Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
Not a member yet
145 research outputs found
Sort by
To investigate the relation between LDH and CRP levels and mortality of COVID-19 (SARS-CoV-2) patients admitted in SURGERY ICU at Shariati Hospital from 19 February 2020 till 19 February 2021
Get PDFObjective:
The aim of this study is to investigate the relation between LDH and CRP levels and mortality of COVID-19 (SARS-CoV-2) patients admitted in SURGERY ICU at Shariati Hospital from 19 February 2020 till 19 February 2021
Methods:
Our study is a cross-sectional descriptive study . There are 81 patients that are enrolled in this study. We studied the lab reports including CBC parameters (WBC, neutrophils count, neutrophil percentage ) other inflammatory markers ESR and CRP and we also study the medical records of cases for collecting the details about age, gender , length of stay in SURGERY ICU, BMI, fever, survival status, comorbidity, intubation and NIV that was referred to Shariati hospital Tehran from 19 February 2020 (30-11-1398) till 19 February 2021(1-12-1399) regarding the relation between LDH and CRP levels and mortality of COVID-19 (SARS-CoV-2) patients admitted in SURGERY ICU.
The data obtained was analyzed by the SPSS software and the significance value of < 0.05 was considered.
Result:
In this study, the information of 81 patients was considered. The data comes from medical records of Shariati hospital, Tehran. We took 11 variables to compare data of different patients that were recorded in registry and system of medical records in Shariati hospital, Tehran.
This study population included 81 patients, out of which 41 were female patients and 40 were male patients from age 25 to 89. In total 80.2% had mild disease vs 18.5% who had severe disease . 65 patients survived and 16 were admitted to the SURGERY ICU with endotracheal intubation and later on died. The length of stay in SURGERY ICU is 1-25 days. Out of 81 patients 52 (62.4%)have comorbidity and 29 (35.8%) don't have comorbidity. 12 patients (14.8%) receive NIV and 69 patients (85.2%) don't receive NIV. Most of the patients don't have fever.
The minimum and maximum level of CRP are 4 and 416 respectively and for LDH are 9 and 2401 respectively.
The prognostic factors for the severity of COVID-19 infection identified in this study (CRP and LDH) help predict the course of the disease at an early stage. Elevated concentrations of CRP and LDH at admission were found to be associated with a higher risk for COVID-19 severity as they are significant (p-value =0.049 and 0.048 respectively).
Conclusion:
In this study laboratory investigation showed the SURGERY ICU patients to be having significantly higher values of inflammatory markers CRP and LDH than the non-SURGERY ICU patients. LDH and CRP were superior and an effective biomarker in predicting the severity of COVID-19
Evaluating the effectiveness of nurse-led education on the anxiety level of preoperative candidates for opening vascular access in Shariati Hospital.
Get PDFIntroduction: Every year, many chronic kidney disease (CKD) patients undergo surgeries to provide suitable vessel access for hemodialysis. These surgeries cause remarkable anxiety in these patients. Therefore, this study was conducted to examine the effectiveness of nurse-led training on the level of anxiety experienced by these patients.Methods: 38 cases were randomly selected from the candidates for opening vascular access in Shariati hospital, Tehran, Iran. Divided equally into two groups of cases and controls, the anxiety rate was measured in both groups using the Spielberger state-trait anxiety inventory at baseline. After 30 minutes of our special personalized training, the anxiety rate was reevaluated in cases and, using paired t-test, was statistically compared with the anxiety rate before the intervention.Results: The mean baseline anxiety rate was 40.94 and 40.42 in cases and controls, respectively. These numbers altered to 34.78 in cases and 40.05 in the controls after the training intervention. Statistical comparison yielded a significant decrease in the case group (p = 0.048), while the observed difference was statistically insignificant in the controls (p = 0.788).Conclusion: providing an appropriate personalized nurse-led educational package can remarkably reduce the anxiety level in preoperative candidates for opening vascular access in kidney failure cases. Further studies are required to better develop the content of these training and also to define whether a gap between the training and surgery is required to increase the effectiveness
The Comparison between the conservative approach and pectoralis major flap transposition in the treatment of mediastinitis following median sternotomy
Get PDFIntroduction: Mediastinitis is an important complication of open heart surgery and other thoracic operations. Deep sternal wound complications significantly increase morbidity and mortality. The best treatment for deep sternal wound following sternotomy is still under discussion. Repeated irrigation and debridement of the wound and closed chest catheter irrigation with the recent addition of plastic surgery approach such as pectoralis major flap transposition are all valid options with their own supporters.
