Medicine
Mahla Effati; Majid Montazer Bavil Olyaee
Abstract
Introduction: Over the past few decades, advances in surgical techniques and perioperative management have led to improvements in the prognosis of thoracic esophageal perforation. However, the optimal treatment approach remains controversial, with various surgical techniques available and differing outcomes ...
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Introduction: Over the past few decades, advances in surgical techniques and perioperative management have led to improvements in the prognosis of thoracic esophageal perforation. However, the optimal treatment approach remains controversial, with various surgical techniques available and differing outcomes reported in the literatureMaterial and Methods: Data collection was conducted by reviewing electronic medical records, surgical databases, and pathology reports to extract relevant information on patient demographics, clinical characteristics, preoperative evaluations, surgical techniques, intraoperative findings, postoperative outcomes, and long-term prognosis. Data on surgical techniques utilized in the treatment of thoracic esophageal perforation were meticulously documented.Results: Surgical management was performed in all 80 patients, with various surgical techniques employed based on the extent and severity of esophageal injury. Primary repair of the esophageal perforation was performed in 45 patients (56.3%), esophageal diversion with cervical esophagostomy in 25 patients (31.3%), and esophagectomy with reconstruction in 10 patients (12.5%). The choice of surgical technique was guided by the surgeon's preference, extent of esophageal injury, and presence of associated comorbidities.Conclusion: Our study provides valuable insights into the seven-year prognosis and outcomes of surgical techniques used in the treatment of thoracic esophageal perforation. Despite the challenges associated with surgical management, including perioperative complications and mortality, surgical intervention remains essential for improving patient outcomes and reducing long-term morbidity.
Medicine
Ali Sharifi; Abbasali Dehghani
Abstract
Introduction: The outcomes after esophagectomy have transformed the management of esophageal pathologies. esophagectomy has revolutionized the field of esophageal surgery by providing patients with less postoperative pain, reduced complications, faster recovery, and improved functional and oncological ...
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Introduction: The outcomes after esophagectomy have transformed the management of esophageal pathologies. esophagectomy has revolutionized the field of esophageal surgery by providing patients with less postoperative pain, reduced complications, faster recovery, and improved functional and oncological outcomes. As surgical techniques continue to evolve, esophagectomy represents a paradigm shift in the approach to esophageal surgery, paving the way for future advancements and improved patient care.Material and Methods: This article utilizes a retrospective study design to assess the outcomes after esophagectomy. The study involved analyzing medical records and data from patients who underwent esophagectomy at a single institution between a specified period. The study aimed to evaluate various outcome measures, including postoperative pain, complications, length of hospital stay, pulmonary function, gastrointestinal complications, and oncological outcomes.Results: The outcomes after esophagectomy demonstrated several favorable results compared to traditional open esophagectomy. Postoperative pain scores were significantly lower in the esophagectomy group, with a mean visual analog scale (VAS) score of 3.5 (range: 1-7) compared to 6.8 (range: 4-9) in the open surgery group (p < 0.001). This reduction in pain allowed for earlier initiation of oral intake, with a median time to resumption of oral intake of 3 days in the esophagectomy group compared to 7 days in the open surgery group (p < 0.001).Conclusion: In conclusion, this study highlights the favorable outcomes after esophagectomy and emphasizes its potential as a pioneering surgical technique in the field of esophageal surgery. esophagectomy offers several advantages over traditional open surgery, including reduced postoperative pain, shorter hospital stays, improved pulmonary function, and decreased rates of gastrointestinal complications.
Medicine
Amir Heydarian; Baharak Najafi Fakhraei Azar
Abstract
The management of acute abdomen referred in the emergency department is a complex and challenging task for healthcare professionals. Acute abdomen referred refers to abdominal pain that is perceived in a location distant from the actual underlying pathology. In the emergency department setting, the primary ...
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The management of acute abdomen referred in the emergency department is a complex and challenging task for healthcare professionals. Acute abdomen referred refers to abdominal pain that is perceived in a location distant from the actual underlying pathology. In the emergency department setting, the primary goals of management are to rapidly assess the patient, make an accurate diagnosis, and provide timely interventions to alleviate pain and prevent complications. In this conclusion, we will summarize the key aspects of managing acute abdomen referred in the emergency department. The management of acute abdomen referred in the emergency department begins with a thorough history and physical examination, which can provide valuable clues to the underlying cause. Prompt imaging studies, such as ultrasound, CT scans, or MRI, are often utilized to aid in the diagnosis. These imaging modalities provide detailed anatomical information and help identify the affected organs or structures contributing to the referred pain. Pharmacological interventions play a crucial role in the emergency management of acute abdomen referred. Analgesics, such as NSAIDs or opioids, are administered to relieve pain and provide comfort to the patient. Antibiotics may be initiated in cases where infection is suspected or confirmed. Proton pump inhibitors and antispasmodics are used to address specific causes of referred pain, such as peptic ulcers or functional gastrointestinal disorders. Surgical intervention may be necessary in cases where conservative management approaches fail or when a definitive diagnosis requires direct visualization and tissue sampling. Emergency surgical procedures such as appendectomy, cholecystectomy, or salpingectomy are performed to address specific underlying causes of acute abdomen referred. In the emergency department, timely decision-making and effective communication among healthcare professionals are crucial for the optimal management of acute abdomen referred. Multidisciplinary collaboration, involving emergency physicians, surgeons, radiologists, and other specialists, ensures a comprehensive approach to diagnosis and management.
