The Impact of Epidural Analgesia on Cesarean Section Rates and Neonatal Outcomes: A Retrospective Cohort Study

This retrospective cohort study aimed to assess the frequency of emergency cesarean sections with epidural analgesia and its implications on Apgar scores and Neonatal Intensive Care Unit (NICU) admissions among patients at Tehran University of Medical Sciences Hospitals from 2017 to 2018. Data from 7170 patients were extracted from the hospital information system (HIS) through a consensus method. Descriptive statistics, cross-tabulation, and logistic regression analyses were conducted using Stata v17 software. Out of 9387 patients, 62.7% underwent cesarean sections, and 37.1% had normal vaginal deliveries. Epidural analgesia was administered to 127 patients, with 98.4% achieving successful normal vaginal delivery. Nulliparous women constituted 64.29% of those receiving epidural analgesia. Apgar scores at five and ten minutes were comparable between epidural and non-epidural groups. Emergency cesarean rates with epidural analgesia were low (1.6%). Findings align with previous research indicating no significant impact of epidural analgesia on Apgar scores. Nulliparous women predominated in the epidural group, consistent with pain pattern disparities. The study supports recent research showing epidural analgesia does not increase emergency cesarean rates, even in high-risk pregnancies. This study suggests that epidural analgesia does not significantly impact Apgar scores, NICU admissions, or emergency cesarean rates. While the comprehensive dataset enhances reliability, retrospective design limitations are acknowledged. Prospective studies exploring factors contributing to neonatal mortality and overall labor duration are recommended for more robust evidence

Bleeding Reduction by Acupuncture in Rhinoplasty: A Triple-Blind Randomized Clinical Trial

Background: Bloodless surgical field obtained by controlled hypotension reduces the bleeding, the surgical time and improves outcome of rhinoplasty and other facial plastic surgeries. Since acupuncture is used for epistaxis, this study was designed to investigate its effectiveness in reducing the bleeding in open rhinoplasty. Methods: In a triple-blinded randomized clinical trial, 88 patients with ASA I and II physical status, aged between 20 – 48 years, who were candidates of open rhinoplasty were enrolled in the study. After randomization, 44 patients were assigned to each group of acupuncture or control. They were given identical anesthesia. In addition to the hemodynamic monitoring, blood loss was assessed in all patients and compared between the two groups. Results: There were statistically significant differences between two groups in terms of the amount of bleeding (P = 0.001) and surgeon satisfaction (P = 0.010). Coagulation indicators were similar in both groups (All P > 0.05). Mean SBP and DBP, average HR and average MAP in both acupuncture and control groups did not show significant differences (All P > 0.05). Adverse events such as bradycardia or hypotension requiring treatment were not seen. Conclusion: Our findings demonstrated that acupuncture could reduce bleeding during rhinoplasty without side effects

The Efficacy of General Anesthesia with Sevoflurane for Pain Management in Neonates and Infants with Idiopathic Clubfoot Treated with Ponseti Technique and Percutaneous Achilles Tenotomy

Background: Idiopathic clubfoot deformity is a relatively common congenital pediatric foot deformity. A percutaneous Achilles tenotomy (PAT) is required to correct the equinus deformity as it is the most resistant component of clubfoot deformity. Although this procedure is mainly performed with local anesthesia, performing this procedure with general anesthesia has significant advantages. Aims: The purpose of this study was to compare the safety and efficacy of post-procedural pain management of PAT in the treatment of clubfoot with the Ponseti method when performed in a clinic setting with local anesthetic or under general anesthesia Methods: This is a multicentric prospective observational evaluation on children less than one year of age with idiopathic clubfoot whom referred for Ponseti casting and PAT. This procedure was done in the control group with local anesthesia and in the intervention group with Sevoflurane mask 8% (MAC 2) and maintenance of anesthesia with Sevoflurane mask 4% (N2O/O2, 50%). The neonatal infant pain scale (NIPS), the amount of milk, and mood changes were evaluated as a criterion to measure the pain level. Results: NIPS score in the intervention group was significantly lower than the control group. Children in the intervention group consume significantly more milk than the control group. Furthermore, 76% of children in the intervention group were classified as "calm," 24% as "relatively restless," and no child was classified as "severely restless." While in the control group, 54% of children were classified as "severely restless," and the remaining 46% as "relatively restless." Conclusion: Our result showed that using general anesthesia to perform achillotomy in the treatment of clubfoot in children could be associated with less pain in these patients and without significant complications

A Giant Hemangioma of the Tongue

Introduction: Vascular abnormalities are relatively uncommon lesions, but head and neck is a common region for vascular malformation which is classified as benign tumors. In this paper, the authors report a rare presentation of vascular malformation in the tongue and its managements. Case Report: An 18 months 2 old child presented with a giant mass of tongue which caused functional and aesthetic problem. The rapid growth pattern of cavernous hemangioma was refractory to corticosteroid. The lesion was excised without any complication. Since the mass was so huge that not only filled entire oral cavity but was protruding outside, airway management was a great challenge for anesthesia plan and at the same time surgical technique was difficult to select. Conclusion: Despite different recommended modalities in managing hemangiomas of the tongue, in cases of huge malformations, surgery could be the mainstay treatment and provided that critical care measures are taken in to account, could be performed very safely

