Reviews in Clinical Medicine

1-3

Authors: Reza Boostani; Fariborz Rezaeitalab ; Behzad Pourmokhtari; Amirali Ghahremani

Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by recurrent apnea during sleep. Nocturnal laboratory-based polysomnography (PSG) is the gold standard test for diagnosis of OSA. The sufferers may complain from daytime sleepiness, snoring or occasional headaches. Serious consequences such as cardiovascular complications, stroke or symptoms of depression may complicate the syndrome. Headache prevalence due to sleep apnea is estimated 1%-2% in general population and affects 2%-8% of middle age population. Morning headache is more common in the OSAS patients. OSAS patients present with various characteristics of morning headache. Treatment with continuous positive airway pressure usually reduces headache. The pathophysiologic background for a relation between obstructive sleep apnea and morning headache is multifactorial. Some theories have been proposed for OSAS-related headaches such as changing oxygen saturation during sleep, cerebral vasodilation and increased intracranial pressure due to cerebral vasodilation, sleep disruption and depression but the definite cause of headaches in OSAS patients is not yet clear.

8-12

Authors: Hosna Ghandeharioun1 ; Fariborz Rezaeitalab2 ; Reza Lotfi 1

Overnight polysomnography is the gold standard for the detection of obstructive sleep apnea-hypopnea syndrome (OSAS). However, it is expensive and needs attending personnel. The study of simplified sleep apnea monitoring is one of the recent trends for sleep medicine research. The proposed clinical prediction rules employ the vital and social statistics, symptoms, craniofacial traits, and obesity-related measures for initial screening of OSAS in an ambulatory setting. However, most of them are partially or completely clinical and not home-based. One disadvantage of this sort of screening methods is their inability to asses OSAS severity. Another approach of initial OSAS screening is a usage of just one or two physiological signals such as electrocardiography (ECG), pulse oximetry, snoring, nasal airflow, or even speech sound. In this study, we aimed to review the different strategies and to compare their performances, reported by means of their sensitivity–specificity and accuracy for OSAS incidence and severity. OSAS severity is determined by apnea-hypopnea index (AHI) value. Based on the data obtained from the related articles, the most accurate methods of AHI estimation exploit ECG and pulse oximetry signals.

18-22

Authors: Anoush Azarfar1 ; Mohammad Esmaeili1 ; Nayere Tousi 2 ; Mitra Naseri1 ; Fatemeh Ghane1 ; Yalda Ravanshad3 ; Anahita Alizadeh4

Introduction: The role of magnesium supplement to prevent primary and/or secondary kidney stones has not been fully determined. The aim of this study is to evaluate the effects of magnesium supplement in modifying urinary risk factors of recurrent kidney stones. Method: We searched MEDLINE, Scopus, and Google Scholar databases on December 7, 2014 and reference lists of systematic reviews and randomized, controlled trials. Among the initial 282 articles found by our search strategy and hand searching, we found eight English-language studies were eligible for our study. Result: Magnesium supplementation could be beneficial in nephrolithiasis prevention through increasing urinary magnesium, citrate, and calcium while declining urinary oxalate. In pediatric patients, the results were more prominent and could decline urinary oxalate up to 90% of the baseline. Conclusions: Magnesium supplementation could be beneficial, especially with potassium-citrate combination. However, due to the low number of well-designed randomized controlled trials, especially in pediatrics, the conclusions of this study need further confirmation.