Medicine
Mehrnoosh Rassam; Abbasali Dehghani; Ramin Azhough
Abstract
Introduction: In the subsequent sections of this article, we will delve into the specific methodologies employed in video-assisted pilonidal sinus surgery with minimally invasive hook circulators, review existing literature on postoperative pain outcomes, and discuss the implications of these findings ...
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Introduction: In the subsequent sections of this article, we will delve into the specific methodologies employed in video-assisted pilonidal sinus surgery with minimally invasive hook circulators, review existing literature on postoperative pain outcomes, and discuss the implications of these findings for the future of pilonidal sinus disease management.Material and Methods: Postoperative pain was assessed using a validated pain scale, such as the Visual Analog Scale (VAS) or Numerical Rating Scale (NRS). Pain scores were recorded at predefined intervals post-surgery, including immediately upon awakening, at discharge, and during follow-up visits on days 1, 3, 7, and 14.Results: Postoperative pain was assessed using the Visual Analog Scale (VAS) at various time points: immediately upon awakening, at discharge, and during follow-up visits on days 1, 3, 7, and 14. The pain scores were consistently low across all time points, indicating minimal postoperative pain. This trend suggests effective pain management associated with the use of minimally invasive hook circulators.Conclusion: the study's results support the favorable impact of minimally invasive hook circulators on postoperative pain outcomes in pilonidal sinus surgery. The reduced pain scores, minimal analgesic requirements, and improved recovery trajectories underscore the potential benefits of incorporating these techniques into clinical practice.
Medicine
Ali Reza Lotfi; Abbasali Dehghani
Abstract
Introduction: Pain intensity represents an important but understudied aspect of sinonasal mucormycosis surgery. Understanding the relationship between pain intensity and mortality is crucial for optimizing pain management strategies and improving patient outcomes.Material and Methods: Data collection ...
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Introduction: Pain intensity represents an important but understudied aspect of sinonasal mucormycosis surgery. Understanding the relationship between pain intensity and mortality is crucial for optimizing pain management strategies and improving patient outcomes.Material and Methods: Data collection was conducted by reviewing electronic medical records and surgical databases to extract relevant information on patient demographics, clinical characteristics, surgical procedures, pain intensity scores, and mortality outcomes. Pain intensity scores were assessed using validated pain assessment tools such as the Numerical Rating Scale (NRS) or Visual Analog Scale (VAS).Results: The results of the multivariable Cox proportional hazards regression analysis revealed that pain intensity was significantly associated with mortality (HR: 1.82, 95% CI: 1.45 - 2.28, p < 0.001). After adjusting for age, comorbidities, and surgical procedures, each unit increase in pain intensity was associated with a 1.82-fold increase in the hazard of mortalityConclusion: Our study highlights the significant association between pain intensity and mortality following sinonasal mucormycosis surgery. Effective pain management plays a crucial role in optimizing outcomes for patients undergoing surgical treatment for mucormycosis, and efforts to improve pain control should be integrated into perioperative care protocols.
Medicine
Parham Maroufi; Mahdi Nazari
Abstract
Introduction: This systematic review aims to evaluate the analgesic effect of intravenous dexamethasone in patients undergoing volar plate surgery for distal radius fractures. The findings of this review will provide valuable insights into the potential role of dexamethasone as an adjunctive analgesic ...
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Introduction: This systematic review aims to evaluate the analgesic effect of intravenous dexamethasone in patients undergoing volar plate surgery for distal radius fractures. The findings of this review will provide valuable insights into the potential role of dexamethasone as an adjunctive analgesic agent in this surgical setting. By synthesizing the available evidence, this review aims to contribute to the existing literature and guide clinical decision-making regarding postoperative pain management strategies. Material and Methods: Data extraction was performed independently by two reviewers using a standardized data extraction form. The following information was collected: study characteristics (author, year of publication, study design), patient demographics (sample size, age, sex), surgical details (type of volar plate surgery, anesthesia technique), intervention details (dose, timing, and duration of intravenous dexamethasone administration), control group characteristics, outcome measures, and relevant results. Any discrepancies were resolved through discussion and consensus. Results: The primary outcome measure assessed in the included studies was postoperative pain intensity. Pain intensity scores were evaluated using various validated pain rating scales, including the visual analog scale (VAS) and numerical rating scale (NRS). Secondary outcome measures included postoperative opioid consumption, time to first analgesic request, duration of analgesic effect, adverse effects related to dexamethasone administration, and patient satisfaction scores. Conclusion: this systematic review provides evidence supporting the analgesic effect of intravenous dexamethasone following volar plate surgery for distal radius fractures. Dexamethasone effectively reduces postoperative pain intensity, opioid consumption, and the need for rescue analgesia. The sustained analgesic effect and favorable safety profile make dexamethasone a promising adjunctive analgesic in this surgical setting.
Medicine
Ali Sharifi; Abbasali Dehghani
Abstract
Introduction: Gastrectomy plays a central role in the management of gastric cancer, and its short-term outcomes have significant implications for patient care and treatment decisions. Surgical morbidity, postoperative recovery, length of hospital stays, and the impact of minimally invasive techniques ...
