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Investigating the effect of intravenous dexmedetomidine on bleeding rate and surgeon satisfaction in septorhinoplasty patients
Mojtaba Ghaedi, Mojtaba Sohrabpour, Gholamreza Motazedian, Navid Kalani , Reza Sahraei , Mohammad Sadegh Sanie Jahromi,
Volume 82, Issue 4 (July 2024)
Abstract
Background: Rhinoplasty is a challenging and complex surgery because it is designed to meet the unique needs of the patient. In rhinoplasty surgery, many factors contribute to achieving the desired result. These factors include the surgeon's care and observation, analysis of the existing anatomy, choice of surgical technique, degree of soft tissue and cartilage trauma, amount of bleeding, quality of surgical instruments and anesthesia, and anything that helps reduce bleeding.
Methods: This double-blind study was conducted on 50 patients aged 18 to 45 years undergoing septorhinoplasty surgery referred to Motahari Hospital in Jahrom city in 2022. Patients were randomly divided into dexmedetomidine and control groups. The degree of sedation, bleeding and surgeon satisfaction were evaluated and recorded. Data analysis was performed using SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and descriptive statistics (mean, standard deviation, percentage, number, frequency) and inferential statistical tests (Mann-Whitney U test, Kruskal-Wallis, t-test, chi-square test). The significance level in all tests was considered P<0.05.
Results: The majority of patients in the study groups were female and the mean age of patients in the dexmedetomidine group was 34.36±7.33 years and in the control group was 36.60±9.59 years. The study groups were similar in terms of age and body mass index (P<0.05). The frequency of patient sedation in the dexmedetomidine group was lower than the control group, but it was not statistically significant (P<0.05). The results showed that at the beginning of the operation and 90 minutes later, the satisfaction level of the patient surgeon in the dexmedetomidine group was significantly better than the control group (P<0.001). In the dexmedetomidine group, the field of view of the surgeon was relatively clear and completely clear. The amount of bleeding in the dexmedetomidine group was lower than the control group, but it was not statistically significant (P<0.05).
Conclusion: Dexmedetomidine increased the surgeon's satisfaction by reducing bleeding and improving the surgeon's visual field. Therefore, this drug can be used as an anesthetic aid in surgery.

Comparison of duration and survival rate of burn patients above 90% in the burn unit isolation room and BICU
Najibeh Mohseni Moalem Kolae , Abdolreza Jafarirad, Mohammadhossein Hesamirostami , Khadije Moeiltabaghdehi , Mojtaba Ghorbani , Abolfazl Hosseinnattaj,
Volume 82, Issue 4 (July 2024)
Abstract
Background: Death is one of the serious consequences of burns, which usually occurs as a result of hospital infections. This study was conducted with the aim of investigating the existing disagreement regarding the admission of more than 90% patients in the burn intensive care unit with the isolation room of the burn unit.
Methods: This retrospective descriptive-analytical study was conducted based on case review. The statistical population included the files of patients hospitalized in the burn wards and burn intensive care unit of Zare'e Sari Burn and Psychiatric Center from 2011 to 2023 who died. All these patients were included in the study as a census. The data was extracted through a checklist prepared by the researcher. Descriptive and inferential analysis of the data was performed using SPSS version 21 software. The variables studied included gender, age, burn percentage, burn factor, and duration of hospitalization, and determining the relationship between burn percentage and survival time in the two burn intensive care units and the isolation room of the burn unit was the main variable. The mean and standard deviation were used to describe quantitative data, and the frequency and percentage were used to describe qualitative data.
Results: Among 882 cases, 226 patients had burns above 90%. 143 cases were related to men (63.3%). Most patients were in the age group of 19 to 40 years (61.9%). The cause of the burn (54.9%) was flame. Among the patients (83.2%) were hospitalized in the isolation room of the burn ward. Although the average days of hospitalization of patients above 90% in the burn intensive care unit was 13.71±11.82 days and the burn isolation room was 8.66±9.11 days, the Mann-Whitney test showed that the average survival time of these patients in the burn isolation room of the burn ward was significantly different from the intensive care unit. (sig.=0.001).
Conclusion: Although the average survival time in the two groups showed a significant difference, ultimately all patients in the two groups died within a few days of each other.

