Unusual Esophageal Foreign Bodies in a Schizophrenic Patient: A Case Report

Introduction: The possibility of foreign body ingestion should be considered in psychiatric patients. In some complicated cases, foreign bodies become problematic and require immediate surgical intervention. Case presentation: A 45-year-old man with schizophrenia swallowed razor blades and pieces of glass resulting in esophageal perforation, pneumothorax, pneumomediastinum and urgent need for surgery. He was presented in shock state but successfully passed post-operative period in the intensive care unit and surgical ward and was ultimately transferred to the psychiatric ward. Conclusion: Management of asymptomatic patients depends on the demographic factors of patients as well as the site affected in the gastrointestinal tract

Outcomes of Catheter-Directed Thrombolysis in Patients with Acute Arterial Thrombotic Limb Ischemia: A Prospective Interventional Case Series

Introduction: Acute limb ischemia is a critical medical condition that can quickly become a life threat. Therapeutic modalities such as catheter-directed thrombolysis (CDT) have demonstrated various levels of efficacy in previous studies. Objective: This study presents the descriptive findings of a series of cases who presented with acute arterial thrombotic limb ischemia and underwent CDT. Methods: This was a cross-sectional single-hospital-based case series, in which all patients who were diagnosed with acute arterial thrombotic limb ischemia, and consequently underwent CDT during the one-year study period were included.  Detailed baseline characteristics and clinical findings of the studied patients on presentation, after intervention and at one-year follow-up are presented. Results: A total of 21 patients with a mean age of 60.7±15.2 years, including 16 males (76.2%) were included. The initial technical and treatment success rates were 20 (95.2%) and 14 (66.7%), respectively. The amputation-free and the overall survival rates after the one-year follow-up were 15 (71.4%) and 17 (81%), respectively. Four patients (19%) developed complications, two (9.5%) of which were significant (pulmonary hemorrhage and intraventricular hemorrhage). Amputation was performed in 6 (28.6%) cases. Conclusion: In this study, the treatment success rate and the technical success rate were satisfactory

Primary Patency Rate of Superficial Femoral Artery Angioplasty in Patients with Stenosis/Occlusion of Femoropopliteal Artery

Background: The primary patency rate (PPR) is still controversial in angioplasty and heart bypass surgery for blood vessel repair and reconstruction in patients with femoropopliteal disease. Objectives: This study aimed to investigate the prolonged PPR rate in patients with stenosis/occlusion of the femoropopliteal artery undergoing superficial femoral artery (SFA) and popliteal angioplasty. Methods: A case series study population consisted of patients demonstrating femoropopliteal artery occlusion referred to Sina Hospital, Tehran, Iran for angiography during 2016-2018. After angiography, patients underwent either stent placement or balloon angioplasty in the case of stenosis/occlusion of femoropopliteal arteries. After angioplasty, patients were followed up in the 3rd, 12th, and 24th months for re-examination, and color Doppler ultrasonography of femoropopliteal arteries was also performed to measure the patency rate. The SPSS Statistics version 21.0 was used to analyze the data. The Kaplan–Meier method and a log-rank test were utilized to evaluate this rate. Results: Sixty patients were included in the study, from which 44 were women (73.3%) and 16 were men (26.6%) with a mean age of 69.9 years. Fifty-two, 41, and 29 patients were examined at intervals of 3, 12, 24 months, with PPRs of 86%, 79%, and 68%, respectively. There was a significant relationship between claudication degree and procedure success (P = 0.02). Conclusion: The prolonged PPR rate of patients after femoropopliteal artery angioplasty was acceptable and was a safe and effective treatment. For future studies, an increase in the number of study variables, a more comprehensive classification, and PPR-related variables are suggested

Patency rate and factors affecting the clinical outcome of patients with aortoiliac artery occlusion undergoing intra-arterial stenting

Background Occluding plaques are commonly found inthe infrarenal aorta and the iliac artery in patients with peripheralarterial disease (PAD). Aortoiliacocclusive disease(AIOD) occurs commonly in patients with PAD.Methods: This is a prospective study was carried out between2015 and 2017 in Sina hospital. Patients with occlusionin aortoiliac artery and its branches were included.Stent was placed for patients, if they had any obstructionor stenosis in aortoiliac artery in angiography. Patientswere examined in terms of clinical status and ABI calculationand underwent Color Doppler ultrasound of aortoiliacartery to determine patency rate at 1, 3, 12, and 24months after stent placement.Results: The mean age of patients was 64.60 (±10.41).The main symptoms of the patients were claudication(41.8%), ulcer (27.3%), pain at rest (20%), and gangrene(20%). The lesion was bilateral in 21 patients (38.2%).According to TASC stratification, lesions were of type A in26 patients (47.3%), type B in 4 patients (7.3%), type Cin 5 patients (9.1%), and type D in 20 patients (36.4%).The six-month, one-year, and two-year patency rates were89.1%, 83.6%, and 72.7%, respectively. The mean annualABI of patients was 0.79 (±0.11) and two year ABIwas 0.68 (±0.1).Conclusion: It seems that stenting and angioplasty areeffective in improving patients’ conditions and result in agood short and medium-term patency

