Genitourinary Fistula: 5 Years' Experience of Five Referral Centers in Iran.

INTRODUCTION AND HYPOTHESIS: Genitourinary fistula is a devastating ailment that has an impact on women's physical health, mental health, emotional health, and financial security. The management of genitourinary fistula depends on the type, size, and duration of fistula formation. The purpose of this study is to report the features of genitourinary fistula in Iranian women and our experience in the management of fistula. METHODS: Retrospective chart reviews of 283 patients were performed to determine the cause of the fistula, prior repairs, tissue interposition, and the success rate. The operation was considered successful if the patient did not have any urine leakage during the observation time. RESULTS: The mean (SD) age of women was 49.51 (19.39; range: 21-70) years, Of these, 137 (52.9%) had a history of previous genitourinary fistula surgery. The average fistula was 1.53 (0.041) cm in size. The median (interquartile range) operation lasted 70 (15) min. The success rate after fistula repair was 91.5%. The typical follow-up period lasted 13.26 (range: 1-88) months. Forty-three (15.2%) patients had a big fistula (>2.5 cm) and 4 patients (1.4%) had a history of pelvic radiation therapy, among other reasons for failure. After a second repair, all patients' initial failures were resolved. There were no significant complications, as classified by Clavien-Dindo class 2 or greater. Additionally, there were no bowel, ureteral, or nerve injuries. CONCLUSIONS: Our patients with genitourinary fistula had a successful outcome following repair techniques, without any significant morbidity or mortality.

Is sacral neuromodulation effective and safe in pregnancy? A systematic review.

OBJECTIVE: We systematically assessed all available evidence on the efficacy and safety of sacral neuromodulation (SNM) in pregnancy. METHODS: On September 2022, a thorough search was done on Ovid, PubMed, Scopus, ProQuest, Web of Science, and The Cochrane Library. We chose studies that included pregnant women who had SNM previously. Two authors independently evaluated the quality of the study using a standardized tool of JBI. Studies were given a risk of bias rating of low, moderate, or high. Given the descriptive nature of this study, we utilized descriptive statistics to report demographic and clinical features. For continuous variables, we used mean and standard deviation, and for dichotomous data, we used frequencies and percentages. RESULTS: Out of 991 abstracts screened, only 14 studies met our inclusion criteria and were included in the review. Overall, the quality of the evidence available from the literature is low based on the design of the included studies. Fifty-eight women, including 72 pregnancies, had SNM. The indication of SNM implantation was filling phase disorders in 18 cases (30.5%), voiding dysfunction in 35 women (59.3%), IC/BPS in two cases (3.5%), and fecal incontinence. In 38 pregnancies (58.5%), the SNM status was ON during pregnancy. Forty-nine cases delivered a full-term baby (75.4%), 12 cases had pre-term labor (18.5%), two miscarriages, and two postterm pregnancies happened. The most complications in patients with devices were urinary tract infection in 15 women (23.8%), urinary retention in six patients (9.5%), and pyelonephritis in two cases (3.2%). The findings revealed that when the device was deactivated, 11 cases out of the 23 patients (47.8%) had full-term pregnancies, while in ON status, 35 out of the 38 pregnant women (92.1%) had full-term pregnancies. Nine preterm labors in OFF (39.1%), and two in ON status (5.3%) were recorded. The results revealed that this difference was statistically significant (p = 0.002), and those who turned SNM of them off had more preterm labor. Although the studies reported all neonates had a healthy status, two children had chronic motor tic problems and a pilonidal sinus in a case with an active SNM in pregnancy. However, there was no association between the SNM status and pregnancy or neonatal complications (p = 0.057). CONCLUSION: SNM activation in pregnancy seems safe and effective. The choice of whether to activate or deactivate SNM should be made on an individual basis given the current SNM evidence.

Altered plasma visfatin levels and insulin resistance in patients with Alzheimer's disease.

