COVID 19 in a traumatic thoracic aortic injury patient

The number of traumatic thoracic aortic injuries being treated by endovascular procedures is on the rise. Coronavirus (COVID-19) has affected healthcare systems worldwide and was declared a global pandemic by the world health organization (WHO) in March 2020. In this study, we discuss a 37-year-old man with thoracic aorta trauma caused by a motor–vehicle accident that underwent Thoracic endovascular aortic repair (TEVAR) and was incidentally diagnosed with concurrent COVID-19. During this pandemic period, physicians should be on the lookout for COVID-19 with low thresholds for testing, as a timely diagnosis will improve patient outcomes and reduce the risk of transmission. A delay in diagnosis puts the patients at risk of not receiving effective treatment and may result in the transmission of infection to hospital staff, environment (i.e. operating rooms and equipment), and other members of the community

Prevalence and Management of Gastric Leakage After Laparoscopic Sleeve Gastrectomy: A Case Study in Modarres Hospital, Tehran, Iran

Background: Sleeve gastrectomy is an effective procedure for weight loss. However, some serious complications may occur during this operation such as strictures, bleeding, and leak. According to previous studies, the rate of leak was 1.06%. Using endoscopic stents have been hampered by some drawbacks the most important of which is repeated migration. The current study aimed to discuss the prevalence and management of leak after laparoscopic sleeve gastrectomy operated at Modarres Hospital, Tehran, Iran.Methods: This cross-sectional study was conducted on patients with morbid obesity undergone laparoscopic sleeve gastrectomy at Modarres Hospital, Tehran, Iran. In addition to the patients’ demographic data; their leak complications, first symptoms and signs, WBC count, and method of management were extracted and collected from their medical files. Results: A total number of 1263 patients were enrolled in this study. Of them 8(0.63%) patients suffered from leak after the operation. The mean (SD) age of patients with leak was 32.33(6.02) year. The mean (SD) BMI of patients with leak was 45.75(2.07) kg/m2. The mean (SD) of WBC count of the patients with leak was 13680(7272.68). The symptoms of the patients began on different days (3-240 day). Management of the patients was different but most of the patients underwent endoscopic stent.Conclusion: It seems that stent insertion is a useful method for treatment of leak after sleeve gastrectomy, especially in immediate leak

Computed Tomography Angiography-Based Evaluation of Anatomical Variations of the Celiac Trunk and Renal Arteries

Background: The abdominal aorta and its main branches, such as the celiac trunk and the renal arteries are manipulated during various radiologic, surgical, and oncologic procedures. This study aimed at evaluating the anatomical pattern of these vessels to assist surgeons and radiologists reduce the risk of intra- as well as postoperative complications. Methods: A retrospective analysis of 536 Computed Tomography Angiography (CTA) studies of living potential kidney donors was conducted from January 2012 to December 2018.Results: The anatomical variations of the celiac trunk was found in 9.5% of the cases. Among these cases, the most frequent variation was the Left Gastric Artery (LGA) as the first branch of the celiac trunk (80.4% of the cases). Gender was not overall significantly associated with the variations of the celiac trunk (P=0.670); however, there was a significant correlation between male gender and the most prevalent form of the celiac trunk variation (P=0.004). Variations of the renal artery occurred in 22.94% of the cases, with the left accessory renal artery being the most common variant (28.45% of the cases). Gender and the involved side (right / left) were not significantly related to the renal artery variations (P=1.000 & P=0.546, respectively). No concomitant variation of the celiac trunk and the renal artery was detected in our study. Conclusion: The anatomical variations of the celiac trunk and the renal arteries occur commonly; thus, the branching pattern of these arteries should be assessed prior to any procedure concerning them

Acute lower Limb Ischemia Caused by Fungal Infective Atrial Thrombus: A Case Report

Introduction: Septic thromboemboli have two consequences, ischemic and infection. In this paper we discuss a case with acute lower limb ischemia caused by fungal infective atrial thrombus. The patient underwent an anticoagulant therapy. Case presentation:                 A 43-year-old female patient who suffered from valvular heart disease (history of mitral and tricuspid valve replacement) was referred to the vascular surgery department of Modarres hospital with acute left limb ischemia. She underwent a successful emergency surgical thrombectomy. The pathological report of thrombus demonstrated fungal infection.  Conclusion: After surgical thrombectomy to control the acute lower limb ischemia, antimicrobial treatment of septic emboli is necessary

COVID-19-Related Spontaneous Pneumomediastinum: An Atypical Manifestation

COVID-19 is has been an emerging healthcare challenge during the last months. Herein we explain two cases with spontaneous pneumomediastinum as an atypical manifestation of COVID-19 disease; these two patients had confirmed COVID-19, leading to spontaneous pneumodeiastimun as an atypical manifestation during the course of hospital stay, presenting by abrupt deterioration in O2 saturation and symptoms. Spontaneous pneumomediastinum should be considered as a potential reason for the disease exacerbation in patients without previous history of mechanical ventilation. &nbsp

Therapeutic Options and Critical Care Strategies in COVID-19 Patients; Where Do We Stand in This Battle?

