Human amniotic membrane effect on colorectal anastomosis in dogs undergoing radiotherapy with/without diverting stoma: an experimental preliminary study

Background: Radiotherapy is an important factor which results in increase of anastomosis leakage. Diverting loop ileostomy has been usually performed after colorectal anastomosis with history of neo-adjuvant radiotherapy to decrease the chance of leakage. Considering this effect, we assessed the feasibility and outcome of human amniotic membrane in rectal anastomosis in dogs previously treated by high-dose radiotherapy

Materials and Methods: Twelve cross-breed male dogs with the age of 6-8 months and weighting 10-15 kg were randomly divided into four groups. Groups 1 and 2 received radiotherapy and 4 weeks later, single layer end to end anastomosis was performed for all the dogs; also, diverting loop ileostomy was placed in groups 1 and 3. Four weeks later, the anastomosis site was resected and sent for pathologic wound healing scoring. Data were analyzed by SPSS 16 software using Mann- Whitney test

Results: Two dogs [of group 1 and 2] died of peritonitis due to anastomosis leakage during the 2[nd] post operation week. There was no statistically significant difference in wound healing between the case and control groups [P-Value: 0.01]

Conclusion: HAM had a protective role in colorectal anastomosis after neo-adjuvant radiation in cases without loop diverting ileostomy. It can be concluded that HAM placement is a feasible technique instead of diverting loop ileostomy in cases with neo-adjuvant radiotherapy and also in the benign colorectal diseases with high risk anastomoses

[Information needs and information seeking behavior and related factors in Shahroud university of medical sciences]

Introduction: Considering the academic members as fundamental part of education and research in the country, meeting the guidelines of resolving the information needs is very important. So the present study was aimed to assess the information needs and information seeking behavior in academic members of Shahroud University of Medical Sciences in 2013

Methods: A cross-sectional study was conducted. Using census method, 210 of the faculty members, clinicians, GPs and lecturers of the university were investigated. A researcher made questionnaire was applied in order to collect the data. SPSS 16 software was used to analyze the data using Chi-Ssquare and T-test

Results: Findings showed that participants' main purpose to search for information was to update their educational and research information [36.2%], prepare scientific papers [33.3%] and teaching [31.9%]. The first problem regarding the access to information resources was low speed of the Internet. Databases with 48% met the information needs of the participects followed by printed resources which was found to be 13, 8 percent

Conclusion: Databases provides individual information needs three times more than printed resources. Low speed of the Internet was mentioned as the main barrier to impede access to information resources. Therefore, providing up to date databases as well as increasing speed of the Internet are of high importance

[ Comparison of teaching and non-teaching hospitals emergency centers' information management systems of Hormozgan University of medical sciences]

Introduction: Emergency information management system helps to improve the quality of the services rendered in emergency department, to meet the legal, requirements, accreditations, and research purposes. This study aimed to examine and compare teaching and non-teaching hospitals emergency centers' information management systems affiliated to Hormozgan University of Medical Sciences

Methods: This descriptive, cross-sectional study was conducted in 2013. Data were collected using two self-made check lists. Validity of instrument was determined based on content validity and sample size was calculated according to the size of the population, including 4 teaching and 3 non-teaching hospitals. 749 records out of 4656 ones were selected using a stratified random sampling method. Data analysis was performed through descriptive statistics using SPSS 16 Software. T-student test was used to examine differences between scores of teaching and non-teaching hospitals on various aspects

Results: None of the investigated systems has used quality analysis to improve the quality of the collected data. It was found that 43% of investigated emergency centers had not taken any actions for data organizing in medical records. Only 14.5% of emergency centers had classified data contained in records. The mean score of registered medical, financial, and identification of the health care providers data of teaching hospitals was revealed to be higher than non-teaching ones [P<0.01]

Conclusion: In general, emergency centers' information management systems in teaching hospitals had better conditions than those of non-teaching hospitals. Given the major role of emergency information management systems, health managers and policy makers need to plan and set policies required for upgrading their information systems

[Nurses' organizational behavior and their quality of documentation]

