babak sabet

 Diabetic patients frequently experience a serious complication known as impaired wound healing, which increases the likelihood of foot infection and limb amputation. Investigators have been looking for novel methods to treat diabetic foot ulcers (DFUs) recently.

Case Report: 

A 75-year-old woman with type one diabetes mellitus (DM) has been accepted. There was a sizable (40 cm2 full-thickness cutaneous wound) in the plantar part of her right foot (Wagner Ulcer Grade Classification System: grade 3) which had not been treated by the usual treatment for DFUs. In this present case, we used amniotic fluid gel (AF gel) and photobiomodulation therapy (PBMT) (400 mW/cm2 ; 810 nm, once a week for 16 weeks) to treat and speed up the healing of a harsh DFU. The size of the ulcer area significantly decreased as combination therapy progressed, and within 16 weeks, the wound was healed and the pain was reduced.

 This revealed contextual analysis demonstrated the useful effect of the mix of PBMT and AF gel on a serious DFU. To confirm the findings, we recommend conducting additional clinical trials in a clinical setting. In addition, it is recommended that additional research using preclinical models uncover the mechanism of action of the combination therapy.

Persian medicine is an ancient medical school that prioritizes preserving health over treatment. It is a holistic approach that considers genetics, lifestyle, and other factors to find the root cause of a disease. This study investigated the virtual course of Persian and complementary medicine from the perspective of students. We conducted a cross-sectional study. A standard questionnaire was used to collect data from 750 participants. The tool's validity was confirmed based on its content validity, and Cronbach's alpha coefficient was used to estimate the internal consistency of this questionnaire. The questionnaire measured the effectiveness of the virtual education system in various dimensions, and the participants completed it electronically at the end of the course. SPSS 26.0 was used to analyze the collected data. The study used frequency, percentage, and mean to describe data and a desirability score was calculated for each question to evaluate course quality from participants' perspective. The results of the one-sample t-test indicate that the sample mean (57.111) is higher than the population mean (90) (p < 0.01). Based on the independent samples t-test, the mean attitude score of female students towards course is higher than that of male students (p > 0.05). The ANOVA analysis results regarding the mean attitude scores of students towards the course based on their field of study show that the mean attitude scores vary across different fields of study (p < 0.05). The result of present study emphasizes the importance of developing education in Persian medicine in universities to meet the clinical needs of the community and improve health and well-being. This can also promote the status of Persian medicine globally.

The increase in technological developments in recent years and its effects on university systems have compelled countries to rethink higher education structures. Due to these developments, universities of medical sciences are now faced with complex conditions that render the traditional models of higher education ineffective. In this article, the authors present twelve tips based on their experience in creating and developing a smart university (SmU) in the medical sciences. To demonstrate the applicability of these tips, they provide a national example at the end. Shifting from a traditional university to an SmU depends on developing hardware infrastructure, advanced software, and innovative technical applications and platforms. It also requires inter-professional collaboration and the formation of smart learning communities, leadership, and interaction of potential physical, human, financial, intellectual, informational, and technological resources. Additionally, it requires the planning of strategies that guarantee this transformation. Moreover, maintaining such a university requires incorporating social accountability into smart education (SmE) processes and promoting an organizational culture that supports smartization and integrating technology into higher education.

The patent system has long been criticized for limiting access to medicines. Dramatic advances in artificial intelligence and machine learning technology present a revolutionary opportunity in drug discovery, formulation and testing of dosage forms. The pharmaceutical industry claims that patenting is necessary to encourage innovation in the risky, lengthy, and costly research and development (R&D) process. But it still does not provide logical evidence about the actual effects of patents on innovation. The increasing use of artificial intelligence in research is intensifying the debate about pharmaceutical patents. Inventions created or enabled by artificial intelligence raise questions about patentability and patent policy in general. Faster and more efficient research and development weakens the justification for pharmaceutical patents. Research findings suggest that despite the necessity of continuing incentives for drug research and development, lawmakers should consider alternative systems that prioritize access alongside incentives to advance healthcare as a human right.

