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Introduction: Descending necrotizing mediastinitis (DNM) is a type of acute mediastinitis that is rarely reported but is regarded as a fatal disease despite improvements in technological methods and antibiotic therapies. We aimed to determine the demographic, clinical, and paraclinical features of patients diagnosed with acute DNM. Methods: In this retrospective study, patients' hospital records with a diagnosis of DNM admitted to the Namazi hospital in southern Iran during 18 years (2002–2019) were reviewed. Demographic and clinical features were recorded and subsequently analyzed via SPSS 22. Results: Out of 67 mediastinitis patients, 25 (37.3%) were diagnosed as DNM with an average age of 37.2 ± 16.7 years, and 68% were male. Regarding etiology, 52.0% were due to neck infection. Based on the technique of surgery, 52% of the patients underwent the combined method, which was mostly among type I and IIA DNM, while thoracotomy was mostly performed on type IIB DNM (P = 0.08). Based on the incision, type IIA and IIB had the highest frequency of thoracotomy and cervicothoracic incisions (P = 0.02 and 0.002). Puss discharge was significantly lower in type I DNM (P = 0.01). Based on the presenting symptoms of our patients, the majority (72.0%) had a chief complaint of neck pain, followed by chills and fever (48%). There were no reports of mortality during our short-term follow-up. Conclusion: We report one of the largest retrospective studies of DNM patients in our referral center, with a high prevalence of the disease among younger populations, especially under 40 years. The method of treatment should be chosen based on the extent of infection and can be limited to neck exploration in upper mediastinal infections, though thoracic or combined approach in more broad infections. [ABSTRACT FROM AUTHOR]

Here, we report six cases of spontaneous pneumothorax and pneumomediastinitis in patients with COVID‐19 in Iran, which were treated with different drugs such as hydroxychloroquine, sofosbuvir, atazanavir, and remdesivir as antiviral agents. Despite the differences in the type of drugs, pneumothorax occurred in all patients. [ABSTRACT FROM AUTHOR]

Background: Nosocomial infections are amongst important complications of cardiac surgical operations. The principal types of these infections appear as surgical site or respiratory infections. The rate of surgical site infections after cardiac surgery has been reported between 1 and 9 percent and the rate of respiratory infections has been up to twice this range. Various studies have attempted to make use of methods to prevent post-operative infections in addition to routine measures of preparation before surgery. Topical application of bacitracin or gentamicin ointment, intranasal mupirocin ointment, oral rinse and intranasal application of chlorhexidine solution are among these methods. The current study aimed to investigate the impact of mouth and nose disinfection with chlorhexidine solution on reduction of surgical site as well as respiratory infections after cardiac surgical operations. Methods: This study was conducted in the cardiac surgery ward, Sina Hospital, Isfahan from 1388 to 1389 as a randomized clinical trial. Patients undergoing open heart surgery entered the study. Patients were randomly assigned to two groups, whereby in one group preparation for operating room was implemented by routine methods and in the other group, mouth and nose disinfection with 0.2% chlorhexidine solution was performed every 6 hours from one day before to one day after surgery, in addition to routine hospital measures. Each patient was followed for signs of infection up to one month after surgery. Finding: From 180 patients were recruited too this study, Chlorhexidine solution was used in 88 patients and 92 other patients who comprised the control group,. The age of patients ranged from 43 to 77 years. Mean age was 61.8 years in case group and 61.5 years in control group. Total number of infections in case (intervention) group was 6 (7%) including 2 surgical site infections and 4 respiratory infections. A total of 13 patients (14%) in the control group were diagnosed with infections including 7 surgical site and 6 respiratory infections. There was no statistical difference I using chlorhexidine (P=0.232). In the case group 4 infections (66%) occurred in patients suffering from underlying diseases specially diabetes and 9 infections (69%) in the control group occurred in patients with underlying diseases. 1 patient in the control group died from acute heart failure during a second hospitalization, who also had fever and wound infection. Conclusion: Despite lower number of infections in the case (intervention) group, there was no significant difference. Some studies have attained similar results not considering nasal S. aureus carrier state. But some studies on S. aureus carrier patients have found meaningful reductions in postsurgical. [ABSTRACT FROM AUTHOR]

Background: Acute Necrotizing Mediastinitis (ANM) is a lethal disease that without antibiotic therapy and surgical Intervention has a mortality rate about 40% in best medical centers. With development of imaging technology (spiral CT- Scan) and shortening in time of diagnosis and surgery, the outcome and prognosis of the patients are improved. The surgical modalities are trans- cervical and trans- thoracic approaches. Case series: We present a series of four patients with acute necrotizing mediastinitis that admitted to thoracic surgery ward in vali-e-asr Hospital in Tehran, Iran, during years 2009 and 2010. A 31years old woman and three male patients with ages 21, 25 and 63 years. Odontogenic infection was the cause in two cases while pharyngeal perforation and cervical esophageal perforation were the causes of acute necrotizing mediastinitis the others. Results: Mean±SD of hospitalization time was 24±6 days. Infection of cervical space (periviceral spaces) and the superior mediastinum were found in all patients while extension of infection below the carina was found in two of them. All patients were operated by trans- cervical approach. One patient was operated by trans- thoracic approach. All patients were discharged with good general condition. Conclusion: Early usage of spiral CT- scan for diagnosis of acute necrotizing mediastinitis and early drainage with trans- cervical approach could be life saving in acute necrotizing mediastinitis patients with good results. [ABSTRACT FROM AUTHOR]