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Volume 60, Issue 6 (15 2002)
Introduction: In this study, we reviewuated and compared three routine methods for the measurement of urinary protein concentrations with a view to find a suitable method to prevent, diagnose and monitor renal disease under circumstances with limited resources.
Materials and Methods: Two modifications of the Trichoroacetic acid (TCA) turbidimetric method read at 405 and 620 nm and the sulfosalicylic acid (SSA) turbidimetric method were considered. The reviewuated was carried out using a variety of control materials, calibrators and patients urine samples.
Results: The result indicated that the TCA method read at 405nm is appropriate for the measurement of protein in the range of 25-700 mg/L and the TCA "620nm method" is appropriate for the measurement of protein concentration in the range of 100-1000 mg/L. Of the two methods, the TCA at 405 nm was minimally influenced by the type of calibrator. The SSA method showed unacceptable performance in the measurement of protein, specially at lower concentration, in addition the results showed a large variation depending on the type of calibration.
Conclusion: For screening of high-risk populations e.g. diabetics and early diagnosis of microproteinuria the recommended method is the TCA at 405 nm calibrated with a serum-based mixed Albumin/Globulin standard. For routine testing the TCA method at 620 is suggested regardless of type of calibration, although the limitations at lower concentrations should be remembered.
Volume 65, Issue 2 (8 2008)
Background: Until a few decades ago, celiac disease was considered to be essentially a disease of European people and to be very rare in Middle Eastern countries. During the last two decades, having met the criteria for the WHO general screening, the advent and application of novel serological assays used to screen for celiac disease and the use of endoscopic small bowel biopsy have led to increasing numbers of diagnoses of celiac disease in western countries. With this new data, our knowledge on both the clinical pattern and epidemiology of celiac disease has increased, and is now known to be a relatively common autoimmune disorder. Studies performed in different parts of the developing world have shown that the prevalence of celiac disease in this area is similar to or even higher than that in western countries. In fact, celiac disease is known to be the most common form of chronic diarrhea in Iran. However, contrary to common belief, celiac disease is more than a pure digestive alteration. It is a protean systemic disease, and, with a 95 percent genetic predisposition, has a myriad of symptoms including gastrointestinal, dermatological, dental, neurological and behavioral that can occur at a variety of ages. Monosymptomatic, oligosymptomatic, atypical (without gastrointestinal symptoms), silent and latent forms of celiac disease have been identified. In this study we review the epidemiology of celiac disease based on the studies performed in Iran and discuss its pathogenesis, the role of antibodies in the diagnosis of celiac disease and the importance of its diagnosis and treatment in Iran.
Volume 65, Issue 8 (3 2007)
Background: Hyperhomocysteinemia is an independent risk factor for cardiovascular diseases. The frequency of hyperhomocysteinemia is higher in hemodialysis (HD) patients than the general population. The objective of this study is to assess the efficacy of high-dose folic acid supplementation with and without vitamin B12 on lowering plasma total homocysteine (tHcy) concentrations in HD patients.
Methods: Thirty-six HD patients at Imam Hossein Hospital, Tehran, Iran, who had been given folic acid supplements (5 mg/d) for at least 3 months before, were enrolled in this clinical trial. Subjects were also checked for other inclusion and exclusion criteria. The subjects were divided randomly into four groups and underwent two months of supplementation as follows: 5 mg/d oral folic acid + placebo in group one, 5 mg/d oral folic acid + vitamin B12 (1 mg/d orally) in group two, 15 mg/d oral folic acid + placebo in group three and 15 mg/d oral folic acid + vitamin B12 (1 mg/d orally) in group four. Concentrations of plasma tHcy and serum folic acid and vitamin B12 were measured at baseline and after the supplementation period. Dietary intake of patients was also determined during the supplementation period.