28-31

Authors: Aliakbar Saber Moghaddam1 ; Mahdi Hashemi 2 ; Ramin Daneshvar2

Introduction: Intraocular pressure (IOP) can be influenced by several factors including corneal thickness, gender, refractive error, and the presence of diabetes mellitus. In the present study, we systematically reviewed published literature to find association between variations of IOP due to strabismus surgery. Method: PubMed and Scopus were systematically searched with the following search terms: (intraocular pressure OR IOP) AND (strabismus) for the articles in which the fluctuation of IOP before and after strabismus surgery had been evaluated. All types of articles including case series, cross-sectional, clinical trials, and cohort studies with no time limitation were included in this study. Systematically searches, selection of articles, and the extraction of data were performed by two reviewers independently. Result: 1617 out of 1674 articles were excluded due to duplication or irrelevancy. After step by step process of article selection, 57 relevant articles were included for further evaluation. However, only 8 articles met the inclusion criteria. Conclusions: The results of this report showed that IOP may vary due to strabismus surgery, and it decreases after the surgery.

39-42

Authors: Navid Nourizadeh; Akram Adabizadeh*

Introduction: There are many internal and external factors that are considered as the main causes of nasal infections and inflammation in chronic rhinosinusitis (CRS) leading to polyposis. It is suggested that bacterial and fungal elements have an important role in the development of these diseases. Method: Scopus and PubMed were searched thoroughly on 1 February 2015 with the following search terms: (fungal biofilms) AND (nasal polyposis) to find the articles in which the prevalence of fungal biofilms had been evaluated in patients with nasal polyposis. Only English language articles with no time limitation were included in this study. Result: Of 48 records found by initial search, only 10 articles met the inclusion criteria. Data showed that the presence of biofilms is associated with nasal polyposis in 110 of 303 patients and 13 of controls. Discussion: The results of studies confirm that the fungal biofilms play an important role in the pathogenesis of chronic rhinosinusitis with nasal polyposis. Conclusions: According to the results of included studies, there is a close association between the presence of fungal biofilm and different types of nasal disorders including nasal polyposis.

164-167

Authors: Hedieh Nazarzadeh; Yavar Shams Hojati; Reza Nazarzadeh

Introduction: Neuroblastoma is known as one of the most common solid tumors in children, which is recently under the investigation for the expression of CD133, a marker of cancer stem cells. Revealing the prognostic value of CD133 marker expression is important in predicting the outcome and survival of neuroblastoma patients. In this systematic review, we aimed to review the studies on association between CD133 expression and other peripheral neuroblastic tumor prognostic factors. Methods: PubMed was searched for the relevant articles. No time and language limitation were included in our search strategy. Data regarding the patients’ number and age, tumor stage, histology and CD133 expression were extracted. Results: Overall, only 4 relevant articles were retrieved. One articles revealed the positive association between CD133 expression in neuroblastoma samples and its resistance to chemotherapy treatment. Three of the included articles showed the positive relation between CD133 expression rate and tumor stage progression. Two of the included studies revealed much worse survival of the neuroblastoma patients with more expression of CD133. Discussion: Based on included studies, CD133 expression is positively related with poor outcome prognosis in patients, more advanced tumor stage, shorter disease-free survival and overall survival. Conclusion: Although the expression of CD133 has shown increasing trend by advancing the neuroblastoma tumor stage, more studies with larger sample size are needed to accurately reveal the relation.

174-177

Authors: Anoush Azarfar; Yalda Ravanshad; Mohammad Esmaeili; Fatemeh Ghane Sharbaf; Mitra Naseri; Fahime Noferesti

Introduction:Pyelonephritis is known as kidney inflammation due to bacterial infection which should be diagnosed and treated promptly. In this article, we decided to systematically review the diagnostic value and reliability of evaluating urine excretion low molecular weight protein alpha-1-microglobulin (A1M). Methods: PubMed and Scopus were searched for the relevant articles about the efficacy of urine alpha-1-micriglobulin assays in the diagnosis of pyelonephritis in children. The search strategy was microglobulin AND pyelonephritis. No language and date limitations were included in this review. Results: A total of 16 articles were retrieved from PubMed and 23 articles from Scopus. After studying the abstracts, only 5 articles were selected, which specifically studied the efficacy of alpha-1-micrglobulin in the diagnosis of pyelonephritis in children. Discussion: A1M is not an acute phase protein but its concentration alters in several clinical conditions. Conclusion: Evaluating the urine concentration of A1M is a noninvasive and cost effective strategy with the diagnostic capability for urinary tract disorders such as early recognition of tubular damages during pyelonephritis.

