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Background: This study was designed and implemented to investigate the addition of dexmedetomidine to Serratus Anterior Plane Block (SAP) with ropivacaine in reducing pain in patients undergoing post-thoracotomy surgery. Methods: This study included patients classified as American Society of Anesthesiology (ASA) Physical Status II, with a body mass index (BMI) under 40, who were undergoing thoracotomy at Imam Khomeini Hospital in Ahvaz. The subjects were randomly divided into two groups using a randomized controlled trial design. After surgery, in the recovery room, SAP was performed for patients with ropivacaine (0.4 ml/kg of 0.2% ropivacaine solution) (group R) and ropivacaine plus dexmedetomidine (0.5 μg/kg) (group RD). Pain (with verbal rating scale, VNRS), blood pressure (systolic, diastolic, and mean arterial pressure (MAP)), heart rate (HR), and blood oxygen saturation (O2 sat) were measured and recorded before the intervention, and 1, 6, 12, 24, and 48 h after the intervention. Results: Finally, 74 patients were included in this study. Both groups exhibited significant pain reduction at one hour, with sustained pain relief observed in the RD group at 6, 12, and 24 h (P < 0.001). The RD group also showed having lower values HR and MAP at 6 and 12 h (P < 0.001). Patients in the RD group received painkillers faster (P = 0.005) and required lower total narcotic usage (P < 0.0001). Two RD group patients experienced transient bradycardia, which resolved without treatment. Conclusion: The findings of this study show that SAP block with dexmedetomidine is an effective and safe drug along with ropivacaine as a nerve-blocking agent in thoracotomy candidates. [ABSTRACT FROM AUTHOR]

Objective: Preparing patients for emergency surgeries requires accurate consideration of their clinical condition andmedical history to avoid potential hemodynamic instability and compromise the immune system. This study aims to compare the effects of dexmedetomidine and magnesium sulfate infusions in maintaining stable hemodynamics during emergency orthopedic surgery. Effective pain management in mandibular fractures is crucial due to the complications associated with opioids, such as respiratory depression and re-intubation. Non-opioid methods are therefore important. This study aims to compare the effectiveness, safety, and efficiency of intranasal (IN) versus intravenous (IV) dexmedetomidine (Dex) for reducing acute pain following mandibular surgery. Methods: This study was a randomized, double-blind clinical trial. All patients underwent general anesthesia, laryngoscopy, and intubation in a standardized manner. For the IN administration group, Dex was prescribed at a dose of 0.2 µ/kg (in the form of drops) half an hour before the start of anesthesia. For the IV administration group, Dex was administered at a dose of 0.5 µ/kg intravenously over ten minutes, half an hour before anesthesia. During the first 24 hours after surgery, pain intensity and the total amount of opioid medication (measured in mg of pethidine) were recorded for each patient. Results: There was no significant difference in pain intensity between the two groups in the post-anesthesia care unit (P=0.898), one hour (P=0.052) and 24 hours post-surgery (P=0.898). However, pain intensity was significantly lower in the INDex group at the second (P=0.044), fourth (P=0.041), sixth (P=0.048), and twelfth (P=0.025) hours. Total pethidine injected in the IN Dex group was significantly lower than in the IV Dex group (P=0.041). Conclusion: This study underscores the efficacy of IN Dex as a viable alternative for postoperative pain management in traumatic mandibular fracture surgeries. [ABSTRACT FROM AUTHOR]

Introduction: Sleep quality is the main concern of patients after cardiac surgery. We compared the effect of two routinely used sedatives on the sleep quality of patients admitted to the intensive care unit (ICU) after cardiovascular surgery. Methods: It is a prospective, controlled, randomized clinical trial. A total of 120 patients, after cardiac surgery were enrolled. During extubating, patients were randomized into two groups: 60 patients received an infusion of dexmedetomidine (precede; 0.5 μg/kg/h), and 60 patients received 50 μg/kg/min propofol for 6 hours. Baseline characteristics were compared between the groups. The patients completed the St. Mary's Hospital Sleep Questionnaire, and the scores were compared between the groups. Results: The groups were not different in terms of demographics, underlying diseases, smoking/drug abuse/alcohol, number of vessels involved, history of non-cardiac surgery, and mean levels of serum parameters (P >0.05). Most of the medications used were similar between the groups (P >0.05), except calcium channel blockers (more frequently used in the propofol group [ P =0.027). The details of surgery were not statistically significant different (P >0.05); but, the mean volume of platelet received after the surgery was higher in propofol group (P =0.03). The propofol group had less problems with last night's sleep (0 vs 0.1±0.66), felt more clear-headed (4.9±0.6 vs 4.68±0.58, were more satisfied with their last night's sleep (52.1% vs 47.9%), but spent more time getting into sleep (0.38±1.67 vs 0) (P <0.5).