Electrodiagnostic Evaluation of Prognostic Factors Influencing the Surgical Outcomes of Upper Extremity Nerve Injuries Caused by Penetrating Trauma: A Cross-sectional Study.

Background: Peripheral nerve damage is a major cause of disability, which can lead to serious limitations in daily and occupational activities. Although primary repair can restore the function of the damaged organ remarkably, factors predicting the prognosis of nerve repair are a topic of constant debate. We aimed to investigate the factors affecting the outcomes of primary nerve repair in patients afflicted by upper extremity nerve injuries following penetrating trauma. Methods: This cross-sectional study was conducted on 51 patients referred to Shohada-ye Ashayer Hospital in Khorramabad, Iran, from 2016 to 2021. Data including the patient's age, gender, education, type, severity, and mechanism of injury, the damaged nerve, time and of method repair, the surgeon's specialty, as well as the electrodiagnostic findings, were collected and analyzed using SPSS software version 22. Results: The mean age of the patients was 30.41 ± 12.63 years, and the majority of them (84.3%) were men. A significant relationship was found between the sensory amplitude with education (P=0.002), the type of damaged nerve (P=0.048), and the severity of injury (P=0.012). The positive sharp wave was significantly associated with the surgeon's specialty (P=0.034). Besides, the motor amplitude was considerably related to the patient's age (P=0.040) and the surgeon's specialty (P=0.035). Conclusion: Factors determining the outcome of peripheral nerve repair following penetrating trauma to the upper extremity include age, education, the type of damaged nerve, the severity of the injury, and the surgeon's specialty.

Posttraumatic bronchobiliary fistulae due to foreign body remnants after a road traffic injury: a case report.

BACKGROUND: Bronchobiliary fistula is an extremely rare disease that involves abnormal communication between a hepatic segment and bronchial tree. It is mostly caused by untreated hydatid cyst, liver abscess, iatrogenic stenosis, and, rarely, trauma. CASE PRESENTATION: We experienced an extremely rare case of bronchobiliary fistula after motor vehicle accident. A 15-year-old Persian boy visited our clinic with chief complaints of persistent pleuritic chest pain, productive cough, weight loss, and fever for 2 months. Coronavirus disease 2019 reverse transcription polymerase chain reaction test was negative. Chest X-ray revealed hazy opacification of right lower lobe. Bronchoalveolar lavage for acid-fast bacillus came back negative. Thoracoabdominal computed tomography scan revealed a collection in segment VIII of the liver communicating with another 13 × 5 cm multiloculated collection in the lower lobe of the right lung, with air foci within the collection. Right posterolateral thoracotomy was performed with the impression of bronchobiliary fistula. Drainage of hepatic collection with debridement, diaphragmatic repair, and open decortication of lung followed by resection of the involved segment of the right lung was performed. Histopathologic evaluations revealed abscess formation in pulmonary tissue, and many multinucleated giant cells were seen that appear to be due to foreign body remnants after previous laparotomy surgery. The foreign body seemed to be the remnants of Surgicel absorbable hemostat. CONCLUSIONS: Herein, we report an extremely rare case of a posttraumatic bronchobiliary fistula caused by remnants of Surgicel hemostatic agent. Bronchobiliary fistula is mainly caused by untreated hydatid cyst, liver abscess, iatrogenic stenosis, and, rarely, trauma. Migration and erosion of oxidized regenerated cellulose through the diaphragm seems to be the causative factor of bronchobiliary fistula in this patient.

Iranian Herbal Medicines Against Hydatid Cyst Protoscoleces: A Systematic Review.

BACKGROUND: In recent years, more attention has been focused in the practice of both crude extract of medicinal plants, and the screening plant-derived compounds as substitute scolicidal agents during hydatid cyst surgery. The present study was designed to review the protoscolicidal effects of some Iranian herbal medicines against hydatid cyst protoscoleces. METHODS: English databases, including PubMed, Google Scholar, Web of Science, EBSCO, Science Direct, and Scopus were searched for publications worldwide related to protoscolicidal effects of Iranian herbal medicines without date limitation so that identify all published articles (in vitro, in vivo, clinical and case-control) have studied. Keywords included "Protoscolicidal", "Scolicidal", "Herbal medicines", "Extract", "Essential oil", "Plant", "In vitro", and "Iran". Moreover, the language of data collection was limited to English. RESULTS: In total, 40 papers up to 2020 were included in the present systematic review. The most studies were conducted on protoscolicidal activity of methanolic extracts (17 studies) followed by essential oils (15 studies), and aqueous extract (3 studies). The most commonly used part of herbs were leaves (21 herbs), seeds (8 herbs), and fruit (6 herbs), respectively. Moreover, the most prevalent herbal family was Lamiaceae (6 studies), followed by Apiaceae (5 studies) and Liliaceae (5 studies). CONCLUSION: Considering the high efficacy of Iranian herbal medicines against hydatid cyst protoscoleces, it can be concluded that Iranian herbal medicines have ability to consider as new alternative protoscolicidal agents during hydatid cyst surgery; however, more clinical studies are required to discover the precise protoscolicida activity of Iranian medicines in animal and human subjects.

