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Recurrence and survival in early breast cancer subtypes
Ali Taghizadeh, Leila Pourali, Mona Joudi, Bahareh Makvandi , Elahe Hasanzadeh, Saeideh Ahmadi Simab , Golshid Nouri Hosseini , Mehrdad Gazanchian,
Volume 81, Issue 3 (June 2023)
Abstract
Background: Breast cancer is the most common type of cancer in many countries, accounting for over 18% of all cancers in females. There are more than one million new cases of breast cancer each year. Most women diagnosed with breast cancer are over the age of 50, but younger women can also get breast cancer. About one in seven women are diagnosed with breast cancer during their lifetime. There's a good chance of recovery if it's detected at an early stage. In Iran, breast cancer is the most common cancer among women, making up 21.4% of all female cancers. The mortality rate of this cancer is 4.33 for every 100,000 people. The purpose of this research is to see how often different kinds of early breast cancer come back and how long people live after being diagnosed.
Methods: This retrospective study evaluated the medical records of 500 breast cancer patients at two hospitals in Mashhad, Iran during April 2006 to March 2016. We used SPSS software, version 16 (SPSS Inc., Chicago, IL, USA) to analyze data. A P value less than 0.05 means that the results are considered statistically significant.
Results: We included 230 women with breast cancer. The average overall survival was 130.7 months, with 83.2% of people surviving for five years and 78.8% surviving for 10 years. The stage of the disease is strongly linked to the recurrence (P=0.000). Additionally, the specific type of disease is also strongly related to disease recurrence (P=0.01) or metastasis (P=0.01). Patients who have the triple-negative subtype had the highest chance of the cancer spreading and recurrence compared to patients with other subtypes.
Conclusion: The different types of breast cancer are strongly linked to the disease recurrence or metastasis. Patients with triple-negative subtypes had the most cases of cancer spreading to other parts of the body and coming back again, compared to other subtypes. Our findings also showed that patients with the triple-negative disease had the worst overall and disease-free survivals.

Oxytocin plus foley catheter versus misoprostol plus foley catheter on cervical preparation in prolonged pregnancies
Masoume Mirteimouri, Seyyedeh Azam Poorhosseini , Maliheh Rakhshanifar, Seyede Houra Mousavi Vahed , Fedyeh Haghollahi,
Volume 81, Issue 3 (June 2023)
Abstract
Background: The success of labor induction depends on the condition of the cervix at the time of delivery. This study examines the effect of labor induction with an intra-cervical Foley catheter and oxytocin compared to a Foley catheter and misoprostol on cervical preparation and delivery rate in the first 24 hours after induction.
Methods: In a randomized clinical study, pregnant women with a singleton pregnancy and a gestational age of more than 40 weeks, with a Bishop score less than 4 and an intact amniotic sac referred to Umm al-Binin Hospital in Mashhad from 2017 to 2018 were included in the study. They were randomly divided into two groups of Foley catheter and oxytocin (1) or Foley catheter and misoprostol (2). In the first group, immediately after placing the Foley catheter; Oxytocin was started with a dose of 2 milliunits per minute, and every 20 minutes, 2 milliunits were added to reach the maximum dose of 30 milliunits per minute (induction method with a low dose). In the second group, after Foley catheter insertion, sublingual misoprostol was prescribed at a dose of 25 micrograms every 4 hours up to a maximum of 6 doses.
Results: 74 pregnant women were randomly evaluated in two groups of 37 people. There is no statistically significant difference in the demographic variables in the two groups. There was a significant difference in the labor rate in the first 24 hours, and it was higher in the oxytocin group (P=0.009). Bishop's score after 24 hours of induction was not significantly different in the two groups. Reaching the active phase was significantly shorter in the oxytocin group. (P=0.01). The time of catheter removal in both groups and the rate of cesarean section and the occurrence of complications were the same in both groups.
Conclusion: The use of oxytocin with a Foley catheter inside the cervix can accelerate the preparation of the cervix and increase the chance of labor in the first 24 hours, but it does not affect labor complications.

Comparison of thyroid ultrasound results in the diagnosis of metastatic nodules from papillary thyroid cancer with postoperative pathology specimens
Azim Motamedfar , Mohammad Momen Gharibvand, Mohammadghasem Hanafi , Fatemeh Neghab,
Volume 81, Issue 5 (August 2023)
Abstract
Background: The aim of the present study is to determine the accuracy of ultrasound imaging in the diagnosis of metastatic lymph nodes compared to postoperative pathology samples of patients with papillary thyroid cancer.
Methods: This study was carried out using a descriptive and analytical epidemiological method on 103 known patients with papillary thyroid cancer who referred to Imam and Golestan hospitals in Ahvaz for neck ultrasound from September 2021 to August 2022. A total of 103 patients (including 94 women (91.3%) and 9 men (8.7%)) with papillary thyroid cancer with an average age of (39.8±11.9) were included in the study. The average tumor size in these patients was estimated to be (16.8±10mm). The ultrasound results of these patients before surgery were compared with the pathology results of these patients after surgery.
Results: According to the obtained results, metastatic involvement of cervical lymph nodes was diagnosed in 36.6% of patients (38 people). Of these, 30.7% of patients (32 people) were real positive. The results of ultrasound before surgery were shown as false positive in 9.5% of patients (6 people). Lymphatic metastasis was not seen in 58.4% of patients (60 people) before surgery, which was consistent with the pathology result after surgery (true negative). The positive predictive value of examining metastatic lymph nodes by ultrasound was estimated at 84.2% and the negative predictive value at 92.3%. The diagnostic accuracy of ultrasound was 89%, the sensitivity rate was 86%, and the specificity rate was 90% with the area under the curve AUC=0.884 and P<0.001. Ultrasound accuracy is not affected by tumor size, Hashimoto's thyroiditis and metastasis location (P<0.05). In patients with Hashimoto's thyroiditis, the tumor size increases significantly more than 10 mm.
Conclusion: Ultrasound alone has an acceptable diagnostic accuracy in detecting metastatic lymph nodes caused by papillary thyroid cancer. However, the incidence of false negative error increases as the tumor size decreases.