> Conclusion: The sleep quality of patients under the influence of propofol seemed to be better than dexmedetomidine after cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Iran has been one of the most affected countries in the world by COVID-19. The aim of our study was to determine the outcome of COVID-19 in patients with inflammatory bowel disease (IBD). Furthermore, we analyzed the outcome of SARS-CoV-2 infection in patients with IBD treated with immunosuppressant. Materials and Methods: This is a cross-sectional, observational study. This study included all patients with IBD, regularly followed up in our IBD Clinic at a tertiary medical center from February 5th, 2020 to August 5th, 2022. We identified those patients with confirmed SARS-CoV-2 infection either by PCR test or chest computed tomography (CT) imaging. Results: A total of 401 patients were recruited (n=346 [86.28%] with ulcerative colitis, n=53 [13.22%] with Crohn’s disease, and 2 [0.5%] with indeterminate colitis). Of these patients, 273 (68.08%) developed no symptoms or signs during the follow-up period,128 patients developed symptoms similar to COVID-19, and 76 (18.9%) were diagnosed as confirmed COVID-19 cases. Men comprised 60.5% of the confirmed COVID-19 groups, which shows that men were statistically more likely to have symptoms of COVID-19 during the follow-up period (P=0.04). No significant differences were observed among confirmed and non-COVID-19 cases in terms of concomitant medications: steroids (P=0.6), thiopurines (P=0.23), anti-TNF (P=0.23), and aminosalicylate (P=0.61). Three patients required hospitalization, but there were no admissions to the intensive care unit or deaths related to COVID-19. Conclusion: The risk of COVID-19-related adverse outcomes and death in patients with IBD is low. Also, patients with IBD under immunosuppressive treatment are not at an increased risk of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Postoperative Nausea and Vomiting (PONV) is one of the most common complications of general anesthesia, moreover opioid addiction increases the risk of PONV. Hence, this study evaluates the effect of administering dexmedetomidine infusion as an intraoperative analgesic on PONV in opium-addicted patients who underwent elective laparoscopic cholecystectomy. Methods: In a randomized clinical trial, 100 opium-addicted patients who were candidates for elective laparoscopic cholecystectomy surgery under general anesthesia were studied in two groups of 50 participants. The intervention group received dexmedetomidine infusion 10 min after induction of anesthesia until the end of surgery. The placebo group received normal saline at the same time. The rate of PONV was compared between the two groups. Results: Both groups had no significant difference in terms of hemodynamic parameters during surgery, including pulse rate, systolic and diastolic blood pressure, and duration of anesthesia. In the dexmedetomidine group, patients had less PONV than the control group, and this difference was significant (p=0.0164). Conclusion: Dexmedetomidine administration during laparoscopic surgery can reduce PONV, especially in patients addicted to opium. [ABSTRACT FROM AUTHOR]

Background Considering that no study on the efficacy of dexmedetomidine during endoscopic retrograde cholangiopancreatography (ERCP) has been performed in Iran so far, we decided to evaluate the efficacy and effectiveness of dexmedetomidine and patient satisfaction in patients undergoing ERCP. Materials and Methods: A double-blind clinical trial was performed (2020) among 80 patients undergoing ERCP grade ASA I, and II who had no asthma, cardiovascular diseases, and no history of allergies to propofol and dexmedetomidine. The patients were randomly divided into two groups (fentanyl and propofol) and (fentanyl and dexmedetomidine). Their heart rate per minute, mean arterial pressure, respiration rate per minute, and blood oxygen saturation at intervals of 5 and 15 minutes after the start and end of the procedure, the level of patient cooperation, and endoscopies satisfaction were compared. Results: Mean age of the propofol group was 63/13±17/88 and the