Is Intensive Blood Pressure Control Indicated in Older Patients with Hypertension?

PURPOSE OF REVIEW: This review aims to evaluate intensive blood pressure control in older adults, assessing its necessity, effectiveness, benefits and risks including cardiovascular outcomes, adverse events, quality of life, and overall mortality. RECENT FINDINGS: Recent studies have supported that intensive antihypertensive treatment lowers the rates of cardiovascular events compared to standard treatment in older patients with hypertension, and it may also reduce the risk of cognitive decline. Intensive blood pressure lowering strategies are associated with reduced risk of cardiovascular morbidity and mortality as well as all-cause mortality, without compromising quality of life or functional status, and are relatively well tolerated in this patient population. Evidence suggests that maintaining systolic blood pressure below 130 mm Hg can yield cardiovascular and cognitive benefits in older patients with hypertension, particularly among those at risk of myocardial infarction or stroke. However, clinicians should vigilantly monitor for adverse events and engage in shared decision-making when pursuing intensive blood pressure goals tailored to individual risks and benefits.

Does Adenotonsillectomy alter Symptoms of Attention Deficit Hyperactivity Disorder in Children?

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) has the highest prevalence among psychiatric disorders in children. The present study investigated the effect of adenotonsillectomy on the symptoms of ADHD in a 6-month follow-up. MATERIALS AND METHODS: This cross-sectional study was performed on 100 patients referred for respiratory problems during sleep due to adenotonsillar hypertrophy (ATH). The patients' parents were asked to complete the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition checklist as a standard benchmark for ADHD before, 2 weeks, and 6 months after the surgery. The data were analyzed by SPSS software (version 20) through paired t-tests and McNemar's test. RESULTS: The age averages of male and female children were 7.15 and 8.4 years, respectively. The frequency of ADHD in the studied population was 30%, which is much higher than the prevalence of this disorder in the normal population. In the second week after the surgery, the mean score of ADHD decreased from 4.97±2.97 (attention deficit [AD]) and 6.77±1.61 (hyperactivity disorder [HD]) before the surgery to 3.86±2.25 (AD) and 4.28±2.02 (HD) 2 weeks after the surgery (P=0.001). After a 6-month follow-up, these figures further decreased (AD=2.34±2.32; HD=1.97±2.44; P<0.001). CONCLUSION: Adenotonsillectomy had a significant effect on the improvement of ADHD symptoms. There is a necessity for checking patients with ADHD for ATH, especially in case of sleep disorders, sleep apnea, snoring, or mouth breathing.

Opium Use and Head and Neck Cancers: A Matched Case-Control Study in Iran.

BACKGROUND: Head and Neck (H and N) cancers include malignant tumors of the nasal cavity, pharynx, paranasal sinuses, oral cavity, larynx and salivary glands. Opium use might be related to these cancers. The aim of this study was to investigate the relation between Opium and its Derivatives (O and D) use and the incidence of H and N cancers. METHODS: In this case-control study conducted in Kerman, 140 patients with HandN cancers and 280 healthy controls (matched for age, gender, and place of residence) were included. Information about their use of O and D, cigarette smoking, alcohol and diet were collected using a structured questionnaire. Conditional logistic regression was used to investigate the relation between variables. RESULTS: The use of opioids was associated with an increased risk of H and N cancers (Adjusted OR: 8.13; CI: 4.08-16.2). A significant dose-response relation between O and D use was observed, with high use Adjusted OR=8.91; 95% CI: 4.03-19.65 and low use Adjusted OR=6.52; 95% CI: 3.18- 13.36. This dose-response association was stronger in patients with laryngeal cancer and opioids use, with high use Adjusted OR = 11.17; 95% CI=4.48-28.09 and low use Adjusted OR = 9.46; 95% CI= 3.97- 22.52. CONCLUSION: The results show that opium use can be considered as an important risk factor for H and N cancers. Also in Iran, opium seems to play a more important role than cigarette smoking.

C-590T Promoter Polymorphism of the Interleukin (IL)-4 Gene Is Associated with an Increased usceptibility to Nasal Polyposis.

