Colorectal Cancer Incidence in Iran Based on Sex, Age, and Geographical Regions: A Study of 2014-2017 and Projected Rates to 2025.

BACKGROUND: While there has been extensive research on colorectal cancer (CRC) incidence and its associated factors in Iran, a significant gap exists in studies predicting its future trends. Our study aimed to thoroughly report CRC incidence across Iran from 2014 to 2017, by sex, age, and geographical regions, and provide a projection for 2025. METHODS: This retrospective study utilized data from the Iranian National Population-based Cancer Registry (INPCR). Patients with the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) codes C18 to C21 were included. The age-standardized incidence rate (ASR), was calculated per 100000 individuals annually, and crude incidence rates were retrieved for various demographic groups and years. RESULTS: Between 2014 and 2017, a total of 43580 new CRC cases (55.96% males) were registered. Men exhibited an ASR of 134.45, while women's ASR was 94.85. The highest ASRs were observed in Tehran, Qom, and Ilam (18.99, 18.26, and 18.06, respectively). Incidence rates surpassed 20 after age 50 for both genders, reaching their peak within the 80-84 age group. Adenocarcinoma was the most frequent histological type of CRC in nearly all provinces. Case numbers and ASRs are projected to continuously rise until 2025, with a predominance of male cases. CONCLUSION: The anticipated increase in CRC incidence in Iran emphasizes the need for additional studies to better identify risk factors. Furthermore, implementing screening programs is recommended for individuals at a higher risk of CRC, including men, the elderly population, and those residing in regions with a notable prevalence of CRC.

Post-traumatic pseudoaneurysm of the descending aorta.

High-energy deceleration injuries of the thoracic aorta are associated with high mortality. But among long term survivors, just 2 %-5 % of traumatic aortic injuries fail initial detection and are discovered later (Pozek et al., 2012 [1]). We present a rare case of pseudoaneurysm of the descending aorta in a female with a history of chest blunt trauma 45 days before who presented with chronic severe cough and vocal hoarseness that was treated with endovascular intervention in our center.

Inguinal hernia: Lichtenstein VS Shouldice technique repair: A randomized controlled trial.

Background: Inguinal hernia repair is the most frequent operation in general surgery. The chance of a person having to undergo an inguinal hernia operation during his/her life is quite high, 27 % in men and 3 % in women. European Hernia Society guidelines state that the Lichtenstein technique (mesh-based repair) is the standard treatment of elective inguinal hernia in adults. Some authors consider the Shouldice technique (tissue-based repair) the best conventional method for open hernia repair. In this study, we compared these two methods. Methods: In This randomized study, 452 patients were randomly allocated into 2 groups. 51 patients were lost during follow-up period and were excluded from further analysis in the study. Finally, the analyzed patients were 183 patients in Shouldice technique group and 218 patients in Lichtenstein technique group. All patients were examined after 1 week, 1, 3 months, 1, 2, and 3 years after the operation date. Results: After 3 years follow up Recurrence of hernia in Shouldice technique group was 7.1 % and in Lichtenstein technique group was 3 % with significant differences (p-value 0.006). No statistically significant differences were found between the groups in wound infection, Seroma, hematoma, Hydrocele, Bladder damage, chronic pain in the inguinal region, and Patient Satisfaction level after surgery. Conclusion: It seems that inguinal hernia treatment by the Lichtenstein technique is better than the Shouldice technique in elective patients.

Evaluation of Clinical Characteristics and Outcomes of Chest Trauma Patients with COVID-19 Infection Undergoing Emergency Surgeries.

BACKGROUND: This study aims to examine the clinical characteristics and prognosis of patients with chest trauma who were infected with COVID-19 and underwent emergency surgery. OBJECTIVE: In light of the COVID-19 pandemic, this research investigates the impact of COVID-19 on patients with chest trauma who underwent emergency surgery. METHODS: This retrospective cohort study was conducted on 56 patients with chest trauma in two groups with COVID-19, and no covid who underwent surgery in Shahid Madani Hospital. RESULTS: Among the trauma patients, 21 were infected with COVID-19, and 35 were not. The predominant causes of trauma were car and motorcycle accidents. Among COVID-19 patients, 3.3% exhibited symptoms of fever, chills, cough, shortness of breath, and gastrointestinal symptoms, while 5.9% had severe lung involvement confirmed by CT scan. Following surgery, 1.57% (12 individuals) of COVID-19 patients were transferred to the ICU, with an average hospitalization duration of 1.11 days. In contrast, the average hospitalization duration for non-COVID-19 chest trauma patients was 1.9 days (p =0.015). CONCLUSION: Patients with chest trauma who underwent surgery and were infected with COVID-19 demonstrated significant differences in average length of stay, ICU admissions, and pneumonia incidence. However, there was no significant distinction in the mortality rate between the two groups.

