ahmadreza soroush

Laparoscopic cholecystectomy is a surgical procedure used to remove the gallbladder in patients experiencing gallstones or acute cholecystitis. Pain is a common side effect of surgery.

This study evaluates the effectiveness of intraperitoneal dexamethasone injection from the umbilical port site in alleviating pain after laparoscopic cholecystectomy.

This research followed a triple-blind clinical trial that included 80 randomly selected patients who were hospitalized at Shahid Mohammadi Hospital in Bandar Abbas and deemed eligible for laparoscopic cholecystectomy. Patients were randomly divided into two groups, each containing 40 participants. In the test group, 8 mg of dexamethasone was injected into the intraperitoneal space through the umbilical port site during surgery, while no drug was administered in the control group. Pain scores were measured postoperatively using the VAS questionnaire at 6, 12, and 18 hours after surgery. The collected data were analyzed using SPSS version 21 statistical software, employing independent t-tests and chi-square tests.

The experimental group exhibited significantly lower levels of nausea, vomiting, analgesic consumption, and pain compared to the control group (p<0.000).

Study confirmed that intraperitoneal dexamethasone infusion from the port site significantly reduced postoperative pain, nausea, vomiting, and the consumption of painkillers.

 Gastric cancer is the fourth leading cause of cancer-related mortality worldwide.

 This study describes the epidemiologic, pathologic, imaging, and surgical findings of patients with gastric cancer referred to a tertiary hospital in Tehran, Iran.

 This was a single-center cross-sectional study. All the patients referred for a staging laparoscopy of gastric cancer in a tertiary hospital in Tehran, Iran, were included.

 A total of 30 patients participated in the study. The mean age of the patients was 62 ± 12.6 years, of whom 76.7% were male. None of the patients had a family history of gastric cancer. Four patients were active smokers, 1 had opium addiction, and 1 had a history of chronic alcohol use. Most patients (n = 29) had at least 1 symptom or were symptomatic for 2.8 months (2.8 ± 2.3 months). The most common clinical complaints were abdominal pain, weight loss, and nausea. Within the follow-up period, 43.3% (n = 13) of the patients expired. The Kaplan-Meier diagram of the study revealed a mean survival time of 8.4 ± 2.1 months within the 2-year follow-up, with a median of 6.0 ± 2.3 months.

 Our results confirmed the previous findings of the clinicopathologic characteristics of gastric cancer patients. Our primary findings were a younger mean age at the diagnosis, advanced stages of cancer at the first visit, low rates of comorbidity and risk factors, an overall survival rate of 43.3%, and a mean survival time of 8.4 ± 2.1 months in 2 years of follow-up.

Considering the increasing and alarming trend of overweight and obesity as well as its related complications, in this study, a comprehensive clinical guide for the medical care of patients with obesity was written based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, and it has been adjusted as much as possible based on the conditions in Iran.

A complete search was performed in the available databases without any restrictions with a specific strategy. Using the opinions of experts in this field, the best clinical guidelines were selected and obesity clinical guidelines were written for Iranian adults. Recommendations were given based on a detailed review of available clinical evidence and considering objective factors.

A total of 1788 references were used and in response to 9 clinical questions, 123 recommendations, including 160 special statements, were provided to determine a comprehensive medical care program for obesity. In this article, we discuss the prevention, screening, diagnosis, benefits and goals of obesity treatment. Questions 6 to 9 regarding obesity treatment steps and its individualization will be published in the next part of the article.

The detailed evidence-based questions and recommendations outlined in this study identify clinical considerations that facilitate decision-making in obese patients from screening and diagnosis to goals of treatment.

 Based on the critical role of MT4-MMP and MT6-MMP in carcinogenesis, we focused on MT4-MMP and MT6-MMP circulating levels in patients with thyroid nodules.

 Plasma samples were collected from three groups, including papillary thyroid cancer (PTC; n=30), multinodular goiter (MNG; n=30), and healthy subjects (n=22). Enzyme-linked immunosorbent assay (ELISA) was used to obtain the concentration of MT4-MMP and MT6-MMP in the three groups.

