Correlation of cephalic anthropometric parameters and microsurgical anatomy of the optic nerves: a cadaveric morphometric study

BACKGROUND: This study was designed to elucidate the possible correlation of cranial anthropometric measurements with the chiasm to limbus sphenoidale distance to facilitate preoperative estimation of this distance and to choose a better surgical approach. METHODS: Thirty-three fresh adult cadaver heads (22 males and 11 females) were evaluated for cranial anthropometric measurements. The precraniotomy anthropometric measurements included (A) inion to nasion distance and (B) the longest intermeatal meridian. Subsequently, with a standard craniotomy, the following intervals were measured: (C) optic chiasm to falciform ligament, (D) anterior aspect of optic chiasm to limbus sphenoidale, and (E) limbus sphenoidale to inner nasion. A combined ratio parameter, labeled as (F), was calculated from the following equation: F = B/E x 10. RESULTS: The mean values and standard errors of the mean of parameters A to F were 195.8 +/- 14.53 mm, 374.7 +/- 25.29 mm, 10.47 +/- 1.89 mm, 9.93 +/- 2.01 mm, 38.46 +/- 3.17 mm, and 9.81 +/- 1.11, respectively. The parameter D had significant correlation to the parameters B, C, E, and F. The most significant correlation was seen between parameters D and F (p < 0.001). According to linear regression assessment between parameters D and F, the following regression equation was obtained: D = 4.24 + 0.58F. CONCLUSIONS: Optic nerve topography and dimensions show inter-personal variations that may be anticipated to some extent with cranial anthropometric data. Calculating of F ratio gives us an acceptable estimation of the actual distance of chiasm to limbus sphenoidale, which in turn can help the surgeon to select the approach to tumors of intrasellar region. However, the role of meticulous imaging studies cannot be overemphasized to confirm the anticipated estimations.     

Anatomic Porous Replacement hip arthroplasty: first 100 consecutive cases

One hundred consecutive Anatomic Porous Replacement (Intermedics Orthopaedics, Austin, TX) hip replacements were followed for 4 years. Eighty percent of patients had bone ingrowth fixation, 14% stable fibrous, and 6% unstable fibrous (loose) with 4% revised. Only two hips changed fixation grade after 2 years. Bone remodeling showed cancellous hypertrophy of the cortex, usually along the lateral cortex, and 7% had stress shielding (atrophy) of the proximal cortices. Adaptive bone remodeling almost always occurred in type B and C bone. Bone remodeling was statistically related to bone type, prosthetic fill, stem-bone ratio, and collar loading. We concluded that proximal bone ingrowth fixation with proximal load transfer provides good clinical results and excellent bone remodeling. Also, collar loading improves bone response. To expand this fixation in a predictable fashion to all type B and some type C bone requires geometry changes, which have been accomplished in the Anatomic Porous Replacement II.     

Effects of 2 h anesthesia with halothane on blood cell counts and serum biochemical values in sheep and calves

To examine the clinical pathology of halothane in ruminants, five healthy fat-tailed sheep aged 1 to 2 years weighing 35 to 55 kg and four healthy calves aged 2 to 4 months weighing 30 to 65 kg were used. Anesthesia was induced and maintained by halothane using a closed-circuit anesthetic machine. The average induction time was found to be around 5 min in sheep and calves. Hematological studies indicated that there was an increase in neutrophils, significantly different only in sheep at 2 h after anesthesia, and a moderate decrease in lymphocytes. Total white blood cell counts slightly increased during anesthesia. Packed cell volume (PCV) was significantly higher 1 day and 1 week after anesthesia in sheep, but not in calves. The pre-anesthetic serum cholesterol level was around three times greater in calves compared to its level in sheep. However, there was a significant decline in the cholesterol concentration in sheep during 2 h anesthesia. Creatine phosphokinase (CPK) was moderately increased after 2 h anesthesia in both sheep and calves. Moreover, ALT, AST, and ALP were slightly increased 1 day post-anesthesia. Liver biopsies taken 2 weeks after anesthesia were not indicative of any specific pathologic change in sheep or calves. There were no prominent alterations in other biochemical parameters during or after anesthesia. Therefore, it is generally concluded that halothane can be used to induce and maintain general anesthesia in sheep and calves with the least adverse effects on clinical laboratory parameters.     