dexmedetomidine group was 16/99±58/55 (P=0.191). Mean heart rate and respiration rate per minute were not different significantly in any of the time intervals. Mean arterial pressure in the propofol group before, 5, and 15 minutes after the start and end of ERCP were higher than dexmedetomidine group (105/95±15/91, 123/75±25/54, 118/10±13/06 and 14/61±117/50, respectively). The percentage of oxygen saturation at 5 minutes and at the end of the procedure was higher in the propofol group (P=0.01 and P=0.03, respectively) Conclusion: Due to fewer side effects and more satisfaction of patients receiving propofol; this drug is preferred for these patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of ketamine, lidocaine, acetaminophen, and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery. Methods: This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery. Patients were recruited and randomized to four different groups including the ketamine group, the lidocaine group, the acetaminophen group, and the dexmedetomidine group. The hemodynamic parameters such as heart rate (HR), mean arterial pressure, and arterial SaO2, alongside visual analog scale pain scores, sedation assessed by Ramsay score, nausea and vomiting, and opioid use were recorded and compared among the four groups. Results: This study included 140 patients, aged 37 (32, 41) years, with 92 males and 48 females, and each group had 35 patients. Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery, decreased HR at 12 and 24 h after surgery, and more satisfactory sedation (P<0.05). Notwithstanding no significant difference was noted in the pain scores, or nausea and vomiting among the groups (P>0.05). Conclusions: Dexmedetomidine has a better sedation effect compared to ketamine, lidocaine, and acetaminophen for pain control, but the final choice hinges on the patients' physical condition and the anesthesiologist's preference. [ABSTRACT FROM AUTHOR]

Objective: We aimed to compare the effect of dexmedetomidine with remifentanil on hemodynamic stability, surgical field quality, and surgeon satisfaction during rhinoplasty. Methods and materials: In this double-blind randomized controlled-trial, 60 participants scheduled for rhinoplasty at the Mother and Child Hospital, Shiraz, Iran, was randomely divided into the dexmedetomidine group (IV infusion of 1 μg/kg dexmedetomidine over 20 min before induction of anesthesia then 0.6 μg/kg/hr. dexmedetomidine from the time of induction until the end of the operation) or in the the remifentanil group (an infusion rate of 0.25 μg/kg/min from the time of anesthesia induction until the end of the operation). Bleeding volume, surgeon satisfaction, postoperative pain (visual analog scale (VAS)), Level of sedation (Richmond Agitation Sedation Scale (RASS)), Patient satisfaction, Vital signs & recovery, and the Aldrete Score (used to discharge the patients from recovery) were measured for all participants. Results: The patients in the dexmedetomidine group had less bleeding (p = 0.047) and shorter time to return of respiration, extubation, and the postoperative recovery time (p < 0.001). The surgeon satisfaction was higher in the dexmedetomidine group (p < 0.001). Patient satisfaction was significantly different between the two groups (p < 0.001). VAS scores, intaking paracetamol, and RASS score were significantly lower in the remifentanil group (p < 0.001). SBP, DBP, MAP, and heart rate were lower in dexmedetomidine group. Conclusion: Dexmedetomidine was associated with relatively stable hemodynamics, leading to decreased intraoperative bleeding, recovery time, and greater surgeon satisfaction and the level of consciousness in the recovery ward. However, painlessness and patient satisfaction were greater with the use of remifentanil. Trial registration: IRCT20141009019470N112. [ABSTRACT FROM AUTHOR]

Background & Aims: Horner's syndrome is a rare disease with three clinical signs of ptosis, miosis and unilateral anhydrosis of the face and neck. In this syndrome, Hodgkin's lymphoma should be considered as one of the first life-threatening symptoms. Horner's syndrome, or oculosympathetic paralysis, is a rare disease first reported by Mr. Horner (1883-1886) with three clinical signs including unilateral ptosis, miosis, and Unilateral and unilateral anhidrosis of the face and neck were described, all due to involvement of the oculosympathetic pathway (1). Horner syndrome results from an interruption of the oculosympathetic pathway. This condition does not usually cause vision problems or other significant symptoms, but is important as a warning sign that the oculosympathetic pathway has been interrupted, potentially with serious and even life-threatening processes. The