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The effect of different doses of tamsulosin on lower urinary tract symptoms in patients with benign prostatic hyperplasia
Ramin Haghighi, Hossein Bavandi , Ahmad Kameli, Abdullah Razi, Hossein Zeraati ,
Volume 80, Issue 6 (September 2022)
Abstract
Background: The prevalence of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in men increases with age. Alpha-adrenergic receptor antagonists are first-line drugs for the treatment of LUTS, and tamsulosin is the drug of choice. The aim of this study was to compare the efficacy of tamsulosin 0.4 mg and 0.8 mg on lower urinary tract symptoms in patients with benign prostatic hyperplasia.
Methods: This double-blind clinical trial was conducted in the Urology unit of Emam Hassan Hospital in Bojnurd from May 2019 to Feb 2020. In this study, 92 patients with LUTS due to BPH were selected according to available method and randomly assigned into two groups of intervention. In the first group, patients received tamsulosin 0.4 mg and in the second group, tamsulosin 0.8 mg once daily for 8 weeks. The effectiveness of treatment was evaluated using IPSS criteria before and 8 weeks after treatment. According to a checklist, side effects were evaluated during treatment. Data was analyzed based on independent t-tests and repeated measures ANOVA by SPSS software version 22. A significance level of 0.05 was considered.
Results: The results showed that the two groups were not significantly different in age and duration of symptoms. According to the statistics test, there is a significant difference between the two groups in the post-treatment phase. Also, based on analysis of variance with repeated measures statistical test, there was a significant difference between and within two groups in IPSS criteria at different stages of evaluation. The prevalence of complications was (8.6%) in the first group and (11.9%) in the second group. The prevalence of complications was not significant between the two groups.
Conclusion: Tamsulosin is effective in reducing lower urinary tract symptoms and Tamsulosin 0.8 mg is an effective treatment regimen for the treatment of LUTS secondary to benign prostatic hyperplasia in those who have not responded to 0.4 mg treatment. Drug side effects were well tolerated in patients.

A convenient and fast method for assessing the image quality of hepatic triphasic CT scan
Seyed Hamed Jafari, Hajar Zahedi Mehr , Banafsheh Zeinali-Rafsanjani , Sara Haseli, Mahdi Saeedi-Moghadam ,
Volume 80, Issue 6 (September 2022)
Abstract
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.

Evaluation of the diagnostic function of shear wave elastography in the differentiation of malignant and benign breast masses and its relationship with histological factors
Parivash Parvasi, Zahra Fazelinejad, Fatemeh Mahdipour, Shahram Bagheri , Mohammad Momen Gharibvand ,
Volume 80, Issue 7 (October 2022)
Abstract
Background: Shear wave elastography (SWE) estimates the stiffness of a mass based on the velocity of shear wave propagation by sound waves. Due to higher cell density and angiogenesis, malignant masses have higher stiffness than benign ones.
Methods: The present study was a prospective study and was performed on patients who were referred to Ahvaz Golestan Hospital with breast mass during March 2020 to March 2021. Only patients with 4-5 BI-RAD were evaluated. Patients were graded based on ACR BI-RAD. All patients were subjected to ultrasound and selection of BI-RAD 4-5 patients for evaluation with SWE and sampling for pathology testing. In this study, in order to increase the maximum accuracy and take samples from the main location of the lesion, sampling was done by ultrasound-guided biopsy method. Tumor information was recorded by a specialist doctor after ultrasound and SWE. This information included tumor type, tumor size and grade, presence of metastasis, involvement of lymph nodes, average and maximum elasticity. SWE cutoffs were compared for mean and maximum elasticity to distinguish benign from malignant masses.
Results: In this study, 115 patients were evaluated. 63.5% (73) of the patients had benign mass and 36.5% (42) had malignant ones. There was a significant relationship between tumor size and mean and maximum elasticity (P<0.001 The results showed that the diagnostic accuracy of SWE in identifying malignant masses compared to benign ones was 100%, so that the mean (16.61±8.03 kPa) and maximum (21.14±8.88 kPa) elasticity in benign masses were significantly lower than the mean (32.21±7.59 kPa) and maximum (91.62±8.84 kPa) elasticity of malignant masses (P<0.001). There was also a significant difference between the 4 BI-RAD subgroups, so that in BI-RAD 4a, the lowest mean and maximum elasticity were seen (P<0.001).
Conclusion: The results showed that SWE parameters have sufficient diagnostic accuracy in diagnosing malignant breast masses. Therefore, the use of quantitative SWE parameters in conjunction with ultrasound and BI-RADS classification can avoid unnecessary biopsies.