Correlation of radiomics features extracted from nuclear medicine images with lesion metabolism in patients with colon cancer
Yunus Soleymani, Farahnaz Aghahoseini, Peyman Sheikhzadeh,
Volume 82, Issue 5 (August 2024)
Abstract
Background: Nuclear medicine imaging has shown high accuracy in evaluating the metabolism of colon cancer lesions. The aim of this study was to investigate the ability of radiomics features extracted from nuclear medicine images as non-invasive biomarkers of lesion metabolism in patients with colon cancer by examining the correlation of these features with SUV (standardized uptake value) max values.
Methods: The current study was a cross-sectional study that was conducted from July 2022 to July 2023 in the nuclear medicine department of Tehran University of Medical Sciences. In this study, PET/CT (positron emission tomography/computed tomography) images of 60 patients with primary colon cancer were used. Colon cancer lesions were manually delineated on PET images by an experienced physician and saved as VOIs (volumes of interest). Thirty-two textural radiomics features were extracted from each VOI, including feature groups of gray-level co-occurrence matrix (GLCM), gray-level run-length matrix (GLRLM), neighborhood grey-level difference matrix (NGLDM), and gray-level zone length matrix (GLZLM). Then, the correlation of these features with SUVmax values was investigated using the Spearman correlation coefficient statistical test. Also, the value of p<0.05 was considered as the significance level of the test.
Results: A comprehensive analysis revealed that more than 96% of the examined radiomics features specifically, 31 out of 32 exhibited a statistically significant correlation with lesion metabolism values, as indicated by p-values less than 0.05. Among these features, GLZLM_HGZE stood out with a high correlation coefficient of 0.9881, alongside a significance level of less than 0.0001. Similarly, GLZLM_SZHGE also demonstrated a strong correlation, with a coefficient of 0.9723 and a significance level below 0.0001, indicating a robust relationship with SUVmax values. In contrast, GLZLM_LZHGE was the only feature that failed to show a significant correlation with lesion metabolism values (p>0.05).
Conclusion: The radiomics method has the potential to be used as a completely non-invasive method to evaluate the metabolism of colon cancer lesions and facilitate the monitoring and treatment of patients with colon cancer.

Relationship between sarcopenia and postoperative complications in bladder cancer patients undergoing radical cystectomy
Solmaz Ohadian Moghadam , , Mohsen Ayati, Erfan Amini , Faeze Salahshour, Mohsen Shiraghaei ,
Volume 82, Issue 5 (August 2024)
Abstract
Background: Sarcopenia is the degenerative loss of skeletal muscle mass, which is known as a poor postoperative outcome in various cancer types. Radical cystectomy (RC) is often associated with high mortality rates, and sarcopenia is hypothesized to aid in risk stratification. Hence, this study assessed the role of Sarcopenia as an indicator of postoperative outcomes and survival rates in patients undergoing RC for bladder cancer.
Methods: This cross-sectional research was carried out between January 2022 and January 2023 on 30 patients with bladder cancer who were candidates for RC and referred to the urology clinic of Imam Khomeini Hospital in Tehran. One week before surgery, the cross-sectional area of the psoas muscle was measured using MRI to estimate muscle volume, and the sarcopenia index was calculated. Muscle area evaluation was performed by calculating the cross-sectional area of the left and right psoas muscles on MRI. The psoas muscle area was calculated by excluding blood vessels, bony structures, and intermuscular fat regions based on fat signals. The calculated psoas muscle area was then normalized to the patient's height in square meters. To improve the quality of reporting on surgical complications, the patients were re-examined and the duration of patients' hospital stays was measured.
Results: The mean sarcopenic index for the patients was 1264.6 ± 591.5 mm²/m². Seven patients (24.1%) were smokers, while 22 patients (75.9%) were non-smokers. During the 10-month follow-up period, 25 patients (83.3%) remained alive, and 5 patients (16.7%) passed away. The mean value of sarcopenic index in patients with localized cancer was higher than those with advanced cancer, but this difference was not statistically significant. Data analysis revealed a significant association between higher mortality rates and the presence of locally advanced bladder tumors (P = 0.046). Additionally, a reduced sarcopenic index in this study was significantly correlated with lymphovascular invasion. In this study, no correlation was found between perioperative complications and sarcopenic index.
Conclusion: To conclude, a significant association was observed between a reduction in the sarcopenic index and lymphovascular invasion; however, no connection was identified between mortality rates and postoperative complications following RC.