oculosympathetic pathway has a long and circuitous course, beginning in the brain and traveling down the spinal cord to exit in the chest, then up the neck and into the orbit. The sympathetic nervous supply is responsible for the dilation of the pupil (mydriasis). When disrupted, parasympathetic supply is uninhibited, and constriction of the pupil (miosis) ensues. The reaction of the pupils to light and accommodation is normal as those systems do not depend on sympathetic nerve supply. Therefore, this syndrome with unimpressive clinical findings and insignificant symptoms may be a sign of serious pathology in the head, chest, or neck. Patients with Horner syndrome present with a slightly droopy upper lid and a smaller pupil on the affected side; less commonly, there is a deficiency of sweating over the brow or face on the affected side (2). Horner syndrome is almost always diagnosed clinically, though pharmacological testing can be used to confirm the diagnosis. Imaging modalities such as PET, CT and MRI are important components of work‐up for patients presenting with acquired Horner syndrome (3). Factors that cause this disease include trauma, brain tumors, migraines, cluster headaches, hyperthyroidism, and lung cancer(4). Because Horner syndrome sometimes occurs as the first sign of a life-threatening condition, a thorough post-diagnosis systemic examination is necessary to follow up on patients for signs and symptoms (5). This is a clonal malignancy (dependent on asexual reproduction) of the lymphatic system with different clinical manifestations that can be treated in the early and advanced stages (6). Horner's syndrome is an unusual initial manifestation of Hodgkin's disease, and, in this case, it was due to oculosympathetic damage from mediastinal compression (7, 8). The aim of this study was to report and introduce a patient referred to Imam Khomeini Hospital in Kermanshah with a diagnosis of Horner's syndrome and Hodgkin's lymphoma. Case Presentation: The patient is a 30-year-old man with left ptosis about 50 days before seeing an ophthalmologist. The patient also complains of sweating on the right side of the body and lack of sweating on the left side of the upper torso and face. No previous history of specific illness or family history of the symptoms were reported. In ocular examinations, the corrected vision of both eyes is equal to 10/10, normal eye movements, mild ptosis in the range of 2 mm in the left eye, meiosis of the left eye and the development of Anisocoria (an ocular complication in which the pupil of one eye from Size differs from other pupils.) Was reported more clearly in low light. According to the mentioned symptoms, Horner syndrome was presented to the patient. A complete and appropriate examination is sufficient for the initial diagnosis of this syndrome, but in order to confirm the diagnosis and determine the location of the injury, naphazoline drops were used. In this way, this drop was poured in both eyes of the patient and after a few minutes, the ptosis disappeared and the amount of anisocoria decreased. At present, after starting treatment, in addition to improving anisocoria, the amount of ptosis has decreased and the patient is satisfied with continuing treatment. On systemic examination, several large lymph nodes on the left side of the neck were touched in the area of the sternocleidomastoid muscle (SCM). Ultrasound of this area also showed a lymphadenopathy measuring 15 x 25 mm deep in the SCM muscle in the subclavian space (Subclavian triangle) and a lymph node measuring 10 x 15 mm in the upper region of the supraclavicular space with involvement of the upper mediastinum. MRI (Magnetic resonance imaging) of the brain and spinal cord was also reported to be normal. An X-ray of the chest showed umbilical cord lymphadenopathy. Finally, after biopsy of Hodgkin's lymph node, the diagnosis of cervical lymph node was made. Conclusion: In the present report, after examining the patient, Horner syndrome was clinically confirmed and after Hodgkin's lymph node biopsy, the diagnosis of Hodgkin's lymphoma was made. Involvement was also seen in the SCM muscle area and the upper mediastinum. In line with the results of the present study in a study by Simon et al. Conducted in 1985 on a 22-year-old woman with Horner syndrome, a mass in the mediastinum was observed on a patient's chest X-ray and evaluated. Further leads to the diagnosis of Hodgkin. This study suggests that Horner's syndrome is an unusual early manifestation of Hodgkin's disease caused by damage to the oculosympathetic pathway due to pressure on the mediastinum(9). A 1980 study by Maloney et al. On 450 patients with Horner's syndrome reported less than 3 percent of Hodgkin's