Materials and Methods: Due to the high prevalence of deep sternal wound infection (DSWI), we conducted this retrospective descriptive study using existing information to compare conservative method of repeated irrigation and debridement with pectoralis major flap transposition. We presented the results in a descriptive and analytic method. A total of 125 patient health record with deep sternal wound infection in a ten-year period (2003-2013) were evaluated.
Results: Results of this study proved that 83.2% of patients who developed DSWI after surgery, suffered from underlying diseases such as diabetes, renal failure, etc. though no relationship was found between the presence of underlying disease and recovery. Moreover, no significant relationship was observed between diabetes and recovery. Among 125 assessed files, 50 patients received pectoralis flap, among which 48 patients recovered with sternal stabilization and only 2 patients recovered without stabilization. On the other hand, among cases without pectoralis flapping, only 67 patients’ records were available of whom only 35 patients recovered with sternal stabilization while 32 patients recovered without sternal stabilization; the recovery was significantly enhanced in the group receiving flapping.
Discussion: The only factor which improved the outcome in our assessment was using pectoralis flapping which is consistent with the results of studies published in the recent years using plastic surgery methods, i.e. pectorals muscle or omentum flapping which is associated with high success rate and reduced length of in-patient sta
Evaluation and Analysis of Outcomes Resulting from Internal Jugular Vein Catheterization Using In-Plane and Out-of-Plane Ultrasound-Guided Techniques in Oncology Patients at Shariati Hospital
Get PDFCentral venous catheters (CVCs) are primarily used in oncology to protect peripheral veins and provide effective access to chemotherapy. This study investigated the results of in-plane ultrasound-guided imaging compared to out-of-plane imaging in patients with oncology-related CVC placement in the oncology department of Shariati Hospital in Tehran.Methods: This cross-sectional analytical study was conducted on 50 eligible oncology patients over 6 months in 1400 at Shariati Hospital in Tehran. The patients were randomly divided into two groups: in-plane and out-of-plane, and the internal jugular venous catheter was inserted by using one of the methods above by an anesthesiologist. The necessary variables for statistical analysis were collected using predetermined questionnaires.Results: The mean age of the patients was 73.42 years, with 25 female participants. The catheter insertion was successfully performed in all patients. The mean duration of catheter insertion in the study population was 2.289 seconds, the mean number of skin punctures was 1.7, and catheter placement was successful in 62% of patients on the first attempt. A total of 23 complications occurred, with carotid artery puncture being the most common—the catheterization method, whether in-plane or out-of-plane, did not affect the initial success of catheter insertion.Conclusion: According to the findings of this study, internal jugular vein catheterization was successfully performed using both in-plane and out-of-plane methods with similar results. 
The Comparison of Immunohistochemistry Characteristics Between Breast Cancer Patients Under 35 Years Old and Above
Get PDFIncreasing incidence rate of breast cancer in young women obligates investigations of clinical and pathological features in this age group. Less hormone receptor expressions and more aggressive behavior has been discussed in very young breast cancer patients. In this study pathological data of patients diagnosed with Invasive ductal carcinoma referred to Shariati hospital and Tehran cancer institute between 2015 and 2018 was evaluated in two groups : under 35 years old (Group1) and above (Group2). Each group contained 156 cases. 62.8% and 63.5% Estrogen and Progesterone Receptor expressionwas reported in Group 1 in comparison to 77.6% and 74.4% in Group 2 ( P value= 0.004 and 0.0038). Her2 expression was found in 41% and 21.2% in group 1 and 2 respectively ( P value= 0.0001). There was 41.2 ± 25.2 and 29.6 ± 21.7 reported of Ki67 in Group 1 and 2 ( P value= 0.001). In conclusion negative hormone receptor, positive Her2 expression and higher proliferation rates is found in breast cancer patients under 35-year-ol
Sigmoid Duplication a Rare Cause of Colon Obstruction Due to Fecal Material Bezoar; A Case Report