Introduction: numerous factors affect on quality of nursing documentation. Continuous evaluation and identifying factors affecting documentation have a significant role on improving the quality of documentation. This study aimed at Nurses' organizational behavior and their quality of documentation in teaching hospitals of Hormozgan University of Medical Sciences

Method: this is a descriptive cross-sectional study conducted in 2013. The study population were nurses in teaching hospitals of Hormozgan University of Medical Sciences. From a total of 552 nurses, 215 nurses were selected using random sampling. Three standard questionnaires and three Self-made check list were used for data collection. Validity of the tools was measured using comments of professors and experts and reliability of the questionnaire was measured using Cranach's alpha. Collected data were analyzed using SPSS version 16. Pearson, ANOVA, and Tstudent were used to assess relationship between variables

Results: levels of nursing education and type of employment stipulated in the employment contract had significant effect on the score of documentation [P<0.01]. In addition, hospitals and various departments had significant differences in the documentation scores. From the other side, job satisfaction, social capital and organizational citizenship behavior have significant positive correlation with the total score of nursing documentation [P<0.05]

Conclusion: nurses organizational behavior including job satisfaction, social capital, and organizational citizenship behavior, can have an impact on the quality of their documentation. Therefore, hospital managers and supervisors can ensure quality of nursing documentation following improving organizational behavior

[ relationship between social capital and organizational citizenship behavior among teaching hospitals staff at Hormozgan Univercity of Medical Sciences]

Introduction: Organizational citizenship behavior [OCB] and social capital constitute Organizational behavior, which have immense effect on performance and productivity. This study was conducted to analyze the relationship between social capital and [OCB] among employees at teaching hospitals in Hormozgan University of Medical Scinces

Methods: This cross-sectional study was performed in 2011. Standardized questionnaires of Podsakoff and Nahapeit were used to gather data on OCB and social capital, respectively. The validity of questionnaires was approved and its reliability was measured by calculating Cronbach's alpha which was shown to be 0.72, 0.84, respectively. Sampling was done through classified random sampling method. Data analysis was performed using SPSS 19 software and to analyze the relationship between above mentioned variables ANOVA and Pearson tests were used

Results: The mean value of organizational citizenship behavior and social capital were found to be 3.1 +/- 0.53 and 2.7 +/- 0.58, respectively. A statistically significant relationship between OCB and social capital was observed. In addition, There was significant relationship between demographic variables such as education, organizational position, shift work and gender with social capital and OCB [P<0.01]

Conclusion: Considering the importance of organizational citizenship behavior for Institutions, to improve efficiency it is suggested that administrators of hospitals and health care institutes adopt policies to enhance these two issues among staff

study on the role of selective attention, vigilance and ambivalence over emotional expressiveness for predicting pain severity in patients with chronic musculoskeletal pains

When there is a pain requiring focused clinical attention and is associated with emotional and functional disorders, it is called pain disorder. The present study aims to study the role of selective attention, vigilance and ambivalence over emotional expressiveness for predicting pain severity in patients with chronic musculoskeletal pains. The study population included 180 patients with chronic musculoskeletal entered the study by accessible method sampling from 2 hospitals in Tehran [Iran]: Imam Khomeini and Atyeh. They completed Selective Attention Test, questionnaires for Vigilance and Ambivalence over emotional expressiveness and Pain severity Scale. Step-by-step multivariate regression analysis showed that ambivalence can significantly predict emotional expressiveness in patients with selective attention and vigilance were not significant. In musculoskeletal chronic pain, ambivalence can be considered as an emotional determinant influencing pain severity

[ impact of errors in completing death certificate on coding, underlying the cause of death in Shahid Mohammadi hospital of Bandarabbas]

