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Objective: The most effective methods and entry sites for laparoscopic surgery remain a subject of ongoing investigation and discussion. The purpose of the study was to analyze and compare three umbilical entry sites for intraperitoneal access using the direct trocar insertion technique. Material and Methods: A randomized pilot study was conducted between March 2021 and January 2023, involving women eligible for laparoscopic gynecological surgery. The women were allocated to one of three equally sized groups based on trocar entry points: subumbilical, supraumbilical, or umbilical. Success and failure rates of trocar entry, factors influencing success or failure, and early and late complications were systematically evaluated and compared across groups. Results: A total of 243 patients, with a mean age of 32.93±8.33 years, were included in three groups of 81 each. Trocar entry success rates were 97.5%, 89.2%, and 89.5% in the supraumbilical, umbilical, and subumbilical groups, respectively (p>0.05). Failed trocar entry was significantly associated with age, gravidity, body mass index (BMI), waist circumference, hip circumference, and abdominal subcutaneous fat thickness (p<0.001). Regression analysis revealed that, in the subumbilical group, higher gravidity [odds ratios (OR): 0.390, 95% confidence interval (CI): 0.174-0.872, p=0.022) and greater abdominal subcutaneous fat thickness (OR: 0.090, 95% CI: 0.019-0.431, p=0.03) were associated with lower odds of successful trocar entry. In contrast, in the umbilical group, a higher waist circumference was associated with lower odds of successful trocar entry (OR: 0.673, 95% CI: 0.494-0.918, p=0.012). None of the covariates were significant in the supraumbilical group. Conclusion: The study highlighted the importance of selecting the appropriate trocar entry site in laparoscopic gynecological surgery. Surgeons should consider factors such as age, gravidity, BMI, waist circumference, hip circumference, and abdominal subcutaneous fat thickness, as these factors significantly influence the success of trocar entry. [ABSTRACT FROM AUTHOR]

Background & Objective: Occurrence of Hepatitis E Virus (HEV) infection may be common in Human Immunodeficiency Virus (HIV-1) patients and may lead to chronic infection as well as cirrhosis. We intended to determine the incidence of HEV infection among HIV-1 patients in comparison to individuals without HIV-1 infection. Methods: In our cross-sectional study, 87 HIV-1-positive patients were compared to 93 healthy individuals in Kerman, Iran. Plasma and peripheral blood mononuclear cells (PBMCs) were obtained from all the participants. Plasma samples were evaluated for HEV IgM and IgG using the ELISA kit. Then, reverse transcriptase-nested polymerase chain reaction (RT-nested PCR) was used in RNA extractions from PBMCs to check for the presence of HEV RNA. Results: Among the subjects examined in our study, 61 (70.1%) and 71 (77.4%) out of patients with HIV-1 infection and healthy individuals were male, respectively. The average ages of patients with HIV-1 and the control group were 40.2 years and 39.9 years, respectively. No discernible differences were found between the two groups based on IgM and IgG seropositivity against the HEV. However, HEV-RNA was found in 8% of patients with HIV-1 and 1.1% of HIV-1-negative individuals (P=0.03). There was also an association between the HEV genome and anti-HEV and anti-HCV antibodies in HIV-1-positive patients (P=0.02 and P=0.014, respectively). Conclusion: HEV infection may be more common in HIV-1 patients and may develop a chronic infection in immunocompromised individuals. Molecular-based HEV diagnostic tests, including RT-PCR assays, should be performed in HIV-1 patients with unknown impaired liver function tests. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal (GI), liver, and pancreaticobiliary diseases, in addition to the high health care utilization, account for a significant proportion of disability and death in Iran. We aimed to assess the incidence of in-hospital mortality for the total GI, liver, and pancreaticobiliary diseases in all hospitals in Kerman, Iran. Methods: In a cross-sectional study from May 2017 to April 2018, we collected the data of in-hospital death records due to GI, liver, and pancreaticobiliary diseases in all hospitals in Kerman city. GI and liver diseases were classified into three main categories: 1. Non-malignant GI diseases, 2. Non-malignant liver and pancreaticobiliary diseases, and 3. GI, liver, and pancreaticobiliary malignancies. All data were analyzed using SPSS software, version 22 (IBM). Results: Of 3427 in-hospital mortality, 269 (7.84%) deaths were due to GI, liver, and pancreaticobiliary diseases, of which 82 (30.48%) were related to non-malignant GI disorders, 92 (34.20%) to the non-malignant liver and pancreaticobiliary diseases, and 95 (35.31%) were associated with GI, liver and pancreaticobiliary malignancies. Most patients were male (62.08%), and the most common age was between 60-80 years (40.5%). GI bleeding occurred in 158 (58.73%) patients, and variceal bleeding was the most common cause (28.48%). Additionally, cirrhosis was reported in 41 out of 92 (44.56%), and hepatitis B virus (HBV) was the most common cause of cirrhosis among 17 out of 41 (41.46%). Conclusion: Our results show that gastric, colorectal, and pancreatic cancers and cirrhosis due to HBV were the most common causes of mortality associated with GI, liver, and pancreaticobiliary diseases in the hospitals of Kerman. [ABSTRACT FROM AUTHOR]

