mohammad faryadras

Controversy exists over the preferred surgical method for inguinal hernia repair between the open and laparoscopic methods. This clinical trial was performed to compare the rate of early complications and recurrence rates of inguinal hernia between laparoscopic (TAPP) and open methods (Lichtenstein).

In this clinical trial, 84 patients who were candidates for elective inguinal hernia repair at Imam Hossain Hospital were randomly divided into two groups: TAPP and Lichtenstein groups. Spinal anesthesia was used for both groups. Patients were followed for short-term complications (e.g. infection, seroma, hematoma, postoperative pain), hospitalization stays, and recurrence within the first year. Data were analyzed using SPSS software (version 16).

There were no significant differences between the two groups in terms of age and gender. Unfortunately, in the TAPP group, 23 patients (54.8%) received general anesthesia due to lack of co-operation, excessive abdominal wall stiffness, and failure of spinal anesthesia. We found shorter hospitalization stay (P <0.001), less postoperative pain in the first 24 hours (P <0.001), and longer operative time (P <0.001) in the TAPP group compared with those in the Lichtenstein group. There were no significant differences between the two groups in terms of infection and recurrence rates in the first year. Seroma was seen only in 16.7% of the patients in the Lichtenstein group (P <0.012). Pain intensity measured in the first 24 hours at three-time points (1, 8, and 24 hours) was lower in the TAPP group with spinal anesthesia than in the TAPP with GA and Lichtenstein groups (P <0.001).

The results of this study showed that TAPP with spinal anesthesia is associated with reduced postoperative pain in the first 24h, and irrespective of the  type of anesthesia TAPP is associated with lower risk of seroma formation

Warts are benign tumors caused by different types of human papillomavirus. Different methods are used in the treatment of warts. The aim of this study was to compare the effectiveness, side effects and number of treatment sessions of CO2 laser and cryotherapy in the treatment of plantar warts

Seventy patients (140 feet) with plantar warts on both feet who referred to the dermatology clinic of Farshchian (Sina) Hospital in Hamadan during 2019-2020 were selected by convenience sampling method. The warts were randomly treated with either CO2 laser or cryotherapy on each foot. After treatment, patients were evaluated every two weeks for up to five sessions for requirement of treatment repetitions and assessment the extent of healing. In the cases with non-healing lesion, treatment was repeated once every two weeks for up to five sessions. 

The mean age of the patients was 22.11±8.73 years, and 35.7% were male and 64.3% were female. In the CO2 laser and cryotherapy groups, the frequency of recovery rate was 81.4% and 41.4%, (P<0.001), and the mean number of treatment sessions was 1.90±0.84 and 3.55±0.69 (P<0.001) respectively. Frequency and type of side effects in the CO2 laser and cryotrapy group was pain 25.7% and 94.3% (P<0.001), itching zero and 32.9% (P<0.001), blisters 2.9% and 82.9% (P<0.001) and hyperpigmentation with zero and 12.9% (P=0.003), respectively.

CO2 laser is more effective than cryotherapy in less number of sessions and with less side effects for the treatment of plantar warts

Endometrial scratch injury is considered controversial in increasing the success rate of assisted reproductive technology.

To compare the pregnancy outcomes in women candidated for intrauterine insemination with and without an endometrial scratch.

In this randomized clinical trial, 150 women referred to the Fatemieh Hospital, Hamadan, Iran who were candidates for IUI between December 2017 to December 2018 were randomly assigned into two groups (n = 75/each) with or without an endometrial scratch (as case and control groups, respectively). Women in both groups were in the proper and identical protocol for IUI. Chemical and clinical pregnancy, abortion, and live birth rate, also pregnancy complications were compared between the groups.

Chemical and clinical pregnancy rates were higher in the case than the control group (p = 0.25, p = 0.54, respectively). In the case group, the abortion and multiple gestation rates were 14.3% and 4.3%, respectively, while it was 5% in the control group (p = 0.60, p = 0.54 respectively). The endometrium thickness on day 21 was higher in the case group than the control (p = 0.01).

Endometrial scratching in intrauterine insemination women is not associated with an increase in both clinical and clinical pregnancy rates, however, studies with a larger sample size are suggested to evaluate this intervention.

Hypotension is a common complication of cesarean section with spinal anesthesia, which can be dangerous for both mother and neonatal. The aim of this clinical trial study was to investigate the effect of using bandaging on the lower limbs in preventing of post spinal hypotension in cesarean section.

This prospective clinical trial study was performed in 2019-2020 at Fatemieh Hospital in Hamadan. A total of 64 patients undergoing cesarean section with spinal anesthesia were randomly divided into two groups of with bandaging at the time of surgery and without bandaging. Demographic information, hemodynamic status in the first hour after spinal anesthesia, hypotension, nausea and vomiting, bradycardia, tachycardia, atropine levels, ephedrine consumed, was compared in both groups. The data were statistically analyzed by SPSS version 16 software and analyzed.