Airway Management in a Toddler with a Giant Hemangioma of the Tongue

Background: Induction of general anesthesia in a patient with compromised airway has always caused dilemma to anesthesiologist, especially for toddler this is paramounted. Case Presentation: An 18 month old boy had a huge sized lingual mass which not only filled entire oral cavity but protruded outside the mouth up to about 5 cm. Having in mind the diagnosis of hemangioma, prior to induction it was attempted to reduce the mass but could be reduced only minimally by manual decompression. While the tongue, still outside the mouth, with full preparedness for anesthesia was induced maintaining the spontaneous ventilation. During laryngoscopy and intubation the tongue was pulled out of the oral cavity to ease the passage of the endotracheal tube. The mass was excised successfully and patient had an uneventful postoperative course. Conclusion: Maintenance of spontaneous ventilation is the crucial safety element during induction

Effects of different cooking methods and temperatures on residual nitrite content in sausage

Background: Presence of nitrites in meat products is important because they combine with secondary amines and produce nitrosamine carcinogen. Objective: The aim of this study was to determine the effects of different cooking methods and temperatures on residual nitrite content in sausage. Methods: This experimental study was conducted in the Food and Drug Laboratory of Qazvin University of Medical Sciences in 2014. Sausage samples containing 90% meat that were produced under identical conditions in a factory in Qazvin were transferred to the laboratory under suitable conditions and their residual nitrite contents were measured. The residual nitrite content was remeasured three times after using different cooking methods (frying, grilling, and cooking in microwave oven) at different temperatures and durations in 39 experiments. Data were analyzed using one-way ANOVA. Findings: Before cooking, the residual nitrite content was 33.57 mg/kg in the sausage samples and reached to 26.46 mg/kg after frying at 120º C for 5 minutes. Mean residual nitrite content was significantly different at other temperatures and cooking durations. The mean residual nitrite content reached to 1.42 and 0 after frying at 220º C for 5 and 10 minutes, respectively. Conclusion: With regards to the results, the greater the temperature and the duration of cooking, the more the reduction in residual nitrite content of the final product. Keywords: Nitrites, Meat Products, Temperatur

Comparison with the effect of organic acids on preservation of microbial, chemical and organoleptic of chicken's meat

Background: Adding edible acids to foodstuff not only makes a control in microorganisms, but also causes an appropriate taste and color. Objective: The main aim of this study was the relationship between the effect of organic acids on microbial, chemical and organoleptic and its shelf life chicken's meat. Methods: This experimental study was conducted on chicken's meat. At first chicken's meat with %1 solution of sterilized citric, acetic, and propionic acids, and then packed. The samples of packed meats were kept at temperature below 4 celsius degree, and at interval of 2 days tested durations. Different statistical analyses of parameters were investigated through microbial count of aerobic mesophylls, coliforms, psychotropics and nonaerobics), chemical (PH, Total volatile nitrogen, TVN) and organoleptic (percentage of plasma, smell and taste quality). Findings: The results showed that the difference between control and treatment samples with acetic acid and propionic was significant (P<0.01). Also, the difference between control and treatment of acetic acid, propionic acid and citrice acid was significant (P<0.01). The difference between acetic acid and propionic was not significant. By regarding the microbial and chemical parameters, we can preserve the control for 4 days, treatment with citric acid 5 days and care samples with acetic and propionic acids until 6-7 days. Conclusion: With regards to the results of this study, it is possible to use %1 concentration of such organic acids in order to increase the preservation of chicken's meat without causing any kind of undesired superficiality. Keywords: acetic acid, citric acid, propionic acid, shelf life, chicken's meat

Successful Treatment of Acute Invasive Rhino-Orbito-Cerebral Mucormycosis Associated with COVID -19: Case Report and Literature Review

Background and Aim: Mortality associated with post-coronavirus disease 2019 (COVID-19) rhino-orbital cerebral mucormycosis (ROCM) is an evolving concern. Association of COVID-19, corticosteroid therapy, and uncontrolled diabetes mellitus (DM) are considered predisposing factors for ROCM. We present two cases of successful treatment leading to patient survival for post-COVID-19, stage 4c-ROCM. Case Presentation: Two middle-aged men with poorly controlled DM were referred to our hospital for post-COVID-19 ROCM. They had received intravenous antivirals and dexamethasone as treatment in a primary center. Both patients had unilateral oculofacial pain and swelling followed by acute visual loss, unilateral proptosis, facial palsy, and trigeminal hypoesthesia. A computed tomography scan revealed opacity and bony erosion of paranasal sinuses (PNS). Obtained specimens confirmed mucormycosis agent on histopathological examination. After the failure of conservative treatments, retrobulbar injections of liposomal-amphotericin B, PNS debridement, and orbital exenteration, both patients developed blurred consciousness owing to the extension of the infection into the intracranial cavity. Brain magnetic resonance imaging revealed a right frontal lobe abscess in case 1 and a left frontal sinus abscess and involvement in case 2. Both underwent transcranial debridement and resection of necrotic tissue and drainage of the abscess. At follow-up, the patients were in good condition, and the fungal cultures were negative for mucormycosis agents. Conclusion: ROCM may be a complication of COVID-19 in high-risk patients. Control of the patient’s underlying systemic condition and prompt treatment with antifungal agents, along with timely aggressive resection of cerebral abscess and necrotic paranasal tissues, are the mainstays of management for ROCM