Tehran University Medical Journal

Background: Growth disturbance is a common phenomenon in children with congenital heart diseases (CHD). Malnutrition and nutritional disturbances have a higher prevalence among children with down syndrome, especially children with Down syndrome; on the other hand, the prevalence of CHD is higher among syndromic children, which needs surgical repair as the definitive treatment. The nutritional status plays an important role in determining the postoperative complications and recovery. The purpose of this study was to investigate the growth status of children with Down syndrome and congenital heart disease before cardiac surgery.
Methods: This study was conducted as a retrospective study by evaluating the records of all syndromic patients undergoing cardiac surgery at Children’s Medical Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran, from March 2011 to March 2017. Age, weight, height, weight-for-age z-score (WAZ), weight-for-height z-score (WHZ), height-for-age z-score (HAZ), mortality and hospitalization rate in an intensive care unit (ICU) were recorded in these patients. The z-scores more than -1 were considered as normal, between -1 and -2 as mild malnutrition, between -2 and -3 as moderate malnutrition and below -3 as severe malnutrition.
Results: 35 (51.5%) patients were female and 33 (48.5%) were male. The mean age, weight, and height of these children were 26.9±24.9 months, 9.1±4.95 kg, and 79.55±17.95 cm, respectively. The mean of WHZ, WAZ, and HAZ in these children was -2.18+1.65, -1.95+2.25 and -1.22+3.11, respectively. Based on the values of WAZ, WHZ, and HAZ, 85.3%, 77.9% and 75% of patients have malnutrition (mild to severe forms, z-score less than -1). The most common cardiac defect was ventricular septal defect (VSD) accompanied by pulmonary arterial hypertension.
Conclusion: Considering the high prevalence of impaired nutritional status in these children and considering the effect of preoperative malnutrition on surgical outcomes, including mortality, assessing the nutritional status is much important. The adequate nutritional support in these patients leads to a reduction of the mortality, postoperative complications and morbidities.

Background: Prostate cancer has been reported as a worldwide important kind of cancer and the second most common cause of cancer-related mortality among men. Prostate-specific antigen (PSA) serum level is one of the most important markers of prostate cancer diagnosis. While PSA level helps predict the risk of prostate cancer development, researchers still looking for ways to increase the accuracy of prognostic models. To increase the specificity of PSA and decrease of unnecessary biopsies and morbidity, PSA-related parameters such as PSA doubling time (PSADT) have been used. In this study, the relationship between this factor and the severity of prostate cancer was evaluated.
Methods: In this retrospective study, the data of patients who were subjected to transrectal ultrasound-guided (TRUS) biopsy of the prostate and referred to Imam Khomeini Hospital, Tehran, between 2009 and 2017 were reviewed. We enrolled the men with at least two consecutive elevated PSA level within three months to calculate PSADT. Based on the pathology report, primary and secondary Gleason score (GS) were determined. Correspondingly, considering GS, the patients were divided into two groups with high-grade and low-grade tumor (GS<7 considered as low-grade and GS>7 considered as high-grade tumor).
Results: Totally, 1712 cases of TRUS biopsy of the prostate were studied. Among them, 547 (32.3%) had prostate cancer, of whom 73 cases were eligible based on inclusion criteria and were consented to enroll in the study. According to the data obtained, we found a significant difference in PSADT between the two groups of patients with high-grade and low-grade malignancy (mean±SD PSADT, 9.8±14.2 vs. 16.1±14.9 respectively, P=0.004). Considering the seven months as the cut-off point for PSADT in determining malignancy, there was a significant difference between the two groups according to Fisher's exact test (P=0.01).
Conclusion: In our study, PSADT cut-off of 7 months provided the greatest accuracy for differentiation between low-grade and high-grade malignancy, and PSADT has acceptable accuracy for the diagnosis of high-grade tumors.

Background: The endocannabinoid system interacts with the vanilloid and opioid systems. The current study aims to investigate the effects of the extract obtained from the heated Cannabis Sativa female flower base either with capsaicin at the spinal cord level or naloxone at the systemic level on the intensity of chemical and thermal pain sensation.
Methods: This experimental study was performed in the Department of Biology at Ferdowsi University of Mashhad from April 2014 to March 2015 using adult male Wistar rats (200-250 g) categorized into groups of 7 animals. In addition to the control and sham (solvent of chemicals) groups, groups with intraperitoneal administration of 50 mg/kg of the hydroalcoholic extract, 2 mg/kg of naloxone alone and naloxone together with extract were investigated. Moreover, intrathecal administration groups including the concentration of 0.01 mg/ 10 μl of extract, the concentration of           0.002 mg/10 μl of capsaicin alone and the extract together with capsaicin were evaluated. To measure the thermal pain threshold, a tail-flick test was used and to measure the chemical pain intensity, the formalin test was utilized. The obtained data were analyzed statically.