The effect of body indexes on presence of ocular symptoms in covid-19 patients
Mansour Babaei, Mehran Shokri, Seyed Ahmad Rasoulinejad ,
Volume 80, Issue 7 (October 2022)
Abstract
Background: During the COVID-19 pandemic, the presence of ocular symptoms was common in COVID-19 patients, which can cause secondary complications in the treatment of ocular diseases. On the other hand, obesity can cause secondary symptoms in infectious diseases by impairing the function of the immune system, which indicates the relationship between involvement of different tissues and dysfunction of the cellular immune system. The aim of this study was to investigate the relationship between body indexes (i.e., age, height, weight, and BMI) and the presence of ocular symptoms in patients with COVID-19.
Methods: In this cross-sectional study (from March 2021 to May 2021), ocular symptoms (including blurred vision, epiphora, photophobia, discharge and exudate, redness, pain, and itching of the eyes) and body indexes (age, height, weight and BMI) were evaluated in 108 patients with COVID-19, who were referred to Ayatollah Rouhani hospital, Babol, Iran. The independent t-test and Kruskal-Wallis statistical tests were used to examine the data relationship in SPSS software.
Results: The results showed that the mean body weight in COVID-19 patients with blurred vision was significantly higher than COVID-19 patients without blurred vision (P=0.003, t=-3.056). The mean height of COVID-19 patients with epiphora was significantly lower than the mean height of COVID-19 patients without epiphora (P=0.018, t=2.398). Also, the BMI of COVID-19 patients with epiphora was 30.00 ±4.07 kg/m2, while the BMI of COVID-19 patients without epiphora was 27.68±4.42 kg/m2 (P=0.047, t=0.026). In COVID-19 patients with at least one ocular symptom, height was significantly lower than heigh of COVID-19 patients without any ocular symptoms (P=0.001, t=3.397).
Conclusion: Our results indicate the essential role of obesity in the occurrence of eye symptoms in COVID-19 patients. In this study, it was found that blurred vision, epiphora and the presence of at least one eye symptom in COVID-19 patients were significantly associated with the upward trend of BMI (as an index of obesity).

Assessment of mitochondrial DNA copy number in peripheral blood leukocyte of opiate abusers and healthy individuals
Kouros Divsalar, Sara Hesami, Majid Mahmoodi, Navidreza Giahi, Fatemeh Divsalar , Mohammad Pour-Ranjbar , Amin Honarmand,
Volume 80, Issue 7 (October 2022)
Abstract
Background: Based on the studies, variation in the mitochondrial DNA (mtDNA) copy number in peripheral blood leukocytes is associated with increased susceptibility to diseases including cancer. Opiate abusers are at high risk for diseases. In this study, we measured the mtDNA copy number in peripheral blood leukocytes in a group of opiate abusers compared with those in healthy individuals.
Methods: In a case/control study, three groups were selected consisting of 32 opium abusers, 24 heroin addicts and 25 healthy individuals. The amount of 5 ml of whole blood was collected from each individual who participated in the study and stored at -20 centigrade. The sample collection was performed from November 2018 to February 2020. Case groups were recruited from the Methadone maintenance therapy center. Contro group had no history of drug use and cigarette smoking. DNA was extracted from the whole blood samples using the salting out method. The DNA from a mitochondrial gene, dehydrogenase subunit1 (-ND1 gene) and a nuclear gene, human globulin (HGB gene), were quantified by a real-time PCR-based method to measure the relative mtDNA copy number of each group number.
Results: There was no significant difference in demographic characterization between the three study groups, opium abusers, heroin addicts and healthy individuals. We found that opium users had a higher mean of mtDNA copy number than those in the healthy control group (P=0.11). Heroin addicts had also higher mean of mtDNA copy number than those in healthy group (P=0.21). The mean mtDNA copy number in opium abusers was higher than that in heroin addicts (P=0.22), although the difference was not statistically significant.
Conclusion: The results of this study indicated that mtDNA copy number increased in a group of opiate abusers. Considering that alteration of mtDNA copy number is associated with increased susceptibility to several diseases including cancer, further research on mtDNA copy number with a high number of volunteers of opiate addicts may clear the effect of opiate abuse on the human genome.

Frequency of cardiopulmonary resuscitation levels in the neonates delivered in Moheb Yas hospital of Tehran
Mahbod Kaveh, Mohammad Kaji-Yazdi , Mohsen Jafari, Armen Malekiantaghi, Seyed Yousef Mojtehedi , Kambiz Eftekhari,
Volume 80, Issue 7 (October 2022)
Abstract
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.

