The evaluation of head and neck neoplasm in young and old adults

Background: Head and neck neoplasm (HNN) is one of the most common neoplasms in 6th and 7th of life. Its incidence rate is different in various human societies. Some neoplasms have an increasing trend in the young population, and some have a decreasing trend. According to the limited evidence in Iran, we decided to investigate the types and basic characteristics of HNN in young patients with less than 40 years and old patients more than 40 years of age. Methods: In this cross sectional study, we assessed the medical records of 695 patients in the department of Ear Nose and Throat (ENT) of Loghman Hakim Hospital during 2007- 2017 to compare the fundamental characteristics and types of HNN in young and old adults. Chi-square test and Mann-Whitney U test were used and interpreted with a significant level of less than 0.05. Results: The average age of our patients was 51.80±17.39 years old. The majority of the patients were more than 40 years old (n=514, 73.95%) and the rest were younger (n=181, 26.05%). Significantly, the percentage of male patients, diabetic patients, positive history of smoking were more predominant in old adults as compared to young adults (72.76% vs. 49.18%, 10.31% vs. 2.20%, 66.99% vs. 25.44%; all P<0.001). However the neoplasms of salivary glands, thyroid, and paranasal sinus had a significantly higher frequency in young adults (41.98%(n=76); P<0.001, 21.55%(n=39);P<0.001, 6.10%(n=11); P=0.033 respectively). There was a high percentage of larynx neoplasm in old adults as compared to young adults (42.22 %(n=217) vs. 4.41%(n=8); P=0.001). Conclusion: Larynx neoplasm was common among old smokers. The percentage of salivary glands and thyroid neoplasms were higher than other HNN in young adults (≤40 years old), especially female patients and non-smokers. Therefore, HNN is not rare in young people and the physicians must consider it while cancer screening young adults

Cellular and Molecular Mechanisms in Perioperative Hepatic Protection: A Review of Current Interventions

Liver is one of the most important organs needing great concern during the perioperative period. There are a number of different mechanisms that interact with liver cells and might affect their integrity and cell live. Though these mechanisms are not all the same, there is a great common point: all affect the metabolic pathways of the liver. Ischemia, anesthetic drug effects and other perioperative insults may affect the liver. Disturbance in an organ’s blood flow is an inherent part of diverse surgical procedures, which leads to lack of oxygen and nutrient supply. These ischemic periods can be particularly long in case of liver surgeries, such as resection of large hepatic tumors, management of hepatic trauma and liver transplant. Once the blood flow and oxygen supply are restored, the interruption of blood flow affects the oxygen dependent cells in liver, which require mitochondrial oxidative phosphorylation for their metabolism. Molecular mechanisms such as Redox status, ionic interchange disturbances as well as different mediators and cells like KC, SEC, dendritic cells, leukocytes, and lymphocytes, are involved in the process ultimately leading to cell death by apoptosis and necrosis. This review provides an overview on the cellular and molecular mechanisms involved in liver injuries, categorizing these mechanisms in 3 different classes: preoperative mechanisms, intraoperative mechanisms and postoperative mechanisms. Each of them are discussed in a different part of the manuscrip

Accuracy of Endoscopy in Predicting the Depth of Mucosal Injury Following Caustic Ingestion; a Cross-Sectional Study

Introduction: Esophagogastroduodenoscopy (EGD) is currently considered as the primary method of determining the degree of mucosal injury following caustic ingestion. The present study aimed to evaluate the screening performance characteristics of EGD in predicting the depth of gastrointestinal mucosal injuries following caustic ingestion.Methods: Adult patients who were referred to emergency department due to ingestion of corrosive materials, over a 7-year period, were enrolled to this diagnostic accuracy study. Sensitivity, specificity, positive and negative predictive values as well as negative and positive likelihood ratios of EGD in predicting the depth of mucosal injury was calculated using pathologic findings as the gold standard.Results: 54 cases with the mean age of 35 ± 11.2 years were enrolled (59.25% male). Primary endoscopic results defined 28 (51.85%) cases as second grade and 26 (48.14%) as third grade of mucosal injury. On the other hand, pathologic findings reported 21 (38.88%) patients as first grade, 14 (25.92%) as second, and 19 patients (35.18%) as third grade. Sensitivity and specificity of endoscopy for determining grade II tissue injury were 50.00 (23.04-76.96) and 47.50 (31.51-63.87), respectively. These measures were 100.00 (82.35-100) and 80.00 (63.06-91.56), respectively for grade III. Accuracy of EGD was 87.03% for grade III and 48.14% for grade II.Conclusion: Based on the findings of the present study, endoscopic grading of caustic related mucosal injury based on the Zargar’s classification has good accuracy in predicting grade III (87%) and fail accuracy in grade II injuries (48%). It seems that we should be cautious in planning treatment for these patients solely based on endoscopic results.

