Early Oral Feeding After Surgery for Upper Gastrointestinal Malignancies: A Prospective Cohort Study.

OBJECTIVES: Poor nutritional status following abdominal surgeries for esophageal and gastric cancers remains a major challenge in postoperative care. Our study aimed to investigate the efficacy of starting early oral feeding (EOF) in patients undergoing surgical resection of upper gastrointestinal malignancies. METHODS: A total of 180 consecutive patients with a diagnosis of esophageal or gastric malignancies undergoing elective surgical resection between January 2008 and February 2011 were enrolled in this prospective cohort study. Seventy-two patients were assigned to the EOF group, and 108 patients received late oral feeding (LOF). Postoperative endpoints were compared between the two groups. RESULTS: Nasogastric tubes were removed from patients on average 3.3±1.6 days after the surgery in the EOF group and 5.2±2.5 days in the LOF group (p < 0.001). The soft diet regimen was started and tolerated significantly sooner in the EOF group (5.8±1.2 days) than the LOF group (9.5±5.5 days). Hospital stay was significantly shorter in the EOF group compared to the LOF group (6.7±3.1 days vs. 9.1±5.8 days, p < 0.001). Surgical complications and rehospitalization occurred less in EOF group compared with the LOF group. However, the differences were not significant (p > 0.050). CONCLUSIONS: EOF is safe following esophageal and gastric cancer surgery and results in faster recovery and hospital discharge.

Multiple Sclerosis Presenting as a Delirium: A Case Report.

OBJECTIVE: To report a case of multiple sclerosis (MS) with delirium as the first presentation. CLINICAL PRESENTATION AND INTERVENTION: A 34-year-old female was referred to our department with an acute onset of drowsiness, withdrawal from routine activities and aggression, followed by neurologic deficits after a couple of days. Clinical and radiographic examinations were performed, leading to the initial diagnosis of MS. A vast range of differential diagnoses was excluded to confirm the diagnosis of MS. CONCLUSION: Neurological examination and appropriate imaging enabled the diagnosis of MS with delirium in this patient followed by the appropriate treatment.

Hepatitis C virus; its implication for endodontists.

Over 170 million patients worldwide are chronically infected with Hepatitis C virus (HCV); making it a globally important infection. Dentists constantly handle sharp instruments infected with biological fluids and are therefore considered at high-risk of contracting HCV infection. Needle-stick injuries seem to be the most common route of exposure to blood-borne pathogens in dental practice. Moreover, endodontist's constant use of sharp instruments such as endodontic files with limited operative vision in a small working field (i.e. root canal system) increases their risk of exposure to infection. The aim of this study was to review the epidemiology of HCV infection in dental healthcare staff and the tests required for its diagnosis. We also look at the protocols for dental treatment in infected individuals and screening and dental examination tailored for HCV patients.

Oral conditions associated with hepatitis C virus infection.

Hepatitis C virus (HCV) infection in more than 170 million chronically infected patients with no developed preventive vaccine is a globally important issue. In addition to expected hepatic manifestations, a number of extrahepatic manifestations, such as mixed cryoglobulinemia, glomerulonephritis, polyarteritis nodosa, rashes, renal disease, neuropathy, and lymphoma, have been reported following HCV infection, which are believed to be influenced by the virus or the host immune response. HCV combination therapy with pegylated interferon and ribavirin might be associated with side effects as well. The association of HCV with special oral conditions has also been reported recurrently; the mechanism of most of which remains unclear. This article reviews the association of HCV infection with some of the oral conditions such as oral health, Sjogren's syndrome, lichen planus and oral cancer.

Medical students' aptitude toward smoking in Warsaw, Strasbourg and Teheran.

Cigarette smoking is a leading cause of preventable death in the world. Medical students play a role in smoking prevention especially as future physicians, but also as role models in society. Their approach, although influenced by medical education, is based on cultural and socio-economic background. The aim of this study was to analyze smoking habits, prevalence and attitudes towards smoking cessation in medical students from three different countries: Poland, France and Iran. A questionnaire on tobacco smoking was distributed among medical students from three Medical Universities: in Warsaw, Strasbourg and Teheran. The study population consisted of 1,036 students: 499 from Poland, 367 from France and 170 from Iran. The percentage of smokers among medical students was 14% in Warsaw, 14.4% in Strasbourg and 3.5% in Teheran. The prevalence of ex-smokers was 13.6%, 18%, and 1.2% respectively. The use of nicotine replacement therapy or pharmacological aid in smoking cessation was 9% in Warsaw, 7% in Strasbourg, and none in Teheran. In Strasbourg students willing to choose surgical specialization were more likely to be smoking with OR 2.6 (95% CI 1.4-5.0). Never-smokers were more likely than actual smokers to discourage their friends and family from smoking. In Warsaw OR was 3.8 (95% CI 2.0-7.2), in Strasbourg 6.2 (2.6-14.4) and 7.2 (1.0-82.6) in Teheran. In conclusion, similarities in smoking prevalence and attitudes between medical students in Warsaw and Strasbourg were observed, while in Teheran the percentage of smokers reported was much lower. Pharmacological aid or nicotine replacement therapy in smoking cessation was rarely used among medical students.

