فهرست مطالب alireza shavakhi

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the main therapeutic and sometimes diagnostic methods in biliary and pancreatic diseases. A grading system for the difficulty of ERCP (grade one to four, the higher grade represents the more complexity of the procedure) has been developed by the American Society for Gastrointestinal Endoscopy (ASGE). This study aimed to assess the prevalence of ERCP‑related complications, their common risk factors, and specifically the role of difficulty of the procedure based on ASGE grading.

This cross‑sectional study was performed on 620 ERCP‑operated patients over 4 years in two tertiary referral centers affiliated with Isfahan University of Medical Sciences. Data about the difficulty of procedures based on the ASGE grading scale, complications including pancreatitis, bleeding, infection, perforation, arrhythmia, respiratory suppression, aspiration, and major common risk factors were collected.

The overall prevalence of complications was 11.6% including pancreatitis 8.2%, perforation 0.8%, gastrointestinal bleeding 1.3%, cholangitis 2.4%, and cardiopulmonary problems 0.5% (arrhythmia 0.3% and respiratory depression 0.2%). Patients with pancreatic contrast injection (66.7% vs. 11.3% P = 0.04) and sphincter of Oddi dysfunction (SOD) (44.4% vs. 11.1%; P = 0.01) showed a statistically significant higher overall complication rate. The association of these risk factors remained significant in multivariable logistic regression analysis. Patients with pancreatic contrast injection also showed a statistically significant higher prevalence of post‑ERCP pancreatitis (66.7% vs. 11.3% P = 0.04). Furthermore, a significantly higher prevalence of arrhythmia (3.6% vs. 0; P = 0.008) was observed among patients with difficult cannulation. Based on the ASGE difficulty grading score, most of the patients were classified as grade 2 (74.2%) and 3 and 4 (23.4%). No statistically significant difference was noted between the difficulty‑based groups in terms of complications.

The current study showed that the most critical risk factors of ERCP‑induced complications were pancreatic contrast injection and SOD. ASGE grading scale for ERCP complexity did not predict the occurrence of complications in our study population.

Colonoscopy plays a vital role for the diagnosis and treatment of colonic diseases but can be associated with anxiety and discomfort or pain. We tested whether unsedated colonoscopy impacts quality indicators and investigated predictors of pain during colonoscopy.

This randomized controlled trial was performed on candidates for elective colonoscopy at AL Zahra Hospital, Isfahan at 2018–2019. Balanced block randomization was used to allocate 275 cases into two groups. At finally, 124 patients in case and 122 patients in control group enrolled in analysis. Patients in the sedation group received midazolam with/out pethidine before colonoscopy. Pain intensity in rectal examination (PIREX), preprocedural anxiety, pain intensity during colonoscopy, hemodynamics, duration of colonoscopy, polyp detection rate, cecal intubation rate, bloating within 24 h after colonoscopy, and willingness to repeat colonoscopy were assessed and compared between two groups.

Compared to the group with sedation, cecal intubation time was shorter and bloating was less frequent (7% vs. 16%, P = 0.02) in the unsedated group. There was no difference between the two groups regarding polyp detection rate, cecal detection rate, and willingness to repeat colonoscopy. Pain during rectal examination was significantly associated with pain during colonoscopy (P < 0.001, 95% confidence interval; 0.5–1.3).

The assessment of pain intensity during rectal examination may help to identify patients who can benefit from sedation during colonoscopy. Colonoscopy with sedation does not seem to have a negative impact on colonoscopy quality indicators, and may even reduce cecal intubation time and bloating following procedure.

The colorectal cancer (CRC) is one of the most common cancers. There are several invasive and noninvasive methods for detecting CRC. Diagnosis based on the molecular markers in early stages seems to be a good choice. The aim of present study was evaluating the methylation in GRASP gen promoter in colorectal cancer tissue compared with healthy surrounding tissue.

This cross-sectional study was performed on 50 patients suffered from CRC during 2016-2019. The DNA was extracted from 50 Formalin-Fixed Paraffin-Embedded (FFPE) samples of CRC tissues in early stages (I and II), and normal surrounding tissues. In paraffin method, methylation-quantification of endonuclease-resistant DNA was calculated, and their frequency were compared in both groups.

GRASP gene’s promoter was highly methylated in patients with CRC in early stages compared to their normal margins. GRASP gen promoter methylation was 70.47% (P < 0.00001) in CRC tissue compared with 38.08% in normal margin (P < 0.0001).

The results showed that frequency of Grasp gen’s promoter methylation in colorectal cancerous tissue was significantly more than normal surrounding tissue.

