A 20 Years Retrospective Descriptive Study of Human Cystic Echinococcosis and the Role of Albendazole Concurrent with Surgical Treatment: 2001-2021.

Background: Hydatid cyst, caused by the larvae of Echinococcus granulosus, is one of the most severe cestode infections occurring in Iran. The liver is the most commonly involved organ. The present study was carried out to review the demographic of 20 years surgically treated hydatic cysts. Methods: Ninety-eight patients were enrolled in the study. Demographic features, time of surgery, cyst size, and albendazole usage have been reviewed from the medical records of patients in Loghman Hakim Hospital, Tehran, Iran, from 2001 to 2021. Statistical analysis was performed to find any correlation between the uses of concurrent albendazole with surgical procedure. Results: Of 98 patients with hydatid cyst, 57 (58.2%) were female. The mean age of patients was 39.4 ±18.7 yrs, and the mean surgery time was 217.5 ± 81.4 minutes. Regarding the infection site, the liver (60.2%) and lungs (22.4%) were the most affected organs, respectively. 56.1% of patients had one cyst, and 42.9 % had two or more cysts. 20.4% of them had taken albendazole before surgery, but 86.7 % took it after the operation. No recurrent cysts were seen among 91.8% of them, but 8.2% mentioned suffering from a recurrent cyst. 85.7% of those recurrent cases did not receive albendazole before surgery, and 75% of recurrent cases after surgery did not take albendazole (P<0.05). Conclusion: Administration of albendazole before and after the operation was significantly related to reduced recurrence, bleeding, morbidity, and even the time of surgery.

Comparison of two surgical methods (Winograd and sleeve method) in the treatment of ingrown toenail.

BACKGROUND: Ingrowing toenail is one of the most common nail complaints. Although many surgical treatments are described for complicated nails, frequent recurrence of pain and postoperative disability necessitate finding an appropriate treatment. METHODS: In a clinical trial, we compared the Winograd and sleeve (gutter) surgical methods to find a simple, painless, and practical alternative. RESULTS: Of 100 patients (mean 27.8) included in the study, 50 underwent Winograd surgery and the rest the sleeve method. Postoperative infection occurred in four (8%) patients in the sleeve and three (6%) in the Winograd group. The condition reoccurred in five (10%) patients who underwent sleeve surgery and six (12%) who underwent Winograd. Recurrence rate was higher in female patients, although the difference was not statistically significant. Mean surgery duration for Winograd and sleeve methods was 15.7 minutes and 9.4 minutes, respectively, and postoperative work day loss was 2.0 weeks and 1.1 weeks, respectively. CONCLUSION: The sleeve method seems to be more practical and appropriate for patients planning to go back to work sooner and better fulfills the main characteristics for the primary treatment of choice. The authors have indicated no significant interest with commercial supporters.

Demography and Mortality of Body Packers; an Extended Experience from a Referral Center.

BACKGROUND: The incidence of smuggling and illegal transport of substances by internal concealment, also known as body packing, is increasing. The clinical approach to body packers has changed significantly over the past two decades. In addition, the mortality of body packers is an important issue in patient management. The purpose of the current study is to determine the statistics and mortality related to body packing. METHODS: In this cross-sectional study, all body packer patients who referred to Loghman Hakim hospital were evaluated from 2010 to 2017. Demographic characteristics, findings of clinical imaging, treatment, and outcome of the patients were recorded. The data were analyzed using SPSS version 21. RESULTS: A total of 303 patients were enrolled in the study after the diagnosis of body packing by abdominal CT scanning without contrast. Conservative treatment including whole bowel irrigation (WBI) accompanied by close monitoring was done for 78% (n = 236) of patients; moreover, 26 patients (8.5%) underwent surgery after WBI, and 41 patients (13.5%) underwent surgery without bowel irrigation. Mortality was observed in eight patients (2.7%) five of whom (62.5%) died before surgery and had the clinical manifestation of crystal (methamphetamine) and cannabis toxicity. Furthermore, three patients (37.5%) died due to the complications of surgery such as gastrointestinal leakage of an abdominal abscess. CONCLUSION: Conservative treatment seems to be better for the management of body packers. In addition, it is necessary to monitor patients for possible signs and symptoms of intoxication and gastrointestinal obstruction.

Non-linear feature extraction from HRV signal for mortality prediction of ICU cardiovascular patient.

Intensive care unit (ICU) patients are at risk of in-ICU morbidities and mortality, making specific systems for identifying at-risk patients a necessity for improving clinical care. This study presents a new method for predicting in-hospital mortality using heart rate variability (HRV) collected from the times of a patient's ICU stay. In this paper, a HRV time series processing based method is proposed for mortality prediction of ICU cardiovascular patients. HRV signals were obtained measuring R-R time intervals. A novel method, named return map, is then developed that reveals useful information from the HRV time series. This study also proposed several features that can be extracted from the return map, including the angle between two vectors, the area of triangles formed by successive points, shortest distance to 45° line and their various combinations. Finally, a thresholding technique is proposed to extract the risk period and to predict mortality. The data used to evaluate the proposed algorithm obtained from 80 cardiovascular ICU patients, from the first 48 h of the first ICU stay of 40 males and 40 females. This study showed that the angle feature has on average a sensitivity of 87.5% (with 12 false alarms), the area feature has on average a sensitivity of 89.58% (with 10 false alarms), the shortest distance feature has on average a sensitivity of 85.42% (with 14 false alarms) and, finally, the combined feature has on average a sensitivity of 92.71% (with seven false alarms). The results showed that the last half an hour before the patient's death is very informative for diagnosing the patient's condition and to save his/her life. These results confirm that it is possible to predict mortality based on the features introduced in this paper, relying on the variations of the HRV dynamic characteristics.

