A Comprehensive Model for Trauma Research Design

Concomitant research and education are invaluable for patient care and medical practice in trauma. Elucidation of a foundation for the integration of training and service that can be combined with research in trauma is crucial, and every trauma case should be studied for this purpose. In this study, we investigated the unique features of trauma research to formulate a generic comprehensive model that can be used at any point at which one may desire to develop a research plan. The framework of this model is designed to enable proper trauma research plain in combination with the best routine trauma care. Selection of the appropriate method of study, the corresponding basic questions raised, aims, and the relevant epidemiologic context are factors that are included in this review. Furthermore, suitable sources, proper time for data collection, reliable and valid measures, and criteria for the scaling and quantification of the findings are indicated. In addition, the levels, orders, operational stages, and steps to be taken in planning research projects are logically set based on the principles of cognitive task analysis, and correspond to the entire spectrum of trauma care situations. Lastly, a measure of utility value is assigned in terms of the expected extent of efficiency and presumed level of effectiveness

bilateral staged total hip replacement and the natural progress of an untreated case of developmental dysplasia (Dislocation) of the hip: A clinical case report by the surgeon and the patient

The natural history of an untreated case of a Developmental Dysplasia (Dislocation) of the Hip (DDH) associated with multiple congenital abnormalities is reported in a 55-years-old man. The patient�s complaints and the varieties of the typical manifestations emerged in other parts of the body throughout the life are reviewed and discussed as comorbidities of a dysplastic condition. Two-stage bilateral total hip replacement (THR) operations were performed at the age of 55. In addition, to relieve the pain, the walking disabilities were overcome, hence gaining normal walking in swing and stances. The leg length discrepancy was corrected by anatomically positioned prostheses, examined by the knee bending test and characterized and evidenced by radiological features and indices. © 2015, Shiraz University of Medical Sciences. All rights reserved

A Case Matched Gender Comparison Transcriptomic Screen Identifies eIF4E and eIF5 as Potential Prognostic and Tractable Biomarkers in Male Breast Cancer

Purpose: Breast cancer (BC) affects both genders, but is understudied in men. Although still rare, male BC is being diagnosed more frequently. Treatments are wholly informed by clinical studies conducted in women, based on assumptions that underlying biology is similar. Experimental design: A transcriptomic investigation of male and female BC was performed, confirming transcriptomic data in silico. Biomarkers were immunohistochemically assessed in 697 MBCs (n=477, training; n=220, validation set) and quantified in pre- and post-treatment samples from a male BC patient receiving Everolimus and PI3K/mTOR inhibitor. Results: Gender-specific gene expression patterns were identified. eIF transcripts were up-regulated in MBC. eIF4E and eIF5 were negatively prognostic for overall survival alone (Log rank; p=0.013; HR=1.77, 1.12-2.8 and p=0.035; HR=1.68, 1.03-2.74, respectively), or when co-expressed (p=0.01; HR=2.66, 1.26-5.63), confirmed in the validation set. This remained upon multivariate Cox regression analysis (eIF4E p=0.016; HR 2.38 (1.18-4.8), eIF5 p=0.022; HR 2.55 (1.14-5.7); co-expression p=0.001; HR=7.04 (2.22-22.26)). Marked reduction in eIF4E and eIF5 expression was seen post BEZ235/Everolimus, with extended survival. Conclusions: Translational initiation pathway inhibition could be of clinical utility in male BC patients overexpressing eIF4E and eIF5. With mTOR inhibitors which target this pathway now in the clinic, these biomarkers may represent new targets for therapeutic intervention, although further independent validation is required

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Economic indices and malnutrition in children

