Mild anterior displacement of the anus as a cause of Constipation: introducing a new modality for diagnosis.

Introduction: Mild anterior displacement of the anus may be a cause of constipation. Routinely for detection of the anterior anus, the mean anal position index is used but in this study we introduce another modality for this purpose.Material and Methods: In this prospective study, patients with intractable constipation with onset bellow one year of age, normal rectal manometry, normal rectal biopsy and abnormal shape of anal verge, were include. The location of the anus was checked by muscle stimulator and according to the severity of the anteriority mini anorectoplasty or simpleY-V transposition of the anus was performed.Results: Ten patients were studied. All were female with a mean age of 7 months. In 2 cases anorectoplasty and in the others Y-V anoplasty was done. All patients ultimately were cured. Conclusion: Using muscle stimulator in external sphincter is reliable for detection of anterior displacement of the anus. Anorectoplasty or Y-V anoplasty for resolving constipation in these patients are effective

Prognostic Value of Serum Fibrinogen Level in Determining the Severity of Appendicitis Inflammation in Adult and Pediatric Patients Undergoing Appendectomy in Two Local Centres in Tehran

Background: Despite the recent advancements, negative appendectomy cases are notable, especially in children. We evaluated the prognostic value of serum fibrinogen level for the prediction of the severity of acute appendicitis. Methods: A cross-sectional study of children and adults who had undergone appendectomy at Ali Asghar and Rasool-e Akram hospitals, Iran, was performed. Before surgery, serum fibrinogen level was assessed by using the Clauss technique. Finally, serum fibrinogen was compared between the two groups of complicated acute appendicitis and uncomplicated ones. Results: In the adult's complicated and uncomplicated appendicitis, no significant differences were noted in gender distribution, WBC count, and segment levels. Serum fibrinogen and C-reactive protein levels in children with complicated appendicitis were significantly higher than those in the uncomplicated ones. Serum fibrinogen level of 450 mg/dl was the optimum cut-off for predicting the severity of appendicitis in children. Serum fibrinogen level in adults with the complicated appendicitis was significantly higher than the uncomplicated appendicitis group. Also, 530 mg/dl was found the best serum fibrinogen cut-off to predict the severity of appendicitis in adults. Conclusion: Serum fibrinogen level is an appropriate diagnostic marker for the distinction of acute complicated appendicitis from uncomplicated appendicitis in children and adults

Digital monitoring of weight-bearing improves success rates and reduces complications in lower extremity surgeries

The aim of this study is to develop a digital monitoring system to track weight and evaluate its impact on postoperative outcomes after lower extremity surgeries (LES). This parallel randomized controlled trial enrolled 266 patients who underwent LES (fracture or joint replacement) at our medical center between March 11, 2022, and January 10, 2023. Patients were randomly assigned to the intervention and control groups in a 1:1 ratio. The intervention group (n=116) used a cane and shoes equipped with a weight-bearing system after lower limb surgery, while the control group (n=116) used a simple cane and shoes without a weight-bearing system. The primary outcomes included callus formation, duration of union, and success rate of union in the two groups. The intervention group had a significantly higher rate of complete surgical success than the control group (93.9% vs. 79.3%, p=0.001). The intervention group also had a significantly lower risk of non-union than the control group (OR: 2.33, 95% CI: 1.14, 3.48, p=0.001). The mean duration of surgery until the time of union and the meantime of callus formation was significantly lower in the intervention group (p=0.01). The use of a digital monitoring system for weighing in LES significantly increased the success rate and reduced post-operative complications. Therefore, incorporating this system can enhance the rehabilitation process and prevent revision surgeries in patients with LES

Huge Obstructive Bladder Diverticula and Cystic Dysplastic Kidneys in a Newborn: A Challenging Dilemma

This study investigated a 63-day boy with end stage renal disease and abdominalcysts.The antenatal sonography detected anhydraminos, posterior urethral valve,and cystic dysplastic kidneys. Voiding cystourethrogram revealed two obstructivegiant diverticula which at firstlooked like enlarged renal pelvis.The patient had persistenturinary tract infection and perforation of diverticula. The dialysis was ineffectivebecause of leakage,immeasurable inflow and dwell volume, peritonitis and tunnelinfection.As a result, the availability of automated peritoneal dialysis for infantsis recommended to reduce morbidity and increasing the survival rate. Nonethelessthe giant bladder diverticules might be better managed by diverticulectomy procedure

Metabolic syndrome in infertile women with polycystic ovarian syndrome

ABSTRACT Objective The aim of the present study was to determine the prevalence of metabolic syndrome (MS) in infertile Iranian women with polycystic ovary syndrome (PCOS) using the ATPIII criteria. Subjects and methods In this cross-sectional study, 624 women with PCOS were enrolled at a tertiary referral center in Tehran, Iran, between April, 2012 and March, 2013. Diagnosis of MS was according to ATPIII criteria. Also, we divided PCOS patients into following two main groups: (i) with MS (n = 123) and (ii) without MS (n = 501), and then compared variables between two groups. Results The mean age, body mass index (BMI) and waist circumference were 28.6 ± 4.3 years, 26.7 ± 3.7 kg/m2 and 85.2 ± 8.7 cm, respectively. The prevalence of MS was 19.7%. Our findings showed that age, BMI, waist circumference and all metabolic parameters were higher in PCOS women with MS than related values in those without MS. The most and least prevalent forms of MS were low level of high density lipoprotein-cholesterol (HDL-C) and hypertension, respectively. Conclusion It seems the prevalence of metabolic syndrome in our country isn’t as high as western countries. The prevalence rate of MS increased with age and BMI. One of the major cardiovascular risk factors, low level of HDL-C, is the most prevalent metabolic abnormality in our participants

Quality of Life and Caregiver Burden Scale in Iranian Children on Continuous Ambulatory Peritoneal Dialysis

Introduction: Chronic kidney diseases are associated with a poor quality of life in patients and their families. Previous studies have shown a three-fold higher rate of exhaustion in peritoneal dialysis compared to hemodialysis patients and their families. Here we studied the quality of life and caregiver’s burden of children receiving chronic ambulatory peritoneal dialysis (CAPD) in comparison with other chronic diseases among pediatric patients.Materials and Methods: This prospective case-control survey was conducted between 2013 and 2014 in Ali- Asghar Children’s Hospital. The inclusion criteria were age below 18 years and having a chronic disease diagnosed at least six months earlier. The parents of 13 children on peritoneal dialysis (cases) and 160 children with other chronic diseases(controls) were requested to complete the Pediatric Quality of Life Inventory (PedsQL™ 4.0™) appropriate to the patient’s age and the Caregiver Burden Scale (CBS).  Independent t-test was applied to compare the variables between the two groups. P-values < 0.05 were considered significant.Results: Overall, 353 questionnaires were completed. The CAPD group had a higher mean (SD) score of quality of life in all domains, including somatic symptoms [67 (25.6) vs. 18.5(15.6)], emotional symptoms [71(17) vs. 20.5(15.1)], and social functioning [58(32) vs. 21.3(20)] (p-value<0.001). In addition, the case group had a lower mean (SD) score of caregiver’s burden [50(16.7) vs. 80 (13.5)] compared to the control group (P value<0.001).Conclusions: CAPD children and their parents had better a PedsQL™ 4.0™ score and a lower CBS compared to children with other chronic diseases. The most affected area of the quality of life was school functioning in the CAPD group and somatic symptoms in the control group.Keywords: Quality of life; Renal Dialysis; Adaptation; Psychological; Chronic Disease; Child