New algorithm of mortality risk prediction for cardiovascular patients admitted in intensive care unit.

OBJECTIVE: Recognizing and managing of admitted patients in intensive care unit (ICU) with high risk of mortality is important for maximizing the patient's outcomes and minimizing the costs. This study is based on linear and nonlinear analysis of heart rate variability (HRV) to design a classifier for mortality prediction of cardio vascular patients admitted to ICU. METHODS: In this study we evaluated 90 cardiovascular ICU patients (45 males and 45 females). Linear and nonlinear features of HRV include SDNN, NN50, low frequency (LF), high frequency (HF), correlation dimension, approximate entropy; detrended fluctuation analysis (DFA) and Poincaré plot were analyzed. Paired sample t-test was used for statistical comparison. Finally, we fed these features to the Multi-Layer Perceptron (MLP) and Support Vector Machines (SVMs) to find a robust classification method to classify the patients with low risk and high risk of death. RESULTS: Almost all HRV features measuring heart rate complexity were significantly decreased in the episode of half-hour before death. The results generated based on SVM and MLP classifiers show that SVM classifier is enable to distinguish high and low risk episodes with the total classification sensitivity, specificity, positive productivity and accuracy rate of 97.3%, 98.1%, 92.5% and 99.3%, respectively. CONCLUSIONS: The results of the current study suggest that nonlinear features of the HRV signals could be show nonlinear dynamics.

WITHDRAWN: Mortality risk prediction for cardiovascular patients using of artificial neural networks.

Ahead of Print article withdrawn by publisher.

The role of endoscopic autopsy in trauma cases: the first report from Iran.

BACKGROUND: The traditional autopsy is unpleasant for the family members of the dead person. The aim of this study was to assess abdominal traumas by a laparoscope and to determine the accuracy of laparoscopic examination in comparison with the traditional autopsy. METHODS: From December 2004 through August 2005, 50 fresh cadavers (<24 hours old) of blunt trauma victims were selected. They were first assessed by a laparoscope for intraperitoneal and retroperitoneal organs and then the traditional autopsy was performed as gold standard. The organs were assessed regarding the nature and intensity of damages and the results were compared with laparoscopic findings. The diagnostic accuracy of laparoscope was determined for each case with 95% confidence intervals (CIs) using Fisher's exact test. RESULTS: The accuracy for investigation of intraperitoneal and retroperitoneal organs and the overall accuracy values were significant. The accuracy of laparoscope for detecting intraperitoneal organ damage was 90% (95%CI of 81.7%to 94.8%) while for the retroperitoneal organs was 92% (95%CI of 84.7% to 96%). The overall accuracy of laparoscope was 84% (with 95%CI of 74.3% to 90.5%). CONCLUSION: The sensitivity and specificity of laparoscopic examination for intraperitoneal organs are acceptable but its accuracy for retroperitoneal organs is lower. Therefore, it seems that laparoscopic examination is an eligible substitute for the traditional autopsy.

The in-vivo effect of pyrrolidine dithiocarbamate on hepatic parenchymal microcirculation and oxygenation of the rat liver.

OBJECTIVE: Pyrrolidine dithiocarbamate has been shown to be a potent inducer of haemeoxygenase-1. This study investigated its in-vivo effects on systemic and hepatic microcirculatory perfusion. METHODS: Male Sprague-Dawley rats (n=12) were administered intravenously with pyrrolidine dithiocarbamate (10, 20 and 50 mg/kg body weight) or vehicle (0.2 ml physiological saline) served as control. Systemic and hepatic haemodynamics including arterial oxygen saturation, heart rate, mean arterial blood pressure and portal blood flow were monitored. Microcirculation in skeletal muscle and liver was measured by laser Doppler flowmetry and intravital fluorescence microscopy, whereas hepatic tissue oxyhaemoglobin and cytochrome oxidase CuA redox state, which is an indicative of extracellular and intracellular oxygenation were measured by near infrared spectroscopy. RESULTS: Pyrrolidine dithiocarbamate induced a dose-dependent increase in mean arterial blood pressure and skeletal muscle microcirculation. The hepatic parenchymal microcirculation was significantly improved and an increase in sinusoidal diameter and reduction in RBC velocity were observed. Pyrrolidine dithiocarbamate also showed beneficial effect on hepatic tissue oxygenation showed by an increase in oxyhaemoglobin and cytochrome oxidase CuA redox state as well. CONCLUSION: Pyrrolidine dithiocarbamate improves hepatic parenchymal microcirculation and tissue oxygenation, suggesting that it may be used as a potential agent in pharmacological preconditioning in the liver.