Vasculitis, Thrombotic Thrombocytopenic Purpura, and Disseminated Intravascular Coagulation Associated With Methamphetamine Intoxication: A Case Report

Amphetamines and methamphetamines are two groups of substance whose use are increasing globally. Methamphetamines poisoning may develop different sympathetic symptoms; however, developing some complications, such as vasculitis, central nervous system involvement, and kidney injury. In this study, we report a case of methamphetamine poisoning that presented with loss of consciousness and developed Thrombocytopenic Purpura (TTP), Disseminated Intravascular Coagulation (DIC), and pulmonary pseud vasculiti

The Effect of Preoperative Oral Melatonin on Postoperative Pain after Lumbar Disc Surgery: A Double-Blinded Randomized Clinical Trial

BACKGROUND: Despite advances in surgical and anesthesiology techniques, many patients continue to experience postoperative pain after lumbar disc surgeries. The aim of this study was to investigate the effect of preoperative oral melatonin on the severity of postoperative pain after lumbar laminectomy/discectomy. METHODS: In this double blinded randomized controlled clinical trial 80 patients undergoing an elective mini-open microdiscectomy surgery at Imam Khomeini educational hospital in Sari, Iran, were selected and randomly assigned into one of four groups. Patients in group A, B, C, and D received 3, 5 and 10 mg melatonin or placebo tablets one hour before surgery, respectively. Using the visual analogue scale (VAS) the severity of pain, nausea and vomiting, pruritus, and use of narcotics were assessed immediately after surgery and before leaving the post-anesthesia care unit, 6, 12 and 24 hours postoperatively. RESULTS: In all three groups receiving melatonin at all three different doses, postoperative pain was significantly less than the placebo group (P<0.01). There were no statistically significant differences in postoperative pain level between the three groups receiving melatonin (P>0.05). The amount of opioid received by the patients within 24 hours after surgery had statistically significant differences within the groups (P=0.043, F=2.58). The results of post hoc analysis in terms of postoperative pain intensity showed statistically significant differences between the two groups receiving melatonin at a dose of 5 mg and the placebo group (P= 0.04). No serious side effects reported in four groups. CONCLUSION: The use of oral melatonin with a dose of 5 mg, 1 hour before the surgery as an inexpensive method can effectively reduce pain intensity as well as the amount opioid use after lumbar laminectomy and discectomy

Comparison of breast cancer survival in two populations: Ardabil, Iran and British Columbia, Canada

<p>Abstract</p> <p>Background</p> <p>Patterns in survival can provide information about the burden and severity of cancer, help uncover gaps in systemic policy and program delivery, and support the planning of enhanced cancer control systems. The aim of this paper is to describe the one-year survival rates for breast cancer in two populations using population-based cancer registries: Ardabil, Iran, and British Columbia (BC), Canada.</p> <p>Methods</p> <p>All newly diagnosed cases of female breast cancer were identified in the Ardabil cancer registry from 2003 to 2005 and the BC cancer registry for 2003. The International Classification of Disease for Oncology (ICDO) was used for coding cancer morphology and topography. Survival time was determined from cancer diagnosis to death. Age-specific one-year survival rates, relative survival rates and weighted standard errors were calculated using life-tables for each country.</p> <p>Results</p> <p>Breast cancer patients in BC had greater one-year survival rates than patients in Ardabil overall and for each age group under 60.</p> <p>Conclusion</p> <p>These findings support the need for breast cancer screening programs (including regular clinical breast examinations and mammography), public education and awareness regarding early detection of breast cancer, and education of health care providers.</p

Comparing the Scores of Sequential Organ Failure Assessment and a Proposed Bedside Tool in Patients with Systemic Inflammatory Response Syndrome Admitted to ICU

