Investigating the Trend of Medical Journal Publications in Recent Years in Iran

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Educating Medical Students: Strategies and New Methods

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Evidence-Based Approach in Medical Education and Research

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Comparison of Standard and Percutaneous Tracheostomy Complications in Shariati Hospital in Iran

Background: Tracheostomy is a procedure which aims at better managing patients’ airway. It can be done using two methods: standard and percutaneous. The percutaneous method is a favorable choice for critically illpatients because it is a less invasive procedure. This study compares the short-term complications of these two methods (during 7 days after the procedure).Methods: This study was a cross-sectional research performed on 50 ICU patients in need of tracheostomy.The patients were divided into two groups of percutaneous procedure (15 patients) and standard procedure(35 patients). The complications were registered in questionnaires and the data were analyzed using SPSS software (χ² test and t-test).Results: The two groups had no significant difference in age, sex, and vital signs. Average duration of the procedure was 24.4 minutes in the standard procedure (10-45 minutes) and 26.78 minutes (5-70 minutes) in the percutaneous procedure, and there was no significant difference between two groups (P = 0.814). Average bleeding during 7 days after the procedure was 44 cc (10-150 cc) in standard procedure and 24.7 cc (10-50 cc) in the percutaneous procedure, and the difference was significant (P = 0.012). The other variables were not significantly different in two groups.Conclusions: There was no difference in short-term complications between percutaneous and standard tracheostomy method should be selected considering other important factors

Effects of Intraluminal Vancomycin in Decreasing Central Venous Catheter Infection

Background: Central venous catheters (CVC) are important intravenous routes, that nowadays they can be used for various reasons including resuscitation management, intravenous feeding, chemotherapy drugs, and blood transfusions. Due to the special importance and increasing usage of these catheters lengthening the duration of these catheters are very important. Infections are the most common cause of removal of this catheter.Methods: In this prospective study (cohort), 80 patients with central venous catheter were divided into two groups. In the first group Vancomycin once per day injected inside catheter equal to their intraluminal volume and remained for 2 h, then catheter was aspirated and washed. But in control group catheter was washed only with normal saline. Finally, catheter infection rates in the two groups were compared.Results: In the group that used intraluminal Vancomycin, catheter infection was ‎observed in 3 cases and was confirmed by blood culture, but in none of them ‎catheter infection agent was not Gram-positive cocci.‎ In control group, 18 cases of catheter infection were confirmed by culture that in 16 cases were caused by Gram-positive cocci that in 14 cases catheter was removed, and in 2 cases of catheter infection, infectious agent was Staphylococcus epidermidis which catheter maintained with appropriate antibiotics.Conclusions: Use of the intraluminal Vancomycin significantly reduces the rate of infection and thus increase the survival rate of CVC

The Effect of Ticlopidine on Early Arteriovenous Fistula Thrombosis: A Randomized Clinical Trial

Background: Arteriovenous (AV) fistula is the first choice of a long-term vascular access for hemodialysis, but there is a 20-30% probability of thrombosis in the 1st month after its creation. Ticlopidine is a potent drug, which inhibits both primary and secondary platelet aggregation. This study is performed to evaluate the effect of ticlopidine in the prevention of AV fistula.Methods: Totally 124 patients in need of an AV fistula were divided into two groups after creation of their fistula. In the first group, we prescribed ticlopidine for 62 patients, and in the second group, 62 patients received placebo. The two groups were compared to see if their fistulas are patent or thrombotic after 1 and 3 months.Results: Of the 62 patients who received ticlopidine, four had fistula thrombosis, while in 62 patients who received placebo, 16 had fistula thrombosis (P = 0.003). This shows the significant effect of ticlopidine in the prevention of thrombosis in AV fistulas. Also, we compared age, sex, and the fistula location in the ticlopidine and placebo groups, and these attributes had no significant difference between the two groups (P > 0.050).Conclusions: Considering the significant value of ticlopidine in the prevention of AV fistula thrombosis, it can be recommended after the surgery if there is no contraindication for its use

Predictors of Regional Lymph Node Recurrence after Initial Thyroidectomy in Patients with Thyroid Cancer

Background. Regional lymph node recurrence (RLNR) is common in patients with thyroid cancer but clinicopathological predictors are unclear. We aimed to clarify these predictors and identify patients who would benefit from prophylactic lymph node dissection the most. Method. 343 patients with different types of thyroid cancer were analyzed retrospectively. All patients underwent total thyroidectomy between 2007 and 2013. Results. The median ± interquartile range of patients' age was 40 ± 25 years. 245 (71.4%) patients were female. Regarding the risk of regional lymph node recurrence, we found that male gender, age ≥45 years, non-PTC (i.e., medullary, follicular, and anaplastic types) histopathology, T3 (i.e., tumor size >4 cm in the greatest dimension limited to the thyroid or any tumor with minimal extrathyroid extension), stage IVa, and isolated cervical lymphadenopathy as initial manifestation (ICL) are significant risk factors. T3 (p < 0.001; odds ratio = 156.41, 95% CI [55.72-439.1]) and ICL (p < 0.001; odds ratio = 77.79, 95% CI [31.55-191.81]) were the strongest predictors of regional lymph node recurrence. Conclusion. We found easily achievable risk factors for RLNR in thyroid cancers patients. We suggested that patients with specific clinicopathological features like male gender, age ≥45 years, larger tumor size, and extrathyroidal extension be considered as prophylactic lymphadenectomy candidates