مریم عمادزاده

Diabetic nephropathy is the main cause of end-stage kidney disease in diabetic patients. Several inflammatory markers related with diabetic nephropathy have been investigated so far. It is necessary to identify easily available and cost-effective indices. We aimed to determine the relationship between the neutrophil to lymphocyte ratio and mean platelet volume with diabetic nephropathy.

This cross-sectional study was performed from 2021 to 2022 in diabetes clinic of Ghaem hospital, Mashhad.  Patients with type II diabetes were categorized into two groups: without and with nephropathy (urinary albumin excretion greater than 30 mg/24h or GFR less than 60). Patients’ data, including demographic data, past medical and drug history and lab data were gathered and analyzed.

In total, 100 diabetic patients including 50 with (mean age=64.04±7.40 years) and 50 without nephropathy (mean age=56.06±6.36 years), were studied. Patients with nephropathy were older, had a longer history of diabetes and a higher blood pressure (P < 0.05). However, the distribution of gender, weight, height, and BMI was not significantly different the two groups (P>0.05). The absolute neutrophil count was not significantly different between the two groups (P>0.05), while the mean platelet volume, neutrophil% and neutrophil/lymphocyte ratio were significantly higher in patients with nephropathy (P<0.05).

According to our findings, patients with diabetic nephropathy had higher mean platelet volume, neutrophil%, and neutrophil/lymphocyte ratios compared to diabetic patients without nephropathy.

Platelet transfusion is one of the main treatments for thrombocytopenia to reduce severity and frequency of bleeding. Inadequate increase in platelets following platelet transfusion is known as platelet refractoriness. The aim of this study is to investigate the prevalence, as well as predictive factors, of platelet refractoriness.

In a cross sectional study, 73 patients suffering from severe thrombocytopenia due to leukemia or aplastic anemia, hospitalized at the hematology-oncology ward of two main referral hospitals in Mashhad, were evaluated. Platelet transfusion was done in patients with platelets count less than 10,000 per microliter or less than 20,000 per microliter and fever more than 38° C. Platelet count was measured before and 60 minutes after platelet transfusion, and after calculating body surface area (m2), corrected count increment (CCI) was calculated. If CCI is more than 10,000 per microliter, no platelet refractoriness was considered.

55 patients (75.3%) had platelet refractoriness. Higher platelet refractoriness was seen in the group that received more platelet units and patients who received apheresis units had less refractoriness.

Platelet transfusion should be done only if necessary and transfusion of apheresis units must be considered in patients who need regular platelet transfusion.

Studies have shown that conventional sperm analysis does not represent fertility status completely. About 15% of infertile men have normal clinical and laboratory investigation. DNA fragmentation index (DFI) measures the DNA damage. Also, 20% of men with unexplained infertility have increased DFI level compared to the normal level. The present study was performed with aim to evaluate the clinical utility of DFI as an indicator for varicocelectomy.

This longitude observational study was performed in 2020-2021 on 60 patients who underwent varicocelectomy due to infertility in Imam Reza Hospital of Mashhad. The patients were divided into three groups based on DFI levels (DFI ≤15%, 15-30%, and >30%) considered as excellent, moderate, and poor fertility, respectively. Then, pre- and post-operational semen analysis was performed. Data were analyzed by SPSS software (version 24) and paired-t, Wilcoxon, and analysis of variance tests. P<0.05 was considered statistically significant.

The mean DFI in the excellent fertility group was 10.83 ± 2.92, in the moderate 21.10 ± 6.05, and in the poor fertility 46.56 ± 10.73. The moderate and poor fertility participants experienced statistically significant improvement in sperm count, motility, and morphology. On average, the number of 8.92±16.91 million per cc, the motility of 13.93±19.73% and the morphology of 3.17±3.57% improved after the operation.

The higher the pre-operative DFI, the more significant increase in sperm analysis factors is expected. DFI has a prognostic value for varicocele patients, especially those with higher DFI.People who have a higher pre operative DFI score will improve more after operation.

Each unit of donated blood is a valuable health system resource that may rescue a life so we should try to improve the blood product consumption. In this study we assessed the protocols of packed blood cell reserve and consumption to improve these strategies in Dr. Sheikh and Akbar children’s hospitals.

This is a descriptive retrospective study of blood product consumption during 2015-2016 in two academic hospitals of Dr.Sheikh and Akbar children’s hospitals. All reserved and consumed Packed blood cells were evaluated and compared between two time periods before and after applying new blood product request strategies in pediatric surgery ward.