Central insulin resistance is involved in the pathophysiology of Alzheimer's disease (AD). Visfatin (VIS), an adipokine secreted from peripheral adipose tissue, is involved in energy balance and weight control. Besides its metabolic roles, VIS possesses insulin-mimetic, anti-apoptotic, and neuroprotective properties. In this study, we assessed the presence of a correlation between plasma VIS level and insulin resistance or AD. Sixty participants were enrolled in this study; 34 patients with AD and 26 healthy subjects. All subjects underwent comprehensive evaluations including Mini-mental score exam (MMSE) for the diagnosis of dementia. Subjects with MMSE score < 24 were added to the AD group, while healthy subjects should have a MMSE score > 27. Fasting blood sugar (FBS) and insulin levels were measured by enzyme-linked immunosorbent assay. The results indicate a significant elevation in FBS from 103 ± 3.0 to 147 ± 7.6 in AD patients (p ≤ 0.001). Additionally, 71% of AD patients developed insulin resistance, as the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index increased from 2.9 ± 0.5 in healthy subjects to 5.2 ± 0.7 in AD patients (p ≤ 0.05). Body mass index and serum insulin level did not show a significant alteration, but serum VIS levels were significantly (p ≤ 0.01) lower in AD patients (11.15 ± 1.9 ng/ml) in comparison to control group (21.09 ± 2.3 ng/ml). There is a negative correlation between plasma VIS level and the HOMA-IR index (p < 0.05). The results of this study present clear evidence for systemic insulin resistance and decreased serum VIS level in non-obese, non-overweight patients with moderate to severe AD.

Ultrasonography in the diagnosis of lung adhesion before surgery.

Background The presence of pleural adhesions may render video-assisted thoracoscopic surgery difficult or impossible. The aim of this study was to assess the value of chest ultrasonography in the detection of pleural adhesions prior to thoracotomy. Methods Between 2013 and 2014, 42 consecutive patients undergoing thoracotomies (including video-assisted thoracicsurgery) were evaluated with chest ultrasonography. These patients underwent a preoperative ultrasonic examination of the chestwall using a 7.5-10-MHz linear ultrasound probe at 7 points along the chest wall. We measured the movement of the visceral pleuralslide. Results In the upper thoracic wall,ultrasonography demonstrated a sensitivity of 63.0%, a specificity of 66%, a negative predictive value of 77%, a positive predictive evalue of 50.0%, and an overall accuracy of 65.0%. And for the lower thoracic wall, ultrasonography demonstrated a sensitivity of 81.0%, a specificity of 59.0%,a negative predictive value of 89.0%, a positive predictivevalue of 44.0%, and an overall accuracy of 65.0%. Conclusion Chest ultrasonography is moderately accurate in detecting the presence and location of pleural adhesions. The use of preoperative chest sonographic findings to plan trocar placement and to determine the need for an open approach is valuable in helping prevent visceral injury and facilitating video-assisted thoracoscopic surgery.

Sleep Quality in Medical Students; the Impact of Over-Use of Mobile Cell-Phone and Social Networks.

BACKGROUND: Poor sleep quality is closely associated with lifestyle habits including use of mobile cell-phones.This study aimed to identify the relationship between sleep quality due to abuse in mobile cell-phones and engagement in social networks. METHODS: This cross-sectional study was conducted on 380 undergraduate students selected by proportional stratified sampling in Qom, Iran in 2015. Data were collected by two standard questionnaire including Cell-Phone Over-Use Scale (COS) and Pittsburgh sleep quality questionnaire beside the status of usage in cell-phone social networks. T-test, chi-square, Pearson correlation coefficient and multivariate logistic regression were used in data analysis. RESULTS: The mean age of participants was 21.8 ±3.2 yr, 69.1% were female, and 11.7% were married. The mean of COS and sleep quality scores were 48.18 ±17.5 and 5.38 ±2.31, respectively. The prevalence of over-use of cell phone was 10.7% (CI 0.95; 8.8%, 12.6%) and the prevalence of poor sleep quality was 61.7% (CI 0.95; 57.1%, 66.3%). The mean of all aspects and total score of sleep quality showed a direct significant association by cell-phone addiction score except sleep duration score that was inversely. Based on multivariate analysis affected to cell-phone addiction, being male gender and studying in general physician level are the most important predictors of poor sleep quality. CONCLUSIONS: Over use of internet and social networks via smart phones is related to poor sleep quality and quantity. Predefined sport programs, educational, cultural, and interesting entertainment are the essential needs for all medical students. These interventions are more important especially for male students who have longer educational.