Comparison of the efficacy and safety of palomo, ivanissevich and laparoscopic varicocelectomy in iranian infertile men with palpable varicocele

Background: This study aimed to compare the effects of three commonly used varicocelectomy techniques namely, open retroperitoneal ligation [Palomo], open inguinal ligation [Ivanissevich] and laparoscopy, in Iranian infertile men

Materials and Methods: This retrospective study was conducted on 70 infertile men with palpable varicocele who underwent one of the varicocelectomy techniques namely, Palomo, Ivanissevich, or laparoscopy. Basic information about semen parameters were collected and registered prior to the surgery. Three months after the surgery, semen parameters and surgical complications were investigated in all patients

Results: The Palomo technique was significantly associated with fewer complications compared to other techniques [P=0.006]. The means of sperm concentration, normal motility and normal morphology were significantly different among the three groups after surgery [P=0.025, 0.023 and 0.047, respectively]; However, after adjustment for potential confounders, in addition to the baseline values of semen parameters, significant differences were observed only in sperm concentration among the groups [P=0.040]

Conclusion: Varicocelectomy improved sperm parameters. The Ivanissevich technique was more effective in improving sperm concentration compared to the laparoscopic method. The lowest rates of complications were related to the Palomo technique

Comparing anti-hepatitis B antibody level in Iranian obese or overweight with non-obese cases

Background: There is a controversy about the relation between anti-hepatitis B [anti-HBs] antibody level and obesity. We designed this study to compare the vaccine efficacy in obese/overweight and non-obese cases

Methods: In this cross-sectional study, 242 obese/overweight and 85 non-obese individuals were participated. Cases were selected from a referral clinic for obesity and a referral hepatology clinic, both in Tehran, Iran

Results: Obese cases had lower percentage of liver diseases [66.9% vs. 100%, P<0.001] but higher hepatitis B vaccination history [74.9% vs. 51.2%, P<0.001]. Median+/-inter-quartile range of anti-HBs titer in obese cases was significantly lower than controls [48.5+/-194.5 vs. 100+/-557.6, P=0.012]

Conclusion: The level of anti-HBs surface antigen antibody's titer in obese cases without liver disease is lower than control group. Therefore, a suitable strategy is needed to overcome this problem, which can be the use of longer needles for vaccination

Determining the lymphadenopathy characteristics of the mediastinum in lung CT scan of children with tuberculosis

Objective/Background: Most tuberculosis cases in children are primary infection, with difficult and imprecise diagnosis mainly based on the existence of mediastinal lymphadenopathy. Here, we investigated the characteristics of mediastinal lymphadenopathy in lung computed tomography [CT] scans of children with tuberculosis

Methods: This cross-sectional study was performed on 75 children with tuberculosis referred to Masih Danesh-vari Hospital in Tehran, Iran, from 2009 to 2013. Their medical records were investigated, and CT-scan characteristics were extracted by a radiologist

Results: Mean +/- standard deviation age of cases was 11.2 +/- 4.6 years. CT-scan results indicated 94.7% of cases had lymphadenopathy, with lower paratracheal, upper paratracheal, hilar, and subcarinal forms observed in 81.7%, 69.1%, 53.5%, and 47.9% of cases as the most involved stations in lymph nodes, respectively. In 74.6% of patients with mediastinal lymphadenopathy, perilymph node fat inflammation [matting] was observed, with 52.11% exhibiting conglomeration. Bronchial pressure was observed in 4.23% of children with tuberculosis, and bilateral-, right-, and left-parenchymal involvement was observed in 42.7%, 25.3%, and 8% of these cases, respectively. Left- and right-pleural effusion and calcification was reported in 6.7%, 12%, and 5.6% of patients, respectively

Additionally, nearly 80% of patients exhibited mediastinal lymphadenopathy and lung-parenchyma involvement simultaneously. Lung-parenchyma involvement was significantly correlated with subcarinal [p < .001], hilar [p < .001], subaortic [p = .030], lower paratracheal [p = .037], and axillary [p = .006] stations

Conclusion: Situation of mediastinal lymphadenopathy and its synchronicity with lung-parenchyma involvement can help in differential diagnosis of pulmonary tuberculosis from other lung diseases

The authors reply: Impact of metabolic syndrome on response to medical treatment of benign prostatic hyperplasia

No abstract available.

