Background: Opioids, though central to anesthesia, are associated with adverse effects such as respiratory depression, immunosuppression, postoperative ileus, nausea, delirium, and opioid-induced hyperalgesia, all of which hinder recovery. Thus, implementing opioid-free anesthesia strategies has become a critical and necessary evolution in modern anesthetic practice. Objectives: The present study was designed and implemented with the aim of evaluating opioid-free anesthesia and its effects on clinical outcomes in thoracoscopic surgery. Methods: Sixty patients were randomly assigned to two groups (opioid-free and opioid). All patients in both groups underwent surgery performed by the same surgeon. In the control group, anesthesia was induced with fentanyl (1 - 3 μg/kg), midazolam (0.02 mg/kg), atracurium (0.5 mg/kg), and propofol (1.5 - 2.5 mg/kg), and maintained with isoflurane (up to 1 MAC). In the opioid-free group, fentanyl was replaced with ketamine (0.5 mg/kg), and dexmedetomidine (0.6 μg/kg/h) was added for maintenance alongside isoflurane. Postoperative analgesia in both groups included intravenous acetaminophen for visual analog scale (VAS) > 3, as rescue. Clinical parameters (heart rate, blood pressure, respiratory rate, pruritus, nausea/vomiting) and VAS pain scores were assessed at 0, 2, 4, 6, 8, 12, 18, and 24 hours, and complications were evaluated postoperatively. Results: The opioid-free group showed significantly lower heart rate at 6, 8, and 12 hours postoperatively compared with the opioid group (P < 0.05). VAS pain scores were also significantly lower during recovery and at 2, 12, and 18 hours after surgery. Significant postoperative differences were observed between groups in C-reactive protein (CRP), blood urea nitrogen (BUN), and creatinine levels. Conclusions: The results of this study add to the growing body of evidence supporting the feasibility and safety of opioid-free anesthesia in thoracoscopic surgery.

Background: Airway management is a routine part of any type of anesthesia; therefore, the present study was designed to compare the effect of transtracheal dexmedetomidine and transtracheal lidocaine in patients undergoing bronchoalveolar lavage and other adverse events. Methods: Individuals aged 18 to 65 years that were candidates for bronchoalveolar lavage in three groups were included in the study. All three groups of patients underwent a standard treatment with the same anesthesia method with the same treatment group. Patients were administered lidocaine (4 cc 2% lidocaine), dexmedetomidine (0.5 g/kgµ dexmedetomidine), and lidocaine + dexmedetomidine (4 cc 2% lidocaine + 0.5 g/kgµ dexmedetomidine) groups. Results: A total 150 patients with a mean age of 57.2±16.32 were evaluated in three equal groups. The clinical status of the patients showed that the patients in the combined use of dexmedetomidine and lidocaine group underwent sedation significantly more than the other two groups. The incidence of cough in dexmedetomidine and lidocaine group of patients was significantly lower than in the other groups. Conclusion: The simultaneous use of transtracheal lidocaine and dexmedetomidine significantly reduces the incidence of cough in patients undergoing bronchoalveolar lavage.

Mechanical ventilation (MV) causes a wide range of cognitive impairments. Unfortunately, to date, we are lacking knowledge about its underlying neural mechanisms and significant treatment options for the condition. Here, we show that MV-induced memory impairment in rats stems from dysfunctions in the olfactory bulb-medial prefrontal cortex-ventral hippocampus network and hippocampal synaptic currents imbalance. More importantly, we introduce a novel treatment approach, namely olfactory epithelium electrical stimulation (OEES) that shows promising preclinical results in mitigating the mentioned behavioral and neural disorders caused by MV. These results pave the way for research on non-invasive brain stimulation approaches and introduce the olfactory system as a potential target for treating cognitive or psychiatric disorders induced by MV.