Results: Of the folic acid supplemented patients, 27.8% had normal levels of tHcy at baseline and 72.2% had hyperhomocysteinemia. After the supplementation period, plasma tHcy increased by 1.35% in group one and decreased by 6.99%, 14.54% and 30.09% in groups two, three and four respectively. Changes in plasma tHcy and serum vitamin B12 were only significant in group four however, no significant changes were seen for serum folic acid. The percentage of subjects reaching normal levels of plasma tHcy was 5.6 fold higher in group four than in the reference group.
Conclusions: Supplementation with 15 mg/d folic acid together with 1 mg/d oral vitamin B12 is more effective in reducing tHcy levels in HD patients.
Volume 65, Issue 12 (2 2008)
Background: Myeloperoxidase (MPO), an iron-containing protein, is found in the azurophilic granules of neutrophils (PMNs), and catalyzes the conversion of hydrogen peroxide and chloride ions (Cl) into hypochlorous acid, which plays an important role in oxygen-dependent bacterial killing. The enzyme was first isolated in 1941, and deficiency of MPO was first described in 1954. Fewer than 5% of patients with MPO deficiency contract severe infections, which are usually fungal infections in diabetes mellitus (DM) patients. Besides the disorder in antifungal activity, diminished rate of bacterial (S. aureus) killing, and carcinogenesis, it seems that MPO deficiency is also related to atherosclerosis, degenerative neurologic diseases, as well as other disorders. In this study, we compared the levels of the MPO enzyme in the peripheral neutrophils of infected and non-infected DM patients at Imam Khomeini Hospital during 2005-2006. We compared these two groups the prevalence of MPO deficiency in each group, in order to then determine any correlations this may have with infection.
Methods: In this case-control study, 50 patients were in the infected group (case group) and 50 were in the control group. Patients were chosen using simple sampling methods. Data was gathered from blood samples, using a qualitative test to determine MPO deficiency (Kaplow stain), laboratory results (BUN, Cr, PMN, HbA1c), interviews and completion of a questionnaires, as well as hospital records. Data were analyzed with SPSS software using T test and chi-square test, with a confidence index of 0.05.
Results: In spite of differences seen in stained slides, the MPO enzyme was positive in all of the patients, and no differences were seen between the two groups.
The average patient age and the duration of DM in the case group were more than those of the control group. No statistical differences in the type of DM and glycosylated hemoglobin (HbA1c) levels were found between the two groups. Body mass indexes (BMI) and PMN counts were higher in the case group. The most prevalent infections were in the skin and soft tissue, bones and joints, as well as chronic respiratory infections (TB), pneumonia, urinary infections, CNS infections, gastrointestinal and intra-abdominal infections, mucormycosis, and sepsis.
Conclusions: We found no correlation between MPO enzyme deficiency and age, sex, type or duration of DM, HbA1c levels and BMI.
Volume 66, Issue 5 (5 2008)
Background: Chronic Subdural Hematoma (CSDH) is one of the most common challenges of neurosurgeons. Most predominant among the elderly, the incidence increases incrementally with age and might lead to permanent severe complications. The aim of this study is to outline the symptoms and signs and to compare the outcomes and complications among two groups of patients who underwent two different surgical procedures.
Methods: In a cross-sectional and descriptive-analytical study performed on 125 patients with CSDH from 2000 to 2005. Computed tomography scan was used for diagnostic imaging in all cases and magnetic resonance imaging was also obtained for six patients. In one center, group 1, which included 82 patients, underwent surgery with a single burr hole and closed drainage, and, at another center, group 2, which included 43 patients, was treated with a method using two burr holes and close drainage.
Results: Of the 125 patients, 102 were male and 23 were female. The mean age of patients was 65.79±16.41 years. The most common symptoms were weakness in extremities (78.4%), headache (72.8%) and decreased level of consciousness (24%), respectively. At presentation, 88 (70.4%) of the patients had several symptoms and 37 (29.6%) had only one symptom. A history of mild head trauma, such as falling, was observed in 83 (68%) of the patients. The interval between head trauma and the onset of symptoms ranged from 10 to 120 days (mean: 46 days). Hematoma recurred in five cases from group 1, whereas two cases from group 2 had recurrence of hematoma. Postoperative epidural hematoma developed in one case from group 2 and tension pneumocephalus also occurred in one group 2 patients.