Skin metastases in breast cancer: a review article
Behnaz Varaminian, Marzieh Ghalamkari , Tayeb Ramim, Masoumeh Roohaninasab ,
Volume 80, Issue 8 (November 2022)
Abstract
Skin metastases from breast cancer usually occur in more advanced stages of the disease, but can sometimes be the first clinical manifestation of breast cancer or the first evidence of a previous tumor recurrence. These demonstrations significantly reduce survival. Skin metastases from breast cancer have different manifestations. The most common manifestations are nodules. These nodules are soft, round or oval, mobile, firm, and elastic in texture and can be single or multiple, often flesh-colored, but can also be brown, bluish black, and pink to reddish brown. In the absence of a previous history of cancer, it can be difficult to diagnose the early location of metastatic cancers. However, metastases usually show histopathological similarities to the primary tumor. Soft tissue breast metastases usually have a better prognosis than breast or bone cancer metastases. Also, skin metastases from breast cancer do not necessarily have a poor prognosis as skin metastases from other malignancies. The relative risk of death from skin metastases to other malignancies is more than four times higher than skin metastases from breast cancer. Differential diagnosis includes cutaneous lymphoma, intracranial leukocyte infiltration, and cutaneous metastasis. Metastatic skin lesions are often mistaken for benign lesions. Recognizing them quickly is important to prevent long-term anti-inflammatory treatment that delays proper diagnosis. Therefore, to rule out metastasis, abnormal or nodular lesions should be considered for biopsy in patients with a history of systemic malignancy or suspected malignancy. Cutaneous metastases are usually a sign of widespread disease and may not be treatable in most cases. Treatment options include systemic and/or topical treatments. Extensive skin metastases require systemic treatment. For thicker skin metastases, radiation therapy, surgical or electrochemical resection is indicated as monotherapy or in combination. Oxygen in combination with topical 5% methotrexate (OFAMTX, 5% methotrexate in a carrier solution) is a recently described method that facilitates drug penetration into the epidermis. In the absence of visceral or lymph node metastases, OFAMTX is useful as a local skin treatment. This treatment is an effective and tolerable method for superficial skin metastases. Using local treatment in combination with systemic agents increases the overall effectiveness of treatment on skin metastases.

The effect of oral calcium on serum level of vitamin B12 in patients with type 2 diabetes
Mahmoud Parham, Davoud Oulad Dameshghi , Hossein Saghafi, Azam Sarbandy Farahani, Saeed Karimi Matloub, Rasool Karimi Matloub,
Volume 80, Issue 8 (November 2022)
Abstract
Background: Vitamin B12 deficiency is one of the most well-known disorders due to long-term use of metformin due to interference with its absorption.
Methods: This double-blind randomized trial was conducted from June to October 2016 at Shahid Beheshti Hospital in Qom on 60 patients in the age group of 30 to 60 years with a history of type 2 diabetes for one to two years and taking metformin in the amount of one to two grams. Patients were divided into two groups of 30 people. The intervention group received metformin with 1 gram of calcium carbonate daily, and the control group received metformin without calcium. Each of the patients in the intervention group was given 200 calcium carbonate tablets. Vitamin B12 levels of the patients in both groups were measured before the start of the intervention, and they were evaluated in terms of neuropathy according to the Michigan questionnaire. Vitamin B12 of patients and neuropathy in two groups were measured before the intervention and after three months.
Results: There was a difference between the two groups in terms of gender, and no significant difference was observed between the mean ages in the two groups. The mean level of vitamin B12 before receiving calcium in group A (intervention) was lower than group B (control) (P=0.036) and after receiving calcium, the level of vitamin B12 in the intervention group increased (P=0.002). In the control group, the level of vitamin B12 decreased (P=0.030). (P=0.006), and in the control group there was no significant difference in the examination of neuropathy (P=0.2).
Conclusion: Oral calcium daily intake increases vitamin B12 levels in patients with type 2 diabetes and calcium may be able to moderate the decrease in serum vitamin B12 levels induced by metformin in patients with type 2 diabetes.

Comparison of the effectiveness of intranasal ketamine compared with intravenous ketamine in controlling pain during cataract surgery
Hamidreza Shetabi , Khosro Naghibi, Alireza Peyman, Hamed Norouzi,
Volume 80, Issue 8 (November 2022)
Abstract
Background: To improve the quality of sedation in procedures, different medications are used alone or in combination with each other, but so far, no administration method that is agreed upon by anesthesiologists has been presented. This study aimed to investigate the effectiveness and safety of intranasal ketamine in comparison with intravenous ketamine in cataract surgery.
Methods: This clinical trial was performed from December 2016 to March 2017 in Feyz Hospital, Isfahan. Ninety patients over the age of 18 who were candidates for cataracts surgery were randomly assigned to receive 1 mg/kg ketamine through the nasal route (INk) or intravenously (IVK). Ten minutes before the surgery, ketamine was administered in the INK group and intranasal saline in the IVK group. Two minutes before the start of surgery, normal saline was administered in the INK group and ketamine was administered intravenously in the IVK group. Patients received intravenous midazolam 0.04 mg/kg during prep and drape. The quality of sedation and analgesia, vital signs, patient and doctor satisfaction, and side effects were recorded during the study period. Data were analyzed using of SPSS software, version 23 (IBM SPSS, Armonk, NY, USA).
Results: In this study, 90 people were included in the study, 53 of whom (58.9%) were men. The mean age of the patients was 61.5±10.6. Two groups had a significant difference in terms of gender (P=0.696), age (P=0.960), weight (P=0.212), height (P=0.632), underlying disease (P=0.094), and type of disease (P=0.090). Two groups were not significantly different in terms of mean heart rate (P=0.77), mean arterial blood pressure (P=0.13), mean blood oxygen saturation (P=0.58), patient satisfaction (P=0.470) and surgeon satisfaction (P=0.115), pain intensity (P=0.506), level of sedation level (P=0.477) and side effects (P=0.221).
Conclusion: Intranasal administration of ketamine provides similar sedation and cardiovascular response compared to intravenous administration of ketamine. Administering ketamine intranasally is a non-invasive, safe and effective method with easy application and can be a suitable alternative to intravenous administration.