182-186

Authors: Mostafa Dastani

Cardiovascular is the major cause of death in chronic kidney disease and end-stage renal disease. The cardiovascular mortality rate of patients with renal impairment is evaluated to be higher than general population. Coronary artery disease seems to be an important type of cardiovascular complication among patients with chronic kidney disease and end-stage renal disease before the renal replacement therapy. Due to the strong association between chronic kidney disease and the incidence of coronary artery disease, accurate screening, diagnosis, and management of cardiovascular complications would be essential in patients at different stages of renal dysfunction. Despite the need for the comprehensive knowledge about different aspects of coronary artery disease in patients with renal failure, there is not sufficient evidence regarding the pathophysiology, ideal diagnosis, and treatment strategies for coronary heart disease in population with chronic kidney disease. In this study, we briefly reviewed the existing literatures about the possible screening, diagnosis, and the treatment approaches of risk of coronary heart disease in patients with kidney dysfunction.

190-194

Authors: Amin Rahpeyma; Saeedeh Khajehahmadi; Ali Ghasemi

Introduction: Dermoid/Epidermoid cysts are rare pathologic lesions that may involve the floor of the mouth. Infection and inflammation of the cyst can produce a clinical picture very similar to the submandibular and submental abscesses with odontogenic origin. Dermoid/epidermoid cysts are on the floor of the mouth with submental or submandibular component can be mistaken for odontogenic infections. Methods: Four biopsy proven dermoid/epidermoid cysts operated in the Mashhad University of Medical Sciences, Ghaem hospital (2012-2013), were reviewed. Results: Four patients, including two classic cases and two infected dermoid/epidermoid cysts, were erroneously diagnosed as odontogenic infection. Discussion: The lesions located solely below mylohyoid muscle need to be removed through anextraoral approach but the lesions above the mylohyoid muscle or those that have both supra- and infra-mylohyoid components can be removed through an intraoral incision. Conclusion: Dermoid/epidermoid cysts should be considered in the differential diagnosis of submental/submandibular swellings. In the absence of an odontogenic cause of infection, fine-needle aspiration biopsy and appropriate imaging evaluation techniques with sonography, CT or MRI are mandatory for correct diagnosis and surgical treatment planning. The clinicians should be very cautious to differentiate odontogenic infections from infected dermoid/epidermoid cysts.

200-204

Authors: Mehrnaz Zarrini; Farokh Seilanian Toosi; Behroz Davachi; Sirous Nekooei

Magnetic resonance imaging is an exclusive imaging method which can distinguish injured tissues from the healthy tissues or organs without using ionizing radiation. Magnetic resonance imaging is able to provide quantitative data regarding the anatomical and physiological features of each specific organ. Magnetic resonance imaging is a non-invasive method, but contrast agents are necessary to enhance the visualization of inaccessible organs in some organs such as gastrointestinal (GI) imaging. Various types of contrast agents have been used in studies including intravascular administration and oral materials. Oral contrast agents can be the artificial materials or natural factors. Natural contrast agents consist of fruit juice or pulps. Some advantages have been reported regarding the natural types of contrast agents over the artificial agents including better taste and tolerability. We briefly reviewed the different types of contrast agents and focused on the studies in which natural oral contrast agents used to investigate their efficacy in increasing the gastrointestinal magnetic resonance imaging clarity.

