arezoo chouhdari

Cushing disease is a rare problem that usually has an important effect on the quality of life (QoL).

This survey aimed to evaluate patients’ QoL and determine predictors of improving QoL scores in patients.

In this before-after study, basic characteristics were collected from 56 patients with Cushing disease who underwent endoscopic transsphenoidal surgery, and their QoL score during one year was assessed. Finally, predictor factors of QoL score improvement were identified. To compare the QoL scores before, 6 months, and 12 months after surgery, repeated measures ANOVA and for determining predictors of QoL score improvement, multivariable logistic regression analysis was used. P<0.05 was considered significant in all tests.

The Mean±SD age of the samples was 33.92±12.82 years, and 43 (76.8%) were female. In all 56 patients who underwent endoscopic transsphenoidal surgery, the QoL score significantly improved. In multivariable logistic regression analysis, weight loss (OR= 1.2, 95% CI; 1.01-6.5, P=0.01), no fatigue (OR= 2.1, 95%CI; 1.6-8.3, P=0.009), no decreased libido (OR= 1.5, 95% CI; 1.2-10.62, P=0.01), no gonadal axis disorder (OR=2.2, 95% CI; 1.07-4.06, P=0.01) and post-operation no thyroid axis disorder (OR=2.5, 95% CI; 1.8-5.7, P=0.01) were predictors for more QoL score improvement.

According to the results of this study, many factors can affect the quality of life in patients with Cushing disease. Therefore, support groups should include the cooperation of physicians and psychologists, provision of health services, and social support to improve the QoL of patients.

The current study aimed to determine the quality of life (QoL) scores before and after treatment in patients with acromegaly.
In this longitudinal before-after study, the acromegaly quality of life (AcroQoL) questionnaire was used to assess the QoL. Demographics, clinical manifestations and co-morbidity data, pituitary axis involvement, biochemical and hormonal component tests, and health-related quality of life (HRQoL) before and after treatment (endoscopic transsphenoidal surgery, medication, radiotherapy) were evaluated in patients over 18 years of age. To compare the mean of continuous data, the independent t and Mann–Whitney tests were used. To compare the mean QOL score before and after the study, the paired-t and Wilcoxon tests were performed. The significance level was set at p<0.05.
Among 80 patients with acromegaly who underwent trans-sphenoid surgery with or without radiotherapy or medication therapy with somatostatin analogs, 52 (65%) entered the remission phase within 6 months. Associations were found between the remission phase and female gender (p=0.004) and lower growth hormone (GH) (p=0.04) but not between remission and lower insulin-like growth factor-I (IGF1) after surgery (p=0.02) or gonadal axis disorder after treatment (p<0.001) statistically. Moreover, a significant association was found between not being in the remission phase and gonadal axis disorder before treatment (p=0.04). The QoL score in all dimensions of the AcroQoL questionnaire increased 6 months after treatment (p<0.001). Total AcroQoL score was higher after treatment in the remission group (p=0.03). The psychological scale had a significantly higher score both on the total scale (p<0.001) and on the two subscales of appearance (p<0.001) and personal relationship (p=0.003).
Because of the importance of QoL in acromegaly patients, further studies in this field are recommended.

This study aimed to evaluate the baseline characteristics of patients infected with SARS-CoV-2, after receiving first or second doses of COVID-19 vaccine.

In this cross-sectional study, we examined 100 patients with SARS-CoV-2 infection after vaccination and collected demographic characteristics and history of underlying diseases, lung involvement, and severity of the disease, as well as the type of vaccine received and the duration of onset of the diseases symptoms after vaccination. The relationship between the disease severity and variables was evaluated by the bivariate analysis. Multiple logistic regression model was performed to predict the severity of the disease by calculating the odds ratios and  95% confidence intervals (CIs).