The effect of hip joint position on knee joint isokinetic dynamometry indices in football and track and field athletes
Mandana Rezaei, Nader Sadri-Aghdam , Mahmood Reza Azghani, Fariba Ghaderi, Hakimeh Adigozali,
Volume 80, Issue 8 (November 2022)
Abstract
Background: Isokinetic dynamometry is a golden standard test to estimate lower extremity sport related injuries in the athlete assessment. Dynamometry is also commonly used to design preventive protocols. The aim of this study was to explore the effects of hip joint positioning in seated and lying positions on knee joint dynamometry indices, including extensor and flexor peak torques in football and track and field athletes.
Methods: Forty four male athletes (including 22 football players and 22 track and field athletes) have participated in this descriptive-analytic study. The sampling method was simple nonrandom sampling. This study was conducted in the Biomechanics laboratory of the Rehabilitation Sciences, Faculty of Tabriz University of Medical Sciences since October 2019 to October 2020. Knee joint dynamometry indices were consisted of concentric and eccentric flexor and extensor peak torques at 60 degrees per second velocity. Optimum length, angle of crossover, and the muscle balance ratios (concentric extensor peak torque/concentric flexor peak torque and eccentric extensor peak torque/concentric flexor peak torque) were also evaluated. All assessments were performed in both seated and lying positions. The indices were compared between football players and track and field athletes.
Results: The interaction effect of group and hip joint was not significant (P<0.05). Further, concentric and eccentric flexor and extensor peak torques and conventional flexor to extensor ratio were higher meaningfully in the seated position compared to the lying (P<0.05). Optimum length was significantly higher in the lying position, but the angle of crossover was higher in the seated position (P<0.05). The hip joint position was not effective on the functional flexor to extensor ratio (P>0.05). Also, dynamometry indices were not different between football and track and field groups (P<0.05).
Conclusion: Findings revealed the effects of hip joint position on strength measurements in football and track and field athletes. This factor should be considered to design strengthening exercises for athletes and also to estimate the sport injury risk.

Relationship between demographic and pathological characteristics on the 5-year survival rate of gastric cancer patients in Tehran province
Fatemeh Ghafari, Shahram Agah, Shiva Irani , Marjan Mokhtare, Ali Mohammad Alizadeh ,
Volume 80, Issue 8 (November 2022)
Abstract
Background: Gastric cancer (GC) is one of the most common malignancies and is considered as one of the leading causes of cancer deaths worldwide. Despite considerable progress in the disease's control and treatment, the patients' survival rate is relatively low. Different factors can affect the survival rate of GC patients. The current study aims to evaluate the association of demographic and pathological characteristics with the survival rate of GC patients.
Methods: This descriptive-analytical study was conducted on Fifty-six patients with gastric cancer from October 2015 to October 2016, who were referred to the gastroenterology clinic of Imam Khomeini and Rasoul Akram Hospitals in Tehran province and followed up for five consecutive years. The survival rate of the patients was measured using Kaplan-Meier method. Moreover, the Log-rank test and the COX regression model were used to determine the association of the survival rate with the demographic and pathological characteristics, including gender, age, tumor location, tumor type, tumor differentiation, metastasis, tumor staging, and Helicobacter pylori status. Data analysis was performed via SPSS version 22, and a P<0.05 was considered statistically significant. 
Results: A total of 56 patients were studied; 73% were men, and 27% were women. Our results showed that gastric cancer is more common in males and older people. Patients' one-year, three-year, and five-year survival rates were 67%, 35%, and 26%, respectively. Also, the survival rate of participants over 60 and in advanced stages of GC was lower than others. The Log-rank test showed that age, tumor type, tumor differentiation, metastasis, and tumor staging could affect the survival rate. However, in the COX regression model, age, metastasis, and tumor staging influenced the survival rate of patients.
Conclusion: The results indicated that the survival rate of gastric cancer patients was relatively low, and the early diagnosis of GC could be a substantial factor in increasing the patients' survival rate. Therefore, an appropriate screening program is necessary to increase the survival rate of GC patients.

