Evaluation of the Learning Curve and Complications Related to Hand-Assisted Laparoscopic Appendectomy in Children with Acute Appendicitis

Introduction: Previous studies have shown that according to the learning curve, one’s knowledge and skills increase with experience and repetition. However, no studies have yet proved that the learning curve can be generalized to medical procedures. Therefore, this study aimed to evaluate the learning curve and complications of hand assisted laparoscopic appendectomy (HALA) in children with acute appendicitis.Materials and Methods: In a prospective randomized study in 2016, ninety patients aged 8-16 years were selected for appendectomy. The participants were then consecutively divided into three groups according to admission time. The first, second, and third groups were operated on by an attending pediatric surgeon, an attending pediatric surgeon and a pediatric surgical fellow (a surgeon who is studying the subspecialty of pediatric surgery) and in the third group only a pediatric surgical fellow, respectively. For each surgery, duration of surgery and hospitalization was determined and recorded, and the time trend of surgery was determined and compared in all three groups using the learning curve.Results: The mean duration of surgery of the groups operated on by an attending, an attending and a fellow, and a fellow alone was 38.7±12.8, 46.9±8.8 and 48.5±11.3 respectively, with a significant difference among the three groups (p=0.002). During the surgery, duration of surgery in the fellow and attending group and the fellow group decreased over time.Conclusion: The learning curve can be generalized to medical procedures and experiences. Duration of appendectomy for fellows can decrease over time as they become more skilled. Usually after performing 30 surgeries and gaining experience, fellows will be able to perform appendectomy nearly as fast as attending surgeons. In the meantime, the root causes of the fluctuations observed during surgery should be scientifically examined and resolved

A Double-Blind Randomized Trial Comparing the Effectiveness and Safety of Nifedipine and Isosorbide Dinitrate in Chronic Anal Fissure

Background: Chronic anal fissure is a common disease that is accompanied with pain and bleeding during defecation. Various surgical and non-surgical methods have been offered for the treatment of this condition. The aim of this randomised clinical study was to compare the effectiveness and safety of nifedipine and isosorbide dinitrate (ISDN) in the treatment of chronic anal fissure. Methods: This double-blind clinical trial study was performed on patients aged 20 to 60 years old in 2012 to 2013. The samples with a primary diagnosis of chronic anal fissure were enrolled from the patients admitted to public treatment at the educational Imam Ali Clinic, Shahrekord, Iran by researchers and general surgery specialists. The patients were randomised into two groups: nifedipine 0.3% (n = 35) or ISDN 0.2% (n = 35) applied three times a day for three weeks. The patients were examined on the 7th, 14th, and 21st days of treatment, and the symptoms including bleeding, pain, and healing status, as well as the side effects of the drugs, were assessed. Pain was evaluated using a visual analogue scale (VAS). Results: After 21 days of follow-up, complete healing was achieved in 77.1% (n = 27) of patients in the nifedipine group and 51.4% (n = 18) in the ISDN group (P = 0.05). The mean VAS of the pain on day 21 was 0.91 (SD 0.01) in the ISDN group and 0.45 +/- 0.78 in the nifedipine group, with a statistically significant difference (P = 0.038). The bleeding was similar in the two groups (P = 0.498). Conclusion: In view of the findings on healing status and pain in the patients, nifedipine may be significantly more effective in the treatment of chronic anal fissure than ISDN

A review on secondary metabolites and pharmacological effects of Prangos ferulacea (L.) Lindl.