Death information plays a critical role in the adjustment of health plans, and the cause of death coding leads to organizing this information. The Purpose of this study was to review the impact of errors in the completion of death certificate on underlying the cause of death coding in Shahid Mohammadi hospital in Bandarabbas. This descriptive-cross sectional study was performed in the second half of 2011 by studying the death certificates of all extinct. First, certificates were written on aside forms and residents determined the sequences of death certificates. Next, researcher recoded certificates and compared his codes with original coders. At last, researcher referred to certificates themselves to extract information about documentation errors. Data were analyzed by SPSS using descriptive statistics, chi [2] test and 95percent confidence interval. The accuracy rate of underlying the cause of death coding was 51.7 percent. There was a significance between coding accuracy and major errors [P=0.001] but there was no significance between coding accuracy and minors. There was a significance between language of death certificate and occurrence of both major and minor errors[0.227and 0.006]. There was also significance [0.227and 0.006] between number of lines and occurrence of both kinds of errors[0.000]. The Impact of majors errors on accuracy of underlying cause of death coding has been proved. To solve this problem, physicians must be trained and the structure of death certificate must be edited

[Validity, reliability and normalization of the fear of pain questionnaire-short form [FPQ-SF]]

In this research, we intended to normalize and examine the reliability and validity of the Fear of Pain Questionnaire-Short Form [FPQ-SF] among Iranian university students. A random sample of 600 students participated in this study. Using confirmatory factor analysis, a 3-factor model with 30 items and a 4-factor model with 20 items were evaluated. For reliability assessment, we used Chronbach's alpha and for validity applied, convergent validity. Convergent validity was measured through correlation between pain anxiety symptoms scale [PASS-20] and anxiety sensitivity index [ASI]. The confirmatory factor analysis [CFA] reassessment of McNeil and Rainwater's 3-factor 30-item model and Asmundson et al proposed 4-factor 20-item model indicated a poor fit to the data. As such, exploratory factor analysis using 4-factor model [severe pain, minor pain, medical and dental pain, and injection pain] with 24 items was developed. The results of Chronbach's Alpha for fear of pain and each of subscales of severe pain, minor pain, medical and dental pain, and injection pain were 0.83, 0.83, 0.80, 0.76 and 0.89, respectively for total sample. Based on the results of this study, it was found that fear of pain questionnaire with four factors and 24 items shows acceptable psychometric properties in psychological research and clinical assessment of fear of pain in Iranian population

Helicopter emergency medical service in Fars province: the referral trauma center of South of Iran

Considering the limited available resources, high cost of the helicopter emergency medical service [HEMS], and high load of trauma patients especially in our centers, a careful assessment of HEMS in our center seemed to be necessary for trauma patients. From April 2001 to September 2007, the data of all patients transferred by HEMS were extracted including: Annual number of services, clinical category, number of proper or improper services, and rescue time for HEMS and ground ambulance. The criteria for the properly transferred group included: Death or being operated in the first 24 hours of admission, admission in ICU care units, and transfer of more than three patients in one mission. Others were considered as improper group. In this period through 185 flights, 225 victims were transferred. The most common reason of HEMS dispatching was trauma. The most difference of rescue time between ground ambulance and HEMS was recorded in Lamerd that was transferring patients with HEMS needed 3 hours less than ground ambulance. However, in Sarvestan, Dashte-Arjan, and Marvdasht, transferred patients with ground ambulance needed less time than air transfer. Most of transferred patients were from Kazeroon, Nourabad and Lamerd respec-tively while 46.3% of patients were in the proper group, and the rest were considered as improper group. Our study revealed that helicopter dispatch to the cities like Lamerd, Lar, Khonj, Abadeh can be more effective, whereas, for the towns like Marvdasht, Dashte-Arjan, Sarvestan, Sepidan, Saadatshar, Tang Abolhayat use of HEMS should be limited to specific conditions. Our study showed inclusion of physicians in the decision making team increased the number of transferred cases

Two-year experience of orthotopic liver transplantation in Afzalipoor Hospital, Kerman, Southeastern Iran

