Modification of the Conventional Influenza Epidemic Models Using Environmental Parameters in Iran.

OBJECTIVES: The association between the spread of infectious diseases and climate parameters has been widely studied in recent decades. In this paper, we formulate, exploit, and compare three variations of the susceptible-infected-recovered (SIR) model incorporating climate data. The SIR model is a well-studied model to investigate the dynamics of influenza viruses; however, the improved versions of the classic model have been developed by introducing external factors into the model. METHODS: The modification models are derived by multiplying a linear combination of three complementary factors, namely, temperature (T), precipitation (P), and humidity (H) by the transmission rate. The performance of these proposed models is evaluated against the standard model for two outbreak seasons. RESULTS: The values of the root-mean-square error (RMSE) and the Akaike information criterion (AIC) improved as they declined from 8.76 to 7.05 and from 98.12 to 93.01 for season 2013/14, respectively. Similarly, for season 2014/15, the RMSE and AIC decreased from 8.10 to 6.45 and from 117.73 to 107.91, respectively. The estimated values of R(t) in the framework of the standard and modified SIR models are also compared. CONCLUSIONS: Through simulations, we determined that among the studied environmental factors, precipitation showed the strongest correlation with the transmission dynamics of influenza. Moreover, the SIR+P+T model is the most efficient for simulating the behavioral dynamics of influenza in the area of interest.

The Association between Lifestyle, Occupational, and Reproductive Factors and Colorectal Cancer Risk

Objective: Association of lifestyle, reproductive and environmental factors has been investigated with increased risk of colorectal cancer in different studies. We explored evidence and investigated association between various risk factors and colorectal cancer. Methods: This case- control study was conducted 155 colorectal cancer patients and 150 hospital-controls. We obtained detailed lifestyle, occupational, reproductive information from both groups. Chi-Square test and Logistic regression model were used to evaluate the risk factors of colorectal cancer. Results: The results showed that frequent intake of fruits, chicken, fish and alcohol drinking were associated with risk for colorectal cancer. Agricultural occupation (OR=7.003, 95% CI=2.19-22.38) and industrial exposure (OR=1.97, 95% CI=0.91-4.22) were associated significantly with risk for colorectal cancer. Regarding reproductive factors, women who reported less than 3 pregnancies was associated with an increased risk of colorectal carcinoma (OR=2.88, 95% CI=1.15-7.17). We did not find significant association between other reproductive factors and colorectal cancer risk in women after adjusting for demographic factors. Conclusion: In this case-control study we observed that agricultural occupation, industrial exposure and high consumption of fish and less than 3 pregnancies in women were associated with an increased risk of colorectal carcinoma.

MR defecography: a diagnostic test for the evaluation of pelvic floor motion in patients with dyssynergic defecation after biofeedback therapy.

BACKGROUND: Dyssynergic defecation is a major cause of chronic functional constipation as a common digestive complaint. We clinically evaluated the effects of biofeedback therapy on the pelvic floor motion indices through magnetic resonance (MR) defecography, quality of life and depression in patients with dyssynergic defecation. METHODS: In this clinical trial study, among patients referring to the Colorectal Clinic of Hazrat Rasoul Hospital, 22 subjects were randomly assigned into two equal groups (n= 11) to receive either standard only or biofeedback and standard therapy. Dynamic changes of the pelvic floor were measured by MR defecography. During the simulated defecation, two MR defecography dynamic indices including abnormal anorectal angle change and perineal descent were measured before and after treatment. The effects of biofeedback therapy on patients' symptoms, quality of life and severity of depression were assessed and compared with the standard therapy. Statistical analysis was carried out using independent _t-test and Mann-Whitney test. RESULTS: Paradox index (p< 0.001), perineal descent index (p< 0.001), depression (p< 0.1), physical function (p< 0.001), vitality (p< 0.001) and role emotion (p< 0.001) significantly improved in the biofeedback therapy group in contrast to the standard therapy SDT group. CONCLUSION: Biofeedback therapy appears to be effective in improving symptoms of functional constipation and dysfunction of pelvic floor motion as well as patient's quality of life and depression state. MR defecography is able to show the changes in dynamic indices of the pelvic floor through biofeedback therapy.

Investigation of dust storms entering Western Iran using remotely sensed data and synoptic analysis.

