Journal of

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Rhabdomyomata are probably the most common tumors that occur very rarely during infancy. In this paper, we report the case of a 49-day-old infant who was diagnosed by echocardiography examination with left ventricle outflow tract (LVOT) obstruction caused by rhabdomyoma. The infant underwent surgical approach, and her mass was shaved. Finally, she was discharged from hospital in good general condition. Six-month follow-up after the operation did not show any obstruction.

 

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Introduction: Along with advances occurring in cardiopulmonary bypass (CPB) including improved anesthesia intubation and early surgical interventions, it has become possible to correct life-threatening congenital heart anatomic abnormalities in patients. Our study aimed to collect information from one of the most important centers of pediatric cardiac surgery in Iran since there is limited information in this field in our country.

Methods: In this study, the results of  pediatric cardiac surgery and mortality were studied for two years. A retrospective, descriptive study was carried out on 789 patients   within two years. 401cases were excluded as they had congenital heart disease complexity. The patients were referred from other pediatric cardiac medical centers. Information related to kinds of surgical operation and deaths were collected from patients' documents and questionnaire. The data were analyzed by descriptive statistical tests in SPSS version-16.

Results: The age range of patients varied from three days to 18 years. The male/female ratio was 53.4%. CPB was not applied for 21.1% of patients. The frequency of operations included PDA (Patent Ductus Arteriosous) [D&L] (%8.5), total correction for TF (Tetralogy of Fallot) (%16.7), systemic to pulmonary shunt (%26.5), ASD (Atrial Septal Defect) and VSD (Ventricular Septal Defect) closure (%5.4) and (%28), respectively as well as coarctationrepaire (%14.6). Total mortality rate was 8.6%. Analysis of the operated population showed that outcome of patients has improved in recent years.

Conclusions: Compared with other studies, the results of our investigation showed that children's congenital heart surgery is on the rise.

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Introduction: Tonsillectomy is one of the most common surgeries all over the world and is performed by various methods. This study aimed to investigate the complications of bipolar electrocautery method of tonsillectomy.

Methods: This cross-sectional study was performed on 234 patients, 114 female and 120 male individuals. The mean age of the patients was 12.2±8.3 (min=3 and max=58.2) years. Some parameters including duration of surgery, intraoperative blood loss, postoperative hemorrhage, severity of pain were measured 4 and 24 hours after operation. The data were analyzed by SPSS software (Version 15) using Mann-Whitney, Kruskal-Wallis and Spearman tests. P values less than 0.05 were considered significant.

Results: In our study, the mean duration of surgery was 12.7±4.5 minutes, mean intraoperative blood loss was 36.6±10.8 ml, and postoperative hemorrhage was observed in 3.4 % of patients. The mean pain scores 4 hours after operation were 2.1±0.7 and 2.7±0.8 for age groups below and over 10 years old respectively, while these scores were 2.4±0.8 and 3.2±1 after 24 hours of operation for them respectively with the difference being significant (p < 0.05). Furthermore, duration of surgery correlated significantly with intraoperative blood loss (r=0.1 and P=0.01) and pain 4 hours after operation (r=0.1 and p=0.004).

Conclusions: In our study, mean intraoperative blood loss, postoperative hemorrhage, and duration of surgery were greater than what has been reported in the majority of previous studies.

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Thrombotic events are very unusual in neonatal period. This congenital anomaly may be caused by certain risk factors such as polycythemia, perinatal asphyxia, septicemia, maternal diabetes, dehydration, and low cardiac output, or it may occur upon catheterization of central lines. A 20-day-old neonate was referred to our ward with primary signs of hypertrophic cardiomyopathy (HCMP). Echocardiography and CT-angiography were performed to find stenosis or no stenosis of aortic valve, which showed a great mass into the ascending aorta. This mass was resected and removed successfully and thereafter the aortic arch was repaired. There was no prothrombic disorder in his family history.