Stapedotomy and Stapedectomy Outcomes as Surgical Approaches in Juvenile Otosclerosis: A Systematic Review

Background: Pediatric otosclerosis is characterized by progressive conductive hearing loss with a relatively low incidence, compared to adults. The treatment approaches range from conservative options, such as hearing aids, to surgical managements including stapedectomy and stapedotomy. Aim: To compare hearing outcomes (air-bone gap<10 dB) after stapedectomy vs. stapedotomy in patients with juvenile otosclerosis. Methods: We conducted a systematic search in Google scholar, PubMed, and Scopus. Studies reporting the outcomes of stapedectomy and/or stapedotomy and those specifically defining the mixed data from data of each procedure for the patients under the age of 18 years old with juvenile sclerosis were included. On the other hand, post-operative air-bone gap was extracted. There was no time limitation for search of studies. Results: After evaluating all studies, post-operative air-bone gap below 10dB ranged from 66% to 91% of cases in stapedectomy group and from 66% to 92% in stapedotomy group. Conclusion:Based on the reviewed studies, we found similar success rates in hearing outcome of the patients with juvenile otosclerosis following stapedotomy and stapedectomy.      

Epidemiologic Features and Outcomes of Caustic Ingestions; a 10-Year Cross-Sectional Study

Introduction: Caustic ingestions are among the most prevalent causes of toxic exposure. The present 10-year survey aimed to evaluate the epidemiologic features and outcomes of caustic ingestion cases presenting to emergency department.Methods: This is a retrospective cross-sectional study on patients who were admitted to a referral toxicology center during 2004 to 2014, following caustic ingestion. Baseline characteristics, presenting chief complaint, severity of mucosal injury, complications, imaging and laboratory findings as well as outcomes (need for ICU admission, need for surgery, mortality) were recorded, reviewing patients’ medical profile, and analyzed using SPSS 22.Results: 348 patients with mean age of 37.76 ± 17.62 years were studied (55.6% male). The mean amount of ingested caustic agent was 106.69 ± 100.24 mL (59.2 % intentional). Intentional ingestions (p < 0.0001), acidic substance (p = 0.054), and higher volume of ingestion (p = 0.021) were significantly associated with higher severity of mucosal damage. 28 (8%) cases had died, 53 (15.2%) were admitted to ICU, and 115 (33%) cases underwent surgery.Conclusion: It seems that, suicidal intention, higher grade of mucosal injury, higher volume of ingestion, lower level of consciousness, lower serum pH, and higher respiratory rate are among the most important predictors of need for ICU admission, need for surgery, and mortality

Diagnostic Accuracy of Computed Tomography Scan in Detection of Upper Gastrointestinal Tract Injuries Following Caustic Ingestion