Personalized business courses are an effective way to learn the basics of a business or industry. This study analyzed the effectiveness of the business course offered at Smart University of Medical Sciences.

This study evaluated the personalized business course using retrospective data to assess learner satisfaction. The course was delivered entirely online but was flexible in delivery. It was designed according to the ASSURE educational model, which emphasizes content presentation and personalization of the learning experience. The course was attended by 132 participants. In this study, the validity of the data collection instrument was confirmed by ten SMUMS faculty members, after which a preliminary study was conducted with 10 pilot samples, yielding a Cronbach coefficient of 96%. For the translation into Persian, the World Health Organization guide was used as a methodological model.

A total of 15 out of 18 participants from the Ministry of Science were satisfied with the course, as were 87 out of 107 participants from the Ministry of Health. Satisfaction with the course was higher among males than females, (84.6% versus 74.3%). The course was rated satisfactory by 81.4% of participants.

Satisfaction with the course may lead to similar courses being offered in the future. This personalized business course was a great success. Participants were satisfied with the content they learned and the progress they made.

To meet the growing demand of students, nowadays universities around the world inclined towards offering intensive virtual or face-to-face courses. There are differing opinions regarding the educational implications of these intensive courses, especially virtual courses. The objective of this study is to design, implement, and evaluate a virtual intensive online program for students of medical universities in Iran during the summer term.

Methods and Materials: 

This study is a developmental design. The study environment was a Smart University of Medical Sciences, and the method of presenting this program was virtual. ADDIE educational design model has been used to design the program. The first and second levels of the Kirkpatrick model (satisfaction and student learning) were investigated. The sample size of the participated students was determined to be 400 people, who were randomly selected and the evaluation data of these two levels were collected from among them. Also, to evaluate the program from the point of view of 8 teachers and head of departments, the open-ended questions were used.

The design, development and implementation of the program was conducted based on a stepby- step approach. The evaluation results showed that the students have a positive reaction and relatively high satisfaction towards the course. Also, based on the results, the post-test average scores have increased in 4 selected of six disciplines and this difference is significant (p<0.01). Finally, based on the open-ended questions, the teachers and head of departments participating in the program listed the strengths and challenges for this program and at the same time offered suggestions for improving the program.

Based on the results, virtual intensive courses can be used as an effective and efficient solution to compensate for academic backwardness, improve student learning, reduce educational costs, and also increase access to education for disadvantaged students.

 In medical education, determining the strengths, weaknesses, desirability, and success of training courses from the perspective of its stakeholders is of particular importance because it can be the basis for subsequent decisions.

 This cross-sectional research investigated the virtual summer semester from the perspectives of its many stakeholders.

 We conducted a multi-methods cross-sectional study. First, remote qualitative interviews were conducted with teachers and heads of departments to explain the features of the virtual summer semester course from their perspective. Twelve teachers and heads of departments participated in qualitative interviews using the intensity sampling method. A matrix was created in Microsoft Word according to the qualitative interview questions (web and telephone), and the answers were categorized based on thematic review. In the second phase, a mini literature review was conducted to develop the desirability and success indicators of online learning courses using questionnaires and checklists. In the third phase, a questionnaire-based survey was conducted among students (82 people). In the last phase, a checklist-based survey was performed among various stakeholders (100 people). Quantitative and qualitative data about the virtual summer semester course have been collected from 194 individuals.

 Based on the thematic review of remote qualitative interviews and created matrix, strengths, weaknesses, and suggestions for improving this course were categorized. Based on descriptive statistics, the mean and SD of the age of teachers and heads of departments participating in the interview was (52.5 ± 8.68), and the mean and SD of the age of students participating in the questionnaire-based survey was (22.10 ± 2.78). In addition, the mean and SD of the age of students, teachers, heads of departments, and course executive team participating in the checklist-based survey were respectively (22.5 ± 3.5), (49.1 ± 7.5), (54.0 ± 2.8) and (34.3 ± 4.9). The findings of the questionnaire-based survey revealed that about 91% of the students have a positive attitude towards the course. In this regard, the average score of the students on all items about the desirability of the course was higher than the hypothetical average (P = 0.048). In addition, the quantitative findings indicated that all the stakeholders had evaluated the course as successful in terms of the organizational capacity of Smart University of Medical Sciences, pedagogy and educational effectiveness, and sufficient and capable human resources. In this regard, the average score of the course success factors differs from stakeholder to stakeholder for the organizational capacity (P = 0.004) and for the two components of pedagogy and educational effectiveness (P = 0.035) and sufficient and competent human resources (P = 0.043).

