Annals of Colorectal Research Annals of Colorectal Research Ann Colorectal Res http://www.colorectalresearch.com 2322-5262 2322-5289 10.5812/acr. en jalali 2017 6 24 gregorian 2017 6 24 In Press In Press
en 10.5812/acr.46479 Water Stream in Bidet Toilet Commode as a Cause of Anterior Anal Fissure: A Case-Control Study Water Stream in Bidet Toilet Commode as a Cause of Anterior Anal Fissure: A Case-Control Study research-article research-article Results

In this study, 165 patients were prospectively enrolled. Male/female ratio was 96/69, and the mean age was 36.3 ± 11.2 years. The anterior fissure-in-ano in the study group was 55.9% (47/84), while it was 17.3 % (14/81) in the control group (P < 0.0001, odds ratio: 6.08, 95% CI: 2.96 - 12.47].

Conclusions

Water used as a single sharp stream to cleanse after defecation in toilet commodes is hazardous and should be avoided.

Objectives

The present study aimed at determining whether water stream usage in toilet commodes increased the incidence of anterior fissure-in-ano; this was determined by the incidence of anterior fissure-in-ano the study and control groups.

Methods

All consecutive fissure-in-ano patients referring to a colorectal clinic from February 2012 to 2015 were included in the study. The patients were classified as a study group (who were using water stream for cleansing purposes in toilet commodes) and a control group (patients who were not using water stream). The characteristics and location (position) of the fissure-in-ano was noted.

Background

Water used as a single sharp stream in toilet commode for post defecation cleansing is a common practice in several countries across the globe including India. Repeated hitting of the anus by water stream could potentially cause injury to the anal canal epithelium and lead to development of fissure-in-ano. As the water stream is emanating from the backside of the toilet commode, the possible injury, if any, would be on the anterior anal canal.

Results

In this study, 165 patients were prospectively enrolled. Male/female ratio was 96/69, and the mean age was 36.3 ± 11.2 years. The anterior fissure-in-ano in the study group was 55.9% (47/84), while it was 17.3 % (14/81) in the control group (P < 0.0001, odds ratio: 6.08, 95% CI: 2.96 - 12.47].

Conclusions

Water used as a single sharp stream to cleanse after defecation in toilet commodes is hazardous and should be avoided.

Objectives

The present study aimed at determining whether water stream usage in toilet commodes increased the incidence of anterior fissure-in-ano; this was determined by the incidence of anterior fissure-in-ano the study and control groups.

Methods

All consecutive fissure-in-ano patients referring to a colorectal clinic from February 2012 to 2015 were included in the study. The patients were classified as a study group (who were using water stream for cleansing purposes in toilet commodes) and a control group (patients who were not using water stream). The characteristics and location (position) of the fissure-in-ano was noted.

Background

Water used as a single sharp stream in toilet commode for post defecation cleansing is a common practice in several countries across the globe including India. Repeated hitting of the anus by water stream could potentially cause injury to the anal canal epithelium and lead to development of fissure-in-ano. As the water stream is emanating from the backside of the toilet commode, the possible injury, if any, would be on the anterior anal canal.

Anal Fissure;Anterior;Cause;Water;Bidet Toilet Anal Fissure;Anterior;Cause;Water;Bidet Toilet http://www.colorectalresearch.com/index.php?page=article&article_id=46479 Pankaj Garg Pankaj Garg Colorectal Surgery Division, Indus Super Specialty Hospital, Mohali, Punjab, India; Garg Fistula Research Institute, Panchkula, Haryana, India; Garg Fistula Research Institute, 1042, Sector-15, Panchkula, Haryana, India. Tel: +91-9501011000, Fax: +91-1722594556 Colorectal Surgery Division, Indus Super Specialty Hospital, Mohali, Punjab, India; Garg Fistula Research Institute, Panchkula, Haryana, India; Garg Fistula Research Institute, 1042, Sector-15, Panchkula, Haryana, India. Tel: +91-9501011000, Fax: +91-1722594556 Pratiksha Singh Pratiksha Singh Garg Fistula Research Institute, Panchkula, Haryana, India Garg Fistula Research Institute, Panchkula, Haryana, India
en 10.5812/acr.46292 A Review of the Incidence of Colorectal Cancer in the Middle East A Review of the Incidence of Colorectal Cancer in the Middle East review-article review-article Methods

