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1.
Int J Surg Case Rep ; 117: 109391, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38518468

RESUMO

INTRODUCTION AND IMPORTANCE: Acute idiopathic cervical kyphosis (AICK) represents a rare entity, and its management remains controversial. Preoperative surgical planning and individual decision-making seem necessary. To date, there is a lack of sufficient evidence and clear guidelines. CASE PRESENTATION: A 21-year-old male was referred with a progressive cervical deformity detected 3 months earlier. The patient suffered from severe progressive myelopathy and represented neither neck trauma nor a familial history of similar expected conditions. His cervical imaging revealed 95 degrees of cervical kyphosis. After 3 separate surgical sessions for 360-degree fixation, the cervical kyphosis was reduced by 90 degrees. No facet dislocation was observed, and laminectomy was unnecessary. Post-operative neurological examination detected significant improvement. Six months and 2-year follow-ups were favorable. To the authors' knowledge, the current case had the most extensive degree of cervical kyphosis reported in the literature. CLINICAL DISCUSSION: Multistage correction of AICK would result in a favorable outcome and reduce the risk of complications. Particular attention should be paid to the wide inter-spinous spaces in high grades of kyphosis during sub-periosteal dissection to prevent iatrogenic spinal cord injuries. CONCLUSION: The present work may provide the first report on the role of cervical postural habits in patients with opiate substance abuse disorder, which could have triggered cervical kyphosis in this particular patient. Multistage correction of AICK would result in a favorable outcome and reduce the risk of complications.

2.
J Perioper Pract ; 33(4): 116-121, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-34791944

RESUMO

Difficult airway and intubation can have dangerous sequela for patients if not managed promptly. This issue is even more challenging among obstetric patients. Several studies have aimed to determine whether the test to predict a difficult airway or difficult intubation, is higher in accuracy. This study aims to compare the upper lip bite test with the modified Mallampati test in predicting difficult airway among obstetric patients. During this prospective observational study, 184 adult pregnant women, with ASA physical status of II, were enrolled. Difficult intubations of Cormack-Lehane grade III and IV were defined as difficult airways and difficult intubation in this study. Upper lip bite test, modified Mallampati test, thyromental distance and sternomental distance were noted for all patients. Modified Mallampati test, upper lip bite test and sternomental distance had highest specificity. Based on regression analysis, body mass index and Cormack-Lehane grade have a significant association. Modified Mallampati test was the most accurate test for predicting difficult airway. The best cut-off points of thyromental distance and sternomental distance in our study were 5cm and 15cm, respectively, by receiver operating characteristic curve analysis. Based on the results of the present study, it can be concluded that in the obstetric population, modified Mallampati test is practically the best test for predicting difficult airway. However, combining this test with upper lip bite test, thyromental distance and sternomental distance might result in better diagnostic accuracy.


Assuntos
Intubação Intratraqueal , Lábio , Adulto , Humanos , Feminino , Gravidez , Intubação Intratraqueal/métodos , Sensibilidade e Especificidade , Estudos Prospectivos , Laringoscopia
3.
J Family Reprod Health ; 16(4): 296-299, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37465435

RESUMO

Objective: During the COVID-19 pandemic, burnout of healthcare workers, including anesthetists, has become a critical issue. This study aimed to provide a practical framework for decreasing and preventing burnout among anesthesiology residents through preserving their good mental health. Materials and methods: Since the onset of the COVID-19 outbreak, anesthesiology residents have been members of medical teams with the attending staff, senior residents, and partner residents. Besides, the following measures were taken to reduce burnout: providing financial support for the attending staff to procure personal protective equipment (PPE), rearrangement of work schedules to reduce the workload, holding training sessions in virtual meetings, and improving the social network system for reducing burnout. Results: The interventional program could help anesthesiology residents to adapt to or cope with the healthcare system status and also prevent burnout. Moreover, development of empathy, integrity, and cohesion in the healthcare system motivated the staff to comply with the principles of medical professionalism. Conclusion: During the current health crisis due to COVID-19, it is essential to implement specific interventional and training programs for decreasing or preventing burnout among healthcare workers.