Evaluation of pelvic, spine and sagittal spine parameters in people without chronic low back pain
Sajad Ataei, Masoud Zeinali, Azim Motamedfar, Maryam Moradi, Hossein Jafari Marandi ,
Volume 80, Issue 9 (December 2022)
Abstract
Background: Chronic low back pain (CLBP) is one of the most common spine disorders, which is seen in 65-80% of people. Knowing the normal patterns of spine and pelvic parameters is very helpful in determining the susceptible subjects for CLBP.
Methods: This study was conducted in healthy people during April 2017 until April 2018 in Golestan hospital of Ahvaz. Inclusion criteria include; Age group 20-65 years, no history of surgery, spine disorders, and having normal radiographs were performed. People who have complained of back pain in the last three months, neuromuscular disease, lumbosacral anomalies, kyphosis and obvious scoliosis, history of spine surgery and vertebral fracture, were excluded. A 36-inch radiology stereotype was prepared in the standing position. Pelvic and spine parameters that were investigated in this research included the following, Pelvic incidence, Pelvic tilt, Sagittal Vertical Axis, T9 Sagittal Angle, Thoracic Kyphosis, Lumbar Lordosis, and Sacral Slope. All data were analyzed with SPSS software, version 24 (SPSS Inc., Chicago, IL, USA).
Results: 50 participants including 27(54%) men and 23(46%) women with an average age of 33±12.5 years and BMI of 25±5.5 kg/m2 were examined. After examining the vertebral and pelvic parameters, it was found that PI is significantly higher in women than in men (P=0.02). It was also found that with increasing age, the amount of Pelvic incidence also increases (P=0.043), so that in people over 60 years of age, the amount of pelvic incidence is significantly higher than other people (P<0.05). Further analyzes showed that BMI has a direct effect on the amount of Thoracic Kyphosis (P=0.03) and Lumbar Lordosis (P=0.04). Thus, the highest amount of Lumbar Lordosis and Thoracic Kyphosis was seen in people with BMI 30-34.9 Kg/m2.
Conclusion: The findings of the present study showed that spine and pelvis indices have an important effect on the occurrence of CLBP. Hence, it is highly recommended to check these parameters in asymptomatic people, especially in older people.

Frequency and risk factors for GI bleeding in children admitted to the PICU of bahrami children's hospital
Kambiz Eftekhari, Armen Malekiantaghi, Neda Habibi ,
Volume 80, Issue 9 (December 2022)
Abstract
Background: Gastrointestinal bleeding (GIB) associated with stress is an important complication in critically ill children admitted to the Intensive care unit (ICU), which can lead to serious complications and in some cases death. Only a limited number of studies have been conducted on the risk factors of gastrointestinal bleeding in Pediatric Intensive care unit (PICU), most studies have been conducted in the adults and neonates, therefore, the aim of this study was to evaluate the frequency of risk factors related to gastrointestinal bleeding in children admitted to the PICU.
Methods: This was a cross-sectional study. In this study, in a period of three years from (March 2016 to March 2019), all patients admitted to the PICU of Tehran Bahrami Children's Hospital were examined. The sample size was calculated 380. Demographic information, diagnosis during hospitalization, underlying disease, and initial tests during the first 24 hours of hospitalization were recorded in the checklist. To evaluate the demographic findings between patients with and without UGIB, chi-square and Fisher tests were used. A p-value of less than 0.05 was considered significant.
Results: 462 patients were studied, of which about (58%) were male. The mean age of the samples was 48 months and the average length of hospital stay in PICU was ten days. In general, (21.21%) of patients had gastrointestinal bleeding on the first day and (12.12%) on the second day of hospitalization. Gastrointestinal bleeding occurred in 50 patients (10.82%). Use of ventilator, pulmonary diseases, coagulation and blood diseases were significantly more common in patients with gastrointestinal bleeding than in children without gastrointestinal bleeding. Cardiac, neurological, hepatic, and renal disease were not significantly different in patients with gastrointestinal bleeding compared to children without gastrointestinal bleeding.
Conclusion: The occurrence of gastrointestinal bleeding in critically ill patients admitted to the PICU is a serious risk. The most important risk factor for upper gastrointestinal bleeding is mechanical ventilation. Other risk factors of gastrointestinal bleeding are lung disease, coagulation diseases, hematologic and oncologic disease.

