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Abstract Introduction This retrospective cross‐sectional study aimed to assess the outcomes of Covid‐19 patients who received remdesivir therapy at the outpatient department of Ziaian Hospital. Method A total of 514 eligible patients were included between May and September 2021. Covid‐19 diagnosis was confirmed through positive SARS‐COV‐2 PCR tests or chest CT scans. Due to limited hospital beds, patients received remdesivir on an outpatient basis. Results Patients received six daily doses of remdesivir for 5 days. Those referred to a physician within 7 days of symptom onset had similar hospitalization rates compared to later referrals. Lower blood saturation levels were associated with a higher likelihood of hospital admission, indicating that earlier administration of remdesivir may be more effective. Patients with over 50% lung involvement had higher rates of disease progression despite treatment. Corticosteroids did not significantly improve outcomes in patients with saturation above 90%. Discontinuation of remdesivir due to side effects was rare, with only 1% experiencing increased liver enzymes, 1.2% facial redness and tremors, and 1.5% allergies. After 1 week of treatment, patients commonly reported symptoms such as hair loss, fatigue, body pain, lethargy, and anorexia, particularly among hospitalized patients. Discussion Patients generally preferred outpatient treatment over hospitalization. Body mass index (BMI) did not significantly impact hospitalization rates, although average weight tended to be higher among inpatients. The study confirmed the effectiveness of remdesivir therapy with a low occurrence of side effects. Conclusion This retrospective study evaluated the outcomes of Covid‐19 patients receiving remdesivir at an outpatient department. Early administration of remdesivir showed better outcomes, while corticosteroids had limited benefits. Outpatient treatment was favored, and BMI did not significantly influence hospitalization rates. Remdesivir demonstrated efficacy with a low incidence of side effects.

Abstract Aim The aim of this study was to evaluate the short‐term and long‐term effects of routine repetitive transcranial magnetic stimulation (rTMS) on the sleep duration, depressive symptoms, and quality of life of patients with treatment‐resistant depression (TRD). Methods In this prospective cohort study, 25 participants with TRD were assessed using the Insomnia Severity Index (ISI) and four sleep duration components of the Pittsburgh Sleep Quality Index (PSQI). Depression severity was measured with Hamilton's Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI‐II), and patient‐perceived quality of life with the 36‐Item Short‐Form Survey (SF‐36). All of these measures were evaluated at baseline (T0), and immediately (T1), 6 weeks (T2), and 12 weeks (T3) after the end of intervention. Results At T1 endpoint, HDRS, BDI, SF‐36, ISI, and three PSQI items (time to wake up, time taken to fall asleep, and Real Sleep Time) significantly improved, though these gains were reduced at follow‐up endpoints (T2 and T3). Adjusting for confounders (age, sex, occupational status, BMI, and hypnotic medication) revealed that only improvements in HDRS, BDI, and time taken to fall asleep at T1 remained statistically significant. Linear regression analyses showed no significant association between reduced time taken to fall asleep and depression symptoms, suggesting rTMS can independently enhance this parameter, irrespective of depression resolution. Conclusion Routine rTMS therapy can potentially enhance sleep duration in TRD individuals, alongside improved depressive symptoms and quality of life. However, these benefits tend to decrease over long‐term follow‐up, emphasizing a more pronounced short‐term efficacy of rTMS.

Abstract Background Omicron (B.1.1.529) is the fifth variant of concern of SARS-CoV-2, which has several subvariants. Clinical features of BA.1 and BA.2 infections have been described in the literature, but we have limited information about the clinical profile of BA.5, which caused the seventh wave in Iran. Methods A prospective observational study was conducted on the BA.5 confirmed patients referred to Imam Khomeini Hospital Complex, Tehran, Iran, from 11th to 31st August 2022. The patients were divided into the two groups of outpatients and hospitalized patients, and their clinical, radiological, and laboratory data and outcomes were recorded and analyzed. Results We included 193 patients with confirmed BA.5 infection, of whom 48 patients (24·8%) were hospitalized. The mean age of the patients was 45·3 ± 16·5 years, and 113 patients (58·5%) were female. The mean number of days patients had symptoms was 6·8 ± 2·4 days. The most common symptoms were weakness (69·9%), sore throat (67·4%), myalgia (66·3%), hoarseness (63·7%), headache (55·4%), fatigue (54·9%), and dry cough (50·3%). Fever and dyspnea were significantly more observed in the hospitalized patients (p

