JOURNAL OF RESEARCH IN CLINICAL MEDICINE
Year:2021 | Volume:9 | Issue:1|Papers Count:31

Introduction: Central serous chorioretinopathy (CSCR) is a condition of choroidal and retinal pathologies that may affect vision, so we assessed vision by the ocular wavefront in the acute form of CSCR. Methods: This cross-sectional study included 21 cases (16-male, 5-female) of acute onset CSCR who were referred to the retina clinic of Nikookari Eye Hospital Visual acuity and ocular examination with and without pupillary dilation was recorded. Central macular thickness and sub-foveal fluid height of all patients were measured by spectral-domain optical coherence tomography (SD-OCT). All of the patients were analyzed by binocular visual function analyzer of Tracy Technology after complete pupillary dilation. The items such as spherical equivalent, total root mean square, total lower-order aberration, total higher-order aberration, defocus, astigmatism, secondary astigmatism, coma, spherical aberration, trefoil, Strehl ratio in point spread function, the average height in the modulation transfer function, and root mean square error registered. Generalized Estimation Equations (GEE) were used to compare two groups of affected CSCR and normal contralateral eyes. Results: The mean uncorrected distance visual acuity in the CSCR eyes (Decimal Notation) is 0. 82 ± 0. 17 and in the contralateral eyes is 0. 95 ± 0. 09 (P = 0. 002). Analysis of macular OCT data CSCR group represents central foveal thickness of 485. 9 ± 165. 12 μ m and mean fluid height of 284. 3 ± 165. 42 μ m. The mentioned optical parameters of ocular wavefront aberrations do not have significantly different results in the two groups. Conclusion: Our study showed that CSCR reduced uncorrected visual acuity; however no significant ocular wavefront change was detected in acute CSCR.

Congenital hypothyroidism is a common inborn endocrine disorder. The majority of cases are asymptomatic, meaning that its diagnosis may be missed especially in settings where newborn screening is absent. We present a delayed diagnosis case of congenital hypothyroidism and emphasize on the need for high levels of suspicion in order to aid prompt diagnosis and treatment. Our case is a 3 years and 4 months old male, who was first presented at 5 months of age due to poor growth. He passed meconium after the fourth day of life, developed jaundice in the first week of life, and slept a lot in his neonatal period. He had coarse faces, protruding tongue, widened anterior fontanelle and herniation of umbilicus. He was started on oral 50 micrograms of levothyroxine daily. In resource-limited settings where universal newborn screening is absent, healthcare workers should have a high level of suspicion in picking up the early signs of the condition.

Recurrent cellulitis is one of the cutaneous tuberculosis mimickers. As a skin lesion can mimic other skin diseases, the diagnosis can easily be missed especially in immunocompetent patients without any other risk factors. We present a case of a 62-year-old female patient with the history of right hand extensor tenosynovitis presented with right hand and forearm swelling and pain, associated with fever. Clinically, her right hand and forearm were erythematous with a small nodule at the right elbow. She was treated for recurrent right upper limb cellulitis and thrombophlebitis complicated by septic shock needing several courses of antibiotics. However, she did not show any significant response to the treatment. Multiple septic work ups were carried out and all were negative, except aspiration of her right elbow nodule was positive for Mycobacterium tuberculosis. An anti-tuberculous treatment was started but unfortunately, she succumbed due to nosocomial infection.

Creutzfeldt-Jakob disease (CJD) is a rare rapidly progressive neurodegenerative disease. The diagnosis of CJD is based on magnetic resonance imaging (MRI) findings, electroencephalography (EEG), or 14-3-3 protein detection. We report a case of a previously-healthy 72 year-old woman, with evidence of coronavirus disease 2019 (COVID-19), who complained of behavioral changes and rapidly progressive dementia. While hospitalized, she did not have orientation to time and place and repeated an irrelevant sentence in response to questions. Also, anomia and impaired comprehension was observed. Myoclonic jerks, abnormal signal intensity at bilateral parieto-occipital cortices in MRI, periodic sharp wave complexes in EEG, and increased lactate dehydrogenase in cerebrospinal fluid (CSF) highly recommended CJD as the diagnosis. This is the second case of CJD after COVID-19 during this pandemic, which can be an alarm to clinicians about the silent impact of COVID-19 on the central nervous system.

Medicinal mushrooms are known and used to be nutraceuticals for centuries to enhance health benefits and treat several diseases. Among them, Ganoderma lucidum (i. e., G. lucidum, red Reishi, or Lingzhi) is appreciated as a medicinal mushroom or significant herbal food for treating diseases, extending life, and developing drugs. It is detected in different locations, likely contributed confusing concerning its classification. Concomitantly, it has been utilized as tea, alcoholic drinking, and complementary medicine to bestow numerous health benefits. Thereby, it is essential to identify chemical constituents and provide its activities in health benefits regarding these products. In this mini-review, we try to show the advantages of G. lucidum which may encourage its production and usage in disease treatment.