 Analysis of data demonstrated increased levels of MT4-MMP (PTC: 4.90±1.35, MNG: 4.89±1.37, and healthy: 3.13±1.42) and MT6-MMP (PTC: 8.29±2.50, MNG: 7.34±2.09, and healthy:5.01±2.13) in thyroid nodules by comparison with healthy subjects (P<0.05). There were no significant differences in the levels of the two MT-MMPs between PTC and MNG (P>0.05). Increased plasma levels of MT4-MMP (odds ratio=2.48; 95% CI: 1.46–4.19; P=0.001) or MT6-MMP (odds ratio=1.81; 95% CI: 1.29–2.53; P=0.001) were associated with increased risk of PTC tumorigenesis. Interestingly, a strong positive association was observed between MT4-MMP and MT6-MMP in the three groups (PTC: r=0.766**, P=0.000; MNG: r=0.856**, P=0.000; healthy r=0.947**, P=0.000). Areas under the ROC curve for MT4-MMP and MT6-MMP were 0.82 and 0.96, respectively. At the cutoff value>4.7 (ng/mL), MT4-MMP and MT6-MMP showed a sensitivity of 63.3% and 90.0%, respectively, with 100% specificity.

 Our work has led us to imply that the higher levels of MT4-MMP and MT6-MMP are closely linked with both PTC and MNG tumorigenesis. They may probably promote the development of thyroid lesions; however, more research is needed to further clarify the current findings.

Current treatment of choice for locally advanced rectal cancer is neoadjuvant chemoradiotherapy (neo-CRT) followed by surgical resection and adjuvant chemotherapy. Some patients may experience complete pathological response (cPR) after the neoadjuvant treatment. However, the predicting factors are still debated.

In this registry-based retrospective cohort study, 258 patients with locally advanced rectal cancer were included. Patients were categorized into two groups with or without cPR. Logistic regression analysis was recruited to investigate the odds ratio for all independent variables, and those with significant results were included in multivariate regression analysis.

Achievement of cPR was 21.3%. The odds ratio of cPR was significantly lower when the tumor distance from the anal verge was > 10 centimeters (OR = 0.24, P = 0.040). Also, the odds of cPR with N1 involvement in comparison with N0 involvement decreased for 0.41 (P = 0.043). It was also true for patients with N2 involvement in comparison with N0 involvement (OR = 0.31, P = 0.031). Higher odds ratio of cPR was observed in patients who underwent surgery in > 12 weeks after neo-CRT (OR = 2.9, P = 0.022). Furthermore, the odds of cPR decreased for 0.9 with increasing in carcinoembryonic antigen (CEA) level (P = 0.044).

Patients with rectal cancer in clinical stage II or lower, without the involvement of the lymphatic system at diagnosis, and with tumors located in the lower parts of the rectum, with lower levels of CEA, and longer duration between neo-CRT and surgery were more likely to achieve cPR after neo-CRT. With the current knowledge, the “wait and watch policy” is still debated and needs to be defined more precisely by upcoming studies.

Laparoscopic Heller myotomy (LHM) is considered the standard surgical approach in patients newly diagnosed with achalasia worldwide. However, proceeding to fundoplication after LHM remains controversial due to the observed postoperative symptoms, including dysphagia and regurgitation. This study was conducted to compare the postoperatively experienced regurgitation and dysphagia between those undergoing LHM with fundoplication and those with mere LHM.

This four-year controlled clinical trial was performed on adult patients with esophageal type two achalasia, referring to the Shariati Hospital, who gave their written informed consent to enroll. The diagnosis of achalasia was confirmed using manometric assessments. The control group underwent LHM with fundoplication, while the cases received LHM without fundoplication. The validated Achalasia Patients Questionnaire was used for assessing the experienced symptoms pre- and postoperatively. Also, esophagography was used to investigate the alterations of the symptoms pre- and postoperatively.

A total of 48 patients were evaluated. 23 were assigned to the case group, while 25 were considered the controls (male to female ratio: 25 to 23). The mean age of the patients was 36.94 years, and the average disease duration was 6.22 years. Cases and controls were matched demographically. There was no statistically significant difference between the cases and controls regarding postoperative active or passive regurgitation or dysphagia to either solids or fluids. Also, the mean score of total clinical symptoms after the surgery was not significantly different between cases and controls. Lastly, esophagography revealed significant improvement regarding all the symptoms postoperatively (P = 0.001); however, no statistically significant difference existed in this regard between cases and controls.