A pandemic of COVID-19 made an appearance in Wuhan, China, in late December 2019 and rapidly became a serious concern worldwide, with killing more than 238000 people until 3rd May 2020. Given the fact that a vaccine against the virus probably won’t be available anytime in the near future, the therapeutic strategies have become more prominent. Many supposedly effective drugs are under evaluation which may hinder the replication of SARS-CoV-2, and subsequently the infection. Lately on 1th may 2020, FDA authorized the use of experimental drug, Remdesivir for "emergency purpose" in COVID-19 cases. Chloroquine and hydroxychloroquine, among the very first under-trial drugs, have been revealed to have promising impacts in treatment of SARS-CoV2. Broad-spectrum antivirals as well as HIV protease-inhibitors are still subject to assessment. Particularly angiotensin-converting enzyme 2 (ACE2) inhibitors are increasingly taken into consideration because of ACE2 being recognized as a host-cell receptor for COVID-19. Immune-Enhancement therapy by Interferons and Intravenous immunoglobulin (IVIG) has been shown to be effective in some cases. Moreover, Convalescent Plasma Therapy and auxiliary blood purification were considered as the treatment of SARS-CoV2 infection. Among the critically ill patients, Oxygen-therapy, timely usage of inflammatory inhibitors, and controlling viral shedding by antivirals may reduce the mortality and morbidity of COVID-19

A Case Based-Shared Teaching Approach in Undergraduate Medical Curriculum: A Way for Integration in Basic and Clinical Sciences

To present a multiple-instructor, active-learning strategy in the undergraduate medical curriculum. This educational research is a descriptive one. Shared teaching sessions, were designed for undergraduate medical students in six organ-system based courses. Sessions that involved in-class discussions of integrated clinical cases were designed implemented and moderated by at least 3 faculties (clinicians and basic scientists). The participants in this study include the basic sciences medical students of The Tehran University of Medical Sciences. Students’ reactions were assessed using an immediate post-session evaluation form on a 5-point Likert scale. Six two-hour sessions for 2 cohorts of students, 2013 and 2014 medical students during their two first years of study were implemented from April 2014 to March 2015. 17 faculty members participated in the program, 21 cases were designed, and participation average was 60 % at 6 sessions. Students were highly appreciative of this strategy. The majority of students in each course strongly agreed that this learning practice positively contributed to their learning (78%) and provided better understanding and application of the material learned in an integrated classroom course (74%). They believed that the sessions affected their view about medicine (73%), and should be continued in future courses (80%). The percentage demonstrates the average of all courses. The program helped the students learn how to apply basic sciences concepts to clinical medicine. Evaluation of the program indicated that students found the sessions beneficial to their learning

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin

National, sub-national, and risk-attributed burden of thyroid cancer in Iran from 1990 to 2019

An updated exploration of the burden of thyroid cancer across a country is always required for making correct decisions. The objective of this study is to present the thyroid cancer burden and attributed burden to the high Body Mass Index (BMI) in Iran at national and sub-national levels from 1990 to 2019. The data was obtained from the GBD 2019 study estimates. To explain the pattern of changes in incidence from 1990 to 2019, decomposition analysis was conducted. Besides, the attribution of high BMI in the thyroid cancer DALYs and deaths were obtained. The age-standardized incidence rate of thyroid cancer was 1.57 (95% UI: 1.33–1.86) in 1990 and increased 131% (53–191) until 2019. The age-standardized prevalence rate of thyroid cancer was 30.19 (18.75–34.55) in 2019 which increased 164% (77–246) from 11.44 (9.38–13.85) in 1990. In 2019, the death rate, and Disability-adjusted life years of thyroid cancer was 0.49 (0.36–0.53), and 13.16 (8.93–14.62), respectively. These numbers also increased since 1990. The DALYs and deaths attributable to high BMI was 1.91 (0.95–3.11) and 0.07 (0.04–0.11), respectively. The thyroid cancer burden and high BMI attributed burden has increased from 1990 to 2019 in Iran. This study and similar studies’ results can be used for accurate resource allocation for efficient management and all potential risks’ modification for thyroid cancer with a cost-conscious view

Chronic constipation and acute small bowel obstruction due to small bowel encapsulation: A case report

Key Clinical Message Peritoneal encapsulation is most of the time asymptomatic and is found incidentally, but when symptomatic it usually presents with bowel obstruction. CT scan is a gold standard for the diagnosis of bowel encapsulation. Abstract Congenital peritoneal encapsulation (CPE), abdominal cocoon syndrome (ACS), and sclerosing encapsulating peritonitis (SEP) are syndromes in which the small bowel is encapsulated. Small bowel encapsulation is usually asymptomatic and rarely presents with small bowel obstruction. In this article, we report a 65‐year‐old man who presented to our hospital with signs and symptoms of small bowel obstruction. He underwent an urgent operation, and small bowel encapsulation was diagnosed. One year after the surgery, all symptoms improved