 According to the results and the conditions of the COVID-19 pandemic and its effect on medical education, these short-term and intensive structured virtual courses can be expanded and developed into regular semesters. The course's sustainability can be maintained by continual improvement.

The patent system has long been criticized for limiting access to medicines. Dramatic advances in artificial intelligence and machine learning technology present a revolutionary opportunity in drug discovery, formulation and testing of dosage forms. The pharmaceutical industry claims that patenting is necessary to encourage innovation in the risky, lengthy, and costly research and development (R&D) process. But it still does not provide logical evidence about the actual effects of patents on innovation. The increasing use of artificial intelligence in research is intensifying the debate about pharmaceutical patents. Inventions created or enabled by artificial intelligence raise questions about patentability and patent policy in general. Faster and more efficient research and development weakens the justification for pharmaceutical patents. Research findings suggest that despite the necessity of continuing incentives for drug research and development, lawmakers should consider alternative systems that prioritize access alongside incentives to advance healthcare as a human right.

The training and education of competent and qualified surgeons have been one of the challenges of the surgical profession. The concept of surgical competence has been affected widely due to a series of developments in the new disease emergence, various surgical techniques and the introduction of advanced tools and equipment into the operating. The development of surgical competence and achieving this goal requires accurate identification and analysis of the dimensions of competence. This study was done to explain the concept of surgical competence using the 8-step Walker and Avant approach.

This study is a qualitative study that was conducted from May- October 2016 at Shahid Beheshti University of Medical Sciences. The present study is a qualitative and conceptual analysis study, which is done with Walker&Avant's eight-step approach to determine the defining characteristics of the concept of surgical competence. A systematic search was conducted between 1990 and 2020 by keywords search such as surgery, surgical, operation OR laparoscopy AND competence competency development competency proficient, proficiency, expertise, clinical, in the database like Google Scholar, PubMed, SID, Magiran, Scopus, Web of Science. Twenty articles were included in the study based on inclusion and exclusion criteria. Moreover, the defining features of the concept were extracted from it.

Based on the results of this study, the concept of surgical competence was defined and the four dimensions of elements, goals, components and the process of developing surgical competence were identified. Then, by clarifying the characteristics of surgical competence, a model of surgical competence development was drawn. Surgical competence development depends on the acquisition of specialized knowledge and numerous skills that are acquired through experience and deliberated practice under the supervision of others in the surgical community of practice and over time.

Surgical competence is a set of observable and measurable skills that allows a surgeon to manage the surgical process independently pbt while maintaining the patient's safety. It includes specialized knowledge, communication skills, cognitive and technical skills, and basic surgical skills.

Weakened wound healing is a popular, severe complication of patients with diabetes which poses a risk for foot infection and amputation. Researchers have searched for new treatments for treating diabetic foot ulcers (DFUs) in recent years. In this case report, for the first time, we applied photobiomodulation therapy (PBMT) and Altrazeal powder together to treat a severe case of DFU in a 47-year-old woman who was suffering from type 1 diabetes. Along with the progress of combination therapy, we observed that the ulcer area was significantly reduced, and the wound healed within 16 weeks. Furthermore, dermatitis and purulent secretion were treated, and the pain was reduced. This reported case study indicated the beneficial effect of the combination of PBMT and Altrazeal powder for the healing of a severe DFU in a patient with type one diabetes. The combined application of PBMT plus Altrazeal powder demonstrated an additive effect. Further clinical trials in the clinical setting are suggested to validate the results further. Besides, more studies in preclinical models are suggested to find the mechanism of the action of combination therapy.

