فهرست مطالب عادله صاحب نسق

Community-acquired pneumonia (CAP) remains one of the leading causes of hospital admissions and a common cause of death. Population-based studies assessing the etiology and incidence of CAP are lacking in developing countries. In this prospective study, we assessed the incidence, etiology, and outcomes of CAP in the Iranian population.

This five-year hospital based cross-sectional and descriptive study included 357 patients with CAP, between 18 and 95 years of age. Demographic criteria and clinical data of CAP including fever, cough, sputum, dyspnea, hemoptysis, gastrointestinal symptoms and loss of consciousness were recorded. Laboratory findings and prescribed antibiotics were retrieved from the patients’ records. Results of bronchoalveolar lavage fluid and sputum specimens and also culture results were recorded.
Paired t-test, independent-samples T Test and chi-square were used to examine the relationships among different variables. P<0.05 was considered significant.

The total number of patients in the study was 384 patients, of which 55.2% were male and 44.8% were female (P value = 0.2). The most common underlying disease was community-acquired pneumonia (35.9%). The most common symptom was productive cough, which was observed in 85.2% of the patients. The most common microorganisms isolated from culture were Staphylococcus aureus (9.1%) and Acinetobacter (8.9%). The most commonly used antibiotic in this study was ceftriaxone (43.3). In addition, Acinetobacter species were the most common pathogen in exudative pleural effusion (51.5%). Among the people with higher than normal ESR, 62.2% were male and 37.8% were female, which showed a significant difference (P = 0.03). Out of 89 deaths following pneumonia, 43.8% were under 65 and 56.2% were over 65 years of age, which was significant (P= 0.01).

Considering the high prevalence of Staphylococcus aureus and higher mortality in the elderly and patients with decreased level of consciousness or underlying obstructive pulmonary disease, it is necessary to conduct detailed examinations for sputum culture at the beginning and administer appropriate treatment, based on the identified pathogen as soon as possible in order to reduce drug resistance.

Proton pump inhibitors (PPIs) are one of the main therapeutic agents for acid-related diseases. Pantoprazole, with minimal drug interaction, is one of the well-known PPIs. According to various studies, 25-75% of pantoprazole injections have no indications and cause a high burden on health systems. The aim of this study was to investigate the indication and rate of pantoprazole injections in Yazd Rahnemoon Hospital, Iran.

This cross-sectional study was performed in 72 hospitalized patients in invasive care units, and internal and emergency wards between March and December 2019. Demographic and clinical data, risk factors, PPI indication, and doses of utilized pantoprazole were recorded. The rationality of pantoprazole prescription was confirmed by comparing the drug information from up-to-date database under the supervision of a clinical pharmacist in the hospital.

In total, out of 60 patients who received IV pantoprazole, 52.8% could have received the oral form and in 69.4% there was no indication to use IV pantoprazole.

In this study, parenteral form of pantoprazole was not indicated in majority of the patients. Guidelines should be approved to prevent irrational administration of parental PPIs in hospitals.

Osteosarcomas are primary malignant tumors of bone including osteoid or imma ture bone cells. Most of time it is located in long bones among adolescence ages. It is rarely located in the cervical spine.

The author presents a rare occurrence of a cervical spine osteosarcoma that developed in a young boy. The location of the tumor at C5-6 was confirmed by MRI, and a paravertebral mass like lesion in T2 weighted images. The tumor induced vertebral body collapse with disc material destruction. The tumor was incompletely resected, with signs and symptoms of disease progression only some weeks later.

Although reports of osteosarcoma originating from the vertebral body is not uncommon, but in cervical area and a rapid progression like this is incredible. Multidisciplinary team based approach to such rare cases is the best way to possible overcoming disease.

Anemia in critically ill patients is common and affects their outcome. Treatment of anemia in ICUʾs patients have some challenges. Red blood cells transfusion is associated with some serious adverse effects which further affects patient’s outcome. In this article, the etiology of the anemia in critically ill and its management strategies is reviewed.

This study was done to summarize findings from earlier evidence on the prevalence and effect of anemia in critically ill patients on their outcome. We searched in medical data sources of PubMed, Scopus and Google Scholar using the following keywords: anemia OR erythropoietin, OR red blood cell, OR transfusion, AND critical illness, OR intensive care. After reviewing title and abstracts, all clinical studies conducted on this group of patients were included.

In most studies, the evidence supports restrictive protocol of RBC transfusion (transfusion at Hb < 7 g/dL) preferably over a liberal transfusion strategy (transfusion at Hb < 10 g/dL), in ICU patients. Only those with acute cardiovascular disease or early stages of severe sepsis may benefit from higher threshold of 9-10g/dL for blood preparation transfusion.

The occurrence of anemia is common in critically ill patients. Considering its multifactorial etiology, it has a negative effect on patients’ outcome. Blood transfusions are associated with some serious adverse effects, such as Acute respiratory distress syndrome and infections. The potential risk benefit must be carefully evaluated in every patient for whom a blood transfusion is being considered.

This descriptive study included all hyperthyroid patients. All therapeutic results were recorded and analyzed.

In this study, 329 records were studied and 104 patients met the study inclusion criteria. Graves' disease (GD) and toxic adenoma were reported in 94% and 6%, respectively. Among the patients with GD, 30.5% (21.7-40.3%) did not respond to initial ATD treatment and 20% had recurrent GD despite appropriate initial response. Overall, antithyroid drugs failure occurred in 50.5% (40.45-60.55%) of the patients. Lower age, lower body mass index (BMI), high thyroid weight, and higher baseline thyroid hormone levels were associated with ATD failure (P <0.05). Patients with toxic adenomas and patients who did not respond to ATD or those who experienced relapse of hyperthyroidism received radioactive iodine or underwent surgery. Hypothyroidism occurred in 13.1% of patients with ATD alone, in 66.7% of those with surgery, and in 79.4% of the patients who received radioactive iodine (P= 0.0001).

A significant proportion of hyperthyroid patients experience drug failure. Age, BMI, thyroid weight, and basal levels of thyroid hormones are associated with drug treatment failure. Prevalence of hypothyroidism after treatment with radioactive iodine is higher than the drug treatment alone or surgery groups.