The mean±SD age of COVID-19 patients was 62.54±14.93 years. 59% of patients were male. The mean interval between vaccination and onset of symptom disease was 4.95 days.  In bivariable analysis, there was a difference between the mean of the lung involvement in CT scan, O2 saturation, hypertension (HTN), and Severity of the disease (p < 0.001). In multiple logistic regression analysis, HTN (OR: 5.6, 95CI:1.07-25.5, p = 0.04), O2 saturation < 90% (OR:1.53, 95% CI: 1.39-2.92, p =0.003) and lung involvement ≥ 30% in CT scan were predictors of disease severity.

Due to the short time interval between COVID-19 vaccination and the disease symptoms in this study, it is recommended all people with any symptom of disease to avoid the vaccination

Social accountability is one of the primary missions of every hospital. Hospital managers should be familiar with the social aspects of medical practices and be informed about their services' effects on the target populations and hereby improve the quality of services and the satisfaction of service recipients through planning. The purpose of this study is to provide solutions to strengthen the accountability of managers and service providers to the people in hospitals and their responsibility towards the health of society, as well as patients and clients towards their health status.

Method and Materials: 

This study was conducted using the qualitative and step-by-step thematic analysis method and using field observations and experiences, participation in the think tank meetings of the Ministry of Health and Medical Education, participation in national documents criticizing sessions, as well as the study of the articles and contents contained in the websites of WHO, National Health System of England (NHS) and ACGME. Themes and strategic actions related to the topic were extracted and with qualitative analysis, the activities and solutions were listed, categorized, and edited.

In this study, in 8 areas and 37 strategic issues, more than 350 Practical solutions and some suggestions have been presented to the health officials.

In order to improve the indicators of social responsibility of hospitals, it is suggested to provide an appropriate structure for community-oriented education, forecasting health changes, needs assessment, development of indicators and standards, training the communication skills, behavioral interactions, professional ethics and respect the rights of the patients to the learners and employees, training and monitoring of the points related to diagnosis, treatment, care and prevention of diseases and optimal management of educational processes and hospital services, as well as social prescribing.

 Determine clinical and brain MRI findings in patients with repeated stereotypical TIA.

 Thirty-six patients with symptoms of repeated stereotypical TIA were performed MRI & MRA.

 Twenty patients had infarct that 14 cases had lacunar infarct and 6 cases had large infarct.Of these 20 patients, 12 cases had subcortical infarct and 8 cases had cortical infarct. Also, among 36 patients, 18 cases had artery stenosis. There is a significant relationship between artery stenosis and the presence of infarct.In addition, there was no significant relationship between infarct size and the size of the stenosed arteries.

 Most patients with repeated stereotypical TIA have infarct in DWI and they have a thrombotic cause and antiplatelet drug can be used instead of anticoagulants.

Opium use is a common cause of lead intoxication in Iran. The present study was conducted to determine the blood lead levels in oral and  inhaled consumption of opium. 

A retrospective study was carried out between 1396-1395 on 200 patients with lead intoxication in Loghman-Hakim Hospital. We recorded and evaluated the patients' demographic information, type of opioid (oral or inhalable), blood lead levels, and treatment outcomes. For statistical analysis, independent t-test, one-way ANOVA, and correlation coefficient were performed using SPSS software, version 18. 

Based on the obtained results, %97 of the patients were oral opium users. The mean (standard deviation) of blood lead levels in oral opium users was 34.29 ( 108.86) ppm and in inhaled type, 11.44(33.37) ppm. A significant correlation was found between the blood lead levels and age of the patients (r = 0.002, p=0.2). There was no significant statistical difference between the sexes, the method of opium use, the outcome of the patient, and the serum level of lead (p >0.05).

Based on our results, the mean blood lead levels in inhaled and oral opium consumption are close to each other. Also, considering the public perception about the safety of inhalant use opium, it is suggested that to increase public awareness of the harms of inhaled use, in addition to oral consumption, educational prorams be planed by administrators and health care providers. Also, studies with more inhaled opium users should be carried out to statistically compare blood levels of lead in two groups of oral and inhaled consumptions.

Lifestyle changes are associated with an increased incidence of stroke especially in young adults. The purpose of this study was to investigate the lifestyle of ischemic stroke cases under the age of 50 years.

This descriptive cross-sectional study was conducted on young adults with ischemic stroke who were admitted to some hospitals, Tehran, Iran between 2018 and 2019. Total lifestyle information collected in the form then was compared in males and females.