End-stage liver diseases are common in Iran. The only therapeutic option for these patients is liver transplantation. To present our 2-year experience of liver transplantations in Afzalipoor Hospital, Kerman, southeastern Iran. From November 2009 to September 2011, 12 patients underwent orthotopic liver transplantation in our center. Their data including demographics, indications for transplantation, MELD scores, post-operative complications and their management were collected. Patients [7 women and 5 men] aged between 14 and 55 years. Indications for the transplantation included HBV infection [n=5], cryptogenic cirrhosis [n=2], Wilson's disease, alcoholism [n=1], HCV infection [n=1], Budd-Chiari syndrome [n=1], and autoimmune hepatitis [n=1]. MELD score of patients ranged from 16 to 30. All patients received tacrolimus, mycophenolate mofetile and corticosteroid, post-operatively. 2 patients died of pulmonary and intra-abdominal infections with resultant to multiple organ failure. Nonfunctioning of transplanted liver and ongoing bleeding resulted in death in another patients. 9 patients are well doing and have excellent liver functions. We had relatively successful results in our experience of orthotopic liver transplantation. Vicinity of our center to Shiraz Transplant Center would be an important factor in this success

[Accuracy of cone beam computed tomography, intraoral radiography and periodontal probing for periodontal bone defects measurement]

Cone beam computed tomography [CBCT] produces high-quality data about diagnosis and periodontal treatment. To date, there is not enough research regarding periodontal bone measurement using CBCT. The aim of this study was to compare the accuracy of CBCT in measuring periodontal defects to that of intraoral radiography and probing methods. Two-hundred and eighteen artificial osseous defects [buccal and lingual infrabony, interproximal, horizontal, crater, dehiscence and fenestration defects] were created on 13 mandibles of dry skulls. The mandibles were put into a plexiglass box full of water to simulate soft tissue. CBCT images, radiographic images taken with parallel technique and direct measurements using a WHO periodontal probe were recorded and compared to a standard reference [digital caliper]. Inter and intra observe consistencies were assessed using Intra class correlation coefficient and pearson correlation. Inter and intra observer consistencies were high for CBCT and probing methods [ICC-Intra class correlation coefficient>88%], but moderate for intraoral radiography [ICC-Intra class correlation coefficient>54%]. There were not any significant differences between observers for all techniques [P>0/05]. According to paired T-test analysis, mean difference for CBCT technique [0.01 mm] was lower than that for probing [0.04 mm] and radiography [0.62 mm]. CBCT was able to measure all kinds of lesions, but radiography could not measure defects in the buccal and lingual sites. All three modalities are useful for identifying periodontal defects. Compared to probing and radiography, the CBCT technique has the most accuracy in measuring periodontal defects

Gabapentin may relieve post-coronary artery bypass graft pain: a double blind randomized clinical trial

One of the most common complaints after coronary artery bypass graft [CABG] is postoperative pain. Gabapentin is an anticonvulsant and antineuralgic agent. To evaluate the analgesic effect of preemptive gabapentin on post-operative pain and morphine consumption after cardiac surgery. A double-blind randomized clinical trial was conducted on 60 male candidates for CABG. The patients were divided into two groups-the gabapentin [n=30] and the control group [n=30]. The test group received 800 mg gabapentin orally two hours before the surgery followed by 400 mg of the drug two hours post-extubation. The control group received placebo instead. Then severity of pain was recorded according to an 11-point visual analog pain scale. The amount of morphine consumed, its side effects and hemodynamic changes were also recorded during and at 2, 6, 12, 18 and 24 hours after extubation. The mean +/- SD cumulative morphine consumption at the first 24 hours after extubation in gabapentin group was 0.9 +/- 1.5 mg while it was 1.5 +/- 4 mg for the control group. Therefore, gabapentin group consumed 38% less than the control group [P=0.01]. The pain scores during rest and coughing at 2, 6, and 12 hours after extubation were also significantly lower in the gabapentin group compared with the control group [P=0.02]. The mean +/- SD mechanical ventilation time was 5.4 +/- 1.7 hours for gabapentin group and 1.6 +/- 4.4 hours for the control group [P=0.035]. The other variables including hemodynamic changes [HR, SBP and DBP], and incidence of nausea, vomiting and respiratory depression showed no significant difference between the studied groups within 24 hours after extubation. Oral pre-medication with gabapentin before CABG significantly reduces post-operative pain and morphine consumption in adult cardiac surgery