| Conclusion: As a treatment for CSDH, the single burr hole method was significantly better than the two burr hole method. |
Volume 70, Issue 11 (3 2013)
Background: Warthin tumor- like papillary carcinoma of thyroid is a rare variant of papillary thyroid carcinoma. It is characterized by distinct papillary structures lined by oncocytic tumor cells with nuclear features of papillary carcinoma and marked lymphoplasmocytic infiltrate in the papillary stalks. This tumor derives its name from its resemblance to Warthin tumor of major salivary glands.
Case presentation: We report a 54- year- old man presented with bilateral thyroid masses. Histopathological study showed papillary structures lined by cells with eosinophilic granular cytoplasm and ground- glass nuclei with lymphoplasmacytic infiltration of the stalks.
Conclusion: Warthin tumor-like papillary thyroid carcinoma could be mistaken for benign lymphoepithelial lesions such as Hashimoto thyroiditis, Hurthle cell tumors and tall cell variant of papillary carcinoma. Follow- up information on the previously reported cases has suggested that these tumors behave similarly to usual papillary carcinoma.
Volume 71, Issue 7 (October 2013)
Background: It is rare to find squamous metaplasia in the thyroid gland. Its existence is usually seen in association with a pathological lesion such as mucoepidermoid carcinoma, squamous cell carcinoma and diffuse sclerosing variant of papillary thyroid carcinoma. In most cases the squamous cells are few in number and squamous metaplasia is focal and small in size. Extensive squamous metaplasia of the thyroid gland is a very rare finding.
Case Presentation: We report a case of massive squamous metaplasia in Hashimoto thyroiditis in a 53 year-old- male with a four year history of hypothyroidism. Also seen in the history is impaired thyroid function tests of low T3 and T4 levels with rise in TSH. The patient currently presented with neck discomfort and a somewhat firm nodular neck mass. Ultrasonography revealed heterogeneous nodular enlargement of both thyroid lobes and a calcified nodule of the left lobe. Fine needle aspiration of the thyroid nodule was performed which reported findings suspicious for malignancy. Based on these findings the patient underwent total thyroidectomy.
Conclusion: In this article we address the causes and sources of massive squamous metaplasia in the thyroid gland. We also discuss the histopathologic differential diagnostic lesions which could be the cause of potential pitfalls encountered in the interpretation of the cytopathology and histopathology of such lesions arising in this gland.
Volume 73, Issue 2 (May 2015)
Background: Cytotoxic lymphocyte antigen-4 (CTLA-4) plays an important role in regulating T cell activation. CTLA-4 gene polymorphisms are related with genetic susceptibility to various autoimmune diseases, including systemic lupus erythematosus (SLE). We analyzed the role of CTLA-4 polymorphisms at positions -318CT in patients who suffer from SLE. Methods: This study was performed on 180 SLE patients referred to 5th Azar University Hospital in Gorgan, Iran. Three hundred and four ethnically-and age-matched healthy controls with no history of autoimmune diseases entered the study between 5th May 2008 and 23rd October 2009. DNA was extracted from blood samples according to the standard procedure. Polymerase chain reaction- restriction fragments length polymorphism (PCR-RFLP) was used to analyze the genotype and allele frequencies of this polymorphism. PCR was carried out using the following primers: forward 5′-AAATGAATTGGACTGGATGGT-3′ and reverse 5′-TTACGAGAAAGGAAGCCGT G-3′. The frequency of alleles and genotypes were assessed using direct counting. Chi-square test and Fisher’s exact test were used to compare the association between the alleles and genotype frequencies and SLE. P<0.05 were considered statistically significant. Results: The CC genotype was observed in 94.5% of the SLE patients and 82.4% of the controls the difference was statistically significant (P=0.0001, OR=3.51, CI95%=1.77-7.53). The CT genotype, on the other hand, was more frequently observed in the control group (17.1% vs. 5.5%, P=0.0001, OR=0.28). T allele was significantly more common in the controls compared to SLE patients (P=0.0001, OR=0.26, CI95%=0.13-0.53). Conclusion: Our results suggest that the -318C/T polymorphism of CTLA-4 gene might play a significant role in the genetic susceptibility to SLE. Therefore, further studies on populations, especially from other Middle East countries, are needed to confirm our results.
