Knowledge, attitude, and practice of interns and practitioners graduated from the Medical Universities of Shahid Beheshti, Tehran, and Iran about colorectal cancer screening between 2014-2015

Background: Cancer is the third most common cause of death in Iran. Colorectal cancer is an ideal tumor for screening. Therefore, early diagnosis through screening can reduce its prevalence and mortality. On the other hand, knowledge of practitioners about screening programs has a direct relationship with their performance.Methods: In the present cross-sectional-educational study, knowledge, attitude, and practice of medical interns and practitioners about colorectal cancer screening were evaluated in 2014-2015 and were reviewed using Chi2 and ANOVA statistical tests. Results: From among 300 physicians surveyed, 17.3% knew the age of the screening for colorectal cancer, 73% knew the average-risk, and 68% knew the high-risk criteria correctly. About 48% of the respondents recommended Fecal Occult Blood Test (FOBT) method for population at medium risk and 75% of recommended colonoscopy as a screening method in highrisk populations. Also, 90% of physicians knew the signs and symptoms of colorectal cancer. About half of the practitioners asked their patients about risk factors and advised them to undergo screening. About 55% of the participants who had family members needing screening decided to undergo screening and 6.3% of them who needed screening, decided to undergo screening.Conclusion: Colorectal cancer is growing in the country; a fact that can be prevented. The results of the present study showed that practitioners have little knowledge of appropriate age of screening and screening methods and insufficient attitudes and actions about this issue. It is recommended that general practitioners and family physicians, who are the first lines of encounter with the patients, be properly trained.Keywords: Knowledge; Attitude; Performance; Colorectal cancer; Medical student

Asymptomatic Giant Left Atrium: Do Atrial Size Changes After Successful Valve Replacement? 7-Years Follow-up Case Report

Background: Giant left atrium (GLA) associated with mitral valve surgery reported to have a mortality ranging from 8% to 32%. Most of the patients are symptomatic with that of shortness of breath, dysphagia, palpitations, chest pain, and thromboembolic events. Asymptomatic giant enlargement of the left atrium is rare. Either we must do or not do a reduction arterioplasty at the time of the mitral valve surgery is a controversy in the literature.Case Report: The patient had mitral valve replacement with a with a 31 mm carbomedics mechanical valve prosthesis 7 years past during her last visit. No reduction arterioplasty was done with a valve operation. Her 7-years close follow-up was uneventful. In the last visit, echocardiography and spiral chest computerized tomography scanning were requested. In both of the requested images giant left trial enlargement was seen, but the patient was without symptoms regarding her giant left atrium.Conclusions: In this case report, it seems that if we want left atrial size decline, it is necessary to have reduction arterioplasty during mitral valve surgery. However, it does not mean a definite therapeutic efficacy, especially when considering future symptoms

Alternative Medicine’ Complaints Lodged to the Tehran Forensic Medicine Organization From 2011 to 2017

Background: Complementary and alternative medicine is a non-conventional therapy and includes a wide range of medical treatments in different countries. This study was done to evaluate alternative medicine complaints lodged to the Tehran Forensic Medicine Organization from 2011-2017.Methods: In this cross-sectional study, all documented complaints of complementary medicine lodged to the Tehran Forensic Medicine Organization from 2011-2017 were reviewed and assessed with retrospective follow-up. The inclusion criterion was complaints from complementary and alternative medicine, and the exclusion criterion was incomplete data. The study data included patients’ demographic data, the therapist, the specialty of the therapist, type of disease, treatment method, adverse effects, the initial and final decision by the commission, and the amount of medical error. This information was extracted from the existing documents and recoded in the checklists.Results: Medical errors were found in 53.4% of the complaints examined. The most common cause of complaint (63%) was the adverse effects, of which the most common ones were phytotherapy (45.2%) and cupping (Hijama) (20.5%). The error was significantly different between physician and non-physician healers (P=0.001).Conclusion: Based on this study, among the alternative medicine complaints lodged to the Tehran Forensic Medicine Organization from 2011-2017, the adverse effects were the main problem of complementary therapies confirmed in more than half of the complaints