Bilateral Y shaped ureter (bifid renal pelvis): a case report
Mohammad Bakhtiar Hesam Shariati , Fahimeh Rajabi , Ehsan Motavasel ,
Volume 80, Issue 9 (December 2022)
Abstract
Background: Congenital malformations of the kidney and urinary tracts happen in 3-6 per 1000 live births and these abnormalities are the reason, for (ESRD) in children and also the reason for subsequent kidney problems such as kidney stones, infections and hypertension in adulthood. One of the most common anomalies of the renal system is the double collecting system. Knowledge of anatomical variations and disorders before surgery can make the surgical procedure smoother for the surgeon and prevent unwanted mistakes. Imaging through radiology, computed tomography, and MRI is the best way to diagnose early, follow-up, and planning for surgery, diagnosis of complications and extra kidney abnormalities.
Case Presentation: Our report in this article is about four years old girl who went to the MRA center of Baath Hospital in Sanandaj due to flank pain in December 2019. After abdominal imaging, signs of an abnormality of the double collecting system were revealed. Abdominal and pelvic ultrasound revealed abnormalities of the UVJ, and the distal part of the right urethral duct was approximately 2 mm in size. Also, the anterior-posterior diameter of the right renal pelvis was reported to be 2 mm and the upper calyx of the right kidney was quite dilated. This incomplete integration leads to complete or incomplete forms of the renal collecting system. The prevalence of this anomaly is also mostly unilateral, but our report, in this case, is about bilateral ureters.
Conclusion: We reported a rare case of bilateral Y-shaped bifid ureter, that's in this kind of anomaly 2, pyelocaliceal systems connect at the junction of the ureter to pelvic (bifid pelvis), and this abnormality was accidentally detected on ultrasound and MRI examinations. However, since duplex kidneys are often asymptomatic and therefore mainly diagnosed incidentally in patients, the actual number of patients with symptoms is probably lower.

Short term effect of low-level laser therapy on tooth stability after orthodontic treatment
Batoolalsadat Mousavi Fard , Samaneh Sadeghi, Mehrdad Shahsavaripour,
Volume 80, Issue 9 (December 2022)
Abstract
Background: The purpose of this article was comparing the clinical effectiveness of low-level laser therapy (LLLT) in reducing relapse.
Methods: In this clinical trial study 14 patients (11 females and three males) who were under non-extraction treatment (MBT 022 slot) and at the finishing stage of orthodontic treatment at Orthodontics Department of Kerman Dental Faculty from April 2016 to June 2017 participated. Treatment time was two year and the patients at the finishing stage of orthodontic treatment were divided into two groups (RCT code IRCT2017053034061N1). Group 1 (study) were treated with a low-level Gallium aluminum-arsenide diode laser and group 2: control. The exclusion criteria involved patients who consumed medicine that interrupted bone metabolism and those with conditions for which laser therapy could be contraindicated. The laser apparatus emitted a wavelength of 810 nm about 50 seconds and operated with maximum power of 200 MW in continuous wave mode (200 mW, 50 seconds radiation to mesiolingual, mesiobuccal, distolingual and distobuccal surfaces, 35.7 J/cm2). An alginate impression was made from maxillary arch for all patients immediately, four, five and six months after removing the orthodontic archwire and braces and study casts were prepared. The little irregularity index of anterior maxillary arch was measured on the dental casts, with a 0.01 mm precision digital caliper. Intergroup comparisons were performed with Student's t-test and repeated measure ANOVA was perform to compare measurements among groups in different times. The significance level was considered at P<0.05.
Results: There was significant difference among the irregularity index at five and six months after orthodontic treatment between two groups (P<0.05). In the control group except between five and six months after treatment, there was significant difference in irregularity index. The relapse was higher immediately and after four months in the laser group compared to other sequences (P=0.0001).
Conclusion: Sample showed that Low-level laser therapy (LLLT) is a non invasive method for reducing relapse after orthodontic treatment.

The evaluation of the awareness level of patients with hemorrhagic stroke about their hypertension possibility and use of antihypertensive drugs
Mehran Kouchek, Niloufar Taherpour, Mirmohammad Miri, Roja Asadpour , Fatemeh Ilbeygi, Seyed Pouzhia Shojaei, Mohammad Sistanizad,
Volume 80, Issue 9 (December 2022)
Abstract
Background: Hypertension is an important and controllable risk factor for heart diseases, stroke, renal failure and peripheral vascular disease. The aim of this study was to determine the level of awareness of patients with hemorrhagic stroke to control blood pressure and to provide solutions to improve patients’ awareness.
Methods: This study is a descriptive cross-sectional study that was conducted to evaluate the knowledge of patients with hemorrhagic stroke about the use of antihypertensives. The study population consists of all patients with hemorrhagic stroke, who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran from September 2020 to March 2021. Data related to blood pressure awareness and drug history was completed by the researcher through the method of direct contact with the patients or their relatives. In this study, 17 patients diagnosed with hemorrhagic stroke due to hypertension who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran, were included. The extent of the exact treatment adherence was assessed using the Morisky questionnaire.
Results: In this study, the median of patients age was 67 and 10 (58.82%) of them were women. The median systolic and diastolic blood pressures were 170 and 95 mmHg on admission. 4(23.53%) subjects were not aware of the disease. Out of 13 people who were aware of their hypertension, 11(64.71%) were under the supervision of a physician. However, 7(63.64%) of the subjects, despite being under the supervision of a physician and acceptable drug adherence, did not have controlled blood pressure and expired.
Conclusion: This study is a warning for patients and health care providers to pay more attention to blood pressure control. Furthermore, educating the community as well as medical staff about the importance of timely diagnosis and accurate treatment of hypertension is highly recommended.

