The effect of adding gentamicin to contrast media for prevention of cholangitis after biliary stenting for non-calculous biliary obstruction, a randomized controlled trial

Aim

Cholangitis is the most common infectious complication of ERCP. In vitro studies showed that addition of aminoglycosides to contrast medium was effective in reducing cholangitis but the results of clinical trials are conflicting. We studied the effect of adding gentamicin to contrast medium in reducing the rate of post-ERCP cholangitis in patients with non-calculous obstructive jaundice.

Methods

All patients with non-calculous obstructive jaundice who underwent endoscopic biliary stenting at the Shariati Hospital, Tehran, between December 2009 and October 2010 were enrolled in the study. Gentamicin (10 mg) or distilled water was added to each 10 cc contrast medium during ERCP. Intravenous antibiotics were administered before and after the procedure in all patients. After ERCP and stent deployment, patients were followed for 72 h for symptoms and signs of cholangitis.

Results

A total of 114 patients were eligible for the study. Of these, 57 patients were included in each group. Cholangiocarcinoma was the most prevalent diagnosis. The obstruction was relieved in all patients by stenting. Five patients in each group (8.8 %) developed cholangitis. There was no significant difference in the incidence of cholangitis between the two groups (p?=?1.000).

Conclusions

With adequate drainage of the obstructed biliary tract by proper stenting, adding gentamicin to contrast media had no significant effect on incidence of post-ERCP cholangitis.     

Pseudo inferior oblique overaction,clinical findings,mechanism, and surgical outcomes

Graefe's Archive for Clinical and Experimental Ophthalmology - To investigate clinical findings of the pseudo inferior oblique overaction (IOOA) syndrome and the outcomes of strabismus surgery...     

Lack of Association between Serum Adiponectin/Leptin Levels and Medullary Thyroid Cancer

Background Adipokines are bioactive proteins that mediate metabolism, in ammation and angiogenesis. Changes in the secretion of key serum adipokines - adiponectin and letpin - may be associated with obesity, cancer and metabolic disorders. Thyroid cancer is one of the most important types of endocrine cancer. Therefore, investigating the association between serum levels of adiponectin and leptin and thyroid cancer might be important. The purpose of this study was to assess adiponectin and leptin levels in medullary thyroid carcinoma (MTC) cases in order to identify novel tumor markers. Materials and Methods This research was based on a case-control study, including 45 patients with medullary thyroid cancer (21 men and 24 women) and 45 healthy controls (24 males and 21 females). Adiponectin and leptin levels were measured by ELISA in both groups. Height and weight were measured and body mass index (kg/m2) was calculated. Results Adiponectin and leptin levels were not signi cantly different between medullary thyroid carcinomas and the control group. Also, there was no correlation among age and body mass index and the disease. Conclusions These results suggest that changes in serum adiponectin and leptin levels do not play an important role in the diagnosis or could act as as biomarkers for medullary thyroid cancer.     

Fine versus coarse atrial fibrillation in rheumatic mitral stenosis: The impact of aging and the clinical significance

Background

Atrial fibrillation (AF) as the most rhythm disturbance in patients with rheumatic mitral stenosis (MS), is classified in to coarse and fine subtypes according to the height of fibrillatory wave amplitude. The aim of this study is to identify the factors associated with the presence of fine versus coarse morphology in patients with rheumatic MS.

Methods

In this cross‐sectional study, patients with confirmed diagnosis of severe rheumatic MS admitted between March 2013 and March 2017 were screened. Patients were categorized to sinus rhythm (SR) and AF rhythm (coarse and fine subtypes) groups according to the admission electrocardiogram. The association between various clinical and echocardiographic factors and the development of fine versus coarse AF were examined.

Results

Among 754 patients with the diagnosis of rheumatic MS, 288 (198 female) were found to have AF (38%). Among them 206 (71.5%), and 82 (28.5%) patients had fine and coarse morphology respectively. Patient in these two groups were quite similar in terms of echocardiographic parameters and comorbidities. However, patients with fine morphology AF were significantly older. (p‐Value=.007).

Conclusion

Coarse morphology of AF is common in patients with rheumatic MS. While echocardiographic or most clinical parameters do not seem to associate with the occurrence of coarse or fine morphology, age seems to be the only independent factor correlated with the presence of fine subtype of AF in this population.

     

The Effects of Forward Head Posture on Neck Extensor Muscle Thickness: An Ultrasonographic Study

Objective

This study aimed to compare neck extensor muscle thickness, thickness changes, and strength between participants with forward head posture (FHP) and controls with normal head posture (NHP).

Association of the serum apelin,but not ghrelin,with the presence and severity of coronary artery disease

Increasing evidence suggests that apelin and ghrelin may participate in atherogenesis. We sought to investigate whether the serum levels of apelin and ghrelin are significantly different in patients with coronary artery disease (CAD) compared to patients with nonsignificant coronary stenosis and determine the correlation between these adipokines and the severity of coronary stenosis.The study population included 31 stable CAD patients, 38 unstable CAD patients, and 39 non-CAD subjects. Serum levels of apelin and ghrelin, fasting blood glucose, lipid parameters, hs-CRP and hematological indices were determined in all groups using routine standard laboratory procedures. Serum apelin levels were significantly lower in patient with unstable CAD (0.354 ± 0.063 ng/mL) compared to stable CAD patients (0.401 ± 0.045 ng/mL, p = 0.003) and non-CAD subjects (0.415 ± 0.055 ng/mL, p<0.001). In addition, serum apelin levels were inversely correlated with the severity of coronary stenosis in CAD patients (p<0.05). However, there was no significant difference in ghrelin levels among the 3 groups.This data may suggest that the presence of unstable CAD may be associated with lower serum apelin which may indicate the potential role of this peptide in the progression and destabilization of coronary plaques.     

Treating patients differently: Comparison of medical-staff behaviour and attitudes towards cases of self-immolation and unintentional burns

Discrimination in service delivery can interfere with follow-up care, service receipt, and return to normal quality of life. This study was conducted to assess and compare patients’ perception of caregivers’ behaviour and attitudes in two groups; self-immolation and cases of unintentional burn.This study was conducted at the burn unit of Taleqani Hospital in Ilam in 2008. All patients admitted to the burn unit over a 6-month period from September 2008 to March 2009 were enrolled. In the total of 116 patients, 57 cases of self-immolation and 59 cases of unintentional burns were studied. Data were generated through interviews and questionnaires.Among the hospitalised cases, 49.1% were cases of self-immolation. Medical staff behaviour and attitudes were judged as relatively good or good in 86.5% and 68.4% of unintentional burn and self-immolation patients, respectively (P = 0.011). This inter-group difference was only dependent on the nature of burns (self-immolation vs. unintentional), and other studied variables did not significantly affect results.The stigma of self-immolation should not impair the quality of care or the behaviour and attitudes of caregivers. It is necessary to train and monitor staff in this regard so that cases of self-immolation can receive services without discrimination.     

Molecular genotyping of Giardia duodenalis in children from Behbahan,southwestern Iran

Parasitology Research - Giardia duodenalis is an intestinal flagellated protozoan that infects humans and several animal species. Giardiasis causing more than 200 million symptomatic infections...     

Multifocal electroretinogram in diabetic macular edema and its correlation with different optical coherence tomography features

International Ophthalmology - To evaluate multifocal electroretinogram (mfERG) parameters in eyes with diabetic macular edema (DME) and its correlation with vision and optical coherence tomography...