Neonatal Respiratory Distress Syndrome: Things to Consider and Ways to Manage

Involving more commonly the premature (less than 37 weeks of gestational age) infants, neonatal respiratory distress syndrome is an important clinical syndrome responsible for a high rate of mortality and morbidity. The main progress in respiratory distress syndrome (RDS) management is attributable to prescription of surfactant for fastening pulmonary maturation. Respiratory protection, such as mechanical ventilation and nasal continuous positive airway pressure, and surfactant are building blocks of disease treatment. In this chapter, we are going to have a rapid review on epidemiology, diagnosis and treatments of RDS

Traumatic brain injuries in elderly patients; to Be transferred or not?

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Disparity in discharging elderly traumatic brain injury patients to rehabilitation centers based on trauma center level.

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Can we really consider tumor size and surgical extent as predictive factors for recurrence in clinically early-stage papillary thyroid carcinoma patients?

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Thyroglobulin antibodies may serve as predictive marker for papillary thyroid carcinoma in indeterminate cytology: Acceptable or not?

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HBV Infection Trend in Iranian Disabled Children; Is It really Worrying?

We read with a great interest the article written by Davoodbeglou and colleagues entitled “Evaluation of Hepatitis B Infection Prevalence in Institutionalized Intellectually Disabled Children” which is recently published in your prestigious journal1. The authors concluded that HBV infection is more prevalent among institutionalized disabled children and that we should change our health policies for HBV infection management in this population. They have conducted a valuable study with an important subject in a high risk population for hepatitis. Despite our interest to the findings of Davoodbeglou et al. study there are some challenging points about their work; so we think that some comments may be of benefit. The first, authors have claimed a higher prevalence of HBV infection among vaccinated children in comparison with those with no or undetermined vaccination history. While there are studies in which the efficacy of neonatal HBV immunization has been proven2. How the authors justify this finding?In addition the authors have not mentioned the sampling method of their study which is the crucial factor of prevalence studies. This may seriously affect the results of study. Also the time period in which the study was conducted has not been determined by the authors. Was it after or before distribution of national vaccination program for hepatitis B? In this regard we should be aware of the maximum age of disabled individuals included in the study.In conclusion we appreciate the valuable effort of the authors; however we were wondering if we could kindly ask them to interpret better our concerns

Improvement of Tinnitus following Tympanoplasty and Tympanomastoidectomy Surgeries in Patients with Chronic Otitis Media

peer reviewedBackground: After otorrhea and hearing loss, Tinnitus is the most common symptom in pa­tients with chronic otitis media (COM). The aim of this study was to evaluate the improvement of tinnitus in COM patients after tympanoplasty and tympanomastoidectomy surgeries. Mate­rials and Methods: This cross-sectional study was conducted on COM patients suffering from Tinnitus referred to Baqiyatallah hospital, Tehran, Iran undergoing tympanoplasty or tympano­mastoidectomy surgeries between March 2013 and August 2014. Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) questionnaires were filled before and two months after surgery by each patient, and considered subjects were compared with each other. Audiometry test was taken from each patient before and two months after surgery. Audiometry results as well as Air-Bone gap were measured and evaluated prior and after surgery. Data were analyzed using SPSS software by ANOVA, sample t-test and Chi-square tests. Results: Eventually, 26 male and 24 female patients with a mean age of 38.62±11.88 years were enrolled. Air conduc­tion at all frequencies was 49.99±17.37 before and 36.98±22.06 after surgery (P<0.001). Sever­ity of tinnitus was 62.92±30.54 before and 30.54±20.08 after surgery based on THI (P<0.001). Also, it was 7.46±1.66 before and 3.5±2.06 after surgery based on VAS evaluations (P<0.001). Tinnitus severity reduction was significantly associated with the improvement of hearing loss and decrement of air-Bone gap (P<0.001). Tinnitus symptoms such as loudness, annoyance, impact on life and perception of Tinnitus significantly reduced after surgery. Moreover, Tym­panomastoidectomy was more effective on the improvement of Tinnitus in comparison with Tympanoplasty (P=0.019).Conclusion: It seems that, both tympanomastoidectomy and tympa­noplasty surgeries are effective on the improvement of tinnitus in patients with COM; however, Tympanomastoidectom surgery was shown to be more effective.[GMJ.2016;5(2):63-69

Dual Ectopic Multinodular Goiter: A Case Report

peer reviewedBackground: As the first endocrine gland to form during embryogenesis, Thyroid develops in the 7th embryonic week through migration from foramen cecum to its adult position, anterolat­eral of 2nd and 4th tracheal cartilages. Ectopic Thyroid can be found anywhere along the migra­tion path with or without co-existence of a normally located Thyroid. Ectopic thyroid glands at two different locations are so rare that only about 24 cases of dual ectopia have been reported. We present the first case of dual ectopic submandibular multinudolar goiter. Case Report: We describe a 35-year-old housewife who consulted us complaining two huge and gradually-grow­ing swellings in right and left upper neck regions. In physical examination, two great well-de­fined masses, one in right and one in left submandibular regions, were seen which had firm for­midability with no mobility, tenderness or evidence of inflammation. Imaging and fine-needle aspiration confirmed the diagnosis of dual ectopic submandibular multinodular goiter in our patient as the first case of occurrence. Conclusion: Finally, we recommend ectopic thyroid to be considered in the diagnosis of laterally located and submandibular neck masses especially in the absence of normally located thyroid. Additionally, we confirmed the idea that not all the laterally-located ectopic thyroids are malignant.[GMJ.2016;5(2):98-102

Facial injuries in Iranian veterans during the Iraq-Iran war (1980-88): differences from recent conflicts.

peer reviewedOur aim was to identify the pattern and mechanism of facial injuries in Iranian veterans during the Iraq-Iran war and to assess the effectiveness of current protective equipment by retrospectively evaluating 100 Iranian veterans of that war. We randomly included veterans with injuries to various parts of the face, with or without injuries to other organs. None died. We recorded anatomical distribution, incidence, and mechanism of injury as well as injury scores using common references scales. Data are expressed as mean (SD) or number. Fragmentation injuries were the most common (n=40) followed by blast (n=37), shock wave (n=18), and gunshots (n=5). Thirty-five patients had mandibular fractures with a mean (SD) score of 3.7 (1.4). Fifteen patients had injuries to the upper face and 79 to the midface. Twenty-four patients had facial lacerations more than 10 cm long, with a mean facial injury score of 2.4 (2.0). Nineteen had ocular injuries with a mean (SD) ocular trauma score of 64.9 (12.9). Despite recent developments in protective equipment we have seen no significant reduction in the incidence of facial injuries in battle, which could indicate that we need better facial support equipment and more effective education in its use. However, using protective equipment such as goggles and a mandibular protector is highly recommended

Breastfeeding and Gut Microbiota

Human breast milk (HBM) not only is a source of nutrition for infants but also contains a variety of biologically active components and bacterial species. These molecules and bacteria guide both intestinal microbiota and infantile immune system. Recently published studies have found several vital roles for gut microbiota including effects on the individual’s personality, decreased predisposition to the diseases, and a variety of other health-related consequences such as possible therapeutic effects or preventing role. In this chapter the components of human breast milk and its effect on shaping the human gut microbiota have been reviewed