Results: Intrathecal administration of the extract together with capsaicin led to a significant reduction of thermal hyperalgesia (P<0.001) and chemical hyperalgesia (P<0.001) induced by intrathecal administration of capsaicin. On the other hand, intraperitoneal administration of naloxone together with the extract did not effect on the thermal pain threshold. While the administration of naloxone increased the severity of chemical pain during the acute phase compared to the group treated with the extract alone (P<0.01). Conclusion: The phytocannabinoids of the flower extract may have inhibited capsaicin-induced hyperalgesia via cannabinoid receptors activation and the TRPV1 receptor desensitization. Naloxone administration has also been able to attenuate the analgesic effect of hydroalcoholic flower extract during the acute phase of chemical pain. Probably the extract is thought to exert part of its effect on pain through opioid receptors.

Background: Since pulmonary angiography is the only non-invasive method for diagnosing pulmonary embolism, the use of radiation reduction methods without affecting the quality of images seems necessary. One of the simplest reasons for unnecessarily increasing of patient exposure is repetitive imaging due to poor image quality. Therefore, it is necessary to identify and eliminate the factors that reduce the image quality, which leads to duplication of imaging or reduced accuracy.  In this study, the reasons for decreasing the image quality of pulmonary computed tomography (CT) angiography were investigated.
Methods: This cross-sectional study was performed over a period of 6 months (May to November 2018) in a university-affiliated hospital. Data of 75 patients suspected of pulmonary embolism who were referred for CT angiography were collected. All CT scans were performed by a 16-slice CT scanner (Lights Speed, GE Healthcare) with fixed imaging parameters including 100 kVp and 100 mA. In order to evaluate the adequacy of pulmonary artery enhancement, the Hounsfield unit (HU) of the main pulmonary artery was measured in the aortic arch, upper, and lower segmental parts. Also, 8 factors affecting the image quality were examined.

Background: One of the most empirical subjects particularly in substantial operations for example in surgeries involving the vertebral column, are the implication of sedatives in a manner which would create the least complications such as changes in the hemodynamic parameters. Two such drugs that are widely used in this capacity in clinical settings are midazolam and dexmedetomidine. Hemodynamic stability is particularly important in surgical operations, especially during spinal surgery. One of the ways to prevent hemodynamic changes during surgery is the use of drugs such as midazolam and dexmedetomidine.
Methods: This double-blind randomized clinical trial recruited 105 patients undergoing laminectomy spinal surgery under spinal anesthesia at Al-Zahra Hospital, Isfahan between 21 April 2019 till 1 September 2019. Patients were randomly divided into 3 groups: First was the midazolam group, second the dexmedetomidine group and the third was the control group. Data were presented as mean±standard deviation and percentages. In order for the evaluation of differences to be performed between all groups, an evaluation using the one-way analysis of variance was utilized. Statistical analysis was done by means of the SPSS software version 23 (IBM Corporation, Armonk, New York, USA). The P-value which was accepted as significant was P less than 0.05. (P<0.05)

Background: Pulse pressure has recently been considered as a predictor of coronary heart disease. The difference between systolic and diastolic blood pressure is called pulse pressure. Various factors including increased age, vascular stiffness, stenosis, and hypertension are associated with pulse pressure. The present study, therefore, aimed to investigate the relationship between some cardiovascular function indicators such as vascular stenosis, blood pressure and cardiac output with pulse pressure as a predictor of cardiovascular diseases.
Methods: This case-control study was performed on 544 patients who were referred to Imam Ali Hospital in Kermanshah, Iran, from March 2015 to February 2016. In this study, according to the angiographic findings, individuals with artery stenosis were considered as the case group (n=272) and those without artery stenosis were considered as the control group (n=272). Statistical analysis was performed using descriptive statistics, Chi-square and odds ratio estimation by SPSS22 software.