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:Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder associated with multisystem organ involvement. The STOP-BANG questionnaire is a short and valid questionnaire used to screen OSA. This study aimed to investigate the ability of the STOP-BANG questionnaire to predict postoperative OSA- related respiratory complications in patients undergoing bariatric surgery. Materials and Methods:In this cross-sectional study, all the eligible patients were evaluated in preoperative visits using a predetermined checklist including demographic and clinical information related to OSA and the STOP-BANG questionnaire. After bariatric surgery, patients were assessed for postoperative OSA-related complications. The receiver operating characteristic (ROC) curve was used to determine the cut-off point of the STOP-BANG checklist score based on the patient's postoperative outcomes. Results:In total, 115 subjects were included in the study. There were significant associations in terms of gender, age, body mass index (BMI), patient's neck circumference, diabetes, heart diseases, and the mask ventilation grade variables between the two groups of patients with high risk and low risk according to the STOP-BANG questionnaire (P < 0.05 for all comparisons). In addition, ai rway obstruction and hypoxia (mild and moderate) were more prevalent in the high-risk group than in the low-risk one (P < 0.05 for all comparisons). A significant difference was reported with a cut-off score of 2 in the STOP-BANG questionnaire for those with and without airway obstruction. Moreover, the cut-off point of 4 in the STOP-BANG questionnaire was determined as a predictor for both airway obstruction and mild-to-moderate hypoxia. Conclusion:STOP- BANG scores may be used as a preoperative risk stratification tool to predict the risk of intraoperative adverse events and postoperative complications in bariatric surgery.

Introduction: This study assessed the incidence and severity of side effects associated with coronavirus disease 2019 (COVID-19) vaccination among healthcare workers registered with the Medical Council of the Islamic Republic of Iran. Methodology: A retrospective cohort study was conducted on the healthcare workers focusing on the side-effects of COVID-19 vaccines from March to June 2021. Data were collected using online questionnaires. Multivariable logistic regression was used to assess the association between side effects of the vaccines and demographic variables, comorbidities, vaccine type, and history of COVID-19. Results: Out of 42,018 people who were included, 55.85% reported at least one side effect after receiving the first vaccine dose. 4.59% of those with side effects sought diagnostic intervention or were referred to treatment centers. Multivariable logistic regression indicated that being a woman, higher education, having a history of COVID-19 infection, and having comorbidities increased the risk of side effects. The AstraZeneca vaccine significantly increased the risk of side effects compared to the Sputnik vaccine, while the Sinopharm vaccine decreased this risk. The risk of developing a side effect decreased with age. The risk of moderate and severe side effects was significantly associated with gender, younger age, comorbidities, and a history of COVID-19 infection. Moderate and severe side effects were less reported by those who received the Sinopharm vaccine. Conclusions: Clinical complications after COVID-19 vaccination, directly or indirectly caused by the vaccines, are common. However, the benefits of COVID-19 vaccines greatly outweigh the risk of reversible side effects, especially among the high-risk population.

AIMS:Allergic asthma is associated with anxiety-related behaviors, leading to poor quality of life. Previous studies mainly described the neuropathophysiology of asthma-induced anxiety. However, the effects of corticosteroids, the most common anti-inflammatory agents for asthma treatment, on the neurophysiological foundations of allergic asthma-induced anxiety are unexplored.MAIN METHODS:Here, we evaluated lung and brain inflammation as well as anxiety in an animal model of allergic asthma pretreated with inhaled fluticasone propionate. Furthermore, to define the neurophysiological bases of these conditions, we studied the medial prefrontal cortex (mPFC)-amygdala circuit, which is previously shown to accompany asthma-induced anxiety.KEY FINDINGS:Our data showed that allergen induces anxiety, mPFC and amygdala inflammation, as well as disruptions in the local and long-range oscillatory activities within the mPFC-amygdala circuit. Interestingly, we observed a roughly consistent trend of changes with inhaled fluticasone pretreatment. Namely, the asthma-induced behavioral, inflammatory, and neurophysiological changes were partly, but not totally, prevented by inhaled fluticasone pretreatment.SIGNIFICANCE:We suggest that early treatment of asthmatic patients with inhaled corticosteroids improves mPFC-amygdala circuit function by attenuating neuroinflammation leading to reduced anxiety. These findings could lead clinical guidelines of asthma to consider the neuropsychiatric disorders of patients in treatment recommendations.