Among 179 reserved packed blood cells in Dr.Sheikh Hospital, only 14 units were consumed  so the consumption/reserve ratio was  7.8% while among 36 reserved packed blood cells in Akbar Hospital , only 5 units were consumed  so the consumption/reserve ratio was 19.4%. CAH surgery and cleft palate increased the packed blood consumption rate as 17.4 and 3.1 times respectively.

packed blood cell reserve strategies modifications based on patients’ condition and the type of surgery instead of just a rigid and routine protocol will improve the consumption to reserve rate of blood products.

Cardiovascular disease is estimated the cause of 17.3 million deaths annually in the world and 27.4% of deaths in Iran. Since the common risk factors cannot currently predict all causes of cardiovascular disease, researchers have suggested that other factors such as oxidative stress, trace elements, inflammation, and homocysteine may be potential contributors to cardiovascular disease. Therefore, in this study, we assess the association of serum level of homocysteine with the severity of coronary artery involvement.

In this cross-sectional study, 347 patients referred to Ghaem Hospital for angiography and 103 healthy individuals without cardiac symptoms were evaluated. Subjects were divided into five groups with more than 50% stenosis of one (1), two (2), and three (3) arteries, individuals with normal angiography or less than 50% involvement (4), and healthy subjects (5). Serum homocysteine level was measured by ELISA at Bou-ali Research Institute. Statistical data analysis was performed using SPSS software version 21.

In this research, 106 healthy people, 91 normal people, and 80, 87, and 89 people with stenosis in one, two, and three arteries, respectively were studied. The mean homocysteine in the groups with stenosis of one, two, and three vessels was significantly higher than the normal and healthy groups (P <0.001). The results of logistic regression analysis showed that increment of one unit of homocysteine raised the chance of vascular involvement in people with one, two, and three-vessel involvement into 1.235 (1. 053-1. 273), 1.289 (1.125-1.414), 1.461 (1.326-1.611), respectively (P <0.001)

The results of the present study showed that increase in concentration of homocysteine as an independent risk factor can lead to greater prevalence and progression of vascular stenosis.

Hypertrophic cardiomyopathy is the most common genetic heart disease which is described as the thickening of the heart wall and causes abnormal cardiac load. It can be associated with dangerous complications such as heart failure, atrial fibrillation, myocardial infarction and even sudden death. In this study we investigated echocardiographic findings in Hypertrophic cardiomyopathy patients.

In the present study echocardiographic records of 58 patients who were referred to echocardiography clinic of Ghaem hospital between March 2014 and March 2018 were analyzed. After investigation and categorizing the data in echocardiographic recordings, these data were analyzed using SPSS software version 22 and significance level was set as p<0.05. Exclusion criteria was included patients with suboptimal echocardiography view.

the most common hypertrophy phenotype among the patients was anterolateral phenotype (44.8%). In patients with mild and severe left ventricular outlet tract obstruction, 60% of them had anterolateral phenotype. Among the patients with mitral regurgitation, in 69.6% of them the etiology was systolic anterior movement. In the present study 21.8%, 23.6% and 20% of patients had mild, moderate and severe left atrial enlargement respectively. Left atrial enlargement severity was significantly associated with the degree of diastolic dysfunction. (P<0.001)

As the anterolateral phenotype is the most common pattern in patients with hypertrophic cardiomyopathy and associated with more incidence of mitral regurgitation and LV out flow track obstruction, patients with this phenotype need to be evaluated more precisely.

Despite the high costs of infertility treatment and the lack of access to advanced treatment for many couples, the role of infertility in the occurrence of psychological and social problems can also be mentioned. Considering the possible effects of vitamin D on the characteristics of sperm, a purposeful relationship between these two categories can be of great help to the community health system. The aim of this study was to evaluate the level of vitamin D in patients with spermogram disorder and compare it with the control group.

This descriptive-analytical study was performed on 114 patients were divided into two groups of 57 controls and infertile in the age range of 20 to 59 years and the infertile group were men with fertility disorders.The control group included fertile men with at least one child under the age of 5. Spermograms and levels of vitamin-D and hormonal factors such as LH and FSH, testosterone in both control and infertile groups were evaluated and comparisons were made between the two groups.

Sperm count parameters and sperm motility and sperm shape Vitamin D were a significant difference between the two groups (P <0.001). It was also found that vitamin D had a significant and direct correlation with testosterone in the patient group (P = 0.001).

These results suggest the possible relationship between vitamin D and sperm quality in men. Therefore, treatment of vitamin D deficiency in men can be a solution to reduce infertility disorder in men.

Educational grand round is a common clinical education method that is implemented in most departments of hospitals and its purpose is to provide an opportunity for students to link theoretical information to practical facts. The purpose of this study is to examine the views and opinions of students and faculty members to find gaps in Grand round of clinical education to take an effective step in training efficient physicians by improving the educational process.