Optimal duration of treatment for HCV genotype 1 infection in slow responders: a meta-analysis.

BACKGROUND: A head-to-head comparison of the 72-week and 48-week anti-HCV therapies in slow responders with genotype 1 infection has been performed in several randomized clinical trials (RCTs). OBJECTIVES: This review aimed at summarizing and pooling the results of these studies. MATERIALS AND METHODS: RCTs that had evaluated the 72-week vs. 48-week anti-HCV therapy (peginterferon and ribavirin) in slow responders with HCV genotype 1 infection were systematically identified. A meta-analysis was performed using the random effects model. Heterogeneity in results was assessed on the basis of the Q statistics, and publication bias was evaluated by using Harbord's modified test. The end point was set as a sustained virological response (SVR). RESULTS: Data of 1206 subjects were retrieved from 7 studies. A total of 631 patients had received extended therapy. Slow virological responders who received the 72-week therapy had a significantly higher probability of achieving SVR than their counterpartswho received the 48-week therapy [RR = 1.44 (95% CI, 1.20-1.73)]. With regard to publication biases, the heterogeneity in funnel plots was not significant (P = 0.19, I2 = 30%, PHarbord = 0.1). CONCLUSION: Our meta-analysis showed that the 72-week therapy with peginterferon and ibavirin is significantly superior to the standard 48-week therapy in slow responders th HCV genotype 1 infection.

Iranian dental students' knowledge of hepatitis B virus infection and its control practices.

With more than two billion infected people, from whom 350 to 400 million suffer from chronic infection, hepatitis B virus (HBV) is still a major health problem worldwide. As dental treatment puts both dentists and patients at a higher risk of HBV infection, dentists can play an important role in preventing HBV transmission in dental settings. This study was performed to evaluate dental students' awareness and practice regarding HBV-related issues and to compare the results obtained from different academic years. One hundred and forty-two questionnaires consisting of questions on students' knowledge of HBV and preventive measures against this virus were completed by third- to sixth-year dental students of Tehran University of Medical Sciences (TUMS), Tehran, Iran. Overall, a relatively good level of knowledge was observed amongst this population. However, students' answers to practice questions were less satisfying. It is noteworthy that in some cases students of higher academic years showed less awareness. This finding highlights the necessity of continued infection control education. TUMS students must complete an infection control workshop before they start their clinical education. The authors propose that such training at the beginning of each academic year would be worthwhile.

Halothane-induced hepatitis: A forgotten issue in developing countries: Halothane-induced hepatitis.

Halothane was introduced as an anesthetic in the 1950s and was considered a revolutionary agent in the field of anesthesia. Soon after, halothane-induced hepatitis became a concern, leading to the development of less toxic gases that induced a lower incidence of side effects. Two types of halothane-related hepatotoxicity have been described: type 1, or mild hepatitis, is associated with elevated transaminase levels and self-limiting symptoms, and type 2, or severe hepatotoxicity, is associated with acute fatal liver failure and is fatal in most cases. Hepatotoxicity is most likely to be immune-related, based on much evidence. Free radicals that are produced by the metabolism of halothane in the liver can modify cellular proteins and introduce neo-antigens to the immune system. Sensitization to these neo-antigens induces a more severe response after multiple exposures; most cases of type 2 hepatitis occur after repeated contact. New halogenated anesthetics such as enflurane, sevoflurane, and desflurane, are not metabolized in the liver, causing few cases of sensitization. Compared with halothane, these anesthetics are expensive. As a result, replacement of halothane with new halogenated anesthetics requires a precise cost-benefit analysis, especially in developing countries that have low health care budgets.

Anti-HBs antibody status and some of its associated factors in dental health care workers in Tehran University of Medical Sciences: Anti-HBs Ab and associated factors in dental society.

