Argon Plasma Coagulation in Treatment of Post Intubation Tracheal Stenosis

INTRODUCTION: Acquired tracheal stenosis can be created by various malignant or benign causes. The most common cause of acquired non-malignant tracheal stenosis is endotracheal intubation, even for a short period. Argon plasma coagulation is a non-contact method of thermal hemostasis. Argon plasma coagulation can be used easily and fast and has low depth of penetration. METHODS: This study is single blinded. Subjects are patients with tracheal stenosis after endotracheal intubation who were selected by non-probability sampling and were studied from March 2007 to November 2009 in bronchoscopy and laser center of Masih Daneshvari Hospital, Tehran. First, for each patient, a diagnostic flexible bronchoscopy was performed to identify the type, location, and severity of the stenosis. Then, under general anesthesia, patients underwent rigid bronchoscopy. Then, with Argon plasma coagulation device (ERBE VIO 200D) the stenosis was removed as possible. After two weeks, a new PFT (pulmonary function test) was done for checking the obstructive signs.RESULTS: Of these 34 patients, 24 were asymptomatic for more than 1 year and responded to treatment(70/6%), 5 were asymptomatic for more than 10 months and less than 12 months (14/7%) and 5 did not have asymptomatic periods more than 10 months, and did not respond to treatment. In PFT follow-ups, FEV1 in all patients who were asymptomatic for more than 10 months had a significant progress; therefore, in 27 out of 29 patients at the end of the study, FEV1 was more than 90% and 2 patients had FEV1 of 70-90%.CONCLUSION: In fact, although the surgical treatment remains the main treatment of tracheal stenosis after intubation (PITS), if this method is not possible for any reason, APC is very useful as a safe and effective method

Estimation of Effective Doses and Lifetime Risk of Exposure-induced Cancer Death in Pediatric CT Scans

Background: The increasing frequency of computed tomography (CT) scans for a range of purposes, particularly pediatrics, has raised concerns regarding the population's radiation exposure and subsequent chances of cancers. This study aimed to estimate the effective doses of pediatrics radiation and induced cancer risks from five most common CT scan procedures in Yazd Province, Iran.Methods: Data of pediatric patients from four age groups of ≤1, 1-5, 5-10, and 10-15 years old were retrospectively collected from 6 educational institutions located in diverse areas of Yazd Province. For each participant, the effective doses and REID (risk of exposure-induced death) rate were estimated by Impact Dose and PCXMC software, respectively. Then, the findings were reported by categorizing the patients regarding their effective diameter.Results: The effective doses and REID values did not show any significant differences among the studied age groups. The highest mean of effective dose was recorded for the scan of abdomen-pelvis (average ± standard deviation, 5.24±3.19 mSv) followed by chest (3.76±2.28 mSv), brain (1.25±1.07 mSv), and sinus (0.65±0.4 mSv) examinations. The highest REID was documented for chest scan (490±314 excess deaths in one million scans) followed by abdomen-pelvis procedure (404±280).Conclusion: The radiation doses delivered to the pediatric patients and the associated fatal cancer risk with common CT procedures were comparably in the same range of the previous studies. Our findings can represent an estimation of the radiation-induced risks of CT scans and can be used for extending the knowledge of clinicians and researchers

A Comparative Evaluation of the Clinical Course, Laboratory Data and Chest CT scan Findings in Pediatric Patients with Covid-19 and Their Prognostic Value in Disease Outcome Estimation