Cancers of the gastrointestinal (GI) track are a serious global health problem. The human GI tract is home to trillions of
microorganisms that known as gut microbiota and have established a symbiotic relationship with the host. The human intestinal
microbiota plays an important role in the development of the gut immune system, metabolism, nutrition absorption, production of
short-chain fatty acids and essential vitamins, resistance to pathogenic microorganisms, and modulates a normal immunological
response. Microbiota imbalance has been involved in many disorders including inflammatory bowel disease, obesity, asthma,
psychiatric illnesses, and cancers. Oral administration of probiotics seems to play a protective role against cancer development as a
kind of functional foods. Moreover, clinical application of probiotics has shown that some probiotic strains can reduce the incidence
of post-operative inflammation in cancer patients. In the present narrative review, we carried out update knowledge on probiotic
effects and underlying mechanism to GI cancers. Currently, it is accept that most commercial probiotic products are generally safe
and can used as a supplement for cancer prevention and treatment. Nevertheless, well-designed, randomized, double blind, placebocontrolled
human studies are required to gain the acceptance of the potential probiotics as an alternative therapy for cancer control..
Keywords: Probiotic, Prebiotics, Gastrointestinal cancer, Gut microbiota.
(Please cite as: Javanmard A, Ashtari S, Sabet B, Davoodi SH, Rostami-Nejad M, Akbari ME, et al. Probiotics and
their role in gastrointestinal cancers prevention and treatment; an overview. Gastroenterol Hepatol Bed Bench
2018;11(4):284-295).

Intra-abdominal adhesions and their complications occur frequently after laparotomy. The aim of this study was to compare oral versus intraperitoneal administration of simvastatin in decreasing post-laparotomy adhesions in rat.

Thirty male Wistar albino rats were divided into three groups of ten. All the rats underwent laparotomy and induction of adhesions using the method of Meso-Stitch approximation of injured cecum and abdominal wall. One group received oral simvastatin (40 mg/kg) daily during two weeks before the laparotomy. In the two other groups, 2 ml of solution of simvastatin (40 mg/kg) or distilled water (as placebo) was spilled into abdomen before closing abdominal wall, respectively. After 14 days, all the rats were put under laparotomy again to be compared. Rates and grades of adhesions were assessed using Hoffman et al. and Lauder et al. Scale and histopathological reports.

In placebo group, the grade II and III adhesion was seen in 2 and 8 rats, respectively. In local simvastatin group, there was no adhesion in 5 rats, and grade I and II adhesion was seen in 3 and 2 rats, respectively. In oral simvastatin group, 6 rats were without adhesion, and 3 cases with grade I and 1 case with grade II adhesion. The frequency and grade of adhesion were statistically different in simvastatin groups compared to the placebo group (P < 0.001), but not with each other.

Oral simvastatin for two weeks before the laparotomy can reduce post-laparotomy adhesion bands as well as local administration of simvastatin solution.

Hydatid cyst communicated with biliary tract increases the morbidity and mortality rates. Therefore, early detection and treatment are vital.

From 96 patients undergone hydatid cyst surgery, 12 were excluded. The specifications, size, location, and position of the cyst, the condition of the cyst wall thickness, the caught lobe, cyst rupture, liver abscess, and the size of the inside and outside liver bile ducts were identified through computed tomography scanning. Age, gender, icterus, white blood cell (WBC) count, the total, direct, and indirect bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase were identified.

In 21 patients (13 men and 8 women), there was communication between the hydatid cyst and biliary tract; from them, 14 patients had icterus. There were significant differences between the size of the cyst, the levels of liver enzymes, bilirubin, and alkaline phosphatase, and WBC count in communicated and non-communicated hydatid cysts (P = 0.001). There were no significant differences between the two groups in terms of age, gender, location of the cysts in the liver, and the thickness of the liver.

Only the cyst size and the level of bilirubin were the predicting factor for the communication between hydatid cyst and biliary tract.