Totally 11% ischemic stroke was under age 50 years. 60.7% of young adult patients were men. There was significant difference between body mass index (BMI) (P = 0.03), type of job (P = 0.04), physical activity (P = 0.02), fruit and vegetables consumption, and gender of patients (P = 0.02).

According to the association between inappropriate lifestyle and ischemic stroke in young adults, it is recommended to set preventive medicine and health promotion units with insurance coverage in all clinics for risk assessment of stroke in healthy general population specialty young adults

Metronidazole (MTZ) can decrease the levels of several cytokines. This research aimed at the investigation of the anti-inflammatory impact of MTZ in COVID-19. A randomized, single-blind clinical trial for comparing the anti-inflammatory effect of MTZ in two eligible groups of adult patients with lower respiratory tract involvement due to Covid-19 treated with a standard national method with or without MTZ was performed. Inflammatory markers were measured as the primary outcome in two groups. Oxygen saturation, length of hospital stays, and mortality of patients were evaluated as secondary outcomes. Among 44 patients with lower respiratory tract due to Covid-19, 20(45.5%) were randomly allocated in group A with the current standard treatment plus the MTZ tablet for 7 days orally and 24 (54.5%) in group B with the current standard treatment. The mean of ESR in group A was statistically significantly lower than that of group B on the seventh day (A: 38.25 ± 18.75 vs. B: 47.67 ± 26.41, p = 0.02). Moreover, the mean of IL6 diminished significantly in both A (p = 0.01) and B (p = 0.01) groups on the seventh day compared to the first day. The decrease of TNF was not significant in any of the groups A (p = 0.3) and B (p = 0.4) from the 7th day to the first day. No significant difference was not found between group A and group B groups on the CRP level (p = 0.1). Findings of this study showed the anti-inflammatory impact of MTZ in the patient with lower respiratory inflammation due to COVID-19.

Chest pain indicating acute coronary syndrome (ACS) accounts for approximately 5-10% of presents in the emergency departments (EDs). Rapid decision making is very important because longer hospital stay is associated with higher financial burden. The aim of this study was to compare current practice with a 2-hour accelerated diagnostic protocol (ADP) to manage chest pain in patients suspected to have ACS.

This is a longitudinal follow-up study on 900 patients with negative troponin measured on entrance to the ED and initially low-risk for myocardial infarction according to the emergency department of chest pain assessment score (EDACS) at the Loghman Hakim Hospital, Tehran, Iran in 2018. Patients were divided in two groups (based on odd or even days at admission time) at a ratio of 2:1 (i) current protocol with a second troponin measuring after 6 hours and (ii) ADP with a second troponin measured after 2 hours. Major adverse cardiac events (MACE) associated factors assessed in two groups over 30-days.

Totally, the rate of return to EDs with the major adverse cardiac events was 4% (n=24) in the current protocol group and 1% (n=1) in the ADP group within 30 days. The odds ratio for MACE in 30 days in the current protocol was 4.3 times more than ADP group (95% CI: 1.28-14.56, OR: 4.33, p:0.02). In multivariable logistic regression analysis, this estimation for the current protocol was 4.10 times more than comparison group (95% CI: 1.23-13.81, OR: 4.10, p:0.01).

A 2-hour ADP in patients at low-risk for myocardial infarction by EDACS had fewer adverse follow-up events than the current protocol.

 External ventricular drains (EVDs) infection is a life-threatening complication.

 To investigate the rate of EVDs infection and its predictive factors in neurosurgery patients hospitalized at a tertiary teaching hospital in Iran.

 In this survey, all patients referred to a subspecialty hospital in Tehran (Iran) with an external ventricular drain (EVDs) from Jun 23, 2018, to Jun 23, 2019, are monitored within 30 days of EVDs placement for infection. Data on demographic information, underlying diseases, number of EVD replacements, length of hospital stay, type consumed antibiotic before neurosurgery, length of tunneling, type of airway, duration of mechanical ventilation, duration of surgery(hours), surgeon name, APACHE II score, length of intensive care unit stay are collected. The diagnosis was based on the Center for Diseases Control and Prevention criteria for meningitis/ventriculitis and clinical vision of infectious or critical care specialists. A logistic regression model was developed to identify factors that can predict the infection.