Introduction: The aim of this study was to survey the attitudes of internists, cardiologists, and pulmonologists regarding treatment or no treatment of isolated subsegmental pulmonary embolism (ISSPE) with anticoagulant drugs. Methods: Qualified physicians were asked to select their management options from a questionnaire that included a patient scenario with subsegmental pulmonary embolism (SSPE) and negative past medical history of thromboembolism. Results: A total of 113 physicians responded to the survey. Of these, 8.8% preferred not to treat patients without further evaluation; 15% decided not to treat, but follow-up the patient with a serial lower-limb colour Doppler ultrasonography; 1.7% preferred anticoagulant treatment only during hospitalization and follow-up without medication; 5% preferred anticoagulant treatment for less than 3 months; and 34.5% chose a 3–6-month treatment with anticoagulation. Furthermore, 24% of physicians opted for anticoagulant treatment for more than 6 months, and 9.7% left the decision up to the patient. Opting not to treat was an option selected by more board-certified faculty members specialized in cardiology, internal medicine, and pulmonology compared with residents (p = 0.038). Willingness to provide anticoagulant therapy in the internal medicine, cardiology and pulmonology groups was 56.6%, 37.3% and 6%, respectively (p = 0.007). Conclusion: The majority of physicians surveyed prefer anticoagulant therapy in patients with SSPE.

Abstract Background Oral cancer surgery can have a deep effect on the quality of life in the patient both in terms of functional and psychological aspects. This study aimed to translate and validate the European Organization for Research and Treatment of Cancer head and neck cancer specific quality of life questionnaire (EORTC QLQ-H&N43) in Azerbaijan. Methods Forward-backward translation was applied in order to translate the EORTC QLQ-H&N43 from English into Azeri. Then, a sample of patients with oral cancer attending a teaching hospital affiliated to Azerbaijan Medical University completed the EORTC QLQ-C30 (the core cancer specific questionnaire), and the EORTC QLQ-H&N43. To evaluate psychometric properties of the QLQ-H&N43, known groups validity, convergent and divergent validity was performed. Internal consistency reliability was examined by estimating the Crornbach’s alpha coefficient. Results Ninety-six patients with confirmed diagnosis of oral cancer were entered into the study. The mean age of patients was 59.6 (SD = 10.7) years and 36 patients (37.5%) diagnosed as having stage IV and 10 patients (10.5%) were metastatic. The results obtained from comparing quality of life scores among these patients showed that the questionnaire was able to differentiate among patients who differed in stage and metastasis lending support to its validity. In addition convergent and divergent validity showed satisfactory results. The internal consistency of the multi-item scales as assessed by the Cronbach’s alpha coefficient showed acceptable results (alpha ranging from 0.66 to 0.78). Conclusion The findings suggest that in general the Azeri version of EORTC QLQ-H&N43 has satisfactory internal consistency reliability and validity, but additional psychometric evaluation is needed to draw firm conclusions.

Background: Colorectal cancer is a common cancer and has a high rate of mortality and morbidity. This can be reduced by screening tests. Some of the studies have recently referred to Red Cell Distribution Width (RDW) as a marker for early detection of various cancers. The aim of this study was to investigate the RDW and early detection of colorectal cancer and polyp. Methods:A total of 90 patients were divided into three groups. One group included patients with colon cancer, another group with colon polyps, and the third group with normal colonoscopy as a control group. Blood samples were taken from patients and mean corpuscular volume (MCV), hemoglobin (HB), platelet (PLT), red blood cell distribution width (RDW), ferritin, serum iron, and total iron-binding capacity (TIBC) values were recorded. Transferrin saturation (Tsat) was also calculated. Statistical analysis was performed to remove the anemia effect of patients who had Tsat less than 20%, which was compared to patients who had Tsat over 20%. For the relationship between RDW and colon cancer, a receiver operating characteristic (ROC) curve was used. Results: The area under the receiver-operating characteristic curve (AUC) of the RDW for predicting colon cancer was 0.698, with cut off >14 which had 80% sensitivity and 60% specificity. Conclusions: RDW can be considered as a parameter for predicting colorectal cancer.

