sina's educational and therapeutic hospital. Data were collected from March 2016 to March 2018. All data were obtained from computerized archives and manual archives of the hospital. SPSS 16.0 was used for statistical analysis using Chi-square, Kolmogorov-Smirnov, and Mann-Whitney tests. Out of 517 patients studied, 221 (42.7%) of them were male. The average age of the patients was 45.64±34.01. The Most Common isolated bacteria from all patients were Escherichia coli (48.8%) and Staphylococcus epidermidis (22.9%). According to the antibiotic prescription in the present study, most patients (35.8%) took at least two antibiotics. The most antibiotics falsely prescribed by physicians in the present study were used for the treatment of the infections caused by E. coli (50.34%) and Klebsiella pneumoniae (20.97%). There seems to be a need to set up a team to prevent antibiotic misuse and microbial resistance and to pay attention to the antibiotics prescribed for infectious patients. These include training programs for physicians, consulting with infectious disease specialists, reducing empirical prescriptions by physicians, and spontaneous antibiotic use by patients.

Reconstruction surgeryfor head and neck cancers restore patients’ function and appearance. Careful selection of flap for reconstruction of a defect after an ablative surgery can be a complex process and may affect on quality of life (QOL) of the patients. This study aimed to compare the quality of life between free and pedicle flap reconstruction groups in head and neck neoplasm patients. This was a cross-sectional study of QOL in patients withhead and neck neoplasm that attend follow-up clinics from July to September 2019. All patients that underwent reconstructive surgery with either pedicle or free flaps were included in the study. At least 6 month-time was elapsed from the reconstructive surgery. QOL of the patients was evaluated using Medical Outcomes Study Short Form (MOS SF-36) questionnaire. The patients’ demographic data and medical history were collected using electronic patients’ records.   Seventy patients completed the questionnaire. Forty one (58.57%) patients underwent pedicle and 29 (41.43%) patients free flap reconstructive surgery. There was no significant difference between pedicle and free flap groups with regard to age, gender, radiotherapy or chemotherapy (P>0.05). The present study indicates that there was no statistically significant difference between pedicle and free flap groups with regard to 8 domains of SF-36 questionnaire (P>0.05), neither was significant difference between two groups with regard to the physical or mental component summaries (P>0.05). The present study on quality of life of head and neck neoplasm patients that had undergone pedicle or free flaps showed no significant difference between two groups.