BACKGROUND: Dental health care providers are at risk of infection with hepatitis B virus (HBV). Dentists can occupationally become infected with HBV through needle sticks or exposure to blood and other body fluids. OBJECTIVES: To evaluate anti-HBs antibody titer in students, professors, clinical assistants and non-clinical staff of Faculty of Dentistry, Tehran University of Medical Sciences (TUMS), and to investigate the probable correlation between the level of immunity and a number of associated factors. PATIENTS AND METHODS: 230 participants who had a history of previous HBV vaccination (receiving at least two doses of HBV vaccine) and a negative history of being infected with HBV were studied. Participants' data were recorded using a checklist, and the level of antibody was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: While there existed statistically significant correlations between age, occupation, smoking, complete and scheduled vaccination and time of the last vaccination with the level of anti-HBs antibody, the correlation between gender and level of the antibody was not significant. Multiple regression analysis revealed significant association between immune response and age and time of the last vaccination. CONCLUSIONS: Due to the significant correlation between younger age and anti-HBs antibody titer in our study, it makes sense to establish a mandatory complete and scheduled vaccination program for all members of dental society younger than 40 years.

Lipid Profiles and Hepatitis C Viral Markers in HCV-Infected Thalassemic Patients.

BACKGROUND/AIMS: The distribution of blood lipids, glucose and their determinants in thalassemic patients with chronic hepatitis C virus (HCV) infection has rarely been investigated. Thus, we aimed to investigate the relationship between both liver histologic findings and viral markers and serum lipids in thalassemic patients chronically infected with HCV. METHODS: We enrolled 280 polytransfused thalassemic patients with chronic hepatitis C. HCV viral load was determined using the Amplicor test. Genotyping was performed using genotype specific primers. Fasting serum lipid, glucose, ferritin and liver function enzyme concentrations were measured. A modified Knodell scoring system was used to stage liver fibrosis and to grade necroinflammatory activity. Perls' staining was used to assess hepatic siderosis. RESULTS: Just one subject had total cholesterol >200 mg/dL, and 7% had triglycerides >150 mg/dL. The mean high-density lipoprotein cholesterol (HDL-C) and glucose levels were 37 and 104 (97-111) mg/dL, respectively. Viral markers, liver histological findings and aminotransferase activity were not associated with serum lipid levels. Serum triglycerides, total cholesterol and ferritin were independent risk factors for impaired glucose tolerance or diabetes in these patients. CONCLUSIONS: The majority of the patients had blood lipid levels (with the exception of HDL) within the defined normal range; viral and liver histological factors do not appear to play a significant role in changing the levels of serum lipids or glucose in these patients.

Frequency and antimicrobial susceptibility of Shigella species isolated in Children Medical Center Hospital, Tehran, Iran, 2001-2006.

Appropriate antimicrobial treatment of shigellosis depends on identifying its changing resistance pattern over time. We evaluated 15,255 stool culture submitted from July 2001 to June 2006 to the Laboratory of Children Medical Center Hospital. Specimen culture, bacterial identification, and disk diffusion susceptibility testing were performed according to National Committee for Clinical Laboratory Standards guidelines. From 15,255 stool samples, 682 (4.5%) were positive for Shigella species. The most common species of Shigella were S. flexneri (48%) and S. sonnei (45%); other results were S. dysenteriae (5%) and S. boydii (2%). The rate of sensitivity to ceftriaxone (95%), ceftizoxime (94%), and nalidixic acid (84%) were among our isolates. Resistance to co-trimoxazole and ampicillin was 87% and 86%, respectively. S. flexneri was more multiresistant than other species (47.9%). Our isolates are overall most sensitive to ceftriaxone, ceftazidime, and nalidixic acid (> 84%). They were most resistant to co-trimoxazole and ampicillin (> 86%). Because resistance varies according to specific location, continuous local monitoring of resistance patterns is necessary for the appropriate selection of empirical antimicrobial therapy.

Frequency and antimicrobial susceptibility of Shigella species isolated in Children Medical Center Hospital, Tehran, Iran, 2001-2006

Appropriate antimicrobial treatment of shigellosis depends on identifying its changing resistance pattern over time. We evaluated 15,255 stool culture submitted from July 2001 to June 2006 to the Laboratory of Children Medical Center Hospital. Specimen culture, bacterial identification, and disk diffusion susceptibility testing were performed according to National Committee for Clinical Laboratory Standards guidelines. From 15,255 stool samples, 682 (4.5 percent) were positive for Shigella species. The most common species of Shigella were S. flexneri (48 percent) and S. sonnei (45 percent); other results were S. dysenteriae (5 percent) and S. boydii (2 percent). The rate of Sensitivity to ceftriaxone (95 percent), ceftizoxime (94 percent), and nalidixic acid (84 percent) were among our isolates. Resistance to co-trimoxazole and ampicillin was 87 percent and 86 percent, respectively. S. flexneri was more multiresistant than other species (47.9 percent). Our isolates are overall most sensitive to ceftriaxone, ceftazidime, and nalidixic acid (> 84 percent). They were most resistant to co-trimoxazole and ampicillin (> 86 percent). Because resistance varies according to specific location, continuous local monitoring of resistance patterns is necessary for the appropriate selection of empirical antimicrobial therapy.