Evaluation of nodule incidence as findings of lung involvement in Covid-19 infection and its comparison in three CT scan centers of Shiraz
Razieh Behzadmehr, Ariana Rasekhi , Banafsheh Zeinali-Rafsanjani , Alireza Rasekhi,
Volume 81, Issue 5 (August 2023)
Abstract
Background: Several typical and atypical findings have been observed in Covid-19 high-resolution computer tomography (HRCT). To our knowledge, there is no study investigating the relationship between the presence of nodules in Covid-19 patients and the patient's condition. Therefore, the present study assessed the frequency of pulmonary nodules in Covid-19 patients according to their condition.
Methods: This cross-sectional study assessed the medical images of the patients referred to three university-affiliated centers (Nemazi, Ali Asghar and Shahid Faghihi Hospital) to perform Covid-19 HRCT from April to September 2020. The centers have been named H1, H2, and H3. Patients who were referred to these centers had good, poor, and fair conditions, respectively. The history of patients was assessed carefully. Patients' demographic information, nodule shape, number, size, location, presence of cavitation, and GGO around the nodule were assessed and recorded.
Results: Overall, 20576 patients (mean age=46.75±16.64 years old) were included in the study. Only 2.1% of cases had solid nodules. Most of them (96.76%) were accompanied by a GGO (halo sign), and only 10.42% were associated with a cavity. The good condition, patients showed significantly more solid nodules (3.46%) than others. In size of the nodules in good-condition patients (1.8 cm) is significantly larger than in fair-condition (1.22 cm) or poor condition patients (1.15 cm). 79.86%, 12.5%, and 7.64% of nodules were multiple, dual/triple, and single, respectively.
Conclusion: The frequency of nodules in the HRCTs of good-condition patients was significantly higher than in fair- or poor-conditionpatients; they also had more multiple and larger-sized nodules. The Pearson-coefficient test also revealed a small negative correlation between the presence of nodules and the patient's condition. It seems the presence of nodules indicates higher immunity to viral infections. In the follow-up, it was revealed that people who had nodules were not hospitalized in the ICU. Further study is needed to prove this point.

Comparison of magnetic resonance imaging and CT scan in patients with complaints of mediastinal and chest wall mass
Mahdi Yadollahzadeh, Nader Rezaei , Mohsen Farrokhpour , Mehdi Azimi, Maedeh Barahman, Mohammad Bahadoram , Amirhossein Forouzanmehr , Seyed Ali Javad Mousavi ,
Volume 81, Issue 6 (September 2023)
Abstract
Background: The realm of diagnosing intrathoracic lesions involves a spectrum of imaging methodologies, among which computed tomography (CT)-scan and magnetic resonance imaging (MRI) stand prominent. In the context of Iran, where there is no study comparing the efficacy of CT-scan and MRI for evaluating intrathoracic lesions, our study endeavors to bridge this gap. Mindful of the nuanced advantages and drawbacks inherent in each method, we aim to conduct a comprehensive comparative analysis of CT-scan and MRI in diagnosing intrathoracic lesions, focusing on patients seeking care at Firoozgar Hospital's pulmonary clinic.
Methods: Embarking on a cross-sectional exploration at Firoozgar Hospital Pulmonary Clinic in Tehran, Iran, our investigative journey unfolded between April 2020 and March 2021. Thirty patients, spanning ages 21 to 69, presenting with intra-thoracic lesions encompassing mediastinal and chest wall anomalies, underwent simultaneous CT scan and MRI examinations. In pursuit of diagnostic certainty, histopathology was ordained as the gold standard, and the ensuing results underwent meticulous scrutiny and analysis utilizing SPSS 23 statistical software.
Results: Our study cohort comprised 30 patients, averaging 44.83 years (SD=12.71), with males constituting 60% of the population. Delving into the histological reports, CT-scan and MRI accurately diagnosed 25 (83.3%) and 28 (93.3%) cases, respectively, in retrospective analysis. The Kappa matching coefficient for CT-scan stood at 0.783, while for MRI, it soared to 0.912. A notable revelation surfaced as the Kappa matching coefficient for both CT-scan and MRI maintained a robust 0.783 (P<0.001 in all three cases).
Conclusion: MRI might wield a superior diagnostic prowess compared to CT-scan in evaluating intrathoracic lesions. The robust Kappa matching coefficients endorse a substantial concordance between the two imaging modalities. The implications further beckon contemplation that, in select scenarios, the acquisition of biopsy and histopathology may prove redundant when scrutinizing intrathoracic lesions using the tandem approach of CT-scan and MRI. However, to etch these findings into the annals of medical certainty, a multicenter study endowed with a judicious sample size emerges as an imperative next step.

