Effects of ondansetron, metoclopramide and granisetron on perioperative nausea and vomiting in patients undergone bariatric surgery: a randomized clinical trial.

INTRODUCTION: Post-operative nausea and vomiting (PONV) is a common problem after sleeve gastrectomy. In recent years, following the increase in the number of such operations, special attention has been paid to preventing PONV. Additionally, several prophylaxis methods have been developed, including enhanced recovery after surgery (ERAS) and preventive antiemetics. Nevertheless, PONV has not been completely eliminated, and the clinicians are trying to reduce the incidence of PONV yet. METHODS: After successful ERAS implementation, patients were divided into five groups, including control and experimental groups. Metoclopramide (MA), ondansetron (OA), granisetron (GA), and a combination of metoclopramide and ondansetron (MO) were used as antiemetics for each group. The frequency of PONV during the first and second days of admission was recorded using a subjective PONV scale. RESULTS: A total of 130 patients were enrolled in this study. The MO group showed a lower incidence of PONV (46.1%) compared to the control group (53.8%) and other groups. Furthermore, the MO group did not require rescue antiemetics, however, one-third of control cases used rescue antiemetics (0 vs. 34%). CONCLUSION: Using the combination of metoclopramide and ondansetron is recommended as the antiemetic regimen for the reduction of PONV after sleeve gastrectomy. This combination is more helpful when implemented alongside ERAS protocols.

Pediatric Surgery Workforce Around the World: A Need to Revise Residency Programs?

Objectives:The study aimed to address the shortage of pediatric surgery specialists globally by investigating the discrepancies in training programs and population metrics across different countries and regions. Methods: An international survey of pediatric surgeons gathered data on training duration, examination procedures, certification, and population metrics like mortality rate and surgeon-to-population ratio. Results: The study included 44 countries. The average length of pediatric surgery training was 5.7 years, with no significant difference between different regions. The pediatric mortality rate and surgeons count per 100 000 people were inversely correlated, while training duration was associated with GDP and life expectancy, but not pediatric mortality rate or surgeons' count. Conclusion: Many countries' pediatric surgery training programs do not align with their actual need for pediatric surgeons. Nations with limited economic resources may opt to shorten residency programs or offer pediatric surgery as a direct specialty after medical school to mitigate the shortage effectively.

Amyand's hernia in an elective inguinal hernia repair: A case report.

INTRODUCTION AND IMPORTANCE: Amyand's hernia is a rare condition in which the appendix is situated inside an inguinal hernia sac. It occurs in less than 1 % of all inguinal hernias, and preoperative diagnosis is often challenging, even with the aid of ultrasonography or computed tomography. The course of treatment depends on the degree of inflammation of the appendix. In this report, we present a case of Amyand's hernia that was discovered during elective inguinal hernia repair. CASE PRESENTATION: We are presenting a case of a 65-year-old man who complained of right inguinal swelling and pain for one week. Upon clinical examination, a nontender and reducible mass was discovered in his right inguinal region. Further ultrasound examination suggested the presence of a right inguinal hernia, without any additional notable findings. During the surgery, the appendix was found to be present inside the indirect inguinal hernia sac, and due to its normal condition, the hernia was reduced, and a prosthetic mesh was placed. CLINICAL DISCUSSION: Amyand's hernia is a rare form of inguinal hernia, predominantly found in men, with the appendix being trapped within the inguinal canal. The clinical presentation and treatment depend on the appendix's inflammation, and while ultrasonography is commonly used for diagnosis, preoperative detection of Amyand's hernia is often challenging. CONCLUSION: Amyand's hernia is a rare but potentially life-threatening condition. A high index of suspicion is required to make the diagnosis. Surgical intervention is the treatment of choice, and In the absence of complications, the prognosis is favorable.

ChatGPT in Iranian medical licensing examination: evaluating the diagnostic accuracy and decision-making capabilities of an AI-based model.

INTRODUCTION: Large language models such as ChatGPT have gained popularity for their ability to generate comprehensive responses to human queries. In the field of medicine, ChatGPT has shown promise in applications ranging from diagnostics to decision-making. However, its performance in medical examinations and its comparison to random guessing have not been extensively studied. METHODS: This study aimed to evaluate the performance of ChatGPT in the preinternship examination, a comprehensive medical assessment for students in Iran. The examination consisted of 200 multiple-choice questions categorised into basic science evaluation, diagnosis and decision-making. GPT-4 was used, and the questions were translated to English. A statistical analysis was conducted to assess the performance of ChatGPT and also compare it with a random test group. RESULTS: The results showed that ChatGPT performed exceptionally well, with 68.5% of the questions answered correctly, significantly surpassing the pass mark of 45%. It exhibited superior performance in decision-making and successfully passed all specialties. Comparing ChatGPT to the random test group, ChatGPT's performance was significantly higher, demonstrating its ability to provide more accurate responses and reasoning. CONCLUSION: This study highlights the potential of ChatGPT in medical licensing examinations and its advantage over random guessing. However, it is important to note that ChatGPT still falls short of human physicians in terms of diagnostic accuracy and decision-making capabilities. Caution should be exercised when using ChatGPT, and its results should be verified by human experts to ensure patient safety and avoid potential errors in the medical field.