All the published reports citing the incidence of CRC in the Middle East were collected by conducting a literature search using Pubmed. Data was extracted from the included articles, and summarized in tables and charts, according to “country of origin”, “gender”, and “ASR”. Data presented by GLOBOCAN on the incidence/prevalence and mortality rates of CRC are also showed in separate charts and tables.

Background

Colorectal cancer (CRC) accounts for about 10% of cancers and is the third most prevalent cancer worldwide. It is also one of the leading causes of cancer-related mortality. The objective of the current study was to investigate the incidence of CRC East by reviewing reports on number and age standardized incidences of CRC in both genders in different areas of the Middle East.

Conclusions

Although Middle East is generally a low risk region for CRC, the incidence rate of CRC is more in western regions, including countries located on the coast of the Mediterranean sea, compared to eastern and southern regions. Moreover, males and females are at risk at younger ages compared to western countries.

Results

This research identified 194 articles, through the Pubmed search. After removing duplicate and triplicate publications, 96 full-text articles were assessed for eligibility and 78 were excluded. According to data from Reviewed articles, the highest and the lowest ASR for colorectal cancer were respectively 48.3 (European-American Jews) and 4.2 (Shiraz, south Iran) in males and 35 (European-American Jews) and 2.72 (Shiraz, south Iran) in females (1, 2). According to GLOBOCAN, the highest ASR was 35 (Israel) and the lowest was 4.48 (Yemen) in both genders. Except for Jews, the mean age of patients was 53 to 54.9.

Methods

All the published reports citing the incidence of CRC in the Middle East were collected by conducting a literature search using Pubmed. Data was extracted from the included articles, and summarized in tables and charts, according to “country of origin”, “gender”, and “ASR”. Data presented by GLOBOCAN on the incidence/prevalence and mortality rates of CRC are also showed in separate charts and tables.

Background

Colorectal cancer (CRC) accounts for about 10% of cancers and is the third most prevalent cancer worldwide. It is also one of the leading causes of cancer-related mortality. The objective of the current study was to investigate the incidence of CRC East by reviewing reports on number and age standardized incidences of CRC in both genders in different areas of the Middle East.

Conclusions

Although Middle East is generally a low risk region for CRC, the incidence rate of CRC is more in western regions, including countries located on the coast of the Mediterranean sea, compared to eastern and southern regions. Moreover, males and females are at risk at younger ages compared to western countries.

Results

This research identified 194 articles, through the Pubmed search. After removing duplicate and triplicate publications, 96 full-text articles were assessed for eligibility and 78 were excluded. According to data from Reviewed articles, the highest and the lowest ASR for colorectal cancer were respectively 48.3 (European-American Jews) and 4.2 (Shiraz, south Iran) in males and 35 (European-American Jews) and 2.72 (Shiraz, south Iran) in females (1, 2). According to GLOBOCAN, the highest ASR was 35 (Israel) and the lowest was 4.48 (Yemen) in both genders. Except for Jews, the mean age of patients was 53 to 54.9.

Incidence;Colorectal Cancer;Middle East Incidence;Colorectal Cancer;Middle East http://www.colorectalresearch.com/index.php?page=article&article_id=46292 Ahmed Mohammed Ali Hussein Alhurry Ahmed Mohammed Ali Hussein Alhurry Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Abbas Rezaianzadeh Abbas Rezaianzadeh Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Salar Rahimikazerooni Salar Rahimikazerooni Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7136281453 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7136281453 Mohammad Abdzaid Akool Mohammad Abdzaid Akool Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Faranak Bahrami Faranak Bahrami Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Seyedeh Saeedeh Shahidinia Seyedeh Saeedeh Shahidinia Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Mahboobeh Pourahmad Mahboobeh Pourahmad Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
en 10.5812/acr.48494 Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis research-article research-article Background

Ideal operative timing for non-emergent, acute diverticulitis (AD) remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy.