BackgroundPattern recognition receptors (PRRs) as the recognition of pathogenic fungal structures induce the secretion of cytokines by immune systems. Toll-like receptors (TLRs) 2 and 4 are the main PRRs that recognize fungal components. AimThe present study aimed to assess the presence of dermatophyte species in symptomatic cats in a region of Iran and to investigate the expression of TLR-2 and 4 in cat lesions with dermatophytosis. MethodsA total of 105 cats suspected of dermatophytosis with skin lesions were examined. Samples were analysed by direct microscopy using potassium hydroxide (20%) and culture on Mycobiotic agar. Dermatophytes strains were confirmed by the polymerase chain reaction (PCR) amplification and then sequencing of the Internal Transcribed Spacer rDNA region. Also, for pathology and real-time PCR studies, skin biopsies were taken by sterile single-use biopsy punch from active ringworm lesions. ResultsDermatophytes were found in 41 felines. Based on the sequencing of all strains, Microsporum canis (80.48%, p < 0.05), Microsporum gypseum (17.07%) and Trichophyton mentagrophytes (2.43%) were the dermatophytes isolated from cultures. Cats under 1 year (78.04%) revealed a statistically significantly higher prevalence of infection (p < 0.05). Gene expression by real-time PCR revealed the increased TLR-2 and 4 mRNA levels in skin biopsies of cats with dermatophytosis. ConclusionsM. canis is the most prevalent dermatophyte species isolated from feline dermatophytosis lesions. Increased expression of TLR-2 and TLR-4 mRNAs in cat skin biopsies suggests that these receptors are involved in the immune response by recognizing dermatophytosis.

Purpose This study aimed to evaluate the cost-effectiveness of cetuximab in different genetic populations of metastatic colorectal carcinoma patients, including KRAS and RAS wild types and mutants, when added to FOLFIRI treatment regimens for evidence-based disease management in Iran. Method A Markov decision model was designed in TreeAge software with the three states of stable, progress, and death. Clinical outcomes were extracted from published clinical studies, and costs were extracted from the Iranian local data. The primary outcome was an incremental cost-effectiveness ratio (ICER) in the simulated population. Results The cost-utility model from the perspective of the health system indicated that the average direct medical costs of a patient that has not been genetically screened are $56985.27 and $20767.74 in FOLFIRI + cetuximab and FOLFIRI regimens, respectively. However, costs per patient in the KRAS wild-type population were $21845.52 in FOLFIRI and $78,321.22 in FOLFIRI + cetuximab. In RAS wild-type patients, FOLFIRI and FOLFIRI + cetuximab costs per patient were $23111.62 and $84976.39, respectively. Incremental QALYs for the above scenarios were 0.069, 0.193, and 0.285, respectively. Therefore, the ICER of add-on cetuximab in Iran compared to the treatment alternatives in the scenarios with and without KRAS screening was $520771.55/QALY, $292768.16/QALY, and $217460.51/QALY. Conclusion Although genetic screening in precision medicine reduces costs per outcome, according to the willingness-to-pay threshold of $4349.50 in the Iranian health system, add-on cetuximab to the FOLFIRI regimen is not a cost-effective strategy even with genetic screening and a 20% price reduction.

Mechanical ventilation (MV), as a life-saving procedure in critical patients, is a risk factor to develop of neurocognitive dysfunction and triggers of inflammation and apoptosis in the brain. Since diversion of breathing route to the tracheal tube diminishes brain activity entrained by physiological nasal breathing, we hypothesized that simulating nasal breathing using rhythmic air-puff (AP) into the nasal cavity of mechanically ventilated rats can reduce hippocampal inflammation and apoptosis in association with restoring respiration-coupled oscillations. We found that stimulating olfactory epithelium through applying rhythmic nasal AP, in association with reviving respiration-coupled brain rhythm, mitigates MV-induced hippocampal apoptosis and inflammation involving microglia and astrocytes. The current translational study opens a window for a novel therapeutic approach to reduce neurological complications induced by MV.