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Introduction: Congenital cardiac abnormalities are among the problems that affect the quality of life of children and parents, especially the mothers. Meanwhile, mothers are severely stressed and harmed due to their emotions and feelings, so that the suffering can reduce their quality of life. This study aimed to compare the quality of life of mothers of healthy children and mothers of children with congenital heart disease after cardiac surgery.
Methods: This is a cross-sectional descriptive-analytic study where 100 mothers of healthy children and 60 mothers of children with congenital heart disease referring to Vali-e-Asr Hospital in 2016 and 2017 were incorporated. The mothers' quality of life was assessed using the World Health Organization Quality of Life Scale (WHOQOL-BREF). The collected data was analyzed in SPSS software (version 22) using independent t-test, Mann-Whitney, Kruskal-Wallis and Chi-square. The significance level for all tests was considered less than 0.05.
Results: According to the findings, the mean age of mothers with healthy children was 31.91 ± 8.57 years and that of mothers of children with congenital heart disease was 32.48 ± 6.46 years. The mean score of the quality of life of mothers with healthy children was 71.25 ± 16.43 and that of the second group was 66.51 ± 15.46. The mean scores of social relationships, mental health, and physical health in mothers with healthy children were significantly higher than those of mothers after their child's surgery. However, there was no significant difference between the two groups as for the mean score of overall quality of life and environmental health.
Conclusions: According to the results, it was found that the quality of life of the mothers with unhealthy children is lower than that of mothers with healthy children. Therefore, proper training and timely counseling are recommended as potential measures to somewhat improve their quality of life.

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Introduction: As the most anterior part of the face, the nose is more prone to trauma than other parts of the face, thereby making it the most common facial fracture site. Closed reduction has long been used as the standard treatment of the nasal fracture, which can be performed outpatiently or inpatiently. Bleeding due to the fracture can be minimized by adopting certain strategies before the realignment of the nasal fracture. One of these strategies is to use phenylephrine spray before surgery. This study aimed to evaluate the effect of phenylephrine spray in closed reduction of nasal fractures.
Methods: A total number of 200 patients with nasal fracture – who were admitted to the ENT department of Vali-e-Asr Hospital in 2014 and 2015 – were incorporated in this clinical trial via simple randomization method. The patients were assigned into case and control groups. The case group received phenylephrine spray twice: 30 minutes before the surgery and before anesthesia. The control group did not receive phenylephrine spray. To evaluate the efficiency of the spray, data concerning intraoperative and postoperative bleeding, pain intensity, blood pressure, and the need for tampon in both groups were recorded. The data were compared in the SPSS software version 18 using T-test and Chi-Square test at a confidence level of 95%.
Results: The average age of the participants was 25.12±13.73 years and the majority were men (n=127; 63.5%). The mean systolic pressure of the patients in the case group was significantly higher than that of the patients in the control group (P=0.02). Furthermore, the bleeding volume during surgery in the cases was significantly lower than that of the controls (P=0.01). However, postoperative bleeding volume, pain intensity, and the need for tampon were not significantly different in the groups.
Conclusions: By reducing the intraoperative bleeding, phenylephrine spray can play an important role in decreasing the complications caused by surgery. However, it is not recommended for the patients with heart diseases because it increases systolic pressure.