Association between sonographic features of thyroid nodules and cellular examination obtained by fine needle aspiration
Soudeh Hamedi , Marzieh Hadavi , Farhad Mohammadi , Somayeh Behzadi, Kourosh Sayehmiri,
Volume 80, Issue 9 (December 2022)
Abstract
Background: As we know, thyroid nodules are common, but many of them are benign, and this shows that sampling of nodules is not necessary to diagnose benignity.The aim of this article was to determine the diagnostic accuracy of ultrasound features for diagnosing malignant thyroid nodules in patients referred to Fajr infirmary in Ilam.
Methods: This descriptive-cross-sectional study was conducted on 122 patients referred to Fajr Ilam Clinic in October 2015 to January 2018.Clinical characteristics such as age, gender, BMI and history of underlying thyroid diseases and Hashimoto's thyroiditis were collected with the help of a questionnaire.The dependence of ultrasound characteristics with thyroid malignancy was determined using a multivariate analysis test. This ultrasound feature was compared with the results of fine needle aspiration cytology and the diagnostic accuracy indices were calculated for each ultrasound feature.This article was conducted using statistical tests, chi-square, independent t-test, Mann-Whitney test, and bivariate logistic regression using Spss software.
Results: The study sample included of 30(24.6%) malignant and 92(75.4%) benign nodules. Hypoechogenicity and microcalcification showed statistically significant positive associations with thyroid malignancy (P<0.05).Also, according to Fisher's exact test, 7% and 20% of men had benign and malignant nodules, and 86% and 80% of women had benign and malignant nodules, respectively. But there was no statistically significant difference between the two groups (P>0.05). Hypoechogenicity had 63.3% sensitivity and 67.04% specificity, microcalcification had 60% sensitivity and 65.93% specificity. Having at least one good sonographic feature resulted in the highest sensitivity (86.67%), while the presence of both features had almost perfect specificity (91.3%) and the highest positive likelihood ratio (4.21).
Conclusion: According to the results of this article, the presence of Microcalcification variables and Hypoechogenicity are the most important criteria in predicting thyroid malignancy, and they are Locate in the TI-RADS grading. Therefore, nodules larger than 1 cm in size with the characteristics of microcalcification and homogeneity ultrasound should be the main focus of diagnostic evaluations.

The effect of neonatal bloodletting in the treatment of neonatal jaundice: a review article
Reza Saeidi, Ali Saeidi, Azri Izanloo, Mehdi Hosseini,
Volume 80, Issue 9 (December 2022)
Abstract
Neonatal hyperbilirubinemia occurs in 60-80% newborns in the first few days of birth, in most cases, jaundice is physiologic and usually improves without treatment. Bloodletting is the withdrawal of blood from a patient to prevent or cure illness and disease. Recently the Bloodletting is one of the common treatments for neonatal jaundice. In this review study, we have evaluated medical articles and narrative books (hadiths) for the application of this method in neonatal jaundice. In this systematic review we evaluated PubMed databases, Cochrane, Google Scholar, collaboration library, SID, Magiran, and narrative books (hadiths) with the subject of cupping and Bloodletting were included in the study 1983 and September 2019. In this study, all of articles with the title “Bloodletting“, "cupping" and “Wet cupping”, “Dry cupping”, “Air trapping”, “Scarification”, “Hejamat”, “ear cupping” and the abstracts of the articles presented in the conferences were studied. Then, in the evaluation stage of the articles, all the studies unrelated to the issue were excluded from the research. Also, in this study, all Shia and Sunni hadith sources and the Holy Qur'an were evaluated. The evaluation of hadiths was carried out by Jama Al-Ahadith software, which is a collection of Shia and Sunni hadith books. We assessed 1120 articles related to Bloodletting, none of which were related to neonatal jaundice and Bloodletting. Cupping is a therapeutic method that dates back thousands of years. Bloodletting by scarification was an accepted practice in Ancient Egypt. In Greece, bloodletting was in use in the 5th century BC. "Bleeding" a patient to health was modeled on the process of menstruation. During the Roman Empire, the Greek physician Galen, who subscribed to the teachings of Hippocrates, advocated physician-initiated bloodletting. The popularity of bloodletting was reinforced by the ideas of Galen. In our study in Shiite and Sunni narrations, only two narrations recommended infant Bloodletting after four months just for prevention. According to our finding there is no article or narration that recommended Bloodletting for neonatal jaundice.

