فهرست مطالب عنایتاللهنوری

The aim of this study was to evaluate the prevalence of helicobacter pylori (H. pylori) infection and its association with endoscopic, histopathological findings, and clinical symptoms of children with dyspepsia referring to Masoumeh Children Hospital of Qom. The eradication therapy of H. pylori infection in children as well as the clinical response to dyspepsia in H. pylori-negative children, were evaluated.

This cross-sectional study was performed on 170 children 4 to 15 years old with dyspepsia referred to Hazrat Masoumeh Hospital in Qom. After recording basic information about children such as age, sex, place of residence, and their disease history, these children were examined by endoscopy. Two biopsy specimens were obtained from the body and the antrum of the stomach. And if the rapid urease test and histology were positive for H. pylori tissue examination, the confirmed H. pylori infection would be considered in the child with H. pylori infection. Consequently, these patients were divided into two groups: H. pylori-positive and H. Pylori-negative. The two groups were compared for clinical signs and symptoms, endoscopic findings, and histological results.

85 patients (49.4%) were male and 87 patients (50.6%) were female. No significant relationship was found between the sex of the patients, place of residence, and H. pylori infection. There was no significant difference between the two groups in gastritis erosive, duodenitis, gastritis erythematosus, esophagitis, and acute inflammation in the antrum. No mass was found in both groups, and no hemorrhagic gastritis, ulcer, duodenal metaplasia, dysplasia, maltoma, H. pylori accumulation, or atrophy was recorded. In H. pylori-positive subjects in 83 patients (95.4%), chronic inflammation in the antrum was mild and in four patients, it was moderate (4.6%). This finding in H. pylori-negative patients, in 31 patients (36.5%) was not found, and in 54 patients (63.5%) was found. There were no significant differences between the two groups in the clinical signs, abdominal pain, heartburn, anorexia, burning, recent weight loss, hematomas, melena, the only clinical symptom of nausea in HP positive patients (37.9%) and HP negative in 46 patients (54.1%) had a significant difference between the two groups. Nodular gastritis was found in the endoscopic evaluation of 27 (31%) patients with H. pylori infection, significantly more than dyspeptic patients (15 cases) who were H. pylori negative.

According to the results of this study, no clinical signs other than nausea were correlated with H. pylori infection. In endoscopic findings, nodular gastritis has a significant correlation with H. pylori positivity, and according to the histopathological evaluation we significantly found more chronic gastritis in H. pylori infection.

Neutropenia is the absolute count of neutrophils less than 1500 per cubic millimeter. Because the early detection of the cause of neutropenia and appropriate measures to reduce its mortality and financial costs are important, this study was conducted to investigate the relationship between the cause of neutropenia and the severity of neutropenia with clinical and laboratory findings to take appropriate measures.

This study was a cross-sectional descriptive-analytical study. In this study, 111 patients with neutropenia were studied in Hazrat Masoumeh Hospital in Qom City, Iran, by a census method in 3 years from 2014 to 2016. Necessary information was obtained from the patients' medical records through a questionnaire. Data were analyzed by SPSS software.

The study findings showed relationships between the cause of the disease and variables of age (P= 0.007), the severity of neutropenia (P<0.001), disease outcome (P<0.001), length of hospital stay (P<0.001), Hb (P<0.001), and WBC (P<0.001). The causes of neutropenia in the studied patients were viral (54.1%), sepsis (24.3%), malignancy (10.8%), anemia (4.5%), idiopathic (3.6%) and ITP (2.7%).

The present study showed a significant relationship between demographic and laboratory findings with the cause and severity of the disease. Therefore, considering these factors at the beginning of hospitalization can play a crucial role in promoting proper management in the treatment of patients with neutropenia.

Cholecystectomy is one of the most common abdominal surgeries and its preferred method is laparoscopy. The difficulty of laparoscopic cholecystectomy in diabetic patients is not clear and the preferred method of cholecystectomy in these patients is still under controversy. Therefore, this study was performed to evaluate the difficulty of laparoscopic cholecystectomy in diabetic and non-diabetic patients.

