Olfactory impairment in patients with coronavirus disease 2019 self-perceived as asymptomatic.

BACKGROUND: Olfactory impairment may be present among patients with coronavirus disease 2019 self-perceived as asymptomatic. This study aimed to assess olfactory function among these individuals. METHODS: A cross-sectional study involving patients with coronavirus disease 2019 self-perceived as asymptomatic was conducted. Assessments included the subjective Malaysian Smell and Taste Questionnaire and the culturally adapted Malaysian version of the objective Sniffin' Sticks Identification smell test. RESULTS: In 81 participants (mean age of 31.59 ± 12.04 years), with mean time from diagnosis to smell test of 7.47 ± 3.79 days, subjective assessment showed that 80.2 per cent were asymptomatic (questionnaire score of 6) and 19 per cent had mild symptoms (questionnaire score of 7 and 8). The mean objective smell test score was 10.89 ± 2.11. The prevalence of olfactory impairment was 76.6 per cent among patients with coronavirus disease 2019 self-perceived as asymptomatic. There was no association between the questionnaire and the smell test scores (p = 0.25). There was a correlation between the smell test score and the duration from diagnosis to smell test (p = 0.04). CONCLUSION: The objective assessment demonstrated that coronavirus disease 2019 patients who perceived themselves as asymptomatic showed olfactory impairment.

The association between the reflux symptoms index and nasal symptoms among patients with non-allergic rhinitis.

BACKGROUND: Laryngopharyngeal reflux symptoms assessed with the reflux symptom index can overlap with non-allergic rhinitis symptoms. This study aims to explore the association between the reflux symptom index and nasal symptoms in non-allergic rhinitis patients. METHODS: A cross-sectional study was conducted on consecutive adults with non-allergic rhinitis. The reflux symptom index (score of more than 13 = laryngopharyngeal reflux) and nasal symptoms (categorised as mild (total score of 0-3), moderate (4-7) or severe (8-12)) were assessed. RESULTS: The study included 227 participants (aged 58.64 ± 12.39 years, 59.5 per cent female). The reflux symptom index scores increased with total nasal symptom scores (mild vs moderate vs severe, 8.61 ± 6.27 vs 12.94 ± 7.4 vs 16.40 ± 8.10; p < 0.01). Logistic regression indicated that laryngopharyngeal reflux is more likely in patients with severe nose block (odds ratio 5.47 (95 per cent confidence interval = 2.16-13.87); p < 0.01). CONCLUSION: Laryngopharyngeal reflux symptoms are associated with nasal symptom severity, and nasal symptoms should be primarily treated. Those with predominant nose block and laryngopharyngeal reflux symptoms are more likely to have laryngopharyngeal reflux.

Management of rhinosinusitis in adults in primary care.

Rhinosinusitis is a common health problem encountered in primary care. It is due to mucosal inflammation of the nose and paranasal sinuses. Less than 2% of the cases are associated with bacterial infections. Diagnosis is based on clinical symptoms and supported by nasal endoscopy and imaging studies. Intranasal corticosteroids and normal saline irrigation are important treatments. Antibiotics are seldom indicated.

Varicella zoster causing preseptal cellulitis - uncommon but possible.

BACKGROUND: Varicella has been known to be a harmless childhood disease. However, it has been reported that severe complications have taken place following Varicella infection, in both immunocompetent, as well as immunocompromised, individuals. Cutaneous complications of Varicella may manifest as preseptal cellulitis, albeit rarely. REPORT: We present a case of a 4-year-old boy who presented with symptoms and signs of preseptal cellulitis following Varicella infection. He was referred to the otorhinolaryngology team for a nasoendoscopy to rule out sinusitis, in view of the fear that a child presenting with a swollen red eye may be a case of true orbital cellulitis. He was treated successfully with intravenous antibiotics and surgical drainage of the preseptal collection. CONCLUSION: It is imperative for clinicians to be aware that a simple Varicella infection may lead to cutaneous complications in the pediatric age group, especially in children who are 4 years and younger. They may develop preseptal cellulitis, whose presentation might mimic that of orbital cellulitis. Empirical treatment with antibiotics would be advantageous for the patient. A nasoendoscopic examination may also be warranted in these cases to rule out sinusitis as a cause of orbital cellulitis.