Correlation of Internet Use for Health Care Engagement Purposes and HIV Clinical Outcomes Among HIV-Positive Individuals Using Online Social Media

The authors aimed to describe cell phone and Internet use and assess the correlation of Internet use for health care engagement purposes and HIV clinical outcomes among HIV-positive individuals. The authors conducted a national survey using online social media to examine cell phone and Internet use, self-reported HIV viral load (detectable vs. undetectable), and antiretroviral adherence rating (excellent vs. less than excellent). Participants (N = 1,494) were asked about their Internet use for health care engagement purposes (including e-mailing health care providers, refilling medications online, and making medical appointments online). Approximately 95% of participants accessed the Internet nearly daily or daily in the past month (mean hours on Internet use per day = 5.2) and 55.5% used the Internet for health care engagement purposes. Those who used the Internet for any health care engagement purposes had a 1.52-fold odds of reporting an undetectable viral load (p = .009) and a 1.49-fold odds of reporting excellent adherence (p = .001). Although Internet access and use were similar across racial/ethnic, educational, and socioeconomic groups, disparities existed with the use of the Internet for health care engagement purposes among racial/ethnic minorities, those with low to moderate financial stability, lower education, and history of incarceration. The authors’ data reveal that among HIV-positive users of online social media, use of the Internet for health care engagement purposes is associated with better self-reported virologic and adherence outcomes.     

Drug utilization evaluation of albumin in a teaching hospital of Mashhad,Iran: an interventional pre–post design study

Background Albumin is a protein colloidal solution with limited availability and high cost. It should be used in such approved indications as paracentesis, extensive burn, spontaneous bacterial peritonitis, and nephrotic syndrome. Objectives The aim of this study was to evaluate and compare the appropriateness of albumin usage before and after an evidence-based guideline. Setting Four wards of Imam Reza Hospital, Mashhad, Iran. Method An interventional pre–post design study was performed on 2 groups of patients; in gGroup 1 as a preparation phase group in 6 months from February 2015 to July 2015 and Group 2 as an interventional group from September 2015 to February 2016. A guideline for proper indications of albumin, designed and finalized based on the physicians’ comments, was implemented in Group 2. Main outcome measure The pattern of albumin consumption. Results Fifty patients were evaluated in each group. The implementation of the guideline resulted in reduction of improper albumin use from 62 to 57.5%, which was not statistically significant; however., it reduced inappropriate dose and duration of albumin therapy (55.5–16.7%), the number of consumed albumin vial, and the average cost for each patient (317.78 ± 3.15–149.81 ± 1.91 USD) significantly, as well. Conclusion This study illustrated that in this hospital in most cases, albumin was used inappropriately and at an alarming rate. This improved after the introduction of an evidence-based guideline. Moreover, guideline implementation resulted in significant cost reduction.     

Cooking Methods and Esophageal Squamous Cell Carcinoma in High-Risk Areas of Iran

Cooking methods have been implicated in the etiology of gastrointestinal cancers, reflecting exposure to potential carcinogens as results of cooking. We used a validated food frequency questionnaire and a pretested cooking method questionnaire in 3 groups: 40 esophageal squamous cell carcinoma (ESCC) cases from a high-risk area in northeast of Iran, 40 healthy subjects from the same high-risk area, and 40 healthy subjects from a low-risk area in Southern Iran. We compared the frequency of boiling, grilling, and frying, and the frying score among these 3 groups. We also calculated “frying index” by multiplying the frequency of each fried food item by its frying score. Mean frying to boiling ratios were 18.2:1, 12.8:1, and 2.6:1 for cases, high-risk controls, and low-risk controls, respectively (P < 0.01). Reuse of cooking oil for frying was reported in 37.5% of the ESCC cases, 25% of high-risk controls, and 7.5% of low-risk controls (P < 0.001). Frying index was higher in the high-risk than in the low-risk controls (P < 0.001) and in cases than in the high-risk controls (P < 0.05) after adjusting for smoking, opium use, rural residence, education, and ethnicity. High-temperature cooking and frying may be associated with increased risk of ESCC in high-risk areas.