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

Spontaneous aortocaval fistula: a case report and literature review

Spontaneous aortocaval fistula is a rare complication of abdominal aortic aneurysms. We describe two cases of spontaneous aortocaval fistula. The first patient is a woman who was admitted with abdominal pain and pulsatile abdominal mass. Another patient was a man admitted with progressive abdominal pain and hypotension. Computed tomography [CT] scan in both patients showed an infrarenal aortic aneurysm and simultaneous contrast enhancement in the inferior vena cava. Both patients underwent an urgent laparotomy in which the diagnosis of an aortocaval fistula was confirmed. We review the literature on spontaneous aortocaval fistula as a consequence of complicated aortic aneurysms

[Effects of education on the knowledge and self-efficacy of health volunteers about the necessity of moldy bread separation from other bread waste]

Bread waste is consumed as a food in the livestock, and can cause considerable harm to human and animal beings if they are moldy. Since health volunteers can convey health knowledge to people in a simple and intelligible language, the present study was conducted to evaluate the knowledge of health volunteers about the necessity of moldy bread separation from other bread waste and the effect of education on their knowledge in the Abkooh Sugar Factory of Mashhad. In this interventional experimental study, 39 active health volunteers at the health center of Abkooh Sugar Factory of Mashhad, Iran participated and were recruited by non-probability convenient sampling, and were randomly assigned into the experimental group [n=21] and control group [n=18]. Relevant data were collected through questionnaire and training was performed by providing a CD [educational video] for the experimental group. After a two-month training period, data were collected again. Data of before and after training were analyzed in SPSS 16 using paired t-test and mean +/- SD [p < 0.05]. After training, the scores of volunteers in the intervention group raised from 22.86 +/- 4.8 to 26.36 +/- 4.9; and paired t-test showed a significant difference between their scores before and after education [p=0.03]. Also, their perceived self-efficacy on the necessity of separation of moldy bread from other bread waste was significantly different across the two groups [p=0.023]. The results indicated the effect of education on the knowledge of health volunteers about the necessity of moldy bread separation from other bread waste

quality of life of the elderly in Sabzevar, Iran

Background and Purpose: Geriatric age is a course in life where the elderly are subject to potential threats such as chronic diseases, isolation and seclusion, lack of social support, and accordingly mental and physical disabilities threaten their personal independence. These factors can lead to diminish the quality of life. Therefore, the quality of life of the elderly people in Sabzevar was investigated in this study

Methods and Materials: In this cross-sectional descriptive analytical study, 304 elderly of above 60 years dwelling in Sabzevar, Iran in 2010 were selected through systematic cluster sampling. The study data were collected through standardized SF-36 Health Status Questionnaire. They were analyzed through frequency tables and mean?SD, using independent t-test, oneway ANOVA and chi-square in SPSS 15. Level of significance was considered 0.05

Results: The mean quality of life was 44.9?8.7. The highest mean was associated with energy and vigor [50.6?0.5] and the lowest with general health [39.2?19.7] In general, 38.7% had a good life quality and 23.3% did not. Also, 44.4% of elderly men had unsuitable quality of life as far as pain was concerned, and 44.3% were affected with limited physical movement. No significant differences were observed between men and women as regards their limited activity, as well as social, mental and physical problems. However, there was a significant difference as to their pain

Conclusion: Since all dimensions of life quality were below 50 in the present study, the life quality of elderly people in Sabzevar, Iran can be considered unsatisfactory

[Prevalance of anemia in type 2 diabetic patients and the role of nephropathy]