Prevalence and risk factors of intestinal metaplasia in patients with dyspepsia
Mehdi Ghobakhlou, Hamidreza Ghasemi Basir , Ahmad Jahdari , Elnaz Ataei, Ali Saadatmand,
Volume 80, Issue 9 (December 2022)
Abstract
Background: Intestinal metaplasia in the stomach is one of the precancerous lesions of gastric tissue. If the lesions are diagnosed early before invasive cancer develops, it is possible to prevent the progression to malignant lesions. Therefore, this study was performed to evaluate the prevalence and risk factors of intestinal metaplasia in patients with dyspepsia.
Methods: This descriptive cross-sectional study was performed on patients who were referred to Shahid Beheshti Hospital in Hamadan, Iran from the beginning of 2019 to the end of 2020. A total of 250 patients over 16 years of age who complained of dyspepsia for at least more than three months were included in the study. Examination was performed for patients along with the completion of a pre-designed questionnaire including demographic information and metaplasia risk factors. Also, endoscopy and biopsy specimen of gastric mucosa were performed for histological examination. Finally, the data were analyzed using SPSS software version 16 with related statistical tests.
Results:  There was no significant relationship between job type, level of education, marital status and family history of gastric cancer, smoking, alcohol, high salt, dairy products and high-nitrate diet with the disease. There was a significant relationship between body mass index and the presence of intestinal metaplasia in men (P=0.032). The average age of men with metaplasia was about 13 years older than those without the disease. Also gastric ulcer (84%) and pan gastritis (40.4%) were the most common cases in endoscopic results. The number of female patients with epigastric pain was about 14% higher than male patients. Gastric ulcer was significantly associated with gender, with about 12% more gastric ulcers observed in men than women (P=0.014). Also, no significant relationship was observed between the presence of Helicobacter pylori and the severity of its colonization with intestinal metaplasia. (P=0.230)
Conclusion: In this study, no significant relationship was observed between the presence of Helicobacter pylori and the severity of its colonization simultaneously with intestinal metaplasia. Apart from the two factors of increasing age and type of sex, no serious risk factors for intestinal metaplasia were seen.

Evaluation of effective factors on the premature rupture of membranes in pregnant women referred to Afzalipour Hospital, Kerman
, Fatemeh Kalantarimoghaddam, Fatemeh Karami Robati ,
Volume 80, Issue 10 (January 2023)
Abstract
Background: Preterm premature rupture of membranes (PPROM) is one of the factors that can increase maternal and neonatal mortality, which is affected by several factors. This study aimed to investigate the factors affecting the frequency of preterm premature rupture of membranes in pregnant women.
Methods: This descriptive-analytical study was conducted in Afzalipour Hospital in Kerman from January 2018 to January 2019. All pregnant women with PPROM and normal pregnant women referred to this Hospital were included in the study through convenient sampling. The data collection tool was a checklist containing patients' demographic information (age, education, occupation, gestational age, number of pregnancies, urinary tract infection (confirmed by the attending physician), history of premature rupture of the water sac, vaginal bleeding (bleeding in any period of pregnancy as the person had visited the doctor), history of premature birth, pregnancy care and trauma (any trauma)). To analyze the data, descriptive statistics (frequency, percentage, mean, and standard deviation), analytical (Chi-square test) and SPSS software version 22 were used.
Results: In this descriptive-analytical study, 400 pregnant women were studied. Two hundred of pregnant women had preterm premature rupture of membranes and 200 of pregnant women did not have such condistion and were normal. The mean age of pregnant women was 27.4±5.4 years old and the mean gestational age of pregnant women was 34.1±2.1 weeks. The mean parity of pregnant women was 2.3±1.4. Risk factors such as maternal age (P=0.011), number of pregnancies (P=0.035), maternal education (P=0.018), history of preterm premature rupture of membranes (P=0.046), history of preterm delivery (P=0.019), trauma (P=0.037) and pregnancy care (P=0.037) affected preterm premature rupture of membranes.
Conclusion: The results of this study showed that maternal age, number of pregnancies, maternal education, and history of preterm premature rupture of membranes, history of preterm delivery, trauma, and prenatal care are risk factors for PROM. Therefore, by educating pregnant mothers about these risk factors, the incidence and complications of preterm premature rupture of membranes can be reduced.

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