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The application of Botulinum toxin (Masport) in urology has a long history. We aimed to assess the effect of local Masport on improvement in patients with urethral stricture by reducing the recurrence of urethral stricture. This pilot study conducted was a double-blind randomized clinical trial with code IRCT20191222045852N1 on patients suffering from urethral stricture. Finally, 28 patients were allocated to intervention and control groups. Twelve patients received intralesional injection with Masport in addition to internal urethrotomy, while 16 patients underwent internal urethrotomy with normal saline. The Cox regression hazard model was used to evaluate the effect of treatment status on recurrence time adjusted for the age, length, and location of the stenosis, cause of the stenosis, and history of previous operations. The effect of treatment type was significant at the .05 level. The past medical history and cause of urethral stricture had a significant impact on relapse-free survival. Also, the improvement in the mean score of the EuroQol Visual Analogue Scale (EQ-VAS), International Prostate Symptom Score (IPSS), and Q-max in the group with Masport was significantly different from the group with normal saline. The internal urethrotomy with intralesional injection of Masport has a better survival prognosis than internal urethrotomy with normal saline group. Therefore, the authors suggest that, given this successful initial clinical trial, consideration be given to future studies involving the use of botox in the management of urethral strictures in conjunction with internal urethrotomy.

Introduction: Urogenital system injuries (UGIs) are seen in 10% of adult cases with multiple trauma. Although UGIs are rarely life threatening, they can cause major long-term morbidities. This study aimed to evaluate the characteristics of traumatic UGIs in patients who were referred to emergency department following multiple traumas. Methods: This retrospective cross-sectional study was conducted on multiple trauma patients who were presented to emergency department during a 10-year period (2008-2017). All patients with kidney, ureter, bladder, urethra, or external genitalia injuries were studied. The patients’ data were extracted from their clinical profiles. Results: Out of the 13598 admitted patients in our trauma center, UGIs were seen in 267 (1.9%) cases. The mean age of patients with UGIs was 27.3 ± 6.1 years (74.15% male). The highest incidence of UGI was seen in those aged between 21 and 30 years (39.7%) and motorcycle accidents (49%) was the most frequent cause of trauma. 221 patients had an unstable situation and were emergently transferred to operation room (13.57% with traumatic kidney injury). The most common injured sites of urogenital system were kidney with 155 (58%) cases, followed by external genitalia with 91 (34.1%) cases. 77.5% of cases were managed conservatively and the rest (22.5%) underwent surgical procedures. Conclusion: UGIs comprise a low percentage (2%) of traumatic injuries, which are mostly caused by blunt trauma due to road traffic accidents. Kidney is the most common injured organ and UGIs mostly happen in young ages.

Background: Caustics produce one of the most serious complications of poisonings. This research was aimed to study demographical, clinical and endoscopic findings in patients with corrosive injury. Methods: In a retrospective survey, all records of the patients who had been admitted to Razi and 17th Shahrivar hospital in Rasht city due to the ingestion of caustic agents during 2002-2009 and endoscopy had been performed for them in the first 24 hours after ingestion were studied. The information was analyzed by descriptive method using SPSS 16 software. Results: Among 258 patients in Razi Hospital, 174 (67.4%) were female with mean age of 29.33 years old. 127 patients (61.1%) had intentional ingestion. 208 patients were finally studied. Among them, 175 patients were hospitalized for 2 days (average 1.73 days). Among 45 patients of 17th Shahrivar hospital, 24 (53.3%) were female. All of them had accidental ingestion. The most frequent site of injury in adults was esophagus (37.2%) and in pediatric population was the mouth (66.6%). Of all pediatric patients, one case had grade IIb endoscopic injury. Among cases who underwent endoscopy (in adults),20.8%, 16.7%, 41.6%, 16.7%,4.2% had grade zero, I, IIa, IIb and III injury, respectively .In all cases, bleaches were the most frequent consumed material. Conclusion: In both studied groups, female patients were more affected by corrosive agents and in adults, intentional ingestion was approximately 1.5 times more frequent than the accidental cases; while all of pediatric patients had accidental poisoning. Most of the lesions had been received only medical treatment without any surgical interventions.

