The effect of intranasal dexmedetomidine on hemodynamic disturbances caused by laryngoscopy and endotracheal intubation.

BACKGROUND: Induced stimulation while endotracheal intubating affects hemodynamic status. The present study compares the hemodynamic changes caused by endotracheal intubating after administering two doses of intranasal Dexmedetomidine. METHODS: In an experimental (before-after) trial, 88 patients undergoing general anesthesia enrolled in the study. The Iranian Register of Clinical Trial (IRCT) code of the study was IRCT20160307026950N15 (https://en.irct.ir/trial/39269). Patients were allocated to two intervention groups and one control group by random. Intranasal Dexmedetomidine and Normal saline 0.9% were administrated 30 minutes before induction of anesthesia. (1 µg/kg Dexmedetomidine in group 1, 2 µg/kg Dexmedetomidine in group 2 and 1 mg Normal saline 0.9% in group 3). Vital signs and hemodynamic parameters were measured and recorded in minutes 1, 3, 5, and 10th after induction. Data analysis was done by ANOVA and Chi-square tests. RESULTS: Heart rate, systolic and diastolic blood pressure, and mean arterial pressure were reduced in patients receiving dexmedetomidine (P<0.05), but there were no significant changes in the control group. In arterial oxygenation (P>0.05), there was no significant difference between the three groups in the arterial blood oxygen amount. CONCLUSION: Premedication of intranasal dexmedetomidine influences the hemodynamic changes due to anesthesia induction. The dose of 2 µg/kg is better than one µg/kg in improving the hemodynamic state following intubation.

Delayed diagnosis of oral cancer in Iran: challenge for prevention.

PURPOSE: The aim of this study was to investigate the diagnostic delay and its determinants among oral cancer patients in Tehran, Iran. MATERIALS AND METHODS: This study was conducted between September 2004 and September 2006 in three university hospitals, and included 100 consecutive patients with primary oral squamous cell carcinoma (international classification of disease, ICD-10 sites C01 to C06). Data were obtained through questionnaire interviews and medical records of the patients were reviewed to obtain information on the date of diagnosis, primary tumour site and the stage of the tumour at the time of diagnosis. Statistical analysis was performed by t test, ANOVA and logistic regression. RESULTS: The mean diagnostic delay was 7.2 months (SD 7.5, range 1 to 36 and median 4). The most important determinants of longer diagnostic delay were being single (OR = 4.8; 95% CI = 1.5 to 14.8; P < 0.05) and being at advanced tumour stages (OR = 5.3; 95% CI = 1.8 to 15.6; P < 0.01). The mean patient and professional delays were 5.3 months (SD 6.1 and median 2) and 2.1 months (SD 2.1 and median 1), respectively. Patients at advanced tumour stages were more likely to have longer patient and professional delays than those at early stages (OR = 5.6; 95% CI = 1.8 to 17.3 and OR = 3.4; 95% CI = 1.2 to 9.4, respectively; P < 0.05). Living alone was also a determinant of longer patient and professional delays (OR = 7.1; 95% CI = 2.0 to 24.7, OR = 3.5; 95% CI = 1.2 to 10.3, respectively; P < 0.05). CONCLUSIONS: Developing preventive programmes that focus on the enhancement of public and professional awareness about oral cancer is essential to promote earlier diagnosis in Iran.

Survival after lip cancer diagnosis.

The purpose of this study was to analyze the 5-year survival rates of 82 patients with lip cancer attending 5 university hospitals during 1999-2003 in Tehran, Iran. We used information from patient records, telephone calls, and death register files of the Iran Ministry of Health to ascertain the patients' vital status. Associations between survival and the variables of sex, age, stage of the tumor at the time of diagnosis, treatment modality, and tumor histopathologic type were analyzed with Kaplan-Meier, log-rank, and Cox regression methods. Of all patients, 70 (85%) were men, with a median age of 62 years (mean, 58.6 years [SD, 15 years]; range, 27-85 years) at the time of diagnosis. The median follow-up time of the patients was 57 months (mean, 56.4 months [SD, 28 months]; range, 0-112 months). The 1- to 5-year overall survival rate was 91% to 62%. The tumor stage at the time of diagnosis and the treatment modality were associated with survival (P < 0.05) in both univariate and multivariable analyses. Patients who underwent surgery and had lower stage tumors at the time of diagnosis showed higher survival rates. No differences in patient survival were found regarding sex, age, and histopathologic type of tumors. These findings indicate that although lip tumors are curable, early detection, diagnosis, and treatment lead to even higher rates of survival. Importance of the early detection of lip cancer should be emphasized in all health care and cancer prevention campaigns directed to the public and professionals.

Survival after diagnosis of cancer of the oral cavity.

In this retrospective study we analysed the survival in 470 patients with oral cancer. Patients who attended five university hospitals in Tehran, Iran, during the period 1996-2002 were included. Data were obtained from a combination of sources including patients' records, telephone calls, and deaths registered by the Ministry of Health. Survival curves were generated using Kaplan-Maier curves. Univariate and multivariate analyses of the relations between survival and age, sex, site of primary tumour, stage, and histopathological type were made using the log-rank test and Cox's regression analysis. Sex and age were not associated with survival. Treatment and stage of tumour at the time of diagnosis were related to survival. The overall survival rates were higher in patients with stages I or II cancer than those in stages III (OR=2.8, 95% CI=1.8 to 4.4) or IV (OR=4.6, 95% CI=3.1 to 6.8) at the time of diagnosis. Patients treated with radiotherapy had lower survival than those who had been operated on and had radiotherapy or operation alone (OR=2.8, 95% CI=1.7 to 4.5). There was no difference in survival depending on the histological type of tumour. To achieve higher survival, early detection and diagnosis of oral cancers should be emphasised in oral health programmes to improve public awareness and preventive activities among dentists in Iran.

Malignant oral tumors in iran: ten-year analysis on patient and tumor characteristics of 1042 patients in Tehran.

This study analyzed characteristics of oral cancer patients from Tehran, Iran, and their tumors. Data came from the patient records of 30 major hospitals in Tehran. Patients (n = 1042), diagnosed with invasive oral cancer in 1993-2003, were classified by primary tumor site according to ICD-10 (C00-C10). Data were analyzed separately for lip, oral cavity and salivary gland tumors. Statistical evaluation included chi and t-test. Of all cases, 59% were male. Age for all cases ranged from 6-103 years, mean age was 58.8 years (SD 16; median 62); 89% were older than 40. Tumor site breakdown was 65% oral cavity, 21% major salivary glands and 14% lip. A clear gender difference (P < 0.001) appeared regarding the primary tumor sites: women dominated in oral cavity cancers and men in lip cancers. The most common cancer site was the tongue (32%), accounting for 50% of the oral cavity cancers. Histologically, 88% of all oral cavity and lip cancers were squamous cell carcinomas, 10% of those were in age /= age 65. At the time of diagnosis, 59% of oral cavity cancers and 29% of lip cancers were at stage III or IV (P < 0.001). The results emphasize an urgent need for a national program focusing on early detection of oral cancers, including educational information addressed to oral health professionals.