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The success of simultaneous balloon dacryoplasty and stenting in failed congenital nasolacrimal duct intubations and its indications
Mansooreh Jamshidian Tehrani , Haniyeh Zeidabadinejad, Fereshteh Tayebi, Mohammad Reza Khalili, Bita Momenaei ,
Volume 80, Issue 12 (March 2023)
Abstract
Background: Congenital nasolacrimal duct obstruction (CNLDO) is one of the most prevalent orbital diseases in children and treatment of recalcitrant cases is always challenging. The purpose of this study is to identify the effectiveness of balloon dacryoplasty and stenting in persistent congenital nasolacrimal duct obstruction following previous intubation of nasolacrimal duct.
Methods: Our study was an interventional study from January 2015 to January 2018 on 16 lacrimal systems of 11 patients (5 males and 6 females) with congenital obstruction of the lacrimal duct (CNLDO) and a history of unsuccessful probing and stenting, in Farabi Hospital of Tehran (affiliated to Tehran University of Medical Sciences). Children who presented to our hospital and had previously been probed with or without intubation by another surgeon first underwent reprobing and re-intubation with a Crawford tube. Endoscopy of the nasolacrimal system was performed in suspected cases of false stent passage or in the presence of a history indicating nasal pathology. Crawford's Monoka tube was removed after two months. Balloon dacryoplasty with intubation was performed as the third surgery in cases who did not respond to probing and stenting after 3-6 months. The success after six months was evaluated using fluorescein dye disappearance test (FDDT) and also the resolution of the patients' symptoms.

Results: The age of the patients was 67±35.01 months (range: 26-121). The site of the canalicular stenosis in our patients was in the common canaliculi or within 2-3 mm from it. After 6 months, surgery was successfully performed in 13 lacrimal systems (81.25%). One patient with congenital lacrimal duct obstruction and Down syndrome and two other patients did not respond to balloon dacryoplasty and stenting and subsequently underwent dacryocystorhinostomy (DCR).
Conclusion: Balloon dacryoplasty combined with Monocrawford intubation is an effective surgical procedure that should be considered in cases of congenital nasolacrimal duct obstruction who have not responded to the probing and stenting of the lacrimal system.

 

Secondary cancers evaluation inside organs at risk during the prostate cancer radiotherapy: a brief report
Reza Shamsabadi, Seyed Hamid Zoljalali Moghadam, Hamidreza Baghani , Seyed Ali Zoljalali Moghadam ,
Volume 81, Issue 3 (June 2023)
Abstract
Background: In prostate cancer radiotherapy, due to the proximity of the prostate to the rectum, it can be affected by high radiation doses. It has been reported that about 70% of secondary cancers after prostate cancer radiotherapy occur in the bladder and rectum, which are exposed to direct radiation. Since prostate cancer radiotherapy may be accompanied by side effects, the aim of this study is to investigate the risk of secondary cancers after the radiotherapy of prostate cancer inside the outfield organs.
Methods: The dose volume histogram data relevant to 39 patients with prostate cancer (who were treated with 3-dimensional conformal radiotherapy technique in 2022 in Tehran) were extracted, and the uniform absorbed dose inside the sensitive tissues was calculated according to the gEUD concept. Then, the risks of secondary malignancies following prostate cancer radiotherapy were calculated using the model introduced by the BEIR report. Accordingly, the lifetime attributable risk values (LAR) were estimated based on the desired organs and patient age at exposure time through the calculation of Excess relative risk (ERR) and Excess absolute risk (EAR) values.
Results: From the obtained results, the gEUD values for the rectum ranged from 51.04 Gy to 74.69 Gy and for the bladder from 27.22 Gy to 75.51 Gy. The maximum calculated risk values for the rectum and bladder were calculated to be 49.85% and 74.91%, respectively. Besides, a significant level of secondary cancer risk within the rectum and bladder was obtained for most of the studied patients. Furthermore, small values of secondary cancer risks were estimated for patients who were irradiated at older ages, and higher ones were obtained for patients who were irradiated at younger ages.
Conclusion: The results showed that there is a higher probability of developing secondary malignancies in the bladder than the rectum. The information obtained in this research can improve the performance of the treatment process, so that information about secondary cancers following radiation therapy for prostate cancer will ultimately help doctors design more effective and optimal treatment designs.

