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Hemorrhagic events related to surgical field is a common disturbing complication which could worsen the outcomes of operation. This study aimed to evaluate how applying of topical tranexamic acid (TXA) could affect bleeding related to septorhinoplasty operation.This double-blind controlled trial study finally evaluated 198 candidates for septorhinoplasty repair who were randomly allocated to two groups: TXA receivers (5 mg/kg) and control group (received 5 mg/kg of saline 0.9 %). Then cumulative volume of hemorrhage was calculated by adding total volume of suctioned blood and numbers of fully blood-filled surgical gauzes (15 mL in each). Additionally postoperative 24 h volume of hemorrhage was measured by counting number of bloody surgical gauzes.Of all participants, 90 % were female. The mean age was 26 ± 7 years. Total cumulative volume of hemorrhage during surgery was significantly diminished when topical TXA was applied (p 0.0001). Additionally drier field of operation was illustrated postoperatively in patients received topical TXA (2 %28 % in TXA and saline 0.9 % receivers, respectively) (p 0.001).Using topical TXA could decrease bleeding volume and make surgical field of septorhinoplasty drier either during surgery or postoperatively.

Introduction: The COVID-19 has been associated with many problems for the general public and especially health care workers (HCWs). This study conducted to provide predictors of COVID-19 outcomes on HCWs in Rasht, Iran.Methods: In a retrospective cross-sectional study, 381 HCWs with positive RT-PCR or high-resolution lungs computed tomography for COVID-19 from February 21 to April 19, 2020 evaluated. The prevalence, demographic, clinical, laboratory, and radiological presentations and outcomes and their correlation were studied.Results: The prevalence of COVID-19 in HCWs was 5.62%, and the total mortality rate was 0.2%. The mortality rates were different between genders (P=0.002) and in general ward compared to intensive care unit (P=0.001). In the multivariate analysis, age (OR:1.12, 95%CI 1.02–1.23, P=0.014), diabetes mellitus (DM) (OR:10.73, 95%CI 1.91–60.3, P=0.007), blood group B (OR:19.2, 95%CI 1.8–199.984, P=0.013), the presence of peribronchovascular involvement (OR:1.1, 95% CI OR:1.02–1.2, P=0.019), dyspnea on admission (OR:1.05, 95%CI 1.01–1.09, P=0.013), higher neutrophil count (OR:1.09, 95%CI 1.04–1.14, PP=0.001), and longer prothrombin time (OR:1.027, 95%CI 1.008–1.046, P=0.005) increase the risk of mortality. The cutoff of 90% for oxygen saturation on admission (sensitivity=91.9%, specificity=88.9%) and 1004 for absolute lymphocyte count (sensitivity=81.8%, specificity=66.6%) were estimated as predictors of mortality.Conclusions: Old age, male sex, underlying disease of DM and hypertension, O2 saturation less than 90%, and absolute lymphocyte count less than 1004/mL in HCWs are prone to adverse outcomes such as the need for mechanical ventilation or death.

Background and Aim: Considering the effect of middle ear infection and dental caries on the children’s quality of life and ability to grow and thrive, high prevalence rates of these diseases in children, we conducted this study to evaluate the association between dental caries status and middle ear infection in preschool children in Rasht City. Materials and Methods: This study included 310 children between 3–6 years of age. Dental caries of the children were evaluated based on WHO decayed and filled primary teeth index. The children were divided into two groups; with and without caries and referred to Amiralmomenin Hospital in Rasht for clinical examination and audiometry test. Descriptive and analytical statistical tests were used for analysis at the significance level of 0.05. Results: 170 girls and 140 boys with mean age of 4.58±1.02 years participated in this study. Thirty children (9.67%) had middle ear effusion. Mean value of dft index was 2.07±2.35. Probability of middle ear infection with effusion in the children with dental caries was139% more (95%CI= 1.04- 5.50, OR = 2.39) than that in the children without dental caries which was statistically significant (P = 0.04). Other variables such as gender, age, education levels of fathers and mothers did not show any significant relationship with middle ear effusion (P >0.05). Conclusion: Middle ear effusion was significantly higher in the children with dental caries than in children without dental caries. Further prospective studies are recommended for evaluation of the effects of improved oral hygine on middle ear infection.