Results: Female students whose mothers were illiterate were 3.51 times more likely to develop head lice. Students who bathed once a week were 0.03 times more likely, and those who shared personal items were 3.6 times more likely to develop the disease.   In terms of father occupation, the highest incidence of head lice among the subjects was 8 people (66.7%) related to people whose father job was free and the lowest was related to other occupations of 4 people (33.4%). There was no significant relationship between     father's job and head lice infection in the subjects (P=0.061). Conclusion: The results of this study indicate the high infection rate of head lice in elementary school students of Kerman. This high level of infestation can cause more contamination among female students consequently, and may cause students to drop out of the school. Serious attention to reducing this infection by holding educational classes for school principals and teachers, as well as parents, seems necessary.

Background: CT is the gold standard method for diagnosing kidney and urinary tract stones. This imaging technique delivers radiation dose to patients, which increases the risk of cancer, especially in patients who need frequent assessment. The aim of this study was to compare the diagnostic ability of ultrasound in Iran compared to CT for diagnosing kidney stones in patients with colic pain.
Methods: The data of this cross-sectional retrospective study was gathered from the patients who were admitted to a University-affiliated hospital, Shiraz University of Medical Sciences from March 2019 to September 2019 suspected of nephrolithiasis and performed CT were collected along with their ultrasound reports. To compare sonography and CT, sensitivity, specificity, and positive and negative predictive values were calculated and the diagnostic percentage difference between the two modalities was evaluated. The diagnostic efficiency of ultrasound in stones of different sizes and locations was also evaluated.
Results: The sensitivity, specificity, and positive and negative predictive values of ultrasound in the initial diagnosis of stones were 83.47%, 62.15%, 85.94% and 57.58%, respectively. Ultrasound diagnosis was not significantly different from CT p=23 actually ultrasound diagnoses were different from CT in only 2.11% of cases. Ultrasound was the most successful in detecting bladder and urethra stones larger than 10 mm.

Conclusion: The results of this study showed that although ultrasound is less sensitive than CT in the diagnosis of nephrolithiasis, the use of ultrasound could be useful as a primary diagnostic test in patients with suspected nephrolithiasis. The important point is that the strategy of starting the evaluation with ultrasound, and performing additional imaging if necessary, leads to a reduction in the radiation dose of patients with nephrolithiasis. These patients have to do this procedure many times to diagnose and follow up the disease and clearly the offered method leads to reduction of the radiation absorbed dose and the possible effects of radiation, which is in line with the principle of ALARA, the basic principle of radiation protection.

Background: The image quality is paramount in interpreting the hepatic dynamic CT scan. A poor quality image results in repeating the procedure, which is very time-consuming for the patient and staff, and besides, it is not cost-efficient. This study intended to determine the correlation between image quality and the Hounsfield unit (HU) of the liver and its vessels in the arterial and venous phase to define the acceptable range of HUs for hepatic CT images.
Methods: The image quality of 146 dynamic CT scans was assessed by qualitative and quantitative methods at Namazi Hospital of Shiraz University of Medical Sciences from September 2019 to August 2021. Two radiologists performed the qualitative evaluation. They categorized the image qualities into three groups; poor, acceptable, and high quality. For quantitative assessment of image quality, the Hounsfield unit of the aorta, hepatic vein, main portal vein, right anterior, right posterior, and left lateral lobe of the liver were evaluated in both arterial and venous phases.

Results: According to the results of the qualitative evaluation of image quality, 59.6%, 17.8%, and 22.6% of triphasic CT scans had good, acceptable, and poor quality, respectively. There was a significant relationship between image quality and Hounsfield units of all ROIs in the arterial phase (P<0.005). Also, a significant relationship was observed between the Hounsfield units of the portal vein right on the anterior and posterior segments of the liver (P<0.03) in the venous phase. Conclusion: In a high quality triphasic CT scan, the Hounsfield unit of different parts in the arterial phase should be as follows: aorta 310±78, portal vein 150±40, hepatic vein 44±7, right posterior and anterior and left lateral segments of liver 77±11, 77±7 and 78±12. Hounsfield units of the portal vein, hepatic vein, and right posterior and anterior segments of the liver in the venous phase should be 155±27, 167±30, 111±19, and 112±16, respectively.

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.