209-211

Authors: Mohammad Davoudi; Parvaneh Davoodi

Nucleophosmin1 is a multifunctional protein that shuttles between nucleus and cytoplasm in some subtypes of acute myeloid leukemias. Mutated Nucleophosmin1 expresses aberrantly in the cytoplasm of the cell and transports from nucleolus to the cytoplasm. It is diagnosed by immunohistochemical techniques, flow cytometry assay and mutational analysis. The aim of this study is to evaluate the effects of Nucleophosmin1 mutation on the clinical presentations, prognosis, diagnosis and the treatment of acute myeloid leukemia. Thirteen articles were extracted from PubMed, Google scholar and Scopus in which the Nucleophosmin1 mutation correlated with gingival hyperplasia, high white blood cell count, lymphadenopathy, high platelet count and other signs and symptoms of myelomonocytic and monocytic acute myeloid leukemias. This mutation is a provisional entity in the classification of acute myeloid leukemia, which influences on the prognosis, clinical course and the treatment of some subtypes of acute myeloid leukemias. Nucleophosmin1 mutation has favorable prognostic value in the absence of other concomitant mutations.

107-111

Authors: Fariba Zemorshidi; Reza Boostani; Mohammad Mehdi Etemadi

Introduction: Human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis is a chronic progressive neurologic disease, which might be associated with brain and spinal cord atrophy and lesions. Here, we systematically reviewed the brain and spinal cord abnormalities reported by magnetic resonance imaging (MRI) modality on HTLV-1-associated myelopathy/tropical spastic paraparesis patients. Methods: PubMed was searched for all the relevant articles, which used MRI in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis. Included criteria were all the cohort and case series with at least 10 patients. We had no time limitation for searched articles, but only English language articles were included in our systematic review. Exclusion criteria were none-English articles, case reports, articles with less than 10 patients, spastic paraparesis patients with unknown etiology and patients with HTLV-II. Results: Total of 14 relevant articles were extracted after studying title, abstracts and full text of the irrelevant articles. Only 2/14 articles reported brain atrophy incidence. Five out of 14 articles studied the brain lesions prevalence. Spinal cord atrophy and lesions were studied in 6/14 articles. Discussion: According to the extracted data, brain atrophy does not seem to happen frequently in patients with HTLV-1 associated myelopathy/tropical spastic paraparesis. None-specific brain lesions identified in articles are indicative of low specificity of MRI technique despite its high sensitivity. Conclusion: Prevalence of spinal cord lesions and atrophy in these patients might be due to the degenerative processes associated with aging phenomenon. Further and larger studies in endemic areas could more accurately reveal the specificity of MRI in these patients.

118-124

Authors: Seyede Zahra Ghaemi; Ali Khakshour; Zohreh Abasi; Nayereh Azam Hajikhani Golchin

Mental health disorders are prevalent in children in all societies. The onset of most mental disorders is in youth (12–24 years of age), but most of the time they are first detected later in life. Poor mental health is strongly related to other health and development concerns so it is common to show high grade of stress, substance use, violence, and depression. The effectiveness of some interventions has been strongly established, although more researches are needed to improve the range of affordable and feasible interventions. The shortage of educational and fiscal policies and the fairly low attention to this subject is the main challenge addressing mental-health needs. Therefore, universal or early intervention programs are needed to develop protective factors by increasing competence or skills, to reduce existing negative behaviors. Moreover child discipline problems can be reduced by school multicomponent intervention strategies and as a result promotion in student’s achievement becomes evident.

129-134

Authors: Roham Salek; Narges Bayat Mokhtari; Soudabeh Shahidsales

Breast cancer is one of the most prevalent cancers that oncologists are faced with in their clinics. The varieties of clinical features of the disease result to very different scenarios in the processes of treatment decision making. While classic factors of stage, grade, age and hormone receptor status are still the criterion for choosing treatment, a very delicate list of other prognostic and predictive factors have been entered to this field over recent two decades. The evidence-based medicine rules to treat patients based on the best evidences that have been found by powered randomized clinical trials. Different panels and guidelines gathering these evidences try to help oncologists to find the best treatment methods through the variable and sometimes contradicting results. As it is always the main objective, increasing the survival rates in addition to the ideal aim of curing the disease is usually the target. Finding the best and the most practical chemotherapy regimen against breast cancer needs to notice the biology of this disease and its varieties along with each individual patient condition. It is clear that not all patients need the most complicated and expensive treatment.