Purpose – During the ART era, persistent immune activation remains a significant challenge in people living with HIV (PLWH). Microbial translocation play an essential role in this setting. Probiotics have several immunological benefits which can reverse this process. The purpose of this paper is to investigate the safety and efficacy of probiotics on CD4 counts among Iranian PLWH. Design/methodology/approach – In total, 50 PLWH with CD4 counts above 350 cells/mm3 did not receive ART participated in a randomized, double-blind trial and underwent 24 weeks of treatment with either LactoCare® or placebo twice daily. CD4 counts of the patients were measured at baseline, 12 weeks and 24 later in the two groups. Side effects were measured monthly using a specific checklist. Findings – The mean CD4 count of the patients showed a significant difference between the two groups after six months. Through six months follow up, the mean CD4 count of the patients showed a significant reduction as compared to the baseline in the placebo group; however, it did not show a significant difference in the probiotic group. Repeated Measures Anova test showed a significant effect for time × treatment interaction on the CD4 count during the trial course. No significant difference between the two groups concerning adverse events was reported. Originality/value – It seems the use of probiotics in PLWH with a CD4 count above 350 cells/mm3 who are not receiving antiretroviral drugs is safe and can reduce the devastating process of CD4+ T cells in these patients.

Background: "Exclusive breastfeeding (EBF) is globally promoted as the ideal method of infant feeding during the first six months of life due to its health benefits to both the mother and child" (1). The aim of this study was to examine the effect of the interventions leading to increased awareness, knowledge, and self-efficacy regarding exclusive breastfeeding and duration of breastfeeding. Methods: This clinical trial was conducted on 129 pregnant women before the gestational age of 21 weeks and 6 days referring to Vali-e-Asr Hospital in Tehran, Iran. The study population was selected using the convenience sampling method. The participants were randomly assigned into two groups of intervention (n=64) and control (n=65). The mothers in the intervention group received one training session on breastfeeding self-efficacy, as well as training and audio packages regarding postpartum care and relationship with neonates. In addition, the women who suffered from anxiety, stress, or depression were provided with psychotherapies. The data collection instruments included the Self-Efficacy Scale, Edinburgh Postnatal Depression Scale, and Spielberger's State-Trait Anxiety Inventory. Results: Exclusive breastfeeding was higher in the intervention group than in the control group during the first six months postpartum (P=0.015). The follow-up study showed that there were higher rates of breastfeeding for the two-year-old children in the intervention group (P

Background and Aim: Nurses’ knowledge, attitude and performance towards the principles of Islamic ethics are remarkable in nursing care in Tehran University of Medical Sciences (TUMS). Materials and Methods: In this cross-sectional study, the knowledge, attitude and performance of 551 nurses were evaluated based on their age, sex, education, and type of employment in TUMS hospitals (by a valid questionnaire). All data were analyzed by SPSS. In this study, a questionnaire was designed through a Focus group discussion and then its validity was evaluated. Moreover, the reliability of the questionnaire was estimated by test-retest method. Results: Our study showed that female sex, work experience of 15-20 years, type of employment, and higher education were associated with a higher level of knowledge, attitude and performance towards principles of Islamic ethics. Also, according to our analysis, there was a significant relationship between age and level of knowledge, attitude and performance of the principles of Islamic ethics (p

