Tehran University Medical Journal

Background: Cardiovascular diseases alone have become the leading cause of death worldwide. One of the treatment methods cardiovascular disease is angioplasty. This study aimed to investigate the clinical results after coronary artery angioplasty, based on the incidence of major cardiovascular events with emphasis on stent types.
Methods: In this retrospective cross-sectional study, the prevalence of risk factors (age, history of previous illness and previous surgery) was assessed by using a case file for patients undergoing coronary angioplasty and stent placement during the years 2006 to 2016 and found during the follow-up. The place of the study was the Imam Ali Hospital's educational center affiliated to Kermanshah University of Medical Sciences, Iran, from July to September 2017.
Results: In this study, 1188 patients undergone to stent containing 909 non-drug stents, 504 sirolimus-eluting stents and 316 paclitaxel-eluting stents. Patients were followed-up one to five years. During follow-up, 98 patients involved major cardiovascular events, 6 cases involved with death and 91 patients involved with myocardial infarction. 1729 of patients undergone angioplasty and during follow-up, 91 patients had stent restenosis. In this study stent restenosis showed the highest correlation with the incidence of major cardiovascular events. With a view to stent type in lesions with stent restenosis, 61.7% was in non-drug stent, 23.5% was in paclitaxel-eluting stent and 14.8% was in sirolimus-eluting stent. This study also showed that despite the superiority of sirolimus-stained stents, there was no difference between paclitaxel-stained stents and non-drug stents in clinical outcomes and restenosis.
Conclusion: The results showed that the syringes impregnated with sirolimus have better quality. Also, stents that have a smaller diameter or need dilatation in the procedure have a worse prognosis and cause more complications in the patient.

Background: Escherichia coli (E. coli) is one of the most important infectious agents in patients undergoing prostate biopsy. It belongs to a large family of gram-negative rods, Enterobacteriaceae. This family includes members of the normal flora of the intestine that are only occasionally pathogenic. Recent considerations of rectal colonization with fluoroquinolone-resistant E. coli shows the need to change strategy of treatment of infection in patients undergoing prostate biopsy. Therefore, the purpose of this study was to determine molecular typing of fluoroquinolone resistant (FQR) E. coli rectal isolates and associated infections in patients undergoing prostate biopsy.
Methods: In this prospective cohort study, rectal swabs were collected from 158 male patients before prostate biopsy at the Urology Research Center of Sina Hospital, Tehran, Iran, from March 2015 to February 2016. The FQR organisms were isolated using selective media, and antibiotic susceptibility pattern was determined for following antibiotics, ampicillin, levofloxacin, cotrimoxazole, amoxicillin-clavulanate, cefazolin, ceftazidime, cefepime, gentamicin, piperacillin-tazobactam, nitrofurantoin, amikacin, fosfomycin, imipenem. In general, phylogenetic background, prevalence of E. coli sequence type 131 (ST131) and its subclones (H30 and H30-Rx ST131) were compared in two groups of FQR E. coli rectal colonization and clinical isolates.
Results: In total, 73 patients had a positive rectal culture for FQR gram-negative bacteria, the most prevalent isolate of which was E. coli. Phylogenetic group B2 was most predominant, followed by A, E, C and D, B1 and F. The antibiotic susceptibility patterns for the FQR organisms showed high levels of resistance to ampicillin and trimethoprim-sulfamethoxazole, while the resistance to amikacin, fosfomycin and imipenem remained very low. In general, antibiotic resistance to several antibiotic was mainly detected in group B2 and with ST131 genotype. Despite the increase in infections among patients colonized with strains of E. coli ST131, its frequency was almost statistically significant between colonized and infected groups.
Conclusion: The ST131 pathogen has a high prevalence in rectal colonization and post prostate biopsy infections, which showed widespread resistance to common antibiotics.

Background: The ineffectiveness of hemodialysis fistulas causes high costs and increases mortality and morbidity rates. The efficacy of drug-coated balloon and nondrug-coated balloon in dysfunctional arteriovenous Fistula was evaluated over six month period.
Methods: In this randomized clinical trial, a total of a total of 50 hemodialysis patients who referred to Imam Reza Hospital in Kermanshah for failing of arteriovenous fistula in 2018 year, were randomly divided into two separate groups of drug-coated balloon angioplasty and non-drug coated balloon angioplasty. All of these procedures were done with the same surgeon. Patients were followed-up for 6 months. Variables and data of patients like age, gender, diabetes mellitus, hypertension, and location of arteriovenous fistula were documented and analyzed by SPSS software, version 21 (SPSS Inc., Chicago, IL, USA) using statistical tests. T-test and chi-square test were used for data analysis and the significance level was considered less than 0.05.