138-143

Authors: Atena Shiva; Shahin Arab

Cancer is a worldwide problem that is caused by a variety of different factors increasing over a number of years. Oral cancer is a very prevalent disease and one of the most 10 common causes of death. It is important that the risk factors can be controlled. Selecting the correct health behaviors and preventing exposure to convinced environmental risk factors can help to prevent the expansion of cancer. Scientists guess that as many as 30-40 percent of all cancer-related deaths are caused by human behaviors such as smoking, consumption of alcohol, poor diet quality and physical inactivity. This result explains the tendency in the following behaviors that can influence the possibility of getting cancer, especially oral cancer in addition to providing information and classes about healthy eating habits and a subsequent healthy lifestyle at home. In fact, a diet rich in fresh fruits, whole grains and vegetables can decrease the risk of the oral cancer because of certain compounds such as vitamin C, E, carotenoids and lycopene. Moreover, limit consumption of meat, particularly processed meat, and replace it with vegetable proteins and fish (rich of omega 3) are helpful and effective.

147-150

Authors: Mahnaz Boroumand Rezazadeh

Due to the important role of thyroid disorders on reproductive health of the women of childbearing age, pregnancy outcome, fetal health, and neurodevelopment of the infant, providing comprehensive assessment of the treatments used for preventing hyperthyroidism and hypothyroidism seems to be essential. Therefore, evaluating the efficacy of different treatments of the thyroid disorders would be beneficial in better managing and controlling the disease during pregnancy. Hypothyroidism (a deficiency of thyroid hormone) is a common thyroid disorder, which might increase the incidence rate of miscarriage, pre-eclampsia, placental abruption, and preterm delivery. Hyperthyroidism, which is not a common disorder during the pregnancy not only leads to similar adverse effects as hypothyroidism but also can result in stillbirth and intrauterine growth restriction. Levothyroxine is the preferred treatment of hypothyroidism and the only drug therapy recommended for treating hyperthyroidism during pregnancy. In this study, we aimed to briefly review the adverse effects of hyperthyroidism and hypothyroidism during pregnancy and review the effects of recent suggested treatments for controlling thyroid disorders on pregnancy outcomes.

158-160

Authors: Ameneh Rezaee Gheshlaghi; Hamid Zamani Moghadam Dolu; Elham Pishbin; Maryam Salehi

Central venous line is one of a creative instrument that saves human’s life in critical medical situation. Central venous line access is frequently involved in the disease management. It is used for rapid fluid therapy, transvenous pacemakers, infusion of some medications, hemodialysis or plasmapheresis and etc. Most of the emergency departments have some staffs that are trained for central venous line insertion but related complications occur during central venous line placement. Central venous line might have some complications and complication follow-up should be considered. Thromboembolism and infection are two important medical complications. Arterial puncture, hematoma, pneumothorax and hemothorax are mechanical Central venous line complications. Chest X-ray and some other techniques should be used for detecting these complications. Central venous line tip misplace is a considerable problem for emergency department staffs, previously chest X-ray has been used for central venous line misplace detection. In some recent studies, contrast-enhanced ultrasonography and intravascular electrocardiography have been used for central venous line misplace.

52-57

Authors: Susan Shafiei; Reza Bagheri; Kayvan Sadri; Amir Hossein Jafarian; Davood Attaran; Shahrzad Mohammadzadeh Lari; Reza Basiri; Amir Mohammad Hashem Asnaashari; Ramin Sadeghi