BACKGROUND: Recent studies have shown interleukin 4 (IL-4) and 5 lipoxygenase (5-LO) to play an important role in development of nasal polyposis. Investigation into the genetic factors associated with allergic and non-allergic nasal polyposis has been examined for more than fifteen years. Despite these efforts, the genetic factors underlying the development of nasal polyposis have yet to be clearly understood. The current study examined the relationship between C-590T promoter polymorphisms of the IL-4 gene and the presence of nasal polyps. Additionally, we examined the levels of 5-LO expression in nasal polyp tissue and its association with the IL-4 promoter gene polymorphisms. METHODS: A total of 320 subjects were enrolled in the study, of which 256 were healthy controls and 64 were patients with nasal polyps. The Real-Time PCR HRM-based method was used to determine the genotypes of IL-4 C-590T. The expression of 5-LO within the 64 samples of nasal polyp tissue was determined by immunohistochemical staining to examine the association of 5-LO with the IL-4 C-590T genotype. RESULTS: Genetic analysis showed a significant difference in the frequencies of the IL-4 polymorphisms at C-590T in patients with nasal polyps as compared with controls (p<0.001). No significant difference was seen in the expression of 5-LO among genotypes in patients with nasal polyps (p=0.139). CONCLUSION: The results suggest that the inheritance of TT and CT genotypes at the IL-4 C-590T promoter gene is associated with nasal polyps however, there is no association between the expression of 5-LO in nasal polyp tissues and IL-4 C-590T genotypes in patients with nasal polyps.

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

BACKGROUND: Metalloproteinase-9 exists in the basement membrane of normal tissues and is a major factor in 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). CONCLUSION: According to the possible role of opioid drugs in cancer and its prognosis both directly and through their impact on serum levels of metalloproteinase, further studies are suggested.

Asthma and Allergic Rhinitis Correlation in Palm Tree Workers of Jahrom City in 2016.

INTRODUCTION: Allergic rhinitis and asthma can be related to occupation. The present study aimed to investigate the correlation between asthma or allergic rhinitis and employment in the palm tree gardens of Jahrom, Iran. MATERIALS AND METHODS: This was a cross-sectional study including 50 palm tree garden workers and a control group of 50 office employees. Data collection included demographics, as well as standard International Study of Asthma and Allergies in Childhood (ISAAC) and A New Symptom-Based Questionnaire for Predicting the Presence of Asthma (ASQ) questionnaires. Data were analyzed using SPSS22. Descriptive statistics, chi-square test, t-test, and logistics regression were used to analyze data. RESULTS: The correlation between asthma and occupation was significant ( P=0.046); and asthma prevalence was higher in palm tree garden workers. However, no relationship was observed between age, duration of employment, smoking cigarettes, hookah, or opium addiction with asthma. Furthermore, in this study, no significant relation was observed between the prevalence of asthma and contact with dust, contact with pets' skin and hair, family history of asthma, or the use of perfume and air freshener. The symptoms of allergic rhinitis (including sneezing, runny nose, and blocked nose) were significantly greater in palm tree garden workers (P=0.038). These symptoms in both workers and office employees were higher in spring. CONCLUSION: In our study, allergic rhinitis and asthma were more common in palm tree garden workers than in the general population. According to our study, people working in this occupation should take necessary precautions.

Effects of Tonsil size on Pulmonary Function test Results after Tonsillectomy in Children.

