Background:Obstructive sleep apnea (OSA) is associated with increased vagal activity, sympathetic nervous system activation, and cardiovascular complications. Excessive daytime sleepiness (EDS) in OSA patients is a predictor of cardiovascular and all-cause mortality. Heart rate variability (HRV) can be used to assess cardiac autonomic modulation, which is affected by OSA. This study aimed to evaluate the relationship between HRV and daily sleepiness in OSA patients based on the excessive sleep scale (ESS) scores.Materials and Methods:The study included 70 patients with OSA, divided into two groups: those with EDS (ESS ≥ 11) and those without sleepiness (ESS < 11). Time and frequency domain parameters were evaluated. The results were compared and analyzed between the two groups.Results:Patients with OSA and EDS had higher cardiovascular risk, as indicated by different HRV parameters (higher low-frequency parameter and higher time domain parameters), compared to non-sleepy OSA patients. A significant positive correlation was found between ODI and AHI with VLF, and significantly higher LF and VLF in EDS patients.Conclusion:OSA patients with EDS had higher cardiovascular risk, as indicated by different HRV parameters, compared to non-sleepy OSA patients. A significant positive correlation was found between ODI and AHI with VLF, and significantly higher LF and VLF in EDS patients. Further studies are needed to better understand the relationship between HRV and daily sleepiness in patients with OSA.

Background:There are some controversies on surgical options for pulmonary hydatid cysts. We analyzed our experience in lung tissue preservation during the surgical treatment and optimal surgical options.Materials and Methods:This observational cohort analysis was conducted from July 2008 to July 2022. The Age, sex, clinical manifestation, recurrent rate, hospital length of stay, postoperative complications, and long-term results in each group were assessed. The American Society of Anesthesiologists Physical Status, Charlson Co-Morbidity Index (CCI), Complexity of surgery, and Clavien-Dindo score were also determined.Results:Out of 138 patients, 81case (53.5%) had intact cysts (G1), and the rest were infected cysts which in turn were subdivided into early infected (G2) and cavity suppurated=28 cases (18.4%) as (G3). Group G3 required special attention because the pericyst surface was severely inflamed, dirty, and had pus, so they were subdivided into 3 distinctive groups including G3a, undergone cystectomy, bronchial opening closure alone, G3b group, undergone cystectomy, capitonnage+bronchial opening closure and G3c group, in which pericystectomy also added to previously mentioned procedures. Major complications in the subgroups of G3a were 2 patients and G3b 3 patients, but in the subgroup of G3c, no considerable complications were seen. Cystectomy, closure of major bronchial opening, and capitonnage were done in intact, and early infected cysts. The results of both were the same, with no considerable major complication.Conclusion:Capitonnage significantly decreased the complication rate. The optimized approach in both G1 and G2 was: cystectomy, closure of major bronchial opening, and capitonnage. In G3, bronchial opening closure, pericystectomy, and capitonnage were the preferred procedures.

Background:The novel coronavirus 2019 primarily affects the respiratory system and may lead to respiratory failure and the need for intubation. This study aimed to investigate the effect of chest physiotherapy on the clinical outcomes of patients with COVID-19.Materials and Methods:This randomized clinical trial was performed in 2022–2023. The research population included 58 patients with COVID-19 who were hospitalized at Izeh Shohada Hospital, Khuzestan. Patients in the control group received routine care, which included the use of supportive drugs based on the doctor’s opinion, oxygen therapy, and nutritional support. The intervention group received chest physiotherapy and breathing exercises for six days. At the end of the third and sixth days, the patients of both groups were evaluated in terms of lung function, respiratory gases, and the length of hospital stay. Moreover, the need for intubation was recorded during study time. Data analysis was done using SPSS version 23 software.Results:In the intervention group, a significant improvement was observed in FVC (P<0.01), FEV1(P<0.01), FEV1/FVC ratio (P<0.01), PaO2 (P<0.01), PaCO2 (P<0.01), and SPO2 (P<0.01) as well as the length of hospital stay (P<0.01) after the intervention. However, no significant difference was observed in the PaO2/FiO2 ratio (P>0.05) and the need for intubation (P>0.05).Conclusion:The results showed that in the new crisis resulting from COVID-19, chest physiotherapy and respiratory exercises could be used as a helpful method in improving lung function, respiratory gases, and reducing the hospital stay in COVID-19 patients.