زمینه و هدف: جاشیر با نام علمی Prangos ferulacea (L.) Lindl. گیاهی دارویی و بومی نواحی جنوبی ایران است که در طب سنتی در درمان بسیاری از اختلالات مورد استفاده بوده و تحقیقات متعددی در جهت شناسایی ترکیبات گیاهی و خواص درمانی آن انجام گرفته است. این مطالعه مروری با هدف بررسی خواص فارماکولوژیکی، توصیف و پیشنهاد عوامل فعال فارماکولوژیکی موجود در آن و نیز بیان مکانیسم های احتمالی اثربخشی آنها جهت استفاده در تحقیقات پزشکی و دارویی آینده انجام شده است. روش بررسی: اطلاعات این مطالعه مروری با جستجوی کلید واژگان Prangos ferulacea، P. ferulacea و Prangos در کتب و مقالات علمی منتشر شده در بانک های اطلاعاتی همچونWeb of Science ، ‌Science Direct، Scopus، EBSCO، Iran medex و Pubmed بدست آمده است. یافته ها: از جاشیر در پزشکی سنتی در تسکین درد، التهاب، بهبود دیابت و به کارگیری علیه میکروارگانیسم های مختلف از جمله باکتری ها و قارچ ها استفاده شده است و بخش های هوایی آن دارای ارزش علوفه ای زیادی هستند. ترکیبات اصلی اسانس گیاه جاشیر، ترکیبات مونوترپنی بویژه آلفا و بتا- پینن می باشند و حضور مونوترپن ها، سزکوئی ترپن ها، کومارین ها، فلاونوئیدها، تانین ها، ساپونین ها، آلکالوییدها، ترپنوئیدها و به ویژه آنتی اکسیدان ها در این گیاه، عامل خواص ضد اکسیدانی، ضد دیابتی، ضد میکروبی، ضد ویروسی، ضد دردی، ضد اسپاسمی و اثر گیاه بر سقط جنین بوده است که در تحقیقات آزمایشگاهی به اثبات رسیده است. نتیجه گیری: کاربردهای سنتی گیاه جاشیر در درمان بسیاری از بیماری ها و وجود ترکیبات گیاهی و دارویی ارزشمند در این گیاه می تواند زمینه ای را برای کشف داروهای با منشا گیاهی در تولید آنتی بیوتیک ها، مسکن ها و داروهای درمان دیابت به وجود آورد و کلیدهایی را در انجام کارآزمایی های بالینی در اختیار دانشمندان قرار دهد

An assessment and comparison of information quality of hospital information systems in medical-teaching hospitals of the city of Isfahan based on delone and McLean's modified model

Background: Taking the positive effects of the hospital information systems on patients' treatment process and organization's function into account, it is necessary to evaluate information quality provided by such systems. Hence, the aim of this study was to assess and compare information quality of hospital information systems in medical- teaching hospitals of Isfahan based on the DeLone and McLean's modified Model. Methodology: This research was applied and analytical-descriptive in nature and was performed in medical-teaching hospitals of Isfahan in 2010. Research population consisted of hospital information system's users, system developers and IT authorities selected by random sampling method. Data collection instrument was self-designed questionnaire. Questionnaires' reliability was estimated by using Cronbach's Alpha coefficient that was found to be 94.08 and 96.8 for system users' questionnaire and system developers and IT authorities' questionnaire, respectively. Results: According to the findings of the study, the difference between the mean scores gained for information quality of all kinds of HISs and different hospitals were statistically significant, i.e. they were not the same (p<0.05). Generally, Kowsar system (new version) and Rahavard Rayaneh system gained the highest and lowest mean score, respectively. The total mean scores obtained for observing the standards stipulated for information quality was 60.2 for all hospital information systems and 60.8 for different hospitals, respectively. Conclusion: According to the results of the research, it can be inferred that based on the applied model, the levelof observing the criteria of hospital information system was rather optimum. Thus, in order to reach a completely optimum condition, it is necessary to pay particular attention to the factors improving information quality, type of activity, type of specialty and property type

Correlation between Clinical, Sonographic and Pathologic Findings of Patients Undergoing Appendectomy

Introduction: Acute appendicitis is the most common cause of acute abdomen and is considered as a surgical emergency. Approximately, 10% of patients with acute appendicitis and delayed diagnosis can face many complications. This study was designed to examine the correlation between ultrasound and pathological findings in patients with appendicitis and aimed to determine the diagnostic levels of ultrasound in these patients. Methods: This study is a retrospective study conducted on 500 patients with clinical symptoms suggestive of appendicitis in 2010-2012 in the Ayatollah Kashani hospital. These patients have undergone appendectomy. Having collected clinical and ultrasound data and compared them with pathological results, the data were analyzed. Results: In this study, 56.3% of patients were male and 43.7% of them were female. The mean age of the study population was 24.8±14.1 years. In this study, the sensitivity of ultrasonography in the diagnosis of acute appendicitis was 83% and its specificity was 56%. The positive predictive value of ultrasound in this study was 89.2% and the negative predictive value was 42.6%. Conclusion: Based on these results and by comparing with those of other studies, the sensitivity and specificity of ultrasonography in the center is acceptable and is at the similar level to other centers. Besides, the accuracy of ultrasound in the negative cases is much more than the positive ones. </span