Background: Aluminum phosphide (ALP) or rice tablet is a common agent used as pesticides. It is cheap, widely available and highly toxic and responsible for many cases of poisoning in the agricultural communities. There is limited evidence about change of liver enzymes in patients with ALP poisoning in this region. Therefore, we decided to evaluate alteration of liver enzymes in ALP poisoning in Rasht. Methods: In this retrospective cross-sectional study, all documents of patients with ALP poisoning admitted to Razi hospital of Rasht in 2008-2009 were assessed. Inclusion criteria were diagnostic clinical manifestation such as hypotension or metabolic acidosis, history of exposure to ALP during the past 24 hours and progressive signs and symptoms despite treatment (administration of sodium bicarbonate and vasopressor). Patients with past history of hepatic disease were excluded. Collected data were analyzed with SPSS software. Results: Of 104 patients with ALP poisoning, 66 patients (63.5%) were men. The mean age was 33.8±14.69 years, and the mean time of hospitalization was 14.94±18.28 hours. Ninety-five patients (91.3%) needed ventilation and 93 patients (89.4%) died. Statistical analysis demonstrated that elevated liver enzymes were not significantly related with gender, age, time of admission, time of hospitalization, the need for ventilation and mortality. Conclusion: It seems that liver enzymes changes is not seen widely in ALP poisoning and had lower importance than other complications. Because of limited studies in liver enzyme alterations in these patients, it is suggested that more studies with largee sample size is performed to investigate the ALP liver side effects.

Background: Adipokines play a role in pathogenesis and progression of certain cancers. Resistin is an adipokine with diverse findings in disease development and progression. The present study aimed to determine Resistin serum levels in bladder cancer cases in order to identify novel tumor markers. Methods: This research was based on a case-control study, including 45 patients with bladder cancer and 45 healthy controls. Resistin levels were measured by ELISA in both groups. Height and weight were measured and body mass index (kg/m2) was calculated. Results: Resistin levels were significantly different between bladder cancer and the control group (p

Background: Methadone is considered a long-acting opioid agonist which is widely used in the treatment of drug addiction. It is believed that opioids can cause erectile dysfunction (ED) by inhibiting gonadotropin and testosterone release. This study is aimed at defining the possible effects of conservative treatment with methadone on erectile dysfunction in the addicts. Methods: A total of 382 male addicts visiting methadone maintenance therapy (MMT) centers in Rasht, Iran, during 2010 were enrolled in this study. International Index of Erectile Function (IIEF) questionnaire and patients' profiles were the main means of collecting data on demographic information, methadone dose intake, and erectile function status before and after the two months of therapy with methadone. Erectile function status was defined by the total score from questions 1, 2, 3, 4, 5, and 15 of the questionnaire. The data was analyzed by X2, McNemer’s test, and paired t-test using SPSS software 18. Results: The mean age of patients was 37.6 ± 8.9 years (range: 18-72 years). Most of the patients were married (79.3%) and they were citizens of Rasht (72.3%). The most frequent substances were opium (188 patients, 49.2%) and crack (129 patients, 33.8%), respectively. Most of the patients received low dose methadone (286 patients, 74.9%). No significant relationship was indicated comparing the average scores of erectile function before and after taking methadone (18.53±6.978 vs. 19.03±5.819) (P=0.138). However, the severity of erectile dysfunction was significantly related to the methadone intake dose (P

Primary signet-ring cell adenocarcinoma of bladder is a rare neoplasm, usually seen in middle age adults. We report the case of an 18-year-old man who presented with intermittent gross hematuria. Computed tomography imaging showed multifilling defects in the bladder. The patient underwent a transurethral resection of the bladder tumor. Histological findings were consistent with poorly differentiated mixed mucinous and signet-ring cell adenocarcinoma. We ruled out other possible origins of tumor by gastrointestinal endoscopy and colonoscopy. The patient was treated with radical cystectomy with prostate and seminal vesicle sparing technique and orthotopic diversion using “W” ileum pouch with pelvic lymphadenectomy to the bifurcation of the aorta was done. Six-month follow-up of patient showed normal conditions without metastatic spread or any recurrence.