Background: Supporting domestic production, by assuming its effect on the increase of accessibility, has been acknowledged as one of the main pharmaceutical policies from two dimensions of better provision of the drugs in the market and the increase of affordability by reducing prices. Therefore, it is expected from the domestic industries to produce pharmaceutical products that, in addition to increasing access and a sustainable supply of drugs, have competitive prices compared to the rival imported products, and reduce the medical costs imposed on patients and the health system. In this study the price of domestically produced drugs were compared with the price of the similar generic ones in India. Methods: In this study, first, India was selected for comparison due to reasons such as low price, good quality, and the possibility of commerce despite sanctions. Then, from the Iranian pharmaceutical statistics, drugs which were only produced in Iran and were highly consumed with respect to the number of sales were included in the study. Prices of Iranian and Indian medicines were extracted from related valid websites. Finally, the price of 110 drugs were compared to determine the success rate of the domestic production industry in offering a reasonable price in the absence of foreign competitors. Results: According to the findings from 57 % of the drugs under study, the median consumer price of these drugs in India was lower than the Iranian consumer price. If this comparison was made with the minimum price of the Indian medicine, this percentage would reach 88. Conclusion: According to the findings mentioned above, it can be concluded that reducing the drugs prices and costs does not occur in all cases of domestic production, and this alone cannot be a good justification for a complete support of the domestic production of drugs; however, it should be noted that reducing costs is not the only reason to support domestic production of these products, and policy makers may act with regard to other factors in line with supportive policies; thus, the reasons regarding each case should be clearly defined for the health system.

Prostate Cancer Associated Non-Coding RNA 1 (PRNCR1) is a long non-coding RNA (lncRNA) which is transcribed from chromosome 8, plus strand. This lncRNA has been reported to be an oncogenic transcript participating in the pathogenesis of several kinds of cancers. Some single nucleotide polymorphisms within this lncRNA affect cancer risk. Moreover, few studies have revealed its possible roles in some non-neoplastic conditions, such as cisplatin-induced acute kidney injury, osteolysis after hip replacement, preeclampsia and pulmonary disorders. In the present narrative review, we explain diverse roles of PRNCR1 in human disorders.

OBJECTIVES:Coma state and loss of consciousness are associated with impaired brain activity, particularly gamma oscillations, that integrate functional connectivity in neural networks, including the default mode network (DMN). Mechanical ventilation (MV) in comatose patients can aggravate brain activity, which has decreased in coma, presumably because of diminished nasal airflow. Nasal airflow, known to drive functional neural oscillations, synchronizing distant brain networks activity, is eliminated by tracheal intubation and MV. Hence, we proposed that rhythmic nasal air puffing in mechanically ventilated comatose patients may promote brain activity and improve network connectivity.MATERIALS AND METHODS:We recorded electroencephalography (EEG) from 15 comatose patients (seven women) admitted to the intensive care unit because of opium poisoning and assessed the activity, complexity, and connectivity of the DMN before and during the nasal air-puff stimulation. Nasal cavity air puffing was done through a nasal cannula controlled by an electrical valve (open duration of 630 ms) with a frequency of 0.2 Hz (ie, 12 puff/min).RESULTS:Our analyses demonstrated that nasal air puffing enhanced the power of gamma oscillations (30-100 Hz) in the DMN. In addition, we found that the coherence and synchrony between DMN regions were increased during nasal air puffing. Recurrence quantification and fractal dimension analyses revealed that EEG global complexity and irregularity, typically seen in wakefulness and conscious state, increased during rhythmic nasal air puffing.CONCLUSIONS:Rhythmic nasal air puffing, as a noninvasive brain stimulation method, opens a new window to modifying the brain connectivity integration in comatose patients. This approach may potentially influence comatose patients' outcomes by increasing brain reactivity and network connectivity.