BACKGROUND: Caesarean section is one of the commonest gynaecological surgeries. AIM: Given the importance of pain relief after caesarean section surgery as well as contradictions in the studies conducted on intravenous lidocaine analgesic effects, this study aimed to evaluate the effect of adding lidocaine to patient-controlled analgesia (PCA) with morphine on pain intensity after caesarean section surgery. MATERIAL AND METHODS: In a double-blinded, randomised clinical trial, 80 women who were scheduled for caesarean section surgery with spinal anaesthesia at Sari Imam Khomeini Hospital in 2017 were randomly assigned into two intervention and control groups. After surgery, all patients were connected to a morphine PCA pump. The PCA solution (total volume = 100 ml) in intervention group contained 50 ml of 2% lidocaine and 30 mg (3 ml) of morphine in 47 ml normal saline. In the control group, the PCA pump contained 30 mg (3 ml) of morphine, and the rest (97 cc) was normal saline. Patients' pain intensity was assessed at 2, 4, 6, 12, 18 and 24 hours after surgery using a visual analogue scale (VAS). Additionally, their postoperative nausea and vomiting, duration of hospitalisation, duration of ileus relapse after surgery, and patients' satisfaction after surgery were evaluated. Data were analysed using SPSS version 22 software.RESULTS: The mean and standard deviation of pain intensity in all patients at the intervals of 2, 4, 6, 12, 18 and 24 hours after surgery were 5.91 ± 1.57, 4.97 ± 1.55, 3.84 ± 1.60, 3.54 ± 1.45, 2.56 ± 1.70 and 0.94 ± 1.70, respectively. Data analysis revealed that, regardless of the groups, postoperative pain intensity significantly decreased (P < 0.0001). However, there were no significant differences between the two groups in terms of mean postoperative pain intensity at any time interval (p > 0.05). Also, there was no significant difference between the two groups in terms of frequency of receiving the diclofenac suppositories after the surgery (p > 0.05). Additionally, there was no statistically significant difference between the two groups in terms of postoperative nausea and vomiting, duration of hospitalisation, duration of postoperative ileus relapse and patients' satisfaction (p > 0.05).CONCLUSION: Based on the results of this study, it seems that adding lidocaine to PCA with morphine, compared with morphine PCA alone, do not have a significant effect on reducing the pain intensity after cesarean section using spinal anaesthesia. Although, further studies with larger sample size are warranted.

There is controversy about whether hypothermia during coronary artery bypass grafting (CABG) surgery is effective in reducing postoperative cognitive deficit (POCD). The objective of this study was to determine the effect of hypothermia on POCD and to undertake a meta-regression to determine whether moderator variables mediate the relationship between hypothermia and POCD. We searched the Web of Science, PubMed database, Scopus, and the Cochrane Library database (up to June 2017), and systematically reviewed a list of retrieved articles. Our final review includes only randomized controlled trials (RCTs) that compared administration of hypothermia (34°C). Statistical analysis of the risk ratio (RR) and corresponding 95% confidence interval (95% CI) was used to report the overall effect. Mantel-Haenszel risk ratio (MH RR) and corresponding 95% CI was used to report the overall effect and meta-regression analysis. Eight RCTs were included in this study, with a total of 1,474 patients. The POCD occurred in 36.06% of all cases. A wide range of hypothermia (28-34°C) did not reduce the occurrence of POCD (RR = 0.983 (95% CI = 0.881-1.143); Z = -0.304; P = 0.761; I2 = 38%). Shorter CPB time reduced the occurrence of POCD (MH log risk ratio = -0.011 (95% CI = -0.021--0.0008); Z = -2.123; P = 0.033). Postoperative cognitive deficit is a common event among CABG patients. Contrary to deep hypothermia, mild hypothermia was significantly effective in reducing the risk of POCD. The neuroprotective effect of hypothermia on POCD may be attenuated by prolonged cardiopulmonary bypass (CPB) time.