BACKGROUND: One of the natural phenomena which have had considerable impacts on various regions of the world, including Iran, is "dust storm". In recent years, this phenomenon has taken on new dimensions in Iran and has changed from a local problem to a national issue. This study is an attempt to investigate the formation of the dust storms crossing the Western Iran. METHODOLOGY: To find the sources of the dust storms entering Iran, first we examine three determined dust paths in the region and their temporal activities, using MODIS satellite images. Then, four regions were identified as dust sources through soil, land cover and wind data. Finally, atmospheric analyses are implemented to find synoptic patterns inducing dust storms. RESULTS AND DISCUSSION: Source 1 has covered the region between the eastern banks of Euphrates and western banks of Tigris. Source 2 is in desert area of western and south-western Iraq. Finally source 3 is bounded in eastern and south-eastern deserts of Saudi Arabia called Rub-Al-Khali desert, or Empty Quarter. Moreover, south-eastern part of Iraq (source 4) was also determined as a secondary source which thickens the dust masses originating from the above mentioned sources. The study of synoptic circulations suggests that the dust storms originating from source 1 are formed due to the intense pressure gradient between the low-pressure system of Zagros and a high-pressure cell formed on Mediterranean Sea. The dust events in sources 2 and 3 are outcomes of the atmospheric circulations dominant in the cold period of the year in mid-latitudes.

Successful management of multiple small bowel perforations due to polyarteritis nodosa.

Classic Polyarteritis nodosa (PAN)) is a medium-sized vessel vasculitis that usually occurs in middle-aged men. One of the dramatic manifestations of PAN that requires surgical intervention is multiple small bowel perforations. Many studies have reported a high rate of mortality in PAN due to acute abdominal complications. We report here the case of multiple small bowel perforations in a 22-year-old man, who presented with an acute abdomen, and eventually, PAN was diagnosed. In our case, PAN led to multiple small bowel perforations and diffuse patchy necrosis. All perforations were primarily repaired and corticosteroids were prescribed. Using corticosteroid in patients with abdominal sepsis is injurious; however, laparostomy is the method we suggest, to achieve the purpose, including prevention of a short bowel and infection control. Our patient was discharged, well, after 48 days of hospitalization and referred to a rheumatologist.

Combination of pseudocontinent perineal colostomy and appendicostomy: a new approach in the treatment of low rectal cancer.

BACKGROUND: Abdominal perineal resection (APR) with applied colostomy remains the standard treatment for low rectal cancer; however, to date, a very high morbidity rate has been reported. AIMS: The aims of this study were to assess fecal continence, persistence of disease-related symptoms, and quality of life in patients with low rectal cancer after APR and pseudocontinent perineal colostomy and concomitant appendicostomy. METHODS: We included 17 patients with low rectal cancer who underwent APR at our hospital in this cross-sectional study. Following APR, pseudocontinent perineal colostomy and concomitant appendicostomy were performed. Patients then underwent antegrade colonic enema with tap water. Patients' symptoms, fecal continence, and quality of life were evaluated at regular time intervals. RESULTS: After a median follow-up of 12 months, 15 of 17 patients completed the study period. All patients were able to perform an antegrade enema by themselves. Mean continence score was 7 (out of 20) based on the Wexner Scale scoring system. Mean global health status score was 78, physical function was 93, and emotional function was 88. Minor morbidity was observed in 6 patients (40%). CONCLUSION: Pseudocontinent perineal colostomy with appendicostomy provides an acceptable level of continence and functional and emotional improvement in patients with low rectal cancer undergoing APR. Hence, this combinative method could be considered as an alternative for abdominal colostomy in selected patients.

Anal sphincter injuries during hemorrhoidectomy: a multi center study.

Hemorrhoidectomy is the treatment of choice for patients with third or fourth-degree hemorrhoids. Although the majority of surgeons believe that surgical hemorrhoidectomy is the most effective approach with excellent results in the management of hemorrhoid disease, but hemorrhoidectomy is not a simple procedure. One of the complications of this surgery is an injury to anal sphincters that can lead to incontinency in some patients. In this study, we aimed to reveal the percentage of external and internal anal sphincter injuries in surgical hemorrhoidectomy. We prospectively enrolled 128 patients from April 2006 to February 2007. They underwent hemorrhoidectomy in three general hospitals in Tehran. All patients were in grade III or IV and underwent open hemorrhoidectomy (Milligan-Morgan). After surgery, all resected material was histopathologically examined by two expert pathologists and the results confirmed by other one if there is any discrepancy. From all specimens which sent to the pathology department 15.8% (21 Pts.) had muscle fibers that Smooth muscle fibers were seen in 80.5% (17 Pts.) of them and striated muscle fibers were found in 19.5% (4 Pts.). Although hemorrhoidectomy is a safe and effective method for treatment of hemorrhoid, but the inadvertent removal of smooth and striated muscle during open hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function.

