[Assessment of the diagnostic and therapeutic characteristics of patients with urologic trauma referred to Hazrat Rasoul-e-Akram hospital between 2007 and 2008]

The mortality rate of car crashes in Iran is very high worldwide. Most of these injured persons have urologic injuries. In our country, the prevalence of urologic injuries accompanied by multiple traumas is about 10-12%. The aim of this study was to evaluate the epidemiology of patients with urologic trauma and the diagnostic and therapeutic modalities. We used a check list that consisted of the etiology of trauma, urologic trauma, co-morbid trauma, vital signs, diagnostic procedures, type of treatment and final outcome. The files of 76 patients with multiple injuries accompanied by urologic trauma that had referred to emergency department of Rasool Akram hospital between 2007 and 2008, were evaluated. We used t, Chi-square, One way ANOVA and their equivalent non parametric tests in our statistical analysis. SPSS V. 16.0 was also used. Mean age of patients was 33 +/- 2 years. The mean hospitalization period was 11.6 +/- 6 days. There were 35 kidney injuries [44.5%] with grades I-V. Twenty-five patients [26.3%] had bladder injuries, 14[18.4%] urethral injuries, 37[48.7%] co-morbid injuries, 13[17.1%] external genitalia injuries [scrotal/testis] and 4[5.2%] had ureteral injuries. Pelvic fracture [19 patients- 24.7%] was the most common co-morbid injury. Overall there were three deaths that were accompanied by non-urologic co-morbidities. There were 43 patient [55.6%] with complete improvement and 30 patients [39.5%] who needed delayed surgery. Complications of urologic surgery were low and nobody died of these complications. There was no significant relationship between trauma etiology and the severity of injury. This difference might have been due to less number of patients, incomplete hospital files or death of patient with severe injury at the time of accident. Complications during treatment were fully controlled. Our facilities for diagnosis and treatment meet our needs

Quality of life one year after coronary artery bypass graft surgery

Coronary artery bypass graft [CABG] is a treatment strategy to relieve the symptoms of coronary artery disease [CAD]. Based on determining the long term outcome of CABG using SF-36 Health Related Quality Of Life [HRQOL] questionnaire, the present study was conducted in our center to determine the CABG results one-year after the operation. Between March 2005 and August 2009, 112 patients with coronary heart disease [CHD] who underwent coronary artery bypass graft [CABG] were enrolled. Patients completed SF-36 HRQOL general health status questionnaire. Stepwise multiple linear regression models were used to detect independent variables predicting changes in each eight subscales of SF-35 questionnaire. The mean age of patients was 61.4 +/- 0.9 years and most of them were male with three vessel diseases that were on pump CABG. The mean physical and mental component summary scores were 59.5 +/- 0.9 and 60.2 +/- 0.9, respectively. Physical functioning [PF] and role physical [RP] improved in males. Regression models showed that there were some statistical models with low R-square to predict role emotional [RE], general health [GH], PF and RP according to ejection fraction after surgery, diabetes, pump type of CABG and male gender. CABG has led to higher and more satisfactory outcomes for PF, RP and RE but lower in other scales comparing with normative data of the society and one-year post-operative scores of other studies. It could mostly be attributed to unmodified risk factors and progression of existing comorbidities

Comparative study on presentation of biliary ascariasis with dead and living worms

Ascariasis is a common parasitic infestation in Asia and Latin America. The most serious presentation is biliary and pancreatic ascariasis [BPA]. The aim of the present study was to compare the clinical presentation of BPA with dead worms with that with living worms. We included 138 consecutive cases of BPA that occurred during the period January 2005 to July 2009. All the patients had endoscopically proven BPA consisting of living or dead worms. Comparison was done by chi-square and independent t tests. The age [mean +/- SD] of the patients was 36.8 +/- 16.1 years. Prevalence ratio between male and female patients was 1:5. Ninety eight patients contained living worms and 40 had dead worms. Males were more prone to develop dead worm BPA. The commonest presentation was biliary colic [131; 94.9%]; others were acute cholangitis [30; 21.7%], obstructive jaundice [19; 13.8%], choledocholithiasis [20; 14.5%], acute pancreatitis [10; 7.2%], acute cholecystitis [6; 4.3%], liver abscess [2; 1.4%], hepatolithiasis [3; 2.2%], stricture of common bile duct [2; 1.4%], pancreatic abscess [1; 0.7%] and cirrhosis of liver [1; 0.7%]. Choledocholithiasis, hepatolithiasis, liver abscess and cirrhosis were associated only with dead worms. We could successfully remove all the worms with endoscopic interventions, but 5 patients required surgical intervention as there were strictures and stones within the biliary tree or Ascaris were in gallbladder. Recurrences of stone and cholangitis occurred only in those with dead worms. Biliary ascariasis with dead worms is more dangerous than that with living worms. Endoscopic or surgical intervention may be required repeatedly in those with dead worms