Get PDFIntestinal duplication is a rare congenital disorder that can occur anywhere in the gastrointestinal tract. The pathophysiology of duplications remains unclear, and various theories have been proposed. This report presents a case of a young man who came to the clinic with constipation and obstructive defecatory syndrome. Preoperative colonoscopy and imaging revealed no abnormalities in the colon. During the operation, a large colon mass was found and resected, and a primary colocolic anastomosis was performed laparoscopically. After specimen extraction, the colon was cut to assess the etiology. A congenital duplicated lumen of the sigmoid was found, with an accumulation of fecal material in the second lumen causing pressure and obstructing the main lumen. Duplications are a rare cause of intestinal obstruction and should be considered in the differential diagnosis of chronic or partial obstruction. This appears to be the first reported case of laparoscopic resection of sigmoid duplication in an adult man with chronic constipation in the literature
Acute incidence of Inflammatory bowel disease and Guillain-Barré syndrome following COVID-19 vaccination
Get PDFBackground: Since 2019, the Covid-19 pandemic has led to the manufacturing of a wide range of different types of vaccines with different mechanisms of action. The data collected from various studies indicate that complications such as injection site pain, headache, fatigue, fever, and malaise are the most common side effects of Covid-19 vaccination. The most common site-specific complications in the gastrointestinal tract and nervous system in different studies were diarrhea, abdominal pain, nausea, vomiting, dizziness, headache, myalgia, peripheral neuropathy, and demyelinating diseases, respectively. In this study, we report a case that developed complications such as Guillain-Barré syndrome and Crohn’s colitis following Sinopharm/BBIBP COVID-19 vaccination. The course of Crohn’s disease (CD) was also complicated by CMV, and the patient developed fulminant colitis, which led to peritonitis.Case presentation: The patient was a 36-year-old Caucasian male who presented with severe generalized abdominal pain, nausea, vomiting, fever, dyspnea, and fatigue 4 days prior to admission. He mentioned a recent hospitalization due to bilateral ascending paraparesis, which was diagnosed as Guillain-Barré syndrome and treated with intravenous immunoglobulin. He also complained of watery diarrhea for a few weeks. The mentioned symptoms occurred following the injection of the Sinopharm/BBIBP COVID-19 vaccine. Due to the presence of pneumoperitoneum on chest radiography, the patient was transferred to the operating room with a diagnosis of generalized peritonitis and underwent midline laparotomy. On exploration of the abdominal cavity, the colon was perforated at two points: the sigmoid colon and the transverse colon. Signs of inflammation were observed around the perforated edges, but not elsewhere. The patient underwent an extended left hemicolectomy with end colostomy. The postoperative pathology report was consistent with CD, showing transmural chronic inflammation, deep fissuring ulcers, and cryptitis in the surgical specimen. Additionally, the immunohistochemical study for CMV was positive.Discussion: Inflammatory bowel disease (IBD) is a chronic gastrointestinal inflammatory disease with a wide spectrum of extraintestinal manifestations. Due to the incidence of IBD and Guillain-Barré syndrome in the mentioned patient following vaccination, there is a possibility of the same pathogenesis for both diseases. The incidence of Guillain-Barré syndrome as one of the extraintestinal complications of IBD has been reported in numerous studies as a result of the coexistence of both diseases. Also, according to the recent history of vaccination in a previously healthy individual, it is possible to justify the association of Guillain-Barré syndrome and IBD with the vaccine. So far, many studies have reported the development of Guillain-Barré syndrome following vaccination, but to the best of our knowledge, no studies have reported IBD following Covid-19 vaccination yet. Another issue in this patient was the complication of Crohn’s colitis with CMV. Despite the 7-8-fold higher incidence of CMV infection in patients with IBD, the role of CMV infection in Crohn’s colitis has not been determined
Pleural and Primary Mediastinal Complications and Treatment of COVID-19 Patients
Get PDFThe persistent disease 2019 (COVID-19) presents prodigious challenges for research and medical research, mainly with specific epidemiological and clinical characteristics. Patients with COVID-19 pneumonia may have conditions ranging from clinical, and asymptomatic to death due to respiratory failure. COVID-19 pneumonia may be associated with pleural complications such as pneumothorax (PT), pneumomediastinum (PM), pleural effusion, and empyema. To investigate primary Pleural and Mediastinal Complications (PPMCs) and how to treat them in patients with COVID-19. In this cross-sectional study, 10,000 patients with COVID-19 were investigated for the incidence of mediastinal and pleural effusions between the beginning of the second half of 2019 and the end of the first half of 2019. In this study, the average age of patients with PPMCs was 54.29 ± 14.69. 