BACKGROUND: The current study was conducted to determine the satisfaction of patients visiting the Faculty of Dentistry, Kermanshah University of Medical Sciences, Iran.

METHODS: This study enrolled patients that were referred to the Dental School, Kermanshah University of Medical Sciences during the winter of 2014. We selected 300 patients through convenient sampling. The participants were asked to complete the patient satisfaction questionnaire, focusing on demographic and patient satisfaction variables. The collected data were analyzed with independent t-test and one-way ANOVA. A p-value of <0.05 was considered statistically significant.

RESULTS: Of the 300 patients, 71%, 27% and 2% patients showed high, average and low satisfaction with services provided by the Dental Faculty, respectively. The results of one-way ANOVA indicated a significant correlation between the patients’ career and their satisfaction (p<0.001). Moreover, the findings of t-test revealed that satisfaction score in the healthcare domain (p=0.006) and admission and registration process (p=0.007) were significantly higher in females than in males; however, a higher satisfaction was reported for males in terms of the personnel and students’ behavior (p=0.01). In addition, there was no significant gender difference in score for cleanliness or total satisfaction.

CONCLUSION: We found that the patients referred to Kermanshah Dental Faculty enjoyed higher satisfaction with the healthcare services.

 Venous aneurysms are rare and are usually found on physical examination or on imaging. In the neck, venous aneurysms are commonly found in the internal jugular vein and are mostly diagnosed as soft tissue masses or vascular malformations. A 44-year old woman was admitted with an asymptomatic slowly enlarging mass on the left side of the neck. Imaging showed the mass as an aneurysm arising from the external jugular vein. She underwent anterior cervicotomy and excision of the aneurysm. Postoperative period was uneventful. She was discharged on the third postoperative day. Venous aneurysms are rare but should be included in the differential diagnoses of soft tissue masses. Venous aneurysms especially the ones in the neck require surgical removal even when asymptomatic. Venous aneurysms may be a source of pulmonary embolism and thus once detected, especially those on the head and neck regions, need surgical excision.

Xanthogranulomatous cholecystitis is a rare disease and its incidence is between 0.7 to 13.2% of all cholecystitis cases, while on autopsy it is about 1.5% of cases. The clinical presentation resembles acute or chronic cholecystitis. Imaging features sometimes masquerade as malignancy and needs histopathological examination for diagnosis. We present a case of xanthogranulomatous cholecystitis with its sonographic and computed tomographic features.

Mastoiditis is a known cause of cerebral venous thrombosis but rarely presents as an isolated laterals sinus thrombosis (LST) and venous infarct. We report an adult female patient who presented with chronic mastoiditis complicated by LST and venous infarct, documented by computerised tomography and magnetic resonance venography. This implicates mastoiditis as a potential and important cause of isolated LST and venous infarcts in brain.

BACKGROUND: Thymic cysts of the mediastinum are uncommon. The incidence rate of thymic cysts is between 1 to 4.8 %. They usually present as an asymptomatic mediastinal mass. The purpose of this study was to report some rare presentations of ten cases with thymic cyst.

METHODS: In this retrospective study, signs, symptoms, imaging features and surgical approaches of ten cases with mediastinal thymic cyst were recorded between 2000 and 2013 in the Razi Hospital of Rasht, Iran.

RESULTS: Age of patients was between 12 and 60 years. Three patients presented with hydrothorax. Two cases were found incidentally. One patient with hydropneumothrax, one with infected thymic cyst and one with neck mass were observed. Other signs were palpitation, chest pain and dyspnea. The most common surgical approaches were median sternotomy in four cases and postero-lateral thoracotomy in three cases. Complication happened in one patient with left phrenic nerve damage. There were no mortalities.

 CONCLUSION: Thymic cysts should be considered in the differential diagnosis of the mediastinal and cervical masses. The treatment of choice is complete excision of the cyst.

CSF-oma is a rare complication of ventriculo-peritoneal shunt. Progressive abdominal symptoms are often a common feature at presentation. The authors report the first case of CSF-oma in Saudi Arabia for a patient who presented with a progressive abdominal distention, acute urinary retention and a leaking gastrostomy tube. Computerized tomography (CT) scan showed a massive CSF-oma pushing on the liver with secondary compression on the inferior vena cava and the right atrium, centralization of the small bowel loops, displacement of the large bowel to the anterior abdominal wall, as well as bilateral obstructive uropathy. The CSF-oma was managed using a laparoscopic approach without the need for shunt externalization nor a diversion to the vascular system. There were no signs of recurrence, clinically or radiologically at 6 month of follow-up.

Lymphadenopathy associated with sinus histiocytosis is known as Rosai Dorfman Disease. Classically it presents as massive bilateral painless cervical lymphadenopathy. We report a unique case of this disease, in which there was involvement of only a single cervical node. The diagnosis was confirmed by documenting the classical cyto-morphological features including emperipolesis. Our case adds a new dimension to the current spectrum of Rosai Dorfman disease and illustrates that an isolated lymphadenopathy can also occur in this disease.

BACKGROUND: The conventional thyroidectomy using knot and tie leads to increased operative time and bleeding but with the advent of harmonic scalpel (HS), which cuts and coagulates the tissues at the same time using a mechanical energy, has significantly decreased the operative time and bleeding. This study assessed to compare the mean operative time and mean post-operative bleeding time in sutureless thyroidectomy using harmonic scalpel with conventional thyroidectomy.