lymphoma(7). Another study by Giles et al. In 1958 on 216 patients with Horner syndrome identified three cases of Hodgkin's lymphoma(6). Also, a 1940 study by Goldman et al., Conducted on 212 patients with Hodgkin's disease, reported no cases of Horner's syndrome(10). Kaplan also stated in his 1980 study that no cases of the syndrome were observed in patients with Hodgkin's disease(11). However, in the present report, MRI of the patient's brain and spinal cord was normal and no complication was observed. However, Williams et al., In their 1959 study of the complications of leukemia and lymphoma, found that neurological complications occur in 15% of patients with Hodgkin's lymphoma(12). Jackson et al., Who studied Hodgkin's disease in 1945, also noted complications such as brain and spinal cord injuries, polyneuropathy, mononorrhea, and myopathy(13).According to the results of this study, with the confirmation of Hodgkin's lymphoma in the patient, it is necessary that in addition to the entire oculosympathetic pathway, the patient be examined for neoplasms, including Hodgkin's lymphoma, due to its high potential. Also, due to the involvement of the upper mediastinum, it can be stated that Horner's syndrome is an unusual initial manifestation of Hodgkin's disease, which is caused by damage to the oculosympathetic pathway due to pressure on the mediastinum. In general, according to the results of the present study and similar studies among the early life-threatening symptoms, although Hodgkin's disease has been reported as uncommon, but due to the high potential for its treatment, it should be Patients with this syndrome should be considered. Also, with the publication of the present study, we can point to the sensitivity among ophthalmologists in identifying certain cases of malignancies associated with Horner's syndrome, which can lead to their early detection and better prognosis. Unfortunately, the lack of similar Iranian and foreign studies and the unavailability of the full text of some other articles for comparison prevented a comprehensive decision on the results. [ABSTRACT FROM AUTHOR]

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Background: Currently no effective antiviral therapy has been found to treat COVID-19. The aim of this trial was to assess if the addition of sofosbuvir and daclatasvir improved clinical outcomes in patients with moderate or severe COVID-19.Methods: This was an open-label, multicentre, randomized controlled clinical trial in adults with moderate or severe COVID-19 admitted to four university hospitals in Iran. Patients were randomized into a treatment arm receiving sofosbuvir and daclatasvir plus standard care, or a control arm receiving standard care alone. The primary endpoint was clinical recovery within 14 days of treatment. The study is registered with IRCT.ir under registration number IRCT20200128046294N2.Results: Between 26 March and 26 April 2020, 66 patients were recruited and allocated to either the treatment arm (n = 33) or the control arm (n = 33). Clinical recovery within 14 days was achieved by 29/33 (88%) in the treatment arm and 22/33 (67%) in the control arm (P = 0.076). The treatment arm had a significantly shorter median duration of hospitalization [6 days (IQR 4-8)] than the control group [8 days (IQR 5-13)]; P = 0.029. Cumulative incidence of hospital discharge was significantly higher in the treatment arm versus the control (Gray's P = 0.041). Three patients died in the treatment arm and five in the control arm. No serious adverse events were reported.Conclusions: The addition of sofosbuvir and daclatasvir to standard care significantly reduced the duration of hospital stay compared with standard care alone. Although fewer deaths were observed in the treatment arm, this was not statistically significant. Conducting larger scale trials seems prudent. [ABSTRACT FROM AUTHOR]

Background: New therapeutic options are urgently needed to tackle the novel coronavirus disease 2019 (COVID-19). Repurposing existing pharmaceuticals provides an immediate treatment opportunity. We assessed the efficacy of sofosbuvir and daclatasvir with ribavirin for treating patients with COVID-19.Methods: This was a single-centre, randomized controlled trial in adults with moderate COVID-19 admitted to the Ghaem Shahr Razi Hospital in Mazandaran Province, Iran. Patients were randomly assigned to 400 mg sofosbuvir, 60 mg daclatasvir and 1200 mg ribavirin (intervention group) or to standard care (control group). The primary endpoint of this study was length of hospital stay. This study is registered by IRCT.ir under the ID: IRCT20200328046886N1.Results: Between 20 March 2020 and 8 April 2020, 48 patients were recruited; 24 patients were randomly