Low Anterior and Very Low Anterior Resection in Patients with Rectal Cancer with or without Diverting Colostomy: A Comparison

Introduction: In colorectal cancer surgery, diverting colostomy after low anterior resection (LAR) and very low anterior resection (VLAR) operations is an issue of great significance to the surgeons. This study set out to compare the results of operation in patients with rectal cancer, undergoing VLAR and a type of LAR of the rectum, with or without diverting colostomy. Materials and Methods: 100 patients with rectal cancer undergoing VLAR and LAR, with or without diverting colostomy at a tertiary care hospital (Imam-Hossein Medical Center) were prospectively assessed from March, 2011 to February, 2015. Demographic data, radiotherapy history, and surgery-related data such as duration as well as post-operative complications were collected and analyzed. Results: Of 100 patients, 50 underwent VLAR or LAR without diverting colostomy, and 50 underwent surgical resection with diversion. The age, male to female ratio, and history of radiation were not different in the two groups (P>0.05). The surgery was successful for 47 (94%) patients without diverting colostomy and for 48 patients (96%) with diverting colostomy. The age, gender, history of radiotherapy, and surgery duration did not affect the surgery success rate (P > 0.05), which is fairly significant. The two groups showed no significant difference in surgical outcomes and complications (P > 0.05). Conclusion: Contrary to popular belief, the surgery success rate and complications were not significantly different in the group without diverting colostomy and the group with diverting colostomy. VLAR and LAR without diverting colostomy are recommended. &nbsp

Clinical Study Mebeverine for Pediatric Functional Abdominal Pain: A Randomized, Placebo-Controlled Trial

We evaluated the effectiveness of an antispasmodic, mebeverine, in the treatment of childhood functional abdominal pain (FAP). Children with FAP ( = 115, aged 6-18 years) received mebeverine (135 mg, twice daily) or placebo for 4 weeks. Response was defined as ≥2 point reduction in the 6-point pain scale or "no pain. " Physician-rated global severity was also evaluated. Patients were followed up for 12 weeks. Eighty-seven patients completed the trial (44 with mebeverine). Per-protocol and intention-to-treat (ITT) analyses were conducted. Treatment response rate in the mebeverine and placebo groups based on per-protocol ( = 0.0503 [0.416]). There was no significant difference between the two groups in change of the physician-rated global severity score after 4 weeks ( = 0.723) or after 12 weeks ( = 0.870) in per-protocol analysis; the same results were obtained in ITT analysis. Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo. Further trials with larger sample of patients are warranted

Cost-Effectiveness of Rituximab Versus Bortezomib in Kidney Transplant Patients

Background and purpose: Kidney transplantation is still the most important and main treatment for advanced kidney failure. However, some patients reject the transplant through an immune system reaction. Improvement of immunosuppression with drugs such as rituximab and bortezomib allows these patients to be eligible for transplantation. This study aims to determine the cost-effectiveness of rituximab versus bortezomib in kidney transplant patients at Farhikhtegan Hospital, Tehran. Materials and methods: The target statistical population in this research was inpatients receiving rituximab and bortezomib in 2022 in Farhikhtegan Hospital. Rituximab with a minimum dose of 375 mg/m2 was administered one day before transplantation. Bortezomib was administered at a dose of 1.3 mg/m2 on four occasions (usually days 1, 4, 8, and 11). The indicators related to the calculation of the cost of the disease and the parameters indicating the effectiveness were determined through library studies and interviews with experts, and finally, the aforementioned information was collected through the examination of the patient's records (hospital database). Cost indicators include the cost of a physician visit (first day, second day, general practitioner, emergency department, discharge day), medicine (main medicine, complementary medicine), hospital hoteling (nursing services, consumables, bed, radiology, ECG, critical care, physiotherapy, preparation of nutrition formulary, examination, and burial permit) and tests (all tests necessary to evaluate and monitor the patient). Efficacy indices included IgG class I, IgG class II, IgM class I, and IgM class II. The data analysis was conducted by SPSS software. Results: 77 kidney transplant patients including 53 treated with bortezomib and 24 receiving rituximab with an average age of 41.01±8.50 years were studied. Our findings showed that the average cost of the bortezomib group was 19,548,230.86 tomans. Before taking bortezomib, the average level of class I and class II IgG was 68.16±6.34 and 67.11±4.96, respectively, which significantly decreased to 17.28±15.73 and 18.13±16.75 after treatment with bortezomib (P=0.000). The average IgM class I and class II before taking medicine were 5.69±1.30 and 5.54±0.95, respectively, which reached 5.43±0.79 and 5.13±0.39 after taking Bortezomib, respectively. This decrease was significant for IgM class II (P=0.000), but not significant for IgM class I (P=0.223). In patients receiving rituximab, before taking the drug, the average level of class I and class II IgG was 71.66±7.86 and 67.83±4.53, respectively, which significantly decreased to 13.95±13.82 and 15.83±14.15 after treatment with rituximab (P=0.000). The average IgM class I and class II before taking rituximab was 5.70±1.23 and 5.45±0.97, respectively, after taking the drug, it decreased to 5.41±0.65 and 5.16±0.38, respectively, and this decrease was not statistically significant (P>0.05). The average cost of the rituximab group was 28,261,539.29 Tomans and caused a significant decrease in the average level of IgG class I and II. The incremental cost-effectiveness rate (ICER) was 1770997.65, which was lower than the threshold defined by WHO. Conclusion: The results of our study showed that rituximab is cost-effective compared to bortezomi

Mebeverine for Pediatric Functional Abdominal Pain: A Randomized, Placebo-Controlled Trial

We evaluated the effectiveness of an antispasmodic, mebeverine, in the treatment of childhood functional abdominal pain (FAP). Children with FAP (n = 115, aged 6–18 years) received mebeverine (135 mg, twice daily) or placebo for 4 weeks. Response was defined as ≥2 point reduction in the 6-point pain scale or “no pain.” Physician-rated global severity was also evaluated. Patients were followed up for 12 weeks. Eighty-seven patients completed the trial (44 with mebeverine). Per-protocol and intention-to-treat (ITT) analyses were conducted. Treatment response rate in the mebeverine and placebo groups based on per-protocol [ITT] analysis was 54.5% [40.6%] and 39.5% [30.3%] at week 4 (P = 0.117 [0.469]) and 72.7% [54.2%] and 53.4% [41.0] at week 12, respectively (P = 0.0503 [0.416]). There was no significant difference between the two groups in change of the physician-rated global severity score after 4 weeks (P = 0.723) or after 12 weeks (P = 0.870) in per-protocol analysis; the same results were obtained in ITT analysis. Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo. Further trials with larger sample of patients are warranted