Background: Surgical margin determination in malignant lesions is essential and has a direct impact on the choice of postoperative treatments and patient follow-up. Therefore, the processes affecting this variable are worth exploring. This study aimed to evaluate the difference in surgical margin values in excisional skin samples during surgery and after formalin fixation.
Methods: A cross-sectional study was performed on forty randomly selected patients with benign and malignant skin lesions who were referred to the plastic surgery ward of Ghaem Hospital in Mashhad from November 2018 to January 2019. Malignant and benign skin lesions were excised with a healthy margin, then the specimens were sent to the pathologist in a formalin-containing container. The amount of tissue shrinkage and the factors affecting them were compared.

Background: Short children face many problems throughout their lives. Consumption of growth hormone and the drugs such as Letrozole, Oxandrolone, and Anastrozole can increase the growth of children and adolescents. There is not an overall estimate of the effects of Letrozole, Oxandrolone, and Anastrozole on the growth of children and adolescents with Idiopathic Short Stature (ISS). There are different estimates of the effect of growth hormone and the drugs Letrozole, Oxandrolone, and Anastrozole on growth in children and adolescents with Idiopathic Short Stature. Therefore, the aim of this study was to compare the efficacy of growth hormone, Letrozole, Oxandrolone, Anastrozole, and a combination of growth hormone and aromatase inhibitors on height gain in children and adolescents with idiopathic short stature using meta-analysis method.
Methods: Search was done in databases such as; Scopus, Web of Science(ISI), and PubMed using keywords: Idiopathic, Short Stature, Body Height, Aromatase Inhibitors, Growth hormone, Letrozole, Oxandrolone, Anastrozole. Randomized clinical trial studies ,that have investigated the efficacy of growth hormone and aromatase inhibitors on height gain in children and adolescents with short stature, were selected. Height standard deviation score (HSDS) before intervention and after treatment has been used to measure the rate of height increase in various studies. This study was written based on the PRISMA checklist and the heterogeneity of this study was evaluated using the Q statistic and I² index.

Conclusion: According to the findings of this study, the measuring of optic nerve sheath diameter in patients suspected of increasing the pressure of idiopathic intracranial hypertension can be helpful as a non–invasive diagnosis method.

Background: Previous studies have shown that several factors affect the outcome of cardiopulmonary resuscitation. In this study, we have evaluated the factors associated with the outcome of resuscitation in in-hospital cardiopulmonary arrest patients (IHCA) 002E.
Methods: This cross-sectional non-probability study was performed on patients with in-hospital cardiopulmonary arrest between 2015 and 2020 in the emergency department (ED) of Al-Zahra Hospital, Isfahan, Iran. Data were then collected from medical records to describe patient characteristics, arrest profile, and survival details. Factors associated with the dependent variable were examined Logistic regression.
Results: Among 848 in-hospital cardiopulmonary arrests, 18 patients (2.1%) survived and were discharged from the hospital. The mean age of patients was 62.74±21.17 years, 583 (68.8%) were male, and 265 (31.2%) were female. The mean age of patients with successful resuscitation and those with unsuccessful resuscitation was 62.33±21.79 (6 to 116 years) and 61.58±21.20 (1 month to 108 years) years, respectively. The rate of unsuccessful resuscitation increased with increasing age (P=0.04). Also, the rate of unsuccessful resuscitation increased if there was an underlying disease (P=0.01). In frequency analysis of resuscitation services, emergency medicine with 633 (57.3%) resuscitation is in the first place in the number of resuscitations, of which 22.9% of them have been successful (ROSC). In the anesthesia service, of 2 resuscitations performed, both were successful. In the general surgery service, 36.5% of 63 resuscitations were successful, and the success rate for the neurosurgery service was 32.4% of 102 resuscitations. Analyzing the duration of successful and unsuccessful resuscitation has great importance. In successful resuscitation, the average time was 18.98 minutes and in unsuccessful resuscitation was 39.20 minutes. Also, the maximum and minimum time for successful resuscitations was 63 and 1 minutes. The maximum and minimum time for unsuccessful resuscitations was recorded as 60 and 10 minutes.

Conclusion: The results showed that several factors were influential in cardiopulmonary resuscitation. Increasing age and underlying disease reduced the success of cardiopulmonary resuscitation.

