PurposeAcute appendicitis (AA) is one of the most common causes of an acute abdomen. The accuracies of the Alvarado and the acute inflammatory response (AIR) scores in the diagnosis of appendicitis is very low in Asian populations, so a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) system, was designed recently. We applied and compared the Alvarado, AIR, and RIPASA scores in the diagnoses of appendicitis in the Iranian population.MethodsWe prospectively compared the RIPASA, Alvarado, and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with right quadrant pain. Appendectomies were performed; then, the postoperative pathology reports were correlated with the scores. Scores of 8, 7, and 5 or more are optimal cutoffs for the RIPASA, Alvarado, and AIR scoring systems, respectively. The sensitivities, specificities, positive predictive values, negative predictive values (NPVs), positive and negative likelihood ratios (LRs) for the 3 systems were determined.ResultsThe sensitivity and the specificity of the RIPASA score were 93.18% and 91.67%, respectively. The sensitivities of the Alvarado and the AIR scores were both 78.41%. The specificities of the Alvarado and the AIR scores were 100% and 91.67%, respectively. The RIPASA score correctly classified 93% of all patients confirmed with histological AA compared with 78.41% for the Alvarado and the AIR scores.ConclusionThe RIPASA scoring system had more sensitivity, better NPV, a positive LR, and a less negative LR for the Iranian population whereas the Alvarado scoring system was more specific.

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Purpose: Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD. Methods: A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study. Results: Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group. Conclusion: Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

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Anal canal duplication (ACD) is a very rare condition, especially in adults. Four cases in adults are reported. In three cases, the orifice of duplication was located behind the native anus, and in one case, it was located anteriorly. In all cases, no communication between the anal canal and the tract of duplication was noted. Complete removals of the duplications were done through a perineal approach. Histology showed fibro-muscular tissue lined with a squamous epithelium. The postoperative courses were uneventful.

Background: Vancomycin (VCM) is an important antibiotic that is active against gram-positive cocci, and its nephrotoxicity remain as a major problem in clinical use. Objectives: This study was designed to investigate the effect of Nasturtium officinale hydro-alcoholic extract (NOE) and vitamin E aganist VCM-induced nephrotoxicity in adult male wistar rats. Methods: A total of 36 animals were randomly divided into 6 equal groups (n = 6) including 1, control group; 2, VCM group; 3, VCM + NOE (250 mg/kg) group; 4, VCM + NOE (500 mg/kg) group; 5, VCM + vitamin E (250 mg/kg) group; and 6, VCM + vitamin E (500 mg/kg) group. VCM (200 mg kg -1 i.p.) was given every 12 hours for 7 consecutive days. NOE and vitamin E were orally given to rats 30

Erectile dysfunction is highly prevalent in hemodialysis patients. The prevalence and the severity of ED increase with age. Evaluations and efficient therapy for ED should be included in routine assessment of hemodialysis patients.