Impact of Metabolic Syndrome on Response to Medical Treatment of Benign Prostatic Hyperplasia

PURPOSE: To investigate the effect of metabolic syndrome (MetS) on the response to medical therapy of benign prostatic hyperplasia (BPH) after a 3-month period of treatment. MATERIALS AND METHODS: This was a cohort study of 100 patients, 47 with MetS and 53 without MetS, referred to either the primary care unit or referral hospital with BPH who had moderate lower urinary tract symptoms of prostate involvement and were candidates for medical treatment. Our main outcome was response to medical treatment with prazosin 1 mg twice a day and finasteride 5 mg daily in patients with BPH on the basis of International Prostate Symptom Score (IPSS). Multivariate analysis of covariance was used to compare BPH treatment response in patients with and without MetS before and after receiving treatment. RESULTS: The mean volume of the prostate was significantly higher in MetS patients than in patients without MetS (57+/-32.65 mL compared with 46.00+/-20.19 mL, p=0.036). The control group demonstrated an 11-unit reduction in IPSS, whereas those with MetS showed a reduction in the symptom score of only 6 units (p<0.001). Regarding the components of MetS separately, triglyceride (p<0.001), fasting blood sugar (p=0.001), and waist circumference (p=0.028) significantly affected the clinical progression of BPH. The observational nature of this study may be a limitation in comparison with an interventional study. CONCLUSIONS: The results of the present study showed that MetS can negatively affect the response to medical treatment of BPH. Therefore, it is necessary to consider MetS in selecting patients with BPH for drug therapy.

Model Determination of Delayed Causes of Analgesics Prescription in the Emergency Ward in Arak, Iran

BACKGROUND: According to the reports of the World Health Organization 20% of world population suffer from pain and 33% of them suffer to some extent that they cannot live independently. METHODS: This is a cross-sectional study which was conducted in the emergency department (ED) of Valiasr Hospital of Arak, Iran, in order to determine the causes of delay in prescription of analgesics and to construct a model for prediction of circumstances that aggravate oligoanalgesia. Data were collected during a period of 7 days. RESULTS: Totally, 952 patients participated in this study. In order to reduce their pain intensity, 392 patients (42%) were treated. Physicians and nurses recorded the intensity of pain for 66.3% and 41.37% of patients, respectively. The mean (SD) of pain intensity according to visual analogue scale (VAS) was 8.7 (1.5) which reached to 4.4 (2.3) thirty minutes after analgesics prescription. Median and mean (SD) of delay time in injection of analgesics after the physician's order were 60.0 and 45.6 (63.35) minutes, respectively. The linear regression model suggested that when the attending physician was male or intern and patient was from rural areas the delay was longer. CONCLUSIONS: We propose further studies about analgesics administration based on medical guidelines in the shortest possible time and also to train physicians and nurses about pain assessment methods and analgesic prescription.

Comment on: Risk of Pancreatic Cancer in Relation to ABO Blood Group and Hepatitis C Virus Infection in Korea: A Case-Control Study

No abstract available.

Sonographic optic nerve sheath diameter as a screening tool for detection of elevated intracranial pressure

Timely diagnosis and treatment of post-traumatic elevated intracranial pressure [EICP] could be reduced morbidity and mortality, and improved patients' outcome. This study is trying to evaluate the diagnostic accuracy of sonographic optic nerve sheath diameter [ONSD] in detection of EICP. Sonographic ONSD of patients with head trauma or cerebrovascular accident suspicious for EICP were evaluated by a trained chief resident of emergency medicine, who was blind to the clinical and brain computed tomography scan [BCT] find-ings of patients. Immediately after ultrasonography, BCT was performed and reported by an expert radiologist without awareness from other results of the patients. Finally, ultrasonographic and BCT findings regarding EICP were compared. To evaluate the ability of sonographic ONSD in predicting the BCT findings and obtain best cut-off level, receiver operating characteristic [ROC] curve were used. Sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], positive likelihood ratio [PLR], and negative likelihood ratio [NLR] of so-nographic ONSD in determining of EICP was calculated. P < 0.05 was considered as statistically significant. There were 222 patients [65.3% male], with mean age of 42.2 +/- 19.5 years [range: 16-90 years]. BCT showed signs of EICP, in 28 cases [12.6%]. The means of the ONSD in the patients with EICP and normal ICP were 5.5 +/- 0.56 and 3.93 +/- 0.53 mm, respectively [P<0.0001]. ROC curve demonstrated that the best cut off was 4.85 mm. Sensitivity, specificity, PPV, NPV, PLR, and NLR of ONSD for prediction of EICP were 96.4%, 95.3%, 72.2%, 98.9%, 20.6, and 0.04, respectively. Sonographic diameter of optic nerve sheath could be considered as an available, accurate, and noninvasive screening tool in determining the elevated intracranial pressure in cases with head trauma or cerebrovascular accident

