Intratympanic Dexamethasone Delivery versus Placebo in Intractable Meniere Disease

Background: Numerous treatments strategies were used for Meniere disease (MD). In this study, we aimed to compare the efficacy of intratympanic dexamethasone versus intratympanic placebo in intractable MD.Methods: This was a single-blinded randomized clinical trial. All patients with Intractable MD underwent ventilation tube insertion into tympanic membrane and were randomly allocated to two groups of 18-patients. The patients of the first group used dexamethasone base drop (placebo) every other day, the second group used dexamethasone drop for 3 months, and all patients were followed for 12 months.Results: Control of vertigo and tinnitus with dexamethasone was more than the placebo, but there was no statistically significance difference between two groups (P > 0.05). Hearing function improvement and aural fullness resolution were higher in the placebo group, but there was no statistically significance difference, too (P > 0.05). Vertigo control in dexamethasone group in our study ranged from 72.2% to 83.3% of patients at different intervals. These figures ranged from 66.6% to 83.3% in placebo group. The highest rate of hearing function improvement in our study was 27.7% in placebo group. Tinnitus also followed the same pattern as hearing function.Conclusions: Intratympanic dexamethasone for MD is very satisfactory if medical treatment fails with good vertigo control and no risk to hearing

Brain abscess as a manifestation of spinal dermal sinus

Dermal sinuses have been associated with a wide spectrum of clinical manifestations ranging from asymptomatic to drainage of purulent material from the sinus tract, inclusion tumors, meningitis, and spinal abscess. To date, there has been no documented report of brain abscess as a complication of spinal dermal sinus. Here, we report an 8-month-old girl who was presented initially with a brain abscess at early infancy but lumbar dermal sinus and associated spinal abscess were discovered afterwards. The probable mechanisms of this rare association have been discussed

Effects of Oral L-Carnitine Supplementation on Lipid Profile, Anemia, and Quality of Life in Chronic Renal Disease Patients under Hemodialysis: A Randomized, Double-Blinded, Placebo-Controlled Trial

In patients on maintenance hemodialysis several factors reduce the body stored carnitine which could lead to dyslipidemia, anemia, and general health in these patients. We evaluated the effect of oral L-carnitine supplementation on lipid profiles, anemia, and quality of life (QOL) in hemodialysis patients. In a randomized, double-blinded, placebo-controlled trial, end-stage renal disease (ESRD) patients on hemodialysis received either L-carnitine 1 g/d (n = 24) or placebo (27 patients) for 16 weeks. At the end of the study, there was a significant decrease in triglyceride (−31.1 ± 38.7 mg/dL, P = 0.001) and a significant increase in HDL (3.7 ± 2.8 mg/dL, P < 0.001) levels in the carnitine group. Decrease in total cholesterol (−6.6 ± 16.0 mg/dL, P = 0.075) and increase in hemoglobin (0.7 ± 1.7 g/dL, P = 0.081) concentrations in the carnitine group were not significant. There was no statistically significant changes in LDL in any group (P > 0.05). Erythropoietin dose was significantly decreased in both the carnitine (−4750 ± 5772 mg, P = 0.001) and the placebo group (−2000 ± 4296 mg, P < 0.05). No improvement was observed in QOL scores of two groups. In ESRD patients under maintenance hemodialysis, oral L-carnitine supplementation may reduce triglyceride and cholesterol and increase HDL and hemoglobin and subsequently reduce needed erythropoietin dose without effect on QOL

Coronary Artery Bypass Grafting: Simultaneous Head and Neck Mass Surgery

Background: Coronary artery disease (CAD) and cancer have common risk factors. According to the necessity of mass resection in patients with CAD at the same time, we decided to do neck and head mass resection and coronary artery bypass grafting (CABG) simultaneously and assess the results.Methods: The current study was done on patients who were candidates for simultaneous head and neck mass resection and CABG. The patients’ files were extracted, the information and complications were recorded in a questionnaire, and then necessary data were extracted.Results: Totally 9 patients (3 females and 6 males) with a mean age of 69.11 ± 6.67 standard deviation years were studied. The most common site of squamous cell carcinoma in this study was tongue. Infection occurred in three patients, two of which (66.66%) died. Side effects occurred in four patients.Conclusions: It seems that, according to the anatomical position of neck mass, proximity to the airways and large blood supply in that area, and also because of inappropriate access to the anatomical zones, the survival rate and complications in this surgical setting (simultaneous surgeries) are different from that of other studies. It seems that further studies are needed to be done with the subject of concomitant head and neck mass surgery and CABG this time with a larger number of patients

