Design and Evaluation of the “Preparation Course for New Entrant Assistants” on the Awareness and Skills of Newly Arrived Surgery Resident

Background: Beginning of assistance course is associated with anxiety. This due to unfamiliarity with the assistance and insufficient training, knowledge, and required skills. The aims of this study were to design, implement and evaluate the effects of a period of 1-month as “preparation course for new entrant assistants” on the awareness and skills of newly arrived residents.Methods: 12 newly arrived assistant student were divided into two equal groups. Some steps such as understanding the environment and legislation, education about an emergency, and dealing with patients and also, suturing, chest tube insertion, and cut down skills were passed by the first group before starting the assistance course. The second group was entered in the assistance course without this preparation course. For performance evaluation and comparison of these two groups, four questionnaires were created and filled consequently before the entrance, at the end of the 2nd month, based on direct observation of procedural skills (DOPS) exam, and at the end of 6th month.Results: There were no significant differences between two groups at the beginning of the study (P < 0.05). At the end of the 2nd month, the first group had better performance in understanding the environment, patient examination, diagnosis and emergency skills in comparison to the second group (P < 0.05). Based on the DOPS score, the first group had significantly better performance (P < 0.05) except in performing cut-down (P > 0.05). Also procedure, the first group was better than the second group just in the consensus of the procedure (P < 0.05). Finally, at the end of the 6th month, the difference between two groups was becoming lower, and supervisors believed that after additional 3 months, this difference would be lost.Conclusions: Conducting a 1-month period of preparation for new entrant assistants can be useful in increasing awareness, understanding the environment, performance, the knowledge of the theory and how to deal with patients as well as increase their skills in performing the expected procedures

ANORECTAL DISEASES IN AVICENNA’S “CANON OF MEDICINE”

Although the development of modern medicine has helped us detect and treat diseases better than in the past, especially in the field of surgery; the history of medicine may be a trigger that can help us use neglected aspects of prior knowledge for the advancement of modern-day science. Since historical papers that have specifically focused on anorectal diseases are rare, but those that exist contain brief discussions in this field, the current study aims to present a detailed review of Avicenna’s approach to anorectal diseases. Therefore, we reviewed On the Diseases of the Anus, the 17th chapter of the third volume of the Canon of Medicine written by Avicenna, and compared his views on the classification and diagnosis of, and the approach to anorectal diseases with that of modern proctology. Avicenna discussed in detail about anorectal diseases such as hemorrhoid, fissure, perianal abscess and fistula, rectal prolapse, fecal incontinence, and pruritus ani. In addition, we introduce herbs which Avicenna used to treat these diseases. Our findings show that Avicenna’s views on the classification and diagnosis of, and the approach to anorectal diseases have few fundamental differences with modern medicine. In addition, the pharmacological effects of some of the herbs that were recommended by Avicenna, and are used in current medicine are proven. Thus the Medieval knowledge can be further scientifically investigated to develop new therapeutic options for anorectal diseases.Premda nam je razvoj moderne medicine pomogao bolje negoli je to bilo u prošlosti detektirati i tretirati bolesti, napose u polju kirurgije, povijest bi medicine mogao biti okidač koji nam može pomoći u korištenju zanemarenih aspekata prijašnjeg znanja, a za unapređenje suvremene znanosti. Budući da su povijesni tekstovi koji se usko fokusiraju na anorektalne bolesti rijetki, ali oni koji postoje sadrže kratku diskusiju u polju, ova studija nastoji detaljno prikazati Avicenin pristup anorektalnim bolestima. Zbog toga smo prikazali 17. poglavlje trećeg sveska Avicenina Kanona medicine, „O bolestima anusa“, i usporedili njegove poglede na klasifikaciju i dijagnozu te pristup anorektalnim bolestima s onima moderne proktologije. Avicena je detaljno raspravljao o anorektalnim bolestima kao što su hemoroidi, rascjep (fisura), perianalni apsces i kanal (fistula), rektalni prolaps, fekalna inkontinencija i analni svrbež. U nastavku predstavljamo trave koje je Avicena koristio za tretiranje spomenutih bolesti. Naše istraživanje pokazuje da Avicenini pogledi na klasifikaciju i dijagnozu te pristup anorektalnim bolestima imaju malo fundamentalnih razlika s modernom medicinom. Zatim su dokazani farmakološki efekti nekih trava koje je preporučivao Avicena i koji se koriste u sadašnjoj medicini. Dakle srednjovjekovno znanje može biti dalje znanstveno proučavano za razvijanje novih terapijskih mogućnosti za anorektalne bolest