Volume 73, Issue 5 (August 2015)
Background: Breast cancer is not only considered as the most common cancer in women but also is known as the second cause of death among them. One of the main causes of death in breast cancer patients is metastasis to different organs such as lymph nodes, bones, lung, liver, brain or other parts of the body. Metastasis to genital organs especially uterus is rare and a few cases are reported. Case Presentation: In this report we present a case of invasive ductal breast carcinoma metastasizing to a uterine leiomyoma in a 52 year old woman who was admitted to Imam Khomeini Hospital, Tehran, in September 2013, diagnosed and treated by modified radical mastectomy of the right breast six years ago. Currently, she presented with complaint of persistent abnormal uterine bleeding for which hysterectomy was performed. The histopathologic examination of the uterine specimen revealed a focus in the myometrial wall composed of spindle cell proliferation without signs of atypia which was accompanied by epithelial glandular structures with cells containing hypochromatic nuclei embedded in a desmoplastic stroma. Considering the history of invasive ductal breast carcinoma in this patient, the diagnosis of stromal nodule or metastasis from a breast origin was suggested as the main differential diagnosis. The Immunohistochemical study performed with different markers showed positivity for GCDFP15 staining confirming metastasis from the breast carcinoma. Conclusion: Although metastasis of breast cancer to the genital organs is an uncommon event, breast carcinoma is still considered the second source of extragenital malignant metastasis to the uterus. Overall, the most popular sites for metastasis of breast carcinoma to the female reproductive system include the ovaries and the uterine cervix. The uterine corpus is the least common site involved. In this regard metastasis to a uterine leiomyoma is a rare event.
Volume 73, Issue 10 (January 2016)
Background: Acute respiratory distress syndrome (ARDS) is one of the most important complications associated with traumatic brain injury (TBI). ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors.
Methods: This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013) done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis.
Results: In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH) 48 (60%) and Subdural hemorrhage (SDH) was Next Level with 39 (48%) Correlation between Glasgow Coma Scale (GCS) and Respiratory Distress Syndrome (ARDS) were significantly decreased (P< 0.0001). The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009) [(2.3±4.6) vs (4.02±7.07)]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%).
Conclusion: Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis demonstrates that Acute respiratory distress syndrome is common after traumatic brain injury. Management of traumatic brain injury is necessary to manage and reduce the mortality.
Volume 73, Issue 11 (February 2016)
Background: Self-immolation is a common method for suicide among women in developing countries. Culture is considered as an influential factor for attempting suicide by selfimmolation. Better understanding of the influence of culture will be useful to develop specific prevention strategies. Therefore, the study aimed to explore how the culture can influence on
attempting suicide by self-immolation among women.
Methods: The study was performed by a qualitative approach using directed content analysis in Imam Khomeini Hospital, Kermanshah, Iran, 2011- 2013. Our participants were selected purposefully among patients who attempted suicide by self-immolation (n= 9), their relatives (n= 6), and treatment staff (n= 6). We used semi-structure interview
for data gathering. The interviews were tape recorded and transcribed. Then, transcribed interview was analyzed by constant comparison.
Results: The main extracted theme was self-immolation sub-culture. Two main categories and 6 sub- categories were also emerged that explored the effect of culture on attempting suicide by self-immolation. The main categories were cultural restriction, and cultural acceptation. Marriage- divorced related traditions, living in extended family, and cultural
conversations and cultural meanings of self-immolation were among extracted subcategories. The category of cultural restriction described the role of culture in the occurrence of family conflicts as a predictor of attempting suicide by self-immolation, and cultural acceptation, the second category, explained how self-immolation is accepted as a
method of choice of suicide in the understudied culture.
