Comparison of the Efficacy of Oral Magnesium with Oral Ketorolac for Postoperative Pain Management in Anorectal Surgery: A Double-blinded Randomized Clinical Trial.

BACKGROUND: Due to the presence of postoperative pain in patients undergoing anorectal surgery, and since the pain affects the quality of life of patients, we aimed to compare the analgesic effectiveness of oral magnesium with oral ketorolac to choose the right analgesic drug for these patients. METHODS: This study was a double-blind, randomized clinical trial performed on 104 candidates undergoing anorectal surgery. Patients were randomly divided into two groups. Group 1 received oral magnesium (250 mg daily), and group 2 received oral ketorolac (10 mg daily). The medicine was given to the patient 2 hours after the operation and every 12 hours for 10 days. Pain measurements were recorded at 24-hour intervals after surgery based on the visual analog scale and numerical rating scale. RESULTS: This study found that postoperative pain was reduced in patients taking magnesium tablets, similar to the ketorolac group. A similar decreasing trend was observed in the group receiving ketorolac; however, the reduction was more pronounced in the magnesium group and was statistically significant on days 1, 3, and 5 (p < 0.001). However, insignificant differences were noted between the two groups on the seventh (p = 0.093) and tenth (p = 0.088) postoperative days. CONCLUSION: Taking magnesium tablets after surgery has a suitable analgesic effect, which is similar to oral ketorolac tablets from the fifth day onwards, but in the initial days, it is less effective than ketorolac statistically.

Printability and microstructure of directed energy deposited SS316l-IN718 multi-material: numerical modeling and experimental analysis.

In the present paper, the interrelated aspects of additive manufacturing-microstructure-property in directed energy deposition of SS316L-IN718 multi-material were studied through numerical modeling and experimental evaluation. The printability concept and solidification principles were used for this purpose. The printability analysis showed that the SS316L section is more susceptible to composition change and lack of fusion, respectively due to the high equilibrium vapor pressure of manganese and the more efficient heat loss in the initial layers. However, the IN718 section is more prone to distortion due to the formation of a larger melt pool, with a maximum thermal strain of 3.95 × 10-3 in the last layer. As the process continues, due to heat accumulation and extension of the melt pool, the cooling rate decreases and the undercooling level increases, which respectively result in coarser microstructure and more instability of solidification front in the build direction, as also observed in the experimental results. The difference is that the dendritic microstructure of the IN718 section, due to the eutectic reaction L → γ + Laves, is formed on a smaller scale compared to the cellular microstructure of the SS316L section. Also, the decrease in cooling rate caused the secondary phase fraction in each section (delta ferrite in SS316L and Laves in IN718) to increase almost linearly. However, the hardness calculation and measurement showed similarly, even though with the transition from SS316L to IN718 the hardness is significantly increased due to higher yield strength of the matrix and the presence of Laves intermetallic phase (~ 260 HV0.3), the hardness in each section decreases slightly due to the coarsening of the microstructure from the initial layer to the final.

Efficacy of Common Bile Duct Stenting on the Reduction in Gallstone Migration and Symptoms Recurrence in Patients with Biliary Pancreatitis Who Were Candidates for Delayed Cholecystectomy.

BACKGROUND: In patients with severe biliary pancreatitis, delayed cholecystectomy associated with a high risk of recurrence is recommended. The current study aimed to evaluate the effect of common bile duct (CBD) stenting on reducing gallstones migration and recurrence of symptoms in patients with pancreatitis and delayed cholecystectomy candidates. METHODS: To this purpose, the randomized, controlled clinical trial was performed on 40 patients with biliary pancreatitis who were candidates for delayed cholecystectomy. Patients were randomly divided into two groups of A and B that underwent CBD stenting after ERCP and received endoscopic treatment without stenting, respectively. A checklist recorded demographics and complications. Group A was followed up after four weeks to remove the stent and record the complications. Group B underwent MRCP to examine the migration of new gallstones as well as the complications. RESULTS: Of the 40 patients, 20 subjects (11 males and 9 females) were allocated to each group, matched for demographic variables. In the one-month follow-up, only one subject in group A manifested symptoms of gallstone migration and recurrence, while in group B, recurrence was observed in 6 patients (P = 0.037). There was no significant difference in the success rate of ERCP and the incidence of complications between the two groups. CONCLUSION: CBD stenting in patients with biliary pancreatitis and gallstone could reduce the risk of recurrence and remigration of gallstones in delayed cholecystectomy cases.

A case report of mediastinal cavernous hemangioma.

When faced with a hypervascular mediastinal tumor, mediastinal hemangioma should be taken into consideration. Although it is uncommon, considering this important diagnosis may avoid a possible extensive surgery that is not necessary.

