[Comparison of complications of open and laparoscopic cholecystectomy in diabetic patients]

Cholecystectomy is one of the most common surgical procedures and laparoscopy is often preferred. Cholecystectomy is indicated in diabetic patients with gall stones because of higher risk of this condition even in asymptomatic patients. In this study we compared open and laparoscopic cholecystectomy in diabetic patients. This randomized controlled trial was performed in Imam Reza Hospital in Kermanshah from 2010 to 2012. 124 diabetic patients with confirmed diagnosis of symptomatic biliary stones were randomly assigned to two equal groups. 62 patients underwent open cholecystectomy and laparoscopic cholecystectomy was performed for 62 patients. Both groups were similar in relation to distribution of age, sex and BMI. The duration of laparoscopic surgery was longer than the duration of open cholecystectomy and this difference was statistically significant [p< 0.0001]. The duration of hospitalization was longer in open group [p< 0.001]. The costs of treatments did not show any significant statistical difference between the groups. The incidence of injury to biliary ducts was equal in both groups [p =0.99]. Considering lower morbidity and shorter duration of hospitalization, laparoscopic cholecystectomy is a safe procedure and is the surgical method of choice for cholecystectomy in diabetic patients with symptomatic biliary stones

familial aggregation of cigarette smoking in Kish, Iran

Based on WHO reports, smoking is an epidemic in developing countries. One of important issues about this behavior is its distribution pattern in family members. The main purpose of this study was to evaluate if cigarette smoking had a tendency to cluster or aggregate in the families and what the determinants were. Using a multi-stage random cluster sampling approach, a household survey was conducted in Kish Island in 2009. We used the Alternating Logistic Regressions algorithm to model to show the familial aggregation. The odds ratio for the aggregation of cigarette smoking between family members was 1.63 [1.29-2.06] which increased to 1.96 [1.50-2.55] after adjustment for demographic factors. There was no significant correlation between siblings' cigarette smoking nor was between spouses but the pairwise odds ratio for parents offspring was significant. In other words, cigarette smoking in at least one of the parents increased the odds of being a smoker in offspring significantly. The study showed that the smoking behavior aggregated in families significantly. The inter-parent offspring aggregation was the main component of the familial aggregation. Higher education and age-gender interaction were determinants of smoking in the families. The programs for prevention and cessation of this behavior in the community might be more successful if they were designed in a family-based rather than an individual- based approach

[Smoking prevalence and associated factors to quit among Tabriz Dormitory university medical students, Tabriz, Iran]

Cigarette smoking as a major public health problem contributes extra health costs, and smoking cessation among youths is a priority for any prevention program. This study aimed to determine the prevalence of smoking and examined factors associated with having attempts to quit smoking and the motivations to quit among medical university students. A cross-sectional survey using a random sampling was carried out among 523 [293 male, and 246 female, aged 22.48 +/- 3.33 years] students in Tabriz University of Medical Sciences. Data were collected by using a self-administered questionnaire. The data were analyzed by t-test, chi-square test and Fisher exact tests. The overall prevalence of smoking was 8.9%. [male 18% and 1.4% female]. There were significant relationships between smoking status with male gender and alcohol consumption [p<0.001]. The reasons for smoking initiation were: satisfying their curiosity, new experience [37.76%], pleasure and entertainment [17.48%], mental, emotional problems and sedation [16.08%], smoker friends [15.38%], inexperience and ignorance [4.89%]. 54.16% of the current smokers had a history of smoking cessation. Regarding the higher prevalence of cigarette smoking in students, especialy in male and attempting to quit smoking in majority of them, preventive interventions in younger age and providing cigarette smoking cessation services for students seem necessary