Epidemiological investigation of emergency department visits in patients with cancer: a three-center study
Mohammad Masud Khubiari , Simin Najafgholian, Bahareh Abbasi, Ramin Parvizrad, Reza Aghbozorgi,
Volume 82, Issue 5 (August 2024)
Abstract
Background: Emergency Departments (EDs) visits reflect medical needs and demands or the only care available to patients. Many ED visits are potentially preventable with access to high-quality, community-based health care. Given the higher incidence of emergency conditions in patients with cancer the global increase in cancer will pose a challenge for emergency services. Therefore, this study was conducted with the aim of epidemiological investigation of emergency department visits by cancer patients in several centers.
Methods: In this cross-sectional study, the triage form and hospital file of known patients with various cancers, who visited in Eds of valiasr and Amir al Momenin hospitals in Arak, Hazrat Rasool Akram and Lolagar hospitals in Tehran, and Shahid Sadouqi and Shah vali hospitals in Yazd, From April to September 2017. To measure the urgency of ED visits, the emergency severity index and triage form were used, and the outcome of the emergency visit was extracted from the patient's file and recorded in the data collection checklist. Multivariate logistic regression analysis was used to examine the association of patient, hospital and potentially preventable factors.
Results: In this study, 1107 patients, 550 men (%49.7) and 577 women (%50.3) with cancer were were studied. Age 65 and older had the most emergency visits. The most common reason for patients to visit was: pain in different organs (18.2%), fever (8.7%), weakness and malaise (7.5%). A total of 617 (55.7%) visits were potentially preventable. Age 17 years and younger (OR, 3.172; 95% (CI), 2.409-4.021) and presence of more than 1 comorbidity (OR, 3.610; 95% (CI), 3.611-4.521) were positively associated with potentially preventable visits.
Conclusion: In this study, 50.7% of ED visits among patients with cancer were identified as potentially preventable, and the most common reason for patient visits was general and non-specific symptoms such as pain, weakness, and malaise. These findings highlight the need for palliative care and evidence-based interventions in outpatient settings.

Determining the diagnostic reference levels (DRL) of CT scan imaging in Saveh Hospitals: a brief report
Mohamad Sarkheil, Mehran Mohseni, Akbar Ali Asgharzadeh , Ali Rasouli Bozcheloie ,
Volume 82, Issue 5 (August 2024)
Abstract
Background: Based on the recommendation of the European Committee and ICRP, DRL values should be determined at the local, national and regional levels for CTDIvol (Computed Tomography Dose Index volume) and DLP (Dose Length Product) dose indicators. According to the radiation protection guidelines, it is essential study has determined DRL in Saveh hospitals
Methods: This study was conducted with two methods based on the results and calculations obtained from the annual Quality Control (QC) reports and the Data Collection (DC) method related to patient scans. In this study, by referring to the annual reports of each device and using radiation components during dosimetry and determining CTDIair or CTDIw, the correction factor was obtained. Using this factor and existing equations, DLP and CTDIvol were calculated based on quality control standards. The second quartile or the median was determined as DRL for head, sinus, chest and abdomen/pelvis imaging protocols and its values were compared with each other and other studies. This study was conducted in February and March 2023 in three hospitals in Saveh city.
Results: The diagnostic reference levels of CTDIvol index were obtained in both QC and DC methods for head (32.76 and 32.36), sinus (11.73 and 9.89), chest (6.06 and 5.11) and abdomen/pelvis (11.86 and 10.56) imaging. The highest DRL values of DLP index in both QC and DC methods are for head, abdomen/pelvis, chest and sinus CT scans, respectively. In the QC method, these values were (603.99), (478.15), (187.15), and (132.65) respectively, and in the DC method, the values were (601.84), (427.76), (219.01), and (114.81) mG.cm.
Conclusion: According to the results of this study and the lack of significant difference between the DRL values of CTDIvol and DLP indicators in both QC and DC methods, it is recommended that the centers, if they have the acceptance criteria for annual quality control, can determine the DRL by referring to the device console information from the DC method.