Introduction: Hearing loss as a sequel of chronic suppurative otitis media (CSOM) is often conductive, but recent studies have found an additional sensorineural component in these patients, thus demonstrating inner ear damage. The aim of the study was to determine the association between CSOM and sensorineural hearing loss (SNHL) and to assess the influence of patient’s age, duration of disease, and presence of cholesteatoma and ossicular erosion on the degree of SNHL. Methods: In a retrospective study, the medical records of 119 patients who underwent surgery was reviewed. Seventy patients met the inclusion criteria of unilateral otorrhea, normal contralateral ear on otoscopy, and age between 10–65 years with no history of head trauma or ear surgery or familial hearing loss. Bone conduction (BC) thresholds for affected and contralateral ear were measured at frequencies of 500, 1000, 2000, and 4000 Hz. Data analysis was performed using SPSS 13 with independent-samples t-test, Pearson correlation test, and twotailed analysis. A p ≤ 0.05 was considered statistically significant. Results: Significant higher BC thresholds were found in the affected ear than in the normal ear for each frequency (p < 0.001), which increased with increasing frequency (7.00 dB at the 500 Hz and 9.71 dB at the 4000 Hz). There was a significant correlation between age and degree of SNHL (r = 0.422, p < 0.001) but no significant correlation was in duration of the disease (r = 0.119, p > 0.05). There was no relationship between presence of cholesteatoma and ossicular erosion with SNHL (p > 0.05). Conclusion: These findings demonstrate that CSOM is associated with some degree of SNHL and cochlear damage, and higher frequencies are more affected. Aging can act as a precipitating factor in this pathological process.

Background: At present, no documented anesthetic technique exists for use in liver transplant surgery. Presence of some controversies in anesthesia plan led us to compare effects of inhaled and intravenous anesthetics in liver transplant surgery. Methods: All those brain dead patients who met the criteria of organ donation were included in the study. The donor's liver is matched with the recipient according to our liver transplant protocols and assigned consecutively to the recipients. In this study 78 patients who met the inclusion criteria, were divided into two groups. All patients in group 1 were anesthetized with inhalation of sevoflurane and patients in group 2 were anesthetized with the IV injection of propofol. Percent of sevoflurane in inhaled gases and IV infusion dose of propofol was determined by a BIS guide to keep BIS between 40 and 45. Patients were monitored by NIBP, ECG, CO – Oximetry and BIS before and during induction of anesthesia. An arterial line from radial artery and Swan–Ganz–Catheter from right internal jugular vein were inserted for all patients. Results: Mean of PCO2, PO2 and HCO3 were different between 2 groups (p=

Objective: The purpose of this study was to investigate the status of knowledge, attitude and practice of medical team about suitable " Healthcare personnel (HCP) attire". Materials and methods: This is a descriptive study that was approved by the Research Ethics Committee of Tehran University of Medical Sciences, and evaluated knowledge, attitude and performance of physicians and nurses about "Health care personnel (HCP) attire" by a questionnaire. In order to create the questionnaire a panel of experts’ reviews was set and a questionnaire was made through Focus group discussion (FGD). The Variables included age, gender, work experience, type of employees' time, type of jobs, education level, type of employee. Results: This study was conducted on 441 physicians and nurses who were working in Tehran University of Medical Sciences. The mean percent of KAP score was 72.6 ± 14.3. The score of the questionnaire in general was 14.91 ± 70.99 for knowledge, 73.5 ± 13.3 for attitude and 73.7 ± 17.1 for performance. Conclusion: According to this survey, the questionnaire score in the general knowledge, attitude and performance about the "Healthcare personnel (HCP) attire" is low.

Objective: Bullying and victimization are common and serious problems in schools resulting in development of emotional and behavioral disorders in adolescents. This study aimed at examining the prevalence of bullying behavior and some of its associated factors among students. Method: This was a cross sectional analytic study involving junior high schoolers in grades seven, eight and nine. This study was part of an international study that used a questionnaire as a tool for data collection. The questionnaire investigated some of the characteristics and qualities possessed by most juveniles and some occasional problems which they may experience. Also, it was used to examine participants’ experiences with bullying and victimization. This questionnaire comprised of 15 sections on demographic characteristics, individual health, family status and types of bullying experiences at school and outside of school, along with the Strengths and Difficulties Questionnaire (SDQ), which is an instrument for screening emotional and behavioral problems in children and adolescents. A multistage cluster sampling from five regions, consisting of the north, south, west, east, and central regions of Tehran, was conducted and 1456 questionnaires were completed by the students. Results: According to the results of this study, prevalence rate for bullying and victimization was 17.4% and 25.8%, respectively. The results indicated that gender had a significant relationship with bullying and victimization, with boys being more likely to be bullies and also more prone to victimization than girls (p < 0.001). Other parameters such as emotional, behavioral, and environmental influence also had a significant relationship with bullying and victimization. Conclusion: Bullying is more prevalent in boys than in girls, and boys are more likely to be victimized as well. Emotional and behavioral problems are identified as risk factors, and future interventions should focus on these risk factors to develop preventive measures.