Epidemiological Investigation of the mortality rate of patients with alkaptonuria during the years 2013 to 2022 in Iran
Samaneh Eslami, Iman Mousaei, Masoumeh Andish, Ensieh Tavana , Amin Moradi, Ali Taghipour, Ehsan Mosa Farkhani ,
Volume 81, Issue 6 (September 2023)
Abstract
Background: Alkaptonuria is a rare disorder that leads to excessive production and accumulation of homogentisic acid in body tissues, and this increase causes tissue degeneration and organ dysfunction through a process called achromasia. Due to very few studies in the field of this disease and access to epidemiological data for the first time in Iran, the present study was conducted with the aim of epidemiological investigation of the mortality rate of patients with alkaptonuria during the years 2013 to 2022 in Iran.
Methods: The design of the present study was cross-sectional (descriptive-analytical). The data related to the deceased registered according to the international coding system of diseases (ICD-10) were extracted from the system of registration and classification of the causes of death of Iran for death due to alkaptonuria disease. The variables investigated in this study included: age, gender and residence status of the deceased. Chi-square and Fisher's exact test were also used to analyze the data.
Results: The specific death rate was calculated as 0.31 per one million people of the population. In this study, 90% of the deaths occurred at the age of less than five years. The age variable included two groups of less than five years and more than five years, where 90% of deaths occurred at the age of less than five years. 60% of the deceased were men and 40% were women. Regarding the residence status variable, 82% of the cases were urban and the rest were rural. Finally, there was no significant difference between the incidence of death due to alkaptonuria disease and the investigated variables, which are age (P=0.291), gender (P=0.958) and residence status (P=0.273).
Conclusion: According to the findings in the present study, although no significant difference was observed between age and the number of cases of death due to alkaptonuria; But most cases of death have occurred in young age groups, which seems that more studies are needed to understand the different dimensions of this disease

Effect of resistance training modalities on angiogenic indices in sedentary male students
Mohammad Ali Gharaat , Yaghoob Mehri Alvar,
Volume 81, Issue 6 (September 2023)
Abstract
Background: Angiogenesis is a physiological process leading to capillary density enhancement and better blood distribution in skeletal muscles, which triggers in response to physical training. The present study aimed to investigate the changes in physiological factors involved in angiogenesis in response to circuit or traditional resistance training.
Methods: Thirty-six healthy sedentary students who were studying at Shahid Rajaee Teacher Training University of Tehran (age: 22.1±2.3 years; height: 172.7±5.1 cm) volunteered to participate in the study (from October 2021 to February 2022). Following a pre-test to evaluate one repetition maximum (1RM) of selected movements (Leg Press, Leg Curl, Leg Extension, Bench Pull, Seated Row, Biceps Curl), subjects randomly divided into Circuit Resistance training (CRT) (training protocol included 4 circles/3 times a week/8 weeks circuit performance/50-55% 1 Repetition Maximum (1RM), n=12), Traditional resistance training (RT) (training protocol included 8 repetition/3 set/3 time per week/8 weeks of same movements with 75% 1RM followed by 2 minutes break to rest between the sets; n=12) and the control group without any regular training (n=12). We assessed the level of Vascular Endothelial Growth Factor (VEGF), plasma level of growth hormone (GH), and Basic Fibroblast Growth Factor (BFGF) to the mentioned training methods. Data were evaluated by utilizing SPSS version 14.
Results: Present findings showed that CRT and RT protocols resulted in significant increases in post-test compared to pre-test in VEGF (P=0.00), GH (P=0.04), and BFGF (P=0.00). In addition, the magnitude of changes in VEGF and GH were significantly greater than the magnitude of changes in control group in post-test (P=0.03, and 0.001, respectively). Furthermore, there was a strong correlation between absolute values of GH and VEGF (r=0.74 and r=0.71) following CRT (P=0.01) and RT (P=0.02).
Conclusion: This study demonstrated that CRT and RT might enhance angiogenesis through an increase in VEGF, bFGF and GH, leading to better blood distribution in muscles.

