The Impact of Early Brain-Dead Donor Detection in the Emergency Department on the Organ Donation Process in Iran.

We aimed to assess the impact of hospital characteristics on the outcomes of detected possible brain-dead donors, in our organ procurement network in Iran. Data was collected through twice-daily calls with 57 hospitals' intensive care units and emergency departments over 1 year. The donation team got involved when there was suspicion of brain death before the hospital officially declared it. The data was categorized by hospital size, presence of neurosurgery/trauma departments, ownership, and referral site. Out of 813 possible donors, 315 were declared brain dead, and 203 were eligible for donation. After conducting family interviews (consent rate: 62.2%), 102 eligible donors became actual donors (conversion rate: 50.2%). While hospital ownership and the presence of trauma/neurosurgery care did not affect donation, early referral from the emergency department had a positive effect. Therefore, we strongly recommend prioritizing possible donor identification in emergency rooms and involving the organ donation team as early as possible. The use of twice-daily calls for donor identification likely contributed to the consistency in donation rates across hospitals, as this approach involves the donation team earlier and mitigates the impact of hospital characteristics. Early detection of possible donors from the emergency department is crucial in improving donation rates.

Biomarkers for Oral Squamous Cell Carcinoma (miR-24, miR-200, and miR-34): Screening and Detection MicroRNA.

INTRODUCTION: Oral squamous cell carcinoma (OSCC) includes about 90% of all oral malignant tumors, and most of them are diagnosed in advanced stages. This study investigated the expression changes of miR-24, miR-200, and miR-34 in saliva samples of patients with oral squamous cell carcinoma, for early diagnosis. METHODS: In this study, 30 patients and 30 healthy individuals were selected. After RNA extraction and cDNA synthesis, the expression levels of miR-24, miR-200, and miR-34 in saliva samples were measured and evaluated using the Real-Time PCR technique. RESULTS: Folding change calculation using 2^(-∆∆ Ct) refers to the relative difference in the expression of the markers of the two groups. The expression level of two biomarkers, miR-200 and miR-34, is decreased in patients compared to healthy people; and the expression level of miR-24 is increased in patients compared to healthy people. CONCLUSION: In general, considering the availability and convenience of saliva sample collection for early detection of the disease, this research result can be considered a diagnostic screening test. To further prove the research results, conducting more extensive studies with more samples is recommended.

Abdominal pain in a young lady with inverted Meckel's diverticulum: a case report.

Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract which is located in small bowel within 2 feet of the ileocecal valve. Nevertheless, an inverted Meckel's diverticulum is an uncommon condition believed to result from aberrant peristalsis in that specific area. This article showed signs, symptoms, and possible clinical presentations using CARE guidelines in a case of inverted Meckel's diverticulum and reviews other possible features lastly, definitive treatment, results, and case follow-up were shown to refresh, and raise surgeons' awareness of this rare disorder.

Successful Surgical Management of Ruptured Hepatic Artery Pseudoaneurysm Post-Liver Retransplant: A Case Report.

INTRODUCTION: Hepatic Artery Pseudoaneurysm (HAP) is a rare and potentially fatal complication following liver transplantation, with unclear etiology. Various predisposing factors, including local infections, biliary-enteric anastomosis, particularly Roux-en-Y hepaticojejunostomy, vascular interventions, and iatrogenic injuries, have been identified. PRESENTATION OF CASE: We report a case of HAP occurring after liver re-transplantation in a twenty-year-old male patient who had initially undergone liver transplantation for cirrhosis resulting from autoimmune hepatitis. Subsequently diagnosed with chronic ischemic liver disease accompanied by diffuse cholangiopathy and a liver abscess, the patient underwent a liver re-transplantation. Within the early days post-re-transplantation, the patient presented symptoms of gastrointestinal bleeding and sudden hypotension. A high clinical suspicion led to prompt laparotomy, ultimately successful preserving both the graft and the recipient's life. DISCUSSION: HAP is an uncommon complication following liver transplantation. This condition may remain asymptomatic until the rupture of the HAP, which can result in gastrointestinal bleeding, hypotension, and, eventually, mortality. While there have been emerging non-surgical techniques proposed for HAP treatment, surgical intervention remains the definitive solution for preserving the graft and ensuring the recipient's survival. CONCLUSION: HAP, while uncommon, represents a life-threatening complication post-transplantation. In the event of rupture, immediate intervention is imperative for the patient's survival. Hence, it is critical for surgeons to be cautious about this complication, recognize its symptoms, and be aware of associated risk factors.