The aim of this study was to compare chemical contents, expression of BMP-8a, and the presence of Mycoplasma and ExoS-ExoU exotoxins producing Pseudomonas aeruginosa in tympanosclerosis (TS) and atherosclerosis (AS) plaques. Thirty-six cases with TS and AS plaques (18 each) were selected and examined for chemical, immunohistochemical, and microbial analysis. SPSS ver. 21 and t test analysis were used for comparing the findings, and the level of significance was considered as p

BACKGROUND: Osteocalcin (OC) is the most common noncollagenous protein in bone matrix, which is synthesized only in bone tissue and by osteoblasts. The potential role of osteocalcin on glucose and fat metabolism has been previously reported. The aim of this study was to compare the serum OC level in pregnant women with and without gestational diabetes mellitus (GDM).METHODS: In the present case-control study, all pregnant women who were referred to a obstetrics and gynecology clinic in Sari, Iran, and met the inclusion criteria underwent an overall screening with a 75-g glucose tolerance test (GTT) at week 24 to 28 of gestation. The study was conducted between September 2018 and February 2019. Based on criteria, the pregnant women with confirmed GDM were matched with pregnant women without GDM in terms of baseline characteristics such as chronological age and BMI. The serum OC levels were also measured if vitamin D and calcium levels were normal. All data were analyzed using SPSS 21.RESULTS: The two groups with and without GDM had no significant difference in terms of age, BMI and OC level. There was no significant correlation between age and BMI with OC level in healthy pregnant women, respectively (P=0.49 and P=0.58). The correlation between BMI and age with OC level in GTT-positive pregnant women was 0.05 and -0.172, respectively, which was not significant (P=0.77 and P=0.36).CONCLUSION: According to the results of this study, there is no significant difference of serum OC levels in pregnant women with GDM compared to healthy pregnancy. Given that the levels of serum insulin or insulin resistance have not been assessed, these indices are recommended to be evaluated in future studies.

Sleep disorders during pregnancy may be linked an increase risk of adverse pregnancy outcomes. This study aimed to evaluate the relationship between sleep quality and duration in pregnancy and risk of gestational diabetes mellitus (GDM).This prospective follow-up study was performed on 240 pregnant women with a gestational age between 20 to 24 weeks, who were referred to Imam Khomeini Hospital in Sari from 2018 to 2019 for prenatal care. The sleep quality of all eligible women were evaluated with the Pittsburgh Sleep Quality Index (PSQI). During the 26 to 28 weeks of gestation, 1-hour and 2-hour oral glucose tolerance test (OGTT) was done for all women.The results showed that women with poor sleep quality had a significantly higher mean BMI and 1-hour and 2-hour OGTT results (P0.05). Compared to women with good sleep quality, women with poor sleep quality (PSQI5) had a greater risk of developing GDM (OR = 2.99, 95% CI 1.77 to 5.06). In women with sleep duration of less than 7 and more than 9 hours, the frequency of GDM was significantly higher than women with the 7-9 hour sleep duration (P0.05). Also, the frequency of GDM in women with three or more than three times of snoring in a week (63.44%) was significantly higher than women with once a week (30.61%) (P-value0.001).It seems that sleep disorders and poor sleep quality can be a risk factor in developing GDM. Therefore, sleep characteristics should be considered in pregnancy care; especially in women with higher risk of GDM.

Objectives Tonsillotomy with radiofrequency (RF) is one of the newest treatments for chronic tonsillitis, but the mechanism of RF effects and complications are still pending. The aim of this study was to evaluate the effects of RF on the histological and bacteriological characteristics of the tonsils (Case-control study). Materials and methods In fifty-two patients with chronic tonsillitis in 2017–2018, immediately after tonsillectomy, the tonsils were divided into 2sections; one sample treated with RF, and the other one considered as control, without intervention. All tonsil samples sent for histological and bacteriological study: morphometric assays made by Digitizer software, and type of bacterial colonies identified by microbiological and biochemical tests. Willcoxon and McNemar tests were used for statistical analysis and level of significance was p ≤ .05. Results Tonsil mucosal thickness (2202.98 ± 323.09 vs. 2463.94 ± 357.61 μm) and size of the tonsil nodule (28,000.42 ± 9608.75 vs. 36,692.81 ± 7040.74 μm2) were significantly lower in the RF+ group than other group (p = .001 and p = .01, respectively). There was no significant differences in thickness of the tonsil epithelium (p = .075), number of lymphoid nodules (p = .860), and the number of reticular tonsil epithelium (p = .813) between the two groups. Bacterial growth in RF- and RF+ groups had no statistically significant difference (p = .06), however, the average colony count of S. aureus in RF+ tonsils were significantly lower, and total number of bacterial colonies were significantly lower in RF+ group(1405 ± 156 vs. 2471 ± 156), (p = .001). Conclusion RF surgery has significant effects on size of the nodules, thickness of the mucous layer and bacteriological characteristics of tonsil tissue. Especially S. aureus seems to be more sensitive to RF effects.