End-stage kidney disease has a high prevalence in patients undergone Coronary Artery Bypass Grafting (CABG) and could cause a wide spectrum of morbidities, due to deep water and electrolyte or acid-base impairments. The aim of this study was to assess the effect of low Creatinine Clearances (ClCr) on arterial oxygenation defect, as common post-CABG morbidity. The study was conducted as a prospective cohort, the pure on pump CABG patients were grouped based on their preoperative ClCr to groups A (ClCr≥60) and B (ClCr

Background: There are various factors affecting the effectiveness of the treatment of breast cancer patients. Although the disease pathology, along with surgery and other therapeutic modalities, plays the principal role in patient outcomes, anesthesia still plays an important role in the success of treatment. This study was designed to show the effects of anesthetic plans on risk classification and assessment in breast cancer surgeries. Methods: Two hundred sixty patients receiving different types of breast cancer surgery for therapeutic and reconstructive purposes were enrolled in this study. They were divided into three groups according to the anesthesia risk assessment. Group 1 consisted of low-risk patients (ASA I) who received small surgeries such as lumpectomy. Patients with intermediate risk of anesthesia (ASA II) or those who underwent breast cancer and axillary surgery with overnight admission (ASA I or II) were considered as group 2. Group 3 comprised the patients with higher risk for anesthesia (ASA class III) regardless of the surgery type or those in any ASA class who were about to undergo advanced and prolonged surgeries such as breast reconstruction with free or pedicle flaps. Results: Two hundred sixty-eight surgical interventions were done in 260 patients. There were 106, 107, and 47 patients in groups 1, 2, and 3, respectively. In group 1, five patients out of 106 were admitted in the hospital for 24 hours after surgery and the remaining 101 patients were discharged from the hospital in a few hours after the operation when they were fully conscious and could tolerate the diet completely. All 107 patients in group 2 were admitted in the hospital for a few days after the operation, though the vast majority of them (98 patients) discharged from the hospital the day after surgery. In the last group, 6 out of 47 patients showed the signs of surgical complications such as partial flap ischemia in the postoperative period, mostly after TRAM or DIEP flap breast reconstruction surgery. Conclusion: The findings of this study support the idea that breast surgeries can be done in an ambulatory situation with no considerable risk. In contrast, all medical and anesthetic considerations should be taken into account in more complex surgeries, especially when they are applied in high-risk patients.

Background: The objective of this study is to review the literature about the muscle relaxants in anesthetic practice. Methods: In this review, our search includes, the studies performed and applied between 2000 and 2016. Therefore, for review of muscle relaxants in anesthesia practice in major surgeries, we referred to Google scholar, UpToDate, science direct, Ovid MEDLINE, Springer, free journals and the references of reviewed articles in the English language. Results: Neuromuscular blocking agents are a chore and essential part of balanced anesthesia. These are used to facilitate endotracheal intubation and provide skeletal muscle relaxation during surgery. The main disadvantage, i.e. residual paralysis, can be treated or prevented by reversing of such a block. Conclusion: The muscle relaxant plays an important role in adequate muscle relaxation, which allows efficient and safe surgery, requiring automated ventilatory control.