Conclusion: Our finding showed that subculture of self-immolation provides influential conditions for attempting suicide by self-immolation. According to the findings, cultural restriction may facilitate conditions to occurrence of attempting self-immolation, and cultural acceptance provides conditions to perdurability of self-immolation as a method of
suicide. Considering these conditions is recommended in designing prevention programs.
Volume 75, Issue 3 (June 2017)
Background: Cardiovascular disease (CVD) is the most common cause of death in the world that is mostly due to vascular disease. Myocardial infarction (MI) is the most lethal form of coronary heart disease Which is increasing in developing countries. This study was done to calculate and compare lost years of life due to death and disability for the most important cause of death (myocardial infarction) in the studied population.
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Methods: This cross-sectional study was carried out in Urmia university of Medical Sciences in Western Azerbaijan Province, Iran during 2012 to 2013. Confirmation of the occurrence of myocardial Infarction in hospitalized patients was based on clinical symptoms, changes in electrocardiogram and increases of cardiac enzymes (CK-M Band Troponin). The burden of health from Myocardial Infarction was calculated- using the disability adjusted life years index (DALY). The morbidity data of MI was collected from myocardial infarction Registration System Department of Health, and mortality data were extracted based on death registration ICD10 (I 20-25). Results: The total occurrence of MI was 7235 patients (60.6% men and 39.4% women) with the mean ages of 69±15 years. Number of disability adjusted life years (DALY) caused by MI was 53804 years (17.7 per thousand people) and the portion of early death Years of Life Lost (YLL) due to premature death was 52170 years (17.1 per thousand people), and Years of Life Lost (YLD) due to disability resulting from the disease was 1634 years (0.54 per thousand people). The disease burden in men was more than in women, and the greatest burden was in the age group of 80 and above in both sexes. Prevalence rate of the MI was estimated 376 (Per hundred thousand people) and the MI accounted for 18.8% of all causes of death. |
Conclusion: The high burden of myocardial infarction, especially in men, raises the incidence of Myocardial Infarction a health priority and the need for proper planning in order to take effective measures for the prevention and treatment.
Volume 76, Issue 7 (October 2018)
Methods: This is a cross-sectional study and conducted on 6460 people, over 30 years old, who have participated in the screening of diabetes plan in Mashhad city that it was done by Mashhad University of Medical Sciences from October to December 2010. According to the fasting blood sugar criteria, 5414 individuals were identified as healthy and 1046 individuals were identified as pre-diabetic. Age, gender, body mass index, systolic blood pressure, diastolic blood pressure and waist-to-hip ratio were measured for every participant. The data was entered into the Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and then analysis of the data was done in R Project for Statistical Computing, Version R 3.1.2 (www.r-project.org). Ordinary logistic regression model was fitted on the data. The outliers were identified. Then Mallow, WBY and BY robust logistic regression models were fitted on the data. And then, the robust models were compared with each other and with ordinary logistic regression model according to goodness of fit and prediction ability using Pearson's chi-square and area under the receiver operating characteristic (ROC) curve respectively.
Results: Among the variables that were included in the ordinary logistic regression model and three robust logistic models, age, body mass index and systolic blood pressure were statistically significant (P< 0.01) but waist-to-hip ratio was not statistically significant (P> 0.1). There were 552 outliers with misclassification error in the ordinary logistic regression model. Pearson's chi-square value and area under the ROC curve value in the Mallow model were almost the same as for ordinary logistic regression model. But it was relatively higher in BY and WBY models.
Conclusion: Based on results of this study age, overweight and hypertension are risk factors of prediabetes. Also, WBY and BY models were better than ordinary logistic regression model, according to goodness of fit criteria and prediction ability.
Volume 77, Issue 5 (August 2019)
Methods: In this cross-sectional study, the data of 7,000 participants in the Diabetes Screening Project in Samen, Mashhad City, Iran, were considered in 2016. There were 540 untreated diabetic patients. The Samen Project was included in the routine examinations of diabetes patients like blood glucose, eyes health, nephropathy, and legs health. So, in order to maintain balance, 600 healthy individuals were selected in a proportional volume sampling in this study. Therefore, the total sample size was 1140 people. In this study, people with diabetes aged over 30 years old were enrolled and participants with the previous history of type 2 diabetes, with normal blood glucose due to drug use or other issues at the time of the study, were excluded.
