فهرست مطالب نویسنده:
bozorg zadeh
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Acute appendicitis is one of the most common etiologies for acute abdomen. However, fewer than 30 cases of acute appendicitis after liver transplantation have so far been reported in the literature. Previous case studies have concluded that acute appendicitis after liver transplantation may present differently than in non-immunosuppressed patients and thus may lead to more complications. Herein, we describe the fourth case of laparoscopic appendectomy in a 40-year-old female presenting with an acute abdomen, 10 years after orthotopic liver transplantation for autoimmune hepatitis. Additionally, we review the literature, and emphasize the importance for laparoscopic, rather than open appendectomy after liver transplantation. Overall, despite the small number of reported cases of appendicitis after orthotopic liver transplantation, we found the incidence and clinical presentation are similar to patients without liver transplantation. The etiologies for appendicitis in patients after liver transplantation may be different than in those not chronically immunosuppressed, with significantly less lymphoid hyperplasia and increased fecalith and cytomegaloviral infections. Preliminary results showed that laparoscopic appendectomy after liver transplantation results in decreased hospital stays and fewer complications.Keywords: Liver transplant, Appendicitis, Appendectomy, Laparoscopy, Abdomen, acute
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سابقه و هدفامروزه چاقی به عنوان یکی از اصلی ترین مشکلات بهداشت عمومی در کشورهای توسعه یافته و نیز کشور های در حال توسعه است و به یک نگرانی عمومی در سطح جهان تبدیل گردید. با توجه به افزایش شیوع چاقی و افزایش بروز سرطان پستان در دو دهه اخیر در زنان ایرانی، این مطالعه با هدف تعیین ارتباط بین چاقی عمومی و چاقی مرکزی (شکمی) با خطر بروز سرطان پستان در زنان قبل و بعد از یائسگی انجام گرفت.مواد و روش هااین مطالعه مورد- شاهدی بر روی 100 مورد بیمار جدید مبتلا به سرطان پستان با تشخیص هیستوپاتولوژیک و 200 شاهد همسان شده سنی با بیماران، انجام گردید. بیماران از بیمارستان های آموزشی شهید یحیی نژاد و شهید بهشتی و مرکز غربالگری سرطان بنیاد حریری بابل و شاهدان از کلینیک بیماران سرپایی یا اطرافیان بیماران انتخاب شدند. قد، وزن، دور کمر و دور باسن با روش استاندارد اندازه گیری شد و نمایه توده بدنی از روی وزن و قد محاسبه گردید. اطلاعات متغیر های دموگرافیک، باروری و برخی فاکتورهای شیوه زندگی طی مصاحبه حضوری از طریق پرسشنامه جمع آوری شد. با استفاده از مدل رگرسیون لجستیک نسبت شانس تطبیق شده چاقی و چاقی مرکزی در خطر بروز سرطان پستان برآورد گردید.یافته هایافته ها نشان داد که 48 نفر (48%) از بیماران مبتلا به چاقی، 42 نفر (42%) دارای اضافه وزن و 45 نفر (45%) مبتلا به چاقی شکمی بوده اند. در مقابل شاهدان 27 نفر (5/13%) چاق، 62 نفر (31%) اضافه وزن و 28 نفر (14%) چاقی شکمی داشتند (001/0p<). میانگین وزن، نمایه توده بدنی و اندازه دور کمر در بیماران بطور معنی داری بیشتر از شاهدان در قبل و بعد از یائسگی بود (001/0p<). نسبت شانس تطبیق شده در خطر بروز سرطان پستان در افراد چاق و اضافه وزن در مقایسه با نمایه توده بدنی طبیعی به ترتیب 5/9=OR (9/26-4/3: CI 95%) و 9/28=)، OR 86-7/9: CI95%) بود. همچنین نسبت شانس تطبیق شده برای چاقی مرکزی 8/3 OR= (8/7- 9/1:CI 95%) برآورد گردید.نتیجه گیریاضافه وزن، چاقی و چاقی مرکزی با شانس ابتلا به سرطان پستان قبل و بعد از یائسگی همراه است. بنابراین، برای پیشگیری از سرطان پستان و عوارض ناشی از آن، اجرای برنامه مداخله ای برای کنترل چاقی و نیز اجرای برنامه های غرباگری سرطان پستان در زنان چاق و داری اضافه وزن ضروری به نظر می رسد.