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Introduction: Gastrectomy plays a central role in the management of gastric cancer, and its short-term outcomes have significant implications for patient care and treatment decisions. Surgical morbidity, postoperative recovery, length of hospital stays, and the impact of minimally invasive techniques and lymph node dissection are all critical factors to consider.Material and Methods: This study aimed to investigate the short-term outcomes of gastrectomy for patients with gastric cancer. A retrospective cohort study design was employed to analyze data from a single-center database. The study period spanned from 2019 to 2020.Results: Subgroup analyses were conducted to identify factors associated with surgical morbidity. Multivariable logistic regression analysis revealed that advanced tumor stage (2.25 95% CI, 2.11-3.19), open surgical approach (5.51 95% CI: 4.88-7.19), and a higher Clavien-Dindo classification (5.595% CI: 5-12.3) were independent predictors of surgical morbidity. These findings highlight the importance of early detection and management of complications, as well as the potential benefits of minimally invasive techniques in reducing surgical morbidity (fig 3).Conclusion: In conclusion, the study on short-term outcomes of gastrectomy in patients with gastric cancer provides valuable insights into the potential risks and benefits associated with the surgical procedure. It emphasizes the need for careful patient selection, meticulous surgical techniques, and comprehensive postoperative care to optimize outcomes and enhance patient satisfaction. Further research is warranted to explore long-term oncological outcomes and survival to provide a more comprehensive understanding of the overall impact of gastrectomy in the treatment of gastric cancer.
Medicine
Mohammad Reza Moharrami; Mahdi Nazari
Abstract
Introduction: This systematic review aims to compare the efficacy and safety of low-dose intravenous ketamine-midazolam with intravenous morphine for pain control in patients with hand fractures. By synthesizing the available evidence, we seek to provide clinicians with valuable insights into the potential ...
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Introduction: This systematic review aims to compare the efficacy and safety of low-dose intravenous ketamine-midazolam with intravenous morphine for pain control in patients with hand fractures. By synthesizing the available evidence, we seek to provide clinicians with valuable insights into the potential benefits and limitations of these analgesic strategies, aiding in informed decision-making for optimal pain management in this patient population. Material and Methods: This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure transparency and methodological rigor in the review process. Results: The primary outcome of pain control was assessed using various pain scales, including the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS). The majority of studies reported comparable pain control between low-dose ketamine-midazolam and intravenous morphine. Both analgesic regimens resulted in significant pain reduction. A subset of studies demonstrated that low-dose ketamine-midazolam provided superior pain control compared to intravenous morphine, particularly in the immediate post-intervention period. However, the overall evidence regarding the superiority of one regimen over the other was inconclusive due to variations in study designs, sample sizes, and outcome measures. Conclusion: Low-dose intravenous ketamine-midazolam and intravenous morphine are both effective analgesic regimens for pain control in patients with hand fractures. While the evidence regarding the superiority of one regimen over the other remains inconclusive, low-dose ketamine-midazolam appears to offer comparable pain control with reduced opioid consumption anda favorable safety profile.
Medicine
Saeid Charsouei; Mohsen Mohammadrahimi
Abstract
Introduction: Neuropathic post-surgical pain (NPSP) is a debilitating condition that can occur following surgical procedures, including radical prostatectomy. Preoperative pain has emerged as a potential risk factor for the development of NPSP, suggesting that early identification and management of preoperative ...
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Introduction: Neuropathic post-surgical pain (NPSP) is a debilitating condition that can occur following surgical procedures, including radical prostatectomy. Preoperative pain has emerged as a potential risk factor for the development of NPSP, suggesting that early identification and management of preoperative pain may play a crucial role in preventing NPSP. This study aimed to investigate the association between preoperative pain and NPSP following radical prostatectomy, providing valuable insights into the pathophysiology and prevention of NPSP. Material and Methods: Following surgery, participants were followed up for a period of six months to assess the development of NPSP. Postoperative pain assessments were conducted at regular intervals, including one week, one month, three months, and six months after surgery. Pain intensity was evaluated using the NRS, and pain characteristics were assessed using validated neuropathic pain assessment tools, such as the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and the Douleur Neuropathique 4 Questions (DN4) questionnaire. Results: Functional impairment and quality of life were also significantly affected in patients with NPSP. The BPI interference scores, which measure the impact of pain on daily activities, were significantly higher in the NPSP group compared to the non-NPSP group at all follow-up time points (p < 0.001). Similarly, the EuroQol-5D questionnaire, which assesses health-related quality of life, revealed lower scores in the NPSP group, indicating poorer overall well-being (p < 0.001). Conclusion: this study highlights the significance of preoperative pain as a risk factor for the development of NPSP following radical prostatectomy. Patients with preoperative pain are at a significantly higher risk of experiencing NPSP, which is associated with higher pain intensity, functional impairment, and decreased quality of life. Efforts should be made to implement preoperative pain assessment protocols and optimize pain management strategies to minimize the risk of NPSP and improve postoperative outcomes.
Medicine
Giti Dehghan Manshadi; Nina Pilehvar
Abstract
Introduction: Anesthesia for elective neurosurgery requires a comprehensive understanding of the unique considerations and challenges associated with neurophysiology, cerebral perfusion, and the prevention of complications. This systematic review aims to provide a comprehensive synthesis of the current ...