Predicting Factors for the Communication between hydatid Cyst and Biliary Tract

Background: Hydatid cyst communicated with biliary tract increases the morbidity and mortality rates. Therefore, early detection and treatment are vital.Methods: From 96 patients undergone hydatid cyst surgery, 12 were excluded. The specifications, size, location, and position of the cyst, the condition of the cyst wall thickness, the caught lobe, cyst rupture, liver abscess, and the size of the inside and outside liver bile ducts were identified through computed tomography scanning. Age, gender, icterus, white blood cell (WBC) count, the total, direct, and indirect bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase were identified.Results: In 21 patients (13 men and 8 women), there was communication between the hydatid cyst and biliary tract; from them, 14 patients had icterus. There were significant differences between the size of the cyst, the levels of liver enzymes, bilirubin, and alkaline phosphatase, and WBC count in communicated and non-communicated hydatid cysts (P = 0.001). There were no significant differences between the two groups in terms of age, gender, location of the cysts in the liver, and the thickness of the liver.Conclusions: Only the cyst size and the level of bilirubin were the predicting factor for the communication between hydatid cyst and biliary tract

Relationship between nurse's stress and environmental - occupational factors

Background: Stress is one of the most common psychological issues for nurses. Its management and adaptation with it is vital and important. The National Association of Safety Professionals introduces nursing as a first stressful job among 40 stressful professions. If stress is successive, long, severe, and attempt to cope with it is unsuccessful, it will have a promotional role for diseases and can result in physical and psychological disorders. The aim of this study was to assess relationship between nurse's stress and environmental and occupational factors in Al-Zahra educational-health care center. Methods: This was a cross-sectional study on 216 nurses. Subjects were selected with random convenience sampling method among nurses working in different wards of Al-Zahra hospital. Data gathering was done with questionnaire contained demographic information and identifying stress level. Data analysis was done in SPSS software using KruskalWallis and Mann-Whiney U tests. Results: Findings showed that 44.4% (93 subjects) had low stress level, 55.1% (118 subjects) had moderate stress level, and 0.5% (5 nurses) had severe stress level. There was no significant correlation with stress level and some demographic information such as age, gender, marriage status, shift wok, overcome work and number of children, but there was significant correlation with stress level and job satisfaction and leisure. Discussion: Study results showed that stress level of nurses working in Al-Zahra hospital was moderate. Responses to this stress can affect nurse-patient relationship in workplace, among this, with appropriate and low-expenses methods can cope with stress and decrease its level. It is recommend that heath care services invest more on exercise and recreational field

Tension-free Primary Closure, Secondary Intention, and Limberg Flap, Which Is More Effective in Treatment of Uncomplicated Pilonidal Sinus Disease?

Background: This study was performed to compare the efficacy and long-term outcomes of three surgical treatments for uncomplicated pilonidal sinus disease, tension-free primary closure, Limberg flap, and secondary intention (wide excision and packing).Methods: In this randomized clinical trial study, 66 patients with uncomplicated pilonidal sinus disease were randomly assigned to be surgically treated using tension-free primary closure, Limberg flap, or secondary intention methods. The outcomes including pain, healing time, recurrence, complications, disability, reoperation, and patient satisfaction were compared between three groups after two years of follow-up.Findings: In Limberg flap group, the healing time and disability were significantly less than the two other groups; besides, the pain was significantly less than secondary intention group and more than the primary closure group (P < 0.0001 for all). There were no significant differences between the groups regarding recurrence, complications, reoperation, and patient satisfaction (P > 0.05 for all).Conclusions: Totally, according to our findings and comparison with other studies, it may be concluded that Limberg flap is relatively better than primary and secondary intention in patients with uncomplicated pilonidal sinus disease

Survey of Factors that Affect the Arteriovenous Fistulas Survival in Semnan and Mahdishahr, Iran

Background: First step in chronic dialysis is establishing a suitable dialysis access. Arteriovenous fistula (AVF) has been known as the gold standard for hemodialysis; and due to complex interaction of factors that affect thesurvival time of fistula, we decided to evaluate survival time and affective factors among the dialysis patients.Methods: In a historical cohort study, we analyzed 52 patients of the Semnan and Mahdishahr Dialysis Centers. The data recorded by history taking and physical examination.Results: The survival of fistula was 83%, 80%, 67%, and 40% after 1, 3, 5, and 10 years respectively. Our results showed that the survival time of fistula was higher among patients with left-side AVFs. Factors such asage, gender, underlying disease, dialysis session per week, the time that patients started dialysis after installing fistula and fistula infection did not statistical significant affect the survival time.Conclusions: The survival time of AVF among dialysis patients of Semnan and Mahdishahr is satisfying, and installing the fistula in left hand lead to higher survival