Efficacy of filgrastim and Lenograstim drug treatment in patients with neutropenia: a systematic review
Sogol Shirzad, Zeinab Karimi, Mehdi Mohsen Zadeh , Masoud Mohammadi,
Volume 81, Issue 7 (October 2023)
Abstract
Background: Neutropenia refers to a decrease in the absolute number of neutrophils in the blood circulation, certain drugs are used in connection with the treatment of neutropenia. Therefore, the aim of this study is to investigate and compare the efficacy of filgrastim and lenograstim drug treatment in patients with neutropenia in a systematic review.
Methods: This study is a systematic review study conducted in connection with the comparison of the effectiveness of filgrastim and lenograstim in neutropenic patients based on the search in Google scholar, PubMed, ScienceDirect, Irandoc, SID, Magiran databases in the time range of January 2000 to August 2023. This systematic review was based on the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including systematic search of databases, organization of documents for review, selection of studies, information extraction and finally presentation of the final report. The keywords used for searching in this study were selected based on published primary studies and MESH, and after a detailed examination of the study questions, they were selected according to the PECO criteria.
Results: 1099 articles were identified in the review of the investigated databases, and after removing duplicate articles, unrelated articles, as well as articles that did not have access to their full text or did not have the required information, eight studies were the final phase, and were checked. Out of the eight selected articles, three articles declared the effectiveness of lenograstim more than filgrastim. Two articles mentioned the greater effect of filgrastim and three articles published in recent years declared the effect of two drugs to be the same. Among these articles, the studies that considered the drug dosage to be the same in the investigated groups and the studies that had a larger statistical population in order to generalize to the society are more important.
Conclusion: According to studies conducted in recent years, both filgrastim and lenograstim recombinant drugs have the same effectiveness in the treatment of neutropenia.

Effect of intravenous administration of atropine-neostigmine versus ondansetron in prevention postdural puncture headache in cesarean section under spinal: a randomized clinical trial
Atefeh Ghosouri, Mitra Jabalameli , Behzad Nazemroaya, Roxana Najafian ,
Volume 81, Issue 7 (October 2023)
Abstract
Background: More than one-third of women develop headaches in the first week after childbirth. Approximately 75% are benign primary headaches such as migraines or tension headaches. Others are secondary and include headaches of vascular origin or from hypertensive disease, infection, space-occupying lesions and dural puncture. Postdural Puncture Headache (PDPH) is a common and annoying complication of spinal anesthesia, especially in cesarean section. This study compares the impress of an Atropine-Neostigmine mixture and Ondansetron on Post Spinal Puncture Headaches in Cesarean sec.
Methods: This triple-blinded controlled randomized clinical trial was conducted on 60 pregnant women candidates for cesarean section under spinal anesthesia, that was carried out from May 2021 to August 2021 at Behshti Medical and Education Center affiliated with Isfahan University of Medical Sciences. The study was approved by the Ethics Committee of the University (IR.MUI.REC.1400.009) and informed consent was obtained from the patients/legal guardians. This clinical trial was registered at www.irct.ir with identification code IRCT 20160307026950N39.
 People were randomly assigned into three groups. A mixture of neostigmine (20 micrograms per kilogram) and atropine (10 micrograms per kilogram) in the first group and 4 mg of Ondansetron in the second group and a similar volume of normal saline in the control group were administered before surgery. Patients were followed up for headaches up to seven days after surgery. The severity of the headache was measured using the VAS scale. One-way analysis of variance (ANOVA) and non-parametric equivalent, Kruskal-Wallis, chi-square test, and repeated measure test were used to measure the relationship between the variables.
Results:  Analysis of the data did not show a significant difference between the three groups in terms of headache severity (P=0.788), headache duration, (P=0.723), the time elapsed from lumbar puncturing to the occurrence of the first headache (P=0.653), and the frequency of attempts for correct spinal tap (P=0.685).
Conclusion: none of our considered interventions had a noticeable impress on preventing or reducing PDPH in Cesarean section.

Investigating the incidence of complications caused by common national vaccinations in children and infants in Shahrood city
Fatemeh Saeedi, Mahdieh Zaki Zade , Mohammadbagher Sohrabi , Mostafa Enayat Rad , Sina Habib Zade , Mansooreh Fateh,
Volume 81, Issue 7 (October 2023)
Abstract
Background: With a national vaccination program, we have achieved success in the prevention of infectious diseases in the community especially in children. Despite this great success, the side effects of vaccination may not encourage some people in the community to get vaccinated. In this study, we investigate the prevalence of common side effects of vaccination in Shahrood city.
Methods: This study investigated the incidence of complications caused by vaccination in infants and children under seven years old in Shahrood city in a 5-year period from April 2016 to March 2020. We collected demographic and clinical information, by referring to the health centers and complications recorded after routine vaccinations such as fever, rash, diarrhea, swelling and other complications of vaccination were collected.
Results: Findings Among the 429 registered complications between 2016 and 2020, most complications were related to pentavalent and trivalent vaccines. Among the registered complications, high fever is the most common complication in both term and pre-term groups. (202 cases, 47.1%) other complications included maculopapular rash (59 cases), mild local complications (55 cases), vomiting (41 cases), and continuous screaming (36 cases), respectively. Among these, 123 cases were resolved without treatment, 297 cases were resolved with drug treatment on an outpatient basis, and only  eight cases required hospitalization.
Conclusion: In general, the vaccination program is highly effective despite having limited side effects.  Knowing this information, can increase vaccination in the country.

