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Purpose Fistulotomy is considered the most effective treatment for anal fistula; however, it carries a risk of incontinence. Sphincteroplasty in the setting of fistulotomy is not standard practice due to concerns regarding healing and potential infectious complications. We aimed to compare the outcomes of patients who underwent fistulotomy with primary sphincteroplasty to those who did not undergo repair. Methods This was a retrospective review of consecutive patients who underwent fistulotomy for cryptoglandular anal fistula. All operations were performed by one colorectal surgeon. Sphincteroplasty was performed for patients perceived to be at higher risk for continence disturbance. The main outcome measures were the healing rate and postoperative septic complications. Results In total, 152 patients were analyzed. Group A (fistulotomy with sphincteroplasty) consisted of 45 patients and group B (fistulotomy alone) included 107 patients. Both groups were similar in age (P=0.16) and sex (P=0.20). Group A had higher proportions of multiple fistulas (26.7% vs. 6.5%, P

Purpose: The severity of acute pancreatitis can range from a mild clinical condition to a life-threatening scenario. Rapid severity assessment remains a challenge, and an obvious clinical need exists for a simple test that can identify patients at risk of developing a severe attack. The aim of the present study was to evaluate the role of computed tomography severity index in acute pancreatitis, and correlating it with morbidity and mortality. Material and Methods: This is a prospective study done on 50 patients of acute pancreatitis. Computed tomography severity index was used along with contrast enhanced computed tomography. Results: Maximum complications were noted in patients (91.67%) classified as severe while patients classified as mild had the least morbidity. This was also reflected in mortality and mean duration of hospital stay. Conclusion: Our study demonstrates that Contrast enhanced computed tomography can clearly prognosticate patients of acute pancreatitis and can predict morbidity, mortality rate and duration of hospital stay in patients of acute pancreatitis and can predict which patients may require surgical intervention, to prevent the progression of disease [Cukurova Med J 2016; 41(1.000): 17-20]

Purpose: The severity of acute pancreatitis can range from a mild clinical condition to a life-threatening scenario. Rapid severity assessment remains a challenge, and an obvious clinical need exists for a simple test that can identify patients at risk of developing a severe attack. The aim of the present study was to evaluate the role of computed tomography severity index in acute pancreatitis, and correlating it with morbidity and mortality. Material and Methods: This is a prospective study done on 50 patients of acute pancreatitis. Computed tomography severity index was used along with contrast enhanced computed tomography.Results: Maximum complications were noted in patients (91.67%) classified as severe while patients classified as mild had the least morbidity. This was also reflected in mortality and mean duration of hospital stay. Conclusion: Our study demonstrates that Contrast enhanced computed tomography can clearly prognosticate patients of acute pancreatitis and can predict morbidity, mortality rate and duration of hospital stay in patients of acute pancreatitis and can predict which patients may require surgical intervention, to prevent the progression of disease

Particulate air pollution is a health concern. This study determines the microscopic make-up of different varieties of sand particles collected at a sand dune site in Badr, Saudi Arabia in 2012. Three categories of sand were studied: black sand, white sand, and volcanic sand. The study used multiple high resolution electron microscopies to study the morphologies, emission source types, size, and elemental composition of the particles, and to evaluate the presence of surface “coatings or contaminants” deposited or transported by the black sand particles. White sand was comprised of natural coarse particles linked to wind-blown releases from crustal surfaces, weathering of igneous/metamorphic rock sources, and volcanic activities. Black sand particles exhibited different morphologies and microstructures (surface roughness) compared with the white sand and volcanic sand. Morphological Scanning Electron Microscopy (SEM) and Laser Scanning Microscopy (LSM) analyses revealed that the black sand contained fine and ultrafine particles (50 to 500 nm ranges) and was strongly magnetic, indicating the mineral magnetite or elemental iron. Aqueous extracts of black sands were acidic (pH = 5.0). Fe, C, O, Ti, Si, V, and S dominated the composition of black sand. Results suggest that carbon and other contaminant fine particles were produced by fossil-fuel combustion and industrial emissions in heavily industrialized areas of Haifa and Yanbu, and transported as cloud condensation nuclei to Douf Mountain. The suite of techniques used in this study has yielded an in-depth characterization of sand particles. Such information will be needed in future environmental, toxicological, epidemiological, and source apportionment studies.