Our results indicate no significant difference regarding the postoperative achalasia-related symptoms, namely regurgitation and dysphagia, between those patients undergoing LHM with and without fundoplication. However, further studies are required to thoroughly investigate the effects of various fundoplication techniques in relation to all achalasia-related symptoms to confirm these results.

Nowadays, metabolomics studies are performed with different approaches to identify biomarkers, clarify the underlying mechanisms of diseases and achieve novel treatment strategies. In this context, gut microbiota-derived metabolites are known as one of the most important mediators of gut microbiota effects on human health and various diseases. Due to the inefficiency of conventional therapies in some cases, personalized medicine is of great clinical importance. Recent studies have shown that alterations in gut microbiota metabolites like short-chain fatty acids (SCFAs), amino acids, bile acid metabolites, and choline metabolites can link gut microbiota to numerous chronic non-communicable diseases including obesity, diabetes, inflammatory bowel diseases, psychological disorders, cardiovascular diseases and cancers. Understanding the composition of gut microbiota and the relationship between its derived-metabolites and the occurrence of various diseases is necessary to achieve new clinical applications. Furthermore, potential therapeutic agents such as prebiotic supplements and next-generation probiotics, dietary interventions, antibiotics, and fecal microbiota transplantation (FMT) could be among the leading strategies for personalized medicine in prognosis, diagnosis and treatment of various diseases, via modulating the diversity and composition of gut microbiota and its metabolites.

A novel human coronavirus (COVID-19) was reported in China at the beginning of 2020 and then emerged as a pandemic. Due to this pandemic, surgical practices changed worldwide. First, postponing elective surgeries to the end of pandemic was suggested. Therefore, conducting safe surgeries became a critical concern. This is a multicenter prospective study. The data of 85 patients undergoing laparoscopic surgery in this pandemic era were recorded to evaluate their postoperative outcomes. Among all patients with mean age of 43.7±15.6 and mean surgical duration of 94.6 minutes, none of them showed any complication or any COVID-19 related symptoms after surgery or in follow up time. The mean hospital stay was 3.5 days. There was no increased risk of postoperative complications and COVID-19 infection for patients undergoing various types of laparoscopic surgery in this study and laparoscopy was safe for the patients.

Pancreatitis is an inflammation of the pancreatic tissue. Gallstones are known to be the most common cause of acute pancreatitis, especially in eastern countries, including Iran. Pancreatitis, in its course, can cause complications for the patient. Different systems have been identified as predictors of the severity of acute pancreatitis. As a result, we decided to examine the factors influencing the severity of biliary pancreatitis and their relationship with the complications in Iranian society.

The present study is a cross-sectional, analytical study that was performed retrospectively on 160 patients with biliary pancreatitis. The main and dependent variable in this study is the severity of pancreatitis, which is divided into two groups of complications (local complications and systemic complications) and without complications. The necessary information was extracted from the patients’ files and evaluated with SPSS software version 22.

Based on the results of single-variable analysis, there was a significant relationship between the patient’s age, sex, Ranson and CRP criteria, and complication of the disease. In the univariate analysis, no significant statistical relationship was found between patients’ BMI(Body Mass Index), CBD (common bile duct) size, serum alkaline phosphatase level, gallstone size, and FBS(Fasting blood sugar), and the complications of the disease, based on the multivariate analysis results.

The results of this study showed that four variables of the female sex, stone size, CRP, and high score of Ranson criteria act as independent risk factors in the development of complicating biliary pancreatitis.

Personalized nutrition is a new approach in medical sciences that is based on genetic profile, individual needs, and environmental conditions considering health status and chronic diseases of every person. Studies have shown that genetic differences cannot solely justify various responses to medications and diets, and other important factors including gut microbiota are also involved. Human body hosts an active and dynamic ecosystem composed of a large number of microorganisms consisting of genes about ten times more than the human genome. Gut microbiota interacts with the human body through releasing metabolites such as short-chain fatty acids and secondary bile acids and fermentation products such as kynurenine, indoles and indole derivatives, tryptophan, serotonin, histamine, and dopamine. Body weight, metabolic rate, and health and diseases are formed as a result of these interactions.