Management of left ventricular thrombus: diagnostic and therapeutic methods: a review article
Maryam Mehrpooya, Zahra Sadeghi,
Volume 81, Issue 8 (November 2023)
Abstract
Left ventricular thrombosis (LVT) is a very serious condition and life-threatening complication that usually occurs after acute occlusion of the left anterior descending (LAD) coronary artery followed by acute myocardial infarction with ST-segment elevation (STEMI), which leads to significant regional wall motion abnormality (RWMA). It should be noted that its diagnosis, treatment, and management are challenging now and depend on various factors such as the type of thrombus, time of percutaneous coronary intervention (PCI), and underlying disease. The preferred diagnostic method is cardiovascular magnetic resonance imaging (CMR), but transthoracic echocardiography (TTE) is routinely used for diagnostic and screening purposes also follow-up of response to treatment. It is worth mentioning that when the diagnosis of left ventricular thrombus is not clear with conventional echocardiography, contrast echocardiography is used for more resolution and detailed information. Left ventricular thrombosis can appear in both acute and chronic forms and lead to significant complications, the most important of them are stroke and systemic arterial embolism (SE). According to previous studies, vitamin K antagonist (warfarin) by keeping INR within the therapeutic range currently used to treat left ventricular thrombosis. Although the use of direct oral anticoagulants (DOAC) has brought excellent outcomes, but due to the lack of large clinical trials, the routine use of these agents is controversial, and only in case of warfarin intolerance or contraindications, DOACs can be used as an alternative. Generally, the best way to prevent left ventricular thrombosis is primary percutaneous coronary angioplasty (primary PCI) which preserves left ventricular function. Depending on the sensitivity of the diagnostic method, thrombus will likely resolve in >50% of patients by six months after the MI. On the other hand, in rare cases, surgery is indicated if a thrombosis remains despite the medical treatment especially if it is accompanied by a left ventricular aneurysm. The purpose of this narrative review is to evaluate the latest evidence in the field of left ventricular thrombosis management and to adopt the best approach for these patients.

The associated risk factors of premature rupture of membrane (PROM) and preterm premature rupture of membranes (PPROM) among pregnant women in Firooz-abadi hospital
Maryam Fakehi, Marjan Ghaemi, Nasim Eshraghi, Melina Poorkazemi, Maryam Mazloomi, Fedyeh Haghollahi,
Volume 81, Issue 8 (November 2023)
Abstract
Background: The aim of this study was to identify the associated risk factors of premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM).
Methods: This retrospective case-control study was conducted at Firooz-abadi Hospital between 2019 and 2021. The study included 90 pregnant women diagnosed with PROM or PPROM (case group), compared with 90 women without this complication (control group) who presented to the hospital during the specified period. Demographic and clinical information of the case group was collected and compared with data from 90 pregnant women in the control group, matched for gestational age and other relevant factors. Statistical analysis was performed to assess the differences between the groups.
Results: Maternal age and weight were found to be significantly lower in the case group compared to the control group (P=0.02, P<0.001, respectively). This suggests that younger age and lower maternal weight may be risk factors for PROM and PPROM. Furthermore, the number of women with a history of PROM or PPROM was significantly higher in the Case group (P<0.001), indicating that a previous occurrence of membrane rupture increases the risk of subsequent incident. In addition, the study findings showed a significantly higher rate of smoking among pregnant women in the case group compared to the control group (P=0.04). Moreover, the occurrence of urinary tract infections during pregnancy and chorioamnionitis was significantly higher in the case group (P<0.001), suggesting that these infections may contribute to membrane rupture.
Conclusion: In conclusion, our study provides valuable insights into the risk factors associated with PROM and PPROM. It highlights that lower maternal age and weight, a history of PROM or PPROM, lower gestational age, a history of gestational diabetes mellitus and first-trimester bleeding, smoking, and urinary tract infections during pregnancy are significantly associated with an increased risk of PROM and PPROM. These findings emphasize the importance of early identification and management of these risk factors in order to prevent or mitigate the occurrence of PROM and PPROM, ultimately improving maternal and neonatal outcomes. Further research and public health initiatives are warranted to raise awareness and promote preventive measures targeting these identified risk factors.

Prevalence of congenital heart disease among term infants with respiratory distress: a case study in Kerman
Mohammad Mehdi Bagheri , Fahimeh Sadeghi Zarandi ,
Volume 81, Issue 8 (November 2023)
Abstract

                                                            
Background: Congenital heart diseases (CHD) as one of the most common disorders in newborns are leading cause of perinatal mortality, also one of respiratory distress syndrome causes in newborns. This study aimed to determine the prevalence of congenital heart diseases in infants with respiratory distress syndrome.
Methods: This cross-sectional study is a retrospective study that surveyed congenital heart diseases in 145 term infants who were hospitalized in neonatal intensive care unit (NICU), Afzalipour hospital, Kerman. These infants were admitted to the neonatal intensive care unit from March 20, 2012 to the end of March 20, 2015 due to respiratory distress syndrome. Information was extracted from the medical records and then were entered in the checklist. Descriptive statistics (frequency, percentage), analytical (chi-square test) and SPSS version 20 software were used to analyze the data.
Results: Out of 145 infants with respiratory distress syndrome, 123 infants had congenital heart diseases. Therefore, the prevalence of congenital heart diseases in patients with respiratory distress syndrome was 84.83%. The most infants with congenital heart diseases were male (66.67%) and weighed between 3-4 kg (47.97%). More than 69% of newborns with congenital heart diseases were born by cesarean section and most of them were receiving medical treatment (85.37%). There was a significant difference between patient outcome and congenital heart diseases (P=0.018). The difference between sex, weight and type of delivery with congenital heart diseases was not significant. In terms of the prevalence of congenital heart diseases, atrial septal defect (ASD) was the most prevalent with 14.48%. After that, patent ductus arteriosus (PDA) was the most prevalent with 11.72%.
Conclusion: Due to the high prevalence of congenital heart diseases in term children with respiratory distress syndrome, all term infants with symptoms of respiratory distress syndrome need cardiac examination, especially echocardiography to diagnose the cause. In addition, due to the high mortality of infants with congenital heart diseases with symptoms of respiratory distress syndrome, the need for more, more accurate and complete care of these infants is suggested.