Neuromyelitis optica and tuberculosis

Neuromyelitis optica [NMO] or Devic's syndrome is defined by Gault and Devic as a retrobulbar neuritis or papillitis accompanied by acute myelitis and occasionally other neurological symptoms or sings not restricted to the spinal cord or optic nerves. Infectious aetiology was suggested but never recognised. We report a 36-year-old woman with NMO which revealed a multisystemic tuberculosis with fatal issue. We discuss this case with review of literature and try to demonstrate that tuberculosis can be considered as NMO's aetiology directly by Mycobacterium Tuberculosis [BK] infestation, or indirectly by immune mediated response to BK. We conclude to search tuberculosis in patients with NMO, especially in countries where tuberculosis is endemic and a great problem of public health, and not to consider it only as a variant of multiple sclerosis because of different therapeutical options

Effect of group reminiscence therapy on depression in older adults attending a day centre in Shiraz, southern Islamic Republic of Iran

The aim of this study was to examine the effectiveness of group reminiscence therapy on depression symptoms among elderly people attending a day centre in Shiraz, Islamic Republic of Iran. A sample of 49 people aged 60+ years participated in 6 group reminiscence sessions that were held twice weekly for a 3-week period and completed a Farsi version of the 15-item geriatric depression scale. Mean depression scores decreased significantly from 8.18 [SD 1.20] before the intervention to 6.73 [SD 1.20] immediately after it and 7.55 [SD 1.19] 1 month after the intervention. When analysed by demographic characteristics only marital status showed a statistically significant difference in depression scores comparing before and after the intervention

comparison of rumination in patients with major depression disorder, obsessive-compulsive disorder, generalized anxiety disorder and normal individuals

Background and Purpose: Rumination is one of the effective factors on the onset and maintenance Major Depression Disorder [MDD]. Thus, the present study was conducted to compare the rumination and its components in normal subjects and patients with Major Depression Disorder [MDD] Obsessive-Compulsive Disorder [OCD] and Generalized Anxiety Disorder [GAD]

Methods and Materials: In this cross-sectional, descriptive analytical study, 28 patients with GAD, 28 patients with OCD, 28 patients with MDD and 28 normal individuals were selected through convenient sampling method. The participants completed Rumination Responses Scale [RRS]. Data were analyzed by SPSS-16 using Multivariate Analysis of Variance [MANOVA]

Results: Mean rumination score in MDD, OCD, GAD and normal subjects were 62.36?13.38, 63.50?12.76, 54.79?15.60 and 44.57?15.25 respectively. The result showed that there are significant differences in the mean rumination scores and its components across the four groups [P<0.05]

Conclusion: The result showed that rumination occurs in both clinical and non-clinical populations, and its incidence is not confined to any specific psychopathology

Central nervous system anomalies diagnosed antenatally and post-delivery management

To find out the prevalence of the central nervous system anomalies [CNS] and the outcome after surgical correction of operable defects. This is a retrospective review of all cases diagnosed antenatally with CNS anomalies in the Department of Obstetrics and Gynecology at King Abdulaziz University Hospital [KAUH], Jeddah, Kingdom of Saudi Arabia from January 1997 to March 2005, and their outcome including perinatal deaths and postoperative outcome following surgical correction carried out as treatment or palliative. Ninety CNS anomalies were diagnosed antenatally, and 86 were confirmed postnatally. Forty-one [47.7%] were neural tube defects [NTDs] [24 were spina bifida associated with hydrocephalus, 3 encephalocele, 14 anencephaly], 36 [41.9%] were hydrocephalus, 4 [4.65%] holoprosencephaly, 3 [3.4%] microcephaly, and 2 [2.32%] with brain cysts. Of the 41 cases that were operated, 6 [14.6%] died, 26 [63.4%] survived with severe neurological sequelae, 6 [14.6%] lost follow-up, and 3 [7.3%] did well for the period of follow-up. The prevalence of CNS anomalies is comparable to worldwide prevalence. The NTDs are important component of these anomalies, and implementation of strategies to decrease the rate of these anomalies would be beneficial to prevent them as they carry a high rate of handicap and suffering, even after surgical correction