Introduction: Considering that the lack of correct understanding of tacrolimus serum levels leads to irreversible complications such as kidney failure, convulsions, etc. in heart transplant patients, it is very important to understand the factors affecting the metabolism and serum levels of this drug. In addition, saliva can be used as a more accessible source to measure tacrolimus levels.Materials and Methods: In our study, 7 patients including 4 men and 3 women were included in the study, 3 patients due to DCM, 1 patient due to myocarditis, 1 patient due to ICM, 1 patient due to ARVC and 1 patient due to RHD underwent heart transplant surgery.: In this study, we aim to compare the levels of tacrolimus in the saliva and serum of patients after heart transplantation. We hypothesize that there may be a correlation between the levels of tacrolimus in saliva and serum, as both are potential sources for drug monitoring in heart transplant patients.Results: Our study highlights the importance of accurately monitoring tacrolimus levels in heart transplant patients. While saliva-based monitoring of tacrolimus levels may be a convenient alternative to blood draw, our findings suggest that it may not provide accurateConclusion: These findings indicate that caution should be exercised when using salivary tacrolimus levels as a sole indicator of drug concentration and further research is necessary to better understand and interpret salivary tacrolimus levels in clinical practice and to optimize post-transplant care for heart transplant patients.

Although classic and standard procedure for patients with ascending Aorta aneurysm with Sever aortic Regurgitation is Bentall surgery but in some selected cases this complex surgery was not performed with different reason like advanced age and coexisting comorbidity involving renal and hepatic and lung Function. In our cases 75 years old man with chronic renal failure ( Cr= 3.2 ) who was known case of sever aortic Regurgitation and Ascending Aortic Aneurysm with 5.5 diameter.replacement of Aortic Valve with Biologic Prosthesis Aortic Valve and Reduction Aortoplasty with Mesh prosthesis was done successfully with good result with early follow up.

Introduction: Coronary artery bypass grafting is a surgical operation that bypasses atherosclerotic coronary vessels and restores blood flow to the ischemic zone of hearts. And two different conventional methods are ON-pump CABG, and Off-pump CABG. Altogether, the efficacy and safety of these two types of surgical procedures are still under debate. In this study, we aim to compare the efficacy, safety, and cost-effectiveness of these two different methods in admitted patients to Imam Reza Hospital in Mashhad in Iran during 2006 to 2016. Materials and Method: In this prospective cohort study, 533 patients who underwent CABG in Imam Reza hospital in Mashhad during 2006 to 2016 were identified. The data was collected using hospital records including demographic data, chief complaint, history of previous disease, ejection fraction, number of graft, blood transfusion, time of anesthesia, time of surgery, days of hospitalization, days of ICU stay, needs for reoperation, post-operative complication, expenses of hospitalization. Results: Of 533 patients were 347 patients of whom male. The mean age was 59.53±10.21 and the mean BMI was 26.38±5.4. The most common chief complaint of the patients was chest pain. 38 patients of 533 cases underwent on-pump surgery and 495 underwent off-pump technique. There were no significant differences for age, and gender. The prevalence of HTN, diabetes, MI, and hyperlipidemia had no differences among two groups. Renal failure was more common in on-pump group; whereas, pulmonary disease was more common in off-pump group. On-pump surgery required significantly longer hospitalization and ICU care. Also needs for reoperation was more common among on-pump surgery. Total expenses were significantly higher in on-pump group.10.5% of those who underwent on-pump surgery died after surgery. This rate was only 3.1% among off-pump group. Conclusion: In this study we showed that, the patients who underwent on-pump surgery, required longer hospitalization, and ICU care. Total expenses were significantly higher in on-pump group. In addition, the mortality rate of on-pump group was significantly higher than the off-pump group. Also needs for reoperation was more common among on-pump surgery. Altogether, it seems that off-pump surgery is safer with low expenses than on-pump CABG.

