Anesthesia management in a pediatric patient with Prune belly syndrome; a case report

Prune belly syndrome (PBS) is a rare congenital disorder, consists of three symptoms: anterior abdominal muscle deficiency, cryptorchidism, and genitourinary malformation. These patients have cardiovascular and musculoskeletal abnormalities, mental retardation, chest deformities, and scoliosis that lead to pulmonary dysfunction. Anesthesia plan in patient needs to rule out any anomalies. For airway management, Laryngeal mask airway (LMA) should be preferred to avoid the use of muscle relaxants. The use of short-acting anesthetics can accelerate recovery from anesthesia.  To reduce postoperative pain, regional techniques are preferred. We report a 6-month- old boy with PBS, and its airway management and anesthesia during surgery

Anesthesia in a pediatric patient with Xeroderma pigmentousoma: A case report

Xeroderma pigmentosum (XP) is an autosomal recessive genetic disorder with the following conditions: neurologic disorders that gradually progress and skin hypersensitivity to ultraviolet (UV). Inhalational anesthetic drugs should be avoided in these patients since they may induce DNA damage, also use of muscle relaxants should be kept to a minimum. Thus for XP patients, total intravenous anesthesia (TIVA) is more appropriate for inducing general anesthesia and airway manipulation must be kept to a minimum. We report a 6 year old boy with XP and its airway management and anesthesia during surger

Evaluation of the Relationship of Low Back Pain with Spinal Anesthesia and its Related Factors in Patients Undergoing Urological Surgery

Background: Spinal anesthesia is the common method in outpatient surgeries, which has complications such as back pain. We aimed to evaluate the relationship between low back pain (LBP) with spinal anesthesia and its related factors in patients undergoing urological surgery. Materials and methods: In this cross-sectional study, 1000 patients undergoing urological surgery were enrolled. The severity of LBP was measured using the VAS (visual analog scale) pain on the 1st day, the 1st week, and the 1st month postoperatively. Patients’ age, sex, and the duration of surgery were collected. data analysis was performed using SPSS software, version 17. Results: Of the 1000 patients undergoing urological surgery, 636 (63.6%) patients and 364 (36.5%) patients underwent spinal and general anesthesia, respectively. In patients under general anesthesia, the LBP prevalence was higher than in patients under spinal anesthesia on the 1st week and the 1st month after surgery (P<0.05). So, the LBP prevalence was as follows: on the 1st day (general anesthesia: 14.5% vs spinal anesthesia: 24.1%, p=0.09), at the 1st week (general anesthesia: 24.9% vs spinal anesthesia:13.5%, P=0.001) and the1th month (general anesthesia: 13.8% vs spinal anesthesia: 4%, P=0.001). On 1st day and 1st week after surgery, the rate of LBP was significantly higher in the >45-year age group than in the age group less than 45 years (P<0.05). The pain rate was higher in patients who had surgery duration of more than 2.5 hours in all three time periods (P=0.001). Conclusion: Although the LBP prevalence on 1st day after surgery in patients undergoing urological surgeries under spinal anesthesia was higher than in patients who underwent general anesthesia, there was a significant decrease in pain levels during the first week and month following the surgery in patients under spinal anesthesia. Older age and longer duration of surgery were related factors to pain

Comparing the Ease of Endotracheal Intubation with and without an Intubation Box in COVID-19 Patients

Background: Endotracheal intubation is a potentially high-risk aerosol-generating procedure. So, an intubation box (I-Box) is designed for personal protection during intubation. This study aimed to compare the outcomes of endotracheal intubation with and without an I-box in COVID-19 patients. Methods: In this study, 60 COVID-19 patients (30 patients in each group) with and without I-box groups were included. outcomes of intubation including duration of intubation, first-pass success intubation, suitable visibility of airways, restriction of movement in the neck, the need to surface maneuvering of the airway, and the number of attempts for successful intubation were compared between the two groups. Results: The time of intubation was significantly longer in the I-box group (15.27±2.6 seconds) than without the I-box group (8.37±1.3 seconds) (p<0.001). All patients (100%) were intubated in the first attempt in the without I-box group while the rate of first-pass success intubation was 50% in the I-box group (p <0.001). The visibility of the airway was significantly better in the without I-box group than the I-box group (without I-box: 23 patients (76.7%), I-box: 15 patients (50%), p= 0.032). The frequency of need to optimizing maneuver of the airway was in without and with I-box was 23.3% and 50% respectively (p=0.032). Conclusion: However, the I-box as a physical barrier can protect healthcare workers but its use increased the time to intubation and the number of attempts for successful intubation and reduced the rate of first-pass success intubation and visibility

Some Viewpoints about Apnea of Prematurity in Neonates under Inguinal Herniorrhaphy: A Brief Review