Introduction: Parkinsonism as a group of movement disorders, exhibits similar clinical presentation. Therefore, clinically differentiating these diseases is difficult. We investigated the diagnostic value of 99m Tc-TRODAT-1 SPECT in this setting. Due to the fact that this modality has some limitations in imaging small organs like the subregions of basal ganglia, we also evaluated the use of anatomical magnetic resonance imaging (MRI) along with functional SPECT imaging in parkinsonism. Methods: This follow-up diagnostic test evaluation study was performed with 40 patients with the clinical presentation of parkinsonism, and 10 healthy subjects as controls. After administration of the radiopharmaceutical, SPECT images were acquired, then co-registered on MRI. Uptake values were evaluated in basal ganglia semi-quantitatively. Results: In this study, 99mTc-TRODAT-1 SPECT was able to differentiate essential tremor and healthy subjects from progressive supranuclear palsy (PSP) and Parkinson’ s disease (PD) with a sensitivity of 76. 47% and specificity of 100% at a cut-off of 0. 53; however, findings were not significant in differentiation of PD from PSP (P˃ 0. 05), and the results were similar in SPECT and co-registered MRI/SPECT images. In evaluation of the uptake pattern in basal ganglia, the lateralization of decreased uptake was only seen in PD; and in PSP, the dysfunction was bilateral in all patients. Conclusion: 99mTc-TRODAT-1 SPECT is sensitive and specific in diagnosing basal ganglia dysfunction; however, 99mTc-TRODAT-1 SPECT alone or co-registration on MRI are not adequate in differentiation of the etiologies of basal ganglia dysfunction.

Introduction: The present study aimed to evaluate the efficacy of plasma D-dimer levels as predicting early morbidity and mortality in patients with esophageal cancer. Methods: For this purpose, 60 patients who had surgery for middle-(n = 35) and lowerthoracic esophageal cancer (n = 25) were recruited. Then, preoperative plasma D-dimer levels were measured in a quantitative and qualitative manner and their relation with postoperative outcomes in each type of cancer was assessed for six months. Results: With regard to the middle-thoracic esophageal cancer, complications were observed in 14 cases and six deaths were reported. Considering the lower type, morbidity was found in 11 cases and mortality was seen in five patients. In both types of cancer, plasma D-dimer levels were significantly higher in patients with complications or deaths compared to those without complications and survivors. Sensitivity, specificity, as well as positive, and negative predictive value (P/NPV) of plasma D-dimer levels were 90. 91%, 78. 57%, 76. 92%, and 91. 67% for diagnosing morbidity of the lower-thoracic esophageal cancer and 80%, 85%, 57. 14%, and 94. 44% for predicting mortality in this type of cancer. Moreover, the given values were equal to 71. 43%, 76. 19%, 66. 67%, and 80% for diagnosing complications of the middle-thoracic esophageal cancer and 83. 3%, 72. 41%, 38. 46%, and 95. 45% in predicting deaths induced by this type of cancer. Conclusion: It was concluded that elevated plasma D-dimer levels could be accompanied by adverse events and early poor postoperative outcomes for esophageal cancer.

Introduction: Considering the importance of tetanus vaccination in both children and adults, recognizing the necessities and priorities of tetanus vaccination is essential for health care providers. Medical interns play a crucial role in the treatment of hospitalized patients, and as future physicians, should be well informed. This study aims to evaluate the knowledge of Tabriz University of Medical Sciences’ medical interns about tetanus vaccination in patients presenting with trauma. Methods: All interns of Tabriz University of Medical Sciences were enrolled in this study. Interns who did not want to participate in the study and those who were on-call, were excluded from the study. Eventually, 250 interns were gathered in a conference hall, and a questionnaire composed of 10 questions was given to them presenting a hypothetical traumatic event. Correct and incorrect answers to each question, and the age, and gender of the interns answering to these questions were analyzed. Results: Only three questions were answered correctly by more than half of the participants; questions number 10, 1, and 2, with 67. 2%, 59. 2%, and 50. 8% of correct answers respectively. On the other hand, 5 questions had less than 20% of correct answers. The maximum overall score was 7. Analysis of these results between the two sexes did not show a significant difference in the number of correct answers and each question’ s correct percentage also did not differ significantly between them. Additionally, age was not shown to be a variable affecting the total score of the participants. Conclusion: Regardless of the age and gender, the knowledge of Tabriz University of Medical Sciences’ medical interns about the precise indications of tetanus prevention in adults and children is poor.