Comparative Study of the Level of Inflammatory Factors of Erythrocyte Sedimentation Rate and Reactive Protein C in Benign and Malignant Thyroid Nodules

ABSTRACT Objective: To evaluate the level of inflammatory factors of erythrocyte sedimentation rate and reactive protein C in benign and malignant thyroid nodules. Material and Methods: In this case-control study, patients who were referred because of an enlarged thyroid gland were selected, patients who had undergone surgery for the thyroid nodule were included in the study. Erythrocyte sedimentation rate and reactive protein C were measured before surgery in patients who were candidates for thyroid surgery. The histopathological records of patients were retrospectively reviewed. Relevant cases had a cytological evaluation of thyroid nodules by fine-needle aspiration cytology (FNAC). The mean of ESR / CRP in both groups was compared using an independent t-test (p>0.05). Results: In malignant tumor type, in all patients, with Pill (PTC), analyzes in the malignant group showed a significant difference between the mean ESR / CRP in both groups with and without thyroid history. Sub-analyzes in the malignant group were significantly different between the mean ESR / CRP in both groups with and without thyroid histories (p=0.009) (40.16 ± 28.81). The association between ESR and CRP, ESR / CRP and tumor size, ESR / CRP and age in each group as well as in the whole patients were evaluated using Pearson correlation test, which showed a positive association between ESR age and ESR (p=0.024, r=0.375). In the malignant group, a negative correlation was found between the age and the CRP rate (p=0.027, r=-0.441), and in the total patients between the age and the rate (ES=0.043, r=-0.256). Conclusion: Factors such as ESR and CRP, which are considered acute phase reactors and their levels increase in acute inflammatory conditions, may not have a significant increase in chronic inflammatory conditions and malignancies.

Seroprevalence and Trend of HBV, HCV, and HIV Infections among Blood Donors of Fars Province, Iran (2006-2018).

BACKGROUND: Blood transfusion is a life-saving procedure; millions of lives are saved each year. However, blood transfusions are associated with certain risks that can lead to adverse consequences. This study aimed to survey the prevalence and trend of hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV) among blood donors of Fars province, Iran (2006-2018). METHODS: This retrospective cross-sectional study was conducted by reviewing the records of the blood transfusion organization of Fars province. A total of 1952478 blood units were screened for transfusion-transmitted infections (TTIs). Then, data were entered into SPSS software (Negare. version 25). Chi-square test was used to compare the sof TTIs among blood donors. Chisquare test for trend was used to analyze the variations in trends of TTIs during this period. Finally, p-values less than 0.05 were considered statistically significant. GraphPad Prism software was used for the depiction of the graphs. RESULTS: Among the 1952478 blood donations within the 13-years, 4479(0.229 %) of donors were HBsAg, HCV Ab, and HIV Ag-Ab positive. The seroprevalence of HBV, HCV, and HIV was 2684(0.137%), 1703(0.087 %), and 92(0.0047%), respectively. CONCLUSION: The current study showed that the overall prevalence of TTIs among blood donors was low and had a descending trend over the years of study.

Evaluate the Effect of Zinc Oxide and Silver Nanoparticles on Biofilm and icaA Gene Expression in Methicillin-Resistant Staphylococcus aureus Isolated From Burn Wound Infection.

Methicillin-resistant Staphylococcus aureus is the cause of nosocomial and community-acquired infections. This study aimed to evaluate the effect of zinc oxide and silver nanoparticles (ZnO-Ag NPs) on biofilms formation and icaA gene expression in methicillin-resistant S. aureus (MRSA). In this study, three standard strains (ATCC 43300, 25923, and 29913) and a clinical isolate are included. The minimum inhibitory concentration (MIC) of nanoparticles was determined by microdilution broth method. The antibacterial effects of ZnO-Ag NPs either alone or in combination with each other were compared with vancomycin (as the control group). The effect of MIC and sub-MIC concentrations of ZnO-Ag NPs on biofilm formation was determined by the microtiter plate method. The expression level of the icaA gene was assessed by real-time PCR LightCycler® 96 software (Version 1.1.0.1320, Roche, Germany). technique. All experiments were repeated three times. Data were analyzed using SPSS software through ANOVA and t-test. The P-value of less than .05 was considered as statistically significant. The average MICs of ZnO, Ag, and ZnO-Ag NPs compounds were 393.2, 179.8, and 60.8 µg/ml, respectively. The compound of ZnO-Ag NPs had a synergistic effect against all isolates. ZnO-Ag NPs decreased the biofilm formation rate at MIC and sub-MIC concentrations (P < .001). Sub-MIC ZnO-Ag NPs concentration significantly reduced the icaA gene expression in S. aureus strains (P < .03). The sub-MIC concentration of ZnO-Ag NPs reduced biofilm formation rate and icaA gene expression in Staphylococcus aureus strains compared with vancomycin. It can be used to cover medical devices after examining more clinical isolates to prevent bacterial colonization.