Follicular Dendritic Cell Sarcoma of the Thyroid Gland in a Patient with Preexisting Hashimoto's Thyroiditis: A Rare Case Report with a Literature Review.

Thyroid follicular dendritic cell sarcoma (FDCS) is an extremely rare malignancy that originates from follicular dendritic cells of the thyroid germinal centers. To the best of our knowledge, there are only 4 reported cases of thyroid FDCS in the English literature. Herein, we present the fifth case of FDCS of the thyroid gland. A 63-year-old woman presented with a painless midline neck mass, enlarging for the last 4 months. Physical examination revealed a 6-cm nonmobile, firm, multinodular thyroid mass with palpable cervical lymphadenopathy. Due to high suspicion for thyroid malignancy, the patient underwent total thyroidectomy with bilateral modified radical neck dissection. Histologic evaluations revealed sheets of storiform eosinophilic tumoral cells with prominent nucleoli containing multinucleated giant cells, and subsequent immunohistochemistry showed immunoreactivity for CD4, CD21, CD35, CD45 (LCA), and CD68. The patient was started on 6 cycles of doxorubicin, ifosfamide, and radiotherapy. She has had monthly thyroid ultrasonography and contrast-enhanced thoracoabdominal CT scan every 3 months for detecting potential recurrence and/or metastasis screening. Fortunately, 8 months after the operation, the patient is alive without any signs of local or distant metastasis.

In vitro and Ex vivo Antiparasitic Effect of Rheum ribes L. Extract Against the Hydatid Cyst Protoscoleces.

BACKGROUND: Cystic echinococcosis is a zoonotic infection in humans and herbivorous animals occurring worldwide, which is caused by the larva stage of Echinococcus granulosus. Rhubarb (Rheum ribes L.) as an herbal medicine has various therapeutic properties such as antioxidant, anticancer, and antimicrobial. With respect to the potential of the biological activities of this plant in traditional and modern medicine, we aim to examine its protoscolicidal effects against E. granulosus protoscoleces in vitro and ex vivo. METHODS: Collected protoscoleces from liver hydatid cysts of infected sheep were exposed to the different concentrations of the extract (225, 450, 900 mg/mL) for 5-60 min in vitro and ex vivo. Then, by using the eosin exclusion assay, the viability of protoscoleces was studied. RESULTS: R. ribes extract had a potent protoscolicidal activity in vitro ; at 450 and 900 mg/ml, it killed 56.3 and 100% of protoscoleces, respectively, after 10 min of exposure. In ex vivo assay, the extract needed more time to kill the protoscoleces than the in vitro; so that at the concentration of 900 mg/mL, all protoscoleces were killed after 15 minutes. CONCLUSION: The obtained results exhibited the potent protoscolicidal effects of R. ribes extract, particularly at the concentration of 900 mg/ml, which completely killed the parasite after <15 min of exposure. However, more supplementary studies are required to verify these findings by assessing animal models and clinical subjects.

The economic evaluation of screening for colorectal cancer: Case of Iran.

BACKGROUND: Given increasing rates of colorectal cancer (CRC) in countries with intermediate incidence rates, the decision to implement population-based screening must consider the trade-off between high costs and a relatively low yield. We estimated the incremental cost-effectiveness ratio of 10 strategies for colorectal cancer screening, as well as no screening, incorporating quality of life, noncompliance, and data on the costs and benefits of chemotherapy in Iran. METHODS: We used a Markov model to measure the costs and quality-adjusted life expectancy of 50-year-old average-risk Iranian without screening and with screening by each test. In this study, we populated the model with data from the ministry of health and published literature. We considered costs from the perspective of a health insurance organization, with inflation to the 2011 Iranian Rial converted to US dollars. We focused on three tests of the 10 strategies considered, currently being used for population screening in some Iranian provinces (Mazandaran Kerman, Golestan, Ardabil, and Tehran): low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. RESULTS: These strategies reduced the incidence of colorectal cancer by 39%, 60%, and 76% and mortality by 50%, 69%, and 78%, respectively, compared with no screening. These strategies generated ICER (incremental cost-effectiveness ratios) of $9067, $654, and $8700 per QALY (quality-adjusted life year), respectively. Sensitivity analyses were performed to evaluate the influence of various parameters on the cost-effectiveness of screening. The results were robust to probabilistic sensitivity analysis. Colonoscopy every 10 years yielded the greatest net health benefit. CONCLUSIONS: Screening for colorectal cancer is cost-effective over conventional levels of WTP (Willingness to Pay). Annual high-sensitivity fecal occult blood testing, such as a fecal immunochemical test, or colonoscopy every 10 years offer the best value for the money in Iran.