HEAD AND NECK SURGERY Temporomandibular Joint Dislocation Reduction Technique A New External Method vs. the Traditional

Abstract: The traditional intraoral approach for temporomandibular joint dislocations reduction, although effective, has some disadvantages. Here, a new extraoral approach is described. This study was performed to evaluate this new method&apos;s success rate. Patients visiting an emergency room were randomly allocated to 2 groups; one group was reduced with the extraoral approach and the other with the intraoral method. Among 29 attempts with the conventional method, 25 were successful (86.2%; 95% confidence interval: 73-100) and among 29 attempts with the external method, 16 were successful (55.2%; 95% confidence interval: 39 -79). This difference was statistically significant. Because of the benefits of the external approach, such as avoiding hand bites and disease transfer, it can be a reasonable choice to reduce a dislocated temporomandibular joint. Key Words: temporomandibular joint, reduction, extraoral approach, TMJ dislocation (Ann Plast Surg 2009;63: 000 -000) T he most common type of temporomandibular joint (TMJ) dislocation is acute episodes of anterior dislocation, although dislocations may occur in any direction with various associated fractures. 1 Dislocations are usually spontaneous and may result from excess mouth opening in case of yawning, laughing, taking a large bite, seizure, or intraoral procedures such as tooth extraction or orotracheal intubation. Treatment depends on patient status and varies from simple reduction to surgical intervention. The latter is usually necessary only for chronic recurrent and chronic persistent dislocations 2 and in acute forms nearly all cases are managed by hand reduction. The traditional intraoral reduction method, although effective, has some disadvantages: it requires a great effort, especially in patients with strong mastication musculatures 1 ; local or systemic analgesics and muscle relaxants or sedatives are necessary occasionally; risks of bite injury regarding hepatitis, AIDS, syphilis, or other transmittable diseases; and patient discomfort regarding the physicians hand in his/her mouth. Therefore, another method using an extraoral approach always has been a concern. 3,4 The external method introduced by Chen et al is supposed to be an easy and effective way to reduce TMJ dislocation, as they stated. 3 Therefore, we performed this study to evaluate the success rate of this new method in comparison to that of the traditional method. METHODS Amir-A&apos;lam General Hospital is a tertiary center for otolaryngology diseases in Iran. Patients referring to the emergency room (ER) were included consecutively in this prospective trail in an 8-month period (January-August 2007). Procedures were performed by second-year otolaryngology residents with a good level of experience in both techniques, who had performed a large number of under-observation reductions before the study. Block randomization was used for allocating patients into 2 different modality groups. ER reception was provided with a list of random blocks of 2. Every patient, before entry to the clinic and visited by ER physicians, was coded to enter to one of the treatment groups. Therefore, both the patients and the reducing physician were not aware of patient allocation. A thorough history was taken regarding demographic information, past history of general ligament laxity, past history of TMJ dislocation, underlying disorders, trauma, prior use of muscle relaxing agents, and time delay between dislocation and reduction. Mandible fractures especially those involving the condylar and subcondylar region were ruled out by physical examination and proper x-rays when needed. To reduce TMJ dislocation, the patient was put in either a sitting or supine position and the operator sat or stood in front of the patient. An attempt was made to reduce the dislocation using the randomly chosen method. The success rate was calculated regarding successful patient treatment for each method on the first try. As the salvage for the unsuccessful cases if the first method failed, the other method was attempted and if that too was not successful, a muscle relaxant (10 mg diazepam) was administered and the TMJ dislocation was reduced. To avoid patient cross over between groups these second reductions were not included in the analysis. Conventional Method The physician, applying bimanual intraoral force on the mandibular molars of the patient in an inferior and then posterior direction, will reduce the dislocated condyle back into the glenoid fossa. New Method 3 The physician places one hand on each of the patient&apos;s cheeks. On one side, the thumb is placed just above the anteriorly displaced coronoid process, and the fingers are placed behind the mastoid process to provide a counteracting force. On the other side, the fingers hold the mandible angle and the thumb is placed over the malar eminence. To reduce the dislocated jaw, one side of the mandible angle is pulled anteriorly by the fingers, with the thumb over the malar eminence acting as a fulcrum. While the mandible angle is pulled anteriorly, steady pressure is applied on the coronoid process of the other side, with the fingers behind the mastoid process providing counteracting force. The mandible is rotated by this maneuver and the dislocated TMJ is usually reduced on one side. Once one side of the dislocation is reduced, the other side will usually go back spontaneousl

Coronary Plaque Morphology and the Anti-Inflammatory Impact of Atorvastatin: A Multicenter 18F-Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Study.