The Prevalence of Pain and the Role of Analgesic Drugs in Pain Management in Patients with Trauma in Emergency Department

Background: Pain could potentially affect all aspects of patient admission course and outcome in emergency department (ED) when left undertreated. The alleviation of acute pain remains simply affordable but is usually, and sometimes purposefully, left untreated in patients with trauma. This study challenged the conventional emergency department policies in reducing the intensity of acute pain considering the pharmacological treatments.Methods: In this case-control study, the prevalence and intensity of pain in 200 patients were evaluated on admission (T1) and 24 hours later (T2) based on the valid, standardized 10-point numeric rating scale (NRS 0-10) for pain intensity. A group of patients received analgesic drugs and others did not. Changes in pain patterns regarding different aspects of trauma injuries in these two groups were compared.Results: The pain prevalence was high both on admission and 24 hours later. 51.5% of the study population received analgesics and 77.6% of them reported a decrease in the intensity of their pain. Only half of the patients, who did not receive any medication, reported a decrease in their pain intensity after 24 hours. The most beneficial policy to manage the acute pain was a combination therapy of the injury treatment and a supplementary pharmacological intervention.Conclusions: Pharmacological management of pain in patients with trauma is shown to be significantly beneficial for patients as it eases getting along with the pain, and still seems not to affect the diagnostic aspects of the trauma. Pain management protocols or algorithms could potentially minimize the barriers in current pain management of patients with trauma

Long COVID, a comprehensive systematic scoping review

Abstract: Purpose To fnd out what is known from literature about Long COVID until January 30, 2021. Methods We undertook a four-step search with no language restriction. A preliminary search was made to identify the keywords. A search strategy of all electronic databases resulted in 66 eligible studies. A forward and backward search of the references and citations resulted in additional 54 publications. Non-English language articles were translated using Google Translate. We conducted our scoping review based on the PRISMA-ScR Checklist. Results Of 120 papers, we found only one randomized clinical trial. Of the 67 original studies, 22 were cohort, and 28 were cross-sectional studies. Of the total 120 publications, 49.1% focused on signs and symptoms, 23.3% on management, and 10.8% on pathophysiology. Ten publications focused on imaging studies. The results are also presented extensively in a narrative synthesis in separated sections (nomenclature, diagnosis, pathophysiology, risk factors, signs/symptoms, management). Conclusions The controversies in its defnition have impaired proper recognition and management. The predominant symptoms were: fatigue, breathlessness, arthralgia, sleep difculties, and chest pain. Recent reports also point to the risk of longterm sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Designing and validating the educational strategies of multi-level classes based on global experiences and assumptions

Background and Aim:  Multi-grade classes are among the curricula used for teaching and training in rural and deprived areas. The conditions in these areas force the educational system to form multi-level classes. This research aims to design and validate the educational strategies of multi-level classes based on global experiences and assumptions. Methods:  The current analytical/descriptive research is of a mixed exploratory type carried out quantitatively and qualitatively. The statistical community in two sections includes authentic documents and texts, experts in the field of primary education and university professors in the field of education and educational management, all experts related to There were multi-level classes that 20 people were selected from the community of experts as a sample in a purposeful way (criterion-based) as a statistical sample. Quantitative and qualitative methods were used to analyze the research questions. In order to design the famous educational approaches of multi-grade classes based on global experiences and assumptions using documents, The study of authentic texts was used using the method of interviews with university professors. Results:  The findings showed that the themes extracted from the interviews with professors and curriculum planning experts consisted of 5 main themes and 41 sub-themes, and these five main patterns obtained were curriculum objectives, effective teaching methods, use of educational standards, fundamental challenges, and qualitative evaluation. Conclusion:   The results of this research showed that the validity of the model designed based on the extracted features was evaluated by appropriate experts