 This cross-sectional study was performed in the pediatrics department of Mashhad University of Medical Sciences. This research was conducted by surveying the people present at the Grand round meetings in the form of a questionnaire. A total of 250 questionnaires were filled from January 2016 to the end of June 2017 among the participants in the grand rounds, of which 235 questionnaires were completed. Data were analyzed using SPSS v.24 software.

 The highest level of satisfaction with the quality of weekly grand rounds is in the group of faculty members with 63.15% and the lowest rate is in the group of interns with 4.34% who evaluated the status of grand rounds very well. While all faculty members and the majority of assistants (70.73%) believed that the intern's presence in the Grand Round was beneficial, about half of the interns (53.62%) acknowledged the usefulness of the Grand Round. The strategy of the faculty members was more emphasis on treatment (42.10%) and problem-based medical reports (36.84%) but more assistants focused on differential diagnoses (46.34%) and medical reports based (34.14%); Interns (63.76%) and stagers (63.20%) emphasized on the discussion of differential diagnoses.

The attitude of stagers and interns is more negative than that of faculty members and assistants regarding the quality of training grand rounds. Their views are also different in important areas such as the patient referral strategy. Therefore, it seems that it is important to conduct further studies with the aim of determining the appropriate standards for training grand rounds for each group of stagers, interns and assistants.

Vaginal birth after cesarean is one of the methods used to reduce the increasing number of cesarean sections. This study was performed with aim to evaluate maternal and fetal complications in women who had successful vaginal delivery after cesarean.

This retrospective study was performed on 160 women who had successful vaginal delivery after one cesarean section with transverse uterine incision at Mashhad Omolbanin hospital in 2016-2018. Demographic data related to delivery and the infants' data were collected from the patients' records. Data was analyzed by SPSS software (version 11) Kolmogrov-Smirnov, Chi-square and t-test. p < 0.05 was considered statistically significant.

Among 160 patients, 141 cases (88.12%) had successful normal vaginal delivery and 19 cases (11.88%) had cesarean section. The two groups of success and failure of normal delivery after cesarean section had no significant difference in terms of mean maternal age (p= 0.18), body mass (p=0.07), gestational age (p= 0.15) and distance from previous cesarean section (p=0.07). The bishop score less than 6 was significantly higher in the failure group than in the success group (p=0.02). In the failure group, postpartum hemorrhage (p= 0.03) and NICU admission (p=<0.001) were significantly higher.

Vaginal delivery after cesarean is a safe delivery method and reduces maternal and fetal risks caused by repeated cesarean section.

Gynecologic cancers are the important cause of women's mortality in the world. Considering the importance of epidemiological recognition of gynecologic cancers in regional form for planning the preventive measures, this study was performed with aim to assess the epidemiologic characteristics of patients with gynecologic cancers referring to Mashhad oncologic centers in 1982-2016.

In this cross-sectional study, after evaluation of all patients’ files recorded in the last 35 years, the required data were extracted and recorded. The study period was categorized into 4 intervals: before 1990, 1991-2000, 2001-2010, and 2011-2016. The relative frequency, mean age at the time of diagnosis, and the 35-year trend were then assessed. Data were analyzed by SPSS software (version 16) and Chi-Square, Anova, and Scheffe tests. P 

Among 2953 studied patients, mean age was (49.32 ± 13.69 years. The highest mean age was observed among the patients with uterine body neoplasms (52.21±12.49) and the lowest mean age in those with ovarian cancer (46.09±16.09). The mean age at the time of diagnosis of ovarian cancer has significantly increased in the last decades (p<0.001) while decreased in those with cervical cancer (p=0.017). Cervical and ovarian cancers had the highest relative frequency during the entire study period (39.3% (1161 cases) and 36.6% (1080 cases), respectively). There was also a significant difference in the frequency of various cancers across different decades (p<0.001).

Cervical cancer was the most frequent neoplasm in this study. The mean age of diagnosis had increased in patients with ovarian cancer and decreased in cervical cancer. Since cervical cancer can be controlled by preventive measures, more attention to screening of this cancer is recommended.

Abnormal uterine bleeding (AUB) is one common problem in perimenopausal women that should be carefully evaluated. Evaluation in terms of endometrial cancer and premalignant lesions is very important. This study was performed with aim to investigate the relationship between the findings of transvaginal sonography and pathology of endometrial curettage in women with abnormal uterine bleeding at perimenopause.