Reoperation etiologies in the initial hospital stay after liver transplantation: a single-center study from Iran.

Background: Liver transplantation (LT) is widely recognized as a life-saving therapy for patients with end-stage liver disease. However, due to certain posttransplant complications, reoperations or endovascular interventions may be necessary to improve patient outcomes. This study was conducted to examine reasons for reoperation during the initial hospital stay following LT and to identify its predictive factors. Methods: We evaluated the incidence and etiology of reoperation in 133 patients who underwent LT from brain-dead donors over a 9-year period based on our experiences. Results: A total of 52 reoperations were performed for 29 patients, with 17 patients requiring one reoperation, seven requiring two, three requiring three, one requiring four, and one requiring eight. Four patients underwent liver retransplantation. The most common cause of reoperation was intra-abdominal bleeding. Hypofibrinogenemia was identified as the sole predisposing factor for bleeding. Frequencies of comorbidities such as diabetes mellitus and hypertension did not differ significantly between groups. Among patients who underwent reoperation due to bleeding, the mean plasma fibrinogen level was 180.33±68.21 mg/dL, while among reoperated patients without bleeding, it was 240.62±105.14 mg/dL (P=0.045; standard mean difference, 0.61; 95% confidence interval, 0.19-1.03). The initial hospital stay was significantly longer for the reoperated group (47.5±15.5 days) than for the non-reoperated group (22.5±5.5 days). Conclusions: Meticulous pretransplant assessment and postoperative care are essential for the early identification of predisposing factors and posttransplant complications. In order to enhance graft and patient outcomes, any complications should be addressed without hesitation, and appropriate intervention or surgery should not be delayed.

Investigating the Coronavirus Disease 2019 Process and its Related Occurrences during the Treatment Course.

Background: The disease process involves the occurrences happening during the disease and treatment course for the patient. Investigating this process is a significant and necessary issue for all diseases, including coronavirus disease 2019 (COVID-19). Materials and Methods: Using the information of 4372 patients with COVID-19 referring to Dr. Masih Daneshvari Hospital in Tehran during the COVID-19 epidemic, being hospitalized, cared for, and home quarantined due to having mild symptoms, the COVID-19 process and its related occurrences were investigated during the treatment course. Results: In the COVID-19 course, considering the disease severity, the likelihood of hospitalization in the general ward or the intensive care unit (ICU) ward, the likelihood of isolation or home quarantine, and the likelihood of occurrences such as recovery or death at the end of the disease course were taken into consideration. Based on the results of this study, the likelihood of hospitalization in the general ward, the ICU ward, and isolation or home quarantine was determined to be approximately 49.54%, 14.73%, and 35.73%, respectively. Also, for patients hospitalized in the general ward, the ICU ward, and isolated or home quarantined, the likelihood of recovery was estimated at approximately 64.79%, 10.82%, and 96.31%, respectively, and the likelihood of death was also estimated at about 35.21%, 89.18%, and 3.69% respectively. Conclusion: Investigating the COVID-19 process and estimating the likelihood of incidence of its related occurrences during the treatment course both create an accurate prognosis and provide the possibility of achieving an efficient treatment for these patients.

A Single-Center Report on Liver Transplantation: First Experiences from Shahid Beheshti University of Medical Sciences.

