فهرست مطالب dr. a. gholizadeh pasha

The use of cuffed catheters for hemodialysis in patients with chronic kidney failure has increased. Thrombosis of cuffed catheter tip is a dangerous complication that can lead to catheter dysfunction and even threaten the patient's life. This study was conducted with the aim of determining the prevalence and causes of cuffed catheter tip thrombosis in order to maintain its function.

This cross-sectional study was conducted in 2020 on patients with chronic kidney failure in Babol who were referred by a nephrologist due to dysfunction of the cuffed catheter. After recording demographic information, all patients were candidates for echocardiography and then venography through the catheter in the angiography unit to determine the cause of cuffed catheter dysfunction. The presence of thrombosis in the catheter tip, the formation of fibrin sheath and the location of the catheter tip were investigated.

91 patients, including 54 men (59.3%) and 37 women (40.7%) were included in the study due to lack of effective dialysis caused by cuffed catheter dysfunction. The average age of the patients was 62.01±14.66 years with a minimum age of 29 and a maximum of 88 years. The most common location of catheter placement was the right internal jugular vein in 79 cases (86.8%). The incidence rate of thrombosis in cuffed catheter tips was 53 cases (59%), with inappropriate location of the catheter tip in 31 cases (58.49%) as the most common cause, while formation of fibrin sheath in the catheter tip in 12 patients (22.64%) and inappropriate catheter length in 10 patients (18.86%) were respectively the other common causes of thrombosis in the tips of cuffed catheters.

The results of the study showed that inappropriate location of the catheter tip was the most common cause of thrombosis in cuffed catheter tips. Therefore, it is recommended to use fluoroscopy during cuffed catheter insertion to ensure the correct placement of the catheter tip inside the right atrium.

The level of patient adherence to treatment and medication orders is one of the important factors influencing the effectiveness of medical treatments. The aim of this study is to investigate the relationship between doctor-patient communication skills and the level of adherence to medication orders after discharge from the hospital.

This cross-sectional study was conducted on 284 patients admitted to the surgery and urology departments of Shahid Beheshti Hospital in Babol, where at least 48 hours had passed since their admission. Patients completed two questionnaires of doctor-patient communication skills (range 21-70) and Burton communication skills (range 18-90) in the hospital. Then, two weeks after discharge, the patients answered the two questionnaires of general adherence and the Morisky Medication Adherence Scale online or by telephone contact, and the results were analyzed.

The mean age of the participating patients was 50.65±18.20 years and the score of general adherence to treatment orders was 24.26±5.77 (range 7-30) and medication adherence was 8.54±2.91 (range 1-11). 222 patients (78.2%) had high adherence to treatment orders. Stepwise regression analysis showed that doctors’ communication skills were a positive factor in medication adherence (p<0.001, ß=0.336) and adherence to treatment orders (p<0.001, ß=0.331). Moreover, patients’ communication skills had a positive effect on medication adherence (p=0.01, ß=0.137) and general adherence to treatment orders (p<0.001, ß=0.205).

The results of the study showed that the communication skills of doctors and patients is a positive predictor of adherence to treatment and medication orders after discharge from the hospital.

The effectiveness of ovarian function suppression therapies in patients with non-menopausal breast cancer has not yet been established. This study was performed to evaluate the role of gonadotropin-releasing hormone agonist (GnRH agonist) receptor in reducing local recurrence or metastasis in non-menopausal women with localized breast cancer.

This clinical trial was performed on 104 non-menopausal women with localized and advanced localized breast cancer (in stages 2 and 3) with positive hormone receptor (HR+) in the two groups of control and intervention with GnRH analog. The control group received standard treatment at the time of the study, which included tamoxifen. The GnRHa group received 3.75 mg triptorelin subcutaneously per month in addition to the standard treatment. Patients were evaluated for local recurrence and metastasis within 36 months.

The mean age of patients was 39.78±3.99 years. 9 patients in the control group (mean metastasis time of 17±6.65 months) and 6 patients in the GnRHa group (mean metastasis time of 14.33±8.12 months) had metastasis (p=0.498). The 36-month disease-free survival was 83.3% in the control group and 88% in the GnRHa group (p=0.518). 36-month disease-free survival in patients with HER2, 1+ or higher levels was greater in the GnRHa group compared to controls (p=0.049). In patients who received GnRH analogues, patients with HER2/neu 1+ and above had 20.7% less metastasis than patients with HER2 0 (p=0.029). However, this significant difference was not seen in the control group and other variables.

According to the results of this study, GnRH analogues do not have a significant effect on reducing the rate of metastasis in patients who received it compared to other patients in a short-term period.

Stomach cancer tends to progress gradually over the years. Considering the relationship between blood type, peptic ulcers and impaired mucus secretion, we aimed to determine the frequency of ABO and Rh blood types in patients with stomach cancer.

This cross-sectional study was performed on 150 patients with stomach cancer, referring to Shahid Beheshti Hospital of Babol for surgical interventions during 2006-2011. Moreover, 150 control patients with no prior history of cancer, referring to the clinics, were included in this study. Data including age and sex were recorded in a checklist. After determining patients’ blood type and Rh, age, sex, blood type and Rh were converted into numerical codes, and the two groups were compared.

The mean age of subjects was 61.25±14.52 years in the study group and 58.37±16.37 years in the control group. The number of male subjects was higher than females in both groups. Among 150 patients with gastric cancer, 36 (24%), 47 (3.31%), 2 (3.1%) and 65 (3.43%) patients had A, B, AB and O blood types, respectively. In the control group, 33 (22%), 36 (24%), 8 (5.3%) and 73 (7.48%) subjects had A, B, AB and O blood types, respectively.

The results showed that the frequency of O blood type was higher in patients with stomach cancer, compared to other blood types.

Inguinal hernia repair is one of the most prevalent procedures in general surgery. Several methods have been introduced for inguinal hernia repair that focus on the reduction of complications of surgery and lowering the recurrence of the hernia. However، controversies remain among surgeons about the preferred treatment method. The aim of this study was to compare the outcomes of repairing inguinal hernia with mesh and non-mesh methods.

All patients aged 18 years old and over that admitted for inguinal hernioraphy in Shahid Behesti hospital in Babol during March to September 2010 included in the study. Demographic data، characteristics of hernia، duration of returning to daily activities and the type of repair of each patient entered in the checklist. All patients followed up for one year in case of any complication and recurrence of hernia. Recurrence of hernia due to ascites or due to any increase in abdominal pressure and missed patients during the follow up period was excluded from the study.

Among all 132 cases 129 patients were male and 3 patients were female and the mean age of the patients was 53. 66±16. 89 years. Forty five (34. 1%) patients underwent hernioraphy with mesh and 87 (65. 9%) patients without mesh. The mean time for patients to return to daily activities was 25. 4±4. 7 days in the mesh group and 28. 53±7. 86 days in the non-mesh group (p=0. 048). Rate of recurrence of hernia during the follow up period was 8 cases (6. 1%) that 6 cases had been repaired with non-mesh method and 2 cases were repaired with mesh method (p>0. 05).

Simple inguinal hernias seem to be repaired better with mesh method than non-mesh method.