Background: Low Back Pain (LBP) is a common musculoskeletal disorder which may have an occupational or non-occupational etiology and is seen in many health care providers. It is an important cause of morbidity and workplace absence. Various factors may result in LBP but the role of occupational stress and anxiety personality disorder is still unclear. Methods: Face-to-face interviews were conducted with 58 anesthesiologists working in the hospitals of Tehran University of Medical Sciences to evaluate the occurrence of LBP in the first year of work. The probable causes of LBP and the level of anxiety were assessed using a questionnaire designed for this purpose, based on Spielberger state-trait anxiety inventory (STAI), and the results were analyzed. Results: Of 58 participants, 44 (75.9%) were men and 14 (24.1%) were women. The mean age of the participants was 45.6±6.3 years. Twenty-four of 58 participants (41.4%) reported LBP in the first year of work. Six participants (10.3%) did not have anxiety state but had LBP in the first year of work. Eighteen subjects (31%) with mild to severe anxiety state also had LBP in the first year of work. Nine anesthesiologists (15.5%) did not have anxiety trait but had LBP in the first year of work. Fifteen participants (25.8%) had mild to severe anxiety trait and had LBP in the first year of work. In general, 24 of 58 participants (41.4%) with an anxiety score of 47.52 (moderate level of anxiety) had LBP, and 34 of 58 participants with an anxiety score of 41.01 (moderate level of anxiety) did not have LBP. There was a significant correlation between the occurrence of LBP and the level of anxiety (P=0.014). The personality type, smoking, history of psychiatric disorders, occupational satisfaction, communication with colleagues, sleep quality, history of LBP during work years, especially in the first year, duration of LBP, stress in the first year of work, and weekly hours of exercise had a significant association with anxiety (P

Intraoperative fluid equilibrium is a decisive matter in perioperative anesthesia management, because most of evaluation studies consider intraoperative fluid administration as a major participating agent in improving or worsening patient outcomes after surgery and it revolves within the responsibility of an anesthesiologist. The understanding of fluid physiology in the human body, clinical features of available intravenous fluid, and nature of surgery indeed will contribute to the success plan of management. Maintaining of patients’ physiological milieu by preserving normal extracellular volume, adequate tissue perfusion, and a balanced acid base condition are the main goals of intraoperative fluid infusion. This review was conducted to overview fundamental basics of fluid therapy during the intraoperative period. Due to the dearth of supporting data for appropriate volume and the available definitions of restrictive and liberal are diffident, the polemic about which particular method of volume expansion still exists. Colloid versus crystalloid controversy in surgical patients is still going on and this would again be encouraged to be a topic for many clinical trials in the future. The current findings’ trend prefers guided and restricted intraoperative fluid therapy with isotonic balanced crystalloids because such fluids are cost effective and have fewer side effects than other fluids.

Background and Aim: Nurses’ knowledge and awareness about religious orders is undoubtedly so important in their relationship with patients in hospitals. So, the aim of this study is to compare the knowledge and attitude of nurses before and after their participation in religious orders workshop. Materials and Methods: In this cross-sectional study, religious knowledge and attitude of 480 nurses working in the hospitals of Tehran University of Medical Sciences (TUMS) were evaluated. The research tool was a questionnaire and such factors as nurses’ age, sex, educational level, and type of employment were considered. The data were collected by a questionnaire and analyzed by SPSS software version 19. Results: Nurses demonstrated a higher level of knowledge and attitude in hospitals where Islamic orders workshop was held than the ones in other hospitals. In total, there was no significant difference among nurses regarding their age, sex, educational level, and type of employment however, nurses working in surgical wards and those with a postgraduate degree showed a higher level of knowledge and attitude than others. Conclusion: It is necessary to provide nurses with knowledge about religious orders because such knowledge may increase patients' satisfaction with the care they receive.

The present study aimed to compare the serum level of uric acid in patients with and without heart failure and also to determine the association between uric acid level and clinical status by Killip class in patients with STEMI. This case-control study was conducted on 50 consecutives as control group and 50 patients with acute heart failure, (20 patients had acute STEMI), who documented by both clinical conditions and echocardiography assessment. The mean plasma level of uric acid in the case group was 7.6±1.6 milligrams/deciliter (mg/dL) and in the control group was 4.5±1.5 respectively (P