BACKGROUND: Nonobstructive coronary plaques manifesting high-risk morphology (HRM) associate with an increased risk of adverse clinical cardiovascular events. We sought to test the hypothesis that statins have a greater anti-inflammatory effect within coronary plaques containing HRM. METHODS AND RESULTS: In this prospective multicenter study, 55 subjects with or at high risk for atherosclerosis underwent 18F-fluorodeoxyglucose positron emission tomographic/computed tomographic imaging at baseline and after 12 weeks of treatment with atorvastatin. Coronary arterial inflammation (18F-fluorodeoxyglucose uptake, expressed as target-to-background ratio) was assessed in the left main coronary artery (LMCA). While blinded to the PET findings, contrast-enhanced computed tomographic angiography was performed to characterize the presence of HRM (defined as noncalcified or partially calcified plaques) in the LMCA. Arterial inflammation (target-to-background ratio) was higher in LMCA segments with HRM than those without HRM (mean±SEM: 1.95±0.43 versus 1.67±0.32 for LMCA with versus without HRM, respectively; P=0.04). Moreover, atorvastatin treatment for 12 weeks reduced target-to-background ratio more in LMCA segments with HRM than those without HRM (12 week-baseline Δtarget-to-background ratio [95% confidence interval]: -0.18 [-0.35 to -0.004] versus 0.09 [-0.06 to 0.26]; P=0.02). Furthermore, this relationship between coronary plaque morphology and change in LMCA inflammatory activity remained significant after adjusting for baseline low-density lipoprotein and statin dose (β=-0.27; P=0.038). CONCLUSIONS: In this first study to evaluate the impact of statins on coronary inflammation, we observed that the anti-inflammatory impact of statins is substantially greater within coronary plaques that contain HRM features. These findings suggest an additional mechanism by which statins disproportionately benefit individuals with more advanced atherosclerotic disease. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00703261.National Heart, Lung, and Blood Institute of the National Institutes of Health (5T32 HL076136) and Marfan Foundation, National Institute for Health Research Cambridge Biomedical Research Centre, British Heart Foundation, Wellcome Trus

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Key audit matters - the answer? : An exploratory study investigating auditors possibilty to accomplish the purpose of the new audit report

Various institutional attempts to recapture confidence of the audit profession resulted in a new section ISA 701 which is likely to be game changing for stakeholders and the auditing profession. The new standard establishes that more entity specific information should be communicated through the new section key audit matters. Simultaneously, a prerequisite for auditors is the confidentiality duty towards their clients. As such regulation that reinforces increased communications in audit reports might conflict with auditors’ professional values and ethical implementation when conducting audit reports. By using qualitative interviews we investigated auditors interpretation of the new standard in order to forecast potential outcomes of the new reports. Our result indicates that auditors’ fear of trespassing the confidentiality duty might be reflected in the caution taken in the reporting process. The limitations of the confidentiality and auditors low willingness to provide entity specific information implies that it will be hard to move away from a standardized way of reporting. The results suggests that auditors need better prospects which enables an increased communication through audit reports, in other words a change of regulation that limits liability claims.

Evaluation of the Reduction of Seismic Response of Adjacent Structures Using Viscous Damper Joint

This study examines the effect of common viscose damper on the behavior of adjacent reinforced concrete structures. For this purpose, three reinforced concrete 3, 5 and 7 floors buildings with a regular plan were selected and were compared in two cases without and with viscous dampers at the seams. They are designed based on discussions of Buildings Regulations 2800 and the 6 and 9 issues of Iranian National Building Regulations. Those buildings face under accelerograms of Bam, Mangil and El Centro, and then they are analyzed with nonlinear modal time history. This Accelerograms before applying to the structures, they are scaled based on the 2800 Regulations. Those buildings were modeled by SAP2000 finite element modeling software. Linear behavior of structural components of the structure and the non-linear behavior viscous damper were modeled. Finally, the seismic response of buildings includes the base shear force, up to a maximum lateral acceleration of seismic classes and classes for both with and without the viscous damper have been extracted and compared. The results showed the reduction in relative lateral displacement, maximum acceleration and base cut applied to structure in the presence of viscous dampers between two structures. This decline is not even in the direction that the viscous damper is viewed as significant