کلید واژگان: سرطان پستان، نمایه توده بدنی، اضافه وزن، چاقی، چاقی مرکزی (شکمی)، زنانBackground And ObjectiveBoth obesity and breast cancer risk increased dramatically during two recent decades in Iranian women. The aim of the study was to investigate the association of obesity and central (abdominal) obesity with breast cancer risk in pre- and postmenopausal women.MethodsIn this case- control study، 100 new patients with histological confirmation of breast cancer and 200 age-matched controls were recruited. The patients were selected from Yahyanejad and Shahid Beheshti hospitals and also Hariri cancer screening center in Babol، Iran. The controls were selected from outpatient clinic or patient''s relatives in the same hospitals. Height، weight، waist circumference (WC) and hip circumference were measured by standard method at time of diagnosis and body mass index is calculated by weight and height. Demographic، fertility factors and some life style data were collected by interview using questionnaires. The adjusted odds ratio and abdominal obesity in breast cancer risk were estimated by logistic regression model.FindingsThe results showed that 48 (48%) patients were obese، 42 (42%) were overweight and 45 (45%) had central obesity while the figures for controls were 27 (13. 5%)، 62 (31%) and 28 (14%)، respectively (p<0. 001). Weight، body mass index (BMI) and WC were significantly greater in cases compared with controls in pre and postmenopausal women (p<0. 001). The adjusted odds ratio for overweight and obesity were 9. 5 (95% CI: 3. 4-26. 9) and 28. 9 (95% CI: 9. 7-86) compared with normal BMI respectively and the adjusted odds ratio for abdominal obesity was 3. 8 (95% CI: 1. 9-7. 8).ConclusionOverweight، obesity and central obesity increase breast cancer risk in pre and postmenopausal women. These findings imply a multiple strategy of obesity prevention for breast cancer control and also to perform breast cancer screening in overweight and obese women.Keywords: Breast cancer, Body mass index, Overweight, Obesity, Central obesity, Women -
BackgroundLiver transplantation (LT) for polycystic liver disease (PLD) has evolved to be an option for treating these patients. Patients with PLD suffer from incapacitating symptoms because of very large liver volumes but liver function is preserved until a late stage.Objective/MethodsHerein, we reviewed the outcome of adult patients with PLD who underwent LT in the US comparing pre-MELD (1990–2001) to MELD era (2002–2009).ResultsDuring this period, only 309 patients underwent LT for PLD. The number of LT for PLD is very low comparing the two eras. The percentage of patients who had combined liver and kidney transplantation (CLKT) for this disease has not changed during MELD era (42.8% vs 38.6%). The waiting time for LT (337 vs 272 days) and CLKT (289 vs 220) has increased in MELD era (p<0.001). In MELD era, 53.4% of LT and 31.2% of CLKT were done as MELD exceptional cases. The allograft and patent survival have significantly improved in MELD era.ConclusionPatients with PLD had marked improvement of their outcomes after LT in MELD era.
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Biliary hamartomata are rare benign lesions. Herein, we report on a 48-year-old man with a history of end-stage liver disease secondary to alcoholic liver disease. The patient received an orthotropic liver transplant from a brain-death woman. At the time of recovery, there were multiple lesions in the transplanted liver measuring 7–10 mm. Pathology revealed multiple biliary hamartomata. The postoperative course of the recipient was uncomplicated and he was discharged home 10 days after the transplantation.
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BackgroundPortal vein thrombosis (PVT) used to be a relative contraindication for liver transplantation (LT). This obstacle has been dealt with following the improvement of LT-related techniques.ObjectiveTo compare the outcome of adult patients with PVT who underwent LT before and after adopting MELD.MethodsWe retrospectively searched our database for deceased donor LT recipients who had PVT, were operated between 1990 and 2009, and were 18 years old or more. The outcome of patients operated in pre-MELD era (1990–2001) was then compared with that of those operated in MELD era (2002–2009).ResultsThe incidence of patients undergoing LT with PVT has increased from 1.2% (491/40,730) in pre-MELD era to 6% (2540/42,601) in MELD era (p<0.01). Patients with PVT in MELD era were older (53.6 vs 50.5), had higher calculated MELD (21.3 vs 18.9), shorter length of hospital stay after LT (25 vs 21.7 days), more likely to develop HCC (14.8% vs 0), and more likely to receive DCD allograft (3.9% vs 0.8%). Donor risk indices were comparable in both groups (1.9 vs 1.9). The median waiting time before transplantation decreased during MELD era (71 vs 99 days). Allograft and patients survival was comparable between the two eras. However, allograft and patients survival rates were lower in patients with PVT compared to those without. In Cox regression analysis, PVT was associated with worse allograft (HR=1.3, 95% CI: 1.2–1.4, p<0.001) and patient survival (HR=1.3, 95% CI: 1.2–1.5, p<0.001) compared to non-PVT patients.ConclusionsThe incidence of patients with PVT has increased in MELD era without improvement in outcomes. Donor and recipients characteristics changed in MELD era. PVT is still associated with poor outcomes compared to patients without PVT.