Evaluating the guidelines adherence in the management of NSTE-ACS referred to shahid chamran hospital within six-month period in 2021: a brief report
Mohammad Mahdi Gholamian , Mehrnoush Dianatkhah, Mohammad Kermani-Alghoraishi, Ehsan Shirvani,
Volume 81, Issue 8 (November 2023)
Abstract
Background: The purpose of this study was to evaluate the adherence to the ESC 2020 guideline for the management of NSTE-ACS patients admitted to Shahid Chamran Cardiology Hospital affiliated to Isfahan University of Medical Sciences in 2021.
Methods: In this retrospective study which was done during April 2021 to September 2021 we reviewed the hospital documents of 239 NSTE-ACS patients, in regard to prescribed medication during the admission period in Shahid Chamran Heart Center. Guideline-adherence was evaluated according to ESC2020 guideline. Totally 18 items were evaluated including Antiplatelet (Clopidogrel, Ticagrelor, and Prasugrel) Anticoagulant (Heparin or Enoxaparin), PPI, Statin, Beta blocker, and RAAS blockers (including ACEI/ARB or MRA). In each section the selected drug and the administered dose were compared with the guideline and the guideline adherence for each part was expressed as percent.
Results: Almost complete guideline adherence was described for 12 out of 18 reviewed items (77%). However, guideline adherence in relation to the type of medicine chosen as an antiplatelet was reported to be very low, and only 1.2% of the cases received ticagrelor or prasugrel which are the guideline recommended antiplatelet agent. Additionally, most of the administered GP2b3a antagonist agents such as eptifibatide were not in accordance with the guideline (Guideline adherence 39.74%). Also, the choice of the anticoagulant agent was among the items with low guideline adherence (29.76%) and the cross-over between anticoagulants (changing heparin to enoxaparin or vice versa) which has been inhibited by the guideline was seen with high incidence in this center (78 cases).
Conclusion: The present study showed relatively high guideline adherence in the most aspects of medical management. However, compliance was reported to be low in relation to the antiplatelet selection, the choice of the anticoagulant agent, and the indication for GP2b3a antagonist use, which maybe due to the higher cost of recommended agents, and shortage of some medications and dosage forms in Iran.

Initial crohn’s disease flare-up following an anal trauma in a 2.5-year-old boy: a case report
Ali Samady Khanghah , Maryam Khalesi , Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Hokmabadi, Khashayar Atqiaee,
Volume 81, Issue 8 (November 2023)
Abstract
Background: Crohn's disease is considered a heterogeneous disorder with multi-factorial etiologies, in which the interaction of genetics and environment manifests the disease. Adverse childhood experiences can affect future physical and mental health outcomes. The rich innervation of the intestine with the Vagus nerve and hormonal interactions on the one hand and the constant contact of the digestive system with various pathogenic and non-pathogenic antigens have a proven role in autoimmune diseases and can gradually be chosen as a therapeutic goal.
Case Presentation: We are reporting a case of Crohn's flare-up after trauma in a pediatric case. A 2.5-year-old male with a through and through anal trauma was presented in Akbar Children's Hospital, Mashhad, Iran, Spring 2023 with active bleeding but conscious. He then underwent a physical examination under general anesthesia in the operating room. At the Lithotomy position, a penetrating wound at the 3 o'clock anal verge and a tear in the perineal area at 9 o'clock, which, according to the evidence of pus discharge, were seen hours after the incident which was irrigated with normal saline and Hydrogen Peroxide respectively. Due to the contamination of the area, a supportive colostomy was decided to be closed after six months. At the appointed time during the colonoscopy, the pediatric gastroenterologist noticed extensive inflammation in the distal patch of the colon, which was consistent with Crohn's disease. Histopathological studies then confirmed this diagnosis. This was even though there were no symptoms of inflammatory bowel disease in the history of the boy's illness before the accident. The patient is then treated with prednisolone, Asacol, and ciprofloxacin, and after the disease subsides, the colostomy surgery team closes the disease.
Conclusion: Trauma can be an immune-disrupting factor in the digestive system, and trying to reset the brain-gut axis can be chosen as a therapeutic goal.