 Of 81 patients with EVDs, 39 (48.1%) were infected. The mean age of patients was 44.33 ± 19.5 years, and 55.6% of them were male. According to the multiple logistic regression analysis, mechanical ventilation for more than 6 days (OR: 2.5, 95% CI: 1.6 - 3.56, P = 0.04) and length of tunneling > 5 cm (OR: 1.98, 95%CI: 1.87 - 4.76, P = 0.02) were identified as factors that could predict EVD infection. Also, consuming ceftazidime + vancomycin, as a prophylaxis agent, had a lower odds ratio for EVD infection (OR:0.4, 95% CI: 0.08 - 0.84, P = 0.04).

 Regarding the predictive factors of EVDs infection, either in the present study or other studies, there should be strategies to manage this life-threatening infection in neurosurgery patients.

It is believed that pituitary carcinoma is a rare disorder and arise from the transformation of benign invasive macroadenomas, and the process of this transformation takes place slowly.

A 51-year-old man presented with the clinical features of Cushing syndrome and walking impairment who was diagnosed with metastatic corticotroph pituitary carcinoma to the spine region, 6 years after the initial resection of a primary invasive pituitary adenoma. He made a visit to neurosurgery and endocrinology clinic with the chief complaint of weight gain, facial and extremities swelling, paresthesia, weakness, motion and speaking impairments, and HTN which all appeared through the last 1 year; hormonal laboratory tests showed urine free cortisol (UFC) 197.8 and 367. 30 ug/24hrs (36-137), cortisol 8 am after 1 mg overnight dexamethasone test 375 ng/mL (50-250) and ACTH 59 pg/mL. MRI study revealed a mass in the brainstem with the compression effect on spinal region, pituitary imagine does not differ from the last MRI. He underwent a neurosurgery for spinal mass resection, which was successful and the total mass was resected. After surgery, the patientchr('39')s condition became better.

Pituitary carcinoma is a rare entity impossible to recognize as a primary tumor because its diagnosis by definition requires the presence of metastasis. Clinical awareness of the rare possibility for aggressive adenomas will progress, to metastasize is essential to appropriately monitor patients for possible early detection and treatment of pituitary carcinoma.

Germinoma is a rare lesion found commonly in the pineal and suprasellar regions of the brain. Clinical presentation mainly involves the location and size of the tumor and the patient age. Endocrine abnormalities are the most common symptom.

The patient was a 26-year-old Iranian female who suffered from germinoma for a long time and was referred to Loghman Hakim Hospital for amenorrhea, polyuria, and polydipsia. Despite diagnostic challenges, she was finally diagnosed with suprasellar germinoma after endoscopic transsphenoidal surgery, followed by radiotherapy and medical interventions to complement the surgery.

It is important to be able to diagnose the patientchr('39')s problem at an early stage based on their history, hormonal profile, laboratory results and radiological view.

The purpose of this study was to investigate and predict ventilator-associated pneumonia (VAP) in the two groups of patients who received either proton pump inhibitors (Pantoprazole) or histamine H2 antagonist (Ranitidine).
Patients in ICU received Pantoprazole or Ranitidine as stress-related mucosal injury and GI bleeding prophylaxis. The incidence rate of VAP and GI bleeding was estimated in each group during ICU stay. Chi-Square and Multivariate Logistic Regression Test were used for data analysis. P.value less than 0.05 was considered significant. Data analysis was performed through SPSS version 19.0.
The incidence rate of VAP in the Ranitidine and Pantoprazole groups was 44.7% and 37.3% respectively (p=0.3). According to the multivariable logistic regression analysis, length of mechanical ventilation ≥ 4 days was a predictive factor for VAP only in the Pantoprazole group (OR: 1.8, 95% CI: 1.56-1.90, p=0.006). No relationship between GI bleeding incidence and stress ulcer prophylaxis was found (p=0.4). Kaplan-Meier curve showed no significant difference between the two groups of Ranitidine and Pantoprazole (p=0.4) in survival time according to the length of ICU stay.
According to the results, there was no difference between the two groups in terms of VAP, GI bleeding and stress ulcer. Due to the lower cost of Ranitidine, it may be a more appropriate choice for GI bleeding prophylaxis in ICU patients.