Introduction: Sentinel node mapping is a new technique of lymph nodal staging in solid tumors, which can decrease the morbidity of regional lymph node dissection considerably. Intra-thoracic tumors including non-small cell lung cancer (NSCLC) and esophageal carcinoma (EC) are among the solid tumors in which sentinel node (SN) mapping has been applied. In the current systematic review, we gathered the best available evidence (systematic reviews) in this regard and presented the results in a systematic review format. Material and methods: We searched MEDLINE and SCOPUS since the inception till 13 December 2014 using the following keywords: (lung OR esophagus OR esophageal) AND sentinel AND (“systematic review” OR meta-analysis OR metaanalysis). No language limit was imposed on the search strategy. Systematic reviews and meta-analyses on SN mapping in EC or NSCLC were included in the current study. Narrative review articles were excluded from the study. Results: Overall five systematic review were included. One of the included studies was on SN mapping in NSCLC and four were on EC. Overall detection rate and sensitivity for EC and NSCLC were high and both were related to mapping technique, pathological involvement of the mediastinal nodes, size and location of the tumors. Conclusion: SN mapping is feasible and highly accurate in EC and NSCLC. Attention to the technique (using radiotracers, peri-tumoral injection) and restriction of the patients to less advanced cases (cN0 and T1, 2) would ensure the best results with high detection rate and sensitivity.

65-71

Authors: Fatemeh Moharrari; Soheila Barabadian

Attention-deficit/hyperactivity disorder (ADHD) is the most common neuropsychiatric illness, which affects about 5% of children worldwide. An 80% genetic background is responsible for ADHD due to its appearance in familial relationships. In addition, dopamine regulation in synaptic spaces, which have a central role in development of ADHD, is moderated by dopamine transporter neurotransmitter, which in turn is modulated by dopamine transporter gene named SLC6A3 or DAT1. Methylphenidate as the first line and most important prescribed medication for ADHD blocks dopamine transporter and increases the dopamine concentration in synaptic clefts. In theory, methylphenidate relay to dopamine transporter to play a role, and dopamine transporter synthesis is dependent on DAT1. This gene have 40 base pair in its 3`-untranslated region end that repeat from 3 to 11 times, with most frequent 9 and 10 repeats in human, forming several alleles in carriers including 9R and 10R and genotypes including 9R/9R, 10R/10R, 9R/10R. These genotypes, as the first suspected candidates, may explain why methylphenidate therapy is not sufficient some patients and how the side effects appear in some cases and not in all patients. Many studies have performed to investigate the association between responses to methylphenidate and genotypes and yet no consistency has occurred. This article has a rapid review on concerned literature.

76-79

Authors: Sharifeh Haghjoo

Cancerous patients, under the chemotherapy or radiotherapy, are at high risk of malnutrition due to the associated complications with the treatment procedures such as chewing problems, dysphagia, nausea etc. Considering the patients’ history of alcohol consumption, smoking or any other diseases and performing several physical examinations are essential in early identification of high-risk patients for nutritional complications, losing unintentional weight and fat free mass. In this review, we tried to briefly explain the risk of malnutrition in patients with head and neck cancers who are undergoing surgery, chemotherapy and radiotherapy. Oral nutrition, nasogastric tube and percutaneous endoscopic gastrostomy are different methods of nutritional interventions, which have been compared due to their efficacy in maintaining the patients’ weight. In this study, we reviewed the results obtained in clinical trials about the efficacy of intense nutritional intervention on limiting the chemoradiotherapy-associated complications in patients with head and neck cancers.

84-87

Authors: Ahmad Shah Farhat; Gholamreza Khademi

Environmental pollution is one of the most serious and fast-growing problems in the world of today. Lead poisoning is a threatening environmental situation with the potential of causing irreversible health issues and serious negative consequences in adults and children. Lead proves to have almost no clear biological function. However, once it enters the body, it is known to cause severe health effects, which might be irreversible. In this article, we aimed to review the related literature to find evidence concerning the effect of lead toxicity on CNS, particularly its role in febrile convulsion. In this review, PubMed database was searched using MeSH terms. One hundred and fifty seven articles were retrieved, most of which were irrelevant to the topic. After a thorough search in PubMed and Google Scholar, seizure was shown to be one of the consequences of lead toxicity, but there was no evidence of epilepsy or febrile convulsion, induced by this metal contamination.