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سنجش هموگلوبین به روش نواری به عنوان یک وسیله تشخیصی ساده، قابل اعتماد و کم هزینه برای غربالگری اهداکنندگان خون از نظر کم خونی، قبل از اهدا استفاده می شود. هدف از این مطالعه بررسی ارزش تشخیصی روش سنجش نواری هموگلوبین و سولفات مس در مقایسه با روش مرجع(سیان مت هموگلوبین) بود.مواد و روش هادر این مطالعه مقطعی، 506 نفر از اهداکنندگان خون به روش سرشماری انتخاب و میزان هموگلوبین خون مویرگی نوک انگشت آن ها به روش سولفات مس و به روش سنجش نواری هموگلوبین سنجیده شد. سپس از تمام اهداکنندگان نمونه خون وریدی گرفته شد تا به روش سیان مت هموگلوبین بررسی شوند. معیار پذیرش هموگلوبین به روش نواری(براساس روش اجرایی استاندارد سازمان انتقال خون g/dL 14 یا بیشتر)، معادل g/dL 5/12یا بیشتر در سیان مت هموگلوبین قرار گرفت. جهت تحلیل داده ها از نرم افزار 13 SPSS و آزمون کای دو استفاده گردید.یافته هادر نتایج به دست آمده حساسیت و اختصاصیت سنجش نواری هموگلوبین به ترتیب 100% و 6/95% و ارزش اخباری مثبت آن 3/23% و در روش سولفات مس، حساسیت و اختصاصیت آن به ترتیب 100% و 95% و ارزش اخباری مثبت آن 8/21% گزارش شد. بین دو روش سنجش نواری هموگلوبین و سولفات مس با روش مرجع تفاوت معنی داری وجود داشت(005/0 p<).نتیجه گیریروش سنجش نواری هموگلوبین در مقایسه با روش سولفات مس دارای حساسیت و اختصاصیت بسیار بالایی است که می تواند به عنوان روشی ساده، قابل اعتماد و کم هزینه جهت غربالگری اهداکنندگان از نظر کم خونی قبل از اهدای خون مورد استفاده قرار گیرد.
کلید واژگان: هموگلوبین، غربالگری، اهداکنندگان خونBackground and ObjectivesHeamoglobin color scale (HCS) is a simple, reliable, and inexpensive method for screening blood donors before donation. We decided to carry out this study to compare the diagnostic value of Hb strip test and CuSo4 test with the gold standard method (cyan metheamolgobin). Materials and MethodsIn this cross-sectional study, 506 blood donors were selected. At first, the Hb level of skin puncture blood was measured by CuSo4 method and Hb strip test. Then, venepuncture samples taken from all donors were measured with cyan metheamoglobin method. The acceptance criteria of Hb in strip test is the level higher than 14 g/dL and in cyan metheamoglobin the level higher than 12.5g/dL. Chi-square was performed for final data analysis using SPSS 13. ResultsAnalysis of results showed that sensivity and specifity rates of Hb strip test with positive predictive value of 23.3% are 100% and 95.6%, respectively. In the CuSo4 method sensivity and specifity were 100% and 95% with the reportedly positive predictive value of 21.8%. Comparison of Hb strip test and CuSo4 method with the gold standard test (cyan metheamoglobin) showed a significant difference (p< 0.005). Cell counter results indicated that the level of Hb in 41 out of 506 blood donors was higher than 17 g/dL which is not countable in the Hb strip test. ConclusionsThis study showed Hb strip test compaired with CuSo4 method has a higher sensivity and specifity rate; thus, it can be used as a simple, reliable and inexpensive method. -
The purpose of this study is to verify and evaluate the error generation parameters in MPSIAC model in the Bakhtiary Basin (NE Andimeshk), then modify the model for some parts of the basin. Estimation of erosion and sediment yield in this watershed was achieved using the empirical MPSIAC model. Therefore, this model was processed in a GIS environment and the results were compared with hydrometric stations (Tang-Panj, Zardfahreh, Ghalyan and Kazem-Abad). The result of MPSIAC model in Tang-Panj station has no distinct difference with the observed data and is calibrated directly with station data. However, there are many differences between the observed and computed results in Kazem-Abad station. For calibration of this basin, some schemes should be used. Therefore, probable errors in resources were identified and initial generating error parameters were verified. Finally, some corrections were done on error resources (vegetation coverage) which improved and calibrated the MPSIAC results and then calibrated. For evaluation of this correction, the outcomes were checked in two similar basins Ghalyan and Zardfehreh.
