The omphalomesenteric duct fibrous band as a rare cause of bowel obstruction: A case report and literature review.

INTRODUCTION AND IMPORTANCE: The omphalomesenteric duct (OMD) is an embryonic structure that normally undergoes obliteration during embryonic development, typically not persisting after birth. Failure of complete or partial obliteration can result in a type of malformation known as OMD remnant. CASE PRESENTATION: We report a case of a 24-year-old male patient diagnosed with bowel obstruction. Abdominal computed tomography (CT) scan revealed the presence of an adhesion band. During surgery, a fibrous band connecting from the umbilicus to the mesentery of terminal ileum was found and resected. Pathological investigation confirmed the presence of an OMD remnant fibrous band. CLINICAL DISCUSSION: OMD remnant can manifest in different forms such as Meckel's diverticulum, umbilical polyp, OMD cyst, OMD fistula, and fibrous band, occurring in approximately 2 % of infants and often presenting symptoms in early childhood. These conditions rarely cause complications in adults. Complications may include obstruction, gastrointestinal bleeding, bowel perforation, and omphalitis which can present with symptoms such as abdominal pain, vomiting, melena, lack of defecation, umbilical discharge, and dermal manifestations. Diagnostic approaches vary depending on the type of OMD remnant and associated complications, but ultrasonography and CT scan can be useful. While asymptomatic OMD remnants generally do not require further intervention, surgical treatment is the main option for complicated and symptomatic cases. CONCLUSION: OMD remnant is a rare condition in adults that can lead to complications. Given that obstruction is a common complication of OMD remnant, OMD remnant should be considered in the differential diagnosis of patients presenting with bowel obstruction.

Jejunal adenocarcinoma; a case report and literature review.

INTRODUCTION AND IMPORTANCE: Small bowel carcinoma (SBC) is a rare malignancy comprising mainly of adenocarcinoma and carcinoid tumors. Among SBCs, small bowel adenocarcinoma (SBA) accounts for 30-40 % and is predominantly found in the duodenum, while jejunal and ileal presence considered rare. CASE PRESENTATION: We have presented a case of jejunal adenocarcinoma in a patient with obstruction symptoms. Prior to the obstruction, the patient mainly suffered from weakness and weight loss, in addition to iron deficiency anemia. During the investigation of underlying causes, we observed evidence of mass. However, before any additional evaluation could take place, the obstruction necessitated surgical intervention. CLINICAL DISCUSSION: Small bowel adenocarcinomas, particularly in the jejunum and ileum, are exceedingly rare and often present with complications such as obstruction, gastrointestinal bleeding, or perforation. Due to the non-specific symptoms, SBAs are challenging to diagnose before complications occur. SBAs are frequently diagnosed at advanced stages, so early diagnosis is crucial, as it can significantly impact patient survival. Thus, efforts should be made to expedite the diagnosis process to avoid complications and improve survival rates. CONCLUSION: SBAs are a rare condition, often diagnosed by related complications. Recognizing the importance of early diagnosis and its positive influence on patient survival, physicians and surgeons should consider SBA in patients presenting with relevant symptoms or cases of obstruction.

Emergency laparotomy and perioperative COVID-19: a single-center retrospective cohort study.

Concerning the perioperative outcomes of patients diagnosed with COVID-19 who underwent emergency laparotomy, more data must be collected. Because COVID-19 can affect multiple organs, cause various complications, and act as a risk factor for surgery, in this study, we aimed to compare the outcomes of emergency laparotomy between SARS-CoV-2 infected and uninfected patients. This retrospective cohort study was conducted on patients who underwent emergency laparotomy from December 2021 to December 2022. Postoperative outcomes were compared between patients with and without confirmed perioperative SARS-CoV-2 infection. The primary outcome was 30-day mortality. Secondary outcomes were postoperative intensive care unit admission, hospital length of stay, re-operation, and postoperative complications. Data were analyzed by SPSS statistic version 27. In this study, 50 patients in the COVID-19 group and 91 patients in the non-COVID-19 group were assessed. The 30-day mortality in the COVID-19 group was significantly higher than in the non-COVID-19 group (34% vs. 12.1%, respectively, P = 0.004). Postoperative complications were significantly higher in the COVID-19 group (64% vs. 26.4%, P < 0.001). The frequency of ICU admission and need for re-operation were significantly higher in the COVID-19 group (P = 0.003 and P = 0.039, respectively). Length of hospital stay was significantly lower in the non-COVID-19 group (P = 0.021). In patients with confirmed COVID-19, emergency laparotomy is associated with increased postoperative morbidity and mortality. Additionally, emergency laparotomy is associated with increasing postoperative complications, length of hospital stay, intensive care admission, and additional surgery requirement.

