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Investigating the type and frequency of errors in the medical diagnostic laboratory in a medical center in Tehran, Iran: a medical-laboratory experience
Mohammad Hossein Kalami , Zeinab Borjian Boroujeni , Peghah Ardi, Ahmad Abolfathi, Mohsen Babaei, Ali Asadi, Mahdi Zareei,
Volume 81, Issue 1 (4-2023)
Abstract
Background: Medical Laboratories have a great impact on patient safety and 80-90% of medical diagnoses are based on the results of laboratory tests. Medical procedures from the initial diagnostic steps such as a test or a simple injection to specialized treatment steps may be erroneous. The aim of this study was to determine the type and rate of human error, equipment, materials and procedures in all stages including before analysis, during analysis and after analysis to analyze the causes and find logical solutions to reduce of them.
Methods: This cross-sectional descriptive study was performed in a medical center in Tehran, Iran during the years 1400-1401. Data collection was considered in accordance with the instructions of the Laboratory Affairs Department of the Ministry of Health and Medical Education regarding the type of errors in the field of job description in each of the technical and non-technical sections. Data was analyzed by IBM SPSS software, version 22 (SPSS Inc., Chicago, IL, USA) software.
Results: During the period of study, the number of  referred patients was about 45,000 and the number of tests 594,000. The total number of errors was 837. The ratio of errors to the patients was 1.9% and to the tests 0.15%. The 37 types of errors were identified and reported in this study. Of these, 11 types of errors were in the pre-analysis, 14 types during the analysis and 12 types of errors in the post-analysis stage. The frequency of errors in the three stages was 180(21.5%), 312(37.3%) and 345(41.2%), respectively that the errors rate did not have a normal distribution and a significant difference was observed (P<0.05, df=2).
Conclusion: Due to the variety of reported errors and the importance of their role in other stages of diagnosis and treatment, it is necessary that all human, equipment and process errors in all stages of laboratory analysis be carefully recorded and corrective and preventive measures be taken to minimize them.

Investigation of risk factors for death in heart failure patients at Shahid Mustafa Khomeini Hospital
Firooz Balavandi, Hossein Moradkhani,
Volume 82, Issue 10 (1-2025)
Abstract
Background: Chronic heart failure (CHF) is a leading cause of cardiovascular mortality and hospitalization. Heart failure (HF) imposes both direct costs to healthcare systems and indirect costs to society through complications, unpaid care costs, premature mortality, and loss of productivity. The aim of the present study was to investigate the quality of care, laboratory and clinical indicators affecting mortality in heart failure patients.
Methods: In a descriptive study conducted in the summer of 1402, data were collected by extracting the list of patients who died with a diagnosis of heart failure from the hospital's information management system, based on random sampling, and recorded in a checklist. The number of patients selected was from a study of factors affecting mortality in heart failure patients at Shahid Mustafa Khomeini Hospital.
Results: 25.8% of patients had bilateral rales on pulmonary auscultation, and 88.7% of them reported shortness of breath, 58.1% edema, and 22.6% chest pain. LVEF of most patients was 10-25. With a decrease in systolic blood pressure and an increase in diastolic and HR, the probability of mortality increased significantly (1.058, 0.932, and 0.983) times, respectively. With a decrease in oxygen level, the probability of mortality increased significantly by 0.983 times. The mean ALT and AST increased significantly and the mean HCT also decreased significantly. With each unit increase in ALT and AST and each unit decrease in Hct, the probability of mortality increased (1.008, 0.985 and 1.283) times, respectively. With the decrease in Hb and FBS and the increase in Cr and BUN, the probability of mortality increased by 0.314, 1.013, 1.884 and 0.969 times, respectively. However, no significant relationship was observed between mortality and the factors Hb, FBS, Cr and BUN with patient mortality.
Conclusion: Dyspnea and edema were common in patients, and bilateral rales and chest pain were observed in less than half of the patients. A decrease in systolic blood pressure and an increase in diastolic and HR significantly increased the probability of mortality. A decrease in oxygen levels also significantly increased mortality in patients.

