Breast Cancer Survivors and COVID-19: Prevalence and Risk of Severe Disease in a Screening Study.

Background: Determining the risk of severe course coronavirus disease 2019 (COVID-19) and its related factors in survivors of common cancers such as breast cancer is important. This study has been designed to evaluate the prevalence of COVID-19 infection in breast cancer survivors and also estimate the risk of severe disease in this population. Methods: Out of 6134 patients in the Shiraz Breast Cancer Registry (SBCR), A total of 292 patients who elapsed less than a year from their breast cancer diagnosis were excluded. We called 5842 patients. Finally, 4135 breast cancer survivors who agreed to cooperate were screened for COVID-19 symptoms by a symptom-based questionnaire in November 2020. COVID-19 in symptomatic participants was confirmed by a polymerase chain reaction (PCR) test. The clinical and paraclinical data of the COVID-19 course were collected for patients with a positive PCR test. Results: A total of 247 (5.9%) participants had at least reported one of the COVID-19 symptoms. Also, 17% of symptomatic participants had a positive PCR test; 83.7% had mild disease, 9.5% moderate, and 16.7% had severe conditions. Chronic cardiovascular disease, hypertension, and diabetes were related to an increased risk of severe illness ( P = 0.018, P = 0.018, P = 0.002). Conclusion: This study suggests that breast cancer intermediate and longtime survivors without other underlying diseases are considered at low risk for developing severe/critical COVID-19.

Comparison of volatile/inhalational and IV anesthesia in long-term survival of patients with breast cancer: a retrospective study.

OBJECTIVE: Breast cancer is a worldwide health concern, and surgical removal has remained the preferred therapeutic option in most patients. Furthermore, the current study was designed to investigate the disease-free survival and overall survival in breast cancer patients, who receive either propofol or isoflurane during operation. METHOD: This retrospective study was conducted on 994 patients (IV group, n = 530; volatile/inhalational group, n = 464) who underwent breast cancer operation from January 2006 to December 2016 at Faghihi Hospital, Shiraz, Iran. All studied patients were followed up till 2020. Patients are classified into two groups, IV and volatile/inhalational, according to the received anesthesia. For statistical analysis, The Cox regression test was conducted to investigate the association between factors affecting the recurrence of the disease and the Log Rank test was utilized to assess the patients' survival. Finally, to reduce the effect of confounding factors, all patients were matched according to age, tumor size and tumor grade. RESULTS: Based on results from the log-rank test, the volatile/inhalational group had a better recurrence-free survival (P = 0.039) compared to the total IV group. However, the overall survival was not considerably different (P = 0.520). CONCLUSION: The current study showed that although 2-year disease-free survival is higher in the volatile/inhalational group, there is no meaningful association between the 5-year overall survival and anesthesia technique.

Inter sphincter rectal resection with and without Malone ante grade continence enema in cases with low rectal cancer: A randomized, prospective, single-blind, clinical trial.

Background: Fecal incontinence is the main morbidity of inter-sphincteric resection (ISR) in ultra-low rectal cancer. Malone Ante grade Continence Enema (MACE) has been proposed for these patients. We aimed to compare the quality of life outcomes in cases with ultra-low rectal cancer who had undergone ISR±MACE. Methods: The current randomized clinical study was accomplished for two years from December 2016 to February 2018 in Imam Khomeini Hospital (Sari City, I.R.Iran) on 30 patients (15 in each group) with rectal cancer. The inclusion criteria of the study were stage 1 and 2a of low rectal cancer with type 2 and 3 of Rullier's classification, those who received neoadjuvant chemo radiotherapy. The exclusion criteria were comorbidity diseases, immune deficiency, poor follow-up. The follow-up period was one year. The Quality of Life (Qol) was reported as primary endpoint. The EORTC QLQ-C30 score and Wexner questionnaires were used. SPSS Version 22 was used. A p-value less than 0.05 was considered statistically significant. Results: The mean age of patients was 56.23± 8.72 years. The overall Qol score was better in the ISR-MACE (P=0.023). The overall Qol was lower in women than in men in both groups. Low anterior resection syndrome score was lower in the ISR plus MACE group than the ISR group (P=0.030). The Wexner score revealed better scores in the ISR with MACE group than the ISR without MACE group (p<0.0001). Conclusion: Patients who underwent ISR plus MACE surgery had better defecation control and better quality of life than patients without MACE.