Introduction: In recent years, there has been a growing concern about the lack of adequate nutrition Knowledge among nurses. Nutrition training in the medical curriculum and for healthcare professionals is contradictory, inadequate, and weak. Nurses are one of the most reliable sources of nutritional information for patients; and yet, little research has been done so far on nurses’ information regarding their important role in nutritional care. Our study is designed to assess the current level of Knowledge, attitudes, and practices of nurses in intensive care units (ICUs). Methods: A four-part questionnaire was used in this study. This descriptive cross-sectional study was conducted from July 2019 to July 2020. The sample size consisted of 110 nurses based on the statistical data obtained from the nursing offices of two hospitals of Tabriz University of medical science including all the nurses working in the ICUs. Thereafter, all questionnaires were re-collected and data were finally analyzed. Results: Results showed that from 110 nurses which were included in this study, 73. 6% had high Knowledge, 45. 5% had moderate practices, and 58. 2% had a positive attitude about nutritional support. Age and level of education had a significant correlation with their knowledge (P = 0. 005 and P = 0. 001, respectively). Nursing attitude had a significant correlation with age and the level of education (P = 0. 03 and P = 0. 003). And also, nursing practice had a significant relationship with age, work experience in the ICU, and the level of education (P = 0. 001, P = 0. 001 and P = 0. 004, P < 0. 05). Conclusion: Nurses surveyed in this study had a high knowledge, moderate practice and a positive attitude regarding nutritional care in patients admitted to the ICU.

Introduction: Pancreatitis is considered as the well-known and serious complication of endoscopic retrograde cholangiopancreatography (ERCP). Different approaches have been suggested to prevent or reduce this complication. Therefore we aim to investigate them in the current study. Methods: This systematic review was performed in 2019 using Embase, google scholar, PubMed, and Cochrane library. The eligible investigations and outcomes of interest were selected and extracted by two reviewers. Meta-analysis was done using random or fixed-effect models. I-square statistic test was used for heterogeneity analysis. Results: Totally, 2758 articles were searched. Thereafter duplicated and irrelevant articles were excluded, and six articles were entered into the present study. Six randomized controlled trials (RCTs) were considered eligible with a total participants of 1685. The relative risk of postERCP pancreatitis (PEP) was not significantly different in non-steroidal anti-inflammatory drug (NSAID) and hydration groups (pooled RR = 1. 19, 95% CI: 0. 40 to 3. 50, P value = 0. 74). The random effect model indicated no significant differences between NSAID and NSAID+hydration groups regarding the incidence of PEP (pooled risk ratio (RR) = 2. 19, 95% CI: 0. 70 to 6. 88, P value = 0. 17). Conclusion: Using only NSAIDs or in part with hydration can decrease the PEP risk. Lack of studies comparing different approaches of prophylaxis in post-ERCP patients or the reporting of different parameters among the existing studies seriously limited the possibility and quality of meta-analysis.

Introduction: Newborns’ incapability to self-regulate their body temperature exposes them to risk of many complications. Therefore, proper initiations of nursing interventions are crucial for ensuring early stabilization after birth. The present study aimed to evaluate the impact of a multi-method training program on knowledge and practices in neonatal nurses. Methods: This quasi-experimental research was carried out with a pre-test– post-test and intervention-control groups design. The population consisted of 60 nurses working in the neonatal and neonatal intensive care unit (NICU) of two hospitals in Iran. The samples were selected using the convenience sampling technique. A researcher-made questionnaire was used. The validation and reliability of the questionnaire were confirmed. The nurses received a multi-method training for two weeks. They were evaluated three months later. Results: The mean knowledge score obtained in the pre-test was 30. 33 ± 2. 01, and it was 47. 73 ± 6. 82 three months after the intervention. There was a statistically significant difference in the trend of changes in the scores of the two groups (F = 125. 72, P < 0. 001). The mean performance score in intervention group before the intervention was 60. 63 ± 5. 69 and after the intervention was 81. 77 ± 6. 37, indicating a significant difference in the trend of changes (F = 90. 285, P < 0. 001). The correlation between knowledge and practice was significant at the 0. 01 level (r = 0. 544, P = 0. 002). The previous in-service training, individuals’ education, and thermoregulation knowledge were determined as predictors of performance (r = 0. 651, P = 0. 013). Conclusion: According to the results, a multi-method training program improves the nurses’ knowledge and performance in the infants’ body temperature regulation care.