Background: Most research on children and adolescents with COVID-19, had limited sample sizes and little clinical, laboratory, and radiological findings. The purpose of this research was to examine the features of children and adolescents with COVID-19 infection.Methods: This analytical retrospective study was conducted on children (1 to 12 years old) and adolescents (13 to 19 years old) with COVID-19 in Shahid Beheshti Hospital, Kashan, Iran. The data were then collected, entered into SPSS and analyzed.Results: In the adolescent group, the frequency of dyspnea (47.1 % vs. 11.9%), cough (67.1 % vs. 39.2%), lethargy (42.9 % vs. 25.9%), headache (35.7 % vs. 10.5%), myalgia (38.6 % vs. 14%), and chest pain (12.9 % vs. 0.7%) were significantly higher than those in children (p<0.05). Furthermore, in terms of laboratory findings, the normal range of neutrophils (13.8% vs. 1.4%), Cr (95% vs. 75.7%), and CRP (77.9% vs. 58%) were higher in children. Moreover, we found that the CT severity score among adolescent patients was significantly higher than that in children (4.84 ± 5.21 vs. 1.76 ± 3.25, p=0.006). Also, the frequency of consolidation (61.3 % vs. 19%), and ground-glass opacity (58.1 % vs. 28.6%) among adolescents were significantly higher compared to child cases (p<0.05) while only the frequency of mosaic pattern of pulmonary parenchymal attenuation was significantly higher among children (p=0.035).Conclusion: This research found milder clinical, biochemical, and radiological symptoms in children with COVID-19 than adolescents. However, radiological examinations showed greater rates of pulmonary parenchymal mosaic attenuation, which might help early diagnosis of COVID-19

Comparison of concomitant use of water pipe and cigarette to exclusive cigarette smoking

Background In spite of increasing prevalence of concomitant use of water pipe and cigarette there is no enough information in this field. So the concomitant use of water pipe and cigarette and its comparison to only cigarette smoking were evaluated in this study. Methods This cross-sectional study was carried out through stratified multistage sampling in several districts of Tehran. The trained interviewers collected the data about water pipe and cigarette smoking by going to the houses randomly. Results The study had 1830 participants among which 243 participants only consumed water pipe, 120 cases only smoked cigarette and 76 cases (4.2%) were dual users.There was no significant difference in both groups by sex. The mean age of dual users and exclusive cigarette smokers were 33.1±11.3 and 46±16.5 years respectively (p≤0.001). Comparing to cigarette smokers (35.2%), most of the dual users (64.7%) believed that water pipe is not addictive (p=0.001). 13.2% of dual users and 5.3% of cigarette users believed that water pipe smoking is safer than cigarette smoking(p< 000). While 54.1% of dual users and 78.5% of cigarette smokers believed that waterpipe consumption could cause serious diseases. Conclusions Younger age and misconception about safety of water-pipe in comparison to cigarette were significantly more in dual users than exclusive cigarette users. It is necessary to promote the knowledge about harms of water-pipe smoking in society especially among youth

Diagnostic accuracy and prognostic value of lung ultrasound in coronavirus disease (COVID-19)

Purpose: This study aimed to assess the correlation between lung ultrasound (LUS) and computed tomography (CT) findings and the predictability of LUS scores to anticipate disease characteristics, lab data, clinical severity, and mortality in patients with COVID-19. Material and methods: Fifty consecutive hospitalized PCR-confirmed COVID-19 patients who underwent chest CT scan and LUS on the first day of admission were enrolled. The LUS score was calculated based on the presence, severity, and distribution of parenchymal abnormalities in 14 regions. Results: The participants’ mean age was 54.60 ± 19.93 years, and 26 (52%) were female. All patients had CT and LUS findings typical of COVID-19. The mean value of CT and LUS severity scores were 11.80 ± 3.89 (ranging from 2 to 20) and 13.74 ± 6.43 (ranging from 1 to 29), respectively. The LUS score was significantly higher in females (p = 0.016), and patients with dyspnoea (p = 0.048), HTN (p = 0.034), immunodeficiency (p = 0.034), room air SpO2 ≤ 93 (p = 0.02), and pleural effusion (p = 0.036). LUS findings were strongly correlated with CT scan results regarding lesion type, distribution, and severity in a region-by-region fashion (92-100% agreement). An LUS score of 14 or higher was predictive of room air SpO2 ≤ 93 and ICU admission, while an LUS score ≥ 12 was predictive of death (p = 0.011, 0.023, and 0.003, respectively). Conclusions: Our results suggested that LUS can be used as a valuable tool for detecting COVID-19 pneumonia and determining high-risk hospitalized patients, helping to triage and stratify high-risk patients, which waives the need to undertake irradiating chest CT and reduces the burden of overworked CT department staff