[Evaluation of gastric surgery complications and their management in patients hospitalized at Ayatollah Taleghani hospital]

Gastric surgeries are still among the major causes of surgery complications. Study on prevalence of these complications and recognition of their risk factors are strongly needed. To study Gastric surgery complications and strategies for their management in patients hospitalized at Ayatollah Taleghani hospital. In this Cross-sectional study all gastric surgeries at Ayatollah Taleghani hospital between 1994 and 2002 were assessed. Variables were age, sex, type of surgery, indication of surgery, type of complication and management strategy [medical or surgical]. Data were collected from patients' medical records. Indications for surgery were gastric malignancy and neoplasia in 277 patients [59.8%], peptic ulcer in 151 [32.6%], and other causes in 7.6%. The most prevalent surgeries were Billroth II [23%] and total gastrectomy [15%]. The highest level of complications was observed in Billroth II [24%]. Complications of surgery occurred in 42 cases [9%] among those 33 males and 9 females. Except for vagotomy and pyloroplasty, less than 50% of complications needed surgical management. This study showed that the prevalence of gastric surgeries complications is 9%, comparable to those found in other studies. The most prevalent surgeries were Billroth II and total gastrectomy, believed to be associated with relatively higher level of complications

Long term effects of kidney donation on blood pressure and kidney function of donors

Kidney transplantation from a live donor has many advantages, but the donor should undergo a major surgery and accept potential morbidity and mortality. In this study, we evaluated the long term effects of nephrecetomy on renal function and blood pressure of kidney donors. In this cross-sectinal study, we assessed 195 kidney donors. The controls were 100 healthy individuals with two kidneys. The variables were age, sex, systolic blood pressure [SBP], diastolic blood pressure [DBP], serum creatinine, creatinine clearance and proteinuria [all before and after kidney donation] and time interval between donation and study. Data analysis was accomplished using SPSS software, and paired t-test and Pearson correlation coefficient were used for data analysis. Although serum creatinine was elevated at the time of study, but this rise was not significant. SBP at the time of study was significantly greater than the time of donation [P<0.001]. Creatinine clearance at the time of study was significantly lower than the time of donation [P<0.001]. There was no correlation between serum creatinine, creatinine clearance, SBP, DBP and age at the time of kidney donation in men. Age at the time of kidney donation was correlated with SBP and DBP and creatinine changes in women [P=0.001 and P=0.002, respectively]. This study showed that nephrectomy does not impair renal function in donor and does not lead to a progressive rise in blood pressure or urine protein excretion up to 6.5 years after nephrectomy. Nevertheless, we suggest that kidney donors should be selected after exact screening for potential risk factors of renal disease

Evaluation of menarche age and relevant factors in Iranian female participants of the 1381 student Olympic Games