Diabetes and obesity are among the most important metabolic disorders which are of worldwide concern. Today, it has been proven that the diversity and composition of the intestinal microbiota play a key role in the incidence and control of metabolic diseases via regulating the metabolism and immune responses of the host. Previous studies reported links between Akkermansia muciniphila, a commensal bacterium in the gut microbiota, and obesity and diabetes. Human and animal studies have shown that this mucin-degrading bacterium is effective in preventing obesity and diabetes by reducing intestinal wall permeability and preventing metabolic endotoxemia and inflammation, as well as modulating energy and fat metabolism. New evidence shows that both forms of the A. muciniphila (live bacterium or its pasteurized form) can control the disease. Considering the difficulties of the survival and cultivation of this anaerobic bacterium and in order to help optimal use of A. muciniphila in clinical treatments of metabolic diseases, in this study we compared the effect of live and pasteurized A. muciniphila. Besides, we investigated the effects of this bacterium as the next generation of probiotics on obesity and management of diabetes.

Postoperative pain, nausea, and vomiting are the most common side effects of laparoscopic cholecystectomy (LC). In the present study, we investigated the differences in postoperative pain, nausea, and vomiting between Veress needle and direct trocar entry methods among patients undergoing LC.

96 patients with gallstones were studied. They were randomly divided into two groups: the patients in the first group (n = 48) were insufflated 8.1 liters per minute CO2 gas by direct trocar port, and the patients in another group (n = 48) were insufflated 2.1 liters per minute CO2 gas by Veress needle. Pain intensity, nausea, and vomiting were assessed at 20 minutes, 4 hours, and 12 hours after the operations.

The duration of CO2 gas insufflation in Veress needle was 88.7 ± 10.7 seconds and indirect trocar was 16.6 ± 1.6 seconds. Visual analog scale (VAS) score significantly reduced in Veress needle compared with direct trocar (0.39 ± 0.98 vs. 1.68 ± 1.48) at 20 min after the operation, while there was no difference at 4 hours and 12 hours after the operation. The requirement and dose of pethidine injection were significantly lower in Veress needle than direct trocar. In addition, nausea and vomiting occurred in Veress needle less than direct trocar at 20 min, 4 hours, and 12 hours after LC.

Pain intensity just in the short term after LC in the group with CO2 gas insufflation in Veress needle was significantly less than the other group, while nausea and vomiting were significantly less during the whole follow-up periods in the group with CO2 gas insufflation in Veress needle. KEYWORDS: Laparoscopic cholecystectomy, N

Increasing prevalence of obesity over the past few decades constitutes a global health challenge. Recent evidence suggests that gut microbiota may contribute to weight control. So, the present study aimed at comparing the frequency of different bacteria in gut microbiota between obese and normal weight people in Iran.

Thirty normal weight (BMI of 18.5- 25 kg/m²) and 27 obese adults (BMI of 30 kg/m² or higher) were included in this case-control study. Dietary intake was assessed using food frequency questionnaire (FFQ). Anthropometric measurements and collection of blood and faecal samples were also done. Then, gut microbiota composition was assessed using quantitative real-time PCR.

The mean age of participants and concentrations of fasting blood glucose and insulin, insulin resistance index, triglyceride concentration and hsCRP were higher in obese group than the normal group (P<0.05). The frequency of Akkermansia was significantly higher in individuals with normal weight than obese individuals (P=0.003). On the other hand, the frequencies of Prevotella and Lactobacillus genera were higher in obese individuals (P>0.05).

In this study, the frequencies of some bacterial genera of intestinal microbiota were significantly different between obese and normal weight individuals. Therefore, population-based studies are needed to confirm current findings. Moreover, in order to achieve personalized medicine goals, information on gut microbiota composition could be helpful.

Cognitive disorders are one of the major public health issues in older population worldwide. Problems in forming and storing new memories, short-term memory impairment, and other cognitive problems are common symptoms of cognitive disorders that have no definite treatment yet. Recent studies have shown an association between gut microbiota and cognitive impairments described as microbiota-gut-brain axis. It seems that gut microbiota is able to influence behavior, brain system, and cognitive functions through this pathway in old age. In this review, the underlying mechanisms of the effect of gut microbiota on cognitive disorders and the role of dietetic intervention with probiotics in cognitive function are discussed.