Intraoperative radiation therapy for early stage breast cancer.

BACKGROUND AND OBJECTIVE: We report our experiences with Intraoperative radiation therapy (IORT) among breast cancer (BC) patients in our region. METHODS: All patients who received radical IORT from April 2014 on to March 2020 were included in the study. Patient selection criteria included: Age equal or older than 45 years old; All cases of invasive carcinomas (in cases of lobular carcinomas only with MRI and confirmation); Patients who were 45-50 years old with a tumor size of 0-2 cm, 50-55 years old with a tumor size of < 2.5 cm, and those who were ≥ 55 years old with a tumor size of < 3 cm; Invasive tumors only with a negative margin; Negative nodal status (exception in patients with micrometastasis); A positive estrogen receptor status. Primary endpoints included death and recurrence which were assessed using the Kaplan-Meier method. RESULTS: Overall, 252 patients entered the study. Mean (SD) age of patients was 56.43 ± 7.79 years. In total, 32.9% of patients had a family history of BC. Mean (SD) tumor size was 1.56 ± 0.55 cm. Mean (IQR) follow-up of patients was 36.3 ± 18.7 months. Overall, 8 patients (3.1%) experienced recurrence in follow-up visits (disease-free-survival of 96.1%), among which four (1.5%) were local recurrence, two (0.8%) were regional recurrence and two patients (0.8%) had metastasis. Median (IQR) time to recurrence was 46 (22, 53.7) months among the eight patient who had recurrence. Overall, one patient died due to metastasis in our series. Eleven patients (4.3%) with DCIS in our study received IORT. All these patients had free margins in histopathology examination and none experienced recurrence. CONCLUSION: Inhere we reported our experience with the use of IORT in a region where facilities for IORT are limited using our modified criteria for patient selection.

Prognostic value of increased postoperative carcinoembryonic antigen in patients with early intestinal anastomosis leakage who underwent right hemicolectomy surgery.

<b> Introduction:</b> Anastomotic leak after colorectal surgery is a serious complication that causes significant postoperative morbidity and mortality. </br></br> <b>Aim:</b> This study aimed to investigate the predictive value of increased postoperative carcinoembryonic antigen (CEA) in early intestinal anastomosis leakage in patients who underwent right hemicolectomy surgery.</br></br> <b>Material and methods:</b> In this prospective study, 535 patients who underwent right colon cancer surgery with stapled anastomosis were enrolled. A subset of 315 patients was included in the study after meeting the inclusion criteria. Preoperatively, their serum CEA levels were measured, and on postoperative days 3 and 6, the levels were measured again.</br></br> <b>Results:</b> Early AL occurred in 18 patients (5.71%). The mean SD age of patients was 65.06 11.69 years. Increased CEA level was associated with increased odds of intestinal AL among the patients after three and six days of surgery (OR after three days = 1.3; 95%CI = 1.11.5, OR after six days = 1.7 95%CI = 1.142.5). The mean CEA level significantly increased among patients with anastomose leakage (P-value < 0.001). </br></br> <b>Conclusion:</b> The results showed that increasing CEA levels can be used as one of the non-invasive markers in detecting early AL in patients with right colon cancer surgery.

Surgical Management of Intestinal Failure; Initial Experiences from an Intestinal Failure, Rehabilitation and Transplant Unit in Iran.

BACKGROUND: Intestinal failure (IF) is a life-threatening medical condition. The management of IF in low- and middle-income countries without home parenteral nutrition (HPN) remains unclear. We recently established an intestinal rehabilitation unit (IRU) and aimed to provide our experience on the current management and outcomes of IF in Iran. METHODS: In this cross-sectional case series, data were collected from an established database on IF in the Shiraz Transplant Center in Abu Ali Sina hospital, affiliated to Shiraz University of Medical Sciences, Iran from January 2018 to October 2018. RESULTS: Overall, 30 patients with a mean age of 44.13 ± 10.32 years, which included 25 males, were recruited. Short bowel syndrome (SBS) (60%) and enterocutaneous fistulae (27%), as complication of previous surgeries, were the main causes of IF. The most common type of IF was type 3 (67 %). Mesenteric ischemia was the leading mechanism of IF (47%). Fifteen patients (50%) received autologous gastrointestinal reconstruction surgery (AGIRS), and two (7%) patients had serial transverse enteroplasty (STEP). At the end of follow-up, 15 patients recovered from IF (50%). The overall survival rate was 83.3%. CONCLUSION: This series introduced the results of a multidisciplinary program for the treatment of IF in a middle-income country that lacks facilities for HPN. Our protocol of care, understanding the need for development of HPN, showed promising clinical outcomes.