Results: All three models (Logistic regression, simple Bayesian and support vector machine models) had the same test accuracy (86%), however, in terms of area under the receiver operating characteristic (ROC) curve (AUC), logistic regression and simple Bayesian models had better performance (AUC=90% against AUC=88%). In the simple Bayesian model and logistic regression, body mass index (BMI) and age variables were the most important variables, while BMI and blood pressure variables were the most important factors in the support vector machine model.
Conclusion: According to the results, all three models had the same accuracy. In terms of area under the curve (AUC), logistic and simple Bayes models had better performance than the support vector machine model. Totally all three models had almost the same performance. Based on all three models, BMI was the most important variable.
Volume 78, Issue 3 (June 2020)
Methods: This double blind clinical trial study was performed in 71 patients aged from 18 to 50 years, undergoing septoplastic surgery for the first time, who were classified in ASA (American Society of Anesthesiologists) classes 1 and 2 in the Ear, Nose, and Throat (ENT) Department of Shafa Hospital, in Kerman, Iran from April 2014 to March 2015. Patients were randomly assigned into two groups using numbers from a randomization table. A dosage of 4 mg of tizanidine was administered orally to the patients two hours before the surgery (septoplasty) in the intervention group. In the control group, placebo pills which were 100 mg vitamin B1 were prescribed. The severity of pain was measured and recorded after 4 and 8 hours, and the morning after the surgery.
Results: 62 patients (87.32%) were male and 9 (12.68%) were female. The mean age of the subjects was 24.6±7.5 years. The two groups were similar in regard to age (P=0.54), but the duration of surgery was different in the two groups (P=0.038) and was longer in the group that received tizanidine. The mean of pain was different between the two groups, after 4 hours and was significantly higher in the group that received tizanidine (P=0.043). The mean of pain was not significantly different between the two groups after 8 hours (P=0.95) or one day after surgery (P=0.79).
Conclusion: Although some researchers have reported that taking tizanidine before some surgeries may reduce postoperative pain, in this study the administration of tizanidine before surgery was not effective in reducing pain after septoplasty.
Volume 80, Issue 10 (January 2023)
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Background: Cerebral palsy is a movement disorder syndrome in early childhood. Signs and symptoms vary among people and over time but include poor coordination, stiff muscles, and weak muscles. Some affected children can achieve near-normal adult lives with appropriate treatment. In recent years, transplantation of human mesenchymal stem cells (hMSC) has become a promising therapeutic strategy for CP. Every year, a lot of costs are spent on the treatment and management of this disease. The purpose of this study is to investigate the safety and effectiveness of this method on CP.
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Findings: In total, 9236 articles were found in the initial search, after reading the titles, of 37 articles, 21 articles were selected in the abstract stage and 18 articles remained in the full-text stage. We finally found 18 articles that showed that using stem cell technology as a scientific method could improve sick patients’ quality of life and movement defects.
Conclusion: According to the available evidence and limited studies, stem cell technology can be safeand cost-effective in improving CP patients, but there is insufficient evidence. On the other hand, there are many studies confirming the effectiveness of these cells in the treatment of movement impairment. In conclusion, stem cells may have a very promising future. Finally, stem cell technology combined with innovative biotechnologies may soon bring promising results to patients.
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Volume 80, Issue 11 (February 2023)
Case Presentation: The patient was a 24-year-old woman who presented with pneumothorax and multiple bullae in both lungs. The patient had no family history of respiratory disease, and the patient herself had no symptoms other than mild shortness of breath following activity from a year ago. A lung CT scan was performed for the patient and multiple bullae were evident in both lungs, which confirmed the diagnosis. There was no evidence of involvement of other organs but the lung. For the patient in the ICU with the diagnosis of left pneumothorax, a chest tube was inserted and she underwent mechanical ventilation. Finally, after 24 days of hospitalization, oxygen therapy of the patient was performed with a normal mask, and she underwent left lung pleurodesis with talcum powder, and a few days later, right lung pleurodesis was performed on the patient. On the 36th day of hospitalization, her general condition improved and she was discharged from the ICU. The patient was discharged in good general condition and had no problem on her four months follow-up.