A 26-year-old female patient was admitted to our hospital, complaining of obstipation, nausea, and vomiting for the past 3 days. She had no significant medical and clinical history. The patient had no history of previous abdominal operations or medication use. Distension of the abdomen was the only finding on clinical examination. Plain abdominal radiography showed air-fluid levels and abdominal computed tomography (CT) showed the clustered terminal ileum and cecum, with dilatation at the proximal parts (figure 1). The findings of laboratory tests were within normal limits. Exploratory laparotomy was performed. At laparotomy, we found that loops of ileum and cecum were trapped in a fibrotic sac with a diameter of nearly 10 cm (figure 2).

Eating disorders (EDs) are widely known by abnormal eating behaviors associated with significant medical complications. Bulimia nervosa (BN) is an eating disorder characterized by uncontrolled episodes of overeating typically followed by some form of compensatory behaviors. We aimed to determine the relationships between socio-demographic characteristics, biochemical markers, and cytokine levels in BN candidates for laparoscopic sleeve gastrectomy (LSG).

A case-control study was designed among 76 BN participants of Iranian descent who were candidates for LSG based on defined criteria for Bulimia by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The healthy control subjects (n = 42) were selected at random from academic staff in the college. Moreover, levels of biochemical parameters and serum cytokines were measured in serum samples.

Routine consumption of caffeine (odds ratio [OR] = 3.1, 95% CI: 1.23–6.41, P = 0.013), tobacco (OR = 1.8, 95% CI: 0.67–3.57, P = 0.03), and alcohol (OR = 3.6, 95% CI: 0.84–7.18, P = 0.048), and depression history (OR = 2.8, 95% CI: 0.76– 5.79, P = 0.037) were substantially more common among patients with bulimia. Also, the serum levels of fasting blood sugar (P < 0.001), HbA1c (P = 0.04), cholesterol (P = 0.03), triglycerides (P = 0.01), blood urea nitrogen (P = 0.03), and pro-inflammatory cytokines including IL-1β, IL-6, and TNF-α were significantly higher in BN candidates for LSG (P ≤ 0.001).

Our findings reveal that lifestyle-related risk factors and a depression history were both related with a significantly increased risk of BN among the candidates for LSG. Furthermore, there is a relationship between clinical characteristics as well as levels of various biochemical and cytokines parameters in serum of BN patients.

Achalasia is the most well known esophageal motility disorder. Laparoscopic Heller myotomy (LHM) is the most effective treatment for achalasia. The aim of this study was to review our results on LHM for achalasia. In this cross-sectional study all patients undergoing LHM between 2015 and 2017 were studied. The myotomy was followed by an anterior or posterior partial fundoplication. All patients were followed up for at least six months. We conducted this prospective study on 36 consecutive patients who underwent LHM over 3 years. The mean age of the patients was 36.64 ± 13.47 years. 30 patients (83.3%) underwent Toupet and 6 patients (16.7%) received Dor fundoplication. 11 patients (30.6%) developed reflux after the procedure. According to the Eckardt Symptom Scoring (ESS), the symptoms improved in 74.2% of the patients and remained unchanged in 25.8% of the patients. Analysis of the ESS, indicated a significant change in regurgitation and retrosternal pain, dysphagia, and weight loss after the surgery (p = 0.001, p = 0.002, p = 0.046, and p = 0.001, respectively). LHM with anterior or posterior partial fundoplication is safe and achieves a good outcome in the treatment of achalasia, especially in patients who have not responded to other methods while no serious complication was reported despite several prior endoscopic interventions.

As the most prevalent endocrine system malignancy, papillary thyroid carcinoma had a very fast rising incidence in recent years for unknown reasons besides the fact that the current methods in thyroid cancer diagnosis still hold some limitations. Therefore, the aim of this study was to improve the potential molecular markers for diagnosis of benign and malignant thyroid nodules to prevent unnecessary surgeries for benign tumors. In this study, 1H-NMR metabolomics platform was used to seek the discriminating serum metabolites in malignant papillary thyroid carcinoma (PTC) compared to benign multinodular goiter (MNG) and healthy subjects and also to better understand the disease mechanisms using bioinformatics analysis. Multivariate statistical analysis showed that PTC and MNG samples could be successfully discriminated in PCA and OPLS-DA score plots. Significant metabolites that differentiated malignant and benign thyroid lesions included citrate, acetylcarnitine, glutamine, homoserine, glutathione, kynurenine, nicotinic acid, hippurate, tyrosine, tryptophan, β-alanine, and xanthine. The significant metabolites in the PTC group compared to healthy subjects also included scyllo- and myo-inositol, tryptophan, propionate, lactate, homocysteine, 3-methyl glutaric acid, asparagine, aspartate, choline, and acetamide. The metabolite sets enrichment analysis demonstrated that aspartate metabolism and urea cycle were the most important pathways in papillary thyroid cancer progression. The study results demonstrated that serum metabolic fingerprinting could serve as a viable method for differentiating various thyroid lesions and for proposing novel potential markers for thyroid cancers. Obviously, further studies are needed for the validation of the results.

