Acute mastoiditis in a child with a history of cochlear implantation : a case report

Background: Acute mastoiditis is one of the complications of acute otitis media in children. Patients with acute mastoiditis commonly have manifestations of acute otitis media and inflammation of the mastoid bone. Computed tomography is the most frequent diagnostic method for diagnosing acute mastoiditis. In this report, we presented a 6-year-old boy with a history of cochlear implantation three years ago, who was referred for acute swelling and pain in the mastoid bone one day ago.  Case presentation: A 6-year-old boy with fever, pain, redness, and swelling of the posterior side of his right ear from one day ago was referred to the clinic. Physical examination showed tenderness, redness, warmness, and swelling on the right auricle and mastoid bone. Implantation in the right ear about three years ago was mentioned. Last week, involvement with coryza, nasal congestion, and low-grade fever without ear pain was mentioned. Acute mastoiditis was confirmed with CT scanning, and he was cured with antibiotic therapy. Discussion: Acute mastoiditis is not common. It may occur after a few times of cochlear implantation, but it occurs rarely after a long time. The main cause is bacterial infection. After confirmation of the diagnosis with CT scanning, treatment with antibiotics should be started intravenously, and then it can be changed to oral antibiotics.     Conclusion: Acute mastoiditis should be considered as a differential diagnosis in pediatrics with acute swelling, pain, and any manifestation of inflammation on mastoid bone, even though there is no history of acute otitis media

Comparison of Loratadine and Cetirizine in Perennial Allergic Rhinitis

Background: Allergic rhinitis (AR) represents a global health problem, affecting 5-50% of the population worldwide and numerous classes of pharmacological agents are available for its treatment. Two more popular of these drugs are Loratadine and Cetirizine. There are few direct comparator studies between these two drugs with inconsistent results.Materials and Methods: A randomized, double-blind study for comparison the therapeutic effects of Loratadine and Cetirizine was conducted in an otolaryngologic clinic of a general hospital. Eighty patients with perennial allergic rhinitis were divided into two equal groups. One group received Loratadine 10 mg daily for two weeks and the other group Cetirizine 10 mg daily also for two weeks. Alterations of the allergic rhinitis symptoms including rhinorrhea, sneezing, nasal itching and nasal obstruction were compared between the two groups.Results: Severity of all four studied symptoms was reduced by both drugs. Although Cetirizine had a little more efficacy, their difference was not statistically significant (P>0.05). These two medications were most effective in reducing the sneezing and least effective on the nasal obstruction.Conclusion: Loratadine and Cetirizine can reduce symptoms of the perennialallergic rhinitis but their difference is not statistically significant

The Effect of Intravenous Infusion of Magnesium Sulfate During Bimaxillary Orthognathic Surgery on Post-operative Pain: A Clinical Trial

Background: This prospective randomized controlled clinical study aimed to investigate the effect of magnesium sulfate (MgSO4) on pain management post orthognathic surgery. Methods: In this study, 52 patients undergoing orthognatic surgery were randomly allocated to receive MgSO4 or saline intravenously. The intervention group (n = 26) received intravenous MgSO4 (30 mg/kg bolus for 15 minutes immediately before anesthesia induction followed by 10 mg/kg/h dissolved in saline via pump infusion) and the second group (n = 26) received the placebo in the same bolus volume as a normal saline in a 15 minute intravenous infusion which was continued until the end of the operation. A visual analog scale (VAS) was used to determine the intensity of pain. Invasive arterial blood pressure and valid and invalid analgesic demand were also recorded. Side effects were recorded, as well. Results: This study was conducted on 52 patients, 26 per group. The results showed no statistically significant differences between the two groups with respect to demographics. During the post-operative period, the patients in the control group showed larger analgesic requirement 7 (26.9%) compared to those in the magnesium group 4 (15.4%) and the difference was not statistically significant (P = 0.308). The post-operative VAS scores evaluated serially from the recovery room also showed a significant difference between the intervention 3 (11.5%) and the control group 14 (53.8%) after the surgery (P = 0.001). However, no significant difference was found between the two groups regarding VAS scores in the surgical ward [7 (26.9%) vs. 8 (30.8%) P = 0.760]. Conclusions: Intra-operative administration of intravenous MgSO4 reduced opioid consumption for pain after bimaxillary orthognathic operations

Evaluation of tubotympanic angle of Eustachian tube and its relationship with Eustachian tube function in patients with chronic middle ear infection