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Introduction: Anesthesia for elective neurosurgery requires a comprehensive understanding of the unique considerations and challenges associated with neurophysiology, cerebral perfusion, and the prevention of complications. This systematic review aims to provide a comprehensive synthesis of the current evidence regarding anesthesia management in elective neurosurgical procedures. Material and Methods: Two independent reviewers screened the titles and abstracts of the identified studies for eligibility. Any discrepancies were resolved through discussion and consensus. Full-text articles of potentially relevant studies were then assessed for inclusion based on the predetermined criteria. Data extraction was performed using a standardized form, including study characteristics (e.g., study design, sample size), patient demographics, type of neurosurgical procedures, anesthesia techniques, intraoperative monitoring methods, hemodynamic management strategies, pain control methods, and reported outcomes. Results: Optimal hemodynamic management was crucial in maintaining cerebral perfusion and preventing ischemic or hemorrhagic complications. Individualized blood pressure targets, guided by cerebral autoregulation monitoring or transcranial Doppler, were associated with improved outcomes compared to general blood pressure targets. Goal-directed fluid therapy, guided by stroke volume variation or cardiac output monitoring, facilitated appropriate fluid administration and reduced the risk of cerebral edema. Conclusion: This systematic review provides valuable insights into anesthesia management in elective neurosurgery. The findings suggest that tailored approaches, such as TIVA, volatile anesthetics, and balanced anesthesia, can be employed based on patient-specific factors. Intraoperative monitoring techniques, including EEG, SSEPs, MEPs, and cerebral oximetry, contribute to patient safety and guide anesthesia management.
Medicine
Seyed Vahid Seyed Hosseini
Abstract
This abstract provides a concise summary of the comparison of laparoscopy versus open appendectomy results. Appendectomy, the surgical removal of the appendix, is the standard treatment for acute appendicitis. Laparoscopic appendectomy (LA) and open appendectomy (OA) have emerged as the primary surgical ...
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This abstract provides a concise summary of the comparison of laparoscopy versus open appendectomy results. Appendectomy, the surgical removal of the appendix, is the standard treatment for acute appendicitis. Laparoscopic appendectomy (LA) and open appendectomy (OA) have emerged as the primary surgical approaches. This review aims to compare the outcomes of LA and OA, including efficacy, safety, postoperative complications, and patient satisfaction. Multiple comparative studies consistently demonstrate comparable efficacy between LA and OA in terms of successful appendix removal. LA offers excellent visualization and accurate identification of the appendix, while OA allows for direct visualization and tactile feedback during the procedure. In terms of safety, LA has advantages such as shorter operative times, reduced blood loss, decreased postoperative pain, and reduced wound infections. OA, despite a larger incision, allows for better exposure and control of bleeding. Postoperative complications show that LA has a lower risk of wound infections, incisional hernias, and postoperative pain. However, LA may have a slightly higher risk of intra-abdominal abscess formation. OA has comparable rates of complications to LA. Patient satisfaction is high for both LA and OA. LA provides advantages such as reduced postoperative pain, smaller incisions, improved cosmetic results, shorter hospital stays, and faster return to normal activities. OA offers immediate symptom relief and the ability to address other intra-abdominal pathologies. In conclusion, both LA and OA are effective and safe approaches for appendectomy. The choice between the two should consider individual patient factors and surgeon expertise. Further research will continue to refine outcomes and inform decision-making for optimal patient care.
Medicine
Sanaz Yasrebinia; Mansour Rezaei
Abstract
Introduction: This study aiming to provide vital insights into the potential impacts of these treatment modalities (morphine or methadone) on the neurodevelopmental trajectories of Neonatal Abstinence Syndrome (NAS) -affected infants. By investigating the potential disparities in neurodevelopmental outcomes ...
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Introduction: This study aiming to provide vital insights into the potential impacts of these treatment modalities (morphine or methadone) on the neurodevelopmental trajectories of Neonatal Abstinence Syndrome (NAS) -affected infants. By investigating the potential disparities in neurodevelopmental outcomes associated with morphine and methadone, we aspire to inform evidence-based treatment decisions and refine the standard of care for NAS.Material and Methods: Eight participating locations included 116 full-term newborns diagnosed with NAS, born to mothers under methadone or buprenorphine maintenance, who were enrolled in a randomized trial comparing morphine to methadone. Upon hospital discharge, 99 of these infants (representing 85% of the cohort) underwent assessment using the NICU Network Neurobehavioral Scale (NNNS). At the 18-month mark, 83 out of the 99 infants (approximately 83.8%) underwent evaluation employing the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III), while the Child Behavior Checklist (CBCL) was administered to 77 of the 99 infants (around 77.7%).Results: Our adjusted analyses further revealed that internalizing and total behavior problems were linked to the utilization of phenobarbital (p=0.03 and p=0.04, respectively), elevated levels of maternal psychological distress (as measured by the Brief Symptom Inventory) (both p<0.01), and the presence of infant medical issues (both p=0.02). Additionally, externalizing problems were associated with maternal psychological distress (p<0.01) and continued maternal substance use (p<0.01).Conclusion: Neonates administered either morphine or methadone exhibited comparable neurobehavioral outcomes in both the short and long term. The neurodevelopmental progress of these infants may be associated with factors such as the requirement for phenobarbital, the general health of the infant, and the quality of postnatal caregiving.
Medicine
Sanaz Yasrebinia; Mansour Rezaei
Abstract
Introduction: As the global community strives to ensure the health and well-being of mothers and newborns, AI emerges as a powerful ally in this noble endeavor. Through this systematic review, we seek to provide a comprehensive overview of the state of AI-driven mortality prediction, offering insights ...