5.
Turk Neurosurg ; 31(4): 481-483, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34270082

RESUMO

In the past decade or perhaps a little earlier than that the concept of teamwork evolved among the circles of surgeons especially among those involved in complicated and time consuming surgeries. Skull base surgeries were one of those surgeries where the role of teamwork was acutely felt owing to innumerable specialties involved in the consummation of such surgeries. Although teamwork in this specialty is the need of the hour but, achieving the spirit of teamwork is not that easy and perhaps a challenging task. This manuscript tackles the much needed demand of teamwork in this arena of surgery and unveils whether such a teamwork is achievable or is just an utopian dream.


Assuntos
Procedimentos Neurocirúrgicos , Equipe de Assistência ao Paciente/organização & administração , Base do Crânio/cirurgia , Comportamento Cooperativo , Tomada de Decisão Compartilhada , Estudos de Viabilidade , Mortalidade Hospitalar , Humanos , Comunicação Interdisciplinar , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/mortalidade , Procedimentos Neurocirúrgicos/normas , Equipe de Assistência ao Paciente/normas , Estudos Retrospectivos , Resultado do Tratamento , Utopias
6.
Iran J Microbiol ; 12(3): 261-262, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32685124

RESUMO

COVID-19 has literally ravaged the entire world. People from all walks of life are badly affected because of compulsory lockdown around the world. Timely diagnosis is a problem as there is no single test that can achieve the highest acceptable sensitivity. Some of the tests are indeed costly and footing the bill by the governments can cause a tremendous load on the Treasury. As it stands, the current tests are beyond patient means and, thus, the patient would never have it performed. Lastly, there is no consensus as to whether everyone should be tested for COVID-19 and not based on presence of clinical features. Unfortunately, since the disease has been declared a pandemic, all should be considered to be infected unless provenother-wise by the tests that are performed.

8.
World Neurosurg ; 135: 173-175, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863886

RESUMO

Avicenna, a great physician and polymath, made a tremendous contribution to our present-day medicine. His ancestral origin has been the subject of debate. In this short and concise article, we have endeavored to trace his ancestral roots and bring to light his exact origin and nationality.


Assuntos
Neurocirurgia/história , Povo Asiático , História Medieval , Humanos , Pérsia , Trepanação/história
9.
Curr Hypertens Rev ; 16(1): 79-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30767748

RESUMO

We are of the opinion that fasting in Muslims during the month of Ramadhan could cause hypertension secondary to dehydration that inevitably follows. Dehydration initiates a cascade of hormonal events that finally culminate in hypertension. This hypothesis however needs to be tested in a randomized trial to be confirmed.


Assuntos
Pressão Sanguínea , Jejum/efeitos adversos , Férias e Feriados , Hipertensão/etiologia , Islamismo , Sistema Renina-Angiotensina , Barorreflexo , Volume Sanguíneo , Deslocamentos de Líquidos Corporais , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Fatores de Tempo , Vasoconstrição
12.
A A Pract ; 13(4): 137-139, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-30973350

RESUMO

Cutaneomeningospinal angiomatosis, popularly known as Cobb syndrome, is a rare clinical disorder predominantly presenting with a vascular skin lesion and a spinal angioma at the same dermatomal level. Several case reports and case series have reported on the surgical management of this syndrome, but we failed to find any information about its anesthetic considerations in the Medline database. Our case report describes the perioperative anesthetic management of a 46-year-old man with Cobb syndrome.


