Return to work after trauma: A survival analysis

Purpose: To evaluate the return to work (RTW) rate, time and predictors among trauma patients using survival analysis. Methods: This cohort study was conducted with a three-month follow-up on 300 trauma patients hospitalized in Shahid Beheshti Hospital, Kashan, Iran in 2014. The data were collected through conducting interviews and referring to patients'' medical records during their hospital stay and follow-up information at one & three months after discharge from hospital. Final analysis was conducted on the data retrieved from 273 patients. Data were analyzed by chi-square test, ManneWhitney U test and survival analysis method. Results: The rate of RTW at the end of the first and the third follow-up months was respectively 21.6% and 61.2%. Survival analysis showed that the RTW time (Time between admission to first return to work) was significantly longer among patients with illiteracy, drug abuse, hospitalization history in the intensive care unit, low socioeconomic status, non-insurance coverage, longer hospital stay, multiple and severe injuries as well as severe disability. Conclusion: Our findings indicated that trauma has profound effects on the rate and time of RTW. Besides disability, many personal and clinical factors can affect the outcome of RTW.     

Association of anesthetic toxic isoflurane gases of the indoor air of operating room,Ahvaz, Iran during 2016

Operating rooms (ORs) in hospital wards are very important because of special conditions of patients. The hazards of contact with low concentrations of anesthetic gases (AG) are undeniable. Nowadays AG isoflurane is one of the important pollutants which is in the air of ORs and used in anesthesia. The purpose of this study was to evaluate the level of anesthetic toxic isoflurane gases of the indoor air of Razi, Golestan and Emam educational hospitals ORs, using active sampling system during 2016. In this study, in order to sampling and detection of isoflurane concentration (ppm), a portable pump (SKC pump) and tubes (Sorbent Tube Tenax TA 250?mg) were utilized. The sampling was done in three different points of the ORs. According to this study, the “Razi” and “Emam” hospitals had the highest and the lowest isoflurane concentrations. According to the results of this study, isoflurane concentrations in three main educational hospital ORs affiliated to the Ahvaz Jundishapur University of medical sciences were 2.342, 2.15 and 2.04?ppm, respectively. According to this study, the average concentration of isoflurane in three main educational hospitals was more than recommended scales by international organizations (2?ppm) and it sounds that exposure to this amount of gas would be the cause of health disorders for staff. The results showed that the mean of isoflurane concentration in different parts of ORs with standard ventilation system was significantly lower than those ORs in which they did not have standard ventilation. While environmental health management and AG contamination in ORs have been ignored, they can cause disorders in ORs’ staffs and causing more spiritual and material costs.     

Reevaluation of an Old Electrocardiographic Criterion for Coronary Disease: TV1 > TV6

Background: Two different studies were conducted to evaluate the value of T wave in V₁ taller than T wave in V₆ (TV₁ > TV₆) pattern as an indicator of coronary artery disease. Method: In the first study 5,300 resting ECGs were examined and the criterion was found in 283 patients. All of these patients were examined with echocardiography. In the second study, ECG tracings and coronary angiograms of another 500 patients were evaluated. Results: In the first study, in 59 of 283 patients left ventricular hypertrophy was detected and these patients were excluded from the study. There were ST segment-T wave changes and/or Q wave on ECG suggesting coronary ischemia or myocardial infarction in 160 of the 224 patients. TV₁, > TV₆ criterion was the sole finding in 64 of the 224 patients. All of the 224 patients underwent coronary angiography and coronary artery disease was detected in 185 patients; 134 of the 160 patients (83.3%) and 51 of 64 patients (80%) had one-vessel or multivessel disease. There was no significant difference among the groups regarding coronary artery disease. Left anterior descending artery was involved in all of the 185 patients. In the second study, 408 patients were found to have coronary disease involvement and 92 patients showed normal or insignificant coronary disease. Sixty-six of the 408 patients with coronary disease and four of 92 patients were found to have the TV₁ > TV₆ pattern. Sensitivity of the criterion was 16.1%, specificity was 95.6%, and accuracy was 94.2%. Conclusions: According to these results, it is concluded that TV₁ > TV₆ with or without other ECG findings is a good criterion suggesting coronary artery disease, especially left anterior descending artery involvement in patients without left ventricular hypertrophy. A.N.E. 1999;4(4):397–400     

Durable complete response to pembrolizumab in microsatellite stable colorectal cancer

IntroductionImmunotherapy by checkpoint inhibitors, i.e., anti-programmed death-1(PD-1) or anti-programmed death-ligand 1 (PD-L1) antibodies, has gained more attention managing solid tumors. Pembrolizumab (an anti-PD-1 antibody) in metastatic colorectal cancer (CRC) was approved in 2017 by the US FDA.Reason for the reportPembrolizumab is not effective in microsatellite stable, mismatch-repair-proficient (MSS-pMMR) molecular phenotype, which comprises most CRC patients. In this report, we present the first case of metastatic CRC with a dramatic and durable response to pembrolizumab despite being of MSS-pMMR phenotype.Case summaryA 34-year-old woman, presented seven years ago with T3N2bM0 colon cancer and an appendix carcinoid tumor. The last relapse with bilateral pulmonary metastases was refractory to all treatments. Although it seemed unresponsive to immunotherapy because of MSS molecular phenotype, due to the high expression level of PD-L1 (85%), we started treatment with pembrolizumab 200 mg every three weeks and continued for the overall 19 courses. Surprisingly, a rapid and complete response was observed that last until now, i.e., 17 months after discontinuation of pembrolizumab.OutcomeDespite non-promising results in the current clinical trials, MSS-pMMR colorectal cancer patients'' deprivation from immunotherapy seems not to be reasonable. There are ongoing clinical trials on checkpoint inhibitors either alone or in combination with other drugs. However, immunostaining for PD-L1 should be considered as a possible response predictor.Graphical abstractImmunotherapy either by cell-based approaches or by checkpoint inhibitors may revolutionize cancer treatmentPembrolizumab has been approved by the FDA in 2017 for colorectal cancer.However, MSS-pMMR molecular phenotype which comprises the majority of CRC patients, has not shown a good response to checkpoint inhibitors.We present a MSS-pMMR case with complete and durable response to pembrolizumabWe suggest immunostaining for PD-L1 as a possible response predictor to checkpoint inhibitors