Peritoneal tuberculosis pretending an acute abdomen; a case report and literature review.

INTRODUCTION AND IMPORTANCE: Peritoneal tuberculosis (PTB) is an infrequent clinical condition that frequently eludes diagnosis. The scarcity of PTB cases underscores the necessity for heightened vigilance within clinical settings to detect its presence. Notably, there has been a noticeable increase in PTB incidence in recent years. Mycobacterium tuberculosis is the causative agent responsible for PTB, affecting multiple gastrointestinal components such as the peritoneum and hepatobiliary system. Peritoneum is a rare site for TB with broad unspecific symptoms. It can be asymptomatic to periodic signs or mimic the positive peritonitis examinations like our case. CASE PRESENTATION: We have reported a case of 19-year-old male experiencing progressive abdominal pain. The presence of generalized tenderness and guarding on physical examination prompted us to perform an urgent laparotomy due to suspicion of peritonitis. During the surgery, we observed the peritoneum exhibiting widespread nodularity, resembling a disseminated seeding pattern, along with mild ascites, which raised our suspicion of peritoneal tuberculosis. Subsequently, cytological analysis of the ascitic fluid and histopathological examination of the lesions confirmed our diagnosis of peritoneal TB. CLINICAL DISCUSSION: We have shared our experience in facing PTB and reviewed recent papers to find further relevant information. The common presentations, probable causes, the role of imaging in diagnosis and the management are discussed for better management strategy and the best surgical decision. CONCLUSION: Peritoneal tuberculosis is a rare condition with challenging diagnosis. Key symptoms include vomiting, abdominal pain, ascites, weight loss, and fever. Prompt recognition and treatment are vital for better outcomes.

Spontaneous ventral gallbladder hernia complicated with perforation; a case report and literature review.

INTRODUCTION AND IMPORTANCE: Ventral gallbladder hernia is a rare condition mostly related to past acquired abdominal wall defects, but spontaneous ones are scarce. It happens more in elderly patients. Etiology and causes are still unspecified, but the most related known causes of spontaneous gallbladder herniation are carcinoma, biliary tracked occlusion or abdominal wall weakness in elderly patients, respectively. CASE PRESENTATION: We have presented a complicated 90-year-old woman with a bulged and warm area at the right upper abdomen with tenderness and positive rebound tenderness. In help with imaging, we found a ventral gallbladder hernia perforated in the subcutaneous layer. Then cholecystectomy and herniation site repair was performed. CLINICAL DISCUSSION: We have explained this infrequent scenario and reviewed recent similar papers to find further relevant information. The common presentations, probable causes, the role of imaging in diagnosis and the management are discussed for the best surgical planning. CONCLUSION: The spontaneous ventral herniation of the gallbladder is an exceedingly uncommon occurrence. The diagnosis of this condition heavily relies on imaging, with computed tomography (CT) scan utilizing both intravenous and oral contrast being the optimal modality. Management of this condition can be accomplished via both laparoscopic and laparotomy approaches. It is our recommendation to perform cholecystectomy and hernia repair simultaneously and expeditiously in all cases. We advise against conservative management strategies.

Small bowel volvulus and mesenteric ischemia induced by mesenteric cystic lymphangioma in an adult and literature review; a case report.

INTRODUCTION AND IMPORTANCE: Mesenteric cystic lymphangioma (MCL) is a rare benign intraperitoneal mass with congenital origin, and it is extremely rare in adults. Mesentery is an unusual location for cystic lymphangioma too. Clinical presentations are nonspecific, and diagnosis is challenging. It can mimic other surgical complications like appendicitis or any acute abdomen causes, so the review of cases is necessary for the best management and surgical planning. CASE PRESENTATION: We have presented a 22-year-old man presented with complaints of abdominal pain, nausea and vomiting. In laparotomy, a cyst was found with large size around the small intestine which caused mesenteric ischemia and changed the color of the small bowel to an ischemic view. The resected cyst was sent and confirmed by the pathology as lymphangiomatosis. MCL is a rare cause of obstruction, which was found accidentally in this case. CLINICAL DISCUSSION: MCLs are clinically challenging lesions with unspecific broad spectrum of clinical presentation ranges. We discuss a rare finding in an adult with intestinal volvulus and mesenteric ischemia. Medical literature and reviews have been searched to find more relevant information about MCLs for the better optimal planning in surgery. CONCLUSION: MCL is a challenging and infrequent case of surgery. Most of the time, it does not cause any complications, but it can also cause some life-threatening conditions like mesenteric ischemia or volvulus and lead to emergent surgery. Complete tumor removal is optimal for managing intra-abdominal cystic lymphangioma with the slightest chance of recurrence.