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Introduction: As the global community strives to ensure the health and well-being of mothers and newborns, AI emerges as a powerful ally in this noble endeavor. Through this systematic review, we seek to provide a comprehensive overview of the state of AI-driven mortality prediction, offering insights that may shape the future of maternal and neonatal healthcare and bring us closer to the goal of ensuring safe pregnancies and healthy beginnings for all. Material and methods: We systematically reviewed the literature, restricting our search to publications from the past decade, and utilized the five major scientific databases as primary sources. Results: Out of the initial pool of 671 works, a total of 18 primary studies were meticulously chosen for in-depth analysis. It was evident that a predominant focus of these studies revolved around the prediction of neonatal mortality, predominantly employing machine learning models, with Random Forest being a popular choice. The top five frequently utilized features for model training encompassed birth weight, gestational age, the child's gender, Apgar score, and the mother's age. The development of predictive models for mitigating mortality during and after pregnancy holds immense potential, not only for enhancing the quality of life for mothers but also as a potent and cost-effective tool for reducing mortality rates. Conclusion: Drawing from the findings of this systematic review, it becomes evident that substantial scientific endeavors have been undertaken in this domain. However, it is equally apparent that numerous unexplored research avenues and opportunities await further exploration within the research community.
Medicine
Saman Nasrollazadeh; Behrooz Nazari; Mohammad Irajian
Abstract
Introduction: Volar plate arthroplasty has proven to be an effective surgical intervention for addressing PIP joint pathologies. However, postoperative pain management remains a significant challenge in achieving optimal outcomes. Dorsal blocking pinning has emerged as a potential solution to reduce ...
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Introduction: Volar plate arthroplasty has proven to be an effective surgical intervention for addressing PIP joint pathologies. However, postoperative pain management remains a significant challenge in achieving optimal outcomes. Dorsal blocking pinning has emerged as a potential solution to reduce pain and improve patient satisfaction. By limiting dorsal translation and extension of the PIP joint, this technique may provide additional stability, alleviate discomfort, and promote better healing. Material and Methods: All surgeries were performed by a single experienced orthopedic surgeon specializing in hand surgery. The volar plate arthroplasty technique involved a standard approach with a volar incision, exposure and reduction of the PIP joint, and fixation with a volar plate. In the dorsal blocking pinning group, an additional step was performed following the volar plate fixation. A 1.6 mm Kirschner wire was inserted dorsally into the PIP joint, providing additional stability and limiting dorsal translation and extension of the joint. Results: Pain intensity scores were assessed using the visual analog scale (VAS) at multiple time points postoperatively. In the dorsal blocking pinning group, a significant reduction in pain intensity was observed over time (p<0.001). At 24 hours after surgery, the mean pain score was 6.8 ± 1.2. By 1 week, the pain intensity decreased to 4.2 ± 0.9, and further decreased to 2.1 ± 0.6 at 4 weeks. At the final follow-up of 12 weeks, the mean pain score was 1.5 ± 0.4, indicating a substantial reduction in pain compared to the immediate postoperative period. Conclusion: This study provides evidence supporting the role of dorsal blocking pinning in reducing pain in the PIP joint following volar plate arthroplasty. The additional stability provided by the dorsal blocking pin contributes to improved pain management and potentially enhances patient comfort and satisfaction.
Medicine
Moen Hosein Pour Feyzi; Ahmad Sheykhloo
Abstract
Thyroidectomy is a common surgical procedure performed to treat various thyroid disorders. In recent years, advancements in surgical techniques and perioperative management have contributed to improved outcomes and reduced complications. This scoping review aims to provide a comprehensive overview of ...
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Thyroidectomy is a common surgical procedure performed to treat various thyroid disorders. In recent years, advancements in surgical techniques and perioperative management have contributed to improved outcomes and reduced complications. This scoping review aims to provide a comprehensive overview of modern surgical techniques and perioperative complications management in thyroidectomy. The review encompasses a wide range of literature, including original research studies, systematic reviews, and clinical guidelines. It explores various modern surgical techniques employed in thyroidectomy, such as minimally invasive approaches (e.g., endoscopic and robotic-assisted), intraoperative nerve monitoring, and indocyanine green fluorescence imaging. The benefits, limitations, and outcomes associated with these techniques are discussed, highlighting their impact on surgical precision, postoperative recovery, and patient satisfaction. Additionally, the review addresses the perioperative complications management in thyroidectomy, focusing on key areas such as bleeding, recurrent laryngeal nerve injury, hypocalcemia, and surgical site infection. It discusses the identification and management of risk factors, the role of advanced imaging and monitoring techniques, and the importance of multidisciplinary collaboration in optimizing patient outcomes. Overall, this scoping review provides a comprehensive synthesis of the current evidence on modern surgical techniques and perioperative complications management in thyroidectomy. It serves as a valuable resource for surgeons, healthcare professionals, and researchers, offering insights into the advancements, challenges, and future directions in this field, ultimately contributing to improved patient care and surgical practice.
Medicine
Elizabet Hitachi
Abstract
It is important to talk comfortably with the patient and their family about the risk factors for coronary heart disease. The patient should know that if these factors such as nutrition and exercise are controlled, other factors such as heredity cannot be very effective. Research has shown that a person ...