Inguinal hernia is more common in premature male babies. UsingGeneral Anesthesia (GA) for the repair operation may cause apnea inthem. Caudal anesthesia on the other hand provides effective anesthesiaand analgesia without the complication of GA. Here we discuss differentmethods of anesthesia in inguinal herniorrhaphy and their merits anddownfalls

Diagnostic Performance of Ultrasonography for Identification of Small Bowel Obstruction: A Systematic Review and Meta-analysis

Introduction: Small bowel obstruction (SBO) is known as a common cause of acute abdominal complaints in the emergency department (ED). The modality of choice for the diagnosis of SBO has not yet been established. This systematic review and meta-analysis aimed to investigate the accuracy of ultrasonography for the diagnosis of SBO. Methods: Systematic search was performed on five electronic databases including Medline, Scopus, Web of Sciences, Embase, and Cochrane Library, and the retrieval period was from the inception of each database to November 2023. The quality of the included studies were investigated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). The pooled values of diagnostic characteristics for ultrasonography were estimated using meta-Disc and Stata statistical software. Results: Twenty-one studies with a total of 1977 patients were included in the meta-analysis. The pooled estimate for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary ROC curve of ultrasonography for diagnosing SBO were 0.93 (95% CI: 0.91–0.95), 0.8 (95% CI: 0.77–0.83), 5.69 (95% CI: 3.64–8.89), 0.1 (95% CI: 0.07–0.16), 83.51 (95% CI: 18.12–182.91) and 0.96, respectively. Conclusion: The findings of this meta-analysis showed that the utilization of ultrasonography holds promise as a diagnostic imaging for SBO with high accuracy. However, additional worldwide studies are essential to get more evidence on the value of ultrasonography for the diagnosis of SBO

Percutaneous Dilatational Tracheostomy and Surgically Created Tracheostomy in ICU Patients

Introduction: Following advances of Intensive Care medicine and widespread administration of mechanical ventilation, tracheostomy has become one of the indispensable surgical procedures. During this research we tried to assess and compare two main strategies for doing tracheostomy: Surgically Created Tracheostomy (SCT) and Percutaneous Dilatational Tracheostomy (PDT).Methods: In a randomized clinical trial, 60 cases of patients who were admitted in Intensive Care Unit (ICU) and needed tracheostomy during their stay were enrolled. Patients were randomly divided into two groups. SCT technique was considered for the first group and PDT for the second one. Demographic characteristics, associated and underlying diseases, type and duration of procedure, duration of receiving mechanical ventilation and ICU stay, expenses and complications of tracheostomy including bleeding, subcutaneous emphysema, pneumothorax, stomal infection and airway loss were all recorded during study and compared between both groups.Results: There were significant differences between two groups of patients in terms of duration of receiving mechanical ventilation (P=0.04), duration of tracheostomy procedure (P=0.001) and procedure expenses (P=0.04). There was no significant difference between two groups in terms of age and gender of patients, duration of ICU stay and complications of tracheostomy including copious bleeding, stomal infection, subcutaneous emphysema and airway.Conclusion: According to the results of our study and similar researches, it can be concluded that PDT can be considered as the preferred procedure in cautiously selected patients during their ICU stay

Dichloromethane fractions of Scrophularia oxysepala extract induce apoptosis in MCF-7 human breast cancer cells

Breast cancer is a prevalent malignancy among women, especially in developing countries. A large number of anticancer agents with herbal origins have been reported. Hence, herbals may play an essential role in prevention and treatment of cancers. We investigated cytotoxic effects of dichloromethane fractions of Scrophularia oxysepala extract on the MCF-7 breast cancer cell line. The cytotoxic activity of Scrophularia oxysepala fractions on the MCF-7 cells was assessed using Trypan Blue dye exclusion and MTT (3-(4, 5-dimetylthiazol-2-yl) -2, 5-diphenyltetrazolium bromide) assays. In addition, apoptosis induction was determined using TUNEL (terminal deoxy transferase (TdT)-mediated dUTP nick- end labeling) assay and DNA fragmentation analysis. Quantitative Real-Time PCR was also used for analyzing the changes in Caspase-3, Caspase-9, and Bcl-2 genes’ expression. Results revealed an effective inhibition of growth and viability in MCF-7 cells treated with dichloromethane fractions. Cell death assay and DNA fragmentation analysis using the TUNEL test confirmed the induction of apoptosis in the MCF-7 cell line. Further, the fractions have resulted in an increased expression of Caspase-3and Caspase-9 mRNA, which highlights the possibility of apoptosis in the treatments. The expression study of Caspase-9 mRNA confirmed that, the fractions have triggered apoptosis via intrinsic mitochondrial pathway. In summary, fractions of Scrophularia oxysepala extract were found to be promising in growth inhibition and induction of apoptosis in MCF-7 breast cancer cells