The Potential Association between the Risk of Post-Surgical Adhesion and the Activated Local Angiotensin II Type 1 Receptors: Need for Novel Treatment Strategies

Background: Post-surgical adhesion bands (PSABs) are a common complication after abdominal or pelvic surgeries for different reasons like cancer treatment. Despite improvements in surgical techniques and the administration of drugs or the use of physical barriers, there has only been limited improvement in the frequency of postoperative adhesions. Complications of PSAB are pain, infertility, intestinal obstruction, and increased mortality. The most important molecular mechanisms for the development of PSAB are inflammatory response, oxidative stress, and overexpression of pro-fibrotic molecules such as transforming growth factor beta. However, questions remain about the pathogenesis of this problem, for example, the causes for individual differences or why certain tissue sites are more prone to post-surgical adhesions. Summary: Addressing the pathological causes of PSAB, the potential role of local angiotensin II/angiotensin II type 1 receptors (AngII/AT1R), may help to prevent this problem. Key Message: The objective of this article was to explore the role of the AngII/AT1R axis potential to induce PSAB and the therapeutic potential of angiotensin receptor blockers in the prevention and treatment of PSAB

An evaluation of the observance rate of component information management in the health system of Chahar Mahal Bakhtiyari province based on world health organization standards

Introduction: Given the essential role of data collection and management in the health system, this study intended to evaluation of the observance rate of component information management in the health system of Chahar Mahal Bakhtiyari province based on World Health Organization standards. Materials and Method: This study descriptive-analytical nature tried to expelore the urban and rural health centers as well as rural health houses. Data were collected through a self-designed checklist produced based on the World Health Organization's standards stipulated by World Health Organization composed of 6 data needs analysis components, 25 data collection components and 29 data processing components for the urban and rural centers on the contrary, for the questionnaire used for rural health houses, the number of components on needs analysis, data collection and processing were 55 and 5,respectively.Then the data were put into Spss16 and analyzed using Anova and t-tests. Findings: The difference between the rate of observing the information management in the information management in the 3 areas in question i.e. need assessment, data ghathering and data processing in the urban and rural health centers and rural health houses was not statistically significant (P>0/05). As for needs analysis, the highest mean score belonged to data collection and data processing with the three components enjoying mean Scores higher than medium. Conclusion: The findings of the study provided some evidence on the close matching and conformity between information management and world health organization standards especially for needs analysis component consideration to using this information in managerial decision making processes

EXPLORING THE EFFECT OF SOCIAL SUPPORT AND RELIGIOUS BELIEFS ON THE LIFE SATISFACTION OF THE ELDERLY LIVING IN THE TOWN OF BORUJEN

Background: The pressures resulting from physical, mental and social fluctuations play a significant role in causing depression and decreasing the happiness in the elderly. The perceived social support and religious beliefs are among some parameters which influence their life satisfaction. Taking this into account, this study intends to examine the effect of social support and religious attitudes on the life satisfaction in the elderly living in the town of Borujen. Method: This study which is descriptive-analytical in nature was conducted on 105 of the elderly living in the town of Borujen. Data were gathered by using a questionnaire consisting of 3 variables i.e. social support, religious beliefs and the level of life satisfaction developed based on the following three questionnaires: Canty-Mitchell's Social Support Questionnaire (2000), Golriz and Brahnew's religious belief questionnaire and Dinner, Emmons, Larsen and Griffin's questionnaire for life satisfaction. The reliabilty of the developed questionnaire was found to be 0.83% using Cronbach coefficient a. The gathered data were analyzed using descriptive statistics, Pearson correlation analysis and step-by-step multiple regression analysis. Method: Based on the findings of the study, the mean score for the level of life satisfaction among the elderly living in the town of Borujen was found to be 22.46. There was a statistically significant relationship between the social support and the level of life satisfaction in the elderly (P<0.001). The addition of the religious belief variable was accompanied by an increase in the social support and the level of life satisfaction in the elderly living in the town of Borujen (P<0.001). Conclusion: Given the need of the elderly to the social support from their surrounding people, it can be inferred that the social support and religious belief play a significant role in their level of life satisfaction promoting their life satisfaction