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Introduction: Congenital heart abnormalities are the most common type of congenital conditions in children. Annually,about 1 to 2 percent of children are born with these diseases. As chronic diseases, congenital conditions of children usuallycause limitations in the quality of their lives, especially if they are in need of frequent and complex surgical procedures. Regarding the role of parents, especially mothers, in the care of these children, their quality of life is of particular importance. This study, therefore,aimed to evaluate and compare the life quality of mothers with healthy children and mothers with children with a congenital heart disease in need of surgery.
Methods: This research is a cross-sectional descriptive-analytical study, in which 100 mothers of healthy childrenand 60 mothers ofchildren with severe congenital heart disease – who were referred to Birjand Valiasr Hospital in 2017 –were entered into the study. The life quality of the mothers was assessed using the Life Quality Questionnaire of World Health Organization (WHOQOL-BREF). Data were analyzed by SPSS software (version 22). P-values less than 0.05 were considered significant.
Results: According to the findings of this study, the age means of the mothers with healthy children and that of mothers of children with congenital heart diseasewere 31.91±8.57 and 32.48±6.46 years, respectively. The mean score of life quality of motherswith healthy children was 71.25±16.43; it was 41.25±19.27 for mothers ofchildren with congenital heart diseases in need of surgery. Life quality and all its sub-scales (social relationships, mental health, environmental health and physical health) were significantly higher in mothers with healthy children than in mothers ofchildren with severe congenital heart diseases in need of surgery before operation(P <0.001).
Conclusions: It was found that the life quality of mothers with children with severe congenital heart disease was significantly different from that ofmothers with healthy children. Therefore, in order to improve their quality of life, appropriate planning in different areas should be performed.

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Introduction: During recent years, the occurrence of terroristic attacks throughout the Middle East and occasionally in Iran has proposed that bioterrorists have the ability to disseminate biologic agents in the region and cause widespread social panic. Medical, health, and laboratory personnel have a serious responsibility towards their public community in terms of the prevention, detection, and treatment of potential bioterrorism attacks. To fulfill their responsibilities, they need to be trained by taking part in the relevant courses during their undergraduate education. In case of potential bioterrorism attacks, an appropriate level of knowledge and preparedness is essential for medical, health, and laboratory personnel to ensure a proper medical response
to such outbreaks. This study aimed to evaluate the level of knowledge, preparedness, and attitude of medical, dentistry, nursing, and laboratory science
technology students in Birjand University of medical sciences, Birjand, Iran on a potential bioterrorism attack.
Methods: This study is a cross-sectional analytical study. A total of 182 students of Birjand University of Medical Sciences in medicine (Med), nursing (Nurse), laboratory science technology (Lst), and dentistry (Dent) who had just passed their microbiology courses took part in this study, in 2017. Students who were not willing to complete the questionnaire were excluded from the study. A non-probabilistic sampling method was used. Data were collected using a licensed questionnaire. The data were extracted from the questionnaires, corrected, and analyzed in SPSS software (version 24). All data were analyzed by the Kruskal-Wallis and Mann-Whitney Tests. P-value less than 0.05 was considered statistically significant.
Results: The result of the study showed that the mean scores (out of 100) of knowledge and preparedness of medicine, dental, laboratory science technology, and nursing students were obtained as 45.5±15.9 and 63.2±13.8, 41.3±6.5 and 66±12.5, 35.7±12.8 and 57.5±11.6, and 36.3±6.5 and 61.5±7.5, respectively. The knowledge score between Med and laboratory science technology students was significantly different (P=0.003). The same significant difference was also found between medicine and nursing students (P=0.007). Moreover, there was a statistically significant difference between dental and laboratory science technology students in terms of preparedness scores (P=0.002). However, no significant difference between dental and medicine students neither on their knowledge nor on their preparedness scores was observed (P=0.376, P=0.257).
Conclusions: It can be concluded that the level of knowledge and preparedness of medical, health, and medical laboratory science students regarding bioterrorism is relatively low. Therefore, enclosing educational programs about bioterrorism in the curriculum of all academic disciplines of medical sciences is suggested.