assigned to the intervention group and 24 to the control group. The median duration of hospital stay was 6 days in both groups (P = 0.398). The number of ICU admissions in the sofosbuvir/daclatasvir/ribavirin group was not significantly lower than the control group (0 versus 4, P = 0.109). There was no difference in the number of deaths between the groups (0 versus 3, P = 0.234). The cumulative incidence of recovery was higher in the sofosbuvir/daclatasvir/ribavirin arm (Gray's P = 0.033).Conclusions: This randomized trial was too small to make definitive conclusions. There were trends in favour of the sofosbuvir/daclatasvir/ribavirin arm for recovery and lower death rates. However, there was an imbalance in the baseline characteristics between the arms. Larger randomized trials should be conducted to investigate this treatment further. [ABSTRACT FROM AUTHOR]

Background The combination of sofosbuvir and daclatasvir is a potent, pangenotypic regimen suitable for mass-scale hepatitis C treatment, especially in resource-limited countries where newer, expensive combinations are not available. This combination has been widely tested on genotype 4. However, Phase III trials of this combination in other genotypes have been cost prohibitive. With the introduction of generic, low-cost sofosbuvir and daclatasvir, large-scale studies in resource-limited countries are now possible. Methods Sofosbuvir at 400 mg and daclatasvir at 60 mg were coformulated into a fixed-dose combination (FDC) tablet (Sovodak, Rojan Pharma, Tehran, Iran). Patients from 46 centers were dosed for 12 or 24 weeks with or without ribavirin, in line with existing guidelines. Responses to treatment were evaluated 12 weeks after the end of treatment (for a sustained virological response at Week 12; SVR12). Results There were 1361 patients recruited. Overall, the patients were 21% female, with a mean age of 50 years; 39% were cirrhotic; 22% were treatment-experienced; 47% were genotype 1, 41% were genotype 3, and 2% were other genotypes. The genotype was not known in 10% of the patients. The intention-to-treat and per-protocol SVR12 rates were 94.7% and 98.8%, respectively. The safety profile was unremarkable, treatment was well tolerated, and compliance with the single-tablet regimen was excellent. Conclusions The treatment with FDC of sofosbuvir and daclatasvir achieved high SVR12 rates, equivalent to those seen in Phase III trials of other pangenotypic options, and has been conducted at a similar scale in a representative, real-world population at a cost of under $100 per patient, which makes this combination suitable for elimination protocols in resource-limited countries. Clinical Trials Registration NCT03200184. [ABSTRACT FROM AUTHOR]

Summary: Background: Microsporum canis is a zoophilic species, found to be the most frequently isolated species in animals. M. canis causes sporadic outbreaks of infections in humans, such as the one that occurred in Canada, where more than 1000 human cases were detected over an 8‐year period. Despite the medical importance of M. canis infections, there are limited in vitro data on the antifungal susceptibility to antifungal drugs, including new generation triazoles and imidazoles. Objective: The aim of the current study was to comprehensively evaluate the in vitro activity of new azoles and comparator drugs against a large panel of M. canis isolates using a microdilution assay. Methods: The in vitro susceptibility to novel triazoles and imidazoles was compared to that of other antifungal drugs using a large collection of M. canis clinical isolates (n = 208) obtained from patients and animals with dermatophytosis in Iran, France and Turkey. Results: All isolates exhibited high susceptibility to the majority of the tested antifungal agents. However, luliconazole, lanoconazole and efinaconazole, as well as econazole, demonstrated superior activity against all strains in comparis on with the other drugs. Conclusion: FDA‐approved antifungal drugs, that is luliconazole, efinaconazole and lanoconazole, showed the highest antifungal activity and should be promising candidates for the treatment of dermatophytosis caused by Mcanis. However, their therapeutic effectiveness remains to be determined in clinical settings. [ABSTRACT FROM AUTHOR]