Background: chronic otitis media is characterized by the accumulation of fluid in the middle ear and behind the tympanic membrane without signs of acute infection. The association between a middle ear infection and anatomical and physiological disorders of the Eustachian tube has been reported in several studies and its malfunction is one of the main causes of middle ear infection.  Aim: We aim to find the relation of tubotympanic angle of Eustachian tube and chromic otitis media.  Methods: In this study, 100 patients with chronic unilateral middle ear infections were included. To determine the tubotympanic angle of the Eustachian tube, a temporal bone CT scan was used in the radiology department of Loghman Hospital. Eustachian tube angle and ear function were recorded. Results: Among the 100 patients in the study, 42 were men and 58 were women. The mean age of patients in the study was 39.64±12.64 years. The angle was 3.79 ± 34.27 in the healthy ear and 2.43 ± 31.06 in the diseased ear, which showed a statistically significant difference between the two groups  Conclusion: Eustachian tube angles in adults may play an important role in the cause of chronic otitis media. In this study, it was found that the horizontalization of the Eustachian tube is associated with chronic otitis media. Besides, determining the angle of the Eustachian tube can help determine the susceptibility to otitis media.&nbsp

Investigating the Genetic Characteristics of Cochlear Implant Candidates with Hearing Impairment

Background: Hearing loss, especially at a young age, has severe personal and social consequences for a person and brings enormous costs to the treatment system. Considering the vital role of genetics in hearing loss, genetics research creates a suitable platform for progress in the treatment of these patients, so we decided to conduct a study with the aim of early diagnosis and even before symptoms appear in order to reduce possible complications. Aim: In this study early diagnosis of hearing loss and even before symptoms appear in order to reduce possible complications. Methods: Based on the history and phenotype and examination of the medical records of 1249 patients who are candidates for cochlear implantation, genetic testing among the patients suspected of non-syndromic genetic hearing loss, a request for genetic testing of stage one or two or both was made and according to the willingness of the families and their cooperation A total of 138 genetic tests were performed and subjected to genetic analysis. Results: Among 138 tested cases, 71 women and 67 men, NSHL inheritance autosomal recessive pattern was 84/78% and autosomal dominant, 5/07 which is very close to previous studies. There were genetic mutations in the Gjb2 gene in ten cases of patients. Ninety-one patients were negative for GJB2 involvement and were candidates for WES, but unfortunately, many families refused to perform the test due to the cost of this test. Seven patients underwent WES, and several genetic mutations were identified in the thesis. WES was performed for 34 patients according to the investigations carried out directly. Conclusion: Iranian society has played an essential role in improving our understanding of the genes involved in proper hearing functioning and how these genes' variants cause hearing loss. Researchers have worked tirelessly to solve the genetic mystery of hearing loss in Iran, which has been very successful. However, more work is still needed

A Case-Control Study of Comparison of Plasma Levels of Matrix Metalloproteinase-9 in Inhaled Opium Addicts and Clinically Healthy Persons

cancer invasion and lymphatic metastasis. Smoking has been reported to increase the metalloproteinase level, but the role of opium consumption in metalloproteinase level has not yet been examined. The current research intended to examine the impacts of opium consumption on the serum levels of metalloproteinase.Methods: This case-control research was conducted in Kerman (in the southeast of Iran), after getting medical approve by the ethics committee. Case group of 33 non-smokers with no active inflammatory diseases who had the experience of inhaled opium and its derivatives were compared with a control group of 40 non-smokers with no active inflammatory disease and no experience of inhaled opium and its derivatives. Student’s t-test, mean, and chi-square test were employed to determine the correlation between the variables.Findings: No statistically meaningful variation was detected in plasma metalloproteinase concentration between the case and control groups (P = 0.160). Also, there was no significant relation between the plasma metalloproteinase concentration and urinary morphine in case groups (P = 0.410), but a statistically significant correlation was found between gender and metalloproteinase in both the case and control groups (P = 0.003)

Comparison of Post Intubation Complications of Endotracheal Tube and Laryngeal Mask Airway in Pediatrics