Introduction: Endoscopy is an invasive procedure and finding noninvasive alternative tools in detection of probable upper gastrointestinal (GI) tract injuries following caustic ingestion is an area of interest. The present study aimed to evaluate the screening performance characteristics of thoraco-abdominal computed tomography (CT) scan in this regard.Methods: This prospective cross sectional study was conducted on patients presenting to emergency department following acute caustic ingestion. The findings of CT scan and endoscopy regarding the presence of upper GI tract damage were compared and screening performance characteristics of CT scan were calculated using MedCalc software.Results: 34 patients with the mean age of 35.38±13.72 years were studied (58.8% male). The agreement rate between CT scan and endoscopy regarding the grade of esophageal and gastric injuries was moderate (K= 0.38; p = 0.001) and fair (K= 0.17; p = 0.038), respectively. The sensitivity and specificity of CT scan in detection of esophageal damage were 96.29) 79.11- 99.80) and 57.14 (20.23 - 88.19), respectively. These measures were 89.65 (71.50 - 97.28) and 40.00 (7.25 - 82.95), respectively for gastric damage. The area under the ROC curve of CT scan in detection of esophageal and gastric damages was 0.76 (95% CI: 0.52 – 1.00) and 0.64 (95% CI: 0.35 – 0.94), respectively.Conclusion: Based on the findings of the present study, CT scan could be considered as a sensitive tool in ruling out upper gastrointestinal mucosal injuries following acute caustic ingestions. However, the correlation between endoscopy and CT scan findings regarding the grading of injury is not high enough to eliminate the need for endoscopy.

Neuroprotective Effects of Curcumin on the Proliferation and Viability of Neural Stem Cells against H2O2

Background: Oxidative stress and neuroinflammation have found to be implicated in several neurodegenerative disorders (ND). Neuroprotection against oxidative agents has been proposed as a therapy on the basis that it might prevent neuroinflammation. Curcumin is an anti-oxidant with anti-inflammatory properties which has been proposed to be used as a therapeutic agent in ND.Aim: In this study, we examined the neuroprotective effect of curcumin on neural stem cells (NSCs) exposed to H2O2 as an oxidative injury model.Methods: After culturing NSCs, they were co-treated with curcumin and H2O2, after which their effects were tested on cell viability using MTT assay.Results: Our results indicated that the high concentration of H2O2 significantly promoted cell death. Specifically, after using 250 µM of H2O2, the mortality increased dramatically in comparison with the control groups. On the other hand, the presence of curcumin encouraged cell survival of NSCs treated with H2O2.Conclusion: Our result showed that curcumin has a protective effect on NSCs against H2O2 and it may ameliorate the mortality rate induced by H2O2

Cell Therapy in Hearing Loss Treatment: A Review of Recent Advances

Background: The mammal's inner ear is responsible for hearing and balance. To perform these tasks, it requires the vestibular and cochlear system. Sensor neural hearing loss (SNHL) is the most common type of hearing loss resulting in degeneration of internal sensory hair cell, where cochlear nerve in cochlear stem cell and gene-based strategies provide the opportunity for replacement for these cells.Aim: In this review, we evaluated the efficiency of stem cell therapy in inner ear.Methods: In this study we examined different articles in different databases such as Google Scholar, PubMed, and Elsevier.Results: The stem cells have offered desired results in the delivery of gene and tissue engineering programs. Evidence suggests that stem cells are considered as a promising tool in medical applications thanks to their high plasticity and trophic characteristics.Conclusion: In this review, Stem cell transplantation is widely used in clinical practice, and the source is highly desirable, since the patient's bone marrow cells can be potentially transplanted without any safety problems

Cell Therapy; A New and Safe Strategy for the Treatment of Spinal Cord Injury: A Review

Background: Spinal cord injury is a progressive process that initially causes abnormal nerve connections. Following spinal cord injury, the spinal cord is impaired after which cell death and apoptosis occurs. Primary damage happens in the spinal cord due to the demyelization of the large axons. Cell therapy is among the new strategies that have been considered for the treatment of neural injuries in recent years.Aim: In this narrative review article, we discuss "Cell Therapy" as a new and safe strategy for the treatment of spinal cord injury. we are going to explain the epidemiological and pathophysiological aspects of spinal cord injuries (SCI) as well as SCI experimental and clinical stem cell strategies.Conclusion: There are several promising advancements and findings in the field of stem cell biology and cell reprogramming, with the aim of treating patients with SCI via stem cell therapy. We reviewed critical issues for clinical translation and we also provided a commentary on recent developments such as termination of the first human embryonic stem cell transplantation trial in human SCI