Oral and parenteral pyridostigmine in preparing Myasthenia Gravis patients for thymectomy;a randomized Clinical trial

Background: Respiratory failure and crisis is one of major complications of thymectomy in myasthenia gravis patients. There are different medication regimes for preparing these patients for surgery and reducing post-operative side effects. The goal of this study is to compare respiratory complications of oral vs. Parenteral preoperative administration of anticholinesterase agents for thymectomy in myasthenia gravis patients. Methods: This randomized controlled trial included 101 patients in class IIA or IIB of myasthenia gravis according to the Osserman classification system. The control group fasted for eight hours before surgery and oral anticholines-terase agents were replaced with parenteral ones. The case group also fasted for 8 hours before surgery, but pyridostigmine was continued at its usual dose until the time of operation and the last dose was given to patients with a small amount of water in the operating room on the operating bed. Results: There was no statistically meaningful difference between the two groups in terms of age, sex and pathologic findings. In comparison, the mean hospital stay for the case group was 3.98 days and 6.34 for the control group (p value = 0.003). There were eight cases of respiratory crisis or failure (16%) in the control group but only 1 case (2%) was observed in case group (p value = 0.014). Only one patient in the case group required re-intubation after the surgery; however, six patients in control group were re-intubated (p value = 0.053). Plasmapheresis was required for five patients in the control group and one patient in the case group (p value = 0.098). Tracheostomy was performed on two patients in the control group to accommodate prolonged intubation, but none of the case group required this procedure. Conclusion: This study shows that continuing oral anticholinesterase agents up to the time of operation, with the last dose at the operative theater, lowers the incidence of post-operative myasthenia crisis and respiratory failure, need for plasmapheresis and shortens the hospital stay. This method may also decrease the need for re-intubation, mechanical ventilation and tracheostomy, thus decreasing the chance of death resulting from complications of the thymectomy

Comparisons of arterial and venous palliative shunts in adult patients with cyanotic congenital heart diseases

Background: Generally, 2 types of surgical operations are available for the treatment of cyanotic heart diseases: corrective and palliative. The goal of palliative surgery is to increase the pulmonary blood flow via systemic-to-pulmonary arterial shunting. Methods: In this case-series study, we evaluated patients older than 15 years old with documented cyanotic heart diseases who underwent palliative shunting in Rajaie Cardiovascular Medical and Research Center between 2001 and 2015. Results: Forty-seven patients at a mean age of 24.74 ± 5.67 years were enrolled in this study. Twenty-two (46.8) patients were male. Nearly half of the study population (23 patients) had central shunting, 23 patients Glenn shunting, and 1 patient Blalock�Taussig shunting. Following surgery, there was a significant rise in the mean partial pressure of O2 and O2 saturation, a significant drop in the hemoglobin concentration, and a significant increase in the platelet count. Five (10.6) patients expired during the study period. The mortality rate of Blalock�Taussig shunting and Glenn shunting was 12.5 and 8.69, respectively. Conclusions: In this case-series study, all the patients showed dramatic improvements in the New York Heart Association functional class, O2 saturation, the partial pressure of O2, the partial pressure of carbon dioxide, hemoglobin levels, and ferritin levels in the first postoperative year; however, these improvements were greater in arterial shunts. The following 10 years saw a decline in these improvements; nonetheless, the clinical status and lab data were good by comparison with the baseline. In adults with congenital cyanotic heart diseases, palliative shunting is a good option and should be considered in patients who are inoperable due to structural problems or high risk of anesthesia or surgery. © 2020, Iranian Heart Association. All rights reserved

Sleep-related eating disorder: A case report of a progressed night eating syndrome

Night eating syndrome is a common disorder in eating behaviors that occurs in close relation to the night time sleep cycle. Although eating disorders are common in society, night eating syndrome has been left neglected by health care professionals. In this report we present a case of eating disorder that exhibits some novel features of night eating syndrome. Our case was a progressed type of eating disorder which may increase awareness among physicians about sleep-related eating disorders. © 2012 Tehran University of Medical Sciences. All rights reserved

Gender and age related changes in number of dopaminergic neurons in adult human olfactory bulb

Introduction: Dopamine is one of the major brain neurotransmitters, and the loss of dopaminergic neurons in basal ganglia cause motor deficits in Parkinson's disease. We proposed that the difficulty in olfaction observed in the elderly may be due to an alteration in the number of dopaminergic neurons. Materials and methods: Sections were taken from olfactory bulbs of post-mortem tissue specimens of 13 humans, males and females, aged from 19 to 63 years (�35 and �50 years), with no history of neurological disorders. The tissues were fixed, embedded, cut on a freezing microtome, and prepared for immunohistochemical analysis using tyrosine hydroxylase (TH) and aromatic l-amino acid decarboxylase (AADC) antibodies. The number of positive neurons was counted. Results: TH- and AADC-positive cells were present in the glomerular layer. There was no significant difference between the numbers of TH- and AADC-positive cells, in males and females, and in young and elderly individuals. The quantitative analysis revealed that the number of TH- and AADC-positive neurons were significantly higher in males than in females (P < 0.05). Moreover, there was a significant increase in the number of TH- and AADC-positive neurons in the olfactory bulbs of the elderly compared with young individuals (P < 0.05). Conclusion: Factors such as gender and age may affect the number of dopaminergic neurons, and there is a correlation between increased dopaminergic neurons and olfactory performance. Moreover, the increase in dopaminergic cells in the olfactory bulb of the elderly may indicate the existence of rostral migratory stream in adult humans. © 2015 Elsevier B.V

Congenital heart defects in children with oral clefts

&amp;nbsp; Background: Oral clefts are among the most common congenital anomalies. Infants with oral clefts often have other associated congenital defects, especially congenital heart defects. The reported incidences and the types of associated malformations and congenital heart defects vary between different studies. The purpose of this study was to assess the incidence of associated congenital heart defects in children with oral clefts. Methods: All infants with cleft lip and palate referred to the Children&apos;s Medical Center and Bahramy; the teaching Hospitals of the Tehran University of Medical Sciences from 1991 to 2005 were prospectively enrolled in this study group. All patients were examined and noted by an academic cleft team contain; a pediatrician and a pediatric surgeon, and received cardiac consultation and echocardiography by a pediatric cardiologist. non cardiac associated anomalies, still born and patients without echocardiography were excluded from the study.&amp;nbsp; Data including age, gender, exposure to contagions and high risk elements ,consanguinity and familial history of oral cleft, type of oral cleft, results of cardiac consultation and echocardiography and associated cardiac anomalies were cumulated and analyzed by SSPS version 13.5Results: Among the 284 infants with oral clefts, 162 were male (57%) and 122 were female (43%). Seventy-nine patients (27.8%) had cleft lip, 84 (29.5%) had cleft palate and 121 (42.6%) had both cleft lip and palate. Of all the patients, 21.1% had congenital heart defects. the most common type Of these congenital heart defects(28.3%) &amp;nbsp;was atrial septal defect.Conclusions: For patients with cleft lip and palate, we recommend preoperative cardiac consultation, careful examination and routine echocardiography for associated cardiac anomalies, as well as appropriate management and prophylactic antibiotic therapy for those with associated congenital heart anomaly