This retrospective analytical study was performed in Shahid Beheshti Hospital and Forghani Educational and Medical Center from April 2019 to April 2020. Samples were easily selected and 86 people in two groups of diabetic and non-diabetic patients were included in the study. All patient records were reviewed based on inclusion and exclusion criteria for factors such as age, sex, diet, duration of surgery, bleeding, adhesions, and open surgery, and finally, diabetes as a risk factor. It was compared between the two groups. Data were analyzed in SPSS software version 22, an independent t-test was used to analyze quantitative data and the chi-square test was used to analyze qualitative data. In this study, a significance level of less than 0.05 was considered.

Abdominal scar, palpable gallbladder and gallstone were not significantly different between the two groups (P=0.33). But the history of cholecystectomy attacks was significantly different between the two groups (P<0.05). Laboratory values were not significant (P>0.05) . Hard operations in diabetic patients were more than nondiabetic patients and even two cases of open surgery were seen in the group of diabetic patients, but there was no significant relationship (P=0.09). Intraoperative bleeding was statistically significant between the two groups (P=0.02), But adhesion during the operation was not related (P=0.38).

Finally, our study showed that diabetes can be a predictive risk factor for the difficulty of cholecystectomy.

Recognition of influential factors is necessary for predicting the severity of cholecystectomy. We aimed to evaluate the diagnostic power of the proposed scoring system for predicting the severity of laparoscopic cholecystectomy.

 In this cross-sectional study, there were 122 patients who underwent cholecystectomy in Shahid Beheshti Hospital during 2018. Prior to surgery, accurate history, and clinical, laboratory, and ultrasound information were recorded and scored on a checklist. Finally, the difficulty of cholecystectomy was divided into three categories of easy (less than 60 minutes, uncomplicated) and difficult (between 60 and 90 minutes, divided into controllable) and very difficult (between 90 and 120 minutes with uncontrollable complications or open surgery). Data were analyzed in SPSS software, version 22, and the indicators were calculated for the purpose of the study.

There were 28 (22.4%) men and 97 (77.6%) women. The mean±SD ages of the patients in easy and difficult operations were 44.71±13.56 and 44.52. 14.56 years, respectively (p=0.939). The patients’ sex and history of acute cholecystitis attacks did not have a significant relationship with the difficulty of laparoscopic cholecystectomy (p ≥0.05). However, between the palpable gallbladder (p <0.0001), impacted stone (p <0.0001), gallbladder wall thickness (p <0.0001), and body mass index above 30 (p <0.0001) there was a statistically significant relationship between the difficulty of operation. There was also a significant relationship between AST (p =0.034), T Bill (p =0.008) WBC (p <0.0001), and the difficulty of laparoscopic cholecystectomy, but between ALT (p =0.065), the severity of cholecystectomy was not significantly related. Sensitivity (86%), specificity (58%), positive predictive value (44%) and negative predictive value (91%) were calculated for the scoring system for the difficulty of laparoscopic cholecystectomy.

 To predict the difficulty of laparoscopic cholecystectomy, we strongly recommend the preoperative scoring system. It is also recommended to conduct further studies on the use of the scoring system during surgery.

Malignant pleural effusion is usually secondary to a number of malignancies. The goal of the treatment of malignant pleural effusion is decrease the symptoms of the patient with the least invasive tool and the most cost-effective method. The purpose of this study was to compare the effectiveness of talc and iodine in the treatment of malignant pleural effusion.

This Retrospective cohort study was conducted on patients with malignant pleural effusion, who were treated with Talc and Povidone iodine at Shahid Beheshti Hospital in Qom and had completed a course of treatment. Demographic data and efficacy criteria for malignant pleural effusion including dyspnea, chest pain, fever, and recurrence frequency after chemotherapy were evaluated and data were analyzed by SPSS.21 software.

