Medical Interns' Perception of the Objective Structured Clinical Examination of Surgery Courses in Babol University of Medical Sciences, Iran, in 2009-2013

Background & Objective: Assessment of perceptions of the students undertaking different examinations is useful in the determination of the efficacy of evaluation methods in medical education. The aim of this study is to assess the attitude of medical interns of Babol University of Medical Sciences, Iran, about objective structured clinical examination (OSCE) in surgery during the years 2009-2013. Methods: This was a descriptive-analytic study. A researcher-made questionnaire was distributed among the students immediately after the final OSCE of the surgery course and their perception about the different aspects of this examination was assessed in the form of 5-point Likert scales. Data analysis was performed by Stata SE software. All values of P were considered significance if P < 0.05. Results: In 164 medical students who filled out the questionnaires, the frequency of satisfaction of students were: 46% with the examination location; 35.8% with the type of questions at each station; 39.7% with fairness and rationality of questions; and 29.4% with suitability of time allocated to stations; 35.4% with standardized patients (SP); 47.8% with supervisors; 62.3% anxiety effect; and 35.3% overall satisfaction with the examination was reported at high or very high level. Overall satisfaction of students had a significant relationship with anxiety, examination location, type and fairness of the questions, time allocated to stations, functions of SPs and supervisors (P < 0.05). Conclusion: Overall, these students perceived the OSCE as a suitable method to assess their clinical skills. Surgery is an important and critical course in the training of medical students and accurate evaluation of clinical competences of trainees in this course should be performed with appropriate examinations like OSCE. Therefore, continuous quality improvement of these exams, effective feedback to the students, and implementation of educational workshops for them during the course can be useful. Keywords Objective structured clinical examination (OSCE) Medical student Perceptio

The Outcomes of Left Thoracotomy and Esophagogastrostomy Method in Patients with Esophageal Cancer in Babol City, Northern Iran (2004-2011)

Background: Since esophageal cancer is highly prevalent, and has a high cost for patients and society, this study aimed to investigate the result of surgery in esophageal cancer with esophagogastrostomy method to lower the problems of these patients.Methods: In this cross-sectional study, all patients who were diagnosed with esophageal and upper gastric cancer with surgical indications during 2004 to 2011 in Shahid Beheshti hospital, Babol City, Iran, participated. Patients then underwent esophagogastrostomy surgery. Patients’ data were gathered using a survey and analyzed using t and chi-square tests via SPSS software. A P-value of less than 0.05 was deemed statistically significant.Results: A total of 47 patients who were confirmed as having esophageal cancer by pathologic evaluation, were investigated. A significant relationship was observed between body mass index and complications after surgery (P = 0.04). 57.1% of underweight patients and 100% of obese patients experienced complications. No significant relationship was seen in other factors. The average age of patients who experienced complications was higher than those who reported no complications, and the difference was statistically significant (P = 0.03). Moreover, the duration of surgery was significantly higher in patients with complications (P = 0.01).Conclusions: It would seem that complications after surgery were higher in underweight patients and the duration of surgery was higher in these patients. No significant relationship was seen in other factors. &nbsp

Ten-year data analysis of digestive system malignancies at Babol, north of Iran: 2008-2017

Background: Unlike some regions of the world where digestive system cancers are not considered as important health problems, these neoplasms are among the most common malignancies in the northern region of Iran. Methods: This observational analytical study was carried out based on data collected by the Cancer Registration Center affiliated to the Vice Chancellery for Health of Babol University of Medical Sciences, North of Iran, during 2008-2017. Crude incidence rate (CR), and age-standardized incidence rate (ASR) have been calculated for different GI cancers, based on the primary involved site; and have been compared in different years, patients&#39; age, gender and place of residence. Results: Totally, 4332 records were related to digestive system cancers. Mean age of patients was 63.48&#177;14.73 years; men (2743; 63.3) were more affected than women (1589; 36.7) (p&#60;0.001). The most incident malignancies of digestive system were from stomach, colorectal and esophagus in men; and colorectal, stomach and esophagus in women, respectively. These three cancers accounted for 3725 (85.98) of total GI malignancies. The mean age of patients in various types of GI cancers was statistically different (p&#60;0.001). Age- standardized incidence rate showed different values in different years; from 521.40 (95 CI: 462.79-580.00) in year 2016 to 1834.33 (95 CI: 1637.36-2031.29) in year 2008. Conclusion: Gastric, esophageal and colorectal cancers were the most prevalent digestive system malignancies in Babol, North of Iran, and accounted for about 86 of all GI tract cancers. A considerable variation has been found in incident gastrointestinal cancers in different years

Clinical Breast Cancer Registry of IR. Iran (CBCR-IR):Study Protocol and First Results