Advantage of using local sedation during upper gastrointestinal endoscopy (UGE) is still challenging. In the current study, the effect of lidocaine spray versus lidocaine viscous solution for pharyngeal local anesthesia during UGE has been compared: Tis is a randomized clinical trial conducted on 130 patients conducting UGE in 2013. Patients were randomly divided into two groups of viscous lidocaine solution (Group V) and lidocaine spray (Group S). Patients’ tolerance, satisfaction, pain/discomfort, and anxiety (based on 11-point numerical score scale) and ease of endoscopy were compared. Ease of procedure, patients’ tolerance, and patients’ satisfaction were not statistically different between two groups (P > 0.05). Patients’ pain/discom ort and anxiety during endoscopy were significantly different between groups (P < 0.05). As a conclusion, there was not any difference between two groups except for pain, discomfort, and anxiety that was higher in those who administered spray that might be due to the method of usage

BACKGROUND: Minimal hepatic encephalopathy (MHE) is the mildest type of hepatic encephalopathy in patients with cirrhosis. Patients with MHE have normal clinical and physical examination but they show some neurocognitive dysfunctions that affect their quality of life negatively. The aim of the current study is to diagnose MHE in patients with cirrhosis and its associated factors. METHODS: This is a cross-sectional study on 120 known cases of cirrhosis referred to hospitals affiliated to Isfahan University of Medical Sciences during 2014-17. The patients' cirrhosis severity was evaluated using laboratory tests and physical examinations based on MELD(Model for End-stage Liver Disease) and Child-Pugh criteria. The Patients’ demographics were filled in a checklist. All included patients with cirrhosis were asked to respond to the questions of Psychometric Hepatic Encephalopathy Score (PHES) test. RESULTS: Mean age of the patients was 51.2±9.7 years. 62 (51.7%) patients were men and 58 (48.3%) patients were women. The mean score of the patients based on MELD criteria was 14.03±6.09. 26.7% of the patients presented MHE. Mean age of the patients with MHE was statistically less than the patients without MHE (p value<0.001). Mean score of MELD criteria among the patients with diagnosis of MHE was significantly higher than the other group (p value<0.001). The patients' Child class was statistically associated with MHE (p value<0.001). Men were significantly more affected than women (p value=0.03). CONCLUSION: MHE was associated with MELD score and Child class of the patients with cirrhosis. The noticeable point was reversible association of age with MHE. Further studies are recommended.

Irritable bowel syndrome (IBS) is one of the most common disorders among young adults. Various studies have demonstrated that the use of probiotics can reduce the overall symptom of IBS, and thus, our aim was to evaluate the efficacy of probiotic products in the reduction of IBS syndrome after colonoscopy.

Our patients were divided among three groups, including immediate probiotic users, start use of probiotics 1 month after colonoscopy, and placebo group. All the patients were interviewed for having common IBS symptoms (stool consistency and frequency, gas, abdominal pain, and flatulence) at baseline, 3rd month of follow‑up, and 6th month of follow‑up.

The mean reduction in abdominal pain was 3.05 ± 1.21, 3.86 ± 0.94, and 3.82 ± 0.63 in the control group, immediate probiotic users, and 1 month after colonoscopy, respectively (P < 0.001). The symptoms of the disease, such as stool consistency, the frequency of defecation, and flatulence (except gas) in the first quarter, in the two treatment groups were significantly improved more than in the control group (P < 0.05). In contrast, the frequency of defecation was not significantly different in the treatment group receiving the probiotics month after colonoscopy compared to the placebo users (P > 0.05).

According to our results, the use of probiotics had the beneficial effect on IBS symptoms. Furthermore, it can be said that reductions in symptoms and pain in the two treatment groups were not significantly different, but after 6 months of treatment, the effect of probiotics in patients who immediately use it after colonoscopy was more visible and more stable.

This study evaluated the clinical efficacy and tolerability of a 14‑day course of bismuth‑based quadruple therapy including tinidazole and levofloxacin in compare to a 14‑day bismuth‑based quadruple therapy including clarithromycin as first‑line treatment for Helicobacter pylori infection in Iranian adults.

The study was a prospective, parallel group, randomized controlled, clinical trial that conducted on 150 patients with H. pylori infection. Patients were randomly assigned to the two groups as follows: first group received pantoprazole 40 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, and clarithromycin 500 mg (PBAC group), and other group received pantoprazole 40 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, tinidazole 500 mg for 7 days, followed by levofloxacin 500 mg for the second 7 days (PBATL group). Main outcomes were eradication rate, tolerance of treatment, and dyspepsia severity.

The eradication rates for PBAC regimen was 81.1% (95% confidence interval [CI]: 71.9–90.2) and for PBATL regimen was 70.8% (95% CI: 60.1–81.6), which was not significantly different (P = 0.147). Tolerance of treatment was similar between groups. The median of severity of dyspeptic after treatment in PBAC group was 10 [9–14.75], which was similar to PBATL group 10 [9–13.5] (P = 0.690).

There is no significant difference between PBAC and PBATL regimen, and efficacy was similar in both groups. The overall rate of treatment failure suggests that up to 18%–30% of patients will fail bismuth‑based quadruple therapy and require retreatment for the infection.