Background: Fine needle aspiration biopsy (FNAB) is usually used to distinguish the malignant and benign nodules. Applying a biopsy needle evokes a sense of fear and pain in the patients. Although some studies refute the usefulness of local anesthesia (LA) prior to fine needle aspiration biopsy, it is still debatable. This prospective cross-sectional study intended to evaluate the effect of LA prior to fine needle aspiration biopsy on pain and anxiety considering nodule size.
Methods: Amongst the patients who were referred to Shiraz Shahid Fagihi Hospital for Thyroid fine needle aspiration biopsy from August 2017 to January 2018, 114 patients participated in this study. LA was performed for 41 patients, and 73 underwent the thyroid nodule fine needle aspiration biopsy without LA. Patients' pain and anxiety were scored using the visual-analog-score and Spielberger anxiety scale. The nodules were categorized into five groups. Pain and anxiety of patients were compared considering their nodule sizes to assess the effects of LA in the reduction of pain and anxiety considering the nodule size.

Results: The patients undergoing LA had a mean age of 44.69 years old and average body mass index (BMI) of 26.7, the patients who performed thyroid nodule fine needle aspiration biopsy without LA had a mean age of 48.17 years old with an average BMI of 26.0. The patients with the maximum nodule size of<10 mm, experienced more pain during the fine needle aspiration biopsy without LA, but there was no significant difference between the S/T-anxiety of these patients. There was no significant difference between the pain and anxiety scores of the patients with larger nodules. Conclusion: The more pain experienced by the patients with the smallest nodules can be attributed to the need for more needle manipulation due to the small nodule size and less precision while piercing the needle into the nodule. Thus, it can be suggested that in patients with a small nodule size, less than 10mm, usage of LA prior to fine needle aspiration biopsy can reduce the pain significantly.

Background: The neonate's Cardiopulmonary resuscitation (CPR) is the most important and common emergency condition in the delivery room. Approximately 10% of newborns are unable to initiate effective breathing and require assistance. The aim of this study was to evaluate the frequency of CPR levels of the neonates delivered during a year in Moheb Yas Hospital who were resuscitated.
Methods: This was a retrospective cross-sectional descriptive study. The sampling method in this study was census. In this study, all the live neonates born during the year (April, 2010 to April, 2011) in Moheb Yas Hospital who were resuscitated, were enrolled in the study. The information of these infants was recorded in separate checklists. This checklist included the following information: mother's age, gestational age, gender of the baby, method of the delivery, multiple births, complications of the placenta and umbilical cord, amount of amniotic fluid, fetal presentation, meconium excretion, fetal heart rate pattern, Apgar of the baby, resuscitation levels, underlying diseases of the mother, maternal diseases during pregnancy, drug use by the mother and premature rupture of the amniotic sac. Finally, the data were analyzed by SPSS software. P-values less than 0.05 were considered statistically significant.

Results: There were 2,176 live births during the study. Of these infants , a total of 322 neonates (15.27%) underwent CPR. 51.8% were male. The mean gestational age was 36.08 weeks. The first minute Apgar was less than 5, between 5-7, and above 8 respectively in 10.5%, 33.4%, and 56% of neonates. About 42% of neonates needed initial resuscitation (warming, drying, and respiratory stimulation). 48% required respiratory ventilation with bag and mask, 5% endotracheal tube, 2.7% cardiac massage, and 1.3% needed medication. In 96.7% of cases, the CPR team was ready for resuscitation before delivery. Conclusion: If resuscitation is performed in a timely and appropriate manner, very few of these infants will need advanced resuscitation. On the other hand, the high need for resuscitation by bags and masks can be secondary to the educational nature of this hospital.

Background: Fetal health diagnostic tests are tools to reduce the incidence of adverse outcomes and neonatal death. However, their diagnostic value is still debated in relation to various outcomes. The aim of this study was to evaluate the value of biophysical profile and sonographic cerebroplacental ratio in predicting childbirth mode and adverse neonatal outcomes.
Methods: In this cross-sectional study, 70 pregnant women (37-41 weeks) who were candidates for termination of pregnancy who were referred to Ayatollah Mousavi Hospital in Zanjan from October 2020 to May 2021 were studied. After selecting the mothers based on inclusion criteria, biophysical profile test (BPP) and CPR sonographic index were performed. Then delivery method, infant weight, fifth minute Apgar score, need for resuscitation and hospitalization of infants in NICU were recorded in each case. T-test, Mann-Whitney test and ROC curve in SPSS 22 software were used for statistical analysis. (P≤0.05).