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Conclusion: Fortunately, with the diagnosis of LAM for the patient according to the CT scan of the patient's lung, she was treated with insertion of a chest tube and by performing pleurodesis, the recurrence of pneumothorax was prevented. In a young woman with spontaneous pneumothorax, sporadic LAM is one of the differential diagnoses.
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Volume 81, Issue 8 (November 2023)
Methods: In this study, the clinical outcomes of 80 patients with acute respiratory failure caused by COVID-19 were evaluated. The disease was confirmed in two methods: clinical and radiographic confirmation of disease in patients with an acute respiratory infection (highly suspected) or in some cases with a positive PCR test. The rate of discharge from the ICU without the need for intubation was evaluated as the primary outcome and based on that, the patients were divided into two groups: NIV failure and NIV success. Mortality rate, length of stay in ICU, frequency of intubated patients and laboratory factors of patients as secondary outcomes in two groups were compared.
Results: Regarding the outcome of death and discharge, there was a statistically significant difference between the two groups. Therefore, all patients with corona who were admitted to ICU and received NIV and were intubated due to non-responsiveness to NIV died and the patients were discharged from the hospital without intubation. All the patients investigated in this study, had received antiviral, antibiotic, and glucocorticoid treatment during hospitalization. In this study, the patients who were in the NIV success group and were not intubated had a lower mean age compared to the group without NIV success (54 vs. 67 years, respectively). The number of white blood cells in the NIV success group was 3945.28±10011.21 and in the group without NIV success was 9242.38±17296.16, which was statistically significant (P=0.004). The number of blood neutrophils in the successful and unsuccessful NIV groups was 12.19±83.04 and 4.31±89.49, respectively (P=0.034). The mean APACHEII score in patients in the NIV success group (11.07±5.05) was significantly lower than the group without NIV success (20.16±4.96).
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Conclusion: Mortality was higher in the intubated group than in the NIV group. The combination of APACHEII score and respiratory rate one hour after receiving NIV can predict success with NIV.
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Volume 81, Issue 11 (February 2024)
Methods: In this historical cohort study, general information was gathered for all suspected stroke patients who sought emergency services in Mashhad, the largest city in northeast Iran, from March 21, 2018, to March 20, 2019, and were then transferred to the Emergency Department of Qaem Hospital. Pre-hospital emergency data were integrated with hospital records using the mission ID. The primary outcome assessed in the study was the length of hospital stay, with model implementation carried out using the statistical software Stata.
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Results: The median hospitalization time until patients' recovery was seven days. Out of the 578 participants, 386 cases (66.8%) recovered, while the remaining 190 cases (33.2%) were censored (83 individuals had died during the study, and 107 individuals had exited the hospital for other reasons). The average age of patients at the time of hospitalization was 71.13±13.01 years. Statistical analysis employing Log-rank and Breslow tests identified a significant difference in hospitalization duration among patients receiving various levels of care and based on their insurance status. During multivariate analysis, the Cox regression model was considered unsuitable due to some variables not meeting the proportional hazards assumption, leading to the utilization of AFT models. Following the evaluation of AFT models, including Log-normal, Log-logistic, Exponential, and Weibull, the log-normal model emerged as the most suitable choice, exhibiting AIC and BIC values of 1273.909 and 1356.740, respectively. Significant variables influencing length of stay included patient admission priority, insurance status, season, and residency status.
Conclusion: The study suggests that parametric survival models are effective for analyzing lifetime data. Additionally, in light of the significant variables identified, enhancing facility readiness and resource allocation could facilitate more efficient planning and implementation. |
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