The Effective Method to Control Bleeding of the Ruptured Hepatic Hemangioma

The patient was a 45-years old man who was sent to our hospital by ambulance after crashing a motorcycle with a car. Upon entering the hospital, his blood pressure(BP) was 110/75 mmHg, his pulse rate was 84 beats/minute, and his respiratory rate was 18 breaths/minute. The patient’s airway and breathing were examined and no problems were found. In addition, external bleeding was not observed. The patient’s Glasgow coma scale (GCS) was 15. His focused assessment with sonography in trauma (FAST) was positive. The patient was a candidate for abdominal and pelvic CT scanning. However, 30 minutes after the initial serum therapy was applied, the patient’s BP was 85/pulse mmHg .the transfusion  a Packed red blood cells (PRBCs) was started and the patient was transferred to surgery. A laparotomy was performed, and about 3 L of blood and clots were found in the patient’s abdomen. After suction the blood, a partial splenic rupture in the inferior pole (grade II injury) was identified and controlled by packing. However, there was widespread bleeding in the liver, which was not controlled by packing. A large hemangioma was observed in the left lobe of the liver; almost the entire left lobe was involved. Two points of the hemangioma were ruptured. Hemangioma tearing was seen in segments II and III of the liver, with lacerations extending 2 to 3 cm (Figure 1). A horizontal mattress suture was used to control the bleeding. Inside the perforation in the lower part of the liver, we entered the hemangioma by a liver needle and used  a 2/0 chromic suture to exit the upper part of the liver. Then, we entered the upper part of the liver and exited the lower part of the liver, and then it was tied. In accordance with this approach, the hemangioma was packed from the lower segment of the liver. To repair the second perforation, the whole liver was not Then, the abdomen was totally examined. There was oozing from the inferior pole of spleen, and a splenectomy was conducted. A drainage tube was inserted around the hepatic hemangioma, and the abdomen was closed. The patient received 4 units of PRBC and 4 units of fresh frozen plasma (FFP) during surgery. The patient’s BP was 110/70 mmHg at the end of the

The Effective Method to Control Bleeding of the Ruptured Hepatic Hemangioma

Introduction: Hepatic hemangioma is the most common benign tumor in the liver. Although intra-abdominal bleeding associated with its rupture is rare, but life-threatening. Here we report a case of ruptured hepatic hemangioma and applied method for controlling its bleeding. Case Report: The patient was a 45-year-old man who was referred after crashing his motorcycle into a car. The patient’s primary survey revealed intra-abdominal free fluid, but stable vital signs. Thirty minutes later, the patient’s systolic blood pressure dropped to 85 mmHg. Laparotomy was performed a large hemangioma was observed involving almost the entire left lobe of the liver. Using a liver needle and 2-0 chromic suture, we entered the hemangioma at the perforation site of the lower portion of the liver and exit from the upper part. Then, we entered the upper part of the liver and exited from the lower part, and then it was tied. According to this approach, hemangioma was packed from the lower segment of the liver. Conclusion: In this case, the patient’s abdomen was primarily closed without extra packing and embolization. The proposed method thus may be more effective compared to conventionally used methods