Evaluation of cytomegalovirus infection after six months of liver transplantation in children in Shiraz, Southern Iran

Liver transplantation [LT] is a life-saving treatment for end-stage liver diseases [ESLD]. Cytomegalovirus [CMV] infection is one of the important causes of morbidity after LT. To evaluate the incidence of late-onset [after 6 months of LT] CMV infection in pediatric recipients. A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test. Three recipients [6%] developed late-onset CMV infection. These patients finally responded to ganciclovir. CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children

Liver transplantation and aortic valve replacement

Surgical procedures involving heart and liver are rare and have been limited to either combined heart and liver transplantation or coronary artery bypass graft surgery [CABG] or aortic valve surgery and orthotopic liver transplantation [OLT]. Aortic valve replacement [AVR] and pulmonary valve vegetectomy for bacterial endocarditis after OLT have also been reported. There are only five cases with aortic stenosis and cirrhosis reported to have combined AVR and liver transplantation. In the presence of cirrhosis, AVR has a significant risk for mortality because of bleeding from coagulopathy, renal failure, infection, and poor post-operative wound healing. Herein, we report on a case and management analysis of combined sequential AVR, and OLT in a 40-year-old cirrhotic man with Child and MELD score of C and 29, respectively. Echocardiography detected severe aortic insufficiency [AI] with enlarged left ventricle. Due to severe AI, the cardiologist recommended AVR prior to transplantation. The patient underwent metallic AVR. 4 months later, he received OLT. Both operations were successful and uneventful. Prioritizing AVR before OLT was successful in this patient. However, each patient must be evaluated individually and multiple factors should be assessed in pre-operation evaluation

Prevalence of zinc deficiency in 3-18 years old children in Shiraz-Iran

Zinc is an essential trace element with a prominent role in human nutrition. Zinc deficiency has been linked to growth retardation, hypogonadism in males, and lack of sexual development in females. It ranges from 50% in sub-Saharan Africa to 5% in high income countries. The aim of this study is to evaluate the prevalence of zinc deficiency in healthy children in Shiraz, Southern Iran. In this study, 902 children aged 3-18 years old were randomly sampled for serum zinc level. Age, sex, weight, height, BMI, stunting and wasting indices were also recorded. With atomic absorption spectrophotometry method, the serum level of zinc less than 70 micro g/dL was considered as deficient. Mean serum level of zinc was 122.3 +/- 55 micro g/dL. The prevalence of zinc deficiency was 7.9%. There was no relationship among serum zinc level and age, sex, height, weight or BMI, but mild wasting [weight for age] and mild stunting [height for age] were significantly more prevalent among zinc deficient children compared to children with normal or high level of zinc. Zinc deficiency in Shiraz is not as prevalent as other areas of Iran. It was significantly more frequent among stunted and wasted [malnourished] children. Difference in soil zinc level, recent wide prescription of zinc supplements by pediatricians and especial pattern of nutrition, considered as possible factors responsible for lower prevalence of zinc deficiency in Shiraz, deserve more investigations

Evaluation of candida infection after six months of transplantation in pediatric liver recipients in Iran

Liver transplantation [LT] is the standard treatment of end-stage liver diseases [ESLD]. Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation. To determine the incidence of late-onset [after 6 months of LT] Candida infection in recipients. A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture. One recipient [2%] developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder [PTLD]. The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications

Liver abscess in children: a 10-year single centre experience

Although liver abscess is more prevalent in developing countries than in developed countries, there is scant data about the characteristics of pediatric liver abscess in our region. We aimed to analyze the characteristics of pediatric liver abscess in our region and compare these with those of developed countries. The clinical features, laboratory, imaging, microbiologic findings, management strategy, and final outcome were extracted from the patients' records retrospectively. There were 18 cases of liver abscess including 16 pyogenic liver abscess, one amebic liver abscess and one candida liver abscess. Fever and abdominal pain were the most common clinical findings and leukocytosis was the most common laboratory finding. The most predisposing factors of liver abscess were immune deficiency, minor thalassemia. Origin of liver abscess was appendicitis in two patients, the rest were considered as cryptogenic. While one patient was treated with antibiotics alone, five cases were taken for open drainage, and 12 cases were treated with percutaneous aspiration. Percutaneous aspiration failed in two patients who were later taken for open drainage, with an overall mortality rate of 5.5%. The overall characteristics of liver abscess in children in our society are not so different from developed countries. However, in contradiction to case reported in developed countries, most cases of liver abscess were seen in healthy patients in our centre. Moreover, liver abscess was reported in our patients at a younger age and was more commonly seen in male children. Mortality rate was similar to that of developed countries