Effect of gum chewing on prevention of post cesarean ileus

Post cesarean ileus is a common complication that induces abdominal distention, delays feeding, and increases hospitalization. Multiple studies showed that false nutrition increases the bowel movement. This study aimed to investigate the effect of gum chewing as false nutrition on the bowel movement and prevention of post cesarean ileus. In this randomized controlled trial, a total of 400 patients who were hospitalized in Mashhad Zeinab hospital were divided into two 200-patient groups. The groups were matched for age, gravity and duration of surgery. In the intervention group, gum chewing was started after surgery, 3 times/day until the regular diet was initiated. In the control group, patients underwent routine care by restricting oral intake until the bowel function was returned. The outcomes were time of the first bowel sound, flatus passage, defecation, ambulation of patients post cesarean, initiation regular diet, and hospitalization. Statistical analysis was performed using unpaired t-test and fishers exact probability test. The mean age, parity and operation time were similar in the two groups. All patients in the intervention group tolerated gum chewing immediately after surgery. The results showed the followings among the intervention group vs. control group, respectively: post operative time intervals to bowel sounds [14.7 hours vs. 16.6 hours; P=0.569], time intervals between surgery and abdominal distention [16.59 hours vs. 14.21 hours; P=0.01], first post operative defecation [28.16 hours vs. 32.21 hours; P<0.000], post operative time interval to onset diet [19.3 hours vs. 16.54 hours; P=0.000], post operative time interval to ambulation [20.14 hours vs. 17.58 hours; P=0.000], post operative lengths of ileus [31.13 hours vs. 30.35 hours; P=0.5], hospitalization [1.84 days vs. 1.92 days; P=0.02]. Gum chewing after cesarean section is safe and well tolerated and reduces post operative ileus, shortens mean duration of first defecation, decreases the time of returning to regular oral diet, shortens the time of patient ambulation and hospital discharge. Gum chewing is offered as a physiologic and inexpensive method to prevent or reduce post cesarean ileus

[ effect of apple vinegar on blood glucose control and lipid profile in rats]

Regarding the recent evidence suggesting the effect of apple vinegar on reduction of postprandial blood glucose, this study was carried out with the aim of determining the effect of apple vinegar on fasting blood glucose, glycosylated hemoglobin [HbA1c], and lipid profile in healthy and diabetic rats. 31 wistar male rats were assigned into 4 groups as follows: the healthy control, apple vinegar-fed healthy, diabetic control, and apple vinegar-fed diabetics. Streptozotocin was used to induce diabetes in rats. The control groups received standard rat food, while the treatment groups received mixed 6% apple vinegar and standard rat food for 4 weeks. Fasting blood glucose, HbA[1c] and lipid profile [total cholesterol [TC], triglyceride [TG], LDL cholesterol, HDL cholesterol] were measured before and after the intervention. Fasting blood glucose did not change with the consumption of apple vinegar. However, HbA[1c] in diabetic group decreased significantly compared with pre-intervention [P<0.05] and control-diabetic group [P<0.05]. In healthy group with the uptake of apple vinegar, reduction of LDL [P<0.005], and increase of HDL [P<0.005] were observed compared to pre-intervention and with healthy control. In diabetic group with the uptake of apple vinegar significant reduction of TG [P<0.005] and significant increase of HDL [P<0.05] were observed compared to the control group. The results of this study showed that uptake of apple vinegar improve lipid profile in healthy and diabetic rats, and reduces HbA1c in diabetic rats

[ effect of white vinegar on fasting blood glucose, glycosylated hemoglobin and lipid profile in normal and diabetic rats]