Background: In this study, we aimed at evaluating the frequency of chemoradiotherapy‑induced mucositis (CIM, RIM) and its related risk factors in patients with the head‑and‑neck cancers (HNCs). Materials and Methods: In this cross‑sectional prospective descriptive study, we evaluated a total of 54 HNCs patients referred to the Oncology Chemoradiotherapy Department of Razi and Amiralmomenin University Hospitals of Rasht, for site and grade (WHO classification) of CIM/RIM, based on their demographic features and possible risk factors. SPSS software version 18 and statistical tests (i.e., Fisher’s exact test) were used, and the level of significance was considered as P < 0.05. Results: Finally, patients enrolled in the study were 34 men and 20 women (40–72‑year‑old), of which 43 cases (79.6%) showed signs and symptoms of CIM/RIM (mostly aged 60–69‑year‑old). Grade 2 mucositis was the most frequent type (18 cases: 33.3%) and mouth floor was the most common site of CIM/RIM (15 patients: 34.9%). Age (P = 0.023), gender (P = 0.012), and the severity of pain (P = 0.018) were significantly related to mucositis in patients with HNCs who underwent chemotherapy or radiotherapy. Conclusion: Mucositis, especially in the oral cavity, is a common complication of chemoradiotherapy in HNCs patients. Age, gender, and the severity of pain are significantly associated with the frequency of CIM/RIM. Key Words: Chemoradiotherapy, mucositis, neoplasms

Rhinoplasty has become one of the most commonly used surgeries in recent years. The visible columella scar is one of the problems of open Rhinoplasty. This study aims to compare the two common V and the inverted-V incisions in terms of their scar after open Rhinoplasty among patients. This comparative cross-sectional study was carried out on 394 open rhinoplasty patients from 2015 to 2016 in Amiralmomenin Hospital of Rasht. Half of the patients were treated with V incision and the other half with inverted-V. Subjective and objective scar assessment was done at least 12 months after surgery by using PSAS and CSAS questionnaires. Of 394 patients under study, 81% (319 cases) were female and 19% (75cases) were male. The subjects were at around the age of 28 ± 6 years and their Rhinoplasty surgery was performed 18 ± 6 months ago. In the subjective study, the final score of PSAS and its items (pain, itching, color, stiffness, thickness, irregularity) were not significantly different in the two studied incisions (p> 0.05). Also, in the objective study, the CSAS final score and its items (satisfactory, pigmentation and irregularity) didn’t show a significant difference in two under study incisions (p> 0.05). No significant difference was observed in forming scars in terms of individual and social variables and skin thickness in two groups (p> 0.05). The two v and inverted-v incisions have similar scar qualities. Besides, scar formation is not related to skin thickness and sex.

Total Thyroidectomy is common therapy in patients with thyroid malignancies, thyrotoxicosis, multinodular goiter and chronic thyroiditis. The most common complications of this procedure are hematoma, recurrent laryngeal nerve injury and hypocalcemia. modern thyroidectomy is focused on the mortality of surgery by preventing damage to adjacent structures, such as parathyroid glands and recurrent laryngeal nerve. Considering the prevalence of this procedure and the lack of similar studies in this area, we decided to evaluate epidemiology and complications of this procedure so we take a step to reduce complications. All patients referring to Amir al-momenin Hospital in Rasht during 2012-2016 for total thyroidectomy were participated. Demographic and clinical datas from their hospital records were collected in a questionnaire and the long-term complications of the disease and permanent injuries after 6 months were re-examined. Data analysis was done and p less than 0.05 was considered significant. Of the 103 patients, 79.6% were female. The average age was 44.61 years. The most common clinical manifestation was masses or nodules in the anterior of neck (84.5%). 58.3% of patients had the final pathology for Papillary thyroid carcinoma, 25.2% multidolateral goiter, 14.6% adenoma and 8.7% thyroiditis. transient hypocalcemia was seen in 26.2% of patients and 2.9% had permanent hypocalcaemia, 2 patients had recurrent nerve injury, which one of them was recovered in the Follow up. Other complications did not accurred. Papillary thyroid carcinoma is one of the most common indications of total thyroidectomy in this area. Low prevalence of complications in this center can be due to the surgeon's expertness and peri and postoperative care.