The comparison of the pennation angle of knee extensor muscles in young women with pronated foot posture and normal ones
Zinat Ashnagar, Mohammad-Reza Hadian, Rahimeh Mahmoodi,
Volume 81, Issue 9 (December 2023)
Abstract
Background: Foot posture is proposed as an important factor that may affect the lower limb alignment. Variations from the normal foot posture may contribute to musculoskeletal injuries of the lower extremity especially knee joint. Considering variations in foot posture and knee joint alignment, this study aimed to assess and compare pennation angles of the vastus medialis oblique (VMO), vastus medialis (VM) and vastus lateralis (VL) in women with pronated foot posture and normal ones.
Methods: This observational, case-control study was carried out on 31 women with pronated foot posture (foot posture index: 6-12) and 31 women with normal foot posture (foot posture index: 0-5) in the age range of 18 to 35 years old.  Participants were recruited from female students of university communities using Non-probability Sampling method. Sampling was carried out from September 2019 up to February 2020 at the biomechanics laboratory of rehabilitation faculty of Tehran University of Medical Sciences. The pennation angle of VMO, VM and VL muscles was measured by using two dimensional. B-mode ultrasound imaging (USI) .A 7.5MHz linear transducer with 50mm footprint was used for the measurements. The ultrasound images were analyzed using Image J software. Three longitudinal scans were captured for each muscle pennation angle while the probe removed between each scan.
Results: The results of this study showed that there is no statistical significant difference between the pennation angles of  VMO, VM and VL in women’s foot posture compare to the normal ones (P>0.05).
However, the results of intraclass correlation coefficient (ICC) of USI measurements showed “good” intrarater reliability for VMO (ICC=0.88), VM (ICC=0.87) and VL (ICC= 0.77) pennation angles.
Conclusion: Based on the results of this study, the pennation angle of knee extensor muscles (VMO, VM, and VL), which was measured in non-weight bearing, is not different in young women with pronated foot compared to the normal ones. In addition, USI demonstrated good reliability for measuring VMO, VM and VL pennation angles.

Investigation of the frequency of resistance to fluoroquinolones in Salmonella enterica subspecies enterica serovar Enteritidis isolates isolated from hospital gastroenteritis samples
Kasra Mardani, Farhad Nikkhahi, Fatemeh Fardsanei,
Volume 81, Issue 9 (December 2023)
Abstract
Background: Salmonella enterica subspecies enterica serotype Enteritidis (S. Enteritidis) is one of the leading causes of food-borne infections associated with the consumption of contaminated food products of animal origin in humans. gastroenteritis due to Salmonella is usually a self-limiting disease and does not require antibiotic therapy. However, antibiotic treatment for salmonellosis may be lifesaving for patients with severe infections.The objective of the present study was to examine antimicrobial resistance and determine its genetic basis in recently isolated S.Enteritidis strains.
Methods: During this study, in a cross-sectional descriptive study, 44 isolates of Salmonella enteritidis from human sources were investigated between September 2021 and September 2022.. After identification of the isolates using phenotypic and molecular methods by Multoplex-PCR, antibiotic resistance testing was performed according CLSI 2023. The strains were examined for the presence of qnrA,qnrB,qnrS and gyrA resistance genes by PCR.
Results:  In a cross-sectional descriptive study, 44 isolates of Salmonella Enteritidis from human sources were investigated between September 2022 and September 2023. 100% of the strains were sensitive to imipenem and meropenem, and the sensitivity to the antibiotics ceftriaxone, ceftazidime, and cefotaxime were 93.2%, 90.9%, and 94.1%, respectively. 81.8% of isolates were sensitive to cotrimoxazole, sensitivity to ampicillin was 84.1%. Only 9.1% of isolates were sensitive to ciprofloxacin. Based on MIC results, 16 isolates had MIC between 0.002 and 0.064 and were placed in the sensitive area. 28 isolates had MIC between 0.125 and 0.5 and were placed in the area of reduced sensitivity. None of the strains resistant to disk diffusion method were resistant to MIC method. qnrA, qnrB and qnrS genes were not observed among ciprofloxacin resistant strains. All nalidixic acid resistant strains had gyrA gene.
Conclusion: In general, it was shown in this study that the resistance to the fluoroquinolone family is increasing among Salmonella Enteritidis isolates. On the other hand, we see a decrease in the sensitivity and prevalence of strains resistant to broad-spectrum cephalosporins among serovar Enteritidis, which is the drug of choice for extraintestinal infections.