A cross-sectional survey of quality of life in colostomates: a report from Iran.

BACKGROUND: Considering the complications that colostomies may cause, patient self-assessments of their social, emotional, physical, sexual and functional conditions may help their surgeons to evaluate the impact of their interventions or use supplementary methods to maintain patient functional status or decrease its loss to the minimum level. The aim of this study was to evaluate the Quality of Life in Iranian patients with colostomies and to compare the age and gender differences among them. METHOD: This cross-sectional study was conducted from 2009 to 2010 to evaluate the quality of life of 96 patients who had undergone surgery for rectal cancer and had permanent colostomies. The European Organization for Research and Treatment of Cancers Quality of Life Questionnaire (EORTC QLQ)-C30 and the EORTC QLQ-CR38 were used to assess patient Quality of Life. RESULTS: The mean scores for the functional subscales were as follows: Physical Function, 70.9 (±2.2); Role Function, 68.4 (±2.6); Emotional Function, 56.9 (±2.7); Cognitive Function, 68.7 (± 2.6); and Social Function, 64.2 (±3.3). The EORTC questionnaires showed significant differences between males and females. Males had better body image scores. Sexual Function and Sexual Enjoyment were impaired in both males and females, but males had significantly higher scores and better roles in Physical and Sexual Functions. More sexual enjoyment problems in older ages were observed in both males and females. CONCLUSION: Having a colostomy was associated with a high level of emotional and sexual function impairment. The differing challenges between males and females should encourage us to design sex-specific interventions that improve the quality of life in this group of patients.

A submucosal fecal mass as the complication of stapled hemorrhoidopexy: A case report.

Despite the early encouraging results and safety profile of hemorrhoidopexy, several serious complications have been reported including rectal perforation, retroperitoneal sepsis, pelvic sepsis and rectovaginal fistulas. The recent article is the report of the case of a 30 year old woman, with a submucosal mass which was palpable in the anterior rectum. She had undergone a stapled hemorrhoidopexy due to a 2nd degree internal prolapsed hemorrhoid three years previously. Operation was planned to identify the nature of the mass and a cylindrical impacted 4 cm × 2 cm fecal mass was excised. The recent finding seems to be the first one being reported in this issue.

Malignant fibrous histiocytoma of rectum: Report of a case.

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma of adults, mostly distributed in the thigh, buttock and groin (46%) and presents rarely in the gastrointestinal tract, classified as gastrointestinal stromal tumors (GIST). MFH is regarded as a diagnosis of exclusion, essentially synonymous with an undifferentiated pleomorphic sarcoma. The recent report presents an 80-year-old man with clinical manifestations of rectal bleeding and final diagnosis of MFH of rectum. It seems that radical resection and adjuvant radiation is important in the management strategy of a patient with such a rare rectal tumor.

Comparison between Ultroid and rubber band ligation in treatment of internal hemorrhoids.

Hemorrhoid is one of the most common surgical diseases and different methods are available for its treatment. This study is a comparison between two methods of treatment of internal hemorrhoid, Monopolar low voltage instrument (Ultroid) and Rubber Band Ligation. This method has been carried out prospectively in which 50 patients who were treated with rubber band ligation and 50 patients with Ultroid were compared according to the incidence of complications, post-operative pain and treatment response. According to this study complete success rate with Ultroid was 82% and partial success rate was 10% and no response to treatment was seen in 8%. In Rubber Band method the complete response rate was 94% (P=0.2). With Ultroid, 74% of patient reported no postoperative pain, 24% reported mild and moderate pain and 2% of patients complained of severe pain. With Rubber band ligation, 72% of patients reported no post-operative pain, 26% reported mild and moderate pain and 1% complained of severe pain (P=0.00). Rubber Band ligation and Ultroid are both considered as outpatient procedures for treatment of hemorrhoids. Both methods are mostly used for grade 1, 2 and sometime grade 3 hemorrhoids. In Ultroid method the operator is required to hold the probe for a period of time, and in most cases, the surgeon should spend between 20-25 minutes for the coagulation of three piles. Some surgeons do not have patience for this modality of internal hemorrhoid treatment. In this study we achieved acceptable results comparable with those of other techniques.