BACKGROUND: Breast cancer (BC), as a significant global health problem, is the most common cancer in women. Despite the importance of clinical cancer registries in improving the quality of cancer care and cancer research, there are few reports on them from low- and middle-income countries. We established a multicenter clinical breast cancer registry in Iran (CBCR-IR) to collect data on BC cases, the pattern of care, and the quality-of-care indicators in different hospitals across the country.METHODS: We established a clinical cancer registry in 12 provinces of Iran. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During this registry, we studied the clinical characteristics and outcomes of patients with cancer who were admitted from 2014 onwards.RESULTS: We registered 13086 BC cases (7874 eligible cases) between 1.1.2014 and 1.1.2022. Core needle biopsy from the tumor (61.25%) and diagnostic mammography (68.78%) were the two most commonly used diagnostic methods. Stage distribution was 2.03% carcinoma in situ, 12% stage I, 44.65% stage II, 21.32% stage III, and 4.61% stage IV; stage information was missing in 1532 patients (19.46%). Surgery (95.01%) and chemotherapy (79.65%) were the most common treatments for all patients.CONCLUSION: The information provided by this registry can be used to evaluate and improve the quality of care for BC patients. It will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran.</p

Study of the regulatory promoter polymorphism (−938C>A) of B-cell lymphoma 2 gene in breast cancer patients of Mazandaran province in Northern Iran

Background: The incidence rate of breast cancer has been dramatically increasing since the last decade in Iran, and it is now one of the most common female malignant tumors. B-cell lymphoma 2 (BCL2) family is the most important regulator of apoptosis, and −938C>A single nucleotide polymorphism (SNP) of BCL2 gene promoter has been demonstrated to influence breast cancer susceptibility. In this research, we study the effect of −938C>A allelic variants on breast cancer risk in Mazandaran province at the North of Iran. Materials and Methods: This analysis performed on 120 breast cancer patients who underwent surgery in some referenced hospitals at Mazandaran province along with 130 healthy individuals as a control. DNA extracted from peripheral blood samples was applied in polymerase chain reaction-single-strand conformation polymorphism analysis to determine −938C>A genotype. The association of the −938C>A genotype and breast cancer risk as well as clinicopathological characters were analyzed by logistic regression method. Results: Results showed that genotype frequency of AA, AC, and CC genotypes was 10%, 62%, and 28% for case and 28%, 50%, and 22% in control group, respectively. In the logistic regression model, BCL2 − 938C/A variant genotype AA was associated with a decreased risk of breast cancer (P = 0.041) by 0.31-fold (odds ratio = 0.31, confidence interval = 0.091–0.909) compared to CC genotype. However, no significant association found between −938C>A genotype and clinicopathological characters. Conclusion: The study showed that AA genotype of BCL2 gene (−938C>A) is associated with decreased susceptibility to breast cancer. Hence, investigating the −938C>A SNP of BCL2 gene promoter could be an appropriate molecular marker to determine individual sensitivity to breast cancer

Study of cyp2E1 gene RsaI/PstI polymorphisms in patients with gastric cancer in north of Iran

Background: North of Iran is amongst high incidence rate areas of gastric carcinoma where environmental carcinogenic compounds especially agricultural pesticides are massively used. Cytochrome P450 2E1 (CYP2E1) enzyme metabolically activates a large number of low molecular mass xenobiotics. The polymorphic nature of cyp2E1 gene control elements is associated with interindividual differences for toxicity of its substrates and may be responsible for increased gastric cancer susceptibility. The current study investigated the allelic frequencies of cyp2E1 gene RsaI/PstI polymorphisms and its association with gastric cancer risk in north of Iran. Materials and Methods: This case-control study comprised of 120 gastric cancer patients and a group of 135 healthy individuals as control. Genotyping of cyp2E1 gene PstI/RsaI polymorphisms were carried out by PCR-RFLP method. Statistical analyzes were performed by Logistic regression model and P<0.05 was considered as significance level. Results: TNM classification showed that most patients (88%) were in advanced stages when the disease was diagnosed. Frequencies of C1C1 and C1C2 genotypes of PstI/RsaI polymorphisms were 96 and 4% in case, and 99 and 1% in control group, respectively whereas homozygote C2C2 genotype was not observed in any of the subjects. In Logistic regression model no significant association was found between RsaI/PstI allelic variants and gastric cancer risk (p =0.443, OR=0.386, CI=0.034-4.395). Furthermore, no significant correlation was seen between genotypic frequencies and clinicopathological characteristics. Conclusions: No significant association was found between cyp2E1 gene PstI/RsaI allelic variants and gastric cancer risk or clinicopathological characteristics of gastric cancer patients in north of Iran

Acute obstetric and gynecologic emergencies among pregnant women in a tertiary care hospital, Iran

Background: Acute abdominal pain is a medium or severe abdominal pain that can lead to a life threatening for pregnant women and frequently requires urgent investigation and management. The aim of this study was to assess the causes and the presentation of acute abdomen among pregnant women admitted at the gynecology and an obstetrics ward of the hospital. Methods: The present study was a cross sectional hospital based study among 118 pregnant women by face to face interview using a semi structured questionnaire. This study was conducted at the gynecology and an obstetrics ward of the hospital, Babol Iran, from April 2004 to February 2009. All analysis was performed with SPSS software. Results: Mean age of women was 29.1±6 years. The frequencies of the most common diagnosis of the patients were ectopic pregnancy (73.7%), appendicitis (10.2%), respectively. The study found that 55.1% of respondents complained their pain lasting more than 24 hours. Besides, 81.4% of respondents felt pain in the supra pubic followed by with nausea/ vomiting. A total of 103 (83.9%) underwent with salpingostomy and 12 (10.1%) were treated with appendectomy. Conclusion: The study concludes that a large prospective study is needed in order to precise diagnosis of the acute abdomen in pregnant women by continual updating of availability of the gynecologists for the management of the acute gynecologic and obstetrics emergencies among pregnant women