Applicability of a Green Nanocomposite Consisted of Spongin Decorated Cu2WO4(OH)2 and AgNPs as a High-Performance Aptasensing Platform in Staphylococcus aureus Detection.

This study reports the synthesis of a nanocomposite consisting of spongin and its applicability in the development of an aptasensing platform with high performance. The spongin was carefully extracted from a marine sponge and decorated with copper tungsten oxide hydroxide. The resulting spongin-copper tungsten oxide hydroxide was functionalized by silver nanoparticles and utilized in electrochemical aptasensor fabrication. The nanocomposite covered on a glassy carbon electrode surface amplified the electron transfer and increased active electrochemical sites. The aptasensor was fabricated by loading of thiolated aptamer on the embedded surface via thiol-AgNPs linkage. The applicability of the aptasensor was tested in detecting the Staphylococcus aureus bacterium as one of the five most common causes of nosocomial infectious diseases. The aptasensor measured S. aureus under a linear concentration range of 10-108 colony-forming units per milliliter and a limit of quantification and detection of 12 and 1 colony-forming unit per milliliter, respectively. The highly selective diagnosis of S. aureus in the presence of some common bacterial strains was satisfactorily evaluated. The acceptable results of the human serum analysis as the real sample may be promising in the bacteria tracking in clinical samples underlying the green chemistry principle.

Analysis of population structure and genetic diversity of Iranian Wild Salicornia (Salicornia iranica Akhani) population.

BACKGROUND: Salicornia is a halophyte plant capable of being irrigated with seawater, which can be used as an alternative food. Given this, it is necessary to study the potentials of this plant's morphological diversity in the natural environment. In this study, 33 wild populations of Salicornia were collected from different geographical areas around Urmia Lake during the flowering stage, and 55 morphological traits and 25 ISSR loci of the plant were analyzed. Based on morphological and molecular traits and the cluster analysis, Salicornia populations were divided into four and two groups, respectively. RESULTS: Overall, the high percentage of polymorphic loci (65.69%), the average number of effective alleles per locus (1.63), and the Shannon data index (0.540) indicate that ISSR markers was used to identify genetic diversity. Molecular data cluster analysis divided the studied populations into two main groups, which included 12.12% and 87.88% of the populations, respectively. Based on the effective analysis of the population's genetic structure and the precise classification of individuals into suitable sub-populations, the value of K=2 was calculated. CONCLUSIONS: The research findings indicated that the populations of Salicornia have a considerable diversity in morphological traits. Furthermore, markers UBC823, B, A7, and K, as well as markers with the Shannon index, effective allele, and large heterozygosis values, are the most effective markers in comparison with other markers used in this study. The findings of this study will aid in parental selection studies for breeding programs of Salicornia in future.

Military nurses' Experiences of Interprofessional education in Crisis Management: a Qualitative Content Analysis.

INTRODUCTION: Today's human health care needs are so complex and dealing with them requires interprofessional collaboration and teamwork, which must be learned by the appropriate educational methods. In this regard, the Crisis Management Interprofessional Education program (CMIPE) in the form of desktop maneuver with the presence of the military nurses and other professional groups involved in the crisis was designed and implemented in Military Nursing School in Tehran, Iran. The aim of this study was to explore the experiences of the military nurses of participating in an interprofessional education program in crisis management domain. METHODS: This was an exploratory case study using conventional content analysis of the experiences of 28 military nurses participating in this program. The qualitative data were collected with three methods including observation in the field (note-taking and filming) and an open-ended questionnaire and two focus group discussions with military nurses. RESULTS: Qualitative analysis of the experiences of military nurses led to the emergence of four overarching themes which included professional mutual recognition, shared mental models, valuing joint responsibility and collaboration, perceived self-worth as a member of an interprofessional team. CONCLUSION: The crisis management education based on an interprofessional approach created new experiences for military nurses by bringing together professional groups involved in a crisis in a constructive interaction, and with emphasis on learning from each other. This empowers them to provide teamwork and interprofessional collaboration in a critical situation, and therefore, enhancing their ability to cope with different crises.

Validity and reliability of the EQ-5D-3L (a generic preference-based instrument used for calculating quality-adjusted life -years) for patients with type 2 diabetes in Iran.