In this study we have 87 subjects from which 48 (55.2%) were treated with Povidone iodine and 39 (44.8%) were treated with talc. There was no significant difference between the two treatment groups in terms of sex, age and type of disease in this study (p <0.05). These cases were the same in the two groups. The findings showed that the frequency of relapse, fever, chest pain and dyspnea was significantly lower in the group treated with povidone (p <0.05). In addition, subjects with betadine treated had higher lung Expansion compared to subjects Were treated with talcum (p <0.05).

Chemical pleurodesis with povidone-iodine can be used as an alternative sclerosing affordable, accessible, safe, tolerable and effective mainly for Talc be considered.

The accuracy of the diagnosis of acute appendicitis has been agreed at 85%. Based on this and considering that appendectomy is one of the most common surgeries in Shahid Beheshti Educational and Medical Center in Qom, we decided to compare the accuracy of acute appendicitis diagnosis with the agreed standard in patients undergoing appendectomy in this center.

This was a retrospective cross-sectional study. It was performed in Shahid Beheshti Hospital in Qom in 2015-2016. Sampling was done by simple random method. Information including sex and age as well as patient pathology diagnosis and complications such as gangrene and appendix perforation were entered into the checklist and analyzed by SPSS software.

In the present study, 250 people were studied, 167 (66.8%) were male and 83 (33.2%) were female. The mean age of patients with acute appendicitis was 23 years and those with other diagnoses had a mean age of 21 years. Also, 167 (66.8%) of them were male and only 83 (33.2%) were female. In this study, out of 250 patients who underwent appendectomy with a diagnosis of acute appendicitis, 194 (77.6%) had a diagnosis of acute appendicitis in pathology and 56 (22.4%) had another diagnosis. The diagnosis of acute appendicitis was 45.5% in women and 44.6% in men, which did not differ much.

Considering these findings and the lower accuracy of appendicitis diagnosis than the agreed standard, it can be concluded that a number of appendectomy procedures, especially appendectomy in women, were unnecessary. It is necessary to examine more carefully before the operation. Received

Knowing the conversion risk factors of laparoscopic cholecystectomy to open surgery, helps the surgeon to plan for surgery accordingly. This study aimed to determine the risk factors for converting laparoscopic cholecystectomy to open surgery.

In this analytical study, the case information of 1104 patients who underwent laparoscopic cholecystectomy in Shahid Beheshti Hospital in Qom from April 2013 to April 2017 was evaluated. Inclusion criteria were all cases of acute cholecystitis, chronic cholecystitis, symptomatic gallstones, and biliary pancreatitis who underwent laparoscopic cholecystectomy. The exclusion criteria were patients who underwent laparoscopic cholecystectomy at the same time with other procedures. Data of all patients including age, sex, history of abdominal surgery, emergency or elective surgery, blood transaminase level, blood bilirubin level, white blood cell count, amylase level, and serum alkaline phosphatase were recorded. Finally, potential risk factors were compared between the two groups. Average, standard deviation, frequency and percentage indices were used to describe the data. Independent samples t‐test and Mann-Whitney U test were used for quantitative data analysis and Chi-square test was used for qualitative data analysis. P<0.05 is considered significant.

1104 patients were studied. 765 patients were female (69.3%) and 339 patients were male (30.7%). In 104 cases, open surgery was performed. The mean age of patients in the method change group was 49.45±8.9 years. Among the studied variables, between sex (P=0.26), age (P=0.056), process of cholecystitis (P=0.65), previous history of abdominal surgery (P=0.62), alanine transaminase (P=0.10) aspartate transaminase (P=0.95) showed no statistically significant relationship with the conversion of laparoscopic surgery to open surgery. However, abnormal ultrasound (P=0.000), emergency surgery (P=0.000), white blood cell count (P=0.008), total bilirubin and alkaline phosphatase (P=0.000) had a statistically significant relationship with the conversion of laparoscopic to open surgery

Due to the high complications and mortality of open cholecystectomy, the detection of these risk factors helps to reduce the rate of open surgery and address these factors before surgery.