Evaluation of patient safety culture in medical students

Introducción: la seguridad del paciente es la prevenciónde la prevención y la mejora de resultados desfavorableso daños resultantes del proceso de atención médica. Hoy,reducir y erradicar estos errores y ampliar la seguridad dela atención se ha convertido en una prioridad mundial.El objetivo principal del presente estudio es investigar laspercepciones de los médicos internos de diferentes hospitalesde la Universidad de Ciencias Médicas Shahid Beheshtisobre el tema de la cultura de seguridad del paciente.Materiales y métodos: se seleccionaron 90 estudiantesde diferentes barrios. El cuestionario de cultura de seguridaddel paciente AHRQ se usó para recopilar los datos. Culturade seguridad del paciente en pasantes se estudió en 7campos utilizando esta herramienta confiable y sostenible.pregunta de puntuación relacionada con cualquier elementode 5 grados (1 a 5) usando Likert hecho. Las opciones incluyentotalmente en desacuerdo, en desacuerdo, neutral,de acuerdo y totalmente de acuerdo. Usando pruebas noparamétricas, se evaluó la relación de respuesta a cada ítemy se analizó la importancia de la diferencia de las razones.Resultados: Los resultados generales mostraron que lapuntuación de los rendimientos medios de la unidad detrabajo (p = 0.00), los errores de replicación (p = 0.00) yel hospital (p = 0.03) fueron significativamente más altosy las puntuaciones del grado de concesiones de seguridaddel paciente (p = 0.00) son significativamente más bajasque el promedio también en los campos de supervisión(p = 0.058) y las comunicaciones (p = 0.1) las medias nomostraron diferencias significativas con respecto al promedio.Se observó el grado de seguridad del paciente entérminos de diferencia estadísticamente significativa entrelas puntuaciones de hombres y mujeres (p = 0.00) y elhospital (p = 0.01), mientras que en otras áreas hay diferenciassignificativas entre los grupos.Conclusión: Los resultados de este estudio mostraronque, en general, en el campo de la cultura de seguridaddel paciente, es necesario adoptar una actitud integral, esla falta de una gestión integral y una reducción eficientede la seguridad del paciente en el hospital, seguido deun aumento de las lesiones a los pacientes y los sectoresde salud

Evaluation of patient safety culture in medical students

Introducción: la seguridad del paciente es la prevenciónde la prevención y la mejora de resultados desfavorableso daños resultantes del proceso de atención médica. Hoy,reducir y erradicar estos errores y ampliar la seguridad dela atención se ha convertido en una prioridad mundial.El objetivo principal del presente estudio es investigar laspercepciones de los médicos internos de diferentes hospitalesde la Universidad de Ciencias Médicas Shahid Beheshtisobre el tema de la cultura de seguridad del paciente.Materiales y métodos: se seleccionaron 90 estudiantesde diferentes barrios. El cuestionario de cultura de seguridaddel paciente AHRQ se usó para recopilar los datos. Culturade seguridad del paciente en pasantes se estudió en 7campos utilizando esta herramienta confiable y sostenible.pregunta de puntuación relacionada con cualquier elementode 5 grados (1 a 5) usando Likert hecho. Las opciones incluyentotalmente en desacuerdo, en desacuerdo, neutral,de acuerdo y totalmente de acuerdo. Usando pruebas noparamétricas, se evaluó la relación de respuesta a cada ítemy se analizó la importancia de la diferencia de las razones.Resultados: Los resultados generales mostraron que lapuntuación de los rendimientos medios de la unidad detrabajo (p = 0.00), los errores de replicación (p = 0.00) yel hospital (p = 0.03) fueron significativamente más altosy las puntuaciones del grado de concesiones de seguridaddel paciente (p = 0.00) son significativamente más bajasque el promedio también en los campos de supervisión(p = 0.058) y las comunicaciones (p = 0.1) las medias nomostraron diferencias significativas con respecto al promedio.Se observó el grado de seguridad del paciente entérminos de diferencia estadísticamente significativa entrelas puntuaciones de hombres y mujeres (p = 0.00) y elhospital (p = 0.01), mientras que en otras áreas hay diferenciassignificativas entre los grupos.Conclusión: Los resultados de este estudio mostraronque, en general, en el campo de la cultura de seguridaddel paciente, es necesario adoptar una actitud integral, esla falta de una gestión integral y una reducción eficientede la seguridad del paciente en el hospital, seguido deun aumento de las lesiones a los pacientes y los sectoresde salud

Assessment of the fitness of Cox and parametric regression models of survival distribution for Iranian breast cancer patients' data

Factors affecting the time of survival after breast cancer (BC) diagnosis remain unknown. However, some of the prognostic factors have been identified. The aim of this study was to investigate the effects of biologic and socioeconomic factors on long-term survival of BC patients. This was a descriptive chart review and survey of all women with a confirmed diagnosis of BC registered in Shohada-e-Tajrish Cancer Research Center database from March 2004 to March 2015. The checklist of study consisted of biologic, demographic, reproductive, genetic, medical, and therapeutic information of patients. The minimum time of follow-up was 3 years and the maximum was 10 years. We then evaluated possible associations of these variables with BC survival using Cox and parametric regression models of survival analysis. The study population was 1276 BC patients. Their mean survival was 23 (range 1–120) months. Between the parametric models, Weibull regression model demonstrated the lowest Akaike information criterion and thus the best fit, and tumor size, number of lymph nodes, BC stage, educational level, and high-fat diet were significant in this model. Based on our findings, educational level, consumption of fat, and characteristics of tumor at the time of diagnosis (disease stage, tumor size, number of involved lymph nodes) are the most important prognostic factors affecting long-term survival of BC patients. We suggest that future studies assess the efficacy of possible interventions for these factors