Background and purpose: Sequential organ failure assessment (SOFA) is used to assess the severity of the disease and mortality rate in patients admitted to ICU. SOFA requires experiments that are impractical in centers with limited resources. The aim of this study was to compare the diagnostic value of bedside SOFA (b SOFA) and SOFA scores in mortality of ICU patients. Materials and methods: This cohort study was performed in 60 patients with Systemic Inflammatory Response Syndrome (SIRS) older than 18 years of age. SOFA and b SOFA scores were recorded at admission, then daily until admission at ICU. Results: According to the Lin and Bland-Altman agreement coefficient, there was a very good agreement between SOFA and b SOFA scores at days 1, 15, 16, 17, 18, and 20. At days 3, 5, 7, 14, and 19 we observed a good agreement and significant correlation between SOFA and b SOFA scores. Findings showed a moderate agreement between SOFA and b SOFA scores at days 2, 4, 6, 8, 9, 10, 11, 12, and 13, but at days 13 and 15 there was a direct relationship between the two scores (P>0.05). Area Under Curve (AUC) method in ROC Curve showed no significant difference in diagnostic value between SOFA and b SOFA scores except at day 17 (P>0.05), indicating acceptable diagnostic value of b SOFA score compared to SOFA score. The sensitivity and specificity of the tools in terms of prognosis were found to be very close at different times showing similar diagnostic values. Conclusion: The study showed diagnostic accuracy, and high sensitivity and specificity for predicting mortality and strong positive correlation between the two tools, so b SOFA is a suitable alternative due to lower cost with greater ease

Comparing Supraglottic Airway Devices for Airway Management During Surgery in Children: A Review of Literature

Context: Supraglottic Airway Devices (SADs) are applied in airway management of pediatric emergency conditions. Objective: This review study aimed to examine the literature regarding pediatric supraglottic airway devices, to introduce the optimal devices in terms of Oropharyngeal Leak Pressure (OLP), risk of insertion failure on the first attempt and risk for blood staining of the device. Data Sources: An electronic search was conducted on MEDLINE, EMBASE, CINAHL and PubMed databases. We also searched the Cochrane database (CENTRAL) and Web of Science up to July 1, 2017. Study Selection: Of 112 potential studies, the full texts of 53 articles were available, in which 15 were duplicated and omitted, accordingly. Papers which did not directly discuss SADs were also excluded. In total, 30 papers were identified related to the children supraglottic devices. Data Extraction: The current review was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Results: The LMA ProSeal may be the best supraglottic airway device for children due to its high oropharyngeal leakage pressure and low risk of insertion failure. It seems that i-gel is a very functional tool as well. Conclusions: Further research is recommended to investigate the most appropriate supraglottic airway in diverse clinical situations and various conditions among children

Autoantibodies in a Three-Year-Old Girl with Visceral Leishmaniasis: A Potential Diagnostic Pitfall

Visceral leishmaniasis (VL), a life-threatening parasitic infection, is endemic in the Mediterranean region. Diagnosis of VL is based on epidemiologic, clinical, and laboratory findings. However, sometimes, clinical features and laboratory findings overlap with those of autoimmune diseases. In some cases, autoantibodies are detected in patients with VL and this could be a potential diagnostic pitfall. In this study, we have reported on a three-year-old girl from a VL-endemic area in Iran, who presented with prolonged fever and splenomegaly. Bone marrow examination, serologic tests, and the molecular PCR assay were performed; however, results were inconclusive. The levels of anti-double stranded DNA, cytoplasmic antineutrophil cytoplasmic autoantibody, and perinuclear antineutrophil cytoplasmic autoantibody were elevated and, at the end, splenic biopsy was performed. The splenic tissue PCR test detected the DNA of Leishmania infantum. The patient’s condition improved with anti-Leishmania therapy, and the autoantibodies disappeared within the following four months. Clinical presentations and laboratory findings of VL and autoimmune diseases may overlap in some patients

Case Report Autoantibodies in a Three-Year-Old Girl with Visceral Leishmaniasis: A Potential Diagnostic Pitfall

Visceral leishmaniasis (VL), a life-threatening parasitic infection, is endemic in the Mediterranean region. Diagnosis of VL is based on epidemiologic, clinical, and laboratory findings. However, sometimes, clinical features and laboratory findings overlap with those of autoimmune diseases. In some cases, autoantibodies are detected in patients with VL and this could be a potential diagnostic pitfall. In this study, we have reported on a three-year-old girl from a VL-endemic area in Iran, who presented with prolonged fever and splenomegaly. Bone marrow examination, serologic tests, and the molecular PCR assay were performed; however, results were inconclusive. The levels of anti-double stranded DNA, cytoplasmic antineutrophil cytoplasmic autoantibody, and perinuclear antineutrophil cytoplasmic autoantibody were elevated and, at the end, splenic biopsy was performed. The splenic tissue PCR test detected the DNA of Leishmania infantum. The patient&apos;s condition improved with anti-Leishmania therapy, and the autoantibodies disappeared within the following four months. Clinical presentations and laboratory findings of VL and autoimmune diseases may overlap in some patients