Septorhinoplasty are the most common nose surgical procedures widely used the world over. The main aim of this study was comparing the results of septorhinoplasty with and without nasal packing. This case control interventional study was conducted on patients who underwent septorhinoplasty in an ENT university hospital in north of Iran. Two separate groups, with or without nasal tampon (each group consisted of 35 patients) were included in the study. Open surgical approach for repairment was executed for all and nasal packing (ie. tetracycline impregnated mesh, that was removed after 48 hours) for 35 patients inserted postoperatively.Patients were studied in three time periodsfor pain (using Visual Analogue Scale) and other postoperative signs and symptoms and convenience and overall satisfaction. No significant difference for postoperative bleeding, ecchymosis, hematoma and rhinorrhea was founded between the groups (p>0.05), but there was a significant difference in short-term outcomes in terms of convenience (p=0.006), edema two days after surgery (p= 0.001), right side and left side edema (p=0.002). The overall satisfaction was significantly higher in patients without nasal packing (p= 0.002). In assessment of the pain rate one week after surgery, there was no significant difference in various age and sex groups (p>0.05). Based on our 8indings routine nasal packing is not working well in septo-rhinoplasty cases and it is recommended to be avoided in these patients.

The true influence of the perioperative intravenous lidocaine on the development of postoperative cognitive deficit (POCD) in coronary artery bypass grafting (CABG) remains controversial. The principal aim is to undertake a meta-regression to determine whether moderator variables mediate the relationship between lidocaine and POCD. Areas covered: We searched the Web of Science, PubMed database, Scopus and the Cochrane Library database (up to June 2017) and systematically reviewed a list of retrieved articles. Our final review includes only randomized controlled trials (RCTs) that compared infusion of lidocaine and placebo during cardiopulmonary bypass (CPB). Mantel-Haenszel risk ratio (MH RR) and corresponding 95% confidence interval (CI) was used to report the overall effect and meta-regression analysis. A total of 688 patients in five RCTs were included. POCD occurred in 34% of all cases. Perioperative lidocaine reduces POCD (MH RR 0.702 (95% CI: 0.541-0.909). Younger age, male gender, longer CPB and higher concentration of lidocaine significantly mediate the relationship between lidocaine and POCD in favour of the neuroprotective effect of lidocaine. Expert commentary: The neuroprotective effect of lidocaine on POCD is consistent in spite of longer CPB time. A higher concentration of lidocaine strengthened the neuroprotective effect of lidocaine.

Background and aims: Injuries as a result of accident and other incidents are the largest and preventable public health issue in terms of morbidity and disability. Thus the present research aims to epidemiologically analyze the accidents in the individuals referred to Haftkel hospital during 2014. Methods: The present research is a cross-sectional study with descriptive analytical approach conducted on a total of 667 patients referred to inpatient medical center and road emergency centers of Haftkal in Khuzestan province, due to the accidents from mid-March 2014 to early March 2015. Data analysis was conducted using frequency distribution and percentage for qualitative variables and mean (standard deviation) for quantitative variables and binary logistic regression and chi-square. P

BACKGROUND: Nowadays, spinal anaesthesia is a suitable choice for most elective and emergency cesarean section (C-section) deliveries. AIM: This study aimed to determine the effect of adding low-dose naloxone to intrathecal morphine on postoperative pain and morphine related side effects after C-section. MATERIAL AND METHODS: In the present double-blind, randomised clinical trial, 70 women aged over 18 years, who were candidates for elective medical C-section under spinal anaesthesia were selected and randomly assigned to either the study group or the control group. For spinal anaesthesia, 10 mg of Bupivacaine plus 100 μg of morphine was administered for all patients. However, patients in the study group received 20 µg of naloxone intrathecally; but the patients in the control group only received normal saline as a placebo. After surgery, patient-controlled analgesia (PCA) pump with paracetamol (Apotel®) was connected to each patient. The intensity of postoperative pain in the patients was evaluated and recorded using Visual Acuity Screening (VAS) at 2, 4, 6 and 24 hours after the surgery. The patients were also examined for postoperative nausea and pruritus. RESULTS: Regardless of the groups to which the patients were assigned, a significant difference in pain intensity was observed during the study period (time effect; p < 0.001). Although the intensity of pain was lower in the study group, the difference was not statistically significant (group effect; p = 0.84). Also, there was no group time interaction between pain intensity and the times studied (p = 0.61). The incidence rates of postoperative nausea and pruritus were significantly lower in the study group compared to the control group (p < 0.001). CONCLUSION: According to the results of this study, adding low dose naloxone to intrathecal morphine did not significantly change postoperative pain intensity in the patients undergone elective C-section using spinal anaesthesia; however, significantly decreased the severity of postoperative nausea and pruritus.

