Journal of Surgery and Trauma
Volume:7 Issue: 2, Summer 2019

Dear Editor:The process of launching a wet lab for cataract surgery on the goat's eye for publication and use of the respectable colleague surgeons of the ophthalmology department is presented as follows.
In order to design an effective and beneficial wet lab, we followed and implemented five main steps as follows:Step 1: Preparing an appropriate physical space
To have a proper wet lab space, a room in Feiz Educational-Therapeutic Ophthalmology Center, affiliated to Isfahan University of Medical Sciences, was considered and prepared. Therefore, after cabinets, plumbing, cooling and heating equipment, and electricity, and telephone system were set up in the room, the required facilities including surgical microscope, the phaco machine, microwave, Trypan blue, extracapsular surgery set, phaco surgery set, safety box, refrigerator, desk, and chair were transferred.
Step 2: Obtaining finance to launch the wet lab
After coordination was made, we received and packed surgery sets using the old equipment from the operating room. Since modern equipment was purchased for the hospital operating room, we were able to transfer the phaco machine and microscopes that were no longer in use. Consumables and goat's eyes were not expensive, and a total of 30 goat's eyes were used.
In this physical space, a senior assistant performed the procedure step-by-step on a goat's eye, and the sophomore assistant followed the instruction as an observer and subsequently exercised it on a goat's eye. Other exercises in the wet lab comprised of scrub, introduction to ophthalmology surgery devices and microscope set-up, and stitching.
Step 3: Providinggoat's eye
To provide the eyes, the slaughterhouse (60 km to Isfahan) was reminded to extract the eyes from the animal's eye orbit in perfect form along with the surrounding fat without the eye surface being touched. The eyes were transferred to the wet lab in cold box at -2 °C inside the dextrose-saline solution. The temperature of the refrigerator was set at -2 °C to keep the eyes. Nevertheless, the cornea should not be dried or frozen. Notably, as the time between the displacement of the eyes from the slaughterhouse and their use in the wet lap and cataract surgery was long, the eyes were kept and transferred in 2/3 and 1/3 serums and a temperature of -2°C in order to prevent corneal opacity.
Goat’s eye was selected given its resemblance to the human eye and accessibility(1). The similarity helps us train the procedures to the assistants and to enable them to practice on their own.
Step 4: Stabilizing the eye
In keeping with the need for eye fixation, researchers used magnetic clip dispensers, as an innovative technique, to stabilize the eye. Bottom of the dispenser was filled with compressed cotton, and the eye was placed on it. We placed the head of the dispenser on the animal's eye so that the eye was accessible from the empty circular space of the dispenser head.
Step5: Preparing the eye for cataract surgery
Given the fact the goat's eye is deprived of vital nerves at the time of slaughter, that the pupil gets dilated, and that the eye was transferred under moist conditions inside 1/3 and 2/3 serums at -2 °Cin order to prevent from the cornea’s dryness and opacity, it was necessary to take certain measures on the goat's eye, because the goat’s eye lenses are made up of a loose, transparent tissue. Therefore, to make it more solid and darker, we induced cataract in the microwave according to our previous studies. It is necessary to explain that cataract induction on the goat's eye is performed for the first time worldwide, and what was observed in articles(2-3)concerned with the porcine eye, which was carried out at a power of 700 w in the microwave for 5-13 seconds. In this study, we evaluated that the goat's eye is different from that of the pig's, and that it has a tissue more susceptible to microwave conditions that the porcine eye such that it transforms in a faster time.
Thus, cataract induction of the goat's eye in the microwave was the first experience. Hence, as we did not have a reference in this regard, we checked the eye in the microwave every 3 seconds, observing that within 9 to 13 seconds at a temperature of 100 °C, total induction was accomplished and the cornea was still transparent for practicing rhexis and phaco in the wet lab. In this way, the goat eye lenses were prepared for cataract procedures including the anterior capsule, rhexis, phaco, irrigation and aspiration, IOL(Inter Ocular Lens), and stromal hydration. We found that the eye cataract could be used for surgical purposes for up to 24 hours after surgery in case they were stored inside a container with a lid under refrigerated conditions or in water. At these intervals, the necessary condition is for the cornea to remain transparent, which was considered by us in the operational plan.

The emergency department (ED) is one of the challenging educational environments in medical education. Clinical teaching at ED requires balancing the provision of patient care services, clinical teaching, and clinical experiences for learners at different levels of learning. Accordingly, using effective teaching strategies at teachable moments and getting feedback from learners provide a balance between patient care and education. This narrative review aimed to review strategies for improving clinical teaching in the ED. Searching the literature was done in ProQuest, PubMed, ISI Web of Science, as well as Science Direct databases, and Google Scholar search engine with the keywords, including "teaching model", "learning", "educational strategy", "training", "emergency department", "emergency medicine", "clinical teaching", "resident", and "medical student", in English language with no time limit for searching. Finally, after reviewing 53 abstracts, 19 articles were included in the present study. In this review, effective training in the ED and important determinants of adequate educational encounters were provided with suggestions on how to implement them in clinical settings. The eight main themes related to the study were extracted, including professional reflection, obvious expectations, interprofessional training, strategies for clinical teaching with limited time, strategies for effective bedside teaching, selecting a teaching strategy for ENGAGE multilevel learner, and applying the principles of adult learning and faculty development. Accordingly, to maximize learning opportunities in the ED, the faculty members' development is recommended for fulfilling accountability in the community.