The anti-personnel landmine is a type of warfare placed beneath the soil designed to explode when one walks on it causing disabling injury or death of one or more people. This dreaded weapon can damage the civilian population long after evacuating the conflict zone; taking a huge human and economic toll. Landmines and cluster munitions have been widely used in the world, since World War II. In addition to conventional and widespread use in military conflicts, a significant proportion of the world's population lives in areas infested with mines, cluster munitions, ammunition and explosive remnants of war and are prone to explosive risks. Knowledge of the mechanisms of anti-personnel mines is essential for rescuers and other personnel.

About 10% of thyroid nodule Fine Needle Aspirations (FNAs) are reported indeterminate, and this number is much higher in Iran. All of these patients undergo thyroid surgery, whereas, only about 20% of them are malignant and they did not need surgery. Therefore, we decided to evaluate the ultrasonographic features of malignant thyroid nodules to find a predictive scoring model for thyroid nodules and consequently reduce the unnecessary thyroid surgeries. This prospective cross-sectional study was conducted on 114 patients with thyroid nodule who were candidate for thyroid surgery. All the patients were assessed by ultrasonography of thyroid before surgery, and after surgery by the gold standard of permanent pathology, the sensitivity, specificity, positive predictive value, and negative predictive value of each parameter of ultrasonography were determined. Finally, by using the logistic regression analysis, a predictive scoring model was suggested. A total of 114 patients with mean age of 43.13±13 years (90 females (78.9%) were studied. Prevalence of malignancy in final pathology was 75.9%, 39.0%, and 15.9% in FNA biopsies which were malignant, undetermined and benign, respectively. FNA correctly verified 48.9% of the malignant pathologies. In all, smaller nodules, hypoechogenicity, metastatic lymphadenopathy, oval shape, thick or incomplete halo, ill margins, microcalcification, and heterogenicity are associated with malignancy (All, P

Myasthenia gravis (MG) is an autoimmune disease affecting acetylcholine postsynaptic receptor of voluntary muscles. Thymectomy is done in these patients and is a mainstay in the treatment of MG; however, the long-term result of surgery is still controversial. This study dealt with the investigation of the results of thymectomy in treatment, recovery and control of the symptoms of these patients.

This study was performed through a retrospective method in patients suffering from MG who underwent trans-sternal thymectomy between 2011 and 2016. We conducted thymectomy, excision of mediastinal mass and contents of tissues between the right and left phrenic nerves for all patients. Then, the effect of various variables including age, sex, time interval between onset of disease and surgery, thymus pathology and the dosage of drug on clinical response after surgery was determined using various statistical tests.

47 patients including 26 men and 21 women with the mean age of 33.0 ± 4.6 years have been investigated. The mean age of patients was 36.2 and 29.7 in men and women respectively (P = 0.041). Spiral chest computed tomography (CT) scan was present in 47 patients demonstrating mediastinal mass in 40 (85.1%) patients. Also, our pathological results showed thymic cells in aortopulmonary window contents of 4 patients. According to the results, the younger age of patients at the time of surgery, shorter time between diagnosis and thymectomy, being a woman and non-thymoma pathology were along with better clinical outcomes after thymectomy.

Our study shows better clinical results of thymectomy in patients with normal chest CT scan and normal or atrophic thymus in pathologic reports. Generally, it seems that performing thymectomy in a shorter time interval after diagnosis of MG is beneficial. Moreover, in MG patients who do not suffer from thymoma, it is along with positive results.