The outcome and complications of modern staged repair surgery in newborns with classic bladder exstrophy in different genders: A retrospective study.

INTRODUCTION: Classic bladder exstrophy (CBE) is a rare anterior midline birth defect that remains a challenge for pediatric surgeons. Despite multiple reconstructive methods, outcomes vary widely in various reports. This study aims to compare the success rate and complications of modern staged repair of exstrophy (MSRE) in each gender and compare together. METHODS: This retrospective cross-sectional study included cases of CBE between 2010 and 2020 that underwent MSRE. Short-term follow-up results, including incontinence rate, vesicoureteral reflux (VUR), urinary infections, deformed genitalia, and so on, were measured in each gender, and their differences were reported. RESULTS: Among the 40 newborns with CBE who underwent MSRE, 25 (62.5%) were boys, while the others had non-male genitalia. The rates of incontinence, VUR, dehiscence, and fistulas did not differ significantly between genders. However, chronic urinary tract infections (UTIs) were more frequent in girls, and boys were more likely to have malformed genitalia (p < .05). CONCLUSION: Our findings indicate a similar rate of complications in each gender. However, chronic UTIs and external genitalia deformities were significantly more common in girls and boys, respectively. Further large-sized controlled trials may be needed to corroborate these findings.

A 20 Years Retrospective Descriptive Study of Human Cystic Echinococcosis and the Role of Albendazole Concurrent with Surgical Treatment: 2001-2021.

Background: Hydatid cyst, caused by the larvae of Echinococcus granulosus, is one of the most severe cestode infections occurring in Iran. The liver is the most commonly involved organ. The present study was carried out to review the demographic of 20 years surgically treated hydatic cysts. Methods: Ninety-eight patients were enrolled in the study. Demographic features, time of surgery, cyst size, and albendazole usage have been reviewed from the medical records of patients in Loghman Hakim Hospital, Tehran, Iran, from 2001 to 2021. Statistical analysis was performed to find any correlation between the uses of concurrent albendazole with surgical procedure. Results: Of 98 patients with hydatid cyst, 57 (58.2%) were female. The mean age of patients was 39.4 ±18.7 yrs, and the mean surgery time was 217.5 ± 81.4 minutes. Regarding the infection site, the liver (60.2%) and lungs (22.4%) were the most affected organs, respectively. 56.1% of patients had one cyst, and 42.9 % had two or more cysts. 20.4% of them had taken albendazole before surgery, but 86.7 % took it after the operation. No recurrent cysts were seen among 91.8% of them, but 8.2% mentioned suffering from a recurrent cyst. 85.7% of those recurrent cases did not receive albendazole before surgery, and 75% of recurrent cases after surgery did not take albendazole (P<0.05). Conclusion: Administration of albendazole before and after the operation was significantly related to reduced recurrence, bleeding, morbidity, and even the time of surgery.

Laparoscopic relief of reduction en-masse in an inguinal hernia: A case report.

INTRODUCTION AND IMPORTANCE: Reduction en-masse is an extremely rare condition that usually develops in prolonged hernias. Spontaneous or iatrogenic reduction of this type of hernia may lead to disastrous consequences such as obstruction, gangrene, or peritonitis. According to the reports so far, surgical management is the only choice for this condition. PRESENTATION OF CASE: In this paper, we report a 48-year-old man who presented with vague abdominal pain and a history of inguinal hernia for years and had reduced his hernia five days earlier. Computed tomography (CT) and ultrasonography confirmed the diagnosis, and the patient was taken to the operating room to relieve the bowel loop utilizing laparoscopy. CONCLUSION: Laparoscopic relief could be an effective tool in diagnosis and surgery of reduction en-masse. Transabdominal preperitoneal repair is the best choice due to its capability to explore the intraabdominal organs and its low risk of recurrence.

Successful laparoscopic removal of gossypiboma: A case report.

INTRODUCTION AND IMPORTANCE: Gossypiboma is defined as developing an exudative inflammatory process around retained foreign bodies (RFBs). This problem may be asymptomatic or present with severe systemic or regional symptoms. Traditionally, every RFB must be removed with a surgical procedure. In the era of minimally invasive surgery, laparoscopic removal is a good choice for these problems. CASE PRESENTATION: A young woman was referred to us with intermittent vague abdominal pain and a history of open cholecystectomy. After initial imaging, we found a twisted string-like object in epigastrium. Considering clinical findings and imaging, the patient was taken to the operating room with a diagnosis of RFB. After an explorative laparoscopy, we found an encapsulated fibrotic mass around a surgical sponge with pus-like secretions. CONCLUSION: After diagnosing either RFB or gossypiboma, surgical intervention is mandatory, even in asymptomatic patients. Laparoscopy can help the surgeon to remove the retained item safely. Also, decreased length of stay and postoperative pain are significant advantages of laparoscopic removal.