Lead poisoning is now more common due to accidental or intentional exposure to opiumimpregnated with lead. We aimed to determine the relationship between the blood lead levels (BLLs) andbasic characteristics in opium-poisoned children.

In this cross-sectional study, 32 children younger than 13 years old who had been admitted toLoghman Hakim Poison Center, Tehran, Iran, due to opium poisoning, were evaluated for BLLs. Patients’demographics, symptoms, signs, and lab tests were evaluated as well as the BLLs.

The median and range of age in children with opium poisoning were 14 and 141 months withminimum and maximum age of 3 and 144 months, respectively, and 62.5% were boys. Their mean BLL was9.78 ± 3.44 μg/dl and in 70% of opium-poisoned children, BLL was ≥ 5 μg/dl. There was a significantdifference between mean BLLs in girls and boys (17.07 ± 6.57 μg/dl in girls and 6.61 ± 3.22 μg/dl in boys,P = 0.02). We found a significant correlation between BLL and hemoglobin (Hb) level. In very low Hb level(< 8 g/dl), the BLL was higher but with increasing Hb level, BLL increased as well; in Hb levels > 14 g/dl,BLL decreased again (P = 0.01).

Although none of the children needed chelation therapy, strategies should be developed toprevent children from being exposed to opium and other materials impregnated with lead regarding itseffects on all organs of children.

Healthy lifestyle factors are associated with a lower risk of stroke. The current study aimed to describe lifestyle-related risk factors in ischemic stroke.

In this cross-sectional study patients with ischemic stroke in two age groups assessed for lifestyle. Demographic characteristics (age, sex, BMI, marital status, educational level, job type as low or full stress, living area), lifestyle habits, and past medical history in two age groups collected in the structured form by researchers. Chi-square (Fisher's exact) test for assessment of the statistical difference between categorical variables applied. Also, a multivariate logistic regression model was used to predict possible life-threatening lifestyles which can lead to stroke under the age of 50 (odds ratio, 95% confidence interval). All statistical tests were two-tailed and were performed with the use of PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc. P values <0.05 were regarded as significant.

Totally, 11.2% of ischemic stroke cases were 50≥ years old. In the multivariable logistic regression model higher BMI (P=0.02, OR =1.5, 95%CI=1.2 – 4.3), smoking (P<0.001, OR=1.8, 95%CI=1.08 – 2.56), alcohol drinking (P<0.001, OR=1.6, 95%CI=1.01 – 3.87), hookahs consumption (P<0.001, OR=1.2, 95%CI= 1.1 – 3.5) were predicting factors for ischemic stroke incidence in age ≤50 and only appropriate diet (low fat, sugar, salt, high fruits and vegetables) (P=0.01, OR= 0.7, 95% CI= 0.04-0.87) was preventive factors against stroke in age ≤50 years in compare with over 50.

Based on this survey many lifestyle factors effects the incidence of ischemic stroke in any age group. Therefore, periodic monitoring and effective in educating healthy people should be planned.

Insulin therapy refusal among type 2 diabetic patients is most challenging for healthcare providers.

This study aimed to evaluate the type 2 diabetic patients’ attitude and compliance with the initiation of insulin therapy.

A cross-sectional study was conducted on 100 type 2 diabetic patients at the Endocrinology Clinic of Loghman Hakim Hospital, Tehran, Iran. A questionnaire was prepared to assess the attitudes toward the onset of insulin therapy. Positive and negative attitudes toward insulin injection were compared between the two groups of accepting and rejecting insulin therapy.