Understanding the risk factors of laparoscopic cholecystectomy for open surgery is essential. The purpose of this study was to evaluate the preoperative laboratory findings in predicting the severity of laparoscopic cholecystectomy.

This cross-sectional study was performed on 122 patients undergoing laparoscopic cholecystectomy. Before surgery, patient information such as age, sex, laboratory findings such as WBC, ALT, AST, T Bill were recorded in the checklist. Finally, the degree of difficulty was divided into two degrees of easy (below 60 minutes without complications) (over 60 minutes with complications such as bleeding or open surgery). Finally, SPSS software was used for data analysis. The level of significance was considered to be less than 0.05.

28 (22.4%) males and 97 (77.6%) females were studied. Mean age of patients was 44.66 13 13.85 years. The number of difficult operations was 35 (28%) and 90 (72%) easy operations. Transplant surgery was done in 3 cases. There was a significant relationship between preoperative laboratory findings between AST (P value: 034), TBC (P value: 008), WBC (P value: 000), and difficulty of operation, but no significant relationship between ALT (P value: 0). 065), no significant relationship was found with the severity of cholecystectomy.

Preoperative laboratory findings are capable of providing valuable data in predicting the severity of laparoscopic cholecystectomy.

The presence of pleural adhesions may render video-assisted thoracoscopic surgery difficult or impossible. The aim of this study was to assess the value of chest ultrasonography in the detection of pleural adhesions prior to thoracotomy.

Between 2009 and 2010, 42 consecutive patients undergoing thoracotomies (including video-assisted thoracic surgery) were evaluated with chest ultrasonography. These patients underwent a preoperative ultrasonic examination of the chest wall using a 7.5-10-MHz linear ultrasound probe at 7 points along the chest wall. We measured the movement of the visceral pleural slide.

In the upper thoracic wall, ultrasonography demonstrated a sensitivity of 63.0%, a specificity of 66%, a negative predictive value of 77%, a positive predictive value of 50.0%, and an overall accuracy of 65.0%. And for lower thoracic wall, ultrasonography demonstrated a sensitivity of 81.0%, a specificity of 59.0%, a negative predictive value of 89.0%, a positive predictive value of 44.0%, and an overall accuracy of 65.0%.

Chest ultrasonography is moderately accurate in detecting the presence and location of pleural adhesions. Use of preoperative chest sonographic findings to plan trocar placement and to determine the need for an open approach is valuable in helping prevent visceral injury and facilitating video-assisted thoracoscopic surgery.

Liver abscess can be defined as an accumulation of secretions within the liver parenchyma, which may be caused by bacterial, fungal, or parasitic microorganisms. In this study, we reported a case of liver microabsorption in a 16-year-old girl with no history of underlying diseases, which could ultimately lead to the diagnosis of Crohn's disease in this patient. The patient was a 16-year-old girl presenting with nausea, vomiting, diarrhea, and anorexia. Of the accompanying symptoms, she mentioned two occasions of fever and chills. The patient was also hospitalized a week ago and in the tests performed, the number of white blood cells was 12,400 and the positive occult blood test in the fecal test was 8-10 red blood cells and 4-45 white blood cells. She was treated with a diagnosis of gastroenteritis and was discharged with partial recovery. There was nothing special in the examination. The only ultrasonography revealed the presence of free fluid in the loop near the ovaries. The patient-specific tests that were requested were all normal. Repeat ultrasonography of the patient reported normal liver with numerous hypovaccal nodules in the entire parenchymal artery, which had increased in size and number compared with the previous assessment. Finally, the patient was discharged 5 days after the fever stopped and due to the improvement of her general condition with the prescription of levofloxacin and metronidazole, and was referred to the clinic one week later In this case, we attempted to review the literature on the etiology, diagnosis, and treatment of hepatic abscess for a physician.