Results: From the obtained results, the gEUD values for the rectum ranged from 51.04 Gy to 74.69 Gy and for the bladder from 27.22 Gy to 75.51 Gy. The maximum calculated risk values for the rectum and bladder were calculated to be 49.85% and 74.91%, respectively. Besides, a significant level of secondary cancer risk within the rectum and bladder was obtained for most of the studied patients. Furthermore, small values of secondary cancer risks were estimated for patients who were irradiated at older ages, and higher ones were obtained for patients who were irradiated at younger ages. Conclusion: The results showed that there is a higher probability of developing secondary malignancies in the bladder than the rectum. The information obtained in this research can improve the performance of the treatment process, so that information about secondary cancers following radiation therapy for prostate cancer will ultimately help doctors design more effective and optimal treatment designs.

Background: MRI is the imaging modality of choice for the detection of diabetic pedal osteomyelitis. The aim of this study is to compare the STIR sequence, as the most important fluid-sensitive sequence, with contrast-enhanced images for diagnosing diabetic pedal osteomyelitis.
Methods: Medical images were compared. Moreover, the effect of adding T1W image findings to the STIR sequence was evaluated. This cross sectional study was collected and analyzed at Namazi Hospital, Shiraz University of Medical Sciences, from 20 March 2016 to 22 September 2017.
Results: The final diagnosis of osteomyelitis was confirmed for 47 bones (78%). 13 bones (22%) didn't have osteomyelitis. The specificity of contrast-enhanced and STIR sequences was 92.3% and 53.8%, respectively; whereas the sensitivity of the two sequences was similar (100%). Records of 48 diabetic patients suspected of having pedal osteomyelitis referred to one of the university hospitals, who underwent foot MRI with and without contrast injection, were assessed. Overall, 48 Patient MRIs and 60 separate bony parts were evaluated. Diagnoses were confirmed by clinical correlation. Finally, sensitivity, specificity and diagnostic accuracy of STIR sequence and contrast-enhanced images were compared. Moreover, the effect of addition of T1W image findings to STIR sequence was evaluated.
Conclusion: This study was performed to suggest a pulse sequence that doesn’t need contrast media injection for diagnosing diabetic pedal osteomyelitis since the previous studies showed that gadolinium-based contrast media shouldn’t be applied in patients with renal failure (glomerular filtration rate<30 ml/min/1.73m². According to the results STIR images had the same sensitivity as T1 post-contrast images; therefore, it can be concluded that contrast media injection can be avoided using this pulse sequence. The specificity of the STIR pulse sequence was lower than that of post-contrast images which was due to the lower ability of this pulse sequence to detect secondary symptoms of osteomyelitis such as cortex disruption, sinus path, and abscess. Using the T1 pre-contrast images, specificity and diagnostic accuracy increased. Finally, it can be concluded that MRI without contrast including STIR and pre-contrast T1W images is a reliable modality for the detection of osteomyelitis in suspected diabetic patients who are more prone to renal disorders.

Background: Ultrasound is widely used to detect renal stones. A no-contrast CT scan is the most accurate modality for stone examination. Considering that determining the size of a stone is the main criterion in treatment planning, the purpose of this study was to compare ultrasound and non-contrast CT scans in determining renal stone size.
Methods: In this cross-sectional study, 140 patients were assessed from June to October 2017 at Namazi Hospital of Shiraz University of Medical Sciences. A radiologist compared the CT scans of patients with their ultrasound images. The ultrasound and CT scan results in terms of stone size were assessed. The correlation rate of stone size in ultrasound and CT scans in different subgroups was assessed by categorizing the stone size into three subgroups. The impact of stone location and the CT window on measuring stone size were evaluated.

Results: The mean stone size measured by ultrasound and CT scan was 11.23±5.26 and 9.48±4.7mm, respectively, which was significantly different. The highest rate of correlation was observed in the stones>10mm (81%) and then in 5-10mm (69.3%). The lowest agreement was observed in stones <5mm (37.5%). Conclusion: Using ultrasonography as a screening test or a primary test for detecting the renal stones is recommended. However, considering the importance of a precise assessment of stone size in choosing the treatment method and the limitations of sonography in the evaluation of small stones, a CT scan should be considered as a standard diagnostic tool if there is no contraindication. In CT images, the application of BW might underestimate the stone size in comparison to SW. Considering the results of previous studies, it is better to use magnified BW to assess the stone size on CT scan images. Although the axial view in a CT scan is more routine, for measuring the stone size it is better to use coronal or sagittal views together with axial views.