In this study, 62% of patients with type 2 diabetes tended to start insulin therapy. There was a statistical difference between the total positive and negative attitude items toward insulin therapy (agree/disagree) and acceptance of insulin therapy (P < 0.05). The most agreements related to a positive attitude in the two groups of accepting and rejecting insulin therapy belonged to statements “Insulin injection prevents complications of diabetes (micro and macrovascular)” as 100% (P < 0.001) and “Insulin injection helps improve my diabetes” as 96.8% (P < 0.001). The most agreements related to negative attitudes in the two groups of accepting and rejecting insulin therapy belonged to statements “Insulin injection causes my dependence on it” as 72.6% (P = 0.001) and “I can control my diabetes with oral medication and diet without insulin injection” as 97.4% (P < 0.001).

As 38% of patients with type 2 diabetes refused to initiate insulin therapy, it seems that effective communication between physicians and patients and continuous follow-ups by health care providers can increase positive attitudes toward insulin injection.

Beta interferon is one of the important drugs for multiple sclerosis. Its common side effects are flu-like symptoms caused by drug injection. The purpose of this study was to evaluate the possibility of predicting the response rate of this drug based on the flu-like drug reaction.

This case-control study performed in Loghman Hakim hospital in Tehran in 2017 and 110 patients with multiple sclerosis under beta interferon treatment studied. Patients were divided into two groups with and without flu-like drug reaction. A neurology resident according to the patient’s history and patient records filled in the questionnaires. The results of the two groups were compared by SPSS 16 software.

A total of 110 patients including 31 patients with flu-like drug reaction and 79 non-complicated patients were evaluated. These patients included 32 males and 78 females with an average age of 35.55 years. The mean duration of beta interferon use was 4.33 years in the case group and 4.34 years in the control group. Finally, a significant correlation between the flu-like drug reaction and the optimal response in the first year treatment was found (p=0.026). In addition, cause of drug discontinuation had significant correlation with presence of flu like drug reaction (p=0.028). There was no significant correlation between the disease annual attacks rate and flu like drug reaction.

Flu-like drug reaction is a common complication of interferon beta drugs, which has a therapeutic difference in patients with and without this drug reaction.

The first-degree relatives (FDRs) of patients with colorectal cancer (CRC) are at a 2 to 3-fold increased risk of developing the disease compared with the general population. This study aimed to determine the relationship between the lifestyle of colorectal cancer patients’ FDRs and their compliance in colonoscopy screening test. This cross-sectional study conducted on FDRs of patients with colorectal cancer in one educational hospital, Tehran, Iran in duration 2018. A total of 114 patients’ FDRs were consulted face to face by preventive medicine specialist and data collecting forms were fully completed. Three months later the FDRs were followed for undergoing colonoscopy screening test or decision to do it soon. Next, the relationship between lifestyle [BMI (body mass index), cigarette smoking, diet, physical activity], socioeconomic status (job, income, health insurance), and comorbidities with a tendency to participate in colonoscopy screening program assessed. In multivariable logistic regression analysis, predictor factors for colonoscopy screening in FDRs were investigated. The data were analyzed using SPSS V. 18 software and the significance statistically was P < 0.05 in the all tests. Overall, 57% of FDRs undergone colonoscopy tests up to time of study or they were tended to do it soon. In multivariable logistic regression, age < 50 years old (P = 0.01, OR = 1.08, 95%CI: 1.01 - 1.8), higher income (equal and more than 20 million Rials) (P < 0.001, OR = 2.5, 95%CI: 1.8 - 11), appropriate physical activity (≥ 150 minutes weekly) (P < 0.001, OR = 5.2, 95%CI: 4.6 - 17.5) and normal diet (intake of carbohydrate, fat, protein, fruit and vegetables) (P = 0.006, OR = 3.02, 95%CI: 2.9 - 6.6) were the predictor factors to compliance the FDRs for participation in colonoscopy screening program. Although in this study there was an association between lifestyle of FDRs and the compliance rate of colonoscopy screening test but according to the vulnerability of the relatives, more research in this field should be carried out

