Shiraz Emedical Journal
Volume:24 Issue: 8, Aug 2023

 Although laparoscopic myomectomy is an effective procedure for the treatment of uterine myoma, there is no clear consensus regarding its rate of recurrence and associated risk factors.

 This study aimed to investigate the recurrence rate of myoma and its risk factors after laparoscopic myomectomy.

 In a historical cohort study, 172 patients who underwent laparoscopic myomectomy and had a minimum follow-up of 2 years were included. Myoma recurrence was checked semiannually by ultrasound imaging. The demographic, clinical, surgical, sonographic, and laboratory indices of the patients were compared between the recurrent and nonrecurrent groups, both in logistic regression models.

 The mean age of the patients was 35 ± 5.7 years (range: 18 - 47 years). Their mean follow-up time was 26.3 ± 4.2 months (range: 24 - 28). The lesion recurred in 25 (14.5%) out of 172 patients. In the univariate analysis, higher age (OR:1.111, P = 0.015), higher body mass index (OR: 1.124, P = 0.024), gonadotropin-releasing hormone (GnRH) therapy (OR = 3.83, P = 0.027), and more than 1 myoma (OR: 2.60, P = 0.032) were associated with myoma recurrence. In the multiple analysis, a higher body mass index (OR: 1.222, P = 0.003) was a significant risk factor for myoma recurrence.

 Laparoscopic myomectomy is an effective procedure for the treatment of uterine myoma and can be used as a uterus-preserving surgical alternative in patients of reproductive age. A more radical surgical procedure might be used for patients with multiple risk factors, as revealed in the present study.

 The identification of the strengths and weaknesses of pre-hospital emergency technicians, as the first providers of treatment services to critically ill patients, is of utmost importance.

 This study was conducted to explain the challenges faced by emergency medical technicians in Shiraz, Iran, within 2021 - 2022.

 The present study was a qualitative study that was conducted using the traditional qualitative content analysis (Graneheim and Lundman, 2004). Sampling in this study was purposeful. A semi-structured interview was conducted with 17 emergency technicians in Shiraz. Lincoln and Guba’s standards were used to validate the data.

 This study identified 3 categories and 12 subcategories. These three categories include management challenges, professional problems, and cultural barriers. Subcategories were “insufficient emergency medical services (EMS) stations”, “lack of human resources”, “role ambiguity”, “lack of organizational support”, lack of job prestige”, “high job stress”, “crowded missions”, “lack of psychotherapy and counseling”, “high-risk profession, “public’s false perception of EMS job”, “abuse of emergency call center services”, and “disrespectful behavior”.

 Considering that the provision of EMS is an inherently stressful and highly anxious job, some measures can be taken to reduce the mental effects of such pressure on the technicians. In addition, they should run public awareness campaigns to improve the cultural level of society to better understand the duties and activities of EMS workers at the community level.

 The neutrophil-to-lymphocyte ratio (NLR) is an inflammation biomarker in patients with liver cirrhosis. While increased NLR is linked to poor clinical outcomes and mortality in diseases like cancers, its association with cirrhosis complications has been sparsely examined.

 This study aimed to evaluate the association between NLR and cirrhosis complications in patients with compensated liver cirrhosis.

 This retrospective cohort study was conducted on 256 patients with compensated liver cirrhosis visiting the Gastroenterology Clinic of Imam Khomeini Hospital, Ahvaz, Iran, in 2020. The peripheral blood lymphocyte and neutrophil counts were evaluated, and the NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Cirrhosis complications were assessed based on clinical and laboratory evaluation during 1 year of follow-up.

 During the retrospective follow-up period, 59 patients (23.05%) experienced cirrhosis complications such as spontaneous bacterial peritonitis (n = 23), gastrointestinal bleeding (n = 22), and hepatic encephalopathy (n = 14). The baseline NLR, Model for End-Stage Liver Disease (MELD) score and Child-Pugh score were significantly higher in patients who later developed complications than in those who did not (P < 0.0001). The NLR with an optimal cut-off of > 1.95 had a sensitivity of 84.75% and specificity of 93.91% in predicting complications during the 1-year follow-up (AUC = 0.905, P < 0.0001).

 Our results indicated that the NLR is a simple, non-invasive, and cost-effective marker for predicting short-term complications in patients with compensated liver cirrhosis.

 Early graft loss (EGL) is one of the rare complications of kidney transplantation. Several factors play a role in the occurrence of EGL in kidney transplant recipients, which must be identified and limited.

 This ten-year retrospective study was conducted in a single center on 32 kidney transplant recipients with EGL to determine the reasons for and risk factors of kidney transplant rejection in Iran.

 This descriptive-analytical study’s population included 605 kidney transplant recipients receiving kidneys during the last ten years in our center. The diagnosis of EGL was based on renal allograft biopsy examination and primary clinical complications, including a rapid increase in serum creatinine. The age, gender, blood group, and rhesus (Rh) of both donors and recipients, as well as the kinship between the donor and recipient (relative and non-relative), right/left-sided living donor/recipient kidneys, primary kidney disease, the presence of underlying disease in the recipient, dialysis duration, the year of kidney transplantation, transplant survival time, patient survival time, and complications (surgery and others) were gathered. The data were analyzed using SPSS version 18.

 In this study, 32 out of 605 kidney transplant recipients (5.28%) experienced EGL (53.1% male and 46.9% female, average age of 41.12 years). The duration of kidney function after transplantation was 5.56 ± 0.13 days. The transplanted kidneys were functional between 72 hours and one week after transplantation in 34.4% of the patients. The causes of EGL were found to be tissue rejection in 31.3% of the patients and vascular thrombosis and hyperacute rejection in 21.8%. Nephrectomy occurred in 41% of the patients, and 43.75% died because of a heart attack.

 Our findings supported previous studies' results, suggesting that EGL is associated with receiving an incompatible kidney transplant and surgery-related complications, including bleeding and thrombosis.