Ultrasonography in the diagnosis of lung adhesion before surgery.

Background The presence of pleural adhesions may render video-assisted thoracoscopic surgery difficult or impossible. The aim of this study was to assess the value of chest ultrasonography in the detection of pleural adhesions prior to thoracotomy. Methods Between 2013 and 2014, 42 consecutive patients undergoing thoracotomies (including video-assisted thoracicsurgery) were evaluated with chest ultrasonography. These patients underwent a preoperative ultrasonic examination of the chestwall using a 7.5-10-MHz linear ultrasound probe at 7 points along the chest wall. We measured the movement of the visceral pleuralslide. Results In the upper thoracic wall,ultrasonography demonstrated a sensitivity of 63.0%, a specificity of 66%, a negative predictive value of 77%, a positive predictive evalue of 50.0%, and an overall accuracy of 65.0%. And for the lower thoracic wall, ultrasonography demonstrated a sensitivity of 81.0%, a specificity of 59.0%,a negative predictive value of 89.0%, a positive predictivevalue of 44.0%, and an overall accuracy of 65.0%. Conclusion Chest ultrasonography is moderately accurate in detecting the presence and location of pleural adhesions. The use of preoperative chest sonographic findings to plan trocar placement and to determine the need for an open approach is valuable in helping prevent visceral injury and facilitating video-assisted thoracoscopic surgery.

Diagnosis of Primary Hydatid Cyst of Thyroid Gland: A Case Report.

A 34-year-old female patient was presented to the general surgery clinic of the hospital complaining of a growing tangible swelling in her neck. In physical examination, the patient had two palpable soft nodules in the left lobe of the thyroid which hadn't invaded the surrounding tissues. The function of thyroid gland was normal and fine needle aspiration (FNA) result reported it benign. The patient went through a left lobectomy and isthmectomy. The histopathology report concluded a nodular hyperplasia and a Hydatid cyst. After surgery, the patient was examined searching for any other organs cyst, but there were no cystic lesion in the cranial, thoracic and abdominal cavities. Accordingly, the case was a primary thyroid hydatid cyst, which is rare, even in endemic regions like Iran.

Povidone-iodine and bleomycin in the management of malignant pleural effusion.

Malignant pleural effusion is a common complication in certain malignancies. Pleurodesis is the best option most of the time. The purpose of this study was to compare the choice of belomycin with povidone-iodine, which is not only determined by the efficacy of the agent but also by its cost, accessibility, safety, ease of administration and the number of administrations to achieve a complete response. We performed a randomized clinical trial on 39 patients presenting with symptomatic malignant pleural effusion. Patients were selected and randomly assigned to undergo chemical pleurodesis with either bleomycin or povidone-iodine. Primary characteristics of patients were assessed and graded before and after treatment concerning pain, dyspnea, and chest radiographs. A complete response was obtained in 79% of belomycin group and 75% of povidone-iodine group which was not statistically significant. Patients on belomycin treatment had a significantly lower score for dyspnea in one month follow up. This was significant after controlling for age, pain score and dyspnea score after drainage, using general linear model. Due to similar effect and significant cost advantage between bleomycin and povidone-iodine, we conclude that povidone- iodine is the agent of choice when utilizing pleurodesis for control of symptomatic malignant pleural effusions.

Successful management of acute necrotizing mediastinitis with trans-cervical drainage.

Acute necrotizing mediastinitis (ANM) is a lethal disease which without antibiotic therapy and surgical intervention can lead to about 40% mortality. With the development of imaging technology, spiral computed tomography (CT) scanning and shortening of the time of diagnosis and surgery, the prognosis of these patients is excellently improved. This study describes the clinical presentation, management and outcome of 4 patients (mean age: 35 years) with ANM. All patients were operated on by a trans-cervical approach, and only one patient was operated on by a trans-thoracic one. After surgery, patients were transferred to the intensive care unit and underwent daily washing and debridement with antibiotic treatments. Odontogenic infection (2 cases), pharyngeal perforation and cervical esophageal perforation were the causes of the ANM. Infection of cervical space (perivisceral spaces) and superior Mediastinum were found in all patients, and Infection below the carina was found in two. All patients were discharged with a good, general condition after an average of 24 days. Early diagnosis of ANM with clinical presentation and on-time CT scanning, early drainage and careful post operation care are very important in the management of patients with ANM and can improve the outcome of trans-cervical drainage to an acceptable technique.