[ identification of related risk factors of thyroid disorder in an Iranian pregnant population]

The study aimed at determining the prevalence of thyroid disorders among a pregnant population and identifying the related risk factors of thyroid dysfunction in these subjects. Between February and July 2008, a nested case-control study was conducted on 608 pregnant women in Bandar Abbas, Iran. We obtained information about thyroid dysfunction in the subject and their family, diabetes mellitus type 1, prior gestational diabetes, hepatitis B and rubella vaccination, any previous miscarriages and fifteen symptoms of hypothyroidism. T4, T3, T3RU, FTI, TPO Abs were measured and thyroid examinations were carried out. Multiple logistic regression tests were used to estimate relative risk of thyroid dysfunction for the variables. The rate of hypothyroidism was compared in groups with significant related risk factors at high or lower risk. Of the 608 pregnant women, 519[85.4%] were euthyroid, 72[11.8%] had sub clinical hypothyroidism, 3[0.5%] overt hypothyroidism and 14[2.3%] were hyperthyroid. There were strong correlations between personal history of thyroid dysfunction [OR:5.23%95CI:2.11-12.95 P:0.00], TPO Abs[OR:2.81 CI%95:1.83-4.32 P:0.00], 3 symptoms or more of hypothyroidism [OR:2.50 CI%95:1.48-4.22 P:0.001], goiter [OR:2.24 CI%95: 1.32-3.80 P:0.002], being in the 20-30 year age range [OR:1.87%95CI:1.004-3.51 P:0.04] and being hypothyroid in pregnancy, respectively, but not with other risk factors, especially family history of thyroid disorder. This study showed thyroid disorders are common among pregnant population and are correlated with personal history of thyroid disorder, TPO Abs, 3 symptoms or more of hypothyroidism, goiter and age range between 20 to 30 years old, all risk factors which should be considered at screening, in clinical practice

[Histological evaluation of micro implant-bone interface following immediate versus delayed loading in a dog's mandibular bone]

Skeletal anchorage devices such as microimplants are successful attempts to have absolute anchorage. The aim of this study was to evaluate the effect of immediate and delayed orthodontic loading on maxillary and mandibular microimplants regarding histologic responses and bone implant contact [BIC] in a dog. Thirthy-two microimplants [Abso Anchor] were bilaterally placed in the mandibular premolar regions of four adult male dogs. The microimplants were divided into loaded and unloaded [control] groups. The control group had two subgroups of 4 and 8 weeks and the loaded group comprised two subgroups of immediate and delayed [after 4 weeks healing period] loading. Loaded samples were subjected to 200g load provided by Ni-Ti coil spring for 4 weeks. The decalcified specimens were prepared for histological examination under light microscope. The microimplants' surrounding tissue was observed histologically and the bone implant contact [BIC] percentage was calculated in each sample. Three way ANOVA was used to compare BICs in different groups. Mobility was detected in two mandibular microimplants, so the survival rate was calculated as 93.7%. BIC values were not significantly different between loaded and unloaded groups, and between immediate and delayed loaded groups. Immediate or delayed loading of microimplants does not load to significant difference in the bone-microimplant contact

Congenital hepatic fibrosis and need for liver transplantation

Herein, we describe two patients who underwent liver transplantation with the clinical diagnosis of hepatic failure and cryptogenic cirrhosis; histopathology of the explanted hepatectomy specimen revealed congeni- tal hepatic fibrosis. To the best of our knowledge, coexistence of hepatic failure and cirrhosis in congenital hepatic fibrosis, have not yet been reported in the English literature