Objectives

To evaluate the effect of operative delay on sepsis and mortality in patients with AD.

Methods

Patients from the American college of surgeons national surgical quality improvement program (ACS-NSQIP) database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI), pneumonia (PNA), need for blood transfusion, septic shock, return to the operating room, length of stay (LOS), readmission, wound dehiscence, and surgical site infections (SSI). Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for primary and secondary outcomes.

Results

32,399 patients underwent colectomy for AD on hospital day 1 - 20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 - 1.057; P < 0.0001) and sepsis (OR = 1.051, 95% CI, 1.035 - 1.067; P < 0.0001). Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion, return to the operating room and increase LOS.

Conclusions

Delaying operation for patients with AD has a significant impact on sepsis and mortality. While non-operative approaches may be attempted, with each additional day operative therapy is delayed there is a significant increase in the risk of morbidity and mortality. This data suggests that surgeons should pursue operative therapy earlier in the hospital course to improve patient outcomes.

Background

Ideal operative timing for non-emergent, acute diverticulitis (AD) remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy.

Objectives

To evaluate the effect of operative delay on sepsis and mortality in patients with AD.

Methods

Patients from the American college of surgeons national surgical quality improvement program (ACS-NSQIP) database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI), pneumonia (PNA), need for blood transfusion, septic shock, return to the operating room, length of stay (LOS), readmission, wound dehiscence, and surgical site infections (SSI). Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for primary and secondary outcomes.

Results

32,399 patients underwent colectomy for AD on hospital day 1 - 20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 - 1.057; P < 0.0001) and sepsis (OR = 1.051, 95% CI, 1.035 - 1.067; P < 0.0001). Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion, return to the operating room and increase LOS.

Conclusions

Delaying operation for patients with AD has a significant impact on sepsis and mortality. While non-operative approaches may be attempted, with each additional day operative therapy is delayed there is a significant increase in the risk of morbidity and mortality. This data suggests that surgeons should pursue operative therapy earlier in the hospital course to improve patient outcomes.

Acute Diverticulitis;Operative Timing;Medical Management;Surgical Management Acute Diverticulitis;Operative Timing;Medical Management;Surgical Management http://www.colorectalresearch.com/index.php?page=article&article_id=48494 Robin F. Irons Robin F. Irons Department of Surgery, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA; Cooper University Hospital and Cooper Medical School of Rowan University, Three Cooper Plaza, Suite 411, Camden, NJ 08103 USA. Tel: +1-9082291171 Department of Surgery, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA; Cooper University Hospital and Cooper Medical School of Rowan University, Three Cooper Plaza, Suite 411, Camden, NJ 08103 USA. Tel: +1-9082291171 Michael E. Kwiatt Michael E. Kwiatt Department of Surgery, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA Department of Surgery, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA Michael J. Minarich Michael J. Minarich Department of Surgery, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA Department of Surgery, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA John P. Gaughan John P. Gaughan Cooper Research Institute and Cooper Medical School of Rowan University, Camden, NJ, USA Cooper Research Institute and Cooper Medical School of Rowan University, Camden, NJ, USA Francis R. Spitz Francis R. Spitz Department of Surgery, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA Department of Surgery, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA Steven J. McClane Steven J. McClane Department of Surgery, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA Department of Surgery, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA
en 10.5812/acr.46367 Validation of the Persian Version of Inflammatory Bowel Disease Questionnaire in Patients Who Referred to Clinics and Hospitals of Birjand University of Medical Science, Iran Validation of the Persian Version of Inflammatory Bowel Disease Questionnaire in Patients Who Referred to Clinics and Hospitals of Birjand University of Medical Science, Iran research-article research-article Conclusions

Due to the high internal consistency and correlation coefficients with SF-36 inventory, it can be used in the studies to evaluate the QOL in the patients.