Local Tranexamic Acid for Local Hemostasis in an Animal Liver Injury Model.

BACKGROUND: Hyperfibrinolysis is a state of increased clot resolution often seen in trauma patients with ongoing hemorrhage. Tranexamic acid (TXA) inhibits fibrinolysis preventing clot resolution affecting hemorrhage continuation and is used by intravenous administration. AIMS: The purpose of this study was to evaluate the local tranexamic acid application for hemostatic control in an experimental animal liver injury model. SETTINGS AND DESIGN: This study was an experimental prospective treatment study to check the local TXA effects on liver injury. This study was approved by the Ethics Committee. MATERIALS AND METHODS: Twenty adult male Sprague-Dawley white rats were equally randomized to two groups after a standardized liver injury was conducted under anesthesia. One group were "liver-packed" with gauze (TXA [-]) and the other group with gauze soaked in TXA (TXA [+]). Bleeding from the injured middle liver lobe was measured at 2 and 15 min, and at 48h second-look surgery, with euthanasia conducted at 14 days. The liver was sent for histopathological and stereological analysis. STATISTICAL ANALYSIS AND RESULTS: There was no difference in bleeding at 2 or 15 min after packing; however, larger amount of free blood at 48 h in the TXA (-) group was noticed. Five animals in the TXA (-) were alive at 14 days compared to eight animals in the TXA (+) group. Significantly larger volume density of fibrosis, granulation tissue, and amorphous tissue were seen in the TXA (+) group compared to the TXA (-) group at the stereological analysis. CONCLUSION: Local TXA application on the injured liver surface might offer better hemostatic control than packing alone. Further studies are mandated before the clinical application of our findings.

Intraoperative radiation therapy in non-breast cancer patients: A report of 26 cases from Shiraz, south of Iran.

Background: Intraoperative radiation therapy (IORT) is the delivery of radiation at the time of surgery. Whereas the dose delivered by external beam radiation therapy (EBRT) is limited by the tolerance of the surrounding normal tissues, IORT allows exclusion of a part or all of the dose-limiting sensitive structures by operative mobilization and/or direct shielding of these structures. The aim of the present study was to report the non-breast cancer patients' outcomes after receiving IORT in Shiraz, Iran. Methods: In this retrospective study, all cases who had received IORT and had non-breast malignancies were selected. Diagnosis was confirmed by biopsy. Additional imaging was done by sonography, magnetic resonance imaging (MRI) and computed tomography (CT). IORT was applied by self-shielded, LIAC 6-12 MeV Sordina mobile linear accelerator. Typically, a single dose of 10-21 Gy was given for maximally resected tumors. The statistical analyses were carried out using SPSS (version 21). Results: Twenty-six patients were treated with IORT alone or combined with EBRT. Different tumors were treated, including colorectal adenocarcinoma (10 cases, 38.4 %), Soft Tissue Sarcomas (STS, 11 cases, 42.3 %), head and neck cancers (3 cases, 11.5 %), one cervix malignancy case and one paravertebral fibromatosis case. Mean ± SD overall survival was 15±14.89 (0-38) and 34.3±15.72 (14-53) months for colorectal cancer and STS, respectively. Conclusion: IORT is mostly useful for pelvic and abdominal malignancies where normal bowel limits the dose that can be delivered with EBRT. However, the dose delivered in a single fraction with IORT is rarely sufficient for tumor control; therefore, IORT is usually preceded or followed by additional EBRT which should be further evaluated preferably in prospective randomized trials.

Guideline for Management of Mesenteric Ischemia: Shiraz Intestinal Failure Unit Protocol.