Precise prediction of menarcheal age enables and prepares girls to face the changes they may experience in this period the future. In Iran, there are no available data in this regard yet. This cross-sectional descriptive study was done on 629 girls from 24 provinces of Iran. Relative questionnaires to collect data were filled out with the help of the participant herself and one other family member as well. The stage of maturity regarding telarche and pubarche, percent of body fat were entered based on history taken and physical examinations. For predicting menarche age in cases, the linear regression model was used. In the 454 cases studied, menarche age, mean of age at menarche was 13.18 +/- 0.06 years old [158.2 +/- 0.7 months]. The means of menarche age in grandmothers and mothers of these 454 cases were 12.9 +/- 0.25 and 13.6 +/- 0.14 years respectively. Earlier menarche was observed in girls of lower height [p < 0.001], girls of lower age at the beginning of study exercise [P = 0.019], girls with lesser number of sisters [P = 0.007], or those with lesser number of brothers [P = 0.003], higher percent of body fat [P = 0.037], those with higher body mass index [P = 0.002], and those residing in mountainous regions [P = 0.001]. The regression model showed that the menarcheal age was predictable based on following variables: current height of individual [p < 0.001] height of place of residence from sea level [p < 0.001] number of brothers [P = 0.006] number of sisters [P = 0.008] [P = 0.001, R-square = 0.99]. Lower height, number of family members and residing in mountainous areas in that order are the most useful predictors of age at menarche. In recent decades, apparently there has been a significant decrease in menarcheal age due to improvement in the quality of nutrition the increasing trend seen today could be due to both weak dietary habits and more sedentary life styles or as a response to increased physical and psychosocial stresses

[ efficacy of horse collagen[Antema] in hemostasis of bleeding due to dental procedures, pilonidal sinus surgery, hemorrhoidectomy and laminectomy]

Hemostasis and control of bleeding are important principles in surgery. Control of bleeding with normal procedures such as cauterization and ligation is sometimes hard and even impossible. Considering different effects of collagen including hemostasis acceleration, complete absorption, tissue repair, and flexibility and appropriate traction, it can help maintain hemostasis. In a randomized controlled clinical trial, 92 cases and 91 controls were compared. Horse collagen [Antema] was used in cases while routine procedures were implemented in controls. Patients were evaluated in 4 groups involving dental procedures, pilonidal sinus open surgery, hemorrhoidectomy, and laminectomy. Statistical indices such as mean, standard error, and statistical tests such as t-test and chi-square were used in the analysis. Mean age was 29.48 +/- 1.29 in the cases and 33.2 + 1.5 in the control group. Seventy four [36 cases, 38 controls] undergoing dental procedures, 61[31 cases, 30 controls] pilonidal sinus open surgeries, 31[18 cases, 18 controls] hemorrhoidectomies, and 12[7 cases, 5 control] laminectomies were investigated. Despite higher severity of bleeding in cases [p=0.011, r=0.247], the time of bleeding control [p<0.001] and the time of complete hemostasis[p<0.001] were lower in cases than in the control group. Antema is effective in hemostasis and it may be used as an adjunct material in hemostasis

[Passive and active immunization in prevention of vertical transmission of HBV infection in infants of HBsAg positive mothers]

In order to prevent liver cirrhosis and hepatocellular carcinoma in later life, it is essential to prevent Hepatitis B virus [HBV] infection in infants. Despite the availability of an effective vaccine, hepatitis B still continues to be a significant health problem. The aim of this study is to reveal the efficacy of passive and active immunoprophylaxis for preventing perinatal transmission of the hepatitis B virus in Iran. In this cohort study with historical controls, 823 children of the HBsAg positive mothers were evaluated. There were 637 cases who had received neither Hepatitis B [HB] vaccine nor hepatitis B immunoglobulin [HBIG], 125 persons received only HB vaccine and 60 neonates that we administered them HB vaccine and HBIG together. The prevalence of HBsAg in cases who have received neither vaccine nor HBIG and aged > 16 years [group1] or <= 16 years [group 2], cases who have received vaccine alone [group 3], and in cases who have received both vaccine and HBIG [group 4] was 56.1%, 40.3%, 12.6%, and 3.6%, respectively. The prevalence of HBsAb had a significant descending rate in groups 4 [85.7%], 3 [68.8%], 2 [33.3%], and 1 [21.8%] respectively. The addition of HBIG to recombinant vaccine will significantly increase the protection against HBV infection in comparison with HB vaccine without HBIG. After focusing on the vertical route for many years, and implementing strategies such as vaccination and HBIG injection to neonates of HBsAg positive mothers, nowadays it seems that we should pay more attention to horizontal way of HBV transmission in Iran