Background: Abdominal surgical site infections are among the most common complications of inpatient admissions and have serious consequences for outcomes and costs. Different risk factors may be involved, including age, sex, nutrition and immunity, prophylactic antibiotics, operation type and duration, type of shaving, and secondary infections. This study aimed to determine the risk factors affecting abdominal surgical site infections and their incidence at Imam Khomeini, a major referral teaching hospital in Iran. Methods: Patients (n = 802) who had undergone abdominal surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. The subjects were followed for 30 days and by a 20-item questionnaire. Data were collected through pre- and post-operative examinations and telephone follow-ups. Results: Of the 802 patients, 139 suffered from SSI (17.4%). In 40.8% of the cases, the wound was dirty infected. The average age for the patients was 46.7 years. The operations were elective in 75.7% of the cases and 24.7% were urgent. The average duration of the operation was 2.24 hours, the average duration of pre-operative hospital stay 4.31 days and the average length of (pre- and post-operation) hospital stay 11.2 days. Three quarters of the cases were shaved 12 hours before the operation. The increased operation time, increased bed stay, electivity of the operation, septicity of the wound, type of incision, the administration of prophylactic antibiotic, type of operation, background disease, and the increased time lapse between shaving and operation all significantly associated with SSI with a p-value less than 0.001. Conclusion: In view of the high rate of SSI reported here (17.4% compared with the 14% quoted in literature), this study suggests that by reducing the average operation time to less than 2 hours, the average preoperative stay to 4 days and the overall stay to less than 11 days, and approximating the timing of shaving to the operation and substituting cefazolin for cefaluthin when prophylactic antibiotic is to be administered, the SSI may be reduced to a more acceptable level.

Intussusception is a rare cause of intestinal obstruction in adult patients. The etiology of malignant nature has been reported to be more frequent in this group and the diagnosis is usually made at operation. Few reports are published for this clinical entity from Middle East. The medical records of all adult patients admitted with the diagnosis of intussusception in a tertiary care center between 1989 and 2009 were reviewed. There were 15 cases of intussusception in this 20 years period. The mean age of patients was 33.6 years, 8 females and 7 males. In 14 cases the leading point of intussusception was in small bowel. Resection and primary anastomosis was the selected procedure in 13 patients; one patient underwent colostomy and one reduction alone. Malignant cause was detected in only 2 cases. 7 Patients were operated on with diagnosis of intussusception according to imaging findings. The diagnosis was made at operation in the remaining 8 cases. Only one anastomotic leakage occurred in patient on systemic steroids. The mean age of our patients is relatively low with more benign etiologies in small bowel. The CT scan may be the most helpful imaging modality in suspected cases but decision for operation in acute presentations should not be deferred for definite diagnosis. Resection of the involved bowel segment and primary anastomosis is associated with a good outcome.

The purpose of this study was to utilize the Context, Input, Process and Product (CIPP) evaluation model as a comprehensive framework to guide initiating, planning, implementing and evaluating a revised undergraduate medical education programme. The eight-year longitudinal evaluation study consisted of four phases compatible with the four components of the CIPP model. In the first phase, we explored the strengths and weaknesses of the traditional programme as well as contextual needs, assets, and resources. For the second phase, we proposed a model for the programme considering contextual features. During the process phase, we provided formative information for revisions and adjustments. Finally, in the fourth phase, we evaluated the outcomes of the new undergraduate medical education programme in the basic sciences phase. Information was collected from different sources such as medical students, faculty members, administrators, and graduates, using various qualitative and quantitative methods including focus groups, questionnaires, and performance measures. The CIPP model has the potential to guide policy makers to systematically collect evaluation data and to manage stakeholders’ reactions at each stage of the reform in order to make informed decisions. However, the model may result in evaluation burden and fail to address some unplanned evaluation questions.

Oral tacrolimus administration is the common route of drug delivery. Recent studies suggest sublingual administration of tacrolimus as an alternative route may produce comparable drug trough levels with similar or even lower doses than the oral route, especially in lung transplant recipients; however, most of this research does not encompass intraindividual variations compared between the 2 routes. This study sought to compare the bioavailability and blood trough concentrations of orally and sublingually administered tacrolimus in adult liver transplant recipients by considering intraindividual variations in tacrolimus pharmacokinetics properties. Six adult liver transplant recipients received their tacrolimus either orally or sublingually within 2 consecutive days. Blood samples to determine tacrolimus concentrations were gathered at 0, 0.5, 1, 2, 4, 6, and 12 hours after oral and sublingual tacrolimus administration. Mean data values were used to calculate the pharmacokinetics parameters via the feathering or residual method, using the 1-compartment, first-order elimination pharmacokinetics model. Compared pharmacokinetics parameters included drug bioavailability, maximum blood concentration (C(max)), time to reach maximum blood level (T(max)), and trough blood concentrations. Trough whole blood levels, area under the concentration-time curve, T(max), and C(max) after oral and sublingual administration of tacrolimus were not significantly different (10.4 ± 7.4 vs 11.2 ± 11.3 ng/mL for trough blood concentration, 181.5 ± 114.1 vs 160.8 ± 115.9 ng.h/mL for AUC, 1.9 ± 1.2 vs 1.4 ± 0.7 h for T(max), and 19.9 ± 10.8 vs 17.2 ± 11.7 ng/mL for C(max)). A double-peak phenomenon was observed in some concentration-time profiles. Sublingual tacrolimus administration does provide therapeutic drug concentrations in adult liver transplant recipients. Therefore, sublingual tacrolimus may confidently be considered as an alternative route to oral administration in patients who are unable to swallow their drugs.

Purpose: Despite increasing transplantation in Iran, organ shortage and long waiting lists remain major problems in the country. Many publications have demonstrated that the willingness of healthcare professionals to participate in the donation process can improve the donation rate. Since nurses are usually the first people among the healthcare staff to recognize a patient as a potential donor, they have an important role in the procurement of organ and tissue from cadaveric donors. Our objectives were to survey nurses’ knowledge and attitudes toward organ and tissue donation and to examine the effect of having them attend a workshop on organ donation. Methods: A 39-item questionnaire was completed by 66 nurses, before and after participation in a 1-day organ donation workshop that was held at the Iranian Tissue Bank (in Tehran, Iran). The questionnaire contained demographic data, 29 questions regarding knowledge, and 8 questions on attitudes toward organ and tissue donation. Results: 69.7% women and 30.3% men participated in this study. The mean score for knowledge was 16.89 (SD= 3.33) before and 23.76 (SD=1.66) after the workshop (p=0.000). The mean attitudes score was 4.76 (SD=1.71) before and 5.08 (SD=1.34) after the workshop (p=0.235). Although 63.63% claimed they were willing to have a donation card only 15.15% actually carried one. Conclusions: This study demonstrated that educational programs can enhance nurses’ knowledge and commitment to the organ donation process and, ultimately, increase the donation rate. Consequently, it is of great importance for organ procurement units to focus on regular training programs for all their healthcare staff.

Imaging and Imaging-Guided Interventions in the Diagnosis and Management of Hepatocellular Carcinoma (HCC)-Review of Evidence - Iranian Journal of Radiology - - Kowsar