We have recently established an intestinal rehabilitation unit (IRU) in Abu Ali Sina transplantation center affiliated to Shiraz University of Medical Sciences, Iran. Our intestinal failure rehabilitation and transplant program aims to provide state-of-the-art care for adult patients with different degrees of intestinal insufficiency and failure. In the IRU, we aimed to design an algorithmic approach to patients with small bowel ischemia and short bowel syndrome (SBS) based on our institutional experience in our country and based on other pioneering studies from other regions of the world.

The effect of silicone gel versus contractubex gel on the upper-extremity postsurgical scars: A randomized, double-blinded, controlled trial.

Background: Wound healing is a process that has three overlapping inflammatory, proliferative, and reconstruction phases. Silicone gel and Contractubex (onion extract gel) are two main topical agents used for the prevention and treatment of hypertrophic scars. This clinical trial study aimed to evaluate the efficacy and safety of onion extract and silicone gel on hypertrophic scars of the upper extremity and compare it to non-treated patients. Methods: This randomized, double-blind, parallel, clinical trial was done on 120 male patients who had undergone upper extremity sharp injury repair. Patients were assigned to three groups, i.e., Silicone gel (Kelo-cortTM; WA, USA) (group 1; 40 patients), Onion extract (ContractubexTM, Merz Pharma, Frankfurt, Germany) gel (group 2; 40 patients), and No Intervention (group 3; 40 patients), using drawing sealed envelopes and a computer-based table of randomization. Data were recorded using the Vancouver scale in each visit by two surgeons who were blinded to the study groups. IBM SPSS Statistics for Windows, Version 22.0. (Armonk, NY: IBM Corp). Data were compared using the ANOVA test. A P-value of less than 0.05 was considered statistically significant. Results: Vascularity (p=0.200), pliability (p=0.058), pigmentation (p=0.701), and height (p=0.438) as subjective scar parameters were approximately similar in post-upper extremity sharp injury wound hypertrophic scar among the three groups. Conclusion: Vascularity, pliability, pigmentation and height, as subjective scar parameters, were not statistically different in post-upper extremity sharp injury wound hypertrophic scar among the groups. Even though onion extract gel and Silicone gel show preventive effects in the literature, especially in burns wounds, further studies are recommended to be conducted to prove the topical effects of above-mentioned gels in patients.

A review of the application of cellulose hemostatic agent on trauma injuries.

INTRODUCTION: Planning for management of bleeding in trauma injuries is very important. The initial purpose in emergency situations should be immediate establishment of an efficient hemostasis, principally in its topical application. In this study, we aimed to review the major relevant articles in the case of application of cellulose hemostatic agent on trauma injuries. METHODS: We searched the online databases such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, and Scopus. Two reviewers independently searched and assessed the titles and abstracts of all articles. RESULTS: Upon screening the titles and abstracts, 24 studies were identified for full-text review. The oxidized cellulose had the best clotting times, while it demonstrated low absorption ability. Surgical and thermosensitive chitosan hemostatic could be valuable for managing hemorrhage from liver injuries in trauma patients. CONCLUSION: Recently, the application of cellulose hemostatic agents has been one of the main improvements obtained for controlling bleeding in trauma injuries. However, generally according to the literature review, the decision about using each agent should be made on a case-by-case basis. However, it can be mentioned that the perfect hemostatic agent has not been still identified.

Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study.

PURPOSE: Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD. METHODS: A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study. RESULTS: Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group. CONCLUSION: Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

Effects of Early Versus Delayed Excision and Grafting on Restoring the Functionality of Deep Burn-Injured Hands: A Double-Blind, Randomized Parallel Clinical Trial.