Nephron sparing surgery (NSS) for unilateral Wilms tumor (WT) has been debated recently and is being used to preserve kidney tissue and function. However, NSS is feasible only for selected cases with higher local relapse rates. There is a significant reduction of nephrons with the development of renal hypertension and progressive renal failure. In this paper, we have analyzed outcomes after bilateral partial nephrectomy (PN) and unilateral partial plus contralateral total nephrectomy in our patients with bilateral WT.
We have analyzed our four patients (8 kidneys) with bilateral WT and 8 unilateral complete resection. Kidney size was measured using volumetric analysis computed tomography scan imaging. The patients were matched with children who had undergone imaging of the abdomen for other malignancies.
Mean kidney volumes after unilateral partial plus total contralateral nephrectomy (60.9 cm3) were significantly greater than the reference kidneys. Total kidney volume was significantly larger after bilateral PN (98.1 cm3) versus unilateral partial plus total contralateral nephrectomy (60.9 cm3).
Our findings suggest that patients with bilateral WT benefit from bilateral NSS. Hypertension is less common after bilateral PN. However, rates of local relapse or disease associated death are separately between the groups.

This study was performed to compare the efficacy and long-term outcomes of three surgical treatments for uncomplicated pilonidal sinus disease, tension-free primary closure, Limberg flap, and secondary intention (wide excision and packing).
In this randomized clinical trial study, 66 patients with uncomplicated pilonidal sinus disease were randomly assigned to be surgically treated using tension-free primary closure, Limberg flap, or secondary intention methods. The outcomes including pain, healing time, recurrence, complications, disability, reoperation, and patient satisfaction were compared between three groups after two years of follow-up.
Findings: In Limberg flap group, the healing time and disability were significantly less than the two other groups; besides, the pain was significantly less than secondary intention group and more than the primary closure group (P 0.05 for all).
Totally, according to our findings and comparison with other studies, it may be concluded that Limberg flap is relatively better than primary and secondary intention in patients with uncomplicated pilonidal sinus disease.

Nowadays, esophageal cancer is among the most malignant cancers with high mortality and morbidity. Although reasonable progress in radiotherapy and chemotherapy has been made, still esophagectomy is the main treatment for the disease. Using esophagectomy induces a durable palliation and provides possible cure.
This study aimed to assess the three-month and three-year survival rates and complications of transthoracic surgery in patients with esophageal cancer.
In a longitudinal case series study was performed in three years, 34 patients with esophagus cancer, operated using trans-thoracic approach were assessed for short- and long-term survival rates and complications.
Immediately after the surgery, anastomotic leakage was seen in 17.6% and vocal cord paresis in 26.6% of cases; in next days, the vocal cord paresis decreased to 11.8%. Hospital mortality rate was 20.6% and the rate of malignancy recurrence in long-term follow-up was 8.8%. Long-term morality rate was 39.0%. There was microscopic residue in 20.5% and macroscopic residue in 6.0% of the patients. Three-month and three-year survival rates were 76% and 61%, respectively.
The achieved three-month and three-year survival rate were reasonable in comparison to other studies. Although the rate of vocal cord paresis after the surgery was about two times more than previous studies, most of the cases were temporary paresis and resolved in coming days.

Giant left atrium (GLA) associated with mitral valve surgery reported to have a mortality ranging from 8% to 32%. Most of the patients are symptomatic with that of shortness of breath, dysphagia, palpitations, chest pain, and thromboembolic events. Asymptomatic giant enlargement of the left atrium is rare. Either we must do or not do a reduction arterioplasty at the time of the mitral valve surgery is a controversy in the literature.
Case Report: The patient had mitral valve replacement with a with a 31 mm carbomedics mechanical valve prosthesis 7 years past during her last visit. No reduction arterioplasty was done with a valve operation. Her 7-years close follow-up was uneventful. In the last visit, echocardiography and spiral chest computerized tomography scanning were requested. In both of the requested images giant left trial enlargement was seen, but the patient was without symptoms regarding her giant left atrium.
In this case report, it seems that if we want left atrial size decline, it is necessary to have reduction arterioplasty during mitral valve surgery. However, it does not mean a definite therapeutic efficacy, especially when considering future symptoms.