Background: Cardiac manifestations that occur in a majority of patients with organophosphate (OP) poisoning may range from innocuous electrocardiographic manifestations, such as sinus tachycardia, to life-threatening complications, including cardiogenic pulmonary edema and myocardial necrosis. In this study, we evaluated the various electrocardiographic manifestations in patients with OP poisoning. Methods: This retrospective-descriptive study was performed by reviewing the medical records from all patients poisoned with organophosphate admitted to Razi Educational Hospital, Rasht, Iran, from April 2008 to March 2011. Patients with incomplete records were excluded from the study. Histories of all patients were collected and ECG analysis was conducted including the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals by a cardiologist. Descriptive statistical analysis was conducted by SPSS software version18. Results: Of the total 100 patients (75 were male) with OP poisoning that referred to the Emergency Ward of Razi Hospital, 63 patients presented ECG abnormalities. The mean age of the patients was 35.78 ± 12.91 years. The causes of poisoning were occupational in 71 patients, suicidal in 26 patients, and accidental in 3 patients. Sinus tachycardia (31%) was the most common ECG abnormality, followed by non-specific ST-T changes (24%). Overall, mortality rate was 5% and all of the deceased patients presented changes in ECG. Conclusion: OP poisoning is associated with significant ECG abnormalities, especially tachycardia and non-specific ST-T changes.

Background: Acetaminophen is widely used as an analgesic and antipyretic drug and it is a frequent cause of acute drug poisoning.This study was carried out to investigate the demographic information and clinical and laboratory findings in acetaminophen poisoning patients referred to “17 Shahrivar” and “Razi” educational hospitals, Rasht. Methods: In this retrospective cross-sectional study, 125 patients with acetaminophen poisoning were studied. Descriptive data were analyzed by SPSS software. Results: 90 of the patients were women and the mean age of the patients was 21.5±9.06 years. Also, 72.8% of the patients were from urban areas and most of the patients (67.2%) lived in Rasht. Spring was the most common season for the incidence of poisoning. Suicide was the most common pattern of poisoning (91.2%). The mean time interval between poisoning and use of antidote N-acetylcysteine was 4.94±3.5 hours. The most common cause of delayed administration of antidote was failure in diagnosis of poisoning. Overall, 31.2% of the patients had no significant clinical manifestations. In other patients, nausea (50.4%) was the most common clinical symptom. The most common abnormal laboratory findings were prolonged prothrombin time and international normalized ratio (29%). Liver aminotransferases were elevated only in 18% of the patients. Conclusion: Poisoning with acetaminophen was mainly found in women, 12-20 years of age, in urban areas and spring season. Suicide was the main reason of poisoning. Regarding the most common cause of delay in antidote therapy (failure in poisoning diagnosis), establishment of a toxicology laboratory in Guilan province can help the better management of poisoned patients.

Background: Naltrexone is a competitive opioid receptor antagonist blocking the euphoric effects of exogenous opioids. When used concomitantly with opioids, naltrexone causes severe withdrawal symptoms. The main aim of the study is to determine the symptomatology and outcome of patients who consumed naltrexone in conjunction with an opioid substance. Methods: This cross-sectional study was performed on the patients hospitalized with history of naltrexone usage coincided with opioid substances at Razi Hospital, Rasht, Iran. The collected data were demographic information, abuse information, clinical signs and symptoms, laboratory findings, and therapeutic measures taken. Data analysis was performed by descriptive tests using SPSS software version 16. Results: The mean age of the patients was 33.7±10.2. The majority of the cases were male (95.6%) and urban (96.7%). The main cause of withdrawal symptoms in 91.1% of the patients was inappropriate naltrexone usage. The main poisoning agent in 80% of the cases was consumed naltrexone alone. The route of consumption in 90.1% of the cases was oral and in 9.9% the cases was IV injection. The major clinical features were nausea, vomiting, and agitation. The main therapeutic measures were supportive intravenous fluids (94.8%) and opioid administration in the form of methadone. The mean hospitalization period was 21.8±18 hours. Conclusion: Severity, clinical course, and outcome of opioid withdrawal by accidental or intentional naltrexone abuse varies greatly among patients and is unpredictable. Common findings upon presentation were gastrointestinal symptoms and agitation and the main therapeutic measures for these patients were support with intravenous fluids and anti-nausea drugs administration as plasil and opioid administration as methadone.