Background: Asthma is a chronic inflammatory disease of the airways. Various tests and questionnaires are designed to monitor the severity of asthma and help the therapist and the health system prescribe the best treatment to control it. This study was designed to compare two methods Asthma Control Questionnaires (ACQ) and Asthma Control test-child (ACT-CHILD) in children with asthma.
Methods: This descriptive cross-sectional study was conducted on 92 children with asthma referred to the Taleghani hospital, Gorgan, in 2022-2023. Patients were in a range of age 4-16 years. Asthma control was evaluated and compared by two methods ACT-CHILD and ACQ. ACT-CHILD included one version for 4-11-year patients completed by their parents and another one for 12-16 –year patients completed by the patients. The clinical symptoms, age, gender and the parents' records related to asthma were completed during the clinical interview. Data was analyzed using Chi-square and Spearman correlation tests. The degree of agreement between two questionnaires was determined using the Kappa coefficient.

Results: 84 children aged 4-11 years (91.3%) and 8 children aged 12-16 years (8.7%) were included in the study. According to the ACT-CHILD, 40.2% of children (n=37) had controlled asthma, 44.6% (n=41) had partially controlled asthma, and 15.2% (n=14) had uncontrolled asthma. Based on the ACQ, controlled asthma was observed in 18.5% (n=17), partially controlled asthma in 35.8% (n=33), and uncontrolled asthma in 45.7% (n=42) of children. Asthma control results based on two questionnaires were significantly different from each other (P<0.001). The agreement between the ACT-CHILD and ACQ methods in evaluating children's asthma was at a weak level (P=0.014, κ=0.157), however, a significant negative correlation was observed between the scores of the ACT-CHILD and ACQ questionnaires (r=-0.588, P>0.001) which after categorizing based on age group, this correlation was confirmed only in children aged 4-11 years (r=-0.627, P>0.001). Conclusion: Our findings showed that there is a poor agreement between ACT-CHILD and ACQ results in the assessment of asthma control. Further studies are recommended.

Background: Developmental disorders in children include a group of problems and limitations in learning and acquiring specific skills of each age group. The term global developmental delay is used to describe developmental disability in children under five years of age, which is in at least two areas of major development. Neuroradiological imaging such as brain MRI provides important information for physicians. The purpose of this study is to determine the role of brain MRI in predicting the clinical outcome of global developmental delay in children.
Methods: In this cross-sectional study, from 79 - from September 2013 to September 2018 at Motahari Clinic of Shiraz University of Medical Sciences, Shiraz Iran - eligible children with developmental disabilities, 37 patient who had brain MRI were selected as a sample and children scores in five ASQ clinical areas and MRI findings were reviewed and compared. Patients suffering from metabolic, genetic, trauma, infection and neoplasms problems and diseases were excluded from the study.

Results: Out of 37 patients studied, 23 were female and 14 were male with a dispersion of three 3 to 60 months of age. 31 of these children had at least one abnormal finding in brain MRI images and the other six were completely normal. In relation to the imaging findings, the highest frequency is related to abnormal head circumference with a prevalence of 54% and the lowest frequency is related to abnormal myelinization with a prevalence of 10.8%. Results of MRI findings correlation with developmental domains demonstrated that Children with white matter disorder on MRI show severe gross motor abnormality (P<0.049) and who had MRI finding of cortical problems suffer from developmental delay in fine motor area. (P<0.001). Conclusion: Considering the mentioned findings; brain MRI can be a useful diagnostic tool in children with developmental delay and also focusing on the developmental area that is more likely to be affected, MRI can help with treatment and rehabilitation process of these children in the future.

Background: A range of diseases can result in end-stage renal disease (ESRD), characterized by a gradual decline in kidney function and associated with significant morbidity and mortality. Currently, renal transplantation as the most effective treatment for managing ESRD. Tissue engineering presents a considerable opportunity to expand the available supply of donor organs for kidney transplants. The aim of this research was to develop a suitable technique for preparing decellularized kidney scaffolds from human tissues.
Methods: The present study was carried out from April 2019 to August 2019 in Mashhad University of Medical Sciences. In this study, two decellularization protocols were compared using sections of human kidney tissue. Therefore, two human kidneys which collected from Ghaem and Imam Reza hospitals were used. In the first protocol, detergents such as 1% Triton X-100 (1A) and 1% SDS (Sodium Dodecyl Sulfate) (1B) were employed, followed by the application of DNase I. The second protocol utilized 0.5% SDS (2A) and 1% SDS (2B). The effectiveness of these techniques was evaluated using hematoxylin and eosin (H&E) staining, 4',6-diamidino-2-phenylindole (DAPI), DNA quantification, and immunohistochemistry (IHC).