BACKGROUND In the Middle East, data on liver transplantation (LT) are limited, and reports on LT from this region are of specific value. The purpose of this study is to report our 8-year experiences and challenges with LTs in our center to improve the outcomes. METHODS 116 patients received whole organ graft from deceased donors, and orthotopic liver transplantation was performed at Taleghani hospital, between January 2009 and July 2017. The patients were prioritized according to Model for End-Stage Liver Disease (MELD) score and Child-Pugh classification. RESULTS The most common postoperative complication was sepsis (16%), although the most common surgical post LT complication was postoperative bleeding. The most common cause of death was primary graft dysfunction (21.9%). Following LT, 50% of the deaths (n = 16) occurred during the first 10 days. Cumulative survival rates were 78.4%, 77.6%, and 66.7% at 1 month, 1 year, and 5 years, respectively. CONCLUSION This report provides invaluable experience from a region where data on LT is largely missing due to the absence of official registration programs. The data could be used to improve the LT program in the region.

Concurrent Occurrence of Tumor in Colon and Small Bowel following Intestinal Obstruction: A Case Report and Review of the Literature.

An intestinal obstruction occurs when either the small or large intestine is partly or completely blocked so it prevents passing the food or fluid through the small/large bowel. This blockage is due to the existence of a mechanical obstruction such as foreign material, mass, hernia, or volvulus. Common symptoms include cramping pain, nausea and vomiting, changes in bowel habits, inability to pass stool, and lack of gas. We present a case of an 83-year-old man who had been referred to Taleghani Hospital with symptoms of bowel obstruction. He underwent the surgery. The findings of exploration of the entire abdomen showed two types of mass separately in two different organs. In postoperative workup, pathology reported two types of tumors (adenocarcinoma and neuroendocrine tumors).

First successful combined heart and kidney transplant in Iran: a case report.

Combined heart and kidney transplant has become an accepted therapy for patients with coexisting heart and kidney failure. This method, compared with single-organ transplant, has a better outcome. Here, we report the first successful combined heart and kidney transplant in Iran. The patient was a 36-year-old man with end-stage renal disease owing to IgA nephropathy, admitted to Masih Daneshvari Hospital in Tehran, Iran for progressive dyspnea and chest pain. In-patient evaluations revealed cardiomyopathy leading to end-stage heart failure. Owing to concurrent heart and kidney end-stage diseases, combined cardiorenal transplant was done. Eight months after his transplant, routine follow-ups have not shown any signs of acute rejection. He is now New York Heart Association functional class I. Both cardiac and renal functions are within normal ranges. Good outcome during follow-up for this case justifies simultaneous heart plus kidney transplants as an alternate treatment for patients with advanced disease of both organs.

Pancreas transplantation in shiraz organ transplant center; the first Iranian experience.

BACKGROUND: Pancreas transplantation is the treatment of choice for selected patients with type 1 diabetes mellitus. We reviewed our first 40 patients who underwent pancreas transplantation in Shiraz Organ Transplant Center. METHODS: Between April 2006 and April 2008, we performed pancreas transplantation on 40 recipients. The operation included portal venous drainage and exocrine enteric drainage. Immunosuppressive therapy included prednisolone, tacrolimus, and mycophenolate mofetil. Ganciclovir was administered as prophylaxis for cytomegalovirus. Peri-operative and regular follow up data on survival and complication were gathered and analyzed. RESULTS: The mean follow-up was 10.1+/-6.5 months (range: 1 - 24 months). Mean age of donors and recipients was 23.6+/-8.2 and 32.30+/-8.9 years, respectively. The mean pretransplant insulin consumption was 43.75+/-17.4 IU. Fasting blood glucose before transplantation was 275.5+/-72.3 mg/dL that decreased to 95.6+/-7.01 at six months follow-up (P<0.001). Complications were as follows: re-exploration (n=9), gastrointestinal complications (n=10), acute rejection episodes (n=12), and chronic rejection (n=4). We lost one patient due to diffuse cytomegalovirus and aspergillus infection three months after the operation with a functioning graft. Overall graft survival was 84.9% and patient survival 97.5%. CONCLUSION: Good patient and graft survival in these series encouraged us to continue the program with all its difficulties.