Hand burns have major impacts on daily activities. An interdisciplinary and multifaceted approach is necessary to effectively treat these burns. Generally, hands are common sites for burn injuries. It is known that Early Excision and Grafting (EEG) of deep burn wounds can decrease scar and subsequent contracture formation compared with Delayed Excision and Grafting (DEG) method. Accordingly, this study aimed to compare the effects of these procedures on function of hands with deep burns, by using the Michigan Hand Questionnaire (MHQ). In this double-blind randomized clinical trial, we evaluated a total of 50 patients (age range: 15-70 years) with deep second-degree burns of both hands from January 2013 to December 2015. The subjects were randomly divided into two groups, treatment (EEG) and control (DEG) groups (25 patients per group). They followed up postoperatively for 3 months. MHQ was completed for each of them to determine the function of the hands, pain sensation, limitation of daily activities, overall satisfaction, and cosmetic appearance during follow-up. Data were analyzed in the groups using SPSS version 16. Baseline characteristics of the groups were matched. In early postoperation, hand functions and daily activities, gross appearance, and pain sensation were better in EEG group. After 1 and 3 months, no significant difference was detected between the groups except for patient satisfaction which was better in EEG group. Also, EEG group was associated with a significant shorter hospital stay and lower treatment costs compared with DEG group. Graft take rate was similar in both groups. EEG is recognized as the standard treatment for deep skin burns, but we did not find any significant difference between effects of EEG and DEG on hand functions although EEG group had shorter hospital stay and lower treatment costs compared with DEG. The main goal of treatment of hand burns is restoration of the hand functions. Based on our findings, hand function was not related to the type of surgery. Also, as all wounds in both surgical groups healed less than 3 weeks, the authors suggest that the excision time limit could be change in our burn center from 10 days to 2 to 3 weeks when we use sheet graft as for hands.

Stereological Comparison of Imbibed Fibrinogen Gauze versus Simple Gauze in External Packing of Grade IV Liver Injury in Rats.

OBJECTIVE: To evaluate the effect of imbibed fibrinogen gauze on survival, bleeding and healing in liver trauma. METHODS: This animal experimental study was conducted on 20 adult male Sprague-Dawley rats; with a mean weight of 300±50 gram; divided into two groups. Grade IV injury was induced to the subjects' liver. Then, the bleeding site was packed with simple gauze in the control group, and imbibed fibrinogen gauze in the experimental group. All animals were re-evaluated for liver hemostasis 48 hours after the initial injury. Bleeding in the intra peritoneal cavity was measured using Tuberculosis Syringe in the first and second operations. Subjects were followed-up for 14 days. Eventually, the rats were sacrificed and their livers were sent to a lab for stereological assessment. Statistical comparisons were performed via Mann-Whitney U-test using SPSS. P-Values less than 0.05 were considered to be statistically significant. RESULTS: Half of the rats in the control group died, while all the rats in the imbibed fibrinogen gauze group survived after two weeks (p= 0.032). Bleeding in the imbibed fibrinogen gauze was significantly less than control group, 48 hours' post-surgery (p<0.001). According to the stereological results, granulation tissue in the imbibed fibrinogen gauze group were more than the control group (P= 0.032). Also, fibrosis in the imbibed fibrinogen gauze group were more than the control group (P= 0.014). CONCLUSION: Our study indicated that imbibed fibrinogen gauze can potentially control liver bleeding and improve survival through increasing granulation tissue and fibrosis in injured liver.

Effects of Azelnidipine-Carboxymethylcellulose Gel on Healing of Full-Thickness Skin Wounds in Streptozotocin Induced Diabetic Rats.

OBJECTIVE: To evaluate the effects of azelnidipine-carboxyl methyl cellulose (AZL-CMC) gel and carboxyl methyl cellulose 2% gel (CMC) on the healing of full-thickness skin wounds of diabetic rats. METHODS: Fifteen Sprague Dawley male rats were studied. The rats were divided into three groups: AZL-CMC gel-treated, CMC 2% gel-treated, and control group. Wounds were assessed by wound area measurement every 3 days and histopathology samples were collected at 4, 7 and 12 days post wounding to evaluate the healing process using stereological study. Mann-Whitney U-test repeated measurement and non-parametric one-way analysis of variance (ANOVA) were used to analyze the data using SPSS, version 18. RESULTS: Numerical density of the fibroblasts of the AZL-CMC gel treated group was 59.17±2.69 (×104/mm3) and higher than the control 22.64±1.34 (×104/mm3) and CMC 2%-treated groups 40.80±5.27 (×104/mm3), respectively, P<0.001. The volume density of the collagen bundles and LV of the vessels were 83.1±4.46 and 42.16±5.78, respectively, in the AZL-CMC treated group, and higher compared to the control (53.96±5.07, 9.9±2.49) and the CMC 2%-treated (65.88±2.13, 18.1±2.20) groups (P <0.001). CONCLUSION: The healing of AZL-CMC gel-treated wound was better than the control wounds, grossly. Wound healing processes and wound closure in the intervention group began sooner and was completed more quickly. The quantitative and qualitative parameters showed the significant wound healing effect of the AZL-CMC gel-treated group.