Evaluating Diagnostic Efficiency of Thyroid Imaging Reporting and Data Systems proposed by the American College of Radiology in Surgically Resected Thyroid Nodules.

AIM: Thyroid nodules are one of the most common clinical findings, with a prevalence of 68% in adults. Thyroid cancer is the fifth most common cancer in women. INTRODUCTION: The purpose of this study is to evaluate the diagnostic efficacy of Thyroid Imaging Reporting and Data Systems proposed by the American College of Radiology (ACR-TIRADS) for the diagnosis of malignancy in surgically resected thyroid nodules. METHODS: In this retrospective study, patients who underwent thyroid nodules resected surgically from 2018-2020 were included. Before resection, an ultrasound was performed for TIRADS scores, and after resection histopathology, thyroid mass was obtained. The outcomes of the two systems were statistically compared. RESULTS: The mean age of the 146 included patients was 47.6 ± 14.08 years, of which 109 (74.7%) were female. Based on TIRADS, 47 patients (32.2%) were in TI-RADS TR3, 36 patients (24.7%) were in TIRADS TR2, 34 (23.3%) in TIRADS 4, 24 (16.4%) in TIRADS TR5 and 5 patients (3.4%) were in TIRADS TR1. The overall sensitivity was 79.9% when ACR-TIRADS TR4 was set as a diagnostic cutoff value. Considering the total of TIRADS TR4 and TIRADS TR5 as predictors of thyroid malignancy, the sensitivity was 74.5% and the specificity was 76.8%. The positive and negative predictive value was 60.3% and 76.8%. CONCLUSION: ACR-TIRADS 4 and 5 can be considered good predictors of malignancy in thyroid nodules. More studies, including larger samples, are required to obtain a better conclusion.

Evaluation of carbohydrate loading on clinical results and metabolic responses in patients undergoing laparoscopic cholecystectomy.

Objective: Insulin resistance is associated with a number of postoperative complication and delays recovery. Carbohydrate rich drinks given preoperatively may decrease these deleterious effects. This study evaluated the clinical effects of a preoperative carbohydrate loading in patients undergoing laparoscopic cholecystectomy. Methods: In this a randomized clinical trial conducted at (XXX) Medical Center located, patients undergoing elective cholecystectomy were included. Patients were randomly divided into fasting and dextrose-receiving groups. The outcomes of this study are the pain, pre- and postoperative blood sugar, fasting blood sugar, insulin, cortisol, albumin, CRP (c-reactive protein), and wound conditions such as wound infection and the amount of fluid discharge from the drain. The data was statistically analyzed using SPSS v22. Results: Patients who received carbohydrates before surgery experienced less pain on the day after surgery (P-value <0.05). Insulin resistance, CRP, CRP to albumin ratio and cortisol levels were significantly reduced in dextrose group (P-value <0.05) However, difference in glucose levels and albumin was not significant in the two groups. Conclusion: The present results show that although carbohydrate loading is associated with reduced postoperative pain and reduction in inflammatory factors along with insulin resistance.

Bronchoalveolar lavage of ventilator-associated pneumonia patients for antibiotic resistance and susceptibility test.