The mean age of both groups of patients was approximately 30 years (P = 0.958). Hypotension (25 vs. 78.1%), bradycardia (9.3 vs. 15.6%) and intraoperative nausea and vomiting (12.5 vs. 59.4%) in the intervention group with significantly less than the control group. The amount of ephedrine (4.1 3 3.1 vs. 20.6 13 13.2 mg) was lower in the intervention group than in the control group (P = 0.01). In the study of hemodynamic status of systolic and diastolic pressure from 2 to 6 minutes and mean arterial pressure from 2 to 10 minutes after spinal with a significant difference in the intervention group was more than the control group (P<0.05). In other minutes, there was no statistically significant difference in terms of hemodynamic status.

The findings of the present study show that bandaging of the lower extremities with bandaging in cesarean section with spinal anesthesia, which is a cheap and available non-invasive procedure, can be effective in preventing post-spinal hypotension and reducing the use of ephedrine.

Some studies have shown that abnormal levels of biomarkers may be associated with adverse pregnancy outcomes. This study aimed to investigate the association between serum levels of Inhibin A and the outcomes of pregnancy.

This retrospective cohort study was conducted on the data obtained from the Inhibin A of 560 pregnant women at 15 to 20 weeks of gestation in Hamadan, Iran. The levels of Inhibin A less than 0.5 and higher than 2 mmol were considered below and high, respectively. The patients were assessed in terms of birth weight, gestational age, Apgar score, preeclampsia, intrauterine fetal death, and cesarean section. The receiver operating characteristic curve level was calculated to detect adverse pregnancy complications. The data were statistically analyzed in STATA software (version 14).

Out of the pregnant women eligible for the study, 33 (5.9%) cases were excluded due to incomplete medical record files and unavailability. Of the remaining 527 patients, 378 (71.7%), 26 (4.9%), and 123 (23.3%) ones had normal, low, had high Inhibin A levels, respectively. Patients with higher serum Inhibin A levels had a higher risk of preeclampsia, low birth weight, and prematurity, compared to those with normal or low levels (P˂0.05).

Based on the findings of the present study, high levels of Inhibin A at 15 to 20 weeks of gestation can be associated with the risk of preeclampsia, low birth weight, and prematurity.

Although antiepileptic drugs have controlled the epilepsy attacks substantially, the side-effects are still considered as a problem to the patients. The aim of this study was to compare the effects of sodium valproate and carbamazepine on sexual function in men with epilepsy.
In this cross-sectional study 35 male married epileptic patients with the history of taking carbamazepine for at least one year and 35 other male married patients using sodium valproate for at least one year have been participated. Both group's sexual activity information has been evaluated by international index of erectile questionnaire. This fifteen question survey has investigated men's sexual activity in 5 fields such as erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. Each question has 5 scores at most and the total score of the survey comes to 75.The results have been analyzed by Chi-Square and Mann-Whitney U tests using the statistical software SPSS (ver.16.0).
The average of total gained scores in sodium valproate takers was more than carbamazepine takers (51.68, 53.42) but there was no significant difference (p=0.582). Twenty-five sodium valproate takers (48.1%) and twenty-seven carbamazepine takers (51.9%) had erectile function disorder but there was no significant difference (p=0.584). The sodium valproate group average scores in all sexual activity fields except sexual desire was more than carbamazepine group but there was significant difference regarding only sexual desire.
sexual activity disorders in men with epilepsy, especially erectile disorder were highly prevalent and also the result showed that patients who take sodium valproate had better status than carbamazepine takers regard to sexual activities except sexual desire.

Spinal dural arteriovenous fistula (SDAVF) is a known cause of nontraumatic slow progressive araparesia and is frequently overlooked because its clinical features overlap with more common causes of myelopathy and also neuroimaging may be normal.
Case Report: A 53 year-old man with developed weakness of both lower limbs had symptoms begun spontaneously 3.5 month before admission and progressed from 1 month ago with bowel and bladder incontinence. The patient's physical examination was normal and neurologic testing revealed lower extremity motor strength of 3/5. Deep tendon reflexes were decreased and superficial abdominal reflexes were absent. Sensation of pinprick and temperature was absent distal to the T4-T5 level. Vibration and proprioception were decreased to the ankle and saddle anesthesia and the patient was non ambulatory. Laboratory routine and specific tests for vitamin B12 level, hepatitis, HIV, HTLV1, 2 were negative. MRI of spine with and without contrast raised the possibility of dural arteriovenous malformation extended from T3 level to conus medullaris which was confirmed by angiography. The patient referred to neurosurgeon for deciding route of treatment.
SDAVF can be a significant non traumatic slowly progressive cause of myelopathy. The majority of the affected patients are males older than 50 years of age. Rapid diagnosis in these patients leads to significant improvement.