Background: Intraoperative awareness occurrence ranges between 0.005% and 1.12% of general anesthesia cases and could be a devastating experience for a patient. The incidence of intraoperative awareness in total intravenous anesthesia (TIVA) is higher than in volatile anesthesia without the depth of anesthesia (DOA) monitoring. This retrospective study aimed to evaluate the incidence of intraoperative awareness with recall during TIVA in the isolated health facility. Methods: We performed a retrospective analysis of the incidence of intraoperative awareness with recall during TIVA that involved a large number of patients over 10 years (from January 2008 to July 2018). Cases of death, coma, dementia, severe psychological disorder, incomplete data, or patients aged under 20 years were excluded from this study. All data from the operating rooms' database and the anesthesia records were analyzed. Intraoperative awareness was detected by the patients who spontaneously self-reported accidental awareness during postoperative anesthetic visits within 2 days following the surgery. Moreover, we also visited highly suspected intraoperative awareness patients on a postoperative day 1 for clarifying intraoperative awareness with recall. Results: Of 13,002 patients under TIVA, 11,433 were included in this study. Two confirmed cases of intraoperative awareness were detected, with an incidence of 0.017% (2 of 11,433). As of the type of surgery, a 67-year-old male received elective general surgery and another 45-year-old male received elective orthopedic surgery. Only one patient was under DOA monitoring, and in both instances, no long-term psychological sequelae were reported. Conclusions: This study suggests that the incidence of intraoperative awareness during TIVA is a very rare event if the well-trained anesthesia staff for TIVA is present and when the DOA monitoring is routinely used in high-risk patients. Furthermore, based on the study data, we conclude that the two intraoperative awareness cases could have been prevented.

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Childhood hearing loss (HL) can be attributed to both environmental and genetic factors, therefore it can be congenital or acquired in nature. The effect of childhood HL is on language development, literacy, self-esteem, and social skills. Taking into account the negative impact of HL in children, this review article aims to bring into attention of the medical community the different causes of HL in children and the methods of screening and diagnosing HL in children.

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Atrial fibrillation (Af) with acute myocardial infarction (AMI) is a life-threatening disease, and electrocardiogram is indispensable for the initial diagnosis of high-risk patterns in the emergency department. Here we report a case of a 63-year-old male of Af with AMI, presented with isolated elevation of the precordial V2 lead ST-segment, mostly arising from major occlusion of the left main coronary artery and right coronary artery.

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Background: Clinical applications of transsylvian-transinsular (TS-TI) approaches to hypertensive basal ganglia hemorrhages (HBGHs) have an enormous difference in functional independence rate. The aim of this study is to investigate the clinical efficacy of minipterional craniotomy with rostral TS-TI approach to HBGH and compare functional independence rate with distal TS-TI variant. Methods: From April 2017 to April 2019, eleven patients with symptomatic HBGH accepting minipterional craniotomies with rostral TS-TI approaches were analyzed retrospectively. Results: The mean volume of preoperative hematoma was 57.08 ml with a 99.20% evacuation rate. Postoperative images revealed no rebleeding or newly developed hypodense lesion. Nine out of eleven patients got clear consciousness with functional independence at 3 months postoperatively. Conclusions: In comparison with distal TS-TI approach, minipterional craniotomy with rostral TS-TI approach to HBGH provides satisfactory outcome with higher functional independence rate.

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Simple hematoma evacuation is often performed in cases of chronic subdural hematoma (CSDH) associated with arachnoid cysts (ACs) on the same side after head injury. However, it is not clear which procedure is appropriate when ACs and CSDH are located on different sides. Here, we present a case of a 3-year-old boy with right frontal–temporal subdural hematoma and an AC over the left frontal–temporal region. Treatment involved craniotomy with hematoma evacuation, but no drainage of contralateral AC was applied. The patient was discharged 7 days after surgery without any neurologic deficits and no symptoms of headache or poor appetite. These results suggest that craniotomy and hematoma evacuation without intervention for the AC is adequate in patients with contralateral CSDH with a large AC.

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Background: Low birth weight (LBW) is related with high morbidity of neonatal consequences and death. This study aimed to determine the incidence of LBW, its risk factors, and complications in born neonates in Qom, Iran 2017. Methods: This retrospective chart review was conducted with 602 newborns participants who were one of Qom hospitals in Iran. Data were extracted from the patients' medical records and entered into data collection sheet and were analyzed by t-test, Chi-square, Fisher exact, and independent t-tests in SPSS v. 18 software. Results: The overall incidence of LBW in born neonates was 9.6%, and the mean of maternal age was 28.8 years. Based on results, twin's birth (Odds ratio [OR] = 1.47), receiving corticosteroid (OR = 4.55), and premature rupture of membrane (PROM) (OR = 1.08) were the most important related factors of LBW and respiratory distress syndrome (RDS) (OR = 6.47.8), sepsis (OR = 5.36), and icterus (OR = 5.8) consequences of LBW. Nevertheless, poor feeding, hypoplasia, premature, tachypnea, meconium, intraventricular hemorrhage, hypotonic, and other neonatal complications do not show the significant relationship with LBW (P > 0.05). Conclusions: According to results, twin's births, receiving corticosteroid, and PROM are the important risk factors for LBW and RDS, sepsis and icterus were the most common complication of LBW. As a result, preventive programs for control of LBW and infant complications are essential.

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Background: In the past decade, Tri-Service General Hospital has trained many actors-background standardized patients (SPs). However, we also have recruited some nonactor SPs since 2010. Reviewing the literature, the reliability of SPs with or without actor background would be the impact factor on high-stakes OSCE has not been well studied. Aim: The purpose of this retrospective observation is to clarify whether a SP with or without a professional actor background will affect the performances of the examination when participating in the Taiwan high-stakes objective structured clinical examination (OSCE). The result will be the policy for selecting which kind of SPs to participate in the high-stack OSCE in our hospital. Methods: In this retrospective observation, we analyzed 74 actor background SPs (A-SPs), and 70 no actor background SPs (NA-SPs) who have participated in each spring test of 2015–2017 Taiwan high-stakes OSCE. The data of SPs performance have come from two parts: one is from the examinee with the global rating of the SPs performance and the other is from the examiner with eight-item checklist for the SPs performance. The scoring of both examinee and examiner is a five-point Likert scale. Results: The results show that there is no significant difference in SPs performance from the examinee scoring in the subsequent 3 years, stable and satisfactory, and let examinees feel like real patients. The scores from examiners also showed that two groups of SPs performed equally well without significant differences. Their performance is reliable and consistent, simulating to be a real patient in both groups. However, only one interest finding, when compared to the different age subdivision of SPs, showed the aged subgroup of A-SPs and NA-SPs with the significant difference in the item of reliability and consistent (4.67 ± 0.53 vs. 4.41 ± 0.50, P < 0.05), the possible reason is related to the less-experienced associate with mild memory decline in aged NA-SPs.Conclusions: Our observation gives the essential information, that the well-trained and experienced SP are necessary for participating in the high-stakes OSCE examination, even without the background of the actor. What we need is a professional SP who not only has excellent professionalism but also has a good personality literacy to engage in his/her work.

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Pulmonary neuroendocrine tumor is a subtype of lung cancer, which does not have favorable outcome. The small-cell and large-cell variants of this cancer comprise 20% of all lung cancers. However, large-cell neuroendocrine tumor (LCNET) is not frequent and seen in about less than 3% of cases of lung cancer. Here, we describe a young nonsmoker male with the unholy triad of LCNET, newly diagnosed diabetes mellitus, and skin metastasis.

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