The main indicators of higher education (HE) internationalization in the field of awarding degrees are the international development of disciplines and interdisciplinary sciences, new educational and learning methods, new and updated curricula, and their correct ways of sharing. This study aimed to examine the system of awarding degrees in health HE of Iran and the United Kingdom. This descriptive-comparative study focused on the field of medical sciences and its related disciplines. The vital information about the variables was collected by visiting the official websites of the UK universities and related or joint organizations. The related information to the Kerman University of Medical Sciences as a sample of Iran medical universities was obtained from the university's Farabar system. All data extraction steps were performed manually. There were differences in the mechanism of setting up a new discipline and the process of students' admission, diversity of degrees' titles and curriculums, stability of disciplines over the time, creativity in creating competition between different disciplines, the reason for establishing a discipline and the requirements for certification and awarding of degrees in health sciences disciplines in Iran and the United Kingdom were described. Propelling of medical education in the health sciences area towards standard awarding degree systems can be responsible for the requirements of internationalization of higher education. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a common chronic demyelinating disease of the central nervous system with various potential etiology, including infectious disease. The number of studies on the association between Helicobacter pylori (H. pylori) infection and MS is limited. So, in this study, we aimed to assess the relation between H. pylori infection and MS in Kerman city, the center of the largest province in Iran. Materials and Methods: In a case-control study, 71 patients with newly diagnosed MS and 145 sex- and age-matched controls were included. Blood samples for IgG anti-HP antibodies were collected from all individuals. SPSS software version 22 was used for data analysis. p < 0.05 was considered statistically significant. Results: 71 patients with newly diagnosed MS consisted of 48 (67.6%) women and 23 (32.39%) men were included in our study. The mean age was 43 ± 10 years. The mean ages in the case and control groups were 43.83 ± 10.40 and 44.41±16.30 years, respectively (p = 0.114). The control group more commonly had used smoking (p = 0.814). Alcohol consumption was higher in the control group (p = 0.965). More than 40% of the patients in the case group and 55.17% in the control group had body mass index (BMI) > 25 (p = 0.074). H. pylori seropositivity was observed in 61.97% of the MS group compared with 76.55% of the non-MS group (p = 0.021). Conclusion: We concluded that patients with newly diagnosed MS had low H. pylori seropositivity, so H. pylori infection may have a protective effect against MS. [ABSTRACT FROM AUTHOR]