Abstract Introduction The incidence of Aspergillus infections has recently increased remarkably in certain tropical and sub-tropical countries, with Aspergillus flavus being identified as the leading cause of infections after A. fumigatus. Lanoconazole (LAN) and luliconazole (LUL) are currently approved for topical treatment of cutaneous fungal infections. We aimed the in-vitro antifungal susceptibility testing of two imidazole, LAN and LUL against A. flavus. Methods One hundred and eighty-seven clinical and environmental A. flavus were tested originating from different climate zones of Iran between 2008 and 2015. The identification of all isolates was confirmed by using PCR-sequencing of β-tubuline ribosomal DNA gene. In-vitro antifungal susceptibility test was performed using CLSI guidelines against LAN, LUL, itraconazole (ITC), voriconazole (VRC), posaconazole (POS), Isavuconazole (ISA), amphotericin B (AMB), 5-flucytosine (5FC), caspofungin (CAS) and anidulafungin (AFG). The minimum inhibitory concentration (MIC) and minimum effect concentration (MEC) values were evaluated according to CLSI M38-A2 guidelines. Results The geometric mean MICs for tested antifungals, in increasing order, were: 0.009 μg/mL for LUL (ranging from 0.004 to 0.062), 0.02 μg/mL for LAN (ranging from 0.004 to 0.125), POS (0.10), ISA (0.16), ITC (0.24), VRC (0.27), AMB (1.8) and 5FC (63.06) μg/mL. The mean value of MECs for AFG and CAS were 0.06 and 0.07, respectively. Conclusion Overall, LUL and LAN showed the lowest MIC against all isolates of A. flavus. Further studies are required to evaluate the in-vivo efficacy of these agents, and the possibility of using these agents in systemic infections. [ABSTRACT FROM AUTHOR]

Conventional Jaffe method of serum creatinine measurement is influenced by several drugs and components of blood as well as the expertise of laboratory staffs. We obtained blood samples of 22 healthy volunteers and sent them to 23 laboratories in Rasht, Iran, in which the conventional Jaffe method would be used for serum creatinine measurement. Also, we tested the samples in 1 reference laboratory with the calibrated Jaffe method. Glomerular filtration rates were calculated using the abbreviated equation of the Modification of Diet in Renal Disease study. Eight of 23 laboratories (34.7%) reported significantly different mean serum creatinine levels from the mean values yielded in the reference laboratory. Seven of 23 laboratories (30.4%) had significantly different estimated glomerular filtration rates in comparison to those calculated in the reference laboratory. Different results for creatinine lead to wrong interpretation of patients' kidney function, and rectifications of this divergence are of utmost importance. [ABSTRACT FROM AUTHOR]

Background: Spinal block is a common procedure for lower limbs surgery. Fentanyl, a synthetic opioid and dexmedetomidine, a selective α2 agonist have been used as adjuvants in spinal anesthesia to prolong intraoperative and postoperative analgesia. The aim of current study is to compare the efficacy of dexmedetomidine and fentanyl added to intrathecal bupivacaine in orthopedic procedures in lower limbs. Methods: In this randomized clinical trial, 90 patients undergoing elective lower limb surgeries were randomly allocated to three groups. Via intrathecal approach, the patients received 2.5 ml hyperbaric bupivacaine 0.5% plus 5 micrograms dexmedetomidine (BD group), 25 micrograms fentanyl (BF group) or 0.5 ml normal saline (BN group), respectively. Time to reach the complete motor block, the highest sensory level, regression from block, analgesic request and duration of the drug effect, hemodynamic changes and side effects were compared between the groups. Results: There was no significant difference between the groups regrading time to reach complete motor block, but time to reach the highest sensory level was shorter in group BD than group BF (6.28 ± 1.75 vs. 7.17 ± 1.45, p = 0.03). Group BD had significantly lower mean of NRS 6 h after operation (1.90 ± 0.84 vs. 6.16 ± 1.44 vs. 6.30 ± 1.17, p < 0.001) and longer duration to regress to Bromage 0 (331.60 ± 73.96 vs. 185.56 ± 35.87 vs. 147.03 ± 33.05 min, p < 0.001), to analgesic request (496.63 ± 70.19 vs. 296.33 ± 44.83 vs. 221.83 ± 22.26 min, p < 0.001), to regress two sensory levels (149.00 ± 23.17 vs. 88.90 ± 12.85 vs. 69.33 ± 6.67 min, p < 0.001) and to regress to S1 (560.53 ± 81.86 vs. 329.83 ± 44.10 vs. 241.83 ± 22.26 min, p < 0.001). Serial changes in SBP (p = 0.006), DBP (p = 0.03) and HR (p = 0.002) in group BF were significantly higher than the other two groups. The three groups had comparable side effects. Conclusions: Using dexmedetomidine as an adjuvant to bupivacaine for spinal anesthesia in lower limb surgeries has longer duration of sensory and motor block and longer postoperative analgesia. Trial registration: IRCT registration number: IRCT2017041010599N15, 24 May 2017. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to an article by researcher Houshang Sanadgol, on the feasibility of administering Levamizol on enhancing Hepatitis B vaccination in hemodialysis patient, published in a previous issue is presented.