Introduction: The World Health Organization (WHO) declared a pandemic in March 2020 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the neurotropism feature of the coronavirus and growing number of coronavirus disease 2019 (COVID-19) associated neurological disorders, including Guillain Barre syndrome (GBS), we conducted a systematic review to thoroughly describe the clinical features, diagnostic workup, and clinical outcome of COVID-19 associated GBS in 78 cases. Methods: We identified case reports and case series of COVID-19 associated GBS by conducting a search in the PubMed/MEDLINE and EMBASE databases. We assessed the quality of studies using an appraisal checklist presented by Cochrane Murad et al. Extracted data included demographic characteristics, clinical presentation, diagnostic workup, and outcome. Results: The systematic search yielded a total of 60 articles reporting 78 patients with a diagnosis of COVID-19 associated GBS. The patients were mainly male (65. 3%) with an average age of 57 years. The ascending symmetrical paresis was the most common presentation (79. 4%), with demyelinating pattern in 54 patients (79. 4%). CSF analysis showed albuminocytologic dissociation in 48 patients (75%). The mortality of COVID-19 associated GBS was estimated as 6. 4% attributable to progressive respiratory failure. Conclusion: Given the associated morbidities such as respiratory failure in patients with COVID-19 related GBS, its timely detection is crucial to prevent poor clinical outcomes. On the other hand, clinicians must be vigilant to identify the clinical findings of SARS-CoV-2 infection in newly diagnosed GBS patients, as this might be a neurological complication of the subclinical viral infection.

Introduction: In this study, we aimed to evaluate computed tomography (CT) findings of peripheral pulmonary artery aneurysms (PPAA) associated with Behcet’ s disease (BD), Hughes Stovin syndrome (HSS), and idiopathic origin. Methods: Contrast-enhanced CT scans of the patients were retrospectively reviewed regarding PPAA. The patients with PPAA were classified into BD, HSS, and idiopathic groups according to the etiology. The groups were compared for demographical features including age and gender, multiplicity, distribution of thrombosis and accompanying pulmonary artery embolism (PAE), and deep venous thrombosis (DVT) history. Results: A total of 30 PPAA (25. 4 ± 13. 4 [11-62] mm) were detected in 10 (2. 3%) (mean age 39. 8 ± 22-1. 0 [8-73] years, female/male: 3/7) among 4391 patients reviewed. In 7 patients, multiple aneurysms were detected, while a solitary lesion was seen in 3 patients. Most commonly, lower lobes (right 8-left 8, 53. 2%) involvement was observed. A thrombosis was detected within 19 (63. 4%) aneurysms. Among 10 patients with PPAA, 4 subjects (40%) had BD, 2 (20%) HS and 4 (40%) idiopathic origin. In 5 patients (50%), there was accompanying PAE and 3 patients had (30%) DVT history. Patients with BD and HSS tended to have multiple lesions than those with idiopathic origin. Accompanying PAE was observed in 2 (100%) of patients with HSS, 2 (50%) with BD, and 1 (25%) patient in the idiopathic group. A DVT history was recorded in 2 (100%) patients with HSS, 1 (25%) with BD. None of the patients in the idiopathic group had a DVT history. The only rupture was observed in the HSS group. Conclusion: Vasculitic diseases lead to PPAA, including BD and HSS which are more likely to be associated with complications and additional morbid conditions than idiopathic processes.

Introduction: This study aimed to evaluate the impact of basic life support (BLS) on the knowledge and performance of high school students. Methods: During a semi-experimental study, 12 068 ninth-grade high school students entered the study. The course included BLS and airway maneuvers regarding foreign body aspiration. The students’ level of knowledge and performance were assessed based on a questionnaire. Results: The students’ mean levels of knowledge were 3 (3-2) and (4-5) before and after the training, respectively. Approximately 60% of the students had excellent scores on practical activities. Conclusion: We conclude that resuscitation training can be effective in promoting public health.

The H antigen is the precursor substance for A and B antigens formation on red blood cells of an individual, and its absence is termed as H deficient phenotype. The lack of H antigen on both red blood cell (RBCs) and secretions results in a classical Bombay phenotype with anti-H antibodies in serum. If the H antigen is absent on RBCs and present in secretions and plasma, the resulting blood group is the Para-Bombay phenotype. Although, the H gene is genetically absent in Para-Bombay (hh genotype), at least one Se (Secretor) gene is present. Para-Bombay or red blood cell (RBC) H negative secretor individuals may or may not have anti-H in their serum. In both cases, routine blood grouping is O. A blood sample from a 24-year-old female was sent to the blood bank, where the routine grouping revealed O RhD positive. Complete blood grouping by Gel technology revealed that her forward grouping was Oh and reverse grouping was B. Patient is secretor for B and H antigens. The adsorption-elution test is negative. Family grouping was also done to find out compatible blood and her family genesis. Patient blood group was Para-Bombay B. Complete blood grouping (forward and reverse), as well as saliva grouping and adsorption-elution test is advisable when there is a discrepancy in ABH grouping.