Assuntos
Atracúrio/administração & dosagem , Fentanila/administração & dosagem , Isoflurano/administração & dosagem , Síndromes Neoplásicas Hereditárias/cirurgia , Anestésicos Gerais/administração & dosagem , Angiomatose/complicações , Angiomatose/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Neoplásicas Hereditárias/complicações , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento
13.
Pak J Med Sci ; 34(4): 1019-1023, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30190773

RESUMO

BACKGROUND AND OBJECTIVE: Upper lip bite test (ULBT) is one of the various bedside tests used for prediction of difficult laryngoscopic intubation. However, its usefulness is not still very clear, and there is controversy regarding its accuracy. The aim of this systematic review was to determine the accuracy of the ULBT for predicting difficult airway including difficult laryngoscopy or difficult tracheal intubation. METHOD: We searched the databases of PubMed, Scopus, and Google scholar for prospective studies published up until October 2016 assessing the accuracy of ULBT in comparison to Cormack-Lehane grading. The selected keywords were "upper lip bite test", "upper lip catch test", "prediction", "difficult airway", "difficult laryngoscopy", "difficult intubation". Inclusion criteria were studies assessing ULBT for prediction of difficult intubation, considering Cormack-Lehane grade III and IV as difficult airway, written in English, and reporting sensitivity, specificity, NPV, PPV, and accuracy. Exclusion criteria were studies not reporting accuracy or not having enough data for its calculation. Based on the mentioned criteria, 27 studies enrolling 18141 patients were included. This systematic review was performed based on the guidelines on conducting systematic reviews of diagnostic studies. RESULTS: Prevalence of airway difficulties according to the direct laryngoscopic view varied from 2.8% to 27% and according to the ULBT was from 2% to 21%. In 11 of the 27 studies, sensitivity of ULBT in prediction of difficult airway was more than 70%. All of the studies except one showed a high specificity for ULBT (>85%). Moreover, these studies indicated a high NPV. Accuracy of ULBT was >85% in 24 out of 27 studies. CONCLUSION: It appears that ULBT is a useful bedside test for evaluation of patient airway before the general anesthesia.

16.
Spinal Cord ; 56(10): 980-986, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29802395

RESUMO

STUDY DESIGN: Cross-sectional psychometric study. OBJECTIVES: To translate the Spinal Cord Independence Measure III (SCIM-III) into Persian, to evaluate it culturally and to analyze the validity and reliability of the Persian version of the SCIM-III (P-SCIM). SETTING: Brain and Spinal Injury Research Center (BASIR), Tehran, Iran. METHODS: The P-SCIM was developed by forward translation, back-translation, and cultural equivalence assessment procedure. The authors studied: (a) correlation of P-SCIM with the Functional Independence Measure (FIM™) for determining convergence validity, (b) P-SCIM scores in neurological categories for comparison and evaluating discriminative validity, (c) Inter-rater reliability of P-SCIM, (d) Cronbach's alpha for measuring internal consistency of P-SCIM-III. RESULTS: The validity of the scale was supported by a Pearson correlation coefficient of > 0.9 (p < 0.001) between FIM™ and P-SCIM. The Persian SCIM was found to be valid in discriminating different neurological categories. The Inter-rater reliability was concluded by Intraclass correlations of a coefficient > 0.9. Bland-Altman analysis demonstrated good agreement between our raters (mean difference: 0.7, limit of agreement: - 8.09-9.58). Also internal consistency of the scale was shown by Cronbach's alpha to be > 0.7 (0.86). CONCLUSION: P-SCIM-III is a valid and consistent tool for determining functionality in Persian speaking people with spinal cord injury.


Assuntos
Entrevistas como Assunto , Traumatismos da Medula Espinal/diagnóstico , Adulto , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Psicometria , Reprodutibilidade dos Testes , Tradução
17.
Artigo em Inglês | MEDLINE | ID: mdl-28261477

RESUMO

Ventilator associated pneumonia currently in vogue seems to have some pitfalls as far as the nomenclature is concerned and thus it imparts an erroneous impression to the reader. As the driving force is in fact the ventilator, the phraseology should preferably be changed to ventilator induced pneumonia to convey the in depth meaning of the term thus evading the terminology currently in practice. A new and emerging paradigm dealing with all side effects of mechanical ventilation can be helpful to solve this etymological conflict.