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Sezar sub-Basin is a part of the Dez-dam catchments area (Zagros Zone, Lorestan Province), with an area of 3370 Km2 and 267 Km periphery length. In this study, erosion potential and sediment- yield of the basin was estimated by EPM and MPSIAC methods using GIS data. The values of the main parameters in the MPSIAC and EPM models in the sub basin were evaluated in a GIS environment. Then, the potential and annual sediment yields were calculated by combination of the main parameters in EPM and MPSIAC methods. In both methods, 80% of the study area is in the high- and very high – erosion potential classes, which are located in southwestern part of the area, where Pabdeh, Gurpi and Gachsaran formations are present. At the next step, clustering erosion in potential and sediment yield of the basin were estimated by fuzzy and clustering methods. The annual sediment in MPSIAC and EPM models were 2985584 and 5205725 m3, respectively. The results of clustering method show the class boundaries in the basin are transitional. Also comparison of three methods show an over-estimation tendency, however, MPSIAC results are more reliable.
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Background and ObjectivesTransfusion transmitted HIV is an important issue in every transfusion center. Despite recent improvements in laboratory screening techniques and formulation of rigid standards for blood safety, the risk of HIVcontaminated blood products remains as a potential problem. This study was conducted to determine the knowledge, attitude and practice regarding blood donation among voluntary blood donors about HIV/AIDS. Materials and MethodsThis is a cross-sectional study in which data were collected through questionnaires.We studied knowledge, attitude and behavior of 440 voluntary blood donors about HIV/AIDS in Sistan and Balouchestan province. Voluntary blood donor's knowledge and attitude were evaluated and their correlation with different variables were compared. The data were analyzed with Chi-Square, ANOVA, Kruscal Wallis and Spearmans rho using SPSS 14. ResultsOur results showed that the knowledge levels of 55% of voluntary blood donors about HIV/AIDS were good, 29.5% intermediate, and 15.5% poor. Seventy point one percent of population in the study had positive attitude,56.9% had neutral attitude and 25.9% negative attitude about HIV/AIDS. The correlation between sex, marriage status, educational status, job, type of donation (voluntary or familial),times of donation (first, repeated and regular repeated) with knowledge and attitude was statistically significant. ConclusionsRelatively high level of knowledge about HIV/AIDS especially in regular repeated donors can be due to acquired information during consultation sessions. Therefore, repeated and regular repeated donors can help improve the blood safety.These findings also highlight the importance of more accurate consultation and the provision of necessary training on HIV/AIDS to voluntary blood donors.
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BackgroundMosquitoes transmit several diseases to human. There are several measures for control of larvae. As part of Integrated Vector Management (IVM) program, the utility of floating layers of polystyrene beads (EPS) is a potential alternative in habitats of mosquito larva. EPS beads prevent oviposition of mosquito as well as killing the immature stages by forming a tick layer on the water surface. They are cheap, environmentally safe and do not need frequent application and remain on the surface of water for long time. The objective of the current study was to asses the effectiveness of two types of polystyrene beads of (EPS) and (SWAP) for control of mosquito larvae under laboratory conditions.MethodsAnopheles stephensi and Culex quinquefasciatus were used for experimental purposes. In each tray 250 larvae of late 3rd and early 4th instars were introduced. The experiment was conducted on 4 replicates for An. stephensi, Cu. quinquefasciatus and combination of both. Emerging of adult mosquitoes were calculated every day until the end of experiments.ResultsMortality rate and Inhibition of Emerge (IE) for Cu. quinquefasciatus, An. stephensi and combination of both species was 97.8%, 100% and 99.07%, respectively using EPS. In average, EPS was able to kill 98.9% of larvae. The figures with SWAP were 63%, 91.05% and 72.65%, respectively. The average mortality for mosquitoes was 75.57%ConclusionEPS and SWAP beads can be very effective and practical for elimination of An. stephensi and Cx. quinquefasciatus under the laboratory conditions.
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