Effects of intravenous infusion of lidocaine and dexmedetomidine on immediate complications after tonsillectomy surgery in children
Behzad Nazemroaya, Azim Honarmand, Shima Shams,
Volume 81, Issue 4 (July 2023)
Abstract
Background: Tonsils are lymphoid tissues of the body's defense system that surround the pharynx and prevent the entry of microbes through inhalation. Tonsillectomy is the final treatment for enlarged tonsils and is one of the most common procedures in the ear, throat and nose. To prevent and improve postoperative complications, various methods are used, including lidocaine and dexmedetomidine injections. The aim of this study was to compare the effects of intravenous infusions of lidocaine and dexmedetomidine on the rate and severity of immediate complications after tonsillectomy surgery.
Methods: This study was conducted as a prospective, triple-blind, randomized clinical trial on 96 patients who were candidates for tonsillectomy under general anesthesia at Al-Zahra Hospital, Isfahan, Iran. The patients had informed consents and met the conditions to enter the study. 30 minutes before induction of anesthesia, patients were randomly assigned to one of three groups receiving lidocaine, dexmedetomidine, or placebo. All patients were examined for intraoperative bleeding, laryngospasm in the first 2 hours after the operation, and laryngitis in the first 24 hours after the operation. SPSS version 26 software was used for statistical analysis.
Results: The findings of this research indicated that at 45, 75 and, 90 minutes after recovery, the mean score of pain and at 15-90 minutes in terms of anxiety was significantly different from the rest in at least one of the three groups (P<0.05). Systolic blood pressure (SBP) and arterial oxygen blood pressure in minutes 30 to 90, as well as Diastolic blood pressure (DBP) in minutes 60, 75 and 90, showed a significant difference between the three studied groups (P<0.05). There was no significant difference between the incidences of laryngospasm in the groups. However, there was a significant difference between the incidences of bronchospasm in all three groups. In terms of factors such as cough and nausea, no significant differences were observed in the studied groups. However, the average amount of bleeding in surgery, the recovery time and, the first time to tolerate liquids and solids in at least one group were significantly different from the others.
Conclusion: Overall, both dexmedetomidine and lidocaine are effective in reducing heart rate, SBP, Per Os (PO), and bleeding, and also increase arterial oxygen pressure, while respiratory rate, laryngospasm, bronchospasm, cough, nausea and extubation time were not significantly different between the three study groups.

Realizing the early prediction chronic kidney disease based-on identifing
Mahdieh Jamshidi, Vahid Jamshidi,
Volume 81, Issue 4 (July 2023)
Abstract
Background: Due to the fact that various factors are involved in the development of chronic kidney disease, this disease appears with different clinical and laboratory symptoms. The variety in type and number of clinical symptoms often misguides the treating physician. The aim of this study is to extract the key features of the disease and find the best data mining methods to improve the accuracy of kidney disease diagnosis.
Methods: This cross-sectional study was conducted from September 2021 to March 2023 for 30 months at Rafsanjan Ali Ebn Abi Taleb Hospital. Predictive models were developed and tested using different combinations of disease characteristics and seven data mining methods in RapidMiner Studio software. The limitations of the study are as follows: 1) The models were based on 40-year-old and older patients records, which may limit the generalization of results to a wider age group. 2) Despite the high accuracy and comprehensiveness of the method, the models were based only on the information of kidney disease patients at Ali Ibn Abi Talib Rafsanjan Hospital. 3) The climate parameter has not been considered in the data set of the investigation to discover the hidden relationships of this parameter with the kidney disease.
Results: The results of the experiments in this study showed that the proposed prediction model using the Bayes method and eight identified key features (age, renal biopsy, uremia, sedimentation, albumin, edema, nocturnal enuresis, and urine-specific gravity), can detect kidney disease in people of different clinical characteristics, with 99.38% accuracy.
Conclusion: Considering that the early diagnosis of kidney disease and the adoption of appropriate treatment methods can prevent the progression of kidney damage, in this study, an attempt has been made to achieve this goal by using new statistical methods and artificial intelligence techniques. Based on the proposed method and the conducted experiments, the most important features and the best data mining method were obtained, and finally, kidney disease prediction was possible with high accuracy.