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• Introduction: Acquisition of clinical and practical skills is one of the highly critical and sensitive aspects of medical education, particularly in the areas related to surgical specialties. Moreover, one of the most important procedural strategies regarding educational medicine is the acquisition of practical skills in various psychological domains. Regarding this, the present study aimed to delineate the effects of practicing on goat’s eye for the residents expected to perform their first surgery on human eyes.
• Methods: This applied study was conducted on all the sophomore residents (n=8) of the Ophthalmology Department of Isfahan University of Medical Sciences, Isfahan, Iran, using a pre-experimental design. The procedures were instructed to the residents through three stages in the wet lab according to a protocol. After the completion of the second stage, the residents gained their first experience of performing surgery on human eyes in the operating room under the supervision of junior and senior residents and the attending specialist. At this stage, in case the further experience was required, the resident could start practicing on goat’s eyes in the wet lab upon prior coordination. At the third stage, the residents received instructions and practiced more advanced techniques. After this stage and upon the entrance of the residents to the operating room, the 3rd and 4th year residents and the attending specialists were surveyed regarding the performance of the 2nd year residents in nine fields in accordance with the aims of the study. In addition, the 2nd year residents completed a self-evaluation checklist. The data were analyzed in SPSS software, (version 16).
• Results: The results revealed that practicing before surgery on the human eye resulted in the reduction of surgical errors (45%), surgical speed and proficiency (20%), and stress and hand tremors (35%) during the first surgical experiences. According to the 3rd and 4th year residents, the practices and instructions provided before the wet lab had a positive effect on decreasing the levels of stress and surgical error during the first surgical experiences of the 2nd year residents. The attending specialists believed that the wet lab experience could have a positive effect on all aspects of surgery, including mental, emotional, and practical factors. Nonetheless, some 3rd and 4th-year residents believed that the wet lab could not provide circumstances identical to the conditions experienced in the operating room. Therefore, the effects of practicing in the wet lab on surgical speed, proficiency, stress, and surgical error were believed to be less significant.
• Conclusions: Overall, the study showed that repeated practice sessions on goat’s eye in the wet lab under the supervision of 3rd and 4th-year residents and attending specialists could not only have positive effects on some practical, mental, and attitudinal indices but also improve the knowledge of the residents.

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• Introduction: Congenital heart disease (CHD) occurs in about 8 cases per 1,000 live births and is responsible for 30% of all neonatal deaths. The reportedly high prevalence of CHD underscores the necessity of the implementation of local evaluations and screening programs in order to plan for appropriate interventions. Regarding this, the present study was performed to determine the prevalence of CHD and its associated risk factors among the newborns with respiratory distress and cyanosis admitted to Vali-e-Asr Hospital in Birjand, Iran, in 2016.
• Methods: This cross-sectional analytical study was conducted on the records of 199 neonates admitted to the Neonatal Unit of Vali-e-Asr Hospital due to respiratory distress and cyanosis in 2016. The data were collected using a predesigned form covering such information as gender, type of delivery, and gestational diabetes. Data analysis was performed in SPSS software (version 22) using the Chi-squared test. P-value less than 5% was considered statistically significant.
• Results: Out of the 199 neonates enrolled in this study, 168 (84.4%) cases suffered from CHD. Patent ductus arteriosus (PDA) was the most common anomaly among the neonates (n=85, 50.5%), followed by atrial septal defect (n=41, 24.4%), ventricular septal defect (n=36, 21.4%), transposition of great arteries (n=4, 2.2%), and other complex heart anomalies (e.g., shone complex; n=2, 1.1%), respectively. The results revealed that the presence of CHD, especially PDA, in neonates was associated with their parental interfamily marriage (P=0.024).
• Conclusions: The high prevalence and mortality of CHD necessitate the control of premarital and preconception potential risk factors (e.g., inter-family marriage) and preparation for the implementation of effective interventions for neonates with respiratory distress and cyanosis.

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• Aplasia cutis congenita (ACC) is a rare congenital disorder that commonly affects the scalp. In this disease, some parts of the skin with or without underlying structures were not formed at birth. The aplastic lesion always presents as a solitary lesion; however, multiple lesions also were reported. In more severe cases, deeper structures, such as the subcutaneous tissue, bone, and dura, can be affected. In this study, we report a case of ACC and its management.