Lower gastrointestinal (GI) bleeding is a common clinical problem in young patients. Te management of this disease in patients is challenging. Te aim of this study is to compare sigmoidoscopy with full colonoscopy in these patients.
In this cross?sectional study, 120 eligible patients under 50 years old with acute rectal bleeding were enrolled. After cleaning the colon, initially the patients underwent sigmoidoscopy. Pain, the comfort of the test by physician and patient, duration of the procedure, and pathologic fndings were recorded. Te procedure continued until the splenic ?exure passed in the ileocecal valve, and this stage was considered as proximal colonoscopy. Pain, easy performance by physician and the patient, duration of procedure, and pathologic fndings were recorded in this stage too. Te variables in the two stages were compared with each other.
Tere were 66 women (55%) and 54 men (45%) and the mean of age was 41 ± 7.9 years. Proximal colonoscopy from splenic ?exure to reach cecum was relatively easier for the physician and the patient than sigmoidoscopy (P It is advised to perform full colonoscopy than sigmoidoscopy in young patients with lower GI bleeding.

Philosophical mentality grant an individual the ability to think critically, analyse the situation correctly, make insightful decisions, and find appropriate solutions for the problems. Evidence shows that this mental capability can also positively affect the individuals’ creativity. In the health domain, where the complexity of healthcare procedures poses challenges to efficient management, presence of such a mental capability in healthcare managers is highly demanded. The aim of this study was to evaluate philosophical mentality in nursing managers of different demographic groups, and explore the correlation between their creativity and philosophical mentality. Five hospitals were randomly selected from 11 teaching hospitals in the Isfahan city situated in central Iran. All nursing mangers in hospitals (80) were surveyed in the census. Smith’s philosophical mentality questionnaire was used as the survey instrument. comprising 30 items related to three dimensions of the construct, including comprehensiveness, flexibility, and contemplation. Data were summarized using descriptive statistical methods. Comparison of philosophical mentality between demographic groups was carried out using t-test and ANOVA. Relationship between the philosophical mentality and its dimensions and creativity was explored using Pearson correlation coefficient. The mean philosophical mentality score was determined to be 72.5. The highest (80.10) and the lowest (63.50) score means were obtained for comprehensiveness and flexibility dimensions, respectively. No significant difference in score mean of philosophical mentality was identified between the two genders and between nursing managers of different levels of education. Creativity showed significant correlation with philosophical mentality and all its dimensions. Philosophical mentality can be equally achieved by any nursing manager regardless of their gender and level of education. Our results encourage hospital administrators to develop training programs on philosophical mentality to enhance creativity and thereby overall managerial performance in their nursing managers.

The purpose of the present research was to determine and compare the differences between the rate of responses to paper and online evaluations of the teaching quality of faculty members and their competence in three semesters in Isfahan University. The research was of longitudinal survey and the statistical social consisted of all students and faculty members in Isfahan University. The statistical sample of students included 11673 individuals (8327 participants in paper evaluation and 3346 participants in online evaluation). The statistical sample of the faculty members included 259 individuals. Regarding the nature of the research, the faculty members who were evaluated simultaneously by both methods were only selected. The research tool was the evaluation questionnaire of teaching quality, which was made available for the students both in paper and online form. The results from the research indicated that during the research, the rate of responses to the online evaluation was increasing with a growth nearly equal to that of paper evaluation. The results also indicated that the necessary adequacy in the rate of responses to online evaluation can be reached by providing appropriate backgrounds.

There are two research approaches in human and behavioral sciences: quantitive and qualitative. In other words, in the field of human and behavioral sciences including pedagogy and psychology, the selection of an approach to research depends on the adopted worldview or paradigm by the researcher. This article aims to study and compare the two approaches to research (quantitative and qualitative) in terms of nature, goal, method, hypotheses, gathering data instruments, sampling methods, validity, verification, statistical analysis as well as their strengths and weaknesses.

This survey aims to study the relationship between various aspects of religiousness and student's happiness. To do this, 240 students of Isfahan Girl's High Schools were selected and studied via multistage cluster sampling. Collected data were analyzed using multiple regression. According to findings, there is a significant relationship between various aspects of religiousness and student's happiness. As a closing remark, it can be said that religiousness and its different aspects have a considerable impact on mental health especially girl student's happiness.

The current research uses meta-analysis method as a new research method to integrate research findings of application of research results. Fifteen researches in this field that were administered in ministry of education were collected from all regions of country. Nine researches have requirements for meta-analysis. The most significant research results were establishment & informational system (effect size=ES=0/6921), continuance of seminars of research findings (ES=0/6445), illustrate accurate priorities of research (ES=0/6891), reinforce technical dimension of methodologies (ES=0/5541) and researchworkshops for teachers (ES=0/4874) respectively.