Background: With respect to the known complications of malnutrition, especially in vulnerable group of children under 5, the present study was conducted in Shaheed Beheshti University of Medical Sciences in 1997 determine the prevalence of malnutrition and its association with economic indices. Materials and Methods: 1028 under-5-year-old children referred to pediatric clinics in Tehran were included in a descriptive-analytical study. Patients were distributed in two groups of case and control, matched according to the confounding factors. Groups were determined following the recognition of malnourished children. Thus, malnourished children were included as the case group and 550 normal children were considered as control. Demographic data including sex, age and family size were all recorded. Having 33 children excluded due to the secondary malnutrition, malnutrition severity was assessed according to the weight and height of age. Results: 161 (16.2%) children including 77 boys and 84 girls were malnourished. Family size of 3 or 4 was found in 22.4% and 32.7% of the case and control group, respectively. These figures were 31.3% and 28.5% for family size of 7. Significant associations were found between children malnutrition and family monthly income (P<0.0001), family size (P<0.02) and maternal education (P<0.03). Conclusion: With respect to the effect of economic indices on malnutrition this should be considered as a priority, thus, complications and expenses would be decreased

Upper gasterointestinal bleeding in Shahid Beheshti Hospital of Kashan, 1997-98

History and Objectives: Upper gasterointestinal (UGI) bleeding is a common cause of admission in the medical and surgical wards. Due to its importance and different causes of bleeding, the present study was carried out to investigate the causes of UGI bleeding and their relationship to the laboratory and clinical data. Materials and Methods: A descriptive study on existing data on 114 patients who were admitted to the ward with UGI bleeding was carried out. Results: The most common cause of UGI bleeding was peptic ulcer (46.5) and other less frequent causes of bleeding were gastritis (33.3), duodenitis (6.1), gastroduodenitis (3.5), esophageal varices (3.5), esophagitis (1.8) and esophageal ulcer (0.9). Five cases had normal endoscopic finding (4.4) from which 4 cases were due to NASAIDs application. 45.6 of patients used NSAID60 for different causes. Conclusion: UGI bleeding is one of the common causes of referral to emergency departments. NSAID plays an important role in UGI bleeding. Therefore correct usage of NSAID is recommended. The most common cause of UGI bleeding is peptic ulcer disease. Further researches are needed to evaluate the effect of H.pylori treatment to prevent UGI bleeding

Prevalence of Hypercalciuria In 6-12 Years Old Children in Urban and Rural Regions of Kashan, 2004

Background: Hypercalciuria is the most common cause of nephrolithiasis. Many hypercalciuric patients are visited in pediatricians’ offices. Various factors like solutes of water and diet affect the prevalence of hypercalciuria in different areas. So this study was carried out to evaluate the prevalence of hypercalciuria and its related factors in 6-12 years old children in Kashan. Materials and Methods: This descriptive study was done on 400 children aged 6-12 years old in kashan city and its villages. After determining the sample size and selecting the school that should be studied, investigating teams were instructed about sampling and collecting data. The questionnaire was completed for every child who had not signs of hyperparathyroidism, Cushing syndrome and history of excessive use of vitamin D. Urine samples were collected in plastic sealed labeled containers and were sent to central laboratory of university. Then sodium, creatinin and calcium of samples were tested by flame – Phothometer and RA 1000 apparatus. Children with urine calcium to creatinin ratio more than 0.2 and urine sodium more then 200 meq/lit were known respectively as hypercalcouria and hypernatriuria. Results: The study was done on 362 out of 400 cases. The prevalence of hypercalciuria was 34.2%, of them 58.1% was male while 47.9% of children without hypercalciuria was male (P<0.09). The prevalence of hypercalciuria at Kashan city and its villages were 33% and 39% respectively. The prevalence of hypernatriuria in children with hypercaliuria was 41.9% but in children without hypercalciuria was 20% (P<0.0001). Conclusion: The prevalence of hypercalciuria in Kashan city and its villages is high. This is even higher in rural than urban regions. Hypercaciuria prevalence in male is more than female. There is direct relation between prevalence of hypercalciuria and hypernatriuria hence it is recommended another study to compare solutes level of drinking water and excessive use of salt in rural and urban regions of Kasha