There is evidence suggesting a lowering effect for vinegar on postprandial blood glucose concentrations. This study aimed at evaluating the effect of vinegar on fasting blood glucose, glycosylated hemoglobin [HbA1c] and lipid profiles in healthy and diabetic rats. Male wistar rats were divided into four groups: the healthy control, healthy fed with white vinegar, diabetic control, and diabetic fed with white vinegar, groups. To induct diabetes, Streptozotocin was used. For a period of 4 weeks the control groups received standard food and the treatment groups received white vinegar-mixed pelleted food [6%]. Fasting blood glucose, HbA1c and lipid profiles were measured before and after intervention. White vinegar had no significant effect on fasting blood glucose and HbA1c in either the healthy or diabetic group. Statistical analysis of data showed that in the healthy group fed white vinegar there was a significant decrease in LDL-cholestrol [LDL-C] and a significant increase in HDL-cholestrol [HDLC]. Also, there was a significant increase in HDL-C compared with healthy control group. White vinegar reduced TG/LDL-C and HDL-C/LDL-C ratios in healthy rats, 44.5% and 25.8%, respectively. The diabetic control group showed a significant increase in triglyceride [TG] along with a significant decrease in HDL-C. However, the diabetic group fed with white vinegar showed a significant decrease in TG compared to the control diabetic group. TG/LDL-C and HDL-C/LDL-C ratios increased in diabetic control group but not in the diabetic group fed white vinegar. The results of this study clearly indicate that consumption of white vinegar for four weeks could have significant favorable effects on the lipid profiles of healthy and diabetic rats

Sickle cell disease in pregnancy

To determine the maternal and neonatal outcome of pregnancies complicated by sickle cell disease. The maternal characteristics and antenatal course of patients with sickle cell disease were studied. The patients were treated with either repeated blood transfusions or with exchange transfusion and the development of sickle crisis or hemolytic crisis, preterm labor, chest or urinary tract infections and thromboembolic phenomena were noted. The neonatal outcome was reorced. The antenatal course of the 25 patients recruited was uneventful for 11 [44%] patients while 14 [56%] required repeated admissions for complications. Five [20%] received repeated blood transfusions while 3 [12%] had exchange transfusion. Four neonates [16%] were of low birth weight due to preterm delivery and intra-uterine growth retardation. No perinatal deaths occurred in this study. Sickle cell disease was associated with increased maternal morbidity but neonatal and maternal mortality was nil which is much better than previously reported

[Radiotherapy in rectal cancer: standards and actualities]

The treatment of rectal cancer has been profoundly modified during last years. In less than one decade we evolved from a situation where the surgery is used to be the only standard treatment for cancer rectum to a situation where radiation therapy associated with surgery is recommended by several authors. The radiotherapy is well established as a major component in treatment cancer rectum. As it reduced the local recurrence to about 50% and improves global survival rate. Even if some points related to timing and technical modalities are still discussed, the association of radiotherapy and surgery nowadays is the standard treatment for rectal cancer. Meanwhile, some tuning still interesting trials will provide assessment of association of radiation therapy and chemotherapy by using new drugs

Treatment of keloids by immediat post-operatoire interstitial brachytherapy

Clinically considered as a pathologic scar remaining beyond 12 to 18 months, the keloid is characterised by a high recurrance rate after excision alone [50% - 100%]. Many therapeutic methods were used [Corticotherapy, pressotherapy], with disappointing results. The aim of this paper is to identify that post operative interstitial radiotherapy by iridium 192 [low dose rate] is effective for improving local control of keloids and preventing recurrence. From 1995 to 1998, 14 patients [18 keloids] were treated at the National Institute of Oncology - Rabat - Morocco. The average age is 27 years. The keloid was located on ear lobes in half of the cases. All patients had previously a trauma [injured, surgery]. 3 patients had multiple keloids. 10 patients [70% of cases] had keloid relapse after surgical excision. The treatment consisted of surgical excision followed immediately by brachytherapy with iridium 192. After 41 months of follow-up, we had obtained a good esthetic results in 7 cases [8 keloids]. 4 patients [5 keloids] recurred after an average delay of 14 months. 4 patients [5 keloids] were lost to follow-up