Clinical and paraclinical findings of patients with a diagnosis of acute pancreatitis and its related factors
Ramyar Rahimi Darehbagh , Sara Moradian , Afshin Hajihasanzadeh, Masood Moradi, Farhang Safar Nejhad ,
Volume 82, Issue 11 (2-2025)
Abstract
Background: Acute pancreatitis is a common and challenging disease that can develop local and systemic complications. It is divided into biliary and non-biliary pancreatitis, based on ultrasonographic findings. This study aimed to evaluate the clinical and paraclinical findings of patients with acute pancreatitis and related factor.
Methods: This cross-sectional study included all patients hospitalized with a diagnosis of acute pancreatitis in Besat and Towhid hospitals of Sanandaj from March 2016 to March 2018. All patients admitted with a confirmed diagnosis of acute pancreatitis during the mentioned period were enrolled. Inclusion criteria were a definitive diagnosis of acute pancreatitis based on clinical features (characteristic abdominal pain), laboratory findings (serum amylase or lipase elevated more than three times the normal level), and/or imaging evidence. Patients with chronic underlying conditions such as diabetes, chronic renal or hepatic failure, advanced cardiac disease, or neoplasms were excluded to reduce confounding effects.
Results: Of the 150 patients, 89 were female (59.33%), and 61 were male (40.67%). The mean age of the patients was 53.11 years old. 62% of patients had biliary pancreatitis, and 38% had non-biliary. The prevalence of alcoholic pancreatitis in the population was 5.33%. The age of people with biliary pancreatitis was more than non-biliary. According to Ranson's criteria, 6% of patients had severe acute pancreatitis, all of whom were over 60.
Conclusion: Acute pancreatitis was more prevalent among women, particularly in the fifth decade of life, with gallstones being the leading cause. Patients with biliary pancreatitis were significantly older, and advanced age was associated with increased disease severity. Moreover, blood glucose, AST, and LDH were significantly higher in severe cases. These findings highlight the importance of early diagnosis, accurate severity assessment, and special attention to elderly patients and those with biliary pancreatitis to reduce complications and improve clinical outcomes.

Comparison of the frequency and pattern of clinical manifestations of patients with phenylketonuria in the two provinces of Sistan and Baluchestan and West Azerbaijan
Elham Shafighi Shahri , Akram Ehsasatvatan, Sara Rigy Nejad ,
Volume 83, Issue 7 (10-2025)
Abstract




Background: Phenylketonuria (PKU) is a genetic metabolic disorder that, if left untreated, leads to irreversible cognitive, behavioral, and neurological damage. Sistan and Baluchestan and West Azerbaijan provinces are among the regions that have reported high rates of the disease due to specific ethnic characteristics. This study aims to compare the frequency and pattern of clinical symptoms in the two provinces of Sistan and Baluchestan and West Azerbaijan.
Methods: This cross-sectional descriptive-analytical study was conducted on 60 patients with PKU who had been referred to Imam Ali Hospital (Zahedan) and Urmia Hospital during the past ten years. Data were collected from medical records and structured interviews.
Results: The mean age of the patients was 5.67 ± 6.98 years. The mean height, weight, and head circumference were 30.28 ± 113.08 cm, 13.22 ± 25.13 kg, and 1.83 ± 43.36 cm, respectively. The mean serum phenylalanine level at the time of diagnosis was 13.58 ± 14.65 mg/dL. Of the 60 patients, 31 (51.7%) were male and 29 (48.3%) were female. The difference between the two sexes in the occurrence of clinical symptoms was not statistically significant (p<0.05). Psychiatric disorders were reported in 20 (33.3%) of the patients. The prevalence of these disorders was significantly higher with increasing age (p = 0.041).
Conclusion: This study indicates the existence of significant regional differences in the clinical manifestations of phenylketonuria; such that patients from Sistan and Baluchestan province experienced a higher rate of psychiatric and neurological symptoms than patients from West Azerbaijan. The severity of symptoms increased with increasing age and duration of illness, emphasizing the importance of early diagnosis and continuous therapeutic follow-up. It was also noteworthy that some patients still had severe clinical symptoms despite having lower phenylalanine levels at diagnosis. Overall, the findings of this study emphasize the need for early diagnosis, equitable access to health services, and sustained metabolic control to improve outcomes for PKU patients in the country.

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