Results: In this study, the mean (SD) gestational age of participants was 38.56±1.11 weeks. Based on the data, there was a statistically significant relationship between CPR and the infant's need for resuscitation and hospitalization in the NICU (P=0.021) and Apgar score (P=0.042). However, there was no statistically significant relationship between CPR and delivery method, gestational age and birth weight. BPP score was not significantly associated with any of the consequences. Based on the results of the ROC curve, CPR with a cut point of 1.59 with a sensitivity of 88.9% and a specificity of 75% is able to predict the need for resuscitation and hospitalization in the NICU, and with a sensitivity of 83% and a specificity of 54.5%, it is able to predict a low Apgar score. However, BPP score did not have a predictive role in any of the studied parameters. Conclusion: It seems that CPR examination around delivery can be useful in predicting the condition of the baby immediately after birth and preparing the treatment staff for immediate action.

Background: Idiopathic thrombocytopenic purpura (autoimmune), the most common cause of acute onset of thrombocytopenia in children who are otherwise healthy. This study was conducted with the aim of investigating the factors affecting the response to treatment in hospitalized children.
Methods: This retrospective study was conducted by examining the files of patients hospitalized due to ITP in Hazrat Masoumeh (S) Hospital from April 2009 to March 2019. The criteria for inclusion in the study included confirming the diagnosis of ITP and the age of 1 month to 14 years, and the exclusion criteria included cases of discharge with personal consent and not completing the patient's treatment course, the presence of pancytopenia or bicytopenia, the presence of moderate or severe splenomegaly or severe in clinical examinations, BMA based on the presence of a diagnosis other than ITP, not receiving any of the ITP treatment protocols, and patients whose first visit with the diagnosis of ITP was in another center or city. The information about age, sex, clinical symptoms on arrival, initial platelets and the platelets of days 3, 5, 14 and 180 were extracted from the patients' files. The type of treatment protocol, the need to repeat the treatment, the recurrence of the disease and the major complications of the treatment were extracted from the patients' files and finally the data were analyzed with SPSS software.
Results: The response to the treatment on different days was unrelated to the age, gender, and initial platelets (except for one exception) (P>0.05). In relation to clinical symptoms, the response to treatment on days three and five was related to the clinical symptoms at the time of presentation and on days 14 and 180 it was unrelated. Response to treatment on days 3 and 5 in different treatment protocols had a significant relationship (P<0.05), but there was no significant difference on days 14 and 180.

Conclusion: The best response was in the combined treatment group with methylprednisolone and IVIg, and the lowest response to treatment was observed in those receiving methylprednisolone alone.

Background: Cardiopulmonary resuscitation is a quick and immediate intervention to prevent death in a person who has suddenly suffered cardiorespiratory arrest. This study aims to investigate the results of cardiopulmonary resuscitation and the factors affecting it with emphasis on the cause of cardiac arrest and 1-year prognosis of the saved patients.
Methods: Materials and methods: This research is a retrospective descriptive-analytical study that was conducted for 24 months, from April 1, 2017 to the end of March 2018, in Shahid Mostafa Khomeini Hospital in Ilam, from July 2022 to September 2022. The necessary information was collected based on the data available in the patients' files. Data analysis was done using SPSS24 software.

Results: Out of 152 patients, 64(42.1%) were men and 88(57.9%) were women. The average in the group that had a successful CPR was 60.75 years and in the group that had an unsuccessful CPR was 68.27 years. 13.7% of all CPRs occurred during shift change. The number of CPR was 11 cases (7.2%) in changing night shift to morning, six cases (3.9%) in changing evening shift to night, and four cases (2.6%) in changing evening to night shift. Most of the patients who underwent CPR were patients with internal diseases. Conclusion: In this study, the final success rate of CPR was close to other studies. These results indicate that performing CPR is considered at any time. However, the reasons for the failure of the rehabilitation operation should be looked for in other factors. These factors can include updating nursing and medical team’s knowledge in the field of resuscitation, experience and skills of the resuscitation team, and periodic training of the resuscitation team, which should be considered regularly in order to reduce unsuccessful cases.

Background: Coronary angiography is an elective method to confirm or rule out coronary artery disease and to decide on the treatment plan but it is an invasive method and it has some complications. The most important and common complication was hematoma. It could be the cause of mortality and morbidity. The present study was conducted with the aim of investigating the time of hematoma occurrence after angioplasty and investigating the effect of various factors (for example age, sex, BMI, BP, hematocrit, anticoagulant agent, etc.) on the occurrence of hematoma.
Methods: This was a prospective cohort study from March 2022 to March 2023 in Mazandaran heart center. The study population was patients who underwent angioplasty through the femoral artery. If the ACT is less than 150-180, sheet removal was done by applying pressure with the hand on the proximal puncture site for 15-20 minutes and ensuring sufficient hemostasis. Then, the ultrasound of the puncture site was performed before pulling the sheet/one hour and six hours after pulling the sheet, and after collecting the data, the data were analyzed to study the effect of BMI, BP, sex, hematocrit, hemoglobin, age, time of sheet removal, anticoagulant agent, etc. on prevalence of hematoma and it size.