Identifying risk factors for conversion to open surgery laparoscopic cholecystectomy and factors are difficult to predict cholecystectomy surgery is required. The aim of this study was to evaluate the findings of preoperative ultrasound in predicting the length of laparoscopic cholecystectomy surgery.

The present study was performed cross-sectional on 122 patients who underwent laparoscopic cholecystectomy in Shahid Beheshti, Forghani and Nekoei’s Hospital in Qom from September 2016 to September 2017.Inclusion criteria: All cases of acute cholecystitis, chronic cholecystitis, symptomatic gallstones and biliary pancreatitis underwent laparoscopic cholecystectomy. The exclusion criteria included patients undergoing laparoscopic cholecystectomy at the same time were other procedures. Before surgery patientschr('39') information such as age, sex, ultrasound findings including gallbladder wall thickness, compressed stone and the presence of fluid around the gallbladder were recorded in the checklist. Finally, the duration of cholecystectomy was divided into two degrees of easy operation (less than 60 minutes and without complications) and difficult operation (above 60 minutes with complications) according to the mentioned variables. Data were analyzed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA). In this study, a significance level of less than 0.05 was considered.

28 (22.4 percent) males and 97 (77.6 percent) females with a mean age of 44.66 13 13.85 years were studied. There were 35 difficult cases (28 percent) and 90 easy cases (72 percent). Conversion to open surgery occurred in three cases. Among the sonographic findings, there was a significant relationship between the increase in gallbladder wall thickness and Impacted stone with the duration of operation (P≤0.05). But no significant relationship was found between the findings of Presence of pericholecystic fluid and the duration of operation (P>0.05).

Overall, the findings of this study showed that preoperative ultrasound is able to provide valuable data in predicting the duration of laparoscopic cholecystectomy.

Definite prompt diagnosis of malignancy in thyroid cold nodule is essential. Accordingly this study was performed to compare the results of FNA and surgical pathology in patients with cold nodule of thyroid.

This observational study was performed as a comparative cross-sectional diagnostic survey among 100 patients with Thyroid Cold Nodule in Qom Beheshti Hospital in 2014. The associations of emergency imaging and surgical results were assessed.

In this study it was seen that FNA and surgical pathology results had significant association (P = 0.0001) and the sensitivity and specificity were 98.9% and 71.4%, respectively.

Finally, according to the results, it may be concluded that FNA has good sensitivity and medium level specificity in diagnosis of lesion type in patients with cold nodule of thyroid.

Asthma is a chronic and common medical illness in childhood. Chronic illnesses can be associated with mood disorders, anxiety, and behavioral disorders, as well as adversely affecting the clinical course of the underlying disease. The purpose of this study was to compare behavioral disorders in children with and without asthma referred to Masoumeh Hospital in Qom.

In this study, 67 asthmatic children as case group and 67 healthy children as control group were enrolled. The demographic and clinical information checklist and the Child Behavior Checklist (CBCL) were completed. Data were analyzed using t-test and chi-square test using SPSS 18 software.

The mean score of CBCL questionnaire in case group with 28.12 2 2.06 was significantly higher than control group with 17.33 9 9.7 (p = 0.01). Mean scores of social isolation subscales (case group: 5.83, control group: 1.18, p = 0.006), anxiety-depression (4.99 vs 2, p = 0.02), intellectual problems (8 Aggressive behaviors (5.5 vs 2.3, p = 0.003) were significantly higher in children with asthma than healthy children.

Behavioral disorders in children with asthma were significantly more than healthy children. The duration of asthma and the severity of asthma, in direct association, can predict behavioral disorders in children with asthma.

