Journal of Research in Medical Sciences
Volume:28 Issue: 1, Jan 2023

Anastomotic leak (AL) is a serious complication in digestive surgery. Early diagnosis might allow clinicians to anticipate appropriate management. The aim of this study was to assess the predictive value of amylase concentration in drain fluid for the early diagnosis of digestive tract AL.

Hundred and fourteen consecutive patients “at risk” of AL, in whom a flexible drainage was placed by surgeon’s choice after digestive anastomosis were included. Patients with eso‑gastric, bilio‑digestive, and pancreatic anastomoses were excluded. Drain amylase measurement (DAM) was routinely performed on postoperative day (POD) 1, 3, 5–7. DAM values were compared between patients with postoperative AL versus patients without AL. A receiver‑operating curve (ROC) with calculation of the areas under the ROC curves area under curves was performed and a cutoff value of DAM was calculated.

AL occurred in 25 patients (AL group) and 89 patients did not present AL (C group). The mean DAM was significantly higher in AL group versus C Group on POD 1, 3, and 5. A cutoff value of 307 IU/L predicted the occurrence of AL with a sensitivity and specificity of 91% and 100%, respectively. Positive and negative predictive values were 100% and 97.5%, respectively. Patients with AL had an elevated DAM prior to the appearance of any clinical signs of AL.

High level DAM could accurately predict AL for proximal and distal digestive tract anastomoses. This simple, noninvasive, and low‑cost method can accurately predict early AL and help physicians to perform appropriate imaging and treatment.

Pancreatic cancer (PC) is associated with a poor prognosis, with various modifiable risk factors affecting the survival of patients. Our aim was to evaluate the survival rate and the prognostic factors influencing survival in PC patients in northwestern Iran.

All the PC patients admitted to the Imam Reza Hospital of Tabriz, Iran, from 2016 to 2020, were enrolled in this study. The survival rate and time were calculated, and the risk factors related to survival were evaluated by Cox regressions. The data were analyzed using the Cox proportional hazards model using STATA software.

Of 110 patients, 12‑, 24‑, 36‑, and 48‑month survival rates were 29.1%, 19.8%, 14.1%, and 8.5%, respectively, with the median survival time of seven months. The mean age was 65.5 years. The results showed that a higher age (hazard ratio [HR] [95% confidence interval (CI)] = 2.04 [1.20–3.46]), lower education (1.72 [1.03–2.89]), delayed diagnosis (1.03 [1.02–1.05]), hypertension (1.53 [1.01–2.31]), concomitant heart disorders (2.67 [1.50–4.74]), COPD (4.23 [1.01–17.69]), consanguineous marriage (1.59 [1.01–2.50]), and the presence of icterus complications (adjusted HR = 3.64 [1.56–8.49]) were directly associated with a worse survival. On the contrary, radiotherapy (0.10 [0.01– 0.85]), chemotherapy (0.57 [0.36–0.89]), and surgical therapy (AHR = 0.48 [0.23–0.99]) were directly related to a good prognosis.

Surgery, chemotherapy, and radiotherapy were the best predictors of survival in PC patients. Moreover, it seems that resolving jaundice can improve survival in these patients. It seems that increasing social awareness, treating underlying diseases, and employing an appropriate therapeutic method may promise a better outlook, improve the survival rate of patients, and reduce PC risk.

Cardiac rehabilitation (CR) is scantly available in Iran, although it is the cost‑benefit strategy in cardiac patients, It has not been established how CR is delivered within Iran. This study aimed to determine: (a) availability, density and unmet need for CR, and (b) nature of CR services in Iran by province.

In this cross‑sectional sub‑study of the global CR audit, program availability was determined through cardiovascular networks. An online survey was then disseminated to these programs in June 2016–2017 which assessed capacity and characteristics; a paper‑based survey was disseminated in 2018 to nonresponding and any new programs. CR density and need was computed based on annual incidence of acute myocardial infarction (AMI) in each province.