The code of ethics for nurses.

Nurses are ever-increasingly confronted with complex concerns in their practice. Codes of ethics are fundamental guidance for nursing as many other professions. Although there are authentic international codes of ethics for nurses, the national code would be the additional assistance provided for clinical nurses in their complex roles in care of patients, education, research and management of some parts of health care system in the country. A national code can provide nurses with culturally-adapted guidance and help them to make ethical decisions more closely to the Iranian-Islamic background. Given the general acknowledgement of the need, the National Code of Ethics for Nurses was compiled as a joint project (2009-2011). The Code was approved by the Health Policy Council of the Ministry of Health and Medical Education and communicated to all universities, healthcare centers, hospitals and research centers early in 2011. The focus of this article is on the course of action through which the Code was compiled, amended and approved. The main concepts of the code will be also presented here. No doubt, development of the codes should be considered as an ongoing process. This is an overall responsibility to keep the codes current, updated with the new progresses of science and emerging challenges, and pertinent to the nursing practice.

Adenoid cystic carcinoma of the sinonasal tract: outcome of endonasal endoscopic surgery at five-year follow up.

OBJECTIVE: To study the outcome of endonasal endoscopic surgery for adenoid cystic carcinoma of the sinonasal tract over a five-year follow-up period. DESIGN: Retrospective analysis. METHODS: Four consecutive patients with adenoid cystic carcinoma of the sinonasal tract, who had undergone endonasal endoscopic surgery, were reviewed regarding age at diagnosis, sex, primary site, tumour-node-metastasis staging, treatment modalities, histopathological findings, duration of follow up, distant metastases and treatment outcome. RESULTS: All patients were diagnosed at an advanced stage and had post-operative adjuvant radiotherapy. Three patients underwent endoscopic endonasal resection and one endoscopic assisted craniofacial resection. The most common primary site was the ethmoid sinus (three patients). Three patients had no evidence of recurrence. One patient who had undergone partial clearance via endoscopic endonasal resection developed cervical node metastases a year after treatment; this patient also developed distant metastases. CONCLUSION: Adenoid cystic carcinoma is difficult to treat. Sinonasal tract tumours can be resected via endoscopic endonasal resection or endoscopic assisted craniofacial resection, but prolonged follow up is advisable. Radiotherapy is an important adjuvant treatment.

Medical ethics in the Islamic Republic of Iran.

Recent trends in biomedical technologies have been associated with increasing discussion about ethical aspects of the new knowledge in many societies, including the Islamic Republic of Iran. Medical ethics has a long history in our country, and great Iranian physicians laid special emphasis on teaching and practising traditional ethics. In recent decades, great strides have been made in biomedical ethics, especially in the fields of education, research and legislation. We present a brief history of medical ethics in our country. Current activities and topics of future plans are also discussed.

Medical ethics in the Islamic Republic of Iran

Recent trends in biomedical technologies have been associated with increasing discussion about ethical aspects of the new knowledge in many societies, including the Islamic Republic of Iran. Medical ethics has a long history in our country, and great Iranian physicians laid special emphasis on teaching and practising traditional ethics. In recent decades, great strides have been made in biomedical ethics, especially in the fields of education, research and legislation. We present a brief history of medical ethics in our country. Current activities and topics of future plans are also discussed

Rewarded gift for living renal donors.

Although the waiting list for renal transplantation is growing from year to year, the participation of unrelated living donors in kidney transplantation remains controversial. Patients want to be transplanted as soon as possible, not years later. Nevertheless, cadaveric organ donation has not been able to meet the requirements for all patients in need. With a continuous shortage of organs, the use of living unrelated donors is likely to decrease patient suffering and waiting list mortality. The excellent short- and long-term results of living unrelated transplantation have stimulated physicians toward a wider use of this donor pool. Therefore, transplants from living donors, whether related or unrelated, may be proposed as a therapeutic option for end-stage renal disease patients. In this article we explain the necessity of compensating altruistic living donors as an incentive. It is concluded that living unrelated renal transplantation programs should be legalized and controlled by international and national transplant societies to prevent illegal trade and to provide better care for donors.