Background

Inflammatory bowel disease (IBD) questionnaire is a disease-specific questionnaire to measure the health related quality of life (QOL) in patients with inflammatory bowel disease.

Objectives

The current study aimed at assessing the validity of the Persian version of the QOL questionnaire in patients with inflammatory bowel disease referred to the clinics and hospitals affiliated to Birjand University of Medical Sciences, Iran.

Methods

The current cross sectional study included 87 patients who referred to the clinics and hospitals affiliated to Birjand University of Medical Sciences from 2014 to 2015; IBD diagnosis was confirmed in the subjects by the pathological analyses and accordingly they were asked to complete the Persian version of IBDQ. Data were analyzed by SPSS (15) using descriptive statistics, internal consistency reliability, construct validity (by the short-form 36), and factor analysis was used for the structural validity of the questionnaire.

Results

A total of 87 patients with the mean age of 38.80 ± 16.17 years enrolled in the study. Mean score of QOL based on IBDQ questionnaire, was 158.99 ± 24.9 out of 224. The factor analysis of the Persian version did not confirm the structural factor of the original questionnaire. Cronbach’s alpha for the questionnaire was 0.94, in domains from 0.68 to 0.89. The correlation between the domains of QOL in IBDQ and SF-36 inventory were 0.44 to 0.69

Conclusions

Due to the high internal consistency and correlation coefficients with SF-36 inventory, it can be used in the studies to evaluate the QOL in the patients.

Background

Inflammatory bowel disease (IBD) questionnaire is a disease-specific questionnaire to measure the health related quality of life (QOL) in patients with inflammatory bowel disease.

Objectives

The current study aimed at assessing the validity of the Persian version of the QOL questionnaire in patients with inflammatory bowel disease referred to the clinics and hospitals affiliated to Birjand University of Medical Sciences, Iran.

Methods

The current cross sectional study included 87 patients who referred to the clinics and hospitals affiliated to Birjand University of Medical Sciences from 2014 to 2015; IBD diagnosis was confirmed in the subjects by the pathological analyses and accordingly they were asked to complete the Persian version of IBDQ. Data were analyzed by SPSS (15) using descriptive statistics, internal consistency reliability, construct validity (by the short-form 36), and factor analysis was used for the structural validity of the questionnaire.

Results

A total of 87 patients with the mean age of 38.80 ± 16.17 years enrolled in the study. Mean score of QOL based on IBDQ questionnaire, was 158.99 ± 24.9 out of 224. The factor analysis of the Persian version did not confirm the structural factor of the original questionnaire. Cronbach’s alpha for the questionnaire was 0.94, in domains from 0.68 to 0.89. The correlation between the domains of QOL in IBDQ and SF-36 inventory were 0.44 to 0.69

Inflammatory Bowel Disease;Quality of Life;Validity;Reliability Inflammatory Bowel Disease;Quality of Life;Validity;Reliability http://www.colorectalresearch.com/index.php?page=article&article_id=46367 Bita Bijari Bita Bijari Associate Professor, Department of Community Medicine, Birjand University of Medical Sciences, Birjand, Iran; Associate Professor, Department of Community Medicine, Birjand University of Medical Sciences, Birjand, Iran. Tel: +98-5632381506, Fax: +98-5632433004 Associate Professor, Department of Community Medicine, Birjand University of Medical Sciences, Birjand, Iran; Associate Professor, Department of Community Medicine, Birjand University of Medical Sciences, Birjand, Iran. Tel: +98-5632381506, Fax: +98-5632433004 Behnam Soltani Behnam Soltani MD, Birjand University of Medical Sciences Birjand, Iran MD, Birjand University of Medical Sciences Birjand, Iran