Introduction: Various fetal surveillance tests are proposed to reduce the rate of stillbirth in diabetic mothers; however there is no sufficient evidence to support this. The purpose of the present systematic review was to assess the effects of fetal testing on reducing fetal mortality in pregnancies with diabetes. Methods: The databases were searched to find English and Persian articles published from 19752018 about antenatal fetal assessment in pregnancies complicated with diabetes. Relevant sources cited in the selected publications were also searched manually. Keywords were GDM, pregnancy, fetal testing, fetal surveillance, NST, BPP, and CTG. A total of 1954 studies were identified. Of these, 1913 were excluded on the basis of title and abstract review. Results: Among the 41 studies retrieved for detailed full-text analysis, a total of 10 fulfilled the inclusion criteria for the analysis. Still birth rate and cesarean rate were 5. 6/1000 and 418/1000, respectively. In diabetic pregnant women (gestational and overt diabetes) with well controlled blood sugar who did fetal surveillance tests, the intrauterine fetal death (IUFD) rate was not different with general population. Conclusion: As this systematic review suggests, fetal mortality is rare with fetal surveillance tests in pregnant diabetic women with good blood sugar control. No randomized clinical trial has been conducted to investigate this claim.

Introduction: Considering the mixed results reported about partial nephrectomy with and without pedicle clamping, this study aimed to compare the impacts of these two techniques on renal functional outcomes. Methods: This was descriptive-analytical study. Patients included in the investigation were randomly assigned to pedicle clamping and non-clamping groups. The day before surgery, the routine tests, as well as diethylene triamine pentaacetic acid (DTPA) scan were carried out for all of the patients, and some questions were asked from them. During the surgery, the amount of blood loss and the duration of pedicle clamping were measured, and after the surgery, the required tests were performed for all patients. Also, three months after hospital discharge, DTPA scan was carried out for all patients once again. Finally, required statistical analyses were performed on the obtained data, using SPSS v. 18. Results: The present study was conducted on 40 patients with renal cancer who underwent partial nephrectomy with (20 patients) and without (20 patients) pedicle clamping. The amount of operative blood loss (P = 0. 000) and blood transfusion (P = 0. 001) in the non-pedicle clamping group were higher than those in the pedicle clamping group. The mean duration of surgery for patients in the pedicle clamping group was 139. 2 minutes, and for those in the non-pedicle clamping group was 149 minutes (P = 0. 258). The mean duration of pedicle clamping was also calculated to be 20. 65 minutes. The results of renal scans 3 months after the surgery indicated that the level of renal function decline in the pedicle clamping group was significantly higher than that in the non-pedicle clamping group (P = 0. 000). Conclusion: The results of this study indicated that partial nephrectomy without pedicle clamping could lead to a better renal function in the short run. However, the level of blood loss, as well as the need for blood transfusion in patients, increases as a result of using this technique.

Herniation of the bladder towards the inguinal canal is a rare condition. A 76-year-old male patient with long-term left groin swelling was admitted to the emergency clinic complaining of abdominal pain that started about 5 hours ago. The patient, whose abdominal examination was normal, had an incarcerated hernia in the left inguinal region. On superficial ultrasonography, intestinal loop herniation in the left inguinal canal and adjacent loculated fluid of 60x20 mm in size was observed. In the computed abdominal tomography, it was determined that the majority of the bladder had passed through the left inguinal canal and into the hernia sac. Lichtenstein method hernioplasty was applied to the patient who was taken to emergency surgery. Isolated bladder herniation is an extremely rare condition. Recognition of bladder herniation in the preoperative period may prevent possible complications during surgery.

With the current technological development, finding and exploring novel chemical compounds from the natural material sources can be one of the significant purposes for researchers. Especially, saffron is known to be the highest-cost medicinal plant, a high-grade spice, and an outstanding dye. Concomitantly, the final saffron products truly affect much their quality to protect the rights for the consumer, as well as its available healthy benefits can be utilized for treating or preventing various diseases. Herein, the chemical characterization and health effects of saffron are shortly introduced and summarized through treatment and prevention of different diseases (i. e.: cancer, liver, ocular, diabetes, antidepressant, Alzheimer, and gastrointestinal diseases), which can favor readers understanding clearly the saffron advantages through this short review. Moreover, it can provide relatively for choosing an effective drying method to maintain the product qualities and facilitate the industrial production of saffron.

On January 30, 2020, World Health Organization (WHO) declared the outbreak of novel coronavirus disease 2019 (COVID-19) as a Public Health Emergency of International Concern (PHEIC). . .