62% (124 patients) were male and 38% (76 patients) were female. In this study, among 10.000 patients with Covid-19, 600 patients (6%) had pleural effusion, of which 456 (4.56%) had mild pleural effusion, and 144 (1.44%) had moderate to severe pleural effusion. Frequency of PPMCs in COVID-19 patients: 0.53% (53 cases) PT, 0.09% (9 cases) hemothorax, 0.06% (6 cases) empyema, 0.96% (96 cases) PM, 0.12% (12 cases) pericardial effusion, 0.17% ( 17 cases) of atelectasis, 0.04% (4 cases) of emphysema were reported. The most frequent pleural complication was pleural effusion, with a frequency of 6%, and the second rank of complications was related to PM, with a prevalence of 0.96%. Being elderly was strongly associated with the rate of intubation and mortality in the hospital (P<0.05). No significant relationship existed between patients' age and PPMCs (p>0.05). There was no significant difference between PPMC in men and women (p>0.05). The results of our study show that PPMC in patients with COVID-19 has a low prevalence, and if they do occur, the most frequent are related to pleural effusion and PM
Evaluation of Brain CT Findings in Patients with Head Trauma Visiting Khatam Al-Anbia Hospital in Zahedan in 2022
Get PDFBackground: Traumatic brain injury (TBI) remains a leading cause of mortality and long-term disability. This study aims to evaluate brain CT scan findings in patients with head trauma admitted to Khatam al-Anbia Hospital in Zahedan during 2022. Methods: This cross-sectional, descriptive-analytical study focused on patients presenting with head trauma at Khatam al-Anbia Hospital in Zahedan throughout 2022 who underwent brain CT scans. A census-based sampling method was employed, and data were collected using a structured checklist. The analysis was conducted using SPSS software. Results: The study included patients with a mean age of 51.78 ± 26.75 years, ranging from 1 to 99 years. Among the 100 participants, 25 (25%) were women and 75 (75%) were men. The highest incidence of TBI was observed in the 70 to 80-year age group, with 15 patients, whereas the lowest incidence was found in the 50 to 60-year and over 90-year age groups, with 6 patients each. Car accidents were identified as the leading cause of head trauma, accounting for 32 cases (32%), followed by physical altercations, which contributed to 10 cases (10%). CT scan results indicated that 10% of the scans were normal, while 90% were abnormal. Notable abnormal findings included subdural hemorrhage (6 cases), frontal bone fractures (16 cases), and cytotoxic edema (6 cases). The most frequent location and type of skull fractures were in the temporal region (8 cases, 29.6%) and
linear fractures (16 cases, 59.3%), respectively. The majority of TBIs were classified as mild (54 cases), with moderate TBIs being the least common (16 cases). Additionally, significant associations were found between injury type, gender, and the nature of the trauma. Conclusions: This study highlights that road traffic accidents are a predominant cause of traumatic brain injuries, consistent with findings from various studies. The most frequently affected age group was 70 to 80 years, with a predominance of men. Abnormal CT findings commonly included subdural hemorrhage, frontal bone fractures, and cytotoxic edema. These results indicate potential regional differences in TBI patterns and emphasize the importance of targeted diagnostic and treatment strategies. The findings underscore the need for early and precise CT imaging in managing head trauma to improve patient outcomes. Further research is essential to refine management approaches and address regional variations in TBI
Sore throat patients after oral and maxillofacial surgery with and without pharyngeal pack
Get PDFBackground: Pharyngeal packing is now widely used in head and neck surgeries after induction of anesthesia. Therefore, the present study was designed to investigate the effect of pharyngeal packing on the occurrence of sore throat and other associated symptoms in comparison with patients without pharyngeal pack in orthognathic surgeries.
Materials and methods: This study was a randomized clinical trial and the target population was patients undergoing maxillofacial surgery hospitalized in two centers, Shafa and Shahid Bahonar Hospitals in Kerman. Sixty patients assigned to two groups, including the group with saline-soaked pack and the group without the pharyngeal pack, were evaluated for the severity of sore throat at time intervals of 2, 6, 12, and 24 hours after surgery as well as the occurrence of comorbid symptoms.
Results: There was no significant difference between the two groups in terms of demographic indicators, length of surgery, and length of recovery. The severity of sore throat at all-time intervals was significantly higher in the pharyngeal pack group in comparison to the control group. Other symptoms such as dysphagia, hoarseness, nausea and vomiting, laryngeal spasm, and cough were not significantly different between the two groups.
Conclusions: The findings of the present study showed that the use of pharyngeal was associated with an increase in the severity of sore throat but had no effect on the associated symptoms. These findings can be a guide to adopting the correct approach to the use of pharyngeal packs in patients undergoing maxillofacial surgery