Background: Postoperative sore throat, cough, nausea, apnea, and laryngospasm are common complications of intubation byendotracheal tube (ETT) in pediatrics. The laryngeal mask airway (LMA) is a supraglottic device used as an alternative equipmentfor ETT in order to decrease the complications.Objectives: To compare the incidence of postoperative sore throat after LMA with ETT in pediatrics.Methods: Seventy-six patients between the ages of 2 - 12 with ASA class I-II who underwent cochlear implant surgery were enrolledand randomly divided into 2 groups including ETT or LMA for airway management. The incidence of complications including sorethroat, apnea, vomiting, laryngospasm, post operative cough, intra, and post operative arrhythmia and the influence of these equipment’son O2 saturation, end tidal CO2, airway pressure, and hemodynamic changes during operation were compared. Wong-Bakerfacial grimace scale was used to evaluate the severity of pain.Results: The rate of postoperative sore throat and laryngospasm in the ETT group was significantly higher than the LMA group (P =0.002, 0.011; respectively). Apnea and vomiting were not significantly different. Rate of postoperative cough, incidence of intra, andpostoperative arrhythmia were not significantly different between the two groups. Mean arterial pressure, peak airway pressure,end tidal CO2, and oxygen saturation during operation, which was measured continuously, had no significant differences betweenthe two groups.Conclusions: LMA significantly decreases the rate of postoperative sore throat and laryngospasm in pediatrics. However, the ratesof apnea, oxygen saturation, and nausea were similar in both groups. Application of LMA as an alternative to ETT is appropriate inpediatric patients

COVID-19 infection control parameters in Iran: an epidemiological modeling : Epidemiological assessment of COVID-19 infection in Iran

Abstract Background: We aimed to evaluate Iran's current COVID-19 infection, emphasizing the number of infection detection and the disease's reproductive number in its high peak in November and after the lockdown in December. Materials and Methods: Using the Johns Hopkins Bloomberg School of Public Health Contact Tracing Evaluation and Strategic Support Application, we used the average weekly new cases and average case mortality in November and December 2020. The average case isolation and identification time (25%, Four days) and the average case contact within the household and community were entered into the application. We examined Two modeling systems with 50% and 70% case isolation for the November period as alternative scenarios for the current infection control rate. Results: Our modeling showed only 11% and 30% of the infections were detected in November and December. The disease's reproductive number is similar to the natural reproductive number of the disease (2-3) in November. The two models used to increase the rate of case isolation to 50% and 70% did not significantly change the reproductive number. Conclusion: The priority in Iran for COVID-19 infection control should be a dramatic increase in the number of testing to achieve the correct number of case detection and fulfill the contact tracing criteria to reduce the disease spread

The Relationship between Severe Hyperbilirubinemia and Abnormal Auditory Brainstem Response in children

Abstract:Background : Hyperbilirubinemia is one of the most common cause of congenital sensory neuronal hearing loss. These patients are screened by auditory brainstem response (ABR) test at bilirubin levels higher than 1% of gestational weight. Aim: to determine whether hyperbilirubinemia less than 1% of gestational weight could induce hearing loss and abnormal auditory brainstem response (ABR).Methods: in this case control study the outcome of ABR test in children younger than 3 years old with a history of term delivery and hyperbilirubinemia (bilirubin level less than 1% of gestational weight) were compared with the control group without hyperbilirubinemia matched for age and sex.Results: Mean ABR amplitude (wave I, V) were significantly prolonged in neonates with jaundice compared with controls (P0.6% gestational weight was 2.25 with 95% CI (1.44-3.89 and p=0.02).Conclusion: Our study showed a relevant association between bilirubin levels less than 20 mg/dl and abnormal ABR

The Relationship between Severe Hyperbilirubinemia and Abnormal Auditory Brainstem Response in children

Abstract:Background : Hyperbilirubinemia is one of the most common cause of congenital sensory neuronal hearing loss. These patients are screened by auditory brainstem response (ABR) test at bilirubin levels higher than 1% of gestational weight. Aim: to determine whether hyperbilirubinemia less than 1% of gestational weight could induce hearing loss and abnormal auditory brainstem response (ABR).Methods: in this case control study the outcome of ABR test in children younger than 3 years old with a history of term delivery and hyperbilirubinemia (bilirubin level less than 1% of gestational weight) were compared with the control group without hyperbilirubinemia matched for age and sex.Results: Mean ABR amplitude (wave I, V) were significantly prolonged in neonates with jaundice compared with controls (P0.6% gestational weight was 2.25 with 95% CI (1.44-3.89 and p=0.02).Conclusion: Our study showed a relevant association between bilirubin levels less than 20 mg/dl and abnormal ABR