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It is important to talk comfortably with the patient and their family about the risk factors for coronary heart disease. The patient should know that if these factors such as nutrition and exercise are controlled, other factors such as heredity cannot be very effective. Research has shown that a person without ischemia can develop ischemia within a year. Recommendations regarding the risk factors for smoking cessation, maintaining blood pressure, low-fat diet and taking medication as needed, participating in regular aerobic exercise, diabetes control, stress management, BODY FAT less than 18-22% are important. Do not use previous medications, if they have not been prescribed after surgery, do not change or stop medications without a doctor's prescription, use medications at their own time, if you forget to take one dose, take only the next dose and do not use it repeatedly. Daily and weekly use of medicines can be used, consult a doctor to use over-the-counter medicines such as painkillers, syrups, herbal medicines to be aware of their interactions and side effects, along with medicines when traveling, in case of flight by plane. Do not leave medicines in the car or in the sun, contact your doctor to maintain the long-term effectiveness of medicines and prevent possible side effects.
Medicine
Fransis Harvardy
Abstract
Indication when upper airway obstruction due to soft tissue or tongue (excluding epiglottis) in a conscious or unconscious patient with a healthy gag reflex and when extensive tissue damage around the mouth and jaw and chin wiring is not possible. It is used in the case of pharyngeal edema or excessive ...
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Indication when upper airway obstruction due to soft tissue or tongue (excluding epiglottis) in a conscious or unconscious patient with a healthy gag reflex and when extensive tissue damage around the mouth and jaw and chin wiring is not possible. It is used in the case of pharyngeal edema or excessive nasal discharge in children to reduce soft tissue damage when nasal tracheal suctioning is frequently required. Nasal airway placement stimulates the patient's nausea reflex. If the tube is too long, it may enter the esophagus and cause the stomach to dilate. Epistaxis may occur and cause blood to be aspirated. The nasal airway should not be used for patients with extensive facial trauma or a fracture of the basilar portion of the cranial base. Choose the nostril that is larger and more open. Examine the passageway for trauma and foreign body wall deviation or polyps. Prepare suction devices for use if necessary. Measure the length of the nasopharyngeal airway from the tip of the nose to the edge of the ear. Nasal bleeding, aspiration, secondary hypoxia with incorrect placement. The endotracheal tube may be inserted through the nose or mouth. The placement method is visible using a laryngoscope and blindly through the nose. The goal is to establish a safe and efficient air route. Protection of trachea and lungs from aspiration of gastric, blood, and fluid contents from airway compartments, airway for mechanical ventilation, direct access to lungs for excretion or suction, discharge of emergency drugs for rapid absorption through bronchial tree.
Medicine
Leila Mahboobi; Babak Sandoghchian Shotorbani
Abstract
This case report delves into the intricate management of a 7-year-old girl suffering from Chronic Recurrent Multifocal Osteomyelitis (CRMO), highlighting the pivotal role of Meloxibell, a medication integrating Meloxicam, in her treatment. The patient presented with severe knee pain, progressing to hip ...
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This case report delves into the intricate management of a 7-year-old girl suffering from Chronic Recurrent Multifocal Osteomyelitis (CRMO), highlighting the pivotal role of Meloxibell, a medication integrating Meloxicam, in her treatment. The patient presented with severe knee pain, progressing to hip pain and lameness, prompting referral to the Department of Pediatric Rheumatology. With no underlying diseases in the patient or her parents, diagnostic evaluations revealed elevated CRP and ESR levels. Imaging studies, including ultrasound and MRI, unveiled multifocal bone involvement, and subsequent biopsies confirmed the diagnosis of CRMO. Hospitalization ensued, during which vital signs remained stable, and comprehensive tests yielded normal results. Meloxibell, administered at 7.5mg, demonstrated remarkable efficacy, resulting in the alleviation of symptoms and subsequent discharge. This case underscores the diagnostic challenges inherent in CRMO and sheds light on the potential of Meloxibell as an effective therapeutic agent. The successful outcome observed prompts consideration of Meloxibell as a valuable addition to CRMO management, warranting further research to elucidate its long-term efficacy and safety profile. As CRMO continues to pose diagnostic and therapeutic challenges, this case report contributes valuable insights to the evolving landscape of pediatric rheumatology, emphasizing the need for individualized treatment approaches in this complex disorder.
Medicine
Reza Eghdam Zamiri; Saeid Charsouei
Abstract
Introduction: The exploration of biomarker profiles in breast carcinoma with nervous system metastasis represents a critical frontier in cancer research. This endeavor holds the potential to revolutionize diagnostic accuracy, prognostic precision, and therapeutic strategies for patients grappling with ...
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Introduction: The exploration of biomarker profiles in breast carcinoma with nervous system metastasis represents a critical frontier in cancer research. This endeavor holds the potential to revolutionize diagnostic accuracy, prognostic precision, and therapeutic strategies for patients grappling with this aggressive form of cancer. As research progresses, the integration of biomarker information into clinical practice may usher in a new era of personalized medicine, offering hope for improved outcomes and a better quality of life for those affected by breast carcinoma with nervous system metastasisMaterial and Methods: This retrospective study analyzed 150 breast carcinoma patients with nervous system metastasis. Clinical data were sourced from records, and tissue samples underwent immunohistochemistry and gene expression profiling. Statistical analyses, including survival curves, explored biomarker associations. A 75-patient validation cohort supported findings.Results: Microarray analysis of gene expression profiles identified distinct molecular signatures associated with nervous system metastasis. Pathway enrichment analysis revealed upregulation of genes associated with cell migration, angiogenesis, and neuroinflammation.Conclusion: Our exploration of biomarker profiles in breast carcinoma patients with nervous system metastasis has provided a nuanced perspective on the molecular intricacies of this formidable disease. The integration of clinical, pathological, and molecular data has facilitated a comprehensive understanding of the heterogeneity inherent in nervous system metastasis.