Impact of viral oncoproteins on human genome methylation: a review article
Farzane Hayati, Esma’il Akade, Negar Dinarvand, Gholam Abbas Kaydani , Shahram Jalilian,
Volume 82, Issue 6 (September 2024)
Abstract
Epstein-Barr virus (EBV), human herpesvirus 8 (HHV-8), hepatitis B virus (HBV), human papilloma virus (HPV), Merkel cell polyomavirus (MCPyV), human lymphotropic virus type 1 (HTLV-1) and Hepatitis C virus (HCV) are among the most important viruses that cause cancer in humans. These viruses are collectively known as oncoviruses due to their potential to induce malignant transformations in host cells. Oncoviruses exert their cancer-causing effects by utilizing various viral oncoproteins and non-coding RNAs, which can drive host cells toward malignancy through multiple pathways. One critical strategy these viruses employ involves altering the host cell's regulatory mechanisms, particularly by influencing DNA methylation processes.
DNA methylation is a crucial modification that occurs on the promoter regions of genes, effectively reducing their expression levels. Under normal cellular conditions, a delicate balance of methylation and demethylation is maintained by a specific set of enzymes. Key players in this process include DNA methyltransferases (DNMTs) and TET methylcytosine dioxygenases (TETs), which are pivotal in regulating gene expression through methylation. These enzymes are prime targets for oncoviruses because, by altering their activity, viruses can hijack the host cell's regulatory machinery. Viral oncoproteins, though diverse in structure and function, often converge on disrupting the expression of these enzymes. By doing so, they induce widespread changes in DNA methylation patterns, effectively reprogramming the gene expression landscape of the host cell. This reprogramming is not random; rather, it is a calculated mechanism through which oncoviruses can manipulate the cell cycle, promoting uncontrolled cellular proliferation and progression towards cancer. By suppressing or activating specific genes, these viruses can push cells past normal checkpoints, eventually leading to tumor formation. Despite the critical role of DNA methylation in cancer development, the precise mechanisms by which oncoviruses modulate these methylation processes are not fully understood. Researchers have made significant progress in exploring the connection between viral infections and cancer, but many of the detailed pathways through which oncoviruses control methylation remain to be elucidated. As a result, this area remains a fertile ground for further research, offering potential avenues for therapeutic intervention in virus-induced cancers.

Investigating the role of vitamin D deficiency as a risk factor and prognosis of breast cancer: a case-control study
Navid Kalani , Lohrasb Taheri , Fatemeh Eftekharian, Ali Talebi, Marzieh Haghbeen,
Volume 82, Issue 6 (September 2024)
Abstract
Background: Breast cancer is the most common cancer diagnosed in women. Epidemiological studies have led to the hypothesis that vitamin D may reduce the risk of breast cancer. This study aimed to investigate the association between vitamin D deficiency and breast cancer.
Methods: This case-control study was conducted on 59 patients referred to Khatam Al-Anbia Comprehensive Cancer Clinic in Jahrom city between May 2021 and March 2022. Thirty patients with pathologically confirmed ductal or lobular breast cancer in situ or invasive in one or both breasts, with no previous history of the disease and within two months of their breast cancer diagnosis, were considered as the case group. Thirty women without breast cancer who had been referred for breast screening examination were considered as the control group. Both groups were matched for demographic characteristics and age. The data collection tools in this study included demographic information and clinical history of the patients and serum vitamin D levels. Data analysis was performed using SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and descriptive statistics (mean, percentage, and standard deviation) and inferential statistical tests (logistic regression, Kolmogorov-Smirnov). The significance level was considered to be P<0.05.
Results: The mean age of the patients participating in the case group was 52.17±10.6 and in the control group was 51.24±9.7. There was no statistically significant difference in age (P=0.654). There was also no significant difference between the two groups in terms of body mass index and different body index classifications, menopause age, and age of onset of menstruation. The number of months of breastfeeding in the control group was significantly higher than the case group (P=0.001). The results of logistic regression showed that, on the other hand, there was no significant relationship between the type of pathology of the disease and serum vitamin D levels.
Conclusion: The results of the present study showed that vitamin D deficiency can be a poor prognostic factor in the course of breast cancer.