Introduction: Mitral stenosis is a prevalent valvular disease in developing countries. Percutaneous mitral balloon valvuloplasty (PMBV) is the gold standard treatment. The main objective of this study was to assess the initial results of PMBV in patients with mitral stenosis during 16 years (2002-2018) in Mashhad, Iran. Materials and Methods: From April 2002 to March 2018, 770 patients underwent PMV in department of cardiology. PMV was performed by the antegrade transseptal method using the Inoue balloon. Results: The obtained success rate was 97%. In this study, the valve area increased from 0.9±1.1 to 1.8±0.2 cm2 (P

Introduction: Patients with primary acute aortic dissection are at higher risk of complications, including increasing aortic aneurysm diameter, aortic rupture, aortic pseudo aneurysm, and recurrent aortic dissection. Case presentation We presented the case of a recurrent pseudo aneurysm and rupture of the aorta in the distal ascending aorta and proximal arch 3 years after the initial procedure for acute aortic dissection. The patient had bleeding from previous skin incision. In computed tomography angiography, the site of rupture of the aorta and abnormal communication with sternum were confirmed. Conclusion Recurrent aortic dissection is a catastrophic event and has high mortality; however, it is rare and is treated in a short time by redo surgery.

Introduction: Although coronary endarterectomy is not an ideal procedure, it is the only available option for cardiac surgeons in some patients with diffuse coronary artery disease. Based on the majority of conducted studies, the results of coronary endarterectomy (including survival, graft patency, and recurrence of the symptoms of myocardial ischemia) are less prevalent than standard coronary artery bypass grafting. Generally, the left anterior descending artery (LAD) is the most commonly involved artery in coronary endarterectomy. The aim of this study was evaluate clinical and early results of Endarterectomy of LAD artery. Materials & Methods: In total, 30 cases of coronary endarterectomy of the LAD were studied from January 2015 until January 2016.this is a retrospective study that Endarterectomy procedure was performed in Imamreza hospital of Mashhad university of medical sciences. Results: The mean age of the subjects was 63±4.5 years (range: 45-78 years). As the findings revealed, eighteen patients were male (60%), and the mean ejection fraction index was 43±5.1 (range: 15-60). Also, prior history of myocardial infarction was documented in 8 (26%) patients. The mortality rate among patients was estimated at 6.6% (n=2). In total, 12 (40%) and 7 (23%) patients required high-dose inotropic support and intra-aortic balloon pump, respectively. Risk of preoperative myocardial infarction was observed in 5 (16.5%) cases, and 3 (10%) patients required re-exploration due to significant hemorrhage. Conclusion: If coronary endarterectomy of the LAD is performed by experienced cardiac surgeons, favorable outcomes can be obtained.

Introduction: One of the higher education’s goals is to train fine graduates with a healthy and adaptable personality. Moreover, academic adjustment is one of the fundamental and broad issues in psychology. Therefore, in order to identify associated factors, the purpose of this study was to determine the relationship between metacognitive strategies, academic adjustment and academic performance in students of Qom University of Medical Sciences in 2015. Methods: This descriptive-correlational study was performed on a sample 303 students in Qom University of Medical Sciences who were selected, in terms of gender, through proportional stratified random sampling from schools of medicine, dentistry, nursing and midwifery, paramedics, health and traditional medicine. Data were collected through O’neill and Abedi’s metacognitive questionnaire and Baker and Siryk’s academic adjustment questionnaire. The data were analyzed using Pearson’s correlation coefficient, independent t-test, and simultaneous multiple regression. Results: Metacognitive strategies had a positive significant correlation with academic adjustment (P=0.000, r=0.379) and academic performance (P=0.004, r=0.173). There was also a positive significant relation between academic adjustment and academic performances (P=0.000, r=0.306). Results of multiple regression revealed that metacognitive strategies and academic performance would positively and significantly predict academic adjustment and explain around 20% of the academic adjustment variance. Conclusion: According to the results, there was a correlation between metacognitive strategies, academic adjustment and academic performance. Therefore, teachers should try to teach these skills to students in order to turn them into active and adaptable learners.