92-95

Authors: Hossein Rahimi; Zahra Mazloum Khorasani; Saeedeh Shariati

Chronic myelogenous leukemia is a myeloproliferative disorder presenting with anemia, elevated blood granulocytosis and the presence of immature granulocytes, basophilia, frequently thrombocytosis and spleen enlargement. The diagnosis is stabilized by hematopoietic stem cell expressing a fusion gene (BCR/ABL) resulted from translocation of 9 and 22 chromosomes. The products of this gene play a central role in developing chronic myelogenous leukemia including maintenance of chronicity and/or progress to accelerated phase and or blastic crisis. Imatinib is the first generated tyrosine kinase Inhibitor, which prevents ATP binding to a specific situation of tyrosine kinase molecules that are involved in phosphorylation of membranous proteins and activation of the pathways that are necessary for tumor cell survey and proliferation. Therefore, tyrosine kinase inhibitor inhibits signaling proteins, which are responsible for tumor growth, invasion, angiogenesis and even metastasis. Although tyrosine kinase inhibitor are specific targeted-designed compounds, every agent interacts with many kinds of tyrosine kinases and produces many unwanted effects. One of the undesirable adverse effects is thyroid dysfunction. The first reported article about tyrosine kinase inhibitor-induced thyroid dysfunction published in 2005 and since then few studies have demonstrated thyroid disturbances ranging from subclinical thyroid dysfunctions to overt clinically thyroid disorders during tyrosine kinase inhibitor therapy. This review attends to summarize only imatinib-induced thyroid disturbances in CML patients with positive Philadelphia chromosome in recent years.

100-102

Authors: Koorosh Ahmadi; Amir Masoud Hashemian; Kaveh Sineh Sepehr

The need for both pre- and post-reduction radiographs has recently been questioned when treating shoulder dislocation. Several case reports and case series have suggested that ultrasonography might be useful bedside diagnostic modality for evaluating shoulder dislocation. The purpose of this review was to evaluate studies that questioned necessity of radiographs for shoulder dislocation and also studies that evaluated bedside ultrasound as an alternative modality in shoulder dislocation. Ultrasonography can be used in patients with suspected shoulder dislocation. It cannot replace radiography because of possible associated fractures but it can be used before and after reduction to confirm successful relocation to reduce the risk of repeated sedation. It can also increase the certainty of physicians in cases that shoulder dislocation management needs to be performed without X-ray assessment

1-4

Authors: Behnaz Boroumand Rezazadeh; Hamid Zamani Moghadam; Mohammad Gharavifard

Ketamine, among wide variety of sedative drugs, has shown beneficial effects when using during the procedural sedation, specifically in pediatrics. Various parameters should be considered in order to perform a safe and effective procedural sedation including optimum dosage of the sedative, administration methods of sedation, and need for applying any adjuvant drug. In this study, we aimed to review the studies, which have compared the efficacy of the different ways of the injection of ketamine such as intravenous or intramuscular ketamine application. Based on data obtained from the related articles, efficacy and safety of these two methods of ketamine usage in the pediatric procedural sedation were widely similar, but the intravenously administration of the ketamine can be proposed as the preferable mode.

9-14

Authors: Amir Rezaei Ardani; Azam Motamedi Nasab

Worldwide growing methamphetamine abuse is one of the most serious health problems with several different consequences for victims, especially in developing countries. Chronic methamphetamine abuse is associated with several psychiatric problems in all countries which are faced to epidemic methamphetamine abuse. Methamphetamine-induced psychosis is a major medical challenge for clinical practitioner from both diagnostic and therapeutic viewpoints. Stimulant psychosis commonly occurs in people who abuse stimulants, but it also occurs in some patients taking therapeutic doses of stimulant drugs under medical supervision. The main characteristic of meth psychosis is the presence of prominent hallucinations and delusions. Other drugs, such as cocaine and marijuana, can trigger the onset of psychosis in someone who is already at increased risk because they have “vulnerability”. The current literature review attends to explain several aspects of MIP epidemiologically and clinically. Investigators proposed pharmacologically treatment based on recently published data.