Paratesticular rhabdomyosarcoma

Paratesticular rhabdomyosarcoma occurs predominantly in children and adolescents. is a rare tumor and It's developped proximal to the tesicle. Clinical signs are like any intrascrotal tumor. Scrotal ultrasound, CT scan and tumor markers are necessary for the diagnostic and stadification of this cancer. Orchidectomy followed by chemotherapy and radiotherapy is the usual treatment. We report 3 cases of paratesticular rhabdomyosarcoma. We discuss the diagnosis and therapeutic attitudes, evolutionary aspects and prognostic factors of these tumors re also discussed

Cavernous haemangioma of the frontal bone

A 28-year-old female presented with a progressive right frontal mass. CT scan and plain films showed an osteolytic lesion in the right frontal bone. Surgery consisted of total resection of the lesion and cranioplasty. The postoperative source was uneventful. Histological examination revealed a cavernous haemangioma of the diploe. In view of this observation and the literature review, aetiology, clinical, radiological and therapeutic aspect of this rare entity are discussed

Cerebral infection by candida albicans

We present a case of cerebral infection by candida albicans in a previously healthy 64-year-old man who had symptoms indicative of raised intracranial pressure without fever. Computed tomography scan and magnetic resonance imaging revealed multiple cerebral granulomas. Diagnosis was made after stereotactic biopsy. The patient's symptoms improved progressively with decrease in the size of lesions after antifungal therapy. No lesions were detected outside the central nervous system. However, he died 3 weeks later from pulmonary embolism. Candida albicans of the central nervous system is uncommon and occurs rarely in immunocompetent patients. As the neurologic sings and symptoms are vague, most cases of cerebral candidiasis are diagnosed just before death or during postmortem study. We have reviewed the main clinico-pathologic features of neurocandidiasis

Transient mutism following removal of cerebellar tumor in a child

to report a case of cerebellar mutism after surgery for posterior fossa tumour n a child. Mutism after posterior fossa surgery is a well described, although rare entity. Most of these tumours are located in the cerebellar vermis and/or extending to the hemispheres. The authors report a case of cerebellar mutism in a 9-year-old Moroccan boy who underwent surgical removal of a vermian medulloblastoma. The child became mute 24 hours postoperatively. He was fully alert without pyramidal signs and without lower cranial nerve palsies. His psychiatric examination was normal. The postoperative computed tomography images revealed nothing remarkable. He was mute for three weeks. Cerebellar mutism should be recognized as an important side effect of surgery

Perinatal factors and neonatal outcome of very low birth weight and extremely premature babies at KAUH

Aim: The study was conducted at King Abdulaziz University Hospital [KAUH] over ten years period to evaluate the neonatal mortality and morbidity of very low birth weight [VLBW] and very preterm infants and to look at the incidence of cerebral palsy in the surviving infants. A retrospective chart review of mother and babies with VLBW [' 500 gms and pound 1500 gms] and a gestational age <32 weeks delivered at KAUH between August 1996 to the end of July 1996 was done. The review looked at maternal characteristics and complications during pregnancy, neonatal mortality and morbidity and follow up of surviving infants. A comparison was made between those born with a gestational age of 22-26 weeks [group A] and 27-31 weeks [group B]. Ninety-two VLBW were evaluated. The incidence of VLBW babies at KAUH was 0.52%. The neonatal mortality was 23.8% while the early neonatal mortality was 22.8%. There was no significant difference in maternal characteristics and complications between the two groups A and B. The early neonatal mortality of group A [75%] was significantly higher than group B [13.7%], while the immediate neonatal complications including hyperbilirubinemia, respiratory distress syndrome [RDS], neonatal sepsis, electrotype and pH disturbances were significantly higher for group B babies than group A. Bronchopulmonary dysplasia [BPD] and intraventricular haemorrhage [IVH] were not significantly different between the 2 groups. Among 64 survivors, thirty were followed for at least 12 months and of these, 7 infants [23.33%] had cerebral palsy [CP] and two [4%] had minor deficits. VLBW and very premature babies are a major cause of neonatal mortality and morbidity. The incidence of cerebral palsy and minor deficits at our institution is comparable to that quoted in other literature