This study aimed to assess the prevalence of Helicobacter pylori infection in gastric and gallbladder in patients with acute cholecystitis or symptomatic cholelitiasis undergoing cholecystectomy.
43 patients with biliary disease (cholecystitis or cholelitiasis) with inclusion criteria were selected in Shahid Modarres Hospital, Tehran, Iran. The data including age, sex, and the presence of Helicobacter pylori in biopsy samples of gallbladder and gastric mucosa for each patient were recorded and analyzed using SPSS software.
The biopsy specimens of gastric and gallbladder mucosa of 43 patients with the mean age of 54.8 ± 9.9 years were studied. 22 (51.2%) patients had acute cholecystitis and 21 (48.8%) had cholelithiasis. Among the gastric samples, 14 patients (32.6%) (9 men and 5 women) and in the gallbladder samples, 19 patients (44.2%) (8 women and 11 men) were positive for Helicobacter pylori. The simultaneous presence of Helicobacter pylori in the gastric and gallbladder mucosa was seen in 6 patients (13.9%). 10 patients (23.2%) were smokers, and 33 (76.7%) were non-smokers.
It can be said that the presence of Helicobacter pylori in gallbladder can play an important role in the creation and spread of the infection. But the simultaneous presence of Helicobacter pylori infection in gastric and gallbladder cannot be a good standard to evaluate the diseases of the bile ducts.

Tardiness or delay in diagnosis of appendicitis, as the most common cause of acute abdomen around the world, is the most important factor in increasing mortality rate in patients. Therefore, early diagnosis is still a challenge for surgeons to be based on signs and symptoms and laboratory tests to make them sure to decide about the surgery.
In a cross-sectional antegrade study, 200 patient who had come with acute abdominal pain to Modarres hospital emergency room, Tehran, Iran, in 12 months were enrolled; the data of 181 patient were complete that was relevant to our study. Alvarado and modified Alvarado scales were used for data collection by the chief resident of surgery. Pathology report was the standard criterion in this survey.
Findings: The accuracy of modified Alvarado score in diagnosis of appendicitis was 81.4% in comparison with 74.0% of Alvarado score. Our modified score with the sensitivity of 88.0% (vs. 67.7%) and the same specificity of 64.4% in detecting normal cases and positive predicting value (PPV) of 66.0% (vs. 41.9%) in diagnosis of acute appendicitis and positive predicting value of 87.3% (vs. 84.1%) in cases of score of more than of 6 was a better score compare to Alvarado score.
Adding abdominal pain, male gender, and qualitative C-reactive protein (CRP) to Alvarado score was resulted in obtaining a higher accuracy in the diagnosis of acute appendicitis.

To determine the preventive effects of local administration of simvastatin for postoperative intra-abdominal adhesion formation in animal model of rat.
In this experimental study, 32 Wistar albino rats as the animal model of intra-abdominal adhesion formation were included. Adhesions were induced in all the animals via abrasion of the peritoneal and intestinal surface during laparotomy. Afterwards, the rats were randomly assigned to receive simvastatin (30 mg/kg body weight) as a single intraperitoneal dose at the time of laparotomy (n=16) or normal saline in same volume at the same time (n=16). At the day 21, animals were euthanized and the adhesions were quantified clinically (via repeated laparotomy) and pathologically and compared between the two groups.
The baseline characteristics of the animals were comparable between two study groups. Clinically, in simvastatin group, 10 rats (62.5%) did not develop any adhesion and 6 (37.5%) had first-grade adhesion; whereas in the control group, 11 (68.8%) rats had first- and 5 (31.2%) had second-grade adhesions (p Our findings suggest that intraperitoneal administration of simvastatin is an effective method for prevention of postoperative intra-abdominal adhesion formation in animal model of rat.