Medicine
Melika Shojaei
Abstract
A B S T R A C TIntroduction: Since its release, ChatGPT has taken the world by storm with its utilization in various fields of life. This review's main goal CHATGPT is a CHATGPT developed by Open AI. This robot is trained with the help of artificial intelligence on a large amount of data to learn language ...
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A B S T R A C TIntroduction: Since its release, ChatGPT has taken the world by storm with its utilization in various fields of life. This review's main goal CHATGPT is a CHATGPT developed by Open AI. This robot is trained with the help of artificial intelligence on a large amount of data to learn language patterns. In the medical application of CHATGPT, the main topic is the conversation between doctors and patients. Method: In this study we searched in Scopus, Google scholar, PubMed databases and by searching with keywords such as "Nursing Services", "Importance of CHATGPT” and “Medical Education” during 2018-2024 to obtain articles related to the selected keywords. This innovation has the potential to automate daily tasks such as generating patient records or writing reports. By studying more than 45 articles about CHATGPT and the role of artificial intelligence in medicine, the results of this study showed that CHATGPT, with its very high potential, can play an important role in the field of interactions between humans and artificial intelligence and intelligent systems in the future. Results: The move towards the use of artificial intelligence in medicine, which is informed by patient information, can provide more personalized and clinically accurate answers to patients. Also, according to the findings of this research, it can be said: Automating administrative functions, scheduling visits, simplifying notes, checking insurance approvals for drugs, and other repetitive daily tasks can reduce the focus on administrative tasks and more time for providing medical care in to authorize the personnel. Conclusion: In this research, the researchers noticed the mistakes of CHATGPT chat bot in creating cancer treatment programs. According to these researchers, this chat bot had provided one-third of its answers in the field of designing treatment programs with incorrect information.
Medicine
Albert Indonis
Abstract
It is a type of paroxysmal supraventricular tachycardia that appears suddenly following a sinus rhythm and drains suddenly. This rhythm may be caused by the rapid evacuation of an atrial fibrillation at a rate of 160-250 beats per minute, or conduction problems in the AV node, called AV node rotational ...
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It is a type of paroxysmal supraventricular tachycardia that appears suddenly following a sinus rhythm and drains suddenly. This rhythm may be caused by the rapid evacuation of an atrial fibrillation at a rate of 160-250 beats per minute, or conduction problems in the AV node, called AV node rotational tachycardia. In this way, an impulse is directed to an area of the AV node that causes the impulse to return repeatedly and rapidly from the same area (they have a shorter excitation phase) and each time the impulse is directed from this area to the ventricular side is also moved, causing a rapid ventricular response. Atrial tachycardia can be detected by three or more irregular atrial beats in a row with a rate of 250-220-250 beats per minute alternating with a normal sinus rhythm. Although PAT is also seen in clients with a healthy heart, it is often an underlying heart disease. Caffeine, nicotine, stress, hypoxemia, extreme fatigue, alcohol consumption, rheumatic heart disease, pulmonary embolism, cardiopulmonary disease, thyrotoxicosis, digitalis intoxication and heart surgery can trigger PAT. PAT reduces ventricular filling time and mean arterial pressure and increases myocardial oxygen demand. Clinical symptoms vary according to the rate and duration of tachycardia and the underlying cause. If the duration of dysrhythmia is short, the patient complains of palpitations and confusion. But if it reduces cardiac output, signs and symptoms such as restlessness, chest pain, shortness of breath, paleness, hypotension and decreased level of consciousness occur.
Medicine
Albert Indonis
Abstract
The lateral branches are bypass grafts that run along the chest wall and are the beginning of where the right or left internal mammary arteries connect to the LAD artery to restore blood flow. Patients undergoing CPB surgery are more likely to bleed than patients undergoing Off Eump surgery. Also, lowering ...
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The lateral branches are bypass grafts that run along the chest wall and are the beginning of where the right or left internal mammary arteries connect to the LAD artery to restore blood flow. Patients undergoing CPB surgery are more likely to bleed than patients undergoing Off Eump surgery. Also, lowering the body temperature for a while leads to a decrease in platelet function. Preoperative evaluations, including platelet count and function, correct hematocrit that determines blood volume, reduce the risks and complications of intraoperative and postoperative bleeding. Heart surgery patients should be routinely treated for coagulation disorders, hereditary, hemophilia, and von Willer's disease, and acquired infections such as lupus and lymphocytic leukemia, and recent use of OTC medications such as aspirin and ibuprofen, and dietary alternatives such as Vit E, Ginseng, and garlic. Get information about anything that interferes with coagulation. Taking antithrombotic drugs, which play an important role in the prevention and treatment of cardiovascular disease, can lead to bleeding. Such as the anticoagulants heparin, Lepirudin, and antiplatelet drugs such as aspirin, clopidogrel, which protect platelets from thio. Patients receiving highly effective anticoagulants and requiring emergency surgery can be tested with the high-sensitivity p2y12 test. This test shows that some people may be ready for surgery in as little as 1 to 2 days. Patients undergoing elective surgery should discontinue high-dose antiplatelet drugs such as glupidergrol for at least 5 to 7 days and low-potency drugs such as aspirin 1 to 3 days before surgery to reduce the risk of bleeding. Patients taking warfarin should stop taking it at least 5 days before surgery. Some may need vitamin K or a combination with FFP to counteract the effects of warfarin. This process can generally take between 6 and 8 hours.