Introduction: Alveolar echinococcosis (AE) is a tumor-mimicking parasitic disease caused by Echinococcus multilocularis. In this study, we aimed to present the radiological imaging findings of AE characterized by malignant features. Methods: The radiological findings of 20 patients who were admitted to our hospital in Van province between years 2014 and 2020 and were diagnosed with AE were retrospectively evaluated. Of these patients, 30% had been operated due to a preliminary diagnosis of a tumor. The study was conducted retrospectively by examining the drawback radiological images of patients from the radiological data archiving system. The diagnosis of AE was confirmed when lesions manifested the following radiological imaging findings: irregular margins, no contrast uptake in dynamic contrast images or late peripheral enhancement, presence of calcifications, and contralateral lobe hypertrophy. Results: The mean age of the patients at the time of diagnosis was 50. 95 (12-86) years. Of the patients, 15 (75%) were women and 5 (25%) were men. Typical histopathological and radiological imaging findings were present in 8 (40%) and 17 (85%) patients, respectively. Only 12 (60%) out of 20 patients had seropositivity by ELISA. The remaining 8 (40%) patients were seronegative. Conclusion: Radiological imaging examinations are essential in diagnosis and evaluation of the extent of the disease. Different radiological techniques can be used to differentiate AE from other diseases. Early diagnosis is important for avoiding unnecessary or inadequate operations due to a misdiagnosis and preventing potential complications.

Introduction: In developing countries, which is an endemic region in terms of tuberculosis, there is an urgent need for fast, accurate and inexpensive serological tests. The aim of this study was to determine the diagnostic value of serum immunoglobulin G (IgG) antibody by ELISA to detect Mycobacterium tuberculosis. Method: This study was performed on patients with pulmonary tuberculosis in 2017-2020. After selecting the 2 case (Pulmonary Tuberculosis and latent tuberculosis, each had 30 patients, total 60 patients) and control (n = 30) subjects according to inclusion criteria, their blood samples were obtained and analyzed in the reference laboratory by standard kits for IgG against 16, 36 and 40 kDa antigens of Mycobacterium tuberculosis. Results: The mean age of the subjects was 50. 60 years old. The majority of participants were 46 (51. 1%) women. There was no significant difference between the two groups regarding sex and age. Serological examination of patients with pulmonary tuberculosis showed 25 positive results and only 4 of the control group had a positive result. Sensitivity, specificity, positive and negative predictive values of serology test were 83. 3%, 86. 67%, 86. 20%, and 87. 88%, respectively. Conclusion: Despite the acceptable sensitivity of the serologic IgG test, according to the statement of World health organization (WHO), it did not possess an acceptable specificity. It is recommended that a wider range of different antigens to be studied. Also, it is essential to evaluate the diagnostic value of the other immunoglobulins in patient in different stages of disease.

Dear Editor: Diabetes mellitus (DM) is a chronic metabolic disorder. There are more than 400 million people with diabetes around the world that is expected to reach 640 million people by 2035. There are currently about 250 million people living in the world with fasting blood glucoserelated disorders. . .

Introduction: Asthma is a chronic pulmonary inflammation occurred in response to different allergens, leading to respiratory system insufficiency. The production of different inflammatory factors and enhanced immune system response may affect the function of other organs. The aim of this study was to investigate the expression of inflammatory microRNAs in cardiac tissue in asthmatic rat models. Methods: In this study, the animals were allocated into control and asthmatic rats (n=8). To induce asthma, rats were challenged with ovalbumin (OVA). Fourteen days after induction of asthma, rats were euthanized and hematoxylin-eosin (H&E) staining was performed to assess pathological changes in their pulmonary tissue. Serum levels of cardiac enzymes were measured using ELISA kits. Finally, transcription level of inflammatory miRNAs, miRNA-146a and-155, were measured using real-time polymerase chain reaction (PCR) analysis. Results: Based on our findings, histological examination indicated the existence of pathological changes in pulmonary tissue after asthma induction. Bright-field analysis revealed an existence of inflammatory response and cytotoxicity in cardiac tissue. Also, the serum levels of creatine phosphokinase-MB (CpK-MB), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were significantly higher in the serum of asthmatic group compared to control group (P < 0. 05). Finally, asthmatic condition induced the expression of (2-fold) miRNA-146a and (1. 5-fold)-155 in cardiac tissue, respectively. Conclusion: As a conclusion, it could be concluded that asthmatic condition induces systemic inflammation in cardiac tissue. On a more general note, we propose that therapeutical approaches directed to inflammatory pathway may be required to preserve cardiac injuries caused of asthma.