Results:  Based on H&E staining results, comparison of the decellularized and native human kidney tissues showed a successful elimination of cell nuclei and the ameliorate extracellular matrix preservation in triton-treated scaffolds (1A) in comparison with the SDS-treated scaffolds (1B) at all times protocols. Furthermore, DNA quantification illustrated triton X-100 in removing DNA was more effective in eliminating DNA from kidney tissues compared to other protocols in renal tissues. In addition, IHC staining demonstrated that the expression of collagen IV and laminin was preserved throughout the decellularization process with Triton X-100 on day fifth. Also, IHC staining indicated human leukocyte antigen (HLA) was completely eliminated in the cortex-medulla of human scaffolds treated with Triton X-100 within day fifth. Conclusion: Our results demonstrated that triton X-100 outperformed SDS as a detergent for decellularizing human kidneys. Meanwhile these results indicate suitable method for decellularization of human kidneys to produce functional kidneys.

Background: Sarcopenia is the degenerative loss of skeletal muscle mass, which is known as a poor postoperative outcome in various cancer types. Radical cystectomy (RC) is often associated with high mortality rates, and sarcopenia is hypothesized to aid in risk stratification. Hence, this study assessed the role of Sarcopenia as an indicator of postoperative outcomes and survival rates in patients undergoing RC for bladder cancer.
Methods: This cross-sectional research was carried out between January 2022 and January 2023 on 30 patients with bladder cancer who were candidates for RC and referred to the urology clinic of Imam Khomeini Hospital in Tehran. One week before surgery, the cross-sectional area of the psoas muscle was measured using MRI to estimate muscle volume, and the sarcopenia index was calculated. Muscle area evaluation was performed by calculating the cross-sectional area of the left and right psoas muscles on MRI. The psoas muscle area was calculated by excluding blood vessels, bony structures, and intermuscular fat regions based on fat signals. The calculated psoas muscle area was then normalized to the patient's height in square meters. To improve the quality of reporting on surgical complications, the patients were re-examined and the duration of patients' hospital stays was measured.
Results: The mean sarcopenic index for the patients was 1264.6 ± 591.5 mm²/m². Seven patients (24.1%) were smokers, while 22 patients (75.9%) were non-smokers. During the 10-month follow-up period, 25 patients (83.3%) remained alive, and 5 patients (16.7%) passed away. The mean value of sarcopenic index in patients with localized cancer was higher than those with advanced cancer, but this difference was not statistically significant. Data analysis revealed a significant association between higher mortality rates and the presence of locally advanced bladder tumors (P = 0.046). Additionally, a reduced sarcopenic index in this study was significantly correlated with lymphovascular invasion. In this study, no correlation was found between perioperative complications and sarcopenic index.
Conclusion: To conclude, a significant association was observed between a reduction in the sarcopenic index and lymphovascular invasion; however, no connection was identified between mortality rates and postoperative complications following RC.

Background: Abortion is the termination of pregnancy before the 20th week of pregnancy, which may be spontaneous or induced. In general, therapeutic abortion is defined as the termination of pregnancy before the 20th week of pregnancy in order to save the mother's life and prevent birth defects. The purpose of this study is to investigate the causes of legal abortion in women referring to Amir al-Mominin Ali hospital in Zabol city.
Methods: This study is a descriptive-cross-sectional study. The studied population included women who had a legal abortion on March 1, 2022 to September 1, 2022 at Amir al-Mominin Ali Zabol Hospital (Zabol-Iran). The tool used was a checklist made by the researcher and approved by the faculty members of Zabol University of Medical Sciences. The researchers collected the necessary information, including demographic information, obstetrics and mother's illness, fetal disorders, test results, ultrasound screenings, pathology results of patients and other conditions that led to the issuance of an abortion license.

Results: In the specified period of time, there were 100 abortion cases that were investigated, and 78 (78%) of these abortions had maternal causes and 22% had fetal causes. The most common maternal causes of abortion were cardiovascular problems (7%) and mothers' age. Also, the most fetal causes were cerebrospinal causes (23%). Mothers who had abortions of maternal origin were significantly older than mothers with abortions of fetal origin (p=0.009). Conclusion: The present study showed that in Sistan region, most cases of legal abortion depended on fetal reasons and mothers' age.