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Introduction: Anal abscess is considered as a relatively common compilation in type 2 diabetes mellitus (T2DM) patients. This study aimed to determine the risk factors of recurrent anal abscess in T2DM patients. Methods: In this 4-year retrospective cross-sectional study, T2DM patients hospitalized due to anal abscess in Shahid Modarres Hospital, Tehran, Iran from December 2016 to December 2020 were studied. The independent risk factors of disease recurrence were determined among demographic factors, underlying diseases, diabetes-related factors, clinical factors, laboratory parameters, abscess type, and culture using multivariate stepwise logistic regression analysis. Results: 203 patients were enrolled in the study. 58 (28.6%) patients had at least one re-occurrence of anal abscess during four years. The recurrent episodes had occurred more frequently in the first year after the initial treatment (55.2%). The prevalence of comorbidities such as metabolic syndrome, coronary artery disease, chronic kidney disease, end stage renal disease, and peripheral vascular disease was significantly higher amongst patients with abscess recurrence. The patients with recurrent anal abscess had statically significant poor glycemic control (HbA1C > 7.5), decreased levels of Estimated Glomerular Filtration Rate (e-GFR), and higher C-reactive Protein (CRP) upon the first admission. Presence of metabolic syndrome, HbA1c > 7.5%, WBC > 11.0 ×109/L, and CRP > 5 mg/l were amongst the independent risk factors of recurrence. HbA1c > 7.5% was the greatest independent risk factor of anal abscess recurrence (OR=2.68, 95% CI: 1.37-5.25; p < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) of HbA1C, CRP, and WBC in predicting the risk of abscess recurrence was 0.81, 0.71, and 0.64, respectively. Conclusion: Th recurrence rate of anal abscess in this series was 28.6 %. It seems that in T2DM patients with uncontrolled diabetes who have metabolic syndrome and increased CRP and WBC in their routine tests, the probability of anal abscess reoccurrence is high.

Background: Obesity nowadays becomes a major medical and social problem in the world. Obesity is a pandemic health problem recognized as a disease of time and is also an important cause of morbidity and mortality. The aim of this study was to investigate the persistent histopathologic changes after Helicobacter pylori (H. pylori) treatment in laparoscopic sleeve gastrectomy (LSG) specimens and correlation between high body mass index (BMI) and histopathological findings. Materials and Methods: Asymptomatic 520 patients were candidate for laparoscopic sleeve gastrectomy (2017-2019) who had not symptom of Helicobacter pylori infection, visually normal endoscopy and had positive H. pylori urease recently. They treated with triple regimen (clarithromycin, amoxicillin for 2 weeks and proton-pump inhibitor (PPI) for 2 month). Eradication was confirmed by urea breath test (UBT). After operation specimens were evaluated histopathologically. Results: Females were 58.3% of the patients. Mean BMI were 44.2 (females) and 46.3 (males). Normal LSG specimens were 58.3%. Most common abnormal histopathology findings were; chronic mild active and inactive gastritis (21.3%), chronic moderate active and inactive gastritis (16.0%), chronic severe active and inactive gastritis (3.3%), had not follicular gastritis, lymphoid aggregates (0.6 %), intestinal metaplasia (0.2%) and PPI effect (0.2%). Significant correlation was observed between the higher patients BMI (BMI>45) with abnormal histopathology findings specially moderate and severe degree of chronic active and inactive gastritis. Conclusion: Patients with higher BMI was at more risk for post H. pylori treatment abnormal pathology like chronic active gastritis which is the risk factor for atrophic gastritis may lead to preventable gastric cancer. Patients with higher BMI (≥45) and H. pylori positive urease test with visually normal endoscopy, mainly candidate for the laparoscopic Roux-en-Y gastric bypass (LRYGB). Permanent endoscopic follow up in these patients are impossible, therefore, endoscopic random tissue mapping even after H. pylori treatment is appropriate.

Any surgical or preoperative treatment and diagnostic procedure may be associated with complications and risks. Therefore, introduction of complicated cases plays an important role in educating those involved in the diagnosis of patients. Generally, if a physician or a nurse is informed that an item is inadvertently left behind in a patient's body during surgery, he/she is obliged to take action by notifying the healthcare system authorities and informing the patient as soon as possible; otherwise, he/she has committed a disciplinary violation. Here we present a 27-year-old female patient with a history of renal failure with prolonged fever following a retained Shaldon catheter in a patient’s chest.