Evaluation of the effect of Islamic fasting on lung volumes and capacities in the healthy persons

To evaluate the changes in pulmonary volumes during and after Islamic fasting. It is a cohort study conducted on 117 healthy subjects selected on a random basis from employees, professors and students of Iran University of Medical Sciences, Tehran, Iran, between December 1999 and January 2000. All of them underwent spirometry 10 days prior to Ramadan, 2 times during Ramadan, and one time 10 days post-Ramadan. In first visit, in addition to spirometry they underwent medical examination to make sure they are healthy. All of their spirometries and background information were collected. Repeated measurements analysis of varience method was used to compare the measurements. Approximately 69% of subjects were male and the mean age was 23.9 years. Mean fasting time was 27.8 days. The mean difference in forced expiratory volume in 1 second [FEV1%] was significant between the 4 visits [P=0.01]. The mean FEV1% increased both during fasting and after Ramadan [P=0.017]. The mean vital capacity and peak expiratory flow rate values increased during Ramadan significantly [p=0.043, P<0.001]. Although the mean maximum mid-expiratory flow decreased in the beginning of Ramadan and significantly increased subsequently [P=0.02], MEF50% [P=0.004] and MEF75% [P=0.047] increased in the beginning of Ramadan and decreased subsequently. As a whole, fasting increases lung volumes and might improve pulmonary function. This finding seems to be relevant to the changes in weight during Ramadan

Combination therapy of interferon-alpha [PDferon and B®] ribavirin for chronic hepatitis C

Introduction: the addition of ribavirin [RIBA] to the standard treatment with interferon [IFN] alpha led to an improvement in sustained virologic response [SVR] from less than 20% with IFN monotherapy to 40-45% in combination therapy. The aim of this study is to assess the therapeutic efficacy and safety of IFN alpha [PDferon B®] in combination with RIBA on Iranian patients with chronic hepatitis C [CHC]

Methods: 48 naive patients aged 18 years or more with CHC were enrolled and treated with 3 mega units [MU] IFN alpha-2b three times a week plus 800-1000 mg RIBA per day for 48 weeks. Follow-up after therapy was 6 months. The efficacy was evident at the end of treatment and at the end of follow-up in terms of sustained normalization of alanine aminotransferase and sustained serum HCV-RNA loss

Results: the rate of sustained biochemical and virologic response were 68.3% and 78%, respectively. Virologic response was 80.9% and 86.4% at weeks 12 and 48 as well. Any patient didn't have serious complication

Conclusion: although we had no control group who used standard IFN, our preliminary finding showed acceptable and promising response rate of PDferon. On the other hand, it seems that adverse events with PDferon are as like as other standard IFNs

efficacy of lamivudine in Hepatitis B - related Cirrhosis

Aim: in patients with chronic hepatitis B and compensated liver disease, lamivudine reduces s e m HBV-DNA to undetectable levels within 1 to 2 months of treatment. The aim of this study was to evaluate the efficacy of lamivudine in cases with hepatitis B related cirrhosis

Methods: this is a quasi-experimental study on 90 patients with cirrhosis due to hepatitis B. All patients received lamivudine at a dose of 100 mg per day, given orally for 52 weeks. The effect of the drug on liver function, viremia and clinical stage of the disease were assessed

Results: mean age of patients was 53.2 +/- 1.43 years. After 24 weeks and 52 weeks, there were only 28.6% and 26.4% of cases with positive HBV-DNA. Child score had a significant decrease after one year treatment with lamivudine

Conclusion: this study presents a sufficient antiviral effect of lamivudine [Biovudine] in HBV-related cirrhosis patients