Frequency of causes of otalgia in patients referred to the ENT clinic: a brief report
Mohamad Ali Damghani , Ayeh Shamsadini , Elham Abbaszade,
Volume 81, Issue 6 (September 2023)
Abstract
Background: Otalgia is defined as pain localizing in the ear that can be primary or referred. By careful history and physical examination, all causes in this extensive differential diagnosis can be excluded. Given that otalgia is one of the most common causes for patients to visit the clinic and has a wide variety of differential diagnosis, the purpose of this study is to investigate the frequency of different etiologies of ear pain in patients referred to referral clinic.
Methods: This cross-sectional study was performed on patients presenting with otalgia. After entering the study, the patient underwent a thorough examination of the ear, nose, throat, head and neck, teeth and salivary glands by a resident under the supervision of a senior otologist, and based on the findings, relevant para clinical procedures such as x-ray, CT scan or stroboscopy were performed. Data collection was done based on a data log check list. Samples were collected during six months. SPSS software version 20 was used for analyses.
Results: The most common causes of otalgia were acute otitis media 29%, external otitis 17% and chronic otitis media 15%. Cerumen and referral ear pain were next in line (13.5%). There was significant relationship between otalgia with age groups (The age between 13 and 30 years were the most referred due to otalgia). There was no significant relationship between otalgia and gender, underlying disease, economic status, smoking and opium use.
Conclusion: Given that otalgia is a common complaint in patients referred to the clinic, knowing its causes and origin is useful in diagnosing, proper treating it and avoiding unnecessary para clinical procedures and empirical treatment. The most common causes of otalgia in this study were acute otitis media, otitis externa and chronic otitis media, respectively. Referral otalgia and cerumen impaction were the next causes. Among the age groups, the age between 13 and 30 years were the most referred due to otalgia, but there was no significant relationship with any of the variables of gender, economic status and smoking and opium use.

Investigating the association between K589E polymorphism of EXO1 gene with the susceptibility lung malignancy as a prognostic marker in the Iranian population
Jamshid Ansari, Milad Pezeshki, Azam Ahmadi, Ali Chehrei,
Volume 81, Issue 9 (December 2023)
Abstract
Background: Lung cancer has the highest incidence and mortality rate of all cancers worldwide. In Iran, it is one of the commonly diagnosed malignancies, and its frequency is increasing rapidly. Genetic variants in DNA repair genes are linked to differences in efficiency of repairing DNA damage, which can influence lung cancer susceptibility. EXO1 is a key gene involved in the mismatch repair pathway. The K589E polymorphism in EXO1 may alter the DNA repair activity of the encoded protein and impact lung cancer risk. The aim of this study was to investigate associations between the K589E polymorphism in EXO1 and lung cancer risk in the Iranian population, and evaluate its potential as a prognostic biomarker.
Methods: This case-control study was conducted to investigate EXO1 K589E variant with susceptibility to lung malignancy in the Iranian population. One hundred patients with lung cancer as a patient group and 100 healthy individuals from Khansari Hospital located in Markazi province were studied, from January 2020 to May 2022. DNA extraction from blood samples of participants was done using a kit.  Genotype determination of both patient and control groups was done using PCR-RFLP technique. Finally, statistical results were analyzed using SPSS software and the logistic regression method.
Results: Genotype and allele frequency  analysis showed the AA genotype (P=0.004, OR=5.391, 95% CI: 1.690-17.200) and A allele (P=0.010, OR=2.851, 95% CI: 1.291-6.300) were correlated with susceptibility to lung cancer. On the other hand, people carrying the G variant allele had a lower risk of lung cancer.
Conclusion:  In summary, this study found the AA genotype and A allele of K589E in EXO1 are correlated with risk of lung cancer in Iranians, while the G allele has protective effects. The K589E polymorphism may serve as a prognostic biomarker for lung cancer susceptibility, but more studies with high population size are required.