Sarcoidosis is a systemic idiopathic disease, characterized by non-caseating granulomas, primarily affecting the lungs and the lymphatics. Skin involvement is common and lesions may appear in scar tissues. In the present report, four cases of scar sarcoidosis following rhinoplasty are presented which were diagnosed based on serology tests, radiography imaging and histopathology findings. Three women and one man between 32 to 54-year-old are discussed in this report. Skin lesions on their nose were found after an average of 3.8 years of their septorhinoplasty surgeries. Two of the patients had systemic signs such as fever, cough and arthritis. Patients with diagnosed sarcoidosis were treated appropriately. Rhinoplasty is a common procedure today, and the fact that rhinoplasty may lead up to scar sarcoidosis in susceptible people can be an item for surgeons for consideration. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(4):267-270.

Introduction:Different prophylactic methods are introduced to prevent surgical site Infection. This study was conducted to evaluatesituation of prophylactic antibiotics (PA) usage in an Iranian university hospital.Aims:A cross sectional study.Methods:This study obtained data from 1010 patients’ medical files in 2015. These patients were admitted to a university otolaryngology (ENT) and ophthalmology hospital in north of Iran. Data from ordered prophylactic antibiotics considering induction time, type of antibiotic, duration of use, dosage amount and intervals was obtained to compare with international and national guidelines. Data analysis was performed by using Chi-square test at significance level of 95%.Results:402 (39.8%) patients were male and 608 (60.2%) ones were female. Mean age and standard deviation was 41.8±22.3 years old, and most participants were in 20-39 years of age. Ophthalmic and ENT related procedure was respectively conducted for 41.7% and 58.3% of patients. Septorhinoplasty and phacoemulsification were the commonest procedures. Totally 999 (98.9%) people received prophylactic antibiotics. Intravenous Cefazolin (for ENT procedures) and topical eye drop of Chloramphenicol 0.5% were prescribed mostly. We found poor accommodation between antibiotic use and guidelines for prophylaxis, mostly in case of duration of apply.Conclusion:Ordered prophylactic antibiotics is not as need as prescribed. Also, accommodation between prescription of antibiotics and available scientific guidelines was improper in this study.

Introduction:Nasal tip ptosis or droopy nose tip is a fairly common nasal deformity. Given the importance of correcting nose tip in rhinoplasty and the need to diagnose the causes of tip ptosis.Aims:The current study was performed aimed to investigate the frequency of the causes of this deformity in rhinoplasty candidates.Methods:In this cross-sectional study, 257 patients (205 women and 52 men; mean age: 26.6 ± 1.7 years old) who came to Amiralmomenin Teaching Hospital of Rasht for rhinoplasty in 2011- 2012 were selected by simple sampling method. The contributing factors that led to tip ptosis were diagnosed and recorded based on the results of preoperative and the intraoperative clinical observations.Results:In this study, 44% (113 patients) of the patients had tip ptosis. Statistically, no significant difference was observed between the incidence of tip ptosis in men and women (p=0.504). The prevalence of tip ptosis among patients older than 40 years old was significantly greater (p=0.039). Based on the results of preoperative and intraoperative observations, long caudal septum was the most important cause of tip ptosis. The most common coordination between the causes of tip ptosis in preoperative and intraoperative observations was the thick skin of nose lobules.Conclusion:It seems that nasal tip ptosis is common in our rhinoplasty subjects, and there is only a partial correlation between the mentioned causes of tip ptosis in preoperative and intraoperative assessments, hence more consideration is required for a precise diagnosis of tip ptosis.