A Survey of the Number of Authors of Articles Based on Different Journal Indexes, the Type of Articles, and the Authors’ Gender in Iranian Medical Journals in 2015-2020

One of the main features of the research system is scientific participation, which is growing rapidly. Scientific participation is often considered as an effective solution for countries to acquire scientific and technological knowledge. Therefore, the purpose of this study was to determine the average number of authors of articles based on the journal indexes, type of articles, and the authors’ gender in Iranian Medical Journals with different indexes in the period 2015-2020. In this cross-sectional study, 60 articles in randomly-selected Iranian Journal of Medical Sciences were selected by simple sampling. After categorizing the journals according to their indexes, we selected 10 journal titles from each index and 20 titles of the first published article of each journal were selected according to the type of article. Then, the data were entered into Excel and analyzed by using SPSS software version 21. The total number of authors of articles according to their index was 4.24. Also, the findings showed that there was a significant difference in the mean of the number of authors in Iranian medical journals. (P-value =0.000). It is suggested that the authors of journal articles should be more inclined to write articles in groups in order to increase scientific cooperation between Iranian authors of medical science journals. This can play an important role in raising the quality of articles

CiteScores of cardiology and cardiovascular journals indexed in Scopus in 2019: A bibliometric analysis

Background: Citations are considered a measure of the scientific impact of research articles. CiteScore is a standard metric, based on the Scopus database, of the number of times articles in a given journal were cited during a given period relative to the number of articles published by that journal during that period.Objectives: To investigate the factors associated with CiteScores of journals on cardiology and cardiovascular diseases and indexed in Scopus in 2019.Methods: This cross-sectional, descriptive-analytical study examined 338 journals to analyse the correlation between CiteScore and such other variables and parameters as coverage by indexing services (databases), type of access, language, type of published articles, age of the journal (year of establishment), H-Index, Scimago Journal Rank, and the quartile of the journal.Results: CiteScore of a journal was positively correlated to the following variables or parameters: coverage by PubMed, Web  of Science, and EMBASE (p < 0.001), articles    in English (p < 0.001), age of the journal (p = 0.001), publishing review articles (p =  0.23), H-Index (p < 0.001), and Scimago Journal Rank (p < 0.001).Conclusion: Coverage of a journal in international databases, especially in PubMed, Web of Science, and EMBASE, is critical to increasing its visibility. Publishing review articles, which tend to be cited more often because they serve as comprehensive sources of information, can increase the CiteScore of a journal. Also, publishing more articles in English contributes to the number of times articles in a journal are cited.

The cost of illness analysis of inflammatory bowel disease

Abstract Background Inflammatory bowel disease (IBD) is a chronic inflammatory condition involving individuals across all age groups. Recent data suggests the increase in the prevalence of IBD and the surge in applying the biologic drugs in which both change the cost of IBD in recent years. Comprehensive assessment of direct and indirect cost profiles associated with IBD in our area is scarce. This study aimed to determine the economic burden of IBD in Iran from a societal perspective, using cost diaries. Methods Patients available on clinic registry and hospital information system (HIS), who were diagnosed with IBD, were invited to take part in this study. Demographic and clinical data, the healthcare resource utilization or cost items, absenteeism for the patients and their caregivers were obtained. The cost of the used resources were derived from national tariffs. The data regarding premature mortality in IBD patients was extracted from HIS. Productivity loss was estimated based on the human capital method. Then, cost date were calculated as mean annual costs per patient. Results The cost diaries were obtained from 240 subjects (Ulcerative colitis: n = 168, Crohn’s disease, n = 72). The mean annual costs per patient were 1077 US$(95$ and 15,183,678 US$for patients with ulcerative colitis and Crohn’s disease, respectively. Highest nationwide economic burden of IBD was found for patients older than 40 years were estimated to be 8,198,519 US$ and 7,120,891 US$, for ulcerative colitis and Crohn’s disease, respectively. Conclusion The medication was found to be the greatest contributor of direct medical costs. Productivity loss in terms of long-term disability and premature mortality were major components of IBD’s economic burden in Iran