19-23

Authors: Majid Safarpanah; Mehran Hiradfar

In recent years, laparoscopy has become a popular surgical method. Laparoscopy is a minimally invasive surgery, which results in minor traumas in comparison with conventional open surgeries. There are several risk factors associated with laparoscopy based on the involved organ and the patient’s general situations. Due to the improvements of clinical approaches, laparoscopic splenectomy has been known as a gold standard method for spleen removal as a result of various diseases, such as ITP. The human spleen plays a key immunologic role in defense against a number of organisms, particularly encapsulated bacteria. The spleen can cause significant morbidity and/or hematologic disturbance if it becomes hyperfunction (hypersplenism) or hypertrophied (splenomegaly). Laparoscopic surgery for cancer is also an appropriate procedure if good tissue handling techniques are maintained. In this study, we attempted to review the results obtained from recent articles about the beneficial features of the laparoscopic splenotectomy in comparison with conventional open surgery.

28-31

Authors: Azadeh Tafakori; Mohammad Gharavifard; Hamid Zamani

There are various criteria that affect the efficacy of the procedural sedation strategies required for performing different processes in emergency departments. Selecting the most effective and the safest sedative with or without analgesic effect for every individual patients and intervention is one of the main parts of the each emergency department practices. Based on previous studies, various sedative agents have been proposed, which have different benefits and adverse effects including propofol, ketamine, etomidate etc. Different side effects of administrating each drug, alone or in combination with each other, have been proposed such as vomiting, respiratory depression, hypoxia, hypotension and cardiac arrest. In this study we aimed to briefly review the properties of applied sedatives in different studies and also mention few related clinical trials with proper blinding, which were conducted to evaluate the efficacy of the sedative in procedural sedation.

37-41

Authors: Samaneh Solltani; Masoumeh Mirteimouri; Ameneh Movahedian; Nushin Chalakinia

Postpartum hemorrhage is among the leading causes of maternal mortality throughout the world. Severe blood loss contributes to the increased blood transfusion risk with its concerned inherent adverse events and therefore increased rate of emergency re-operative interventions such as arterial ligation or hysterectomy. It also can lead to protracted anemia, particularly in low or median income countries. Extended application of antifibrinolytic agents such as tranexamic acid has been customary for long years to stop or reduce blood loss in postpartum period. However, there are not enough reliable evidence to approve the real efficacy of these drugs. In this brief and summary review, we pointed to a few conducted studies. The PubMed was searched for keyword including postpartum hemorrhage, tranexamic acid, cesarean section, vaginal delivery, and blood loss prevention. The articles with language other than English were excluded from our review. We concluded that more convincing information is needed to determine the precise effects of tranexamic acid, and its benefits against adverse effects.

45-48

Authors: Seyed Esmael Nezhadhoseini; Kazem Fotohi; Mohammad Vejdani

Breast surgical site infection is not only one of the main causes of the morbidity and mortality of cases under different types of surgeries, but also it results in longer hospitalization and additional expenses. Identifying various potential parameters related to the occurrence of surgical site infection after the surgery and getting accurate knowledge about them can be beneficial in preventing the surgical site infection. Various types of studies have been conducted to evaluate the possible risk parameters of surgical site infection in every surgery. In this study, we tried to provide a brief review of the available literature regarding the risk factors associated with breast surgical site infection. To this end, we searched the Pubmed database for the relevant articles. We selected eight articles, which have studied the parameters with statistically significant association with the breast surgical site infection. According to our review, further studies with larger sample size can be effective in better evaluating the associated risk factors and presenting the exact effect of some uncertain risk factors of the surgical site infection after breast surgeries.