Pain management is one of the most essential components of postoperative care. Nowadays, the common treatment methods for pain include the use of two large groups of analgesics, namely opioids and nonsteroidal anti-inflammatory drugs (NSAIDs). Therefore, the present study aimed to compare the effects of ketorolac (i.e., a non-inflammatory drug) and pethidine (i.e., a synthetic opioid pain medication) on pain and complications due to hemorrhoidectomy.

This randomized controlled trial included 90 patients with hemorrhoids who underwent hemorrhoidectomy at Imam Reza Hospital in Birjand, Iran, from May 2017 to 2018. The participants were assigned into two groups, namely ketorolac group who received ketorolac therapy and pethidine group who received pethidine. The severity of pain and complications were measured immediately, as well as at 6, and 12 hours after surgery in both study groups. The quantitative data were expressed as mean and percentage. Data analysis was performed using SPSS software (version 22.0) through Mann-Whitney, Friedman, and Chi-square tests. A p-value less than 0.05 was considered statistically significant.

According to the obtained results, out of 90 patients with hemorrhoid, 70.3% were males. The mean age of the participants was 48.29±8.8 years, and there was no significant difference between two study groups regarding age (47.2±8.7 years in the pethidine group, and 49.4±9 years in the ketorolac group, P=0.196). In the ketorolac group, the mean pain scores were 2.33±1.36, 2.28±1.00, and 1.57±0.75, immediately, as well as at 6, and 12 hours after surgery, respectively. In addition, in the pethidine group, the mean pain scores were obtained at 3.15±1.61, 2.64±1.00, and 1.97±0.69, immediately as well as at 6, and 12 hours after surgery, respectively. Accordingly, the pain level was significantly lower in ketorolac group, compared to that in the pethidine group (P<0.05). However, the pain level was higher at 24 hours after surgery in ketorolac group than that in the pethidine group; nevertheless, the difference was not statistically significant (P=0.996).

The findings of the present study suggest more significant therapeutic effects of nonsteroidal NSAIDs, compared to opioid drugs on pain after hemorrhoidectomy.

Traumas to the teeth can damage the pulp that may require root canal treatment. In addition, the evaluation of trauma errors is very important in every educational system. Therefore, the aim of the present study was to investigate technical errors during root canal therapy and compare these errors among the students who were in their 4th, 5th, and 6th years of their education in Dental Faculty of Birjand, Iran.

A total of 428 documents of root canal therapy performed by dental students who were in the 4th, 5th, and 6th years of their education were randomly selected during 2014-2017. For each tooth, four radiographs, including the periapical images of the initial radiograph, master apical file, master cone, and final obturation radiographs, were reviewed under the supervision of an endodontist. Technical errors investigated included transport, ledge, perforation, underfilling, overfilling, and presence of void and broken instrument.
The data were entered into a relevant form and analyzed. The normality was investigated using the Shapiro-Wilk test in the SPSS commercial software (version 22). In the present analysis, because the normality of the data was not confirmed, the Kruskal-Wallis and Mann-Whitney U tests were used, and the Chi-Square test was also utilized at the α-level of 0.05 to compare the ratio.

Technical errors were observed in 149 out of 428 documents (34.8%). Numbers of the documents containing technical errors were 60 (30.6%), 78 (40.6%), and 11 (27.5%) associated with the students of the 4th, 5th, and 6th years, respectively. Only one perforation error was observed by the students of the 5th year. In addition, there was no transport error by the students of the 4th year. Number of the ledge and overfilling errors presented significant differences by the students of various years (Pledge=0.01 and Poverfill=0.002).

Results of this study showed that 65.2% of the students had acceptable performance; however, procedural errors were a fairly common finding among the students. Moreover, there were significant differences between students in different years. Pre-evaluation of radiographs and more accurate case selection could promote the quality of root canal therapy among students.

Ureteropelvic junction obstruction (UPJO) is an obstruction that occurs in renal pelvic-ureter junction. In case the UPJO diagnosis is confirmed, the treatment is surgical. In this regard, closed surgery (laparoscopic surgery) is currently recommended due to the small number of complications arising after this surgery. In the present study, we reported the laparoscopic treatment of a huge ureteropelvic junction obstruction in a 42-year-old man referred to a physician with a complaint of dull abdominal pain radiating to the back. After the computed tomography scan, the laparoscopy was performed under general anesthesia. Sever hydronephrotic kidney was dissected completely from adjacent organs and nephrectomy was performed for this case. Afterward, the ureter was ligated and divided at this level. The procedure was followed by the drainage of the cloudy urine entrapped in the kidney. Renal hilum was dissected and renovascular was secured and divided separately using multiple clips. The specimen was extracted using entrapment sac. This surgical management ended without any complication. The UPJO is a disorder of the urinary tract with an unknown etiology in elderly and middle-aged people. Early diagnosis and timely treatment can prevent some complications, such as poor functioning or nonfunctioning kidney. Nowadays, UPJO standard treatment is a laparoscopic pyeloplasty surgery to relieve obstruction and reconnect the ureter to the pelvis. To this end, a rapid and easy method of urine drainage is conducted to save the kidney.

Squamous Cell Carcinoma (SCC) is the second most common skin cancer after basal cell carcinoma. It is aggressive and has metastasis capability; therefore, timely diagnosis can prevent the occurrence of metastasis. There are some treatments available for SCC, such as radiotherapy, topical chemotherapy, systemic chemotherapy, and surgery. In our case, the surgical treatment and radiotherapy were performed due to the results of the examination reports and large dimensions of the lesion.