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• Congenital structural heart diseases are the most commonly reported fatal anomalies in children. These anatomical disorders often can be corrected surgically . Today, echocardiography is the best and most important diagnostic technique for anatomical abnormalities in the heart. In this method, by using ultrasound waves (sonography), anatomical details, and hemodynamic examination of the heart can be determined. Most pediatric cardiologists provide echocardiographic reports in the form of handwriting or typed text. This method of reporting is sometimes unable to understand the structural anomalies precisely and accurately for the final decision. Nowadays, 2-dimensional echocardiography is acceptable for the diagnosis of some structural heart abnormalities accurately. Even there is no necessary for angiography for surgical planning . But sometimes lack matching echocardiographic findings with surgical reports, it seems that adding a schematic figure base on echocardiography findings from the viewpoint of pediatric cardiologist will be the helper to the congenital cardiac surgeon. This proposed method of reporting will lead to the promotion of surgical treatment in congenital heart diseases.
• The history of the schematic picture in the anatomical textbook for a better understanding of subjects and also diseases has been shown previously by famous painters like Leonardo Davin chi. This suggestion shows that mapping can be viewed as a common language for better understanding of echocardiographic reports and more adaptation between comments of a pediatric cardiologist with designing congenital cardiac surgeon for more precise and complete treatment.

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• Introduction: One way of monitoring angiographic organ is the clinical examination that is dependent on the accuracy of the person performing it; Therefore, human error may be high and require frequent examination is at least 24 hours after angiography. Meanwhile, checking for arterial or intravenous blood gases due to the small size of the vein and the arteries in children is difficult, unlike adults is difficult and requires skill and mastery in the field of venipuncture. Therefore, it is advisable to use simpler and less costly methods such as pulse oximeters to monitor organs that are more accurate and comfortable for the staff and patient. Therefore, this study was conducted to compare post angiography pulse oximetry and physical exam in cardiac congenital of pediatric patients.
• Methods: This study was conducted with 45 patients with congenital heart disease undergoing diagnostic or therapeutic angiography. They were selected by convenience sampling method from among patients referring to the angiography department of Vali-e-Asr Hospital in Birjand, Iran, in 2016. Trained personnel performed the clinical examinations, including temperature, colour, and pulse check (dorsalis pedis and tibialis posterior) for both the angiographic and control organs. Pulse oximetry was also performed concurrently using the Massimo pulse oximeter for both organs and continued for up to 6 hours after angiography. Demographics form and patients' clinical records were used to collect data. The obtained data were analyzed in SPSS software (V: 23) using the Kappa test.
• Results: The agreement between the pulse oximetry of the angiographic and control organs was mild only at one, two, and six hours after angiography, and was moderate three hours after angiography (kappa=0.656 after three hours).
• Conclusions: Although there was no clinical agreement between pulse oximetry and clinical examination, according to our findings pulse oximetry is more accurate, and given the results in the first one to two hours after angiography evaluation of organ is more sensitivity.

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• Introduction: Hemorrhoid is one of the most common anorectal diseases which affects 5% of the general population. Complications and pain are inevitable after all surgeries with different intensities and degrees.Management and control of these complications is one of the most important aspects of postoperative care. There are surgical techniques and interventions for the treatment and control of pain after hemorrhoid. According to the contradictory results of the studies on surgical methods, the present study aimed to compare the effectiveness, complications, and safety of hemorrhoidectomy with Ligasureand Ferguson hemorrhoidectomy.
• Methods: The study sample in this randomized controlled clinical trial studyincluded54 patientswhowere randomly divided into two groupsofLigasureandFerguson surgery. Prior to the surgery, patients were educated abouttheVisual Analogue Scale(VAS).Patients underwent general anesthesia and the same surgeon performed the surgery in both groups. Immediately after the surgery (oncethe patient regainedconsciousness and understoodthe environment), 6, 12, and 24 hours after the surgery, patients’ pain and complications were assessed.The collected data were analyzed using SPSS software (version 18)through independent t-test, Mann-Whitney, Friedman, Chi-square and Fisher’s exact test at a significance level of α=0.05.
• Results: The mean bleeding during the surgery was significantly lower in the Ligasuregroupthan the Ferguson group. The mean pain at 0, 6, 12, and 24 hafterthe surgery was not significantly different between the two groups.Postoperative complications were significantly higher in the Ligasuregroup than the Ferguson group.
• Conclusion: Ligasurehemorrhoidectomy is not superior to the Ferguson method in terms of analgesia up to 24 h after the surgery; however, this method of surgeryis preferable to the Ferguson method in terms of bleeding during the surgery.