Introduction: Focal liver lesions have broad differential diagnoses. With its improved soft tissue characterization and newer sequences, magnetic resonance imaging (MRI) can significantly narrow the differential diagnoses, especially when discriminating benign from malignant lesions. Methods: T1, T1 in-phase and out-of-phase, T2, long TE T2, and diffusion-weighted imaging (DWI) were performed in 159 patients with ultrasound documented focal liver lesion. Qualitative and quantitative assessment of apparent diffusion coefficient (ADC) values and long TE images were done, and a threshold for differentiating benign from malignant lesions was obtained. The MRI diagnosis was compared with the final diagnosis obtained from histopathology in most cases or the follow-up, and other tests (markers and RBC scan) where histopathology was not available. Sensitivity, specificity, and accuracy of MRI sequences in differentiating various focal lesions were obtained. Results: T1 weighted images were useful for identifying fat, hemorrhage, and iron within the lesions. T2 weighted imaging was able to correctly classify 82. 0% of the malignant lesions and 83. 7% of the benign lesions. Long TE T2 images were highly accurate in distinguishing haemangiomas and cysts from solid lesions. On DWI, 89. 5% (i. e., 60 out of 67) of the lesions were correctly classified as malignant, and 88. 0% (i. e., 81 out of 92) of the lesions were correctly classified as benign. Threshold ADC value of 1. 37 × 10-3 mm2/s is highly accurate for differentiating malignant from benign lesions. Conclusion: DWI is a sine qua non in liver lesion assessment allowing improved detection and characterization. Long TE T2 weighted imaging can accurately detect haemangiomas and cysts, and rule out metastasis.

Introduction: Intravascular volume is the most important factor in determining patients’ hemodynamic status. The present study aimed to assay the predictive value of aorta artery diameter and inferior vena cava (IVC) diameter in trauma patients with hemorrhagic shock. Methods: This was a cross-sectional study conducted on 69 trauma patients who were referred to Imam Reza hospital in Tabriz. Inclusion criteria were all trauma patients with hemorrhagic shock. Patients with diseases such as liver disease, cardiovascular diseases, coronary heart disease and concurrent dehydration were excluded. Odds ratios (ORs) and adjusted ORs for the risk of events were obtained using cumulative logit ordinal regression model with version 15 of Stata software. Results: There were 58 men (84. 1%) and 11 women (15. 9%) with an average age of 36. 4± 12. 4 years. Findings showed that for one unit increase in the diameter of the aorta by controlling the effect of other variables, the odds of mortality decreased 2% compared with hospitalization in ward or intensive care unit (ICU). The reduction was also statistically significant (P = 0. 037). Furthermore, by modifying the effect of other variables, one unit increase in the diameter of IVC during inhale and exhale, increases the odds of hospitalization in ward or ICU. Conclusion: This study showed that the diameter of the aorta and also the diameter of IVC during inhalation and exhalation could be used to predict the outcome of trauma patients with hemorrhagic shock and eventually to take steps for emergent and effective treatment.

Introduction: Bronchopulmonary sequestration is a rare congenital abnormality of the lung that has two different types as intralobar and extralobar. In this study, we aimed to present six cases of intralobar sequestration with atypical findings in terms of feeding, drainage, and localization. Methods: Patients diagnosed with intralobar pulmonary sequestration in our clinic between 2015 and 2019 were evaluated retrospectively. Demographical features and atypical computed tomography (CT) findings of the patients were presented by literature. Results: Among 45 patients with intralobar sequestration, 6 (13. 3%) (5 males and 1 female) with a mean age of 43. 5± 25. 4(0-78) years old had atypical pulmonary findings on CT images. Atypical features regarding arterial supply was detected in 8. 9%, venous drainage in 2. 2%, location in 4. 4%, radiological appearance in 4. 4% and co-existing lesion in 2. 2% of the patient with intralobar sequestration. Conclusion: Typical and atypical features of pulmonary sequestration must be well-known for differential diagnosis of solid or cystic pulmonary lesions.

Introduction: Rapid and accurate diagnosis of the disease can have many effects on patients’ healing and recovery, so we decided to investigate the accuracy of brucella capture test with Coombs Wright in patients with brucellosis. Methods: The present study was a descriptive study performed on patients referred to clinics with brucellosis symptoms. Blood samples were taken from all patients. Patients’ information, including age, sex, response to Coombs, Coombs Wright, and Brucella capture tests, as well as patients’ response to treatment, were entered into a pre-prepared checklist. After obtaining laboratory tests for serological assessment, patients’ information including demographic information and laboratory tests were obtained and analyzed using SPSS v. 16. Results: This study was performed on 91 patients with brucellosis. The mean age was 34. 6 years, and 75. 8% of the patients were male. In this study, 84. 6% of patients showed a positive Coombs test, and 26. 4% of patients showed a titer of 1: 80, 85. 7% of the patients showed positive Coombs Wright test, and 29. 7% of the patients had a titer of 1: 160. In the study of Brucella capture tests in patients, 98. 9% of patients showed a positive test, of which 34. 1% had a titer of 1: 160 of the test. Conclusion: The results of this study showed that the Brucella capture test is a powerful test for the diagnosis of brucellosis, and in the same condition, patients are more likely to be diagnosed with two Wright and Coombs Wright tests.