This study assessed the causes of infection in cholecystectomy and compared the infection rates between the open and laparoscopic cholecystectomy.
This was a retrospective cohort study, performed on all patients admitted to Shariati Hospital since February 2017 for cholecystectomy. Initially, the patients were evaluated for infection risk factors, and then surgical site infection rates in these individuals were measured. Infection was assessed at the time of patients discharge (in the first few days after surgery) and again a month later, either in clinic or by phone. Information from 81 patients was collected, and SPSS software version 24 was used to analyse the data using appropriate statistical tests. Statistical significance was defined as p value The mean age of the participants was 45.89 ± 13.38. The relationship between surgical site infections (SSI) and age, sex, comorbidities (diabetes, hypertension, ischemic heart disease, malignancy, chronic lung disease, and chronic kidney disease), taking corticosteroids, smoking, and the emergency or elective nature of the surgery was not significant. The mean age of the patients who underwent open cholecystectomy was higher than the laparoscopic group (p = 0.005). Similarly, the average hospitalization period for those underwent open cholecystectomy was higher (p = 0.03). Finally, the infection rates for open cholecystectomy were 6 times higher than laparoscopic surgeries (RR: 6.11).
There was no significant relationship between SSIs and the risk factors assessed in this study. However, infection rates were higher in the open cholecystectomy group. More studies on the various risk factors of infection and the differences between the laparoscopic and open surgical methods are required.

Pancreas transplantation has emerged as an effective treatment for patients with diabetes mellitus, especially those with established end-stage renal disease. Surgical and immunosuppressive advances have significantly improved allograft survival. The procedure reduces mortality compared with diabetic kidney transplant recipients and waitlisted patients. Improvements in diabetic nephropathy and retinopathy have also been demonstrated. Pancreas transplantation can improve cardiovascular risk profiles, improve cardiac function, and decrease cardiovascular events. Finally, improvements in diabetic neuropathy and quality of life can result from pancreas transplantation. Pancreas transplantation remains the most effective method to establish durable euglycemia for patients with diabetes mellitus.

Central venous catheters (CVC) are important intravenous routes, that nowadays they can be used for various reasons including resuscitation management, intravenous feeding, chemotherapy drugs, and blood transfusions. Due to the special importance and increasing usage of these catheters lengthening the duration of these catheters are very important. Infections are the most common cause of removal of this catheter.
In this prospective study (cohort), 80 patients with central venous catheter were divided into two groups. In the first group Vancomycin once per day injected inside catheter equal to their intraluminal volume and remained for 2 h, then catheter was aspirated and washed. But in control group catheter was washed only with normal saline. Finally, catheter infection rates in the two groups were compared.
In the group that used intraluminal Vancomycin, catheter infection was ýobserved in 3 cases and was confirmed by blood culture, but in none of them ýcatheter infection agent was not Gram-positive cocci.ý In control group, 18 cases of catheter infection were confirmed by culture that in 16 cases were caused by Gram-positive cocci that in 14 cases catheter was removed, and in 2 cases of catheter infection, infectious agent was Staphylococcus epidermidis which catheter maintained with appropriate antibiotics.
Use of the intraluminal Vancomycin significantly reduces the rate of infection and thus increase the survival rate of CVC.

Arteriovenous (AV) fistula is the first choice of a long-term vascular access for hemodialysis, but there is a 20-30% probability of thrombosis in the 1st month after its creation. Ticlopidine is a potent drug, which inhibits both primary and secondary platelet aggregation. This study is performed to evaluate the effect of ticlopidine in the prevention of AV fistula.
Totally 124 patients in need of an AV fistula were divided into two groups after creation of their fistula. In the first group, we prescribed ticlopidine for 62 patients, and in the second group, 62 patients received placebo. The two groups were compared to see if their fistulas are patent or thrombotic after 1 and 3 months.
Of the 62 patients who received ticlopidine, four had fistula thrombosis, while in 62 patients who received placebo, 16 had fistula thrombosis (P = 0.003). This shows the significant effect of ticlopidine in the prevention of thrombosis in AV fistulas. Also, we compared age, sex, and the fistula location in the ticlopidine and placebo groups, and these attributes had no significant difference between the two groups (P > 0.050).
Considering the significant value of ticlopidine in the prevention of AV fistula thrombosis, it can be recommended after the surgery if there is no contraindication for its use.