Thyroid nodules are frequent occurrences. This study aims to evaluate the risk of malignancy based on the 2015 American Thyroid Association Management: Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer.
In this cross-sectional study, ultrasonography and clinical manifestations were compared with pathology findings to predict the risk of malignancy in thyroid nodules. Assessment of the ultrasound findings was based on the criteria recommended by The 2015 American Thyroid Association Management Guidelines for Thyroid Nodules. For the evaluation of the association between clinical and ultrasound findings with histopathology results, we used the chi-square and Fisher’s exact tests. The relative risk and prediction of malignancy was assessed by multiple logistic regression analysis. Data analysis was performed by the SPSS19. The significance level was set at P<0.05.
From 130 patients with thyroid nodules, 110 (84.6%) were female. The mean age of participants was 46.1±11.5 years. Histopathology findings showed malignancy in 17.7% of the nodules, all of were papillary thyroid carcinoma. Multivariate logistic regression showed some of the ultrasonography parameters, absence of halo (P<0.001, OR=28), taller than wide shape (P=0.001, OR=18.3), nodule size more than 4 cm (P=0.04, OR=12.1), irregular margin (P=0.001, OR=10.06), solid or mixed composition (P=0.002, OR=8.1), hypoechoic (P=0.001, OR=4.5), lymph node positive  (P=0.002, OR=4.3), positive calcification (P=0.03, OR=2.08), positive internal vascularity (P<0.001, OR=1.05), and intermediate/high level of suspicion (P=0.001, OR=12) could predict malignancy in patients with thyroid nodules.
Based on increasing rate of thyroid cancer, in this study, the new and accurate ultrasound technique is recommended as alternative diagnostic method due non-invasive nature and lower cost used.

Lumbar disc degeneration is one of the mostcommoncauses of low back pain which can gradually reduce the healthrelated quality of life (HRQoL). The aim of this study was determining factors related with improvement of QOL in lumbar spine decompression surgery. This quasi-experimental research was conducted on 145 patients with lumbar disc degeneration who underwent lumbar spine decompression surgery during 2017 - 2018. We analyzed the quality of life based on EQ5D/VAS score by self-assessment examination according to age, gender, BMI, educational level, life model, smoking habit, leg and back pain scale, regular activity and walking distance (meters). For the reporting of results, descriptive analysis and repeated measure ANOVA for comparison quality of life (QOL) in three times before, 6 and 12 months after surgery were used. P value less than 0.05 was considered statistically significant. All analyses were conducted using SPSS version 19. Overall, 90 (62.1%) of patients were female. Most patients (30.3%) were in the 41 - 50 years age groups. The EQ-5D/VAS scores improved in all age groups in the three times measured (P = 0.001). QOL in normal BMI improved more than overweight and obese (P = 0.001). High level of education was associated with more improvement of QOL after surgery (P < 0.001). Patients who lived with the family had significantly higher QOL score before, 6 and 12 months after surgery (P < 0.001). No association was observed cigarette smoking (P = 0.03) so the lower duration of pain preparation was associated with higher QOL statistically. Overall, EQ5D score in the leg, back pain, regular activity and walking distance (meters) improved in the duration of one year in all subgroups (P < 0.001). According to the results, various factors were effective in improving postoperative quality of life in patients who underwentlumbarspine decompression. So,morestudy isrecommendedonthe socioeconomic, lifestyle to furtherimprovequality of life after surgery.

Primary hypothyroidism is a common medical condition. It can lead to pituitary adenoma which is usually asymptomatic, but it can also lead to symptomatic macroadenomas which are hard to diagnose due to different clinical presentations. A 16-year-old girl presented for endocrinology consultation prior to neurosurgical operation. She had galactorrhea which was accompanied by vertigo & low grade blurred vision without a headache and was diagnosed with pituitary macroadenoma and was planned for a surgery. She had TSH level of more than 100 mU/L, free thyroxine of 1.9 pmol/L. Her thyroid peroxidase (TPO) antibody level was 13.3 IU/mL, insulin growth factor-1 392 µ/l and serum prolactin level 42 ng/ml. During physical exam and with the laboratory findings, we suspected for a primary hypothyroidism as the leading cause of pituitary macroadenoma. As the result, we cancel the surgery and start levothyroxine therapy 100µg daily for her. In the follow-up it revealed that our diagnosis was correct and she went into remission with pituitary gland shrinking and decreasing TSH and prolactin levels. It is important to understand the different presentation of primary hypothyroidism to decrease the unnecessary risk of maltreatment in patients.