BACKGROUND AND AIMS: The psychometric properties of the EQ-5D-3L (a generic preference-based instrument used for calculating quality-adjusted Life -years) have not been known for any type of disease in Iran. This study aimed to assess its validity and reliability in patients with type 2 diabetes. METHODS: Data of 579 patients were collected from the Diabetes Research Center and Clinics in Yazd using EQ-5D-3L, SF-36, and DQoL instruments. The ceiling effects were computed for the EQ-5D-3L index and EQ VAS. The construct validity was assessed by using convergent validity, discriminant validity, and known-groups validity. Reliability was assessed using Cohen's kappa value, Cronbach's alpha, and intra-class correlation coefficient. RESULTS: The ceiling effects of EQ-5D-3L and EQ VAS were 20.18% and 15.33%, respectively. The highest degree of correlation was found between the pain/discomfort of EQ-5D and the BP scale of the SF-36 (0.55). Higher scores of all scales of the DQoL were associated with patients reporting no problems in each EQ-5D dimension. The mean of EQ-5D-3L index and EQ VAS scores were significantly higher in the male, married, and employed patients, and they did not have retinopathy, nephropathy, IHD, hypertension, DFU. The range of kappa values was from 0.39 to 0.71, and value of ICC for the EQ-5D-3L index and EQ VAS was 0.76 and 0.64, respectively. Cronbach's alpha was 0.87 for EQ-5D-3L and 0.74 for EQ VAS. CONCLUSIONS: Our findings demonstrated good construct validity and moderate to good levels of reliability of the EQ-5D-3L for using in the patients with diabetes, and it can be used in research or clinical practice in Iran and other regions of the Middle East.

Sono-coprecipitation synthesis of ZnO/CuO nanophotocatalyst for removal of parathion from wastewater.

Semiconductor photocatalysis is an effective method used to degrade organophosphorus compounds. Here, the potential of a commonly mixed oxide semiconductor, ZnO/CuO, has been examined to degrade methyl parathion. Sono-coprecipitation method was used to provide ZnO/CuO nanocomposites, and it was applied to photocatalytic and sono-photocatalytic degradation of methyl parathion under solar light irradiation. Powder x-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), the Brunauer-Emmett-Teller (BET) surface area, field emission scanning electron microscopy (FE-SEM), and transmission electron microscopy (TEM) were used to characterize the synthesized samples. The optimal experimental conditions such as ZnO/CuO photocatalyst 90:10 M ratios, the initial concentration of 20 mg/L parathion, 1 g/L photocatalyst loading, no compressed air sparging, pH of 8, and ultrasonic power (60 W and 80 kHz) were used to degrade the parathion effectively. The parathion was fully (100% removal) degraded after 60 min sono-photoirradiation in the optimal experimental conditions. A real water sample was used to examine the ability of the ZnO/CuO photocatalyst 90:10 to remove the parathion in the water-soluble ions. Graphical abstract.

Health-related quality of life and its associated factors in patients with type 2 diabetes mellitus.

BACKGROUND: Assessing the health-related quality of life in patients with type 2 diabetes mellitus is important for evaluation of treatment outcome. The purpose of this study was to evaluate the health-related quality of life in type 2 diabetes mellitus patients and its related factors in Yazd. METHODS: Data were gathered by using the EuroQoL-five-dimension-5 level instrument as well as using medical records of 734 outpatients with type 2 diabetes mellitus who were referred to the largest governmental diabetes center in South of Iran, Yazd province. When appropriate, the Kruskal-Wallis test or the Wilcoxon test was used to test the difference in the health-related quality-of-life scores in each factor. Finally, the adjusted limited dependent variable mixture model was developed to investigate factors associated with health-related quality-of-life scores. RESULTS: The mean and median of the EuroQoL-five-dimension-5 level index values of 717 patients who completed the questionnaires were 0.75 ± 0.006 and 0.72 ± 0.20, respectively, and those of the Visual Analogue Scale scores were 69.25 ± 0.63 and 75 ± 30, respectively. The mean scores for health-related quality of life were significantly higher for employed, educated, single, and male patients, as well as patients without comorbidities, diabetes-related complications, and hemoglobin A1c level >7%. Adjusted limited dependent variable mixture model showed that gender, age, marital status, and diabetes-related complications are significant independent predictors of EuroQoL-five-dimension-5 level index value. CONCLUSION: The mean scores for health-related quality of life in patients with type 2 diabetes mellitus were moderate in this study, and this finding is consistent with health-related quality-of-life scores reported in other studies conducted in the Middle East region. Therefore, health-related quality of life should be the most important consideration in the management of patients. In parallel, some factors, especially gender, should be considered to improve health-related quality of life.