Asthma is a chronic inflammatory disease associated with a high prevalence of psychiatric disorders. There are specific brain networks responsible for emotional processes, including two important networks associated with psychiatric problems: the default mode network (DMN), which is more active in the resting state, and the salience network (SN), which is structurally connected to DMN. Although previous studies suggested that neuro-phenotypes of asthma may be recognizable by the neural activity of brain circuits, an association between the brain's functional alterations and psychiatric impairments induced by asthma remains unknown. We aimed to assess DMN and SN activity and its association with psychiatric indices and clinical parameters in asthmatic patients. Electroencephalography was recorded during the resting state with an awake and eyes-open condition in thirty-eight sex and age-matched subjects (19 atopic asthma patients and 19 healthy participants). Power spectrum and functional connectivity were computed for DMN and SN. We examined psychiatric disorders (including depression, anxiety, and stress) and pulmonary function using the DASS questionnaire and spirometry test, respectively. The results showed that DASS scores were significantly higher in asthmatic patients compared to healthy subjects. Asthmatic patients also demonstrate a significant enhancement in power and functional connectivity in the two networks. Notably, these power enhancements of the networks were correlated with psychiatric problems scores, pulmonary function, asthma duration, and poor asthma control. These results introduce new evidence for the association between altered brain activity, the existence of psychiatric disorders, and asthma-related features, including pulmonary function. Also, we provide new insights into asthma-induced inflammatory response and the importance of developing novel interventions and therapeutic strategies for managing allergic inflammation patients who suffer from concurrent psychiatric disorders.

Background: Length of stay is necessary when discussing health care and cost reduction. There is a complex relationship between hospitalization in the emergency department and the outcomes of patients transferred to the ICU. This study aimed to determine the relationship between the length of stay in the emergency department and the results in head trauma patients.Methods: This retrospective analytical cross-sectional study was conducted on 257 patient files selected from 3810 cases from a medical center in Iran over five years. The data included personal and clinical information of the patients.Results: The primary outcomes indicated that cardiopulmonary resuscitation (31.77%, n=88) and mortality (31.41%, n=87) had occurred the most. The mean, standard deviation, and median of the duration of intubation were 10.6 +/- 8.2 and 8.4 days. The three mentioned values were 10.4 +/- 8.5 and 7.8 days for the length of stay in the ICU and 16.1 +/- 11.5 and 12.4 days for the length of hospital stay. Moreover, results indicated that the patients who stayed a shorter time in the trauma emergency department had a shorter duration of intubation and hospital stay.Conclusion: Length of stay in the emergency department is related to the primary and secondary clinical outcomes. Treatment time for patients with trauma in the emergency department should be minimal.

Background: Candida albicans has been shown as the most common species of Candida collected from different animals. Objectives: This study aimed to evaluate the genetic diversity and genetic relationships among C. albicans isolates collected from clinical specimens of animals suffering from candidiasis using microsatellite length polymorphism (MLP).Methods: We used MLP for a group of 60 C. albicans strains isolated from various animal species (dog: 16, cat: 10, horse: 10, cow: 14, chicken: 10), previously defined as animal clinical isolates. Three loci, including EF3, CDC3, and HIS3, were amplified, and the products ran onto an ABI XL 370 genetic analyzer, and fragment sizes were determined.Results: Of the 60 clinical strains illustrated, 49 different genotypes were identified with a discriminatory power index of 0.991. A total of 17 alleles and 26 different combinations were identified for EF3 locus, six alleles and 13 combinations for CDC3 locus, and 17 alleles and 27 combinations for HIS3 locus. The most common genotypes were GP9 (four strains) and GP1 and GP33 (three strains). Wright's fixation index (FST) values were calculated to assess inter-group genetic diversity for all pairwise combinations of the five sub-populations of C. albicans isolated from the different animal hosts. The highest FST values related to C. albicans isolated from chicken to three sub-populations of cats (FST: 0.1397), cows (FST: 0.0639), and horses (FST: 0.0585).Conclusions: The results indicated a moderate genetic differentiation (0.05 < FST < 0.15) between C. albicans strains isolated from cats, cows, and horses as a mammal vs. chickens.