BACKGROUND: Subarachnoid block with local anesthetics and opioids enable efficacious spinal anesthesia because of their synergistic effect and permit the use of low-dose local anesthetics, which results in a stable hemodynamic state. The purpose of this study was to describe the cardiovascular effects of spinal anesthesia with low-dose bupivacaine and sufentanil on patients with coronary artery disease. METHODS: This study was a double-blind randomized clinical trial. A total of 18 patients who had known coronary artery disease were enrolled. Our subjects underwent spinal block for lower limb surgery with 7.5 mg hyperbaric bupivacaine 0.5% and 5 µg sufentanil. Complications related to anesthesia such as hypotension, bradycardia, vasopressor need, and blood or volume use were recorded. RESULTS: The average mean arterial pressure decreased 15% in the first 15 min of spinal block in our cases. No patients presented with hypotension and the subjects were without complaints during the spinal anesthesia. All patients remained alert, and no ST segment changes were observed intraoperatively and until 6 h after the operation. Baseline ejection fraction (EF) 40% or less was observed in 10 patients and these subjects were compared with other patients. Systolic and diastolic blood pressures, mean arterial pressure, and heart rate decreased during the first 15 min in response to spinal anesthesia in both groups of patients, but decreased more significantly in patients with EF > 40%. CONCLUSION: We recommend spinal block with low-dose bupivacaine and sufentanil in patients with coronary artery disease and especially in patients with low EF. Keywords: Bupivacaine, Coronary Artery Disease, Subarachnoid Block

Background: Calculation of the risk of instability and malunion in patients with distal radius fracture and choosing treatment based on this risk percentage is a new method that can greatly help surgeons in decision-making. In this study, we have tried to make a comparison between treatment decision-making based on prediction of the risk of instability and experience of orthopedic surgeons for management of this fracture. Methods: Recorded information of 69 patients with extra-articular distal radius fracture diagnosis was examined. Radiographs and age of each patient were submitted to two orthopedic surgery professors and they were asked to express their opinion about surgical or non-surgical treatment for each patient based on their own personal habit. The risk of instability was calculated for each patient and surgical or non-surgical treatment for each patient was proposed based on this risk percentage with cut-off point of 70%. Then, the treatment proposed by each surgeon was compared with the treatment proposed based on the calculated risk of instability. Results: The study demonstrated that treatment decision-making for distal radius fracture according to the risk of instability with cut-off point of 70% (this is surgery for fractures with instability risk of more than 70% versus non-surgical intervention for cases with risk of less than 70%) is not significantly and reliably consistent with the opinions of two orthopedic surgeons who had the experience of confronting this fracture. Conclusions: Prediction of the risk of instability for management of distal radius fracture needs to be validated through further studies before being used as the decisive factor for management of this fracture. Colleagues are invited to assess the outcomes of using the risk of instability more accurately with further studies. It is suggested to be more prudent and perform more evaluations when the risk of instability calculation with cut-off point of 70% is used to choose the appropriate treatment.

Background: Keeping the patient in a sitting or semi-sitting position for time-consuming oncoplastic breast surgery is a major challenge for anesthesiologists due to several considerations. This cohort study was conducted on two groups of patients undergoing breast surgery. Methods: Study participants were categorized into two groups: one group was composed of normotensive women (group A) and the other group comprised women with controlled hypertension (group B). After the induction of anesthesia in the supine position, the position was changed to sitting and the surgery was done in the sitting position. Hemodynamic monitoring included ECG, heart rate, non-invasive blood pressure (NIBP), invasive blood pressure (IBP), cardiac output (CO), arterial O2 saturation (SPO2), end-tidal CO2 (EtCO2), and bispectral index (BIS). The amount of administrated fluid and vasopressor was recorded for each patient. Any episode of hemodynamic instability was recorded, too. Results: Hemodynamic variation occurred in both groups, but the changes were more significant in group B and the amount of fluid and vasopressor administration was more prominent in group B. Changing the position caused no significant variation in BIS, SPO2, and EtCO2 in the two groups. Conclusions: The sitting position can be safe for time-consuming oncoplastic breast surgery using adequate hemodynamic monitoring. Hemodynamic changes are more significant in patients with controlled hypertension, and more medical interference is needed for these patients.