Adrenal gland cysts with variable symptoms are rare cases of over-kidney clinical conditions. Adrenal cysts are accidentally identified, which is referred to as incidentaloma. Adrenal cysts are non-specific and show radiological findings and Detection of these cysts is usually random. In this article,  a patient with a simple adrenal cyst is introduced

The patient is a 33-year-old woman with a severe abdominal complaint, especially in the upper and lower abdomen, which began one day before the visit. The patient also mentioned three vomiting episodes. CT scan of a multicellular cystic mass in the upper left abdomen was observed with calcified nodules near the pancreatic tail, which, according to the radiologist, suggested a possible false cysts of the pancreas. With the diagnosis of adrenal mass, surgery was performed and symptoms were resolved after surgery.

Undoubtedly, the current elimination of the mass of the current treatment and the laparoscopic adrenalectomy, if available, is the golden standard. This was a simple adrenal cyst, which was associated with non-specific digestive symptoms. Preoperative diagnosis was performed by CT and ultrasound. A laparoscopic adrenalectomy was performed without complications. Pathology was a simple adrenal cyst. However, when managing an adrenal cyst, adrenocarcinoma and cystic pheochromocytoma should be considered before surgery

Although the prevalence of adrenal cysts is rare, intervention is necessary if they are large (size>4), symptomatic, functional, and potentially malignant. Laparoscopic management of these cysts in the form of decoration / extension, safe, effective, with minimal invasion, minimal blood loss and shorter hospital stay.

Embryo echocardiography is a technique for the detection of embryonic anomalies. The aim of this study was to Evaluation of referral indications for fetal echocardiography in pregnant women referred to Echocardiography unit of Masoumeh Hospital in the winter of 2018.

This is a cross-sectional study. In this study, 230 pregnant women entered the checklist. Data was then analyzed using SPSS software version 22.

The most common indication of referral for embryonic echocardiography, suspicion of CHD in ultrasound (heart failure) (21.7%) was the dominance of focal ecchymosis and the lowest incidence of maternal diseases (2.2%). 91.7% of the diagnosis was reported after normal echocardiography and 8.3% abnormal. There was a significant correlation between fetal heart rhythm and normal or abnormal diagnosis after echocardiography (p = 0.02). Among maternal age variables (p= 0.22), pregnancy time (p = 0.97), fetal age (week) =0.76), fetal sex (p= 0.30), fetal heart rate (p = 0.08), NT size (p = 0.24), maternal diabetes mellitus (p = 0.98), condition status (p = 0.93), history of congenital the family (p= 0.13) and specific disease in the mother (p= 0.98) were not associated with the diagnosis after echocardiography.

Embryonic echocardiography is a non-invasive method suitable for early diagnosis of congenital heart disease, which is suitable not only for high-risk pregnancies, but also for low-risk pregnancies.

Identifying the risk factors for the conversion of laparoscopic cholecystectomy to open surgery is necessary and essential. The aim of this study was to determine the relationship between the thickness of the gallbladder wall before the operation of cholecystectomy and the rate of conversion to open surgery.

In this retrospective cross-sectional study 1104 patients, including age, sex, gallbladder thickness, and disease history of the case were extracted. Then, the thickness of the gallbladder was successfully compared with those who completed laparoscopic cholecystectomy and the group that had open-laparoscopic cholecystectomy surgery. Data were analyzed by SPSS software version 22.

1104 patients were entered the study. 765 women (69.3%) and 339 men (30.7%) were female. Mean age of patients in conversion group was 45.49±8.9 years. Conversion to open surgery occurred in 104 (9.4%) including 67 female (6.06%) and 37 male (3.35%). In 326 cases of ultrasonography, patients had a pre-surgical increase in thickness of the gallbladder wall. There was no significant relationship between age, sex, and conversion (P≥0.05) (P = 0.26), but between emergency surgery and gallbladder wall thickness Meaningful found. (P≤0.05).

According to the study’s results, gall bladder wall thickness had a direct relation to conversion rate to open surgery.