METHODS: We conducted a randomized controlled trial at the surgical unit of the Shifa International Hospital and Shifa College of Medicine, Islamabad. Both male and female patients with age of ≥18 years were enrolled in the study. During the period of 6 months, 160 patients were divided equally in HS group (n=80) and conventional thyroidectomy group (n=80) respectively. Patients were enrolled in the study after obtaining informed consent. Patients with re-do thyroidectomies, retrosternal goiter, concomitant neck dissections and known coagulopathies were excluded from trial. The mean operative time and mean post-operative blood loss was recorded.

RESULTS: During the six months period (March to August 2014), 160 patients were randomized into two equal groups (n= 80). Of 160 patients with multinodular goiter, 134 (83.8%) were females and 22 (16.2%) were males. The age ranged from 18 to 61 years in both groups with mean age in group A of 42 years (SD=9) and group B of 43 years (SD =9.8).The mean operative time in HS thyroidectomy (Group A) was 76 minutes (SD=9) and conventional thyroidectomy was 116 minutes (SD=16); difference between two groups =40 minutes (P<0.001). The mean post-operative bleeding in HS thyroidectomy was significantly lower as compared to the conventional thyroidectomy group (18.2 ml vs.76.0 ml, P< 0.001).

CONCLUSION: Mean operative time and mean post-operative bleeding in thyroidectomy with HS was less as compared to conventional thyroidectomy.

BACKGROUND: Although an association between congenital heart disease (CHD) and ABO blood group types have been proposed, this relationship has not been well-established. The purpose of this study was to determine the distribution of different ABO blood groups according to CHD sub-types in a large population of patients undergoing surgical repair for CHD.

METHODS: In a retrospective review of hospital data registry, medical profiles of 34,239 admitted patients between January 2003 and December 2012 were reviewed to identify cases with CHD who had undergone surgical repair. CHD types, ABO blood groups and clinical and final outcomes were recorded.

RESULTS: Data from 1,155 patients were analyzed. We did not find an association of a blood group type and a particular CHD type. Similarly, we did not find an association between blood group types and outcomes.

CONCLUSION: We did not find an association between blood group type and type of CHD or outcomes after CHD correction.

BACKGROUND: Opioids for pain management are associated with a number of adverse effects and consequently their use should be avoided. The aim of this study was to compare the analgesic effect of acetaminophen and fentanyl in the management of postoperative pain in patients following intra-medullary nail fixation.

METHODS: 114 male patients between the ages of 25 and 50 years who underwent intra-medullary nail fixation in Poursina university hospital of Rasht between 2012 and 2013 enrolled in this double-blinded randomized controlled trial study. The trial registration was IRCT 2012122611898N1. After completion of the surgery, patients were taken to the recovery room and were randomly allocated to one of the two groups. One group received intravenous acetaminophen, 1000 mg in 150 mL normal saline in 15 min every 6 hours for 24 hours. Another group received fentanyl as patient controlled analgesia, for 24 hours. Patients were evaluated by visual analogue score (VAS) and pain relief rating (PR) at 0, 15, 30 and 45 minutes, 1, 2, 3, 4 and 5 hours after elimination of intraoperative analgesic effect.

RESULTS: Of 103 patients, 47 were randomized to receive fentanyl and 56 were randomized to receive acetaminophen. The mean age of subjects was 38.7±1.1. The VAS scores were significantly higher (p <0.05) in patients randomized to receive fentanyl at 30 minutes, 45 minutes, 1 hour, 3 and 4 hours.

 CONCLUSION: Intravenous acetaminophen is an effective analgesic agent and may be preferable to fentanyl for postoperative pain management in orthopedic setting.

 BACKGROUND: Globally, pregnancy and childbirth claim the lives of an estimated 514,000 women each year. Most deaths (98%) occur in the developing world. Although India has made substantial progress in maternal health, it still accounts for 25% of global maternal deaths and the maternal death rate is even worse in the exploding slums of India. The study aimed to assess the preference and practices regarding the place of childbirth and to identify the factors affecting the choice among married women in the slums of Aligarh.

METHODS: A cross-sectional survey was conducted from July 2012 to June 2013 in two urban slums of Aligarh with sample of 405 women’s selected using systematic random sampling. Information about the childbirth practices such as place of childbirth and reason for choosing a particular facility for childbirth was recorded along with the socio-demographic data; women’s age, education, occupation, religion, type of family, socioeconomic status and birth order. Chi square test was used to examine the differences between the groups.

RESULTS: Of 405 childbirths, 58.3% were born in a hospital. Most common reason for in-hospital or at-home childbirths were safety (47.5%) and tradition (37.3%) respectively. Among 405 women, 301 women (74.4%) received antenatal care (ANC) services while 208 women (51.4%) received adequate ANC visits (≥3 ANC visits). Better antenatal care utilization, higher levels of education of women and standard of living, lower birth order of the child led to increased utilization of hospitals for childbirth in a significant manner.

CONCLUSION: Home based child birth was observed to be a common practice in slum areas. Socio-demographic variables of reproductive age group women played an important role in selection of place of childbirth.