BACKGROUND AND AIMS: Ventilator-associated pneumonia is highly prevalent nosocomial infection among patients under mechanical ventilation. Bronchoalveolar lavage (BAL) is effective in identifying the type of pathogen involved and determine the course of antibiotic. The aim of this study was to evaluate the prevalence of different pathogens involved in ventilator-associated pneumonia (VAP) and associated antibiotic resistance and sensitivity pattern. METHODS: In this descriptive cross-sectional study, patients admitted to the intensive care unit under mechanical ventilation at Shahid Madani Educational and Medical Center in Karaj during 2018 and 2020 were included. BAL samples were obtained from the patients. Demographic data, duration of hospitalization, duration of mechanical ventilation, and antibiotic susceptibility and resistance tests were recorded for all the patients. RESULTS: Among 335 patients included in the study, 215 (64.2%) were males. The mean age of the patients was 55.06 ± 14.90 years. The most common pathogens reported were Acinetobacter baumannii (40%), Pseudomonas aeruginosa (21.2%), and Staphylococcus aureus (13.4%). The mean age of the patients, gender, duration of mechanical ventilation, and duration of hospitalization were not associated with the type of pathogen, P > .05, respectively. CONCLUSION: BAL of these patients indicated that various pathogens are responsible for VAP, and can vary from patient to patient. Antibiotic resistance and susceptibility pattern of these pathogens vary and therefore is important in determining the course of the treatment.

Complications in Patients with Cardiac Penetrating Trauma.

BACKGROUND: Cardiac penetrating trauma is a medical emergency that mostly affects young people. Based on the type of injury and associated complications, it can present as a surgical challenge and can lead to mortality. OBJECTIVE: The aim of this study is to evaluate the complications of penetrating heart trauma among patients referred to Shahid Madani Hospital. METHODS: In this retrospective descriptive study, the data of penetrating cardiac trauma patients referred to Shahid Madani hospital, Karaj, Tehran, from 2016-2019, were investigated. Information, including age, sex, cause of trauma, traumatized area and complications, was extracted and recorded in a data collection form. The data were evaluated statistically using SPSS v18. RESULTS: A total of 44 patients were included in the study, where the mean age of the patients was 25 years. 73.3% of these patients were men and 26.7% were women. Knife stab wounds were the most prevalent cause of the trauma, present in 93.3% of patients. 73.3% of the patients had cardiac tamponade and 20% had a pneumothorax. The right ventricle was the most common site of the injury in 46.7% of the patients. A mortality rate of 3.4% was reported in this study. CONCLUSION: The results of this study showed that the highest penetrating heart rate trauma occurred among young people, and the most common cause of the trauma was a knife stab. The most common area of the injury was the right ventricular, and cardiac tamponade was the most common complication.

Using new technicque in sigmoid volvulus surgery in patients affected by COVID19.

INTRODUCTION: Coronavirus pandemic-initiated Wuhan city, Hubei Province, China. It mainly involves respiratory system and cause fever, cough. However, it has other manifestations such as GI system, CNS and skin involvement. It is transmitted mostly through respiratory system, but some researchers claim that in can potentially spread by oral, fecal or intestinal gas. During colorectal surgeries such as volvulus sigmoid, surgeons are at risk of exposure to intestinal gas. CASE PRESENTATION: A 57-year-old mentally retarded man came to our emergency department with complain of abdominal pain, constipation, obstipation, nausea, vomiting and abdominal distention. His vital sign was stable and his laboratory data revealed no abnormality. His abdominal x-ray showed intestinal obstruction with suspicious of sigmoid volvulus. His PCR for COVID 19 was positive and his chest CT scan has manifestations of lung involvement. He was proceeded for surgery. CONCLUSION: Owing to odds of spread of coronavirus through intestinal gas, in this case, sigmoid colon was removed without evacuation of intestinal gas.

A retrospective study on the cardiac assessment of isolated sternal fracture patients based on radiographic and clinical outcomes.

OBJECTIVE: Sternal fracture may be associated with major and serious injuries. In this study, the complications associated with isolated sternal fracture in trauma patients are evaluated based on radiographic and cardiac findings. METHODS: This retrospective study was performed on patients with isolated sternal fractures admitted to the emergency department of (XXX) Madani Educational-Medical. Data regarding demographic information, mechanism of trauma, length of hospitalization, electrocardiography (ECG), cardiac enzyme, and chest radiography were recorded in the questionnaire for each patient. RESULTS: The mean age of patients 41.2 + 11.04 years and 63.9% were male. The most common cause of the trauma was car accidents in 41% (25 cases). The mean duration of hospitalization was 1.54 ± 0.90 days. The mechanism of trauma was not associated with x-ray and computed tomography findings, p = 0.53 and p = 0.86, respectively. ECG findings were significantly related to x-ray and computed tomography outcomes, p < 0.001, respectively. CONCLUSION: Patients with isolated sternal fracture with displacement >0.5 cm and hematoma are likely to require cardiac consultation.