Background and Aim: While most of the people with tinnitus have some degrees of hearing impairment, a small percent of patients admitted to ear, nose and throat clinics or hearing evaluation centers are those who complain of tinnitus despite having normal hearing thresholds. This study was performed to better understanding of the reasons of probable causes of tinnitus and to investigate possible changes in the auditory brainstem function in normal-hearing patients with chronic tinnitus. Methods: In this comparative cross-sectional, descriptive and analytic study, 52 ears (26 with and 26 without tinnitus) were examined. Components of the auditory brainstem response (ABR) including wave latencies and wave amplitudes were determined in the two groups and analyzed using appropriate statistical methods. Results: The mean differences between the absolute latencies of waves I, III and V was less than 0.1 ms between the two groups that was not statistically significant. Also, the interpeak latency values of waves I-III, III-V and I-V in both groups had no significant difference. Only, the V/I amplitude ratio in the tinnitus group was significantly higher (p=0.04). Conclusion: The changes observed in amplitude of waves, especially in the latter ones, can be considered as an indication of plastic changes in neuronal activity and its possible role in generation of tinnitus in normal-hearing patients.

Background and Aim: While most of the people with tinnitus have some degrees of hearing impairment, a small percent of patients admitted to ear, nose and throat clinics or hearing evaluation centers are those who complain of tinnitus despite having normal hearing thresholds. This study was performed to better understanding of the reasons of probable causes of tinnitus and to investigate possible changes in the auditory brainstem function in normal-hearing patients with chronic tinnitus.Methods: In this comparative cross-sectional, descriptive and analytic study, 52 ears (26 with and 26 without tinnitus) were examined. Components of the auditory brainstem response (ABR) including wave latencies and wave amplitudes were determined in the two groups and analyzed using appropriate statistical methods.Results: The mean differences between the absolute latencies of waves I, III and V was less than 0.1 ms between the two groups that was not statistically significant. Also, the interpeak latency values of waves I-III, III-V and I-V in both groups had no significant difference. Only, the V/I amplitude ratio in the tinnitus group was significantly higher (p=0.04).Conclusion: The changes observed in amplitude of waves, especially in the latter ones, can be considered as an indication of plastic changes in neuronal activity and its possible role in generation of tinnitus in normal-hearing patients.

Background: In patients undergoing septorhinoplasty, control of bleeding and hemodynamic variables is of great importance and laryngoscopy and tracheal intubation could be followed by a specific and transient increase in systemic blood pressure and heart rate. Objectives: This study aimed to examine the effects of oral gabapentin on hemodynamic changes, during direct laryngoscopy, and the amount of bleeding in the patients undergoing septorhinoplasty. Patients and Methods: In a double-blind clinical trial, 103 patients (American society of anesthesiologists class I, II) aged 18 - 45 years old, who were septorhinoplasty candidates, were randomly assigned into two groups, a 900 mg gabapentin group and placebo, in AmirAl-Momenin academic hospital. The drug was prescribed to the patients orally, 2 hours before the operation. Anesthetic technique was similar for all the patients. Heart rate (HR), systolic (SBP) and diastolic blood pressures (DBP), mean arterial blood pressure (MAP), oxygen saturation percentage of arterial blood (SaO 2 ), before induction of anesthesia, 3, 5, 10, and 15 minutes after the intubation and tracheal extubation, and the amount of bleeding during operation were measured. Statistical analysis was performed with the SPSS (v. 16) software. Results: Variations in the HR, DBP and SaO2, in the specified time intervals, did not show any statistically significant difference, although variations in SBP were statistically significant (higher in gabapentin group). Regarding the average amount of bleeding volume, although there was a lower amount of bleeding in the gabapentin group, the difference was not statistically significant. Also, regarding the pain, there was no significant difference between the two groups in terms of visual analog scale (VAS) average and the received analgesic. Conclusions: The present study showed that premedication with 900 mg gabapentin did not affect the hemodynamic changes induced by laryngoscopy and the amount of bleeding. However, the decreased amount of bleeding was observed in the gabapentin group.

Background: During induction of anesthesia and intubation, hemodynamic changes are very important; especially in patients with coronary artery disease (CAD) and left ventricular dysfunction. A little information is available on the hemodynamic effects of a combination of ketamine-thiopental for induction of anesthesia in patients undergoing coronary artery bypass graft (CABG) surgery, with impaired ventricular function. Aim: The aim of this study was to compare the hemodynamic responses to etomidate versus ketamine-thiopental sodium combination for anesthetic induction in CABG surgery patients with low ejection fraction (EF0.05). Muscle twitching was not observed in the two groups. Conclusion: Hemodynamic stability after administration of ketamine-thiopental sodium combination for induction of anesthesia in patients undergoing CABG surgery, with impaired ventricular function, supports the clinical impression that this combination is safe in CABG surgery patients with low EF.