Post-operative meningitis(POM) is the important challenge with high mortality in the neurosurgery To identify related factors to predict mortality rate of post-operative meningitis. This descriptive longitudinal study, conducted on patients affected by postoperative meningitis within 30 days after neurosurgery from 2017 to 2018, in one subspecialty hospital, Tehran, Iran. Total basic characteristics of patients diagnosed with POM collected and they followed for 30 days. The mortality rate was estimated. For data analysis Chi2 and Fisher exact, so, independent t and Mann-Whitney U, the test used. As well as multivariable logistic regression analysis showed predictor factors of patient's outcome. Finally, Survival curve was executed by SPSS 19. A significant level was considered P < 0.05 for all tests. In this study, the mortality rate was 5.6 times incidence rate. In multivariable logistic regression analysis, having mechanical ventilation (P = 0.03, OR = 1.1, 95%CI= 1.05 - 5.1), length of ICU stays more than 7 days (P = 0.04, OR = 1.2, 95%CI = 0.04 - 6.2), positive cerebrospinal fluid leakage (CSF) culture (P = 0.01, OR = 2.4, 95%CI = 1.9 - 4.08) were forecasting factors to poor outcome. Finally, an inverse relationship between survival function and length of ICU stay in patients affected by postoperative meningitis reported. According to the high rate of mortality and predictor factors in POM, further studies are recommended to find preventive strategies to decrease this dreaded cause of morbidity and mortality in neurosurgical patients.

Platelet volume indices (PVIs) are inexpensive and readily available parameters in intensive care units (ICUs). However, their association with mortality has never been investigated in the post-neurosurgical meningitis (PNM). This study was designed to investigate the association of PVIs with mortality in PNM patients. This retrospective study was conducted in the adult patients undergone various neurosurgical procedures in a neurosurgery department at a tertiary educational medical center in Tehran from 2016 to 2017. In this study, platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet count were measured on ICU admission. A total of 37 patients were included, 18 of whom survived (mortality rate: 50%). PDW and MPV values were significantly higher in non-survivors than in survivors. In non-survivor patients, platelet count was significantly lower and PDW was higher at diagnosis and discharge when compared to on admission. Also, there was no significant linear correlation between Charlson comorbidity index (CCI) and platelet indices. The means of these parameters showed no significant differences in CCI categories between the two patient subgroups. The obtained data revealed that the high levels of MPV and PDW in PNM are not associated with the increased risk of mortality, whereas the decrease in plateletcrit was not associated with increased risk of mortality.

Ventilator-Associated Pneumonia (VAP) is an important cause of morbidity and mortality in patients admitted to Intensive Care Unit (ICU). The current study conducted to estimate VAP incidence,attributable mortality and case fatality rate,cost,so related factors can affect the outcome in patients. In this descriptive longitudinal study,demographic,clinical and para-clinical data were collected and attributable mortality and case fatality rate was estimated. Multivariable analysis was done to predict the possible risk factors on the outcome of VAP patients. Also,patients survival curve was plotted based on their length of ICU stay. Finally,the additional cost due to VAP in ICU was estimated. Totally,8% ICU admissions were affected by VAP and 4% expired during the ICU stay. Further,the attributable mortality rate of VAP was high as compared with standard mortality rate. The most case fatality rate was for Acinetobacter sp. (n=17 60.7%). In multivariable logistic regression analysis,age greater than 40 years,more than 96 hours mechanical ventilation and uncontrolled diabetes mellitus were predictor factors of higher mortality. Inverse association between survival time and ICU length of stay was reported. Finally,the additional cost of VAP was estimated of about 700 US$ per patients. According to the results,strategies to prevent mortality by reducing the duration of ventilation and ICU length of stay should be performed. Also,mandatory fees for the family and the healthcare system should be planned.