Diagnostic Value of Fine-Needle Aspiration Biopsies and Pathologic Methods for Benign and Malignant Breast Masses and Axillary Node Assessment

Bacground: The goal of this study was to evaluate the fine needle aspiration (FNA) preoperatively together with Touch Print, Crush Print, frozen section and pathologic methods to reach a diagnosis for patients with breast and axillary masses. Methods: This study was conducted on 107 patients, and included 111 samples of breast and 43 of axillary masses taken at surgery. Data on epidemiological and clinical features of the patients were collected using a questionnaire. The results of the methods of FNA, Touch Print, and Crush Print were compared with the results of pathology after operations. Results: Comparison between the diagnosis values of FNA with pathology for breast cancer showed sensitivity, sensitivity, positive predictive values, negative predictive values, positive mendacious percentages, and negative mendacious percentages of 80.4%, 98%, 97.3%, 87.6%, 2%, and 19.6% , respectively, and for metastatic axillary lymph nodes, 80%, 95.6%, 94.1%, 84.6%, 4.4%, and 20%. Comparison of diagnosis values of FNA with Touch Print and Crush Print for breast cancer gave values of 82.2%, 89%, 97.3%, 89%, 1.6%, and 17.8%, respectively, and for metastatic axillary lymph nodes 84.2%, 95.8%, 94.1%, 88.4%, 14.2%, and 15.8%. Conclusion: Use of these methods, compared with pathology, can decrease cost, time, and a need for a second surgery and related complications.

A Comparison between the Tie-over and Closed Suction Drainage Therapeutic Strategies in Patients Suffering from Sacral Pilonidal Sinus.

BACKGROUND AND OBJECTIVES: Pilonidal sinus is a disease in the sacrococcygeal region diagnosed through the purulent discharges of the above-said region. Although the exact pathology and etiology of those suffering from pilonidal is not clear yet, the presence of hair seemingly plays a major role in the process of infection and the granulation tissue. Several techniques have been identified for pilonidal surgery. These techniques primarily fall within two categories: Primary repair and Lay open. One of the setbacks of the primary repair method is the creation of a dead area under the wound which can result in blood accumulation and seroma. To solve the problem of removing the dead space, there are two solutions. The first method utilizes a close suction drain, when the wound discharges are over, the drain is removed. The second technique is called Tie-over where different layers of the wound are pushed close to one another and the dead region vanishes. The present research seeks to compare Tie-over and Closed Suction Drainage methods through random clinical trial in order to introduce the superior technique for faster recovery and reduction of the economic load on the patient. METHODS: Some 64 patients suffering from sacral plonidal sinus aging from 15 to 50 in Shohadaye Ashayer Hospital of Khoram Abad in 2013 were selected for the research based on the inclusion criteria. The demographic information of them was collected through questionnaires. The patients were randomly divided into two groups undergoing (A) Tiover and (B) Closed Suction Drainage surgeries. Other information such as return to normal activity and total recovery time was also completed through the questionnaire. SPSS software was used to conduct statistical analysis. RESULTS: The results of the statistical analysis showed that the two groups were similar to one another in terms of age, gender, marital status, job, and literacy. A significant difference was observed only between the level of satisfaction (P-value = 0.035) in groups A and B concerning the factors studied after the operation. The post-operation recurrence of pilonidal sinus among those who smoked cigarettes and had undergone Closed Suction Drainage was significantly greater than the non-smokers (P-value=0.011). As of the group undergoing Tie-over surgery, the difference between the patients' satisfaction in terms of their age was statistically significant and the highest level of satisfaction was observed among those aging 25 to 34 (90%) (P-value=0.023). CONCLUSION: In sacrococcygeal pilonidal cyst surgery, no difference was observed except for the difference in the level of satisfaction. More satisfaction was observed using the Tiover method.