Investigating the mean indexes of the cervical vertebrae through radiography in normal peop
Mahsa Akhavan-Sabbagh, Mohammad Ghasem Hanafi , Mozhgan Samet Zadeh , Arvin Rostami ,
Volume 81, Issue 9 (December 2023)
Abstract
Background: The study of the angles between the vertebrae and the curvatures of the spine plays an essential role in the pathogenesis of spinal disorders. Among the essential topics, the cervical sagittal parameters are widely used in evaluating cervical spine disorders and surgery. Measurement of cervical lordosis curves in healthy people is influenced by various factors. This study was conducted in order to investigate the average indexes of the cervical vertebrae in simple graphs in normal people.
Methods: In this descriptive study, using Gunya and Radiant software, radiographic photographs of the lateral view of the cervical region of 50 people (28 men and 22 women) who were referred for purposes other than problems related to neck pain were examined. Patients who were candidates for surgery and congenital disorders of the cervical spine were excluded. The study was conducted between March to April 2022. In this study, 12 cervical indexes were comprehensively measured and the scope of their changes in relation to age and gender was investigated. The measurements were conducted by an experienced radiologist.
Results:  In this study, 50 participants including 28 male (58%) and 22 female (44%) were included in the study. The mean age of participants 38.42 ± 2.1 years. After comparing the two genders, except for C0-C2/C2-C7 ratio index (4.9 in men and 2.6 in women) (P= 0.012), no significant difference was seen for other indexes (P> 0.05). After comparing the two groups, a significant difference was seen only in the T1 slope (T1S) index, which was significantly higher in people over 35 years old than in people under 35 years old (71.15 vs. 69.04) (P=0.049).
Conclusion: The evidence from this study shows that T1S increases with age and C0-C2/C2-C7 is significantly less in women than in men. These findings can be used to diagnose pathology or destructive changes in the elderly, to evaluate movement disorders, the effectiveness of treatment, and to determine the outcome.

Investigation of epidemiological and histopathological features of central nervous system tumors in the samples referred to the pathology department of a referral hospital in the east of iran in a 10-year period
Yasser Hasanzadeh, Zahra Sagheb Movafagh , Atena Sahrabeygi , Hamid Heidarian Miri , Masoumeh Gharib ,
Volume 81, Issue 10 (January 2024)
Abstract
Background: Identifying the epidemiological aspects of central nervous system (CNS) tumors is the first step in implementing management protocols to control the condition of these tumors. We aimed to examine the epidemiology and histopathology of both benign and malignant tumors of the CNS in one of the referral and university centers in the east of Iran.
Methods: This cross-sectional study was conducted on all files of patients admitted to Qaem Hospital in Mashhad City, Iran, in a period of 10 years from March 2009 to February 2018 with a definitive diagnosis of benign or malignant tumors of the CNS, including tumors of the brain, cerebellum, spinal cord, or meningeal membranes. Information sources included the patients' physical files and the hospital information system (HIS). The statistical software SPSS version 28.0 for Windows (IBM SPSS, Armonk, New York, USA) was used for the statistical analysis.
Results: In total, 775 patients with benign and 771 patients with malignant CNS tumors were included in the study. Regarding epidemiological aspects of benign tumors, the incidence rate of women was almost twice that of men (68.47% versus 31.53%), with an overall average age of 45.31±19.81 years. The most common benign tumors were meningioma (72.77%), followed by schwannoma (13.67%). Regarding malignant brain tumors, the mean age of affected patients was 36.64±19.67 years, with males accounting for 53.04% of cases and females for 46.96%. The most frequent type of tumor was glioblastoma (32.68%), followed by diffuse astrocytoma (16.47%). Both benign and malignant CNS tumors were associated with significant hospital mortality; in-hospital mortality rates for benign and malignant tumors were 10.1% and 17.5%, respectively. Tumor type and its grade were the main determinants of early death in malignant CNS tumors.
Conclusion: The epidemiological characteristics of benign and malignant tumors in our study community were similar to the reports presented in other communities. Knowledge of these characteristics provides the possibility of managing patients and reducing morbidity and mortality related to these tumors.

Seasonal impact analysis on COVID-19 severity: insights from homogeneous epidemiological hospital data using the jaccard correlation coefficient
Ameneh Javanmard, Alireza Salehan,
Volume 81, Issue 10 (January 2024)
Abstract
Background: Coronaviruses were discovered in 1960. Large-sized living organisms from the Coronaviridae family, with single-stranded RNA of animal origin. Coronaviruses in humans can cause mild respiratory illness or severe respiratory illness. In 2020, the World Health Organization declared COVID-19 a global pandemic. The aim of this study is to use the Jaccard similarity coefficient to determine the similarity of COVID-19 behavior patterns in different seasons of the year.
Methods: This study used machine learning systems and similarity metrics to determine the behavior pattern of COVID-19 in different seasons of the year. The location of research was the Mousa ibn Ja'far Hospital in Mashhad, and the time was from May 2020 to August 2021. The symptoms of affected patients were compared with the compiled dataset, and the similarity of patients was prepared in a similarity matrix, and the Jaccard correlation coefficient was calculated on the data. Finally, the analysis of strains from the beginning of emergence to the latest strain was examined. The performance indicators of the algorithm in the Jaccard similarity method showed a recall metric with a value of 0.94, a precision metric with a value of 1, an F1 score with a value of 0.86, and remove accuracy metric with a value of 0.76. The most important factors in the investigation include white blood cells, platelets, RT-PCR, CT SCAN, shortness of breath, fever, SPO2, and respiratory rate.
Results: The transmission of the COVID-19 virus depends on several factors, including human interaction. The evidence of the collected data shows that people with COVID-19 have low lymphocyte count and it is very consistent with the results of recent studies. Due to the lack of a dataset, a comparative study was conducted and a dataset was collected.
Conclusion: This study, leveraging machine learning algorithms, identified a clear seasonal correlation in the spread of COVID-19. Considering geographical and seasonal variations among patients, distinct symptoms were observed in each season corresponding to the prevalent strain during that period.

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