Background: Scientific productions are among the most important criteria in the development of countries. Gastric cancer is the most common gastrointestinal cancer in Iran. In this study, we aimed to analyze the publications about gastric cancer in Iran from 1983 to 2017 using the Web of Science (WoS) database. Materials and Methods: In this scientometric study, at first, all terms related to «Gastric Cancer» were extracted using the Medical Subject Headings. Then, WoS database was searched using these terms. The time frame was until the end of 2017. Then, the results were refined to the countries. The data analyses were performed using Excel software. Results: Among 38554 records indexed in the WoS, 372 (0.965%) were published in Iran, ranking the country 16th in the world. Compound annual growth rate of Iranian scientific productions was 16.76%. Tehran University of Medical Sciences and Shahid Beheshti University of Medical Sciences were identified as the most productive centers with a contribution rate of 31.45% and 15.05%, respectively. The most international collaborations of Iranian researchers were with the United States (5.37%), Sweden (2.68%), and Germany (2.41%). Most articles were published in the Asian Pacific Journal of Cancer Prevention (9.67%). Most scientific productions were related to oncology (36.29%), gastroenterology and hepatology (21.23%), and general internal medicine (11.02%). Most scientific productions were published in the form of an “Article” (63.71%). All of the Iranian scientific productions about gastric cancer were in the English language. Conclusion: Iranian scientific productions in the field of gastric cancer have been increased from 1983 to 2017, although Iran was ranked 16th in the world. [ABSTRACT FROM AUTHOR]

Regarding the importance of non-alcoholic fatty liver disease (NAFLD) and the high prevalence of vitamin D3 deficiency in different societies. This study aimed to evaluate the distribution of Vit D3 deficiency in individuals with non-alcoholic fatty liver disease. In this cross-sectional study, 122 individuals with nonalcoholic fatty liver disease were selected by a simple sampling method. After collecting demographic data, serum Vit 25(OH) D3 level was measured by the ELFA method. Blood lipids level (TG, cholesterol, HDL, LDL), FBS, AST, ALT, alkaline phosphatase, total and direct bilirubin, albumin, and PT were measured by the enzymatic method. To analyze the data, descriptive and analytical methods and SPSS software version 16 were used. The study cases are comprised of 122 individuals (57.4% male). The average age of cases was 42.4±11.7 years, and the mean of serum Vit D3 level was 19.8±22 ng/dl (3-220 ng/dl). Regarding the serum 25(OH) D3 levels data showed 66.4% of cases were Vit D3 deficient (Vit D3 level< 20 ng/dl), 18% had insufficient level (Vit D3 level=20-30 ng/dl), and the remained 15.6% had sufficient level (Vit D3 level> 30 ng/dl). HDL level was higher in individuals with 25(OH) D3 sufficiency compared to those with 25(OH) D3 insufficiency and Vit D3 deficiency (P=0.019). There was no significant relationship between serum Vit D3 level and other investigated variables. The results of this study indicated that most individuals with non-alcoholic fatty liver disease had Vit D3 deficiency. Further studies are suggested. [ABSTRACT FROM AUTHOR]

Background: Approximately two-thirds of infant mortality within the first year of life are caused by preterm labor (PL). Objective: This study aimed to investigate the effects of progesterone-based compounds to prevent PL. Materials and Methods: This randomized clinical trial study was conducted on 146 pregnant women admitted to Department of Obstetrics and Gynecology, Afzalipour hospital in Kerman University of Medical Sciences, Kerman, Iran in June 2019. The participants with PL received Tocolytic and 12 mg Betamethasone in 2 doses over 2 days to mature the fetus's lungs. Stopping PL was considered a 12-hr period without any contractions after finishing the Tocolytic. Following the successful cessation of PL, the participants were monitored for 48 hr. Subsequently, the participants were divided into 2 groups. Participants received 200 mg Lutogel capsules orally per day in group A while group B received a weekly dose of 250 mg Proluton in the form of intramuscular injection, respectively. Treatment in groups continued until the 36th wk of delivery. The participants were followed-up weekly, and if any signs of PL were detected, an obstetrician carried out a vaginal examination. Results: The incidence of PL was the same in both groups. There was no significant difference in the latent phase, average birth weight, and the neonatal intensive care unit admission frequency (p = 0.07, 0.17, 0.58, respectively) between groups. Conclusion: No difference in the results obtained from the neonatal outcomes evaluated in groups. Both medications similarly led to recovering pregnancy and neonatal outcomes caused by PL. Applying the oral form with similar beneficial effects were pointed out in this study, which can be a solution to the issues caused by numerous injections that are inevitable in the injected administration of this medicine. [ABSTRACT FROM AUTHOR]