Background:Echocardiography can be used for risk stratification in patients with acute pulmonary embolism (PE). While the severity of PE has been assessed through laboratory criteria in most studies, the Pulmonary Embolism Severity Index (PESI) scoring system was used in this study to evaluate the severity of echocardiographic criteria in acute PE patients.Materials and Methods:All PE patients admitted to Ghaem Hospital in Mashhad between 2021–2022 were included in the study. Clinical symptoms and echocardiographic markers were checked and recorded when the patients entered the study. Data were analyzed in SPSS version 24 at a significance level of 0.05 using the Chi-square test and t-test.Results:Of 40 patients, 80% were at a high risk of PESI. The most common clinical symptoms were dyspnea (97.5%) and pleuritic chest pain (75%). Right ventricle (RV) size enlargement and its dysfunction were recorded in 57.5% of patients. The average age of patients in the high-risk group was significantly (pvalue: 0.001) higher than the low-risk group. There was a significant correlation between MID-right ventricle and pulmonary artery pressure with the severity of embolism, so that mid-right ventricle and pulmonary artery pressure in the high-risk group were significantly higher (p-value: 0.000) than in the low-risk group. Also, the severity of PE was significantly related to RV size (P = 0.026) and function (P = 0.038).Conclusion:RV size, function, and dilatation, and pulmonary artery pressure variated significantly in different severities of PE.

Background:Neurosurgical operations, especially for brain tumors, are among the most stressful medical procedures due to diagnostic uncertainties, high morbidity, and long post-operative recovery, including ICU admission. Stress management interventions may improve outcomes. This study aimed to compare the effectiveness of Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI) in reducing perceived pre- and post-operative stress and ICU stay in patients undergoing brain surgery.Materials and Methods:In a quasi-experimental design, 80 neurosurgical candidates admitted to Shohadaye Tajrish Hospital during 2020–2022 were randomly assigned to intervention and control groups. The intervention group received 15 CBT-based sessions focused on stress management and cognitive restructuring. Stress levels were assessed using Cohen’s Perceived Stress Scale (1983), and CBT protocols followed Miller (2003). Data were analyzed with SPSS using chi-square tests, independent and paired t-tests, and ANCOVA.Results:Patients who received CBT demonstrated significantly lower perceived stress scores postoperatively (p<0.001) and had a shorter ICU stay by an average of 3.2 days (p=0.049). No significant demographic differences were observed between groups.Conclusion:CBT significantly reduces perioperative stress and ICU duration in neurosurgical patients. Integrating psychological interventions like CBT into preoperative care protocols may enhance recovery, reduce complications, and lower healthcare costs.

Background:Recent pieces of evidence have shown higher efficacy of continuous renal replacement therapy (CRRT) with regard to improvement of survival in critically ill patients by maintaining hemodynamic stability. The present study aimed to assess hemodynamic conditions before and after CRRT with the point-of-care approach.Materials and Methods:The present interventional before-after study was performed on 20 critically ill patients with unstable hemodynamic status admitted to the ICU at Masih-e-Daneshvari Hospital in Tehran in 2019. They were candidate for CRRT due to acute kidney injury (AKI). The main pointed parameters for assessment before and after CRRT included heart rate, mean arterial pressure (MAP), central vein pressure (CVP), the carotid corrected flow time (FTc), carotid peak systolic velocity (PSV), inferior vena cava collapsibility (cIVC), resistive index (RI), and inferior vena cava (IVC) size and distensibility aided by ultrasonography.Results:Regarding the changes in ultrasonography parameters after CRRT, except for carotid PSV, heart rate, and carotid area, other parameters showed a significant change. In this regard, IVC size, FTc, MAP, CVP, internal jugular vein (IJV) area, and RI all significantly decreased while IVC distensibility index significantly increased following CRRT. Similar changes were revealed in the subgroup of patients with hypotension, but in another subgroup without hypotension, the decrease in carotid PSV was also meaningful.Conclusion:Applying CRRT in AKI patients in critically ill situations can effectively balance cardiovascular and hemodynamic parameters and thus lead to more appropriate survival.