Introducation: Cancers are the third most common cause of death in Iran. Colorectal cancer is an ideal tumor for screening. Therefore, early diagnosis through screening can reduce its prevalence and mortality. On the other hand, knowledge of practitioners about screening programs has a direct relationship with their performance.
In a cross-sectional-educational study, knowledge, attitude and practice of practitioners about colorectal cancer screening were evaluated in the target population included 300 interns and graduated practitioners during 93-94 and were reviewed by using Chi2 and ANOVA statistical tests.
From 300 physicians surveyed, 17.3 percent knew the age of the screening for colorectal cancer, 73% knew the average-risk and 68% knew the high-risk criteria correctly. 48.3% of respondents recommended FOBT method for population at medium risk and 75% of respondents recommended colonoscopy as a screening method in high-risk populations. Ninety percent of physicians knew the signs and symptoms of colorectal cancer. About half of the practitioners ask their patients about risk factors and advised them to undergo screening. 55.3% of practitioners that had family members who need screening decided to undergo screening and 6.3 percent of them who needs screening decided to perform screening.
According to the growing nature of colorectal cancer in the country, and that is the only cancer can be prevented and the results of this study which show practitioners have little knowledge of appropriate age of screening and screening methods and insufficient attitudes and actions, It is recommended to train general practitioners and family physicians who are the first line of encounter with the patients, are highly recommended.

Prophylactic oral calcium supplement has been proposed in patients undergoing thyroidectomy in order to decrease incidence of postoperative hypocalcemia, and the duration of hospital stay. This study aimed to assess the effects of prophylactic oral calcium in patients undergoing total or subtotal thyroidectomy. Forty three patients who were scheduled for total and subtotal thyroidectomy, were randomly allocated to the case (n=23) and control (n=20) groups. Oral calcium carbonate (1 gram q 8 hours) was given to the patients in the case group starting 12 hours before surgery till 7 days post thyroidectomy. Clinical symptoms of hypocalcemia and postoperative calcium levels were compared between the two groups. The mean postoperative calcium level 12 hours after surgery was not statistically different between the two groups (8.9±0.5 vs. 8.5±0.7, p=0.092); while after 24 hours, calcium level was significantly lower in the control group (8.9±0.5 vs. 8.4±0.8, p=0.037). The number of patients who had paresthesia was significantly higher in the control group than case group, at both 12 hours (p=0.02) and 24 hours postoperatively (p=0.04). Duration of hospitalization was significantly lower in the case group compared to the control group (p=0.006). Prophylactic oral calcium supplementation decreases the hypocalcemia related paresthesia after thyroidectomy and shortens duration of hospital stay.

First step in chronic dialysis is establishing a suitable dialysis access. Arteriovenous fistula (AVF) has been known as the gold standard for hemodialysis; and due to complex interaction of factors that affect the survival time of fistula, we decided to evaluate survival time and affective factors among the dialysis patients. In a historical cohort study, we analyzed 52 patients of the Semnan and Mahdishahr Dialysis Centers. The data recorded by history taking and physical examination. The survival of fistula was 83%, 80%, 67%, and 40% after 1, 3, 5, and 10 years respectively. Our results showed that the survival time of fistula was higher among patients with left-side AVFs. Factors such as age, gender, underlying disease, dialysis session per week, the time that patients started dialysis after installing fistula and fistula infection did not statistical significant affect the survival time. The survival time of AVF among dialysis patients of Semnan and Mahdishahr is satisfying, and installing the fistula in left hand lead to higher survival.

To evaluate the role of physical examination in decision making for exploring patients with penetrating zone II neck injury. This was a cross-sectional study being performed in a level I trauma center between 2006 and 2010. The present study reviewed the records of 150 patients with penetrating neck injuries. Of 46 cases with zone II deep platysma neck injuries, 3 patients died before taking any significant medical measure. Thirty of 43 patients (70%) presented with hard sings while 13 (30%) did not show these sings. All patients underwent neck exploration. Two patients (4.6%) without hard sings exhibited positive findings, whereas 29 cases (67%) with hard sings reported positive on exploration. Briefly, we hold the view that it seems reasonable to follow an algorithmic approach by using physical examination of the patients with zone II penetrating neck injuries. This prevents unnecessary exploration for management of such patients.