Introduction: Early diagnosis and treatment portal hypertension and varices can reduce the mortality of cirrhotic patient. The aim of this study was to assess portal hypertension parameters in cirrhotic patients by endosonography (EUS). Methods: During 6 months, new cases of cirrhosis referred for variceal screening enrolled in this study. Patients who underwent EUS for CBD stone during the same period served as controls. We assessed the portal, splenic, and azygos veins diameter in both group. We determined the relationship between degrees of hepatic dysfunction in cirrhotic group to portal, splenic, and azygos veins diameter. Presence of esophageal and gastric varices in cirrhotic patient were assess and compared to conventional endoscopy. P-value<0.05 was considered statistically significant. Results: During the study period, there were 17 patients (11male) with cirrhosis and 31 control subjects (11 males) enrolled. The mean ages of cases were 45.60±12 years and controls was 49±15 years. Patients with cirrhotic group had higher mean portal, splenic, and azygos vein diameters than control group but was not statistically significant. From 17 cirrhotic patients, 7 patients had esophageal varices during conventional endoscopy and 9 patients in EUS, also only one patient had gastric varices in conventional endoscopy versus 7 patients by EUS, that was statistically significant (P-value=0.031). Conclusion: EUS compared with conventional endoscopy allows for the collection of valuable data from the diagnosis of portal hypertension, esophageal and gastric varices. [ABSTRACT FROM AUTHOR]

Introduction: Although the lungs are the main target of SARS-CoV-2 infection; but SARS-CoV-2 can damage various organs and cause several extra-pulmonary effects, including gastrointestinal manifestations. The main symptoms of gastrointestinal involvement are abdominal pain, nausea, vomiting, diarrhea, and less common gastrointestinal bleeding. This study aimed to evaluate the prevalence of gastrointestinal bleeding in patients with COVID-19. Methods: This cross-sectional study investigated the prevalence of gastrointestinal bleeding in patients with COVID-19 referred to Afzalipour Hospital in Kerman from April 2020 to May 2021. The records of patients with definitive diagnosis of COVID-19 who were hospitalized in the emergency department, ward and ICU and had gastrointestinal bleeding at the time of admission or in the course of hospitalization were reviewed and their endoscopic and colonoscopic findings were recorded. To analyze the data, descriptive statistics (frequency, relative frequency and mean central index), analytical (chi-square test and regression) and SPSS software version 20 were used. Results: A total of 80 patients with gastrointestinal bleeding with COVID-19 were included in the study. Considering the total number of patients with COVID-19 in the study period (3563 patients), the prevalence of gastrointestinal bleeding in patients with this disease was 2. 24%. The mean age of the patients was 58. 01±20. 71 years. The majority of patients were men (63. 8%). Gastric erosion 27. 7%, gastric ulcer 23%, duodenal ulcer 21. 5%, esophageal ulcer 12. 3%, esophageal erosion 6. 1%, were the most common endoscopic findings. On colonoscopy, hemorrhoids were the most common lesion with consisting 25% of colonoscopic findings. The mortality rate of the patients studied in this study was 36. 2% and 63. 8% were discharged. Conclusion: The current study presented findings on the pattern of gastrointestinal bleeding and its overall prevalence in patients with COVID-19 in Afzalipour Hospital in Kerman. These findings can be used to adopt the best approaches for prevention, diagnosis and treatment of gastrointestinal bleeding in patients with COVID-19 and provide a basis for further studies on useful interventions and a more accurate understanding of the pathophysiology of the disease. [ABSTRACT FROM AUTHOR]