Primary leiomyosarcoma of the adrenal; a case report.

INTRODUCTION AND IMPORTANCE: Primary adrenal leiomyosarcoma (PAL) is an extremely rare neoplasm that usually arises from the smooth muscle cells of the adrenal or adjacent vascular structures. The tumor is asymptomatic until it grows up and develops a mass effect in the retroperitoneal region. Although there are about 50 reported valid cases, surgical intervention is mandatory in the majority of patients. CASE PRESENTATION: Herein, we report the case of a 32-year-old healthy woman with a chief complaint of vague abdominal pain. After initial clinical and radiological examinations, we found a large retroperitoneal mass located around the right adrenal gland. Due to the patient's pain, a laparotomy was performed, and a large mass was resected with free margins. Immunohistochemical examination was positive for vimentin, smooth muscle actin (SMA), and desmin. Therefore, the diagnosis of PAL was confirmed. CONCLUSION: Although PAL is an uncommon malignancy, its diagnostic and therapeutic approaches are almost straightforward. A computed tomography scan can show the characteristics of the tumor and direct the management. Surgical resection is the mainstay of treatment, and the effects of adjuvant therapies have not been apparent yet.

The usage of a magnet-powered instrument in the extraction of metallic or magnetic aspirated foreign bodies: A case report.

INTRODUCTION AND IMPORTANCE: The unintended passage of foreign bodies into the airway, is a common problem among children which can lead to death. Prompt diagnosis and extraction of the entrapped object is the key of success in these cases. Unfortunately, in addition to various extraction methods, in some cases the bronchoscopy may not be successful, and exploratory thoracotomy is inevitable. CASE PRESENTATION: We describe the story of a 7-year-old preschooler boy who was taken to the emergency department complaining the sudden onset of cough and dyspnea. Initial investigations, showed an entrapped oval-shaped object in the right main bronchus. Several conventional bronchoscopic attempts were failed. We used a handmade magnet-powered instrument to extract the object. CONCLUSION: Using the magnet-powered grasping forceps may be beneficial after repetitive failed attempts in the extraction process of airway foreign bodies. Although there is no specific evidence-based guideline for choosing the best removal technique, we recommend using this technique in round-shaped high weight metallic objects as the first removal technique.

A rare case of cutaneous mucormycosis in the forearm: A case report.

INTRODUCTION AND IMPORTANCE: Cutaneous Mucormycosis (CM) is a less frequent type of fungal infection that can present with different skin lesions. Although these lesions appear to be benign and silent, CM rapidly progresses into the deeper layers. Given that no specific laboratory or imaging finding is described for the disease, the diagnosis is mainly based on history and physical examination. In addition, immediate debridement and antifungal agents must be commenced. CASE PRESENTATION: We present a 43-year-old septic man who was hospitalized for his forefoot infection. During his admission, he developed a necrotic-like ulcer in his antecubital fossa. After initial debridement, pathology examination revealed the infection with mucormycosis. We administered intravenous liposomal Amphotericin B, and also multiple surgeries were performed. Unfortunately, the sepsis progressed to multiorgan failure, and the patient passed away. CONCLUSION: CM requires emergent diagnosis and treatment. Early surgical interventions like extensive debridement and repetitive wound irrigation alongside systemic antifungal therapy are the key steps to preventing the progression of the disease.

Gastric pneumatosis and concurrent aeroportia due to gastric outlet obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Gastric pneumatosis with concurrent hepatic portal vein gas is an extremely rare condition in the adult population. It can be idiopathic or associated with well-known etiologies. Gastric outlet obstruction can progressively inflate the stomach and cause pneumatosis. Regarding abdominal signs and the presence of acute abdomen, management varies from just conservative to emergent surgical interventions. CASE PRESENTATION: We introduce an adult patient who presented to our hospital with weakness and dyspnea. After initial measures, unexpectedly we found intraabdominal free gas, concurrent gastric pneumatosis, and aeroportia. Due to the absence of positive abdominal signs, the patient was treated successfully without any surgical or endoscopic interventions. DISCUSSION: Gastric outlet obstruction is a well-known cause of gastric pneumatosis. Progressive dilation of the stomach due to pyloric stenosis is well-described both in infants and adult populations. CONCLUSION: In stable patients, gastric drainage and correction of electrolyte disturbance are the only required treatment. However endoscopic and surgical interventions should be considered in unstable patients or those developing acute abdomen.