Anemia is a common problem in diabetic patients, who usually suffer from a greater degree and severity of anemia based on their level of renal impairment, compared to non diabetic patients. This study investigates the prevalence of anemia in type 2 diabetic patients and aims to determine the role of different stages of nephropathy in development of anemia in these patients. For this study, 1962 outpatients, with type 2 diabetes were selected. A full blood count and iron indices were obtained for all patients. Anemia was defined as Hemoglobin<13g/lit in males and <12 g/lit in females. The correlation of anemia with other variables including sex, age, duration of diabetes, fasting blood sugar, glycosylated hemoglobin, glumerolar filtration rate, albuminuria, uric acid and metabolic syndrome was identified with multivariate logistic regression analysis. In males 9.2% and among females 10.4% of patients had anemia. The prevalence of elevated albuminuria [micro or macroalbuminuria] was 38. 1%. of our patients, 8.1% had moderate [creatinine clearance <60 ml/min/1. 73 m2] and 31. 4% had mild [CCr= 60-90] renal impairment. Patients with moderate renal impairment had significantly higher levels of anemia than patients with mild renal failure [30% Vs. 9%, p<0.001]. Patients with diabetes and macroalbuminuria were also likely to have more anemia than patients with microalbuminuria [32.4% Vs. 8.4%, p<0.001]; also patients with microalbuminuria were also more likely to have anemia than patients without elevated albuminuria [8. 4% vs. 5. 7%, p<0. 001]. Anemia has a high prevalence in type 2 diabetic patients. Any degree of renal impairment and albuminuria are risk factors for anemia in such patients

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

[Functional iron deficiency by percentage of hypochromic red cell in patients treated by chronic hemodialysis in Ghaem and Emam Reza hospital in 2004-2005]

The availability of recombinant human erythropoietin [rHuEPO] over the past decade has advanced the management of anemia in hemodialysis patients. However, iron deficiency either absolute or functional may be leading to failure of rHuEPO treatment. Serum Ferritin [SF] and percent of Transferrin saturation [TSAT] are regarded as the preferred indirect measurements of iron status. These tests, however, have practical limitations and lack sensitivity and specificity to identify ''functional iron deficiency'', witch can occur in the presence of normal or even increased iron stores. Newer methods of assessing iron status are available; with a percentage of hypochromic red cells [%Hypo] >2.5 have been proposed as a marker of Iron deficient erythropoiesis. It measured Hematocrit, Hemoglobin content, SF, and TSAT over 76 chronic hemodialysis patients. The percentage of hypochromic red cells was also measured in a subset of 39 patients. Functional Iron deficiency was defined as a SF > 100 micro g/1 and TSAT 8%. Indivisual characterizing and result of 1ab collected by questinnaire and analyzed by descriptive statistics. 13% of our patients had serum ferritin values > 100 micro g/1 and transferrin saturaton 8% in 80% of our patients at this group. It observed a significant difference in Transferrin saturation [p=0.000] and %Hypo [p=0.001] in these two groups. The diagnostic sensitivity and specificity of %Hypo > 8% in detecting functional Iron deficiency were 80% and 79% respectively. In hemodialysis patients on rHuEPO therapy, Hypo > 8% is a sensitive available marker to identify functional iron deficient patients

[Assessing family problems and the rate of their tendency to admitting and keeping mentally - ill patients at home after discharging from Mashhad hospital [1380-1382]]

The assessment of the remaining documents shows that phenomenon of mentally ill patients has existed since the beginning of the creation of mankind. The attitude and reaction of the society toward this fact has been under permanent change. The prevalence rate of mental problems and their hazardous effects on individuals, families and the society is increasing with growth of population and the urban life. No ethnic or nation has had an effective resistance against being attacked by these disorders. In regard to the importance of families' participation in care and rehabilitation of mentally ill patients as a key in successful treatment all over the world, more attention should be paid. The purpose of this study is to determine possible factors that could influence patients' acceptance by their families after discharging from Hospitals in Mashhad. The samples of this descriptive study [658patients] were randomly chosen and data were collected in 658 patients' families whose their patients discharged from hospital during 1380-1382. Their families interviewed by structured questionnaires. One-way ANOVA and Chi-square were used For information analysis. Findings showed that 23.9% of the families had "high" tendency for accepting the patient at home, 53.8% had "medium" tendency and the remaining 22.3% had no tendency for supporting and keeping patients and the type of family supporting, the patient relationship with his family members and family's supports, the signs of illness, the degree of his ability in doing house affairs, the type of family reactions to the patient's illness signs, level of education [family and patient] and patient's income and occupation, have significant relation with their tendency. There was a significant correlation between family's knowledge of appropriate behavior with patient and their tendency to accepting him/her [P=0.000] and also between the rate of family's satisfaction of state contributions and hospital aids and their tendency to that acceptance [P=0.02]. Experts should carefully evaluate families' psychopathology during treatment and rehabilitation of patients. In order to increase patients' security and acceptance in families, mental health facilities in the community and community mental health councils are essential