Background: Cirrhotic patients are at a greater risk of different kinds of arrhythmias. Despite the well-known arrhythmogenic effects of halothane, developing countries continue to use halothane due to its low cost. This study was designed to investigate the pathophysiology of halothane untoward effects on heart rhythm moreover was aimed to explore the effect of halothane anesthesia on the threshold of epinephrine-induced arrhythmia in cirrhotic rats. Methods: Bile duct ligation was used to induce cirrhosis. The subjects were anesthetized with halothane or pentobarbital. Arrhythmia was induced by intravenous injections of increasing doses of epinephrine. Blood pressure and the electrocardiogram were monitored. The threshold doses of epinephrine for induction of premature ventricular contraction (PVC), ventricular tachycardia (VT) and ventricular fibrillation (VF) were determined. Results: Cirrhotic rats had longer QTc intervals in comparison with sham-operated animals. Halothane-anesthetized rats had significantly shorter QTc intervals than pentobarbital-anesthetized rats in both cirrhotic and sham-operated groups. Halothane significantly decreased the threshold dose of epinephrine for induction of PVC, VT and VF in cirrhotic rats. The BP of different experimental groups did not differ with each other. Conclusion: Cirrhosis intensifies halothane induced ventricular arrhythmia and our results raise concerns regarding the use of halothane in cirrhotic patients.

Background: Deliberate hypotension is a strategy that reduces intraoperative bleeding and increases the speed of surgery in otolaryngology procedures. Magnesium (Mg) sulfate is a vasodilator agent that reduces intraoperative hypnotic requirements and in combination with analgesic agents, it reduces intraoperative and postoperative pain. In this study we evaluated the use of intravenous Mg sulfate for inducing deliberate hypotension in rhinoplasty. Methods: Sixty ASA I, II patients aged between 18 to 45, scheduled for rhinoplasty were recruited into a randomized clinical trial. Patients were randomly assigned into placebo (group P) and Mg sulfate (group M) groups. For patients in group M, 40m/kg Mg sulfate was administered before induction and continued with 15mg/kg/hr infusion during the operation. Patients of group P received normal saline as placebo. In each group mean arterial pressure (MAP), mean heart rate, amount of bleeding, anesthetic agents, opioid requirement and duration of surgery were recorded. The incidence of nausea, vomiting, shivering and the score of pain were recorded in post-operative period in both groups. Results: Patients in group M had lower MAP (P= 0.0001), less intraoperative bleeding (P=0.0001), lower anesthetic agents (P=0.0001) and opioid consumption (P=0.001), and shorter duration of procedure (P=0.0001). Mean heart rate was lower in group P (P=0.001). Moreover, surgeon`s satisfaction was more in group P (P=0.001).They also had less incidence of post-operative nausea and vomiting (P=0.008), shivering (P=0.001) and lower pain scores postoperatively (P=0.0001). Conclusion: Magnesium sulfate can be a useful drug to induce controlled hypotension in rhinoplasty surgery. By employing this agent patients have better anesthetic condition and recovery profile.

Background: Acute postoperative pain is an important surgical side effect that may delay patient discharge in ambulatory operations; moreover, the strategies used to alleviate pain may cause side effects that require longer hospitalization to recover. In this clinical trial, we compared two current anesthetic methods with special concerns about postoperative pain intensity beside other important components of ambulatory anesthesia. Methods: This clinical trial was conducted on two age-matched groups of 75 members who underwent ambulatory breast surgery. Patients in the first group (GA) underwent general anesthesia with propofol plus remifentanil by employing a laryngeal mask airway. In the second group (LA), the surgeon used infiltration of 2% lidocaine in the breast tissue and midazolam was applied as premedication. At the end of surgery, paracetamol was administered to all patients in both groups. The pain score was evaluated when the patients were fully awake using a numerical pain rating scale. Patients with severe pain received analgesia. The length of postanesthesia care unit (PACU) stay was recorded for each patient. Results: None of the patients in the LA group were satisfied because of the experience of needle insertion into their breast tissue (P = 0.001). The patients in the LA group experienced more pain in PACU requiring adjuvant analgesia (P = 0.001). Patients in the LA group had longer PACU admission (P = 0.001). Conclusions: Patients in the LA group had higher pain scores and were dissatisfied with the plan of their anesthesia. This may confirm the role of preemptive analgesia or the effect of emotional stress of breast tissue needling in wakeful patient.

A case of moyamoya syndrome and spherocytosis with concurrent interstitial lung disease who underwent laparoscopic splenectomy is being reported. A theory regarding their coexistence is being forwarded together with their anesthetic management. According to our search, this is the fourth case of moyamoya syndrome and the first case with an associated interstitial lung disease in a 10-year-old child.