Laparoscopic pelvic organ suspension with mesh: a modified technique and primary results

Background: Pelvic organ prolapse recurrence rate is an important issue which impacts the patient's quality of life and results in a new surgical procedure. We use a new technique of laparoscopic pelvic organ suspension (rectal suspension) for pelvic organ prolapse treatment in our center. We evaluated the results of this technique, three months after surgery and at the time of study reporting. Methods: All patients with pelvic organ prolapse for whom laparoscopic pelvic organ prolapse had been done were evaluated. Data were collected from the patient's charts and their short term follow up 3 months after the surgery and their last follow up visit. Demographic, history, physical examination, Wexner's fecal incontinence score and Altomare's Obstructed Defecation Syndrome score, post-operation complications and patient's satisfaction were analyzed, retrospectively. Results: All patients were female with a mean age of 57 ± 11.43 years (range 32–86 years). Mean BMI was 26.1 ± 3.73. Nine patients had rectal bleeding (31%), 18 had prolonged or difficult defecation (62%), 16 had rectal prolapse (55.2%), 11 had gas incontinence (37.9%), 9 had liquid stool incontinence (31%), 5 had stool incontinence (17.2%), 9 had vaginal prolapse (31%), 23 had constipation (79.3%), 9 complaint of pelvic pain (31%), 9 had urge or stress urinary incontinence (31%) and 13 had dyspareunia (44.8%). Conclusions: In conclusion, we believe this procedure has good results in short term follow up (3 months after surgery), but a high recurrence rate in the middle term follow up. Therefore, this procedure is no longer recommended. Resumo: Introdução: A taxa de recorrência do prolapso de órgãos pélvicos é uma questão importante que afeta a qualidade de vida do paciente, resultando em um novo procedimento cirúrgico. Os autores adotaram uma nova técnica de suspensão laparoscópica de órgãos pélvicos (suspensão retal) no tratamento de prolapso de órgãos pélvicos. Os resultados dessa técnica foram avaliados três meses após a cirurgia e no momento do relato do estudo. Métodos: Todos os pacientes com prolapso de órgão pélvico submetidos a suspensão laparoscópica foram avaliados. Os dados foram coletados do prontuário do paciente, na visita de acompanhamento três meses após a cirurgia e na última visita de acompanhamento. Os dados demográficos, histórico médico, avaliação física, escore de incontinência fecal de Wexner, escore da síndrome da defecação obstruída de Altomare, complicações pós-operatórias e satisfação do paciente foram analisados retrospectivamente. Resultados: Todos os pacientes eram do sexo feminino, com média de idade de 57 ± 11,43 anos (variação de 32 a 86 anos). O índice de massa corporal médio foi de 26,1 ± 3,73. Nove (31%) pacientes apresentaram sangramento retal; 18 (62%), defecação prolongada ou difícil; 16 (55,2%), prolapso retal; 11 (37,9%), incontinência gasosa; nove (31%), incontinência fecal líquida, cinco (17,2%), incontinência fecal; nove (31%), prolapso vaginal; 23 (79,3%), constipação; nove (31%), queixa de dor pélvica; nove (31%), incontinência urinária de urgência ou esforço e 13 (44,8%), dispareunia. Conclusões: Os autores acreditam que este procedimento apresenta bons resultados no seguimento de curto prazo (três meses após a cirurgia), mas uma alta taxa de recorrência no acompanhamento a médio prazo. Portanto, esse procedimento não é mais recomendado. Keywords: Pelvic organ prolapsed, Incontinence, Mesh, Wexner's score, Altomare's ODS score, Palavras-chave: Prolapso de órgãos pélvicos, Incontinência, Malha, Pontuação de Wexner, Escore da SDO de Altomar