Ethical and legal aspects of organ transplantation in Iran.

The great advances in the technology of organ preservation, immunosuppression, and surgical procedures have resulted in success in saving lives. However, these advantages have raised major ethical, policy, and religious problems in organ transplantation. Extensive efforts have been made to address these problems in different communities. In this study the transplantation program and implementation of legislation in Iran is reviewed. The history of the organ transplantation "Act of Organ Transplantation and Brain Death," which allows controlled living unrelated donors access to renal transplantation, is discussed as the main subject.

Brain death: recent ethical and religious considerations in Iran.

The Islamic Republic of Iran has a long history of medicine. The principles derived from core Islamic teachings provide a comprehensive moral, ethical, and legal framework for the practice of medicine. The issue of brain death has significant impact on the procurement of organs from cadavers. It is a major subject of debate and interest to bioscientists, legal experts, religious scholars, and the general public. Laws related to the ethical and legal aspects of cadaver organ donation from the brain dead have not been defined in many Muslim countries. This report presents recent advances in Iranian law with regard to the ethics of organ transplantation and the definition of brain death.

Islamic perspective on human cloning and stem cell research.

Recent advances in the field of cloning and stem cell research have introduced new hope for treatment of serious diseases. But this promise has been accompanied by enormous questions. Currently, cloning is a matter of public discussion. It is rare that a field of science causes debate and challenge not only among scientists but also among ethicists, religious scholars, governments, and politicians. One important concern is religious arguments. Various religions have different attitudes toward the morality of these subjects; even within a particular religious tradition there is a diversity of opinions. The following article briefly reviews Islamic perspectives about reproductive/therapeutic cloning and stem cell research. The majority of Muslim jurists distinguish between reproductive and therapeutic cloning. The moral status of the human embryo, the most sensitive and disputed point in this debate, is also discussed according to Holy Quran teachings.

Metabolic and clinical effects of Ramadan fasting in patients with type II diabetes.

OBJECTIVE: To evaluate the effects of fasting on anthropometric indices and carbohydrate and lipid metabolism in patients with type II diabetes. DESIGN: Observational non-interventional study. PLACE AND DURATION OF STUDY: : Diabetes clinic, Shariati Hospital, Tehran, Iran during Ramadan 1419 (winter 1998-99). PATIENTS AND METHODS: Fifty-seven volunteers with type II diabetes underwent anthropometric and biochemical evaluation before and on the 14th and 28th days of Ramadan. Biochemical markers were measured by standard laboratory methods and anthropometric indices by WHO criteria. Statistical analysis was done by ANOVA for repeated measurements and Friedman's two-way ANOVA using SPSSv6 software. RESULTS: Daily cholesterol intake increased in all subjects (p<0.03). Body mass index increased in women (p<0.03), but BMI and waist-hip ratio both decreased in men (p<0.01). Blood pressure, fasting blood glucose and serum fructosamine did not change during the study. Plasma insulin (p<0.05), C-peptide (p<0.01) and insulin resistance (p<0.01) decreased only in men. Total and LDL cholesterol increased significantly in all subjects during the study. CONCLUSION: Ramadan fasting does not alter carbohydrate metabolism or tissue insulin sensitivity in patients with type II diabetes given appropriate dietary education and rescheduling of oral hypoglycaemic medication. Lipid profile is unfavourably altered due to changes in both diet and biochemical response to starvation.

The effect of Ramadan fasting on fasting serum glucose in healthy adults.

The effect of Ramadan fasting on fasting serum glucose (FPG) is still a matter of controversy. One hundred and fifteen healthy volunteers fasted for > or = 25 days during Ramadan. Blood samples were taken 1 week before Ramadan and on the 14th and 28th day of Ramadan. Serum glucose was determined by the glucose oxidase method. FPG decreased from 88.4 + 9.0 mg/dl to 62.9 +/- 7.7 mg/dl (p < 0.001). Men and women both experienced a significant drop in FPG. Calorie intake decreased in all groups (p < 0.001) and was positively correlated with decreasing FPG. FPG decreases with Ramadan fasting and has no serious adverse effect on fasting adults.