Hydroethanolic Allium sativum extract accelerates excision wound healing: evidence for roles of mast-cell infiltration and intracytoplasmic carbohydrate ratio

ABSTRACT The present study was designed to evaluate the in vivo effect of Allium sativum (garlic) hydroalcoholic extract on wound healing in rats. For this purpose, 72 mature Wistar rats were divided into four groups (n=18/each) to receive no treatment, placebo, Cicalfate(r), or 2% Allium sativum (AS) extract, administered topically to the wound area, for 21 days. Following the experimental period, tissue samples were dissected out and underwent to histopathological analyses. Fibroblasts, fibrocytes, mast cells, intra-cytoplasmic carbohydrate ratio, neovascularization, collagen deposition, and re-epithelialization were analyzed in all groups. Animals in the treated groups showed significant enhancement in fibroblast, fibrocyte, and mast-cell distribution. Significantly higher neovascularization was observed on day 3 after wound induction in AS-treated animals versus those in the placebo, Cicalfate, and untreated groups (P<0.05). A dose-dependent, significantly higher intra-cytoplasmic carbohydrate storage was observed in treated animals. Our data show that AS promotes wound healing due to its preliminary impact on mast-cell distribution, which enhanced collagen synthesis and upregulated angiogenesis, and shortened the healing process by enhancing the intra-cytoplasmic carbohydrate ratio.

The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection.

OBJECTIVE: Although tonsillectomy is one of the most common surgeries performed in pediatric, it has potential major complications such as pain and bleeding. This study aimed to compare the bleeding and pain after tonsillectomy in bipolar electrocautery tonsillectomy versus cold dissection. METHODS: This double blind clinical trial was conducted on 70 pediatric patients who were candidate of tonsillectomy. Patients were divided into two groups of including bipolar cautery (BC) and cold dissection (CD). operation time, intraoperative blood loss, and postoperative bleeding and pain were evaluated in the current study. RESULTS: In both of the CD and BC groups, no significant difference was found in terms of sex and age. The average amount of the intraoperative blood loss in BC group was 14.086 ± 5.013 ml and in CD group was 26.14 ± 4.46 ml (p. v = 0.0001). The mean time of operation in BC group was 19 ± 2.89 min and in CD group was 29.31 ± 5.29 min (p. v = 0.0001). patients were evaluated in terms of pain on the first, third, fifth, and seventh days after the operation. No statistically significant difference was found between two groups. Moreover, Compared pain scores in all times across two groups, no significant difference was found. In terms of postoperative bleeding, none of the patients in both groups had bleeding during follow-up. CONCLUSION: Our study showed that bipolar electrocautery tonsillectomy can significantly reduce the operation time and intraoperative blood loss; however, postoperative pain and blood loss were similar in both techniques. We recommend bipolar electrocautery as the most suitable alternative method for tonsillectomy, especially in children.

Effect of Topical Furosemide on Intraoperative Bleeding During Functional Endoscopic Sinus Surgery.

Intraoperative bleeding reduction during functional endoscopic sinus surgery is a key factor in preventing surgery complications. That is implemented through prescribing systemic corticostroid before surgery. This study aimed to explore an efficient nasal Furosemide versus systematic corticosteroids to reduce intraoperative bleeding.

The role of diet in the management of non-ulcer dyspepsia.

BACKGROUND Dyspepsia is a common symptom with an extensive differential diagnosis and a heterogeneous pathophysiology. Many studies have reported that dyspeptic symptoms are associated with ingestion of some foods. Current treatments for functional dyspepsia have generally ignored the potential role of diet. METHODS This cross-sectional study was done at the Gastroenterology Department of Shahid Sadoughi Hospital, Yazd, Iran from September 2008 to March 2009. Based on the diagnostic criteria for functional dyspepsia symptoms presented to outpatient gastroenterology clinics, adult patients were invited to participate in this study. Upper GI endoscopy was performed in all the patients so as to rule out any gross pathology. The patients were asked about a list of nutrients including 114 foods which is commonly used in our area. Then, the effects of specific foods were identified on the relief or aggravation of the symptoms with four degrees: low, medium, high, and very high. RESULTS Of 384 patients, 152 were men and 231 were women with a mean ± SD age of 39.16±14 years (range: 13-80 years). The foods that caused the highest aggravation of symptoms were sausage and bolognas, pickles vinegar, soft drinks, grain, tea, salt, pizza, watermelon, red pepper, and macaroni. However, the most frequent foods that led to the alleviation of symptoms were apples, rice, rock candy, bread, caraway seed, dates, honey, yogurt, quince, and walnut. CONCLUSION This study shows that some foods, especially spicy, pickled, and high-fat foods, strongly induced dyspepsia and aggravated the symptoms in dyspeptic patients.