This descriptive-analytical study was conducted on 184 perimenopausal women aged 40-50 years with AUB in 2017. The patients underwent transvaginal sonography. D&C was done one week after sonography report if endometrial thickness was > 4 mm. Data collection tool was a self-made questionnaire. Demographic findings of the patients and the results of transvaginal sonography, and hystopathologic assessment of endometrium were recorded. Data were analyzed by SPSS software (version 20), and ANOVA and Kruskal-Wallis tests. P

The most common findings of transvaginal sonography was 37% normal, 30% increased thickness, and 20% endometrial polyp. About 47.3% of histopathologic findings were proliferative, then secretory and endometrial polyps and less than 5% of cases was malignant. There was only one case of adenocarcinoma with 6 mm endometrial thickness. In the estimation of the consistency of sonographic findings with D&C findings, there was significant agreement in abnormal and normal groups (P=0.004).

Major and malignant pathologies namely carcinoma and metaplasia can also be detected in cut-off levels less than 8 mm, even around 5 mm. Therefore, use of D&C along with TVUS in low cut-off levels less than 8 mm seems to be necessary.

Infective endocarditis refers to an infectious disease that often affects the heart valves (whether natural or artificial). Unfortunately, there are few studies on the epidemiology of infective endocarditis in Iran. The aim of this study was to evaluate the incidence of infective endocarditis in terms of demographic characteristics of clinical symptoms, underlying diseases and outcomes. Methods & Materials This study was a retrospective-prospective cohort study, which was done descriptively on patients with endocarditis. Accordingly, the information of patients in two hospitals of Imam Reza and Ghaem was followed and recorded in the checklist. The information was included in the field information as well as information about the patients' illness was entered in the statistical software and was evaluated descriptively. Results In our study we observed that of 19 patients evaluated in this study, 17 cases (89.5%) were males and 2 patients (10.5%) were females. We also observed that only 2 patients (10.5%) had heart attack after surgery, 4 (21.1%) patients had recurrent endocarditis after surgery, and 3 patients (15.8%) needed re-surgery due to other diseases and total mobility rates were positive in 9 patients. Conclusion Based on the results observed in this study, the high mortality rate of patients after endocarditis indicates the importance of attention to these patients. Accordingly, consideration of the clinical features of these patients can lead to better management of patients and promote their prognosis.

INTRUDOCTION: Obesity has been known as the most important risk factor for diabetes type 2 and different indexes of anthropometry such as waist circumference, hip circumference and body mass index (BMI),expressing the problems of obesity. The aim of this study was to investigate the relationship between these indexes and diabetes.Method and Materials: In this cross-sectional study conducted in 1389, 7000 people over 30 years old were screened for diabetes. Participants selected by convenient sampling from Samen health centre. The needed information were extracted from data files and put in SPSS software, then analyzed. Over all 540 participants were diabetic,4771 were at risk of diabetesand 1689 persons were healthy. There were significant relationship between waist circumference, hip circumference, waist/hip ratio, waist/height ratio, and BMI in three groups of diabetics, prediabetics and healthy people (p<0.001). We also found significant relationship between sex and three studied groups (p<0.001).Family history of diabetes, B.M.I, hip circumference, w.c/height and diastolic hypertension were predictors of fasting blood sugar with significant relationship (r2=0.06). Regarding to relations between anthropometric indexes and diabetes affecting, it goes without saying that in order to prevent obesity, teaching for improving life style, suitable nutrition, doing exercise, and mobility seems to be needed.

IntroductionIn recent years the metabolic syndrome has been highly common among psychiatric patients. Since many factors including genetic factors contribute to the prevalence of this syndrome, it seems necessary to look for metabolic syndrome among Iranian psychiatric patients. Materials and MethodsThis cross-sectional study was performed on 130 female patients admitted to psychiatric ward of Mashhad 22 Bahman hospital since March 2009 until December 2009 to find whether they had metabolic syndrome. Questionnaires were completed for patients. Pregnant women and those who had had a delivery during the last 6 months were excluded. Data were analyzed through statistical tests such as t-test and chi square and SPSS software version 17. P-value less than 0.05 was regarded as meaningful result.ResultsIn this study the prevalence of metabolic syndrome was, according to criteria of NCEP (ATP III), 39.8%, which is deemed as significantly more than expectable range for healthy Iranian population. Older age, higher waist circumference, BMI and weight, persistence of diabetes mellitus and hypertension, low educational level and marriage status were proven to be associated with increased risk of metabolic syndrome.(p-value<0.05) There were no meaningful relation between metabolic syndrome, duration of administration and type of drugs, and mental disorder. (p-value>0.05)ConclusionIn the present study, the prevalence of metabolic syndrome was examined. And it was proved that the rate of the prevalence of metabolic syndrome is more than what is typically found in similar studies among Iranian psychiatric population. no relationship was detected between metabolic syndrome and any specific drug, however, more extensive studies are suggested.