Cytoreductive Surgery and Hyperthermic Intraoperative Chemotherapy for Management of Peritoneal Carcinomatosis.

BACKGROUND: Treatment of peritoneal metastases has gained interest among oncologic communities around the world. Cytoreductive surgery (CRS) and hyperthermic intraoperative chemotherapy (HIPEC) have come to be the treatment of choice for selected patients with peritoneal carcinomatosis (PC) in recent years. Prior to HIPEC, patients were treated with palliative support and only guaranteed a few months to live. We reviewed our first 30 patients who underwent CRS and HIPEC. The aim of the study was assessment of the patients' survival, morbidity, and mortality rate and identifying prognostic factors of patients treated with CRS and HIPEC. METHODS: In this cross-sectional study, data were retrospectively collected from 45 patients (15 men and 30 women) who underwent CRS and HIPEC between December 2008 and October 2016, at Nemaazi educational hospital and Shiraz central hospital of Shiraz University of Medical Sciences. Peri-operative and regular follow-up data on survival and complications were gathered and analyzed to identify their prognostic value for survival. RESULTS: The mean age of the patients was 49.7±16.46 years. The participants in this study consisted of 19 females (63.3%) and 11 males (36.7%). The most common primary tumor was ovarian cancer (30.1%). A completeness of cytoreduction score of CC0/CC1 was obtained in 80% of patients operated on with curative intent. The overall mortality rate was 20%. The 1- and 4-year overall survival (OS) were 89% and 54%, respectively. CONCLUSION: CRS and HIPEC are most successful in treatment of selected patients. Development of complete resection with CRS in these 8 years and good OS in our patients encourage us to continue the procedure with all its difficulties and cost.

Inferior Vena Cava Reconstruction by Gallbladder Patch: An Experimental Design.

OBJECTIVE: To evaluate the efficacy of the gallbladder for reconstruction of the inferior vena cava in a canine model. METHODS: The experimental study was conducted on 5 dogs; an oval window with a diameter of (4×1 cm) was made in the inferior vena cava and then repaired using the autologous gallbladder patch with preservation of gallbladder function. The patency and functionality of the graft were assessed macroscopically and microscopically at 2 months postoperatively. RESULTS: All the dogs were euthanized at 2 months, showing excellent patency of the vena cava macroscopically. In the microscopic examination, all the patches were completely endothelialized. No evidence of infection and inflammation and thrombosis was noted. CONCLUSION: The gallbladder patch is an available and safe alternate for reconstruction of the inferior vena cava at least in animal model. However, further well designed prospective studies are needed to confirm this hypothesis.

Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems.

PURPOSE: Acute appendicitis (AA) is one of the most common causes of an acute abdomen. The accuracies of the Alvarado and the acute inflammatory response (AIR) scores in the diagnosis of appendicitis is very low in Asian populations, so a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) system, was designed recently. We applied and compared the Alvarado, AIR, and RIPASA scores in the diagnoses of appendicitis in the Iranian population. METHODS: We prospectively compared the RIPASA, Alvarado, and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with right quadrant pain. Appendectomies were performed; then, the postoperative pathology reports were correlated with the scores. Scores of 8, 7, and 5 or more are optimal cutoffs for the RIPASA, Alvarado, and AIR scoring systems, respectively. The sensitivities, specificities, positive predictive values, negative predictive values (NPVs), positive and negative likelihood ratios (LRs) for the 3 systems were determined. RESULTS: The sensitivity and the specificity of the RIPASA score were 93.18% and 91.67%, respectively. The sensitivities of the Alvarado and the AIR scores were both 78.41%. The specificities of the Alvarado and the AIR scores were 100% and 91.67%, respectively. The RIPASA score correctly classified 93% of all patients confirmed with histological AA compared with 78.41% for the Alvarado and the AIR scores. CONCLUSION: The RIPASA scoring system had more sensitivity, better NPV, a positive LR, and a less negative LR for the Iranian population whereas the Alvarado scoring system was more specific.