Medicine
Amir Heydarian; Baharak Najafi Fakhraei Azar
Abstract
Drug poisoning is a critical public health issue with significant implications for morbidity and mortality. This scoping review aims to provide a comprehensive overview of drug poisoning, focusing on epidemiology, diagnostic methods, management, and treatment. By systematically mapping the existing literature, ...
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Drug poisoning is a critical public health issue with significant implications for morbidity and mortality. This scoping review aims to provide a comprehensive overview of drug poisoning, focusing on epidemiology, diagnostic methods, management, and treatment. By systematically mapping the existing literature, we aim to identify the current state of knowledge in these areas and highlight gaps for future research. Preliminary findings suggest that drug poisoning affects diverse populations and involves a range of substances, including prescription medications, illicit drugs, and over-the-counter products. The epidemiology of drug poisoning varies across regions, with different patterns of substance use and associated risks. Diagnostic methods for drug poisoning encompass clinical assessment, toxicology screenings, and laboratory tests, with advancements in technology enhancing accuracy and efficiency. Management and treatment strategies for drug poisoning include supportive care, decontamination procedures, antidote administration, and psychotherapy interventions. Despite advancements in understanding drug poisoning, significant gaps remain in the literature. Limited research exists on specific populations, such as pediatric and geriatric patients, and the long-term consequences of drug poisoning. Additionally, more studies are needed to evaluate the effectiveness of various management and treatment approaches. This scoping review provides a foundation for future research and practice in drug poisoning. By synthesizing the current knowledge on epidemiology, diagnostic methods, management, and treatment, we aim to inform evidence-based interventions and improve patient outcomes.
Medicine
Leila Mahboobi; Babak Sandoghchian Shotorbani
Abstract
Introduction: FMF is a genetic disorder characterized by recurrent episodes of fever and inflammation, primarily affecting individuals of Mediterranean origin. The disease is caused by mutations in the MEFV gene, which exhibit variations in their distribution among different populations. The identification ...
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Introduction: FMF is a genetic disorder characterized by recurrent episodes of fever and inflammation, primarily affecting individuals of Mediterranean origin. The disease is caused by mutations in the MEFV gene, which exhibit variations in their distribution among different populations. The identification of specific mutations is critical for the diagnosis, management, and genetic counseling of FMF patients.Material and Methods: Blood samples were collected from each participant for genetic analysis. Genomic DNA was extracted from the blood samples using a standard DNA extraction kit. The extracted DNA was then subjected to polymerase chain reaction (PCR) amplification of the MEFV gene exons using specific primers. The PCR products were sequenced using Sanger sequencing technology to identify the presence of mutations in the MEFV geneResults: The association between the presence of mutations in the MEFV gene and clinical manifestations was further analyzed using chi-square tests. The results indicated a statistically significant association between the M694V mutation and the presence of fever episodes (p<0.001), abdominal pain (p<0.001), and joint involvement (p<0.001). Similarly, the V726A mutation was significantly associated with the presence of fever episodes (p<0.001), abdominal pain (p<0.001), and joint involvement (p<0.001).Conclusion: our study provides valuable insights into the distribution of MEFV gene mutations in patients with FMF. The identification of specific mutations and their association with clinical manifestations contributes to a better understanding of FMF pathogenesis and can aid in the diagnosis and management of affected individuals. The M694V, V726A, M680I, and E148Q mutations were the most common mutations observed, with the majority of mutations located in exon 10 of the MEFV geneencoding the B30.2 domain of the pyrin protein.
Medicine
Mehrnoosh Rassam; Abbasali Dehghani; Ramin Azhough
Abstract
Introduction: pilonidal sinus disease can have a substantial impact on patients' quality of life, necessitating effective surgical management. Pilonidal sinus surgery using hook circulators represents a minimally invasive technique that has gained popularity in recent years. However, the effect of this ...
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Introduction: pilonidal sinus disease can have a substantial impact on patients' quality of life, necessitating effective surgical management. Pilonidal sinus surgery using hook circulators represents a minimally invasive technique that has gained popularity in recent years. However, the effect of this surgical approach on patients' quality of life remains relatively unexplored. This article aims to bridge this gap by investigating the quality of life outcomes following pilonidal sinus surgery using hook circulators.Material and Methods: Following surgery, patients were followed up at regular intervals to assess their postoperative recovery and quality of life outcomes. Postoperative assessments were conducted at 1 month, 3 months, and 6 months after surgery. The same standardized instruments (PSSS, DLQI, and SF-36) used in the preoperative assessment were administered to evaluate changes in quality of life over time.Results: The SF-36 assesses multiple domains of quality of life, including physical functioning, role limitations, pain, general health, vitality, social functioning, emotional well-being, and mental health. The mean preoperative SF-36 score was 58.7 (range: 40-75). At the 1-month follow-up, there were significant improvements in all domains of the SF-36 (p<0.001). The improvements were sustained at the 3-month and 6-month follow-ups, with mean scores ranging from 60.2 to 66.8.Conclusion: pilonidal sinus surgery with hook circulators demonstrates significant improvements in quality of life outcomes, including symptom relief and enhanced overall well-being. The surgical technique is associated with successful outcomes and a low rate of complications.