Background:Tuberculosis (TB) is clinically divided into two categories: pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB). PTB has many different manifestations, and sometimes the initial diagnosis is challenging and depends on the prevalence of infection as well as the experience and development of local medical centers. Thus, we aimed to review all EPTB patients in our referral center.Materials and Methods:This retrospective study reviewed all confirmed cases of EPTB referred to a referral/general center within the last decade.Results:This study included 68 cases of EPTB. Percentages of males and females were 58.8% and 41.2%, respectively. The majority of EPTB patients were TB meningitis (44.1%), followed by musculoskeletal TB (17.6%). About 8.8% of patients had a positive culture. The acid-fast bacilli test was found to be positive in 19.1% of cases. The mortality rate in this study was 19.1% and the highest rate of mortality was observed in intestinal and mesenteric TB (33.3%).Conclusion:According to this study, the majority of hospitalized EPTB patients had TB meningitis. The mortality rate in intestinal and mesenteric TB was higher compared to other types of EPTB, probably due to delayed diagnosis. In the current study, Positive results for smears and cultures were also low.

The evolution of anesthesia and anesthesiology represents a pivotal chapter in the history of medical science, significantly enhancing patient care and surgical outcomes. General anesthesia, defined as the deliberate induction of a temporary state of pain relief, muscle paralysis, memory impairment, and unconsciousness, has revolutionized medical procedures by inhibiting the normal functioning of the central nervous system. In Iran, the journey of anesthesiology began with early contributions from ancient scholars and practitioners, whose innovative techniques laid the groundwork for future advancements. The field witnessed significant progress in the mid-20th century, aligning with global developments in medical science. Initially focused on intraoperative care, anesthesiology in Iran expanded to encompass preoperative evaluations, postoperative assessments, and comprehensive patient monitoring, addressing complications related to surgery and anesthesia. In addition to analyzing the evolution of anesthesiology from solely surgical intervention to a broader field encompassing preoperative evaluation, postoperative care, and critical care management, this paper addresses the challenges and opportunities facing anesthesia and anesthesiology in Iran, including the need for wider access to safe and reliable services and the integration of advanced technologies.

Background:Asthma impacts the quality of life (QOL) of patients and their families. The magnitude of this morbidity is influenced by several factors, including age, disease duration, and others. This study was conducted to determine the predictors of quality of life in patients with asthma in Ahvaz, Iran.Materials and Methods:This cross-sectional study was conducted among patients referred to the pulmonary clinics of Imam Khomeini and Golestan hospitals in Ahvaz in 2022. The quality of life was assessed using the SF-36v2 questionnaire. The effect of socio-demographic characteristics on quality-of-life scores was examined by t-test, one-way variance (ANOVA), Pearson’s correlation coefficient, and regression models.Results:From a total of 204 studied asthmatic patients, the average age of patients was 43.22±15.17 years. The average QOL in patients was 57.69±22.97. Physical role and social functioning had the lowest and highest mean scores among SF-36 dimensions, respectively. A significant difference was observed between the average QOL score and the variables of age, gender, education level, employment status, illness costs, illness severity, daily exercise, and number of visits (P<0.05). Most clinical, socio-demographic, and economic variables were predictors of SF-36, PCS, MCS, and QOL dimensions (P<0.05).Conclusion:This study showed that the quality of life in asthmatic patients is affected by the severity of the disease, number of visits, age, sex, and education. By performing appropriate interventions on social and economic factors, the quality of life of asthmatic patients can be improved.