Preoperative clinical and paraclinical predictors of choledocholithiasis

BACKGROUND:Choledocholithiasis is the most common cause of obstructive jaundice and cholangitis and occurs in about 10%of patients with symptomatic gallstone.The aim of this study was to find preoperative and non-invasive tests for predicting common bile duct stones(CBDs). METHODS:Findings of clinical examination,history laboratory tests and ultrasound(US)in 60 patients with CBDs were compared retrospectively,with 60 patients with gallstones.The data were collected from medical charts The sensitivity,specificity and positive predictive value (PPV)were determined. RESULTS:The comparison between the two groups showed significant differences in anorexia,itching,dark urine subicterus(slightly elevated serum bilirubin without clinical evidence of jaundice)and jaundice appearance increased bilirubin level,aspartate aminotransferase(AST) and alanine aminotranferase(ALT),CBD diameter>6 mm and stone observation under US(P<0.05).The highest specificity(100%)and PPV(100%)were found in dark urine and pale colored stool,history of cholangitis,and icterus.Among paraclinical tests,alkaline phosphatase (ALP)had the highest specificity(72.1%)and PPV(12.5%) Under US,stone observation in CBD was the most important factor with a sensitivity of 94.5%,a specificity of 100%and a PPV of 100%. CONCLUSIONS:The most important factors for predicting CBDs are history of cholangitis and pancreatitis,presence of icterus,dark urine,pale colored stool,elevation of ALP and sonographic evidence of chledocholithiasis.

Mental health among Iranian combat veterans with ankle-foot neuromusculoskeletal injuries

Background:Veterans with purely physical disorders,such as ankle-foot neuromusculoskeletal disorders,are often neglected in psychological assessments because mental health evaluations are usually focused on those with a psychological disturbance or with a high percentage of injury.The purpose of this study was to evaluate the psychological condition of veterans with ankle-foot neuromusculoskeletal disorders.Methods:A cross-sectional study was performed between 2014 and 2016 on veterans with war-related ankle-foot injuries living in two provinces of Iran.An information form for demographic data and injury-related factors was used.Additionally,the previously validated Persian version of the Symptom Checklist-90-Revision(SCL-90-R)questionnaire was used for data collection.Results:The respondents were 215 male veterans with a mean age of 51.7±7.5 years.The most common mental health problems were observed for the somatization(24.7%),obsessions-compulsions(14.4%),and anxiety(12.6%).Based on the Global Severity Index(GSI),48.6%of individuals had a possible psychiatric/psychological illness.According to the multivariate regression analysis,GSI scores were significantly higher among veterans who were older than 27 years at the time of injury(P=0.005),had an associated injury(P=0.002),and had a history of hospitalization within the past 12 months for reasons other than their injury(P=0.035).Conclusion:Approximately half of the combat veterans with ankle-foot neuromusculoskeletal disorders likely had psychological problems.The evaluation of the patterns and predicting factors of psychological conditions may inform strategic planning efforts and decision-making,which,in turn,may provide a better quality of life for veterans.Further studies that utilize longitudinal designs are needed to evaluate and compare the psychological status of different groups of veterans and other groups in the general population.