Evaluation of the impact of blue light blocking filters on visual quality after PRK surgery
Saeed Rahmani, Aliakbar Shafiee, Abbas Riazi , Alireza Akbarzadeh Baghban , Alireza Jafari , Maryam Dashti,
Volume 82, Issue 6 (September 2024)
Abstract
Background: Problems related to blue light exposure are among the various issues experienced by individuals who have undergone Photorefractive Keratectomy (PRK).Given the growing concerns regarding blue light’s effects on visual health, this study aimed to thoroughly investigate the impacts of blue blocker filters on the improvement of vision in patients post-refractive surgery of the PRK type. The primary objective was to evaluate the overall effectiveness of these filters in enhancing visual quality and in reducing complications associated with the surgery, which can significantly affect a patient’s quality of life.
Methods: In a quasi-experimental study conducted from September 1, 2024, to the end of October 2024, individuals who had undergone PRK surgery were examined at the optometry clinic of Dr. Labbafi Nejad Hospital in Tehran. Participants were subjected to assessments both with and without the application of blue blocker filters. Key parameters, including visual acuity and contrast sensitivity among attendees, were meticulously measured under both conditions. The results were then systematically compared and analyzed to draw meaningful conclusions about the impact of blue blocker filters in this context.
Results: A total of thirty-four participants, comprising 73.5% females and 26.5% males, with an average age of 32.6 years, were incorporated into the study. Post-surgery, the average refraction measured in the right and left eyes was documented as   -0.42±0.16 D and -0.30±0.16 D, respectively. Notably, visual acuity in both eyes significantly improved with the use of the blue light blocking filter (P<0.005) Moreover, contrast sensitivity at varying spatial frequencies of 1.5, 6, and 18 cycles per degree (c/d) also exhibited significant enhancement (P<0.005).
Conclusion: The incorporation of blue blocker filters for individuals with a history of PRK surgery has led to noteworthy improvements in visual acuity and enhanced contrast sensitivity. These findings underscore the critical importance of integrating blue light protection in the post-operative care of patients, as it significantly elevates the overall visual experience and may contribute to better long-term outcomes following refractive surgery.

Comparison of the complications and results of intubation with a cuffed tracheal tube filled with alkaline lidocaine gel and filled with air in patients admitted to Baqiyatallah Al-Azam Hospital
Pourya Mashategan, Mohammad Reza Ghane , Ali Bahramifar, Mahdi Raei ,
Volume 82, Issue 6 (September 2024)
Abstract
Background: Intubation is normally conducted in an emergency or prior to surgery. A cuffed tracheal tube is fitted, whose inflated cuff exerts pressure on the tracheal wall. Such pressure should, therefore, be monitored every day by use of pressure gauge devices. The general guideline in this regard is that the pressure of the cuff must lie between 20 and 30 cm of water. The exaggerated pressure may cause tissue ischemia, wound, and necrosis of the tracheal wall; if it is too low, this could result in air leakage and oropharyngeal secretions, increasing the risk of insufficient ventilation and aspiration pneumonia. This study aimed at comparing the cuff pressure of an endotracheal tube inflated with alkaline lidocaine versus air for any post-extubation complications and cuff pressure changes.
Methods: This prospective cohort study was conducted on patients who were admitted to the intensive care unit of Baqiyatullah Al-Azam Hospital in Tehran between May 2023 and February 2024, underwent intubation in this unit and met the inclusion criteria for the study. This prospective study included 62 patients, and tracheal tube cuff pressure was recorded at 30 minutes, 60 minutes, 120 minutes, 6 hours, and 24 hours after intubation with a pressure gauge. Patients were randomly divided into two groups-an 'air group', whose cuff was inflated to the pressure of 20 cmH2O by air, and a 'lidocaine group,' whose cuff was filled with 2% lidocaine to the same pressure. In this study, the post-extubation complications, such as sore throat, hoarseness, and cough, were assessed immediately and 24 hours after extubation. Similarly, the tracheal tube displacement during the intubation process was monitored in both groups.
Results: The results showed that the pressure of an endotracheal tube cuff inflated with lidocaine was drastically lower than the one inflated with air, with a p-value of 0.001. On the other hand, the sore throat, cough, and hoarseness after extubation and 24 hours later were significantly fewer in the lidocaine group compared with the air group at a p-value of 0.001.
Conclusion: Cuffs inflated with alkalinized lidocaine clearly avoided high cuff pressure at induction and reduced postextubation sore throat. Hence, alkalinized lidocine-filled endotracheal tube cuffs are comparatively safer and more beneficial than conventional air-filled cuffs.

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