Comparison of the Efficacy of Oral Simvastatin and Topical Simvastatin Solution in Decreasing Post-Laparotomy Adhesions in Rats

Background: Intra-abdominal adhesions and their complications occur frequently after laparotomy. The aim of this study was to compare oral versus intraperitoneal administration of simvastatin in decreasing postlaparotomy adhesions in rat.Methods: Thirty male Wistar albino rats were divided into three groups of ten. All the rats underwent laparotomy and induction of adhesions using the method of Meso-Stitch approximation of injured cecum and abdominal wall. One group received oral simvastatin (40 mg/kg) daily during two weeks before the laparotomy. In the two other groups, 2 ml of solution of simvastatin (40 mg/kg) or distilled water (as placebo) was spilled into abdomen before closing abdominal wall, respectively. After 14 days, all the rats were put under laparotomy again to be compared. Rates and grades of adhesions were assessed using Hoffman et al. and Lauder et al. Scale and histopathological reports.Results: In placebo group, the grade II and III adhesion was seen in 2 and 8 rats, respectively. In local simvastatin group, there was no adhesion in 5 rats, and grade I and II adhesion was seen in 3 and 2 rats, respectively. In oral simvastatin group, 6 rats were without adhesion, and 3 cases with grade I and 1 case with grade II adhesion. The frequency and grade of adhesion were statistically different in simvastatin groups compared to the placebo group (P < 0.001), but not with each other.Conclusions: Oral simvastatin for two weeks before the laparotomy can reduce post-laparotomy adhesion bands as well as local administration of simvastatin solution

Simultaneous Helicobacter Pylori Infection in Gastric Mucosa and Gallbladder Mucosa in Patients with Cholecystitis; Is There Any Relationship?

Background: This study aimed to assess the prevalence of Helicobacter pylori infection in gastric and gallbladder in patients with acute cholecystitis or symptomatic cholelitiasis undergoing cholecystectomy.Methods: 43 patients with biliary disease (cholecystitis or cholelitiasis) with inclusion criteria were selected in Shahid Modarres Hospital, Tehran, Iran. The data including age, sex, and the presence of Helicobacter pylori in biopsy samples of gallbladder and gastric mucosa for each patient were recorded and analyzed using SPSS software.Results: The biopsy specimens of gastric and gallbladder mucosa of 43 patients with the mean age of 54.8 ± 9.9 years were studied. 22 (51.2%) patients had acute cholecystitis and 21 (48.8%) had cholelithiasis. Among the gastric samples, 14 patients (32.6%) (9 men and 5 women) and in the gallbladder samples, 19 patients (44.2%) (8 women and 11 men) were positive for Helicobacter pylori. The simultaneous presence of Helicobacter pylori in the gastric and gallbladder mucosa was seen in 6 patients (13.9%). 10 patients (23.2%) were smokers, and 33 (76.7%) were non-smokers.Conclusions: It can be said that the presence of Helicobacter pylori in gallbladder can play an important role in the creation and spread of the infection. But the simultaneous presence of Helicobacter pylori infection in gastric and gallbladder cannot be a good standard to evaluate the diseases of the bile ducts

Hypertension after Bilateral Nephron Sparing Surgery for Bilateral Wilms

Background: Nephron sparing surgery (NSS) for unilateral Wilms tumor (WT) has been debated recently and is being used to preserve kidney tissue and function. However, NSS is feasible only for selected cases with higher local relapse rates. There is a significant reduction of nephrons with the development of renal hypertension and progressive renal failure. In this paper, we have analyzed outcomes after bilateral partial nephrectomy (PN) and unilateral partial plus contralateral total nephrectomy in our patients with bilateral WT.Methods: We have analyzed our four patients (8 kidneys) with bilateral WT and 8 unilateral complete resection. Kidney size was measured using volumetric analysis computed tomography scan imaging. The patients were matched with children who had undergone imaging of the abdomen for other malignancies.Results: Mean kidney volumes after unilateral partial plus total contralateral nephrectomy (60.9 cm3) were significantly greater than the reference kidneys. Total kidney volume was significantly larger after bilateral PN (98.1 cm3) versus unilateral partial plus total contralateral nephrectomy (60.9 cm3).Conclusions: Our findings suggest that patients with bilateral WT benefit from bilateral NSS. Hypertension is less common after bilateral PN. However, rates of local relapse or disease associated death are separately between the groups