Study of Cytochrome P450 1A1 (T3801C) Single Nucleotide Polymorphism in Patients with Breast Cancer in Mazandaran Province-Northern Iran

&nbsp;Background: Breast cancer is the first leading cause of cancer-related death in women. Pesticides which are excessively used in northern Iran are one of the most important risk factors for breast cancer incidence. The cytochrome P450 1A1 (cyp1A1) is a key enzyme in xenobiotics metabolism and SNPs of its coding gene has been verified to be important in cancer susceptibility. The aim of this study was to evaluate the association of cyp1A1 M1 polymorphism with the risk of breast cancer in Mazandaran province. Materials and Methods: Ninety six breast cancer patients with known clinopathological characters and 110 healthy women as control were genotyped for cyp1A1 M1 polymorphisms by PCR-RFLP technique using Msp1 restriction enzymes. Logistic regression model was applied for statistical analysis. Results: The frequency of TT and TC genotypes of M1 polymorphism was calculated 86, 14% for cases and 79 and 21% for control group, respectively. Surprisingly, the mutant CC genotype was not found in any subjects. Statistical analysis showed no significant correlation between allelic variants and breast cancer risk (p value= 0.42, OR=0.66, CI= 0.24-1.81). No significant correlation was also found between genotypic frequency and clinopathological characters. Conclusion: Only TT and TC genotypes were found in the studied subjects. The M1 allelic variants were significantly associated neither with breast cancer risk nor with clinopathological characteristics

Study of the correlation between CYP1A1 gene promoter methylation and smoking in gastric cancer patients

Background: Gastric cancer is one of the main causes of cancer related deaths particularly in northern parts of Iran. It has been recently attributed to the increased application of agricultural pesticides in these areas. CYP1A1 is the prototype member of the cytochrome P450 detoxifying enzymes that its gene expression alterations as a result of genetic or epigenetic changes, has been verified to have significant role on gastric cancer incidence. Materials and Methods: In this cross-sectional study, genomic DNA of tumoral and normal stomach tissues was extracted by phenol chloroform protocol and was subjected to bisulfite conversion by the EpiTech DNA Bisulfite kit. CpG-rich regions of the CYP1A1 gene promoter was amplified using specific primers and subsequently was sequenced in both directions using direct bisulfite Sanger sequencing method. Methylation rate of the individual CpGs was calculated and its correlation with demographic features was estimated by Spearman's test. Results: Results showed a significant positive correlation between promoter methylation of the CYP1A1 gene, particularly those CpGs existing in Xenobiotic response elements (XRE) consensus sequence, and smoking habit as well as familial history of gastric cancer. However, increasing age showed no significant effect on the methylation rate of the CYP1A1 gene promoter. Conclusion: Smoking and familial history of gastric cancer showed positive correlation with CYP1A1 gene promoter methylation. Screening of the CYP1A1 gene promoter methylation in smokers and individuals having positive familial history of disease may be used as a marker for gastric cancer diagnosis

Semi-surgical percutaneous dilatational tracheostomy vs. conventional percutaneous dilatational tracheostomy: A prospective randomized trial

Background: Percutaneous dilatational tracheostomy (PDT) is a common surgical procedure in the ICU. The present study was conducted to compare semi-surgical percutaneous dilatational tracheostomy (SSPDT) with conventional percutaneous dilatational tracheostomy (CPDT). Methods: The present randomized clinical trial was conducted on 160 patients hospitalized in the medical intensive care units (ICUs) with an indication for tracheostomy and were systematically divided into two equal groups of 80. In the CPDT group, after a small incision, a 16-gauge needle was blindly inserted into the trachea and the guidewire was placed inside the lumen. A stoma was created by passing a single dilator over the guidewire. In the SSPDT group, a transverse incision (2 cm) was made 1 cm below the cricoid, and the tracheal ring was then fully reached by releasing the subcutaneous tissues using the index figure, and PDT was then performed. The two groups were compared in terms of their tracheostomy complications (including bleeding, pneumothorax, stoma infection and accidental decannulation) and duration of the procedure. Results: The two groups were homogeneous in terms of age, gender, mean APACHE score (P&#62;0.05). There were no significant differences between the two groups in terms of the mean time from tracheal intubation to tracheostomy (P=0.869). The duration of the procedure was 5.16&#177;1.72 minutes in the SSPDT group and 6.42&#177;1.71 in the CPDT group (P&#60;0.001). The complication rate was 7(8.75) in the SSPDT group and 16(20) in the CPDT group (P=0.043). Conclusion: SSPDT is safer and has fewer complications than CPDT in ICU patients