Introduction: Psoriasis is a common chronic inflammatory proliferative skin disease that has many complications including fatty liver that lead to liver fibrosis. The aim of the present study is to investigate the association between the Severity of NAFLD and the Severity of psoriasis.Methods: This descriptive study was conducted on 54 patients with psoriasis, ultrasound was performed and the various factors of Non Alchoholic Fatty Liver and Severity of psoriasis measured. The Severity of psoriasis was calculated using the PASI Score. Data collected inserted to spss16 software and chi-square test and fisher exact analysis was performed.Results: Our study showed that the prevalence of Non Alchoholic Fatty Liver was high in patients with psoriasis and also the Severity of the Non Alchoholic Fatty Liver increases by the higher grade of psoriasis.that the percentage of fatty liver in low Severity in grades 1 and 2 was respectively 42.3% and 0%, and the average intensity was 43.8 % and 12.5% and high intensity was 50% and 33.3 respectively. Also, the number of platelets, TG, cholesterol, LDL, AST, ALTwere associated with psoriasis which was increased strongly with increasing amounts of TG, cholesterol, LDL, AST, ALT.Conclusion: Our study showed that a high prevalence of Non Alchoholic Fatty Liver in patients with psoriasis that can be measured by ultrasonography and risk factors such as TG, cholesterol, AST, ALT. Also the Severity of the Non Alchoholic Fatty Liver increases by the higher grade of psoriasis that is due to factors such as proinflammatory cytokines and adipocytokine that Cytokines trigger psoriasis and increase the Severity of the disease and besides raising these factors resulted in an increasing in insulin resistance and fat accumulation.

Background: Menopause is associated with physical and psychological as well as sleep problems that cause disruption in quality of life in women. Objectives: The question of whether the Severity of physical and psychological symptoms correlated with the Severity of insomnia in postmenopausal women is investigated in this study. Methods: This cross-sectional study was performed on 214 postmenopausal women referred to health centers in Kermanshah city betweenMay2019andMay2020. Data collection tools includeddemographicandsocial characteristics questionnaires, Menopausal Rating Scale (MRS) and Insomnia Severity Index (ISI). Data were analyzed using ANOVA and Pearson correlation test using SPSS software. Results: The mean total score of insomnia Severity was 14. 3  5. Also, according to the Severity of insomnia, 22 women had no insomnia, but 88 and 87 women had mild and moderate insomnia and 17 women had severe insomnia, respectively. Comparing the mean scores of 11 MRS items in different insomnia severities showed a significant difference in the rate of symptoms, so that in the physical domain, hot flashes and sleep problems, and in the psychological domain, depression items, irritability, anxiety, poor memory and lack of concentration were higher in the sever insomnia, but none of the items of the genitourinary domain were associated with the Severity of insomnia. Conclusions: Our study showed that in postmenopausal women, the rate of physical and psychological symptoms increases with higher Severity of insomnia. Insomnia should be considered as a disorder that requires special attention and treatment in postmenopausal women.

Background: In order to describe the patients and evaluate the effectiveness of treatments for widow spider envenomation, investigators require a reliable assessment tool. In this paper, the development of a clinical index for measuring the widow spider bite Severity, Latrodectus Envenomation Severity Score (LESS), is described.Methods: According to the valid methods for index development, a Delphi group process was applied. A panel of 13 experienced medical toxicologists and physician experts in treatment of black widow spider bites was assembled in December 2013. The participants were asked to score clinical manifestations of Latrodectus envenomation based on their importance on the Severity and patients’ prognosis. Hence, an initial draft of the Severity index was developed and in the second phase of study, the draft was discussed in a focus group of experts to finally comment on each variable and vote about the final scores.Results: The proposed version of LESS comprises of 34 clinical items categorized in 8 organ systems. The index includes definition of each clinical variable to help users of the index how to ascertain or rule out the clinical finding. The maximum theoretical score according to LESS is 87. Acute renal failure, myocarditis, pulmonary edema and ileus received the highest scores in this index.Conclusion: The LESS is a new assessment tool that is designed to more objectively evaluate the Severity and progression of envenomation in victims of widow spider bite. The prognostic-ability, reliability and sensitivity to change of the index should be investigated in future studies.

Introduction: One of the causes of chest pain in children is mitral valve prolapse (MVP). This study aimed to investigate the association between the Severity of chest pain and the Severity of MVP. Materials and Methods: This cross-sectional study was designed on 103 children aged 7 to 18 years suffering from MVP along with chest pain. By using echocardiography, Severity of MVP was assessed in all the subjects by two cardiologists, separately. According to the echocardiography criteria, the Severity of MVP was divided into three types: grade I, II and III. The Severity of chest pain was assessed according to visual analog scale (VAS) criteria (Mild, Discomfortable, Distressing, Horrible, and Excruciating). Results: The mean age of the 103 patients with MVP was 11. 76±, 2. 85 years (F/M: 66/36). The most common site of pain was the left side of the chest. Mitral valve insufficiency was diagnosed in 76 children. Respectively, 31 children suffered from mild type, 58 moderate and 13 severe MVP. 74. 51% of children had MVP along with mitral valve insufficiency. A total of 33 children described their pain as excruciating 8 of whom had severe MVP. The mean Severity of chest pain according to VAS criteria in children with severe MVP was 7. 92±, 1. 03, which was significantly higher than moderate and mild (P=0. 000). Conclusion: There was a positive association between the Severity of chest pain and Severity of MVP in children. Therefore, it seems that attention to chest pain in children with MVP could be useful to evaluate the Severity of MVP.