Introduction: Frequency of Tramadol intoxication is increasing as a result of its useas a drug for suppression of withdrawal symptoms by opioids abusers and its wideaccessibility of this drug. Tramadol intoxication can lead to death and, therefore, earlyidentification of its clinical manifestations is crucial since early detection of theintoxication and its treatment could improve patients' survival This study investigatedthe frequency of clinical and laboratory findings in Tramadol intoxication.Methods: In this cross-sectional study, patients with Tramadol intoxication whoreferred to Razi Hospital in Rasht, Iran, during 2005-06 were examined. Theirmedical records were surveyed for demographic data, past medical history,neurological examination, and routine laboratory tests. All data were statisticallyanalyzed by SPSS software version 14.Result: The majority of the 306 patients (83.3% male) were in the age range of 20-40 years and 68.6% of them had been educated up to high school. The mean dose ofingested Tramadol was 746± 453mg (mean± SD). Agitation (25.2%) and seizure(20.3%) were the most frequent reported symptoms. Among laboratory abnormalities,the most common findings were prolonged PT (18.3%) and increased ALT (5.6%).Conclusion: The most common clinical presentation was agitation and the mostcommon laboratory finding was prolonged PT. Of all the patients, 3 cases wereadmitted to ICU. Although Tramadol poisoning might lead to death, there was onlyone death after Tramadol poisoning in the current study.

Objective: The aim of this study is to further compare the efficacy of PGE2 suppository, the intracervical foley catheter and extra-amniotic saline infusion in nulliparous women referred for labor induction. Materials and methods: Totally 368 nulliparous women with a Bishop score ≤ 4 with singleton gestation, vertex presentation and intact membrane referred for labor induction were randomly assigned to 3 groups; Foley catheter alone, Extra-amniotic saline infusion (EASI) and PGE2 suppository. All women received concurrent dilute oxytocine infusion. The change in the Bishop Score, labor progress, various labor endpoints and outcomes of labor were assessed. Results: From 363 women studied after exclusion of 5, 119 were assigned to EASI, 121 to Foley and 118 to PGE2. Patients' demographics did not differ significantly between three groups nor did indication for induction (P = 0.0001). The EASI group had a significant improvement in Bishop Score 6 hours after induction. The mean time to active phase was 357±135min for EASI,457±178 for Foley and 609±238 min for PGE2 group respectively (P < 0.05).rate of spontaneous rupture of membranes was higher in the EASI group (P = 0.0001) and the mean time from the start of induction up to spontaneous rupture of membranes in the EASI group was shorter than other group(P < 0.05). The mean time to vaginal delivery was 14.8±6.1 in EASI group,11.4±4.8 in Foley and 18.9±6.4 in PGE2 group(P < 0.05).there were no differences in Apgar scores, mean neonatal birth weight and neonatal morbidity. Conclusion: Our study showed that pre-induction cervical ripening by EASI with concurrent oxytocin is better than Foley and PGE2 in Bishop score and various labor end point and outcomes.

Objective: To evaluate whether the use of vascular endothelial growth factor (VEGF) with alginate increases oocyte maturation following in vitro maturation. Methods: This experimental study was performed on 150 immature oocytes (germinal vesicle oocytes) from females who were candidates for assisted reproductive technology. The germinal vesicle oocytes were randomly placed in the control, alginate, and VEGF plus alginate groups. The basic culture medium for oocytes culture (tissue culture medium 199, follicle-stimulating hormone 0.075 IU/mL, and fetal bovine serum 10%) was used in the control, alginate, and VEGF plus alginate groups. For the treatment groups (alginate, and VEGF plus alginate groups), alginate (8%) and VEGF (5 ng/mL) were added to the basic culture medium. After culture, immature oocytes were considered as oocytes unchanged in the nucleus whereas oocytes with a polar body were considered as mature oocytes (metaphase II stage). The mature oocytes in each group were fertilized by intracytoplasmic sperm injection and formed embryos were evaluated by reverse microscope. Results: The oocyte maturation rate (metaphase II) significantly (P < 0.05) increased in the alginate plus VEGF group as compared with the alginate alone and control groups during in vitro maturation. On day 2, the cleavage rates were significantly different in the matured oocytes between the treatment groups and the control group. The percentage of the two-cell stage, four-cell stage and eight-cell embryos was significantly higher in the treatment groups compared with the control group (P