18.
J Clin Anesth ; 36: 84-87, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28183581

RESUMO

STUDY OBJECTIVE: To compare the characteristics of NMDR induced muscle paralysis in breast cancer patients with and without a history of recent chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) regimen. DESIGN: This is a non-randomized prospective cohort study. SETTING: Operating room of a university-affiliated teaching hospital. PATIENTS: Out of a total of 50 patients who had undergone mastectomy, 22 patients were allocated to the "Chemo group" and 28 patients to the "Non-Chemo group", based on a valid history of recent chemotherapy. INTERVENTION: After induction of anesthesia with thiopental and cisatracurium, neuromuscular monitoring was started for all patients. MEASUREMENTS: Initially the time to 100% single-twitch (ST) suppression was measured. Then, the time for the appearance of the first response to post-tetanic count (PTC) stimulation, Train-of-Four (TOF) stimulation, and TOF50% were measured consequently. MAIN RESULTS: Time to get STzero was significantly longer in the Chemo group than in the Non-chemo group. Time for the appearance of the first response of PTC and TOF and TOF50% was significantly shorter in the Chemo group than the other group. The mean duration of intense block was 27.66 minutes in the Chemo group versus 42.47 minutes in the Non-chemo group. CONCLUSION: This research demonstrated that in patients having undergone chemotherapy, the effect of NDMRs starts with a longer lag time and finishes earlier too. Thus, these patients are ready for intubation after a longer time. Moreover, we have to repeat cisatracurium injections after shorter intervals to maintain the desired level of blockade.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Atracúrio/análogos & derivados , Bloqueio Neuromuscular/métodos , Fármacos Neuromusculares não Despolarizantes/antagonistas & inibidores , Adulto , Anestesia Geral/métodos , Atracúrio/administração & dosagem , Atracúrio/antagonistas & inibidores , Atracúrio/farmacologia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Ciclofosfamida/farmacologia , Doxorrubicina/farmacologia , Esquema de Medicação , Feminino , Fluoruracila/farmacologia , Humanos , Mastectomia , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Terapia Neoadjuvante/métodos , Junção Neuromuscular/efeitos dos fármacos , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Fármacos Neuromusculares não Despolarizantes/farmacologia , Estudos Prospectivos
19.
J Crit Care ; 38: 152-156, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27912161

RESUMO

BACKGROUND: Endotracheal tube placement is necessary for the control of the airway in patients who are mechanically ventilated. However, prolonged duration of endotracheal tube placement contributes to the development of ventilator-associated pneumonias (VAPs). The aim of this study was to evaluate whether subglottic suctioning using TaperGuard EVAC tubes was effective in decreasing the frequency of VAP. METHODS: A total of 276 mechanically ventilated patients for more than 72 hours were randomly assigned to group E (EVAC tube) and group C (conventional tube). All patients received routine care including VAP prevention measures during their intensive care unit stay. In group E, subglottic suctioning was performed every 6 hours. Outcome variables included incidence VAP, intensive care unit length of stay, and mortality. RESULTS: Frequency of intraluminal suction, mechanical ventilation-free days, reintubation, the ratio of arterial oxygen partial pressure to fractional inspired oxygen and mortality rate were similar between the 2 groups (P > .05). The mean cuff pressure in group E was significantly less than that in group C (P < .001). Ventilator-associated pneumonia was significantly less in group E compared with group C (P = .015). CONCLUSION: The use of intermittent subglottic secretion suctioning was associated with a significant decrease in the incidence of the VAP in critically ill patients. However, larger multicenter trials are required to arrive at a concrete decision on routine usage of TaperGuard tubes in critical care settings.


Assuntos
Estado Terminal , Intubação Intratraqueal/instrumentação , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos , Feminino , Glote , Humanos , Incidência , Unidades de Terapia Intensiva , Irã (Geográfico) , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/mortalidade , Estudos Prospectivos , Sucção/métodos , Resultado do Tratamento , Adulto Jovem
20.
Saudi J Anaesth ; 10(3): 253-4, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27375376
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