Determining the impact of stoic resilience training on operating room staff
Elmira Hajizade, Hossein Karimi Moonaghi , Jamshid Jamali, Haniye Mastour ,
Volume 81, Issue 10 (January 2024)
Abstract
Background: In health care, the well-being and flexibility of the operating room staff are of great importance due to the hard and stressful nature of their work. Therefore, this study was conducted to determine the effect of Stoic resilience training on the resilience of operating room staff.
Methods: The present study was a semi-experimental pre-test-post-test intervention study with a control group. A study was conducted among 67 people operating room staff working in Imam Ali and Imam Hassan hospitals in Bojnord city in September 2023 In this research, the demographic check list and the Connor and Davidson standard resilience questionnaire were used to collect information. The educational intervention was also implemented using the “SeRenE” Stoic education package. This training package includes 4 exercises, which were used only 3 exercises per day and for 6 consecutive days (45 minutes per day) due to the resilience variable. Statistical analysis was done using SPSS version 24 and at a significance level of 0.05.
Results: Based on the results, the total resilience score increased after the Stoic training (72.03±8.31) and showed a statistically significant difference with the control group (65.03±11.16) (P>0.05). The results showed that after Stoic training, mean of subscales of competence, trust in one’s instincts, tolerance of negative affect, positive acceptance of change and secure relationships, control as well as the total score of resilience increased in the training group. Although the mean score of spiritual influences dimension increased after the training, this increase was not statistically significant (P=0.097).
Conclusion: The findings show that Stoic training had a positive effect on various aspects of resilience among operating room staff, whose effects are more obvious in some subscales such as trusting individual instincts, tolerance of negative emotions, and positive acceptance of change. In general, the results showed that people's resilience increased after Stoic training. It is recommended to include Stoic training programs in the training of health personnel and caregivers.

Microbiota and probiotics, a new approach in the prevention and treatment of breast cancer: a review article
Saeedeh Keyvani-Ghamsari , Kiana Nouri, Ali Khaleseh Nejad , Shokoufeh Hassani,
Volume 81, Issue 11 (February 2024)
Abstract
Today, despite vast advances in cancer diagnosis and treatment, breast cancer is still the leading cause of cancer-related deaths in women. Various factors such as race, age, family history, mutation in the BRCA1/2 gene, diet, inactivity, alcohol consumption, and estrogen levels have been identified as risk factors for breast cancer. In recent years, microbiota has also been recognized as a new risk factor in breast cancer. In fact, the change in the microbial balance that occurs due to many environmental and internal factors of the body can be effective in the spread of cancer by affecting the intracellular pathways and signals. Studies have shown that intestinal dysbiosis affects the spread of breast cancer by affecting the metabolism and production of estrogen, or mechanisms unrelated to estrogen, such as the production of microbial metabolites that affect the immune system and lead to chronic inflammation. In addition, it has been proven that the breast tissue also has its microbiota, the types of which are different in healthy people, patients, even in different stages of breast cancer, and its subgroups. In such a way that a large amount of Proteobacteria, Firmicutes, Lactobacillus, and Actinobacteria are observed in healthy breasts, while their ratio changes in cancerous tissues. Considering the relationship between microbiota and breast cancer, maintaining a healthy microbiota is a new and significant approach to reducing the risk of developing, spreading, and managing this cancer. In this regard, compounds such as probiotics that can affect the balance of intestinal microbiota are considered as an effective approach to prevent and treat breast cancer. Probiotics can stimulate the growth of beneficial bacteria and inhibit the growth of harmful bacteria by causing physicochemical changes and affecting the metabolism of the intestinal microbiota. Furthermore, the consumption of probiotics can prevent the proliferation of cancer cells and reduce the tumor size by balancing the immune system, reducing inflammation, and inducing apoptosis in the cancer cells. This study describes the importance of microbiota in breast cancer, the difference between microbiota in a healthy person and a sick person, and the role of probiotics in the treatment of breast cancer.

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