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• Introduction: Congenital heart defects (CHDs) are diagnosed in ≈8 to 10 per 1,000 live births in the United States. This study aimed to determine the outcomes in children with congenital heart disease.
• Methods: This cross-sectional descriptive-analytical study was conducted using the census method on all patients with a CHD who referred to the pediatric heart clinic in Valiasr Hospital, Birjand, Iran, and underwent heart operation during the desired period. The information contained in the patients' files was used to collect the required data. The rest of the information was gathered by calling the patients' parents. The collected data were analyzed in the SPSS-19 software using the Chi-square test and Fisher's exact test. The significant level was considered at the p-value of ≤ 0.05.
• Results: The results of the statistical analysis indicated that the type of intervention (i.e., operation, intrusion) had no statistically significant relationship with demographic indicators of gender, age by month, chromosomal abnormalities, the type of heart disease, and the development of children under-study; however, it showed a statistically significant relationship with the type of initial complaint. The rate of operation was significantly higher in the subjects, especially in those who had an initial complaint of murmurs. Based on the results, the age of children had a statistically significant relationship with the need for pacemakers and the amount of pleural effusion; these two outcomes increased significantly with the child's aging.
• Conclusion: A large number of demographic and clinical factors were effective in children's postoperative outcomes. Consequently, by conducting further studies at a wider level and controlling variables it is possible to compare the findings, achieve more favorable results, and improve clinical indicators.

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• Introduction: Adopting a suitable strategy to reduce the complications of cholecystectomy plays a significant role in the well-being of patients. We investigated the effects of atorvastatin on clinical symptoms, and inflammatory markers of patients undergoing cholecystectomy.
• Methods: This double-blind randomized controlled trial was conducted in Imam Reza Hospital, Birjand in 2021. In this study, 47 patients received 40 mg atorvastatin (intervention group) and 47 patients received placebo both daily for 4 weeks (placebo group). Then, the frequency of fever, abdominal pain, and nausea before and after cholecystectomy, as well as peri-operative data (duration of operation, and intraoperative bleeding) and laboratory data [White Blood Count (WBC), C-Reactive Protein (CRP), Aspartate AminoTransferase (AST), and Alkaline Phosphatase (ALT)] was collected. The data was analyzed using (SPSS Version 22) based on chi-squared, and independent t-tests at the significance level of (P≤0.05).
• Results: The duration of hospitalization was not significantly different in both groups (P=0.26), however, the duration of operation was significantly longer in the intervention group (P<0.001). The frequency of fever, abdominal pain, and nausea after cholecystectomy was not statistically different (P>0.05). The volume of intraoperative bleeding in the placebo group was more than the intervention group (P=0.05). The decrease of WBC, CRP, and the ALT levels after cholecystectomy was not statistically different (P>0.05); however, AST level after cholecystectomy was higher in the intervention group (P=0.05).
• Conclusions: The use of atorvastatin effectively reduced the volume of intraoperative bleeding. However, this intervention with this dose and duration could not have a significant role in reducing the duration of patients’ hospitalization, duration of operation, and levels of WBC, CRP, ALT, and AST.