Of the 31 provinces, 12 (38.7%) had CR services. There were 30 programs nationally, all in capital cities; of these, programs in 9 (75.0%) provinces, specifically 22 (73.3%) programs, participated. The national CR density is 1 spot per 7 incident AMI patients/year. Unmet need is greatest in Khuzestan, Tehran and west Azerbaijan, with 44,816 more spots needed/year. Most programs assessed cardiovascular risk factors, and offered comprehensive services, delivered by a multi‑disciplinary team, comprised chiefly of nurses, dietitians and cardiologists. Median dose is 14 sessions/program in supervised programs. A third of programs offered home‑based services.

Where programs do exist in IRAN, they are generally delivered in accordance with guidelines. Therefore, we must increase capacity in CR services in all provinces to improve secondary prevention services.

The increased prevalence of obesity in early childhood is a public health problem. Childhood obesity may affect cardiorespiratory fitness and can induce obesity and its comorbidities in adulthood. We aimed to assess childhood overweight status by accelerated weight gain during infancy.

This is a historical cohort that was conducted on 637 7‑year‑old students of Guilan province, north of Iran. Data were collected, including demographic characteristics, weight at 4, 6, 12, and 18 months, and clinical examination. The ROC curve was designated based on the standardized z‑scores, and the most appropriate cutoff point by sensitivity and specificity was noted for predicting obesity at 7 years. Rapid weight gain (RWG) was also assessed.

Among participants, 334 (53.3%) were female. In this study, the mean and standard deviation of RWG in 0–4 months, 0–6 months, 0–12 months, and 0–18 months were 3.50 ± 0.89, 4.64 ± 1.02, 6.54 ± 1.21, and 8.00 ± 1.46 kg, respectively. The highest AUC was dedicated to 0–18 months (0.7 ± 0.05) and the suitable cut-off for RWG in this interval was 8.55 kg with 65.5% and 72.0% sensitivity and specificity, respectively.

Although in the previous investigations, the changes in the first 3 years of life had a significant role in further complications, regarding our results, it seems that even earlier consideration of excess weight gain may be necessary.

The aim of the present systematic review and meta‑analysis was to evaluate the therapeutic efficacy of bosentan, a dual endothelin receptor antagonist, for systemic sclerosis (SSc) patients with digital ulcers (DUs).

A systematic search of MEDLINE, Embase, Web of Science, and Scopus was done using appropriate keywords till September 2021. Weighted mean difference (WMD) as the effect of therapeutic efficacy of bosentan on continuous outcomes was an estimate. Furthermore, the pooled prevalence of diffuse SSc and limited SSc was computed. Fixed or random effects models when appropriate were used for data synthesis.

Totally, 469 patients, with a mean age ranging from 48.1 to 63.7 years, from 8 studies were included in the systematic review and meta‑analysis. The pooled frequency of diffuse SSc and limited SSc was 56% (95% confidence interval [CI]: 39%, 73%) and 44% (95% CI: 27%, 61%). The pooled prevalence of new DUs following bosentan treatment was 21% (95% CI: 10%, 33%). The results of the meta‑analysis showed a pooled mean decrease of WMD: −0.09 (95% CI: −0.020, 0.02, P = 0.10), WMD: −2.82 (95% CI: −5.91, 0.27, P = 0.07), and WMD: −6.65 (95% CI: −9.49, −3.82, P < 0.001) in mean SSc‑Health Assessment Questionnaire, pain, and Rodnan score, respectively. Our meta‑analysis also indicated a significant pooled decrease in the number of new DUs in SSc patients compared to placebo subjects (WMD: −0.89 [95% CI: −1.40, −0.37; P = 0.001]) and baseline values (WMD: −1.34 (95% CI: −1.95, −0.73; P < 0.001).

Bosentan possibly is an efficacious treatment option for SSc‑related DUs. Although further large‑scale randomized clinical trials are required to confirm the preliminary finding and underlying mechanisms of action.