INTRODUCTION: Adenotonsillar hypertrophy is a typical cause of surgery in children. Evaluation and identification of patients as potential candidates tonsillectomy is a primary concern for otolaryngologists. This study focuses on the results of pulmonary function tests (PFTs) after tonsillectomy in children. MATERIALS AND METHODS: This cross-sectional study examined 50 patients suffering from tonsillar hypertrophy in 2013. Full details and results of otolaryngology examinations were recorded. Moreover, patients were examined with respect to forced inspiratory flow at 50% of vital capacity (FIF50%), forced expiratory flow at 50% of vital capacity (FEF50%), forced expiratory volume in 1 second (FEV1)/peak expiratory flow rate (PEFR), and FEV1/forced expired volume in 0.5 seconds (FEV0.5) before and after surgery using spirometry. All data were analyzed using SPSS Software (version 19), and central descriptive measures, and data were compared by performing T-test and Chi-square tests. RESULTS: According to tonsil size, patients were distributed as follows: 18 patients (36%) with +1 tonsil size, 18 patients (36%) with +2 tonsil size, and seven patients (14%) with +3 tonsil size, and seven patients (14%) with +4 tonsil size. Thirty-three (66%) and 17 patients (34%) were female and male, respectively, with a mean of age of 9.7[Formula: see text]2.97 years (range, 7-18 years). Seventy-eight percent of patients were aged 10 years or less. Moreover, 25 patients (50%), 17 patients (34%), and eight patients (16%), respectively, reported obstructive symptoms, recurrent tonsillitis, and both symptoms. In patients with +3 and +4 tonsil size, spirometric parameters indicated relief of symptoms of obstruction. Only in patients with +4 tonsil size were the changes statistically significant. CONCLUSION: Tonsillectomy can relieve obstructive symptoms in patients with tonsils larger than +3 to a great extent. Additionally, spirometry can identify patients with +3 and +4 tonsils who do not have clinical signs of an obstructive upper airway.

Orbital Extension of a Giant Ethmoidal Sinus Osteoma in a 30-Year-old Female.

INTRODUCTION: Osteoma is a benign tumor rarely found in the paranasal sinuses. CASE REPORT: A 30-year-old female presented with an 8-month history of proptosis of the right eye that was progressing slowly. She was diagnosed with ethmoid osteoma and managed with collaborative surgery at the ophthalmology and otolaryngology departments. After surgery, the patient suffered visual loss that was managed medically. The surgical steps and protocol used for safe removal are discussed in the report. CONCLUSION: Management of a giaint osteoma extending to orbital tissue needs meticulous dissection through open approach and collaborative surgery by otolaryngologist and ophthalmologist.

Malignant melanoma metastatic to the larynx: a case report.

Malignant melanoma of the larynx is a rare cancer that can appear as a primary tumor or as a metastasis from a cutaneous head and neck primary. To the best of our knowledge, only 60 cases of primary laryngeal melanoma have been reported in the world literature. Melanomas metastatic to the larynx are even more rare, as only 24 cases have been previously reported. Survival is poor, and recurrence is uncommon. We describe a new case of a malignant melanoma metastatic to the larynx, which represents the first such case in Iran.

Foreign bodies: aspirated or ingested? A report of two unusual cases.

INTRODUCTION: The diagnosis of foreign bodies in the upper aerodigestive tract is usually straightforward but sometimes it can be delayed or the location of esophageal and upper airway foreign bodies can be mistakenly interchanged. CASE REPORT: We present two interesting cases that caused diagnostic challenges which could have led to serious complications if a greater delay in diagnosis had occurred. CONCLUSION: In order to diagnose upper aerodigestive tract foreign bodies without delay, a careful history and physical examination with proper X-rays are helpful.

Interest in Rhinoplasty and Awareness about its Postoperative Complications Among Female high School Students.

INTRODUCTION: Rhinoplasty is a popular cosmetic surgical procedure. Informal statistics show that Iran has one of the highest rates of rhinoplasty in the world. However, rhinoplasty like any other surgery can have complications. MATERIALS AND METHODS: In this cross-sectional study, 320 female students were selected by multistage cluster-stratified sampling from high schools in Kerman, Iran and each completed a questionnaire. RESULTS: More than half of the students said they would like to undergo rhinoplasty. The main reasons for wanting rhinoplasty were beauty and because it is fashionable. However, more than half of the interested students did not know about the possible postoperative complications of rhinoplasty. There was no relation between interest in having rhinoplasty and parents' education, city of birth or economic status. CONCLUSION: Many teenagers are interested in having rhinoplasty in Iran. As the number of teenagers and young adults who choose to have cosmetic surgery increases, surgeons should consider their expectations, motivations and awareness of postoperative complications before surgery.