Introduction: In this study, we aimed to examine the computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/ CT) findings of the pulmonary hamartomas. Methods: Following surgical excisional, transbronchial, or transthoracic biopsy, histopathologically proven pulmonary hamartomas were retrospectively reviewed between 2007 and 2013. The CT and PET/CT images were interpreted regarding the lesion diameter, number, location, components, and standardized uptake values (SUVmax). Results: A total of 22 hamartomas including 2 endobronchial and 20 parenchymal hamartomas were detected in 21 patients (11 males and 10 females). Among them, one patient had both endobronchial and parenchymal lesions. Right lung involvement (63. 7%) was more common than left lung (36. 4%) and upper lobes involvement (50%) than lower lobes (25%). Of all lesions, 54. 5% had smooth margins while 40. 9% had lobulated contour and 4. 5% had irregular margins. Fat density was observed in 54. 5% and calcification in 40. 9%. In 18. 2% of the lesions neither fat density nor calcification was seen. There was no FDG uptake in 5 lesions. Mean SUVmax value was 1. 6± 1. 0 (range between 0 and 3, 2). A SUVmax value > 2. 5 was observed in 5 lesions. Conclusion: Our results were generally consistent with previous reports, but we found a higher female/male ratio and a more common upper lobes involvement of pulmonary hamartomas.

Introduction: Calreticulin (CALR) is a 46 kDa protein in the endoplasmic reticulum and is one of the major proteins in ca2+ binding; it has a key role in oxidative stress, transcription factor activation, and as a chaperone in newly synthesized protein and glycoprotein folding. The high expression of CALR is pivotal for cardiac development in the embryonic period. It has been showed that mutation in exon 9 of CALR causes loss of C-terminal function and contributes to cardiovascular disease (CVD) development. It could conceivably be hypothesized that in addition to the general risk factors, the specific gene defects which are less considered can contribute to CVD development. In this regard, this study determined the possible existence of CALR mutations in CVD development in patients younger than 40. Methods: Thirty patients younger than 40 were recruited for this study, 86. 7% (26) were male, and just 13. 3% (4) were female. The amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) was used to identify mutation in exon 9. The CVD risk factors, including blood pressure, type 2 diabetes, dyslipidemia, history of smoking, alcohol drinking, and familial CVD development were evaluated. Results: In none of the patients, CALR mutations were detected. Since CALR defect causes accumulation of glycogen in the heart’ s cells and contributes to CVD development, our results confirm this, so that 76. 7% of patients did not have diabetes. Conclusion: The findings of the current study show there is no significant differences between exon 9 CALR mutation and CVD development.

Introduction: Umbilical granuloma so far can be treated with surgery or with silver nitrate. In limited facilities, such as remote areas where the surgeons are limited, pharmacological therapy with silver nitrate or topical steroid can be administered. However, treatment with silver nitrate requires medical personnel and has unfavorable adverse effects if performed improperly. This review pointed to evaluate the effectiveness of topical steroids for treating umbilical granulomas, compared to silver nitrate therapy. Method: The literature search was done in databases including PubMed, Embase, and Google Scholar. Literature selection was performed with limitations from 2000 to 2020 to ensure the novelty and limited to articles written in English with a target population of infants younger than 6 months. To retrieve the articles, topical corticosteroids, topical steroids, and umbilical granuloma were used as keywords. Results: The findings from the included studies show similar sample characteristics. The study conducted by Brodsgaard et al. had an older mean sample age than the study of Ogawa et al. (53. 4 vs. 31 days). The risk of topical steroid treatment failure on an individual study conducted by Brodsgaard et al. and Ogawa et al. was 3. 0 (95%CI: 0. 33– 27. 23) and 0. 94 (95%CI: 0. 40– 2. 21), respectively. Overall analysis, the risk of treatment failure was 1. 09 (95%CI: 0. 49– 2. 43), and there was no difference between the two interventions. Conclusions: One of the umbilical granuloma treatment options that can be considered is topical steroids, such as clobetasol propionate 0. 05% or betamethasone valerate 0. 12%. Although topical steroids have a longer therapeutic healing time than silver nitrate, they benefit from a better safety profile. The non-inferiority study of topical steroids to silver nitrate has not been met yet.