Results: 200 patients were examined, of which 44(22%) had hematoma. Women had hematoma more than men (P<0.05). BMI and blood pressure in patients with hematoma decreased and increased, respectively (P<0.05). Older age, female gender, lower hematocrit, and longer duration of sheet retention were effective factors in increasing hematoma size (P<0.05). In the logistic regression model, with increasing BMI, the chance of hematoma occurrence decreased (P=0.029, OR=0.831). Conclusion: Controlling blood pressure and preventing of decreasing the hematocrit, reduces the incidence of hematoma in patients after angiography. Also, preventing hematocrit drop and removal of sheet at the appropriate time, can prevent of increasing in size of hematoma. There is some difference between nursing report and sonography finding. Nursing report overestimated the hematoma size.

Case Presentation: A 76-year-old female patient with diffuse abdominal pain that started a week ago and worsened since 2 days ago in the winter of 2024, referred to the emergency room of Imam Ali Bojnurd Hospital. In the examination, the patient met the criteria for shock. Abdominal examination revealed peritonitis. After initial resuscitation and stabilization of the patient's condition, an X-ray was performed for the patient. According to the Standing chest x-ray, pneumoperitoneum report, the patient underwent surgery with midline incision. In the performed surgery, evidence of gangrene and perforated was evident in a part of the small intestine, and The patient is a candidate for resection of the gangrenous and perforated intestinal segment, and then the two proximal and distal ends of the resected area were removed as an ileostomy from the right side of the abdomen. At the end of surgery, before closing the abdominal wall, the patient suffered a cardiac arrest, and CPR was started for the patient in operation room. After starting the chest massage, the patient suffered a grade 5 liver tear, the bleeding of the liver was stopped by packing with four Large Abdominal pads and CPR continued for 45 min, but unfortunately the patient died. Conclusion: One of the rare complications of cardiopulmonary resuscitation and chest massage is visceral damage, including liver rupture. Considering that its symptoms are similar to cardiac arrest, it is difficult to diagnose in case of rupture and has a high mortality rate. According to the reports of liver and visceral damage after CPR, some studies have recommended the use of Focused Assessment with Sonography for Trauma (FAST) to detect visceral damage after CPR.

Background: Diabetic nephropathy is one of the most important complications of diabetes worldwide. In diabetic patients, although renal biopsies performed with less frequency, it is important because these patients may have glomerular disorders other than diabetic nephropathy. Therefore, in this study, we investigated the results of renal biopsies performed on diabetic patients referred to diabetic clinics in Imam Khomeini and Golestan hospitals in Ahvaz, southwest Iran.
Methods: In this descriptive-cross-sectional study, information related to biopsy samples from 67 patients recognize with diabetes who underwent renal biopsy from August 2103 to September 2018, collected and recorded retrospectively. The presence of diabetic nephropathy and other renal diseases was confirmed by pathological evaluation of all renal biopsy specimens. Then, the data were analyzed by using SPSS 20 software.
Results: The results of this study presented that diabetic nephropathy (67.2%), diabetic nephropathy along with acute tubulointerstitial nephritis (7.5%), acute tubulointerstitial nephritis (6%) and membrane glomerulonephritis (6%) were the most frequent diagnosis in diabetic patients with renal disorder.  Furthermore, in the described cases, class IV (47.9%), III (35.4%) and II (12.5%) and I (4.2%) were the most common classes of nephropathy, respectively. Interestingly, there was no significant association between age, sex, proteinuria and hematuria with the frequency of nephropathy in the patient who underwent renal biopsy. Also, in this study, the frequency of class I and II nephropathy was 100% in patients older than 50 years, while 64.7% of class III was in patients under 50 years of age, which was also statistically significant (P=0.018). On the other hand, in the studied patients, there were not significant different between the frequency of diabetic nephropathy class and proteinuria, azotemia, and hematuria (P>0.05).
Conclusion: According to the obtained results, to reduce the risk of complications and costs, it seems crucial to be more wary in pick out diabetic patients for renal biopsy and to enhance the threshold of renal biopsy in diabetic patients as much as possible.