leila shayan

Hepatocellular carcinoma (HCC) is the 4th leading cause of cancer-related deaths worldwide. Unlike other solid tumors, the underlying-cause of cirrhosis can affect the prognosis in HCC.

To assess the post-transplant survival factors in patients with hepatocellular carcinoma relative to the cirrhosis and alpha-fetoprotein levels in patients with liver transplantation in Abu-Ali Sina transplant hospital, Shiraz, 2010-2020.

In this retrospective study, demographic and clinical data affecting survival includes the underlying cause of cirrhosis and alpha-fetoprotein (AFP) levels were collected from all patients (n=160) who underwent transplantation in Shiraz between 2010 and 2020 with a definitive diagnosis of hepatocellular carcinoma. The one-, two-, three-, four- and five-years survival rates and the median survival time were calculated. Kaplan-Meier method was used to determine survival at different time intervals to determine the factors affecting survival.

The mean age of the study population was 51±14 years and most patients were men (82.5%). At the time of data collection, 109 patients were alive (68.1%), 22 patients died from recurrence hepatocellular carcinoma (13.8%) and 29 patients had deaths from underlying diseases (18.1%). The most common causes of cirrhosis were HBV (49.4%) and HCV (10%), respectively. 102 patients had liver cancer due to hepatitis-related factors (63.7%) and the prevalence of biliary and other diseases as the underlying cause of HCC was 5% and 31.3%, respectively. 55.6% of patients who died of hepatic impairment had AFP less than 500 ng / dl and 8 patients (44.4%) had AFP more than 500 ng / dl and blood AFP level was significantly associated with mortality (P=0.003). The prevalence of recurrence HCC death was also higher in people with AFP above 500 (29.6% vs. 9.17%). Survival rates of 1, 2, 3, 4 and 5 years were 0.86, 0.71, 0.61, 0.41 and 0.36, respectively. Survival in AFP <500 and AFP> 500 was almost the same until 40 months and after that survival time was significantly higher in individuals with AFP <500 (P-value = 0.06).

The present study showed that gender and the underlying causes of cirrhosis do not have a significant effect on determining the patient’s survival rate and the only factor affecting was AFP which is a predictive and prognostic biomarker as a tumor antigen role in HCC.

Transthoracic echocardiography (TTE) is the recommended imaging technique for the evaluation of patients with aortic stenosis (AS). However, in cases with inconclusive findings, cardiac magnetic resonance (CMR) planimetry is used to grade AS severity. This study aimed to compare the results derived from TTE and CMR in patients with severe AS with normal left ventricular (LV) function. In a prospective study, 20 patients with severe AS were recruited and data derived from TTE and CMR modalities were compared with the archived records of 28 age- and sex-matched healthy controls. The data included aortic valve area (AVA), MRI-derived biventricular global strains, and TTE-derived global longitudinal strain (GLS). SPSS software was used to analyze the data with independent samples t test, intraclass correlation coefficient (ICC), and Pearson correlation. P<0.05 was considered statistically significant. An excellent agreement was found in AVA values derived from CMR and TTE with an average ICC of 0.932 (95% CI=0.829-0.973). There was a significant difference in LV-GLS, LV global radial strain (GRS), right ventricular (RV) GRS, and RV global circumferential strain between the groups. A good correlation was found between CMR- and TTE-derived GLS with an average ICC of 0.721 (95% C=0.255-0.896). The mean aortic valve pressure gradient in TTE had a significant inverse linear correlation with LV-GRS in CMR (r=-0.537). All P values were <0.05. There was a good agreement between AVA and strain values derived from cardiac MRI and TTE. The myocardial strain was impaired in patients with severe AS and normal LV function and correlated with disease severity.

To identify the distinctive features of acutely injured patients who were presented to the emergency department (ED) and their association with mortality and surgical intervention outcomes. This cross-sectional study was conducted on all trauma patients resuscitated in the ED of ShahidRajaee (Emtiaz) Trauma Hospital (Shiraz, Iran) from May 2018 to June 2019. Demographic information, themechanism of trauma, trauma type, injured body regions, criteria of abbreviated injury scale (AIS) score,injury severity score (ISS), and surgical intervention was all taken into consideration. The items related to themortality and surgical performance outcomes among the patients were analyzed. Of all 1281 cases, 82.9% were men, and the mean age of the patients was 37.9±19.1 years. The mostcommon mechanism of injury was a car accident, and the thorax was the most prevalent injured area of thebody. The majority of the patients had moderate blunt trauma. The mechanism of trauma, ISS, and the severityof head trauma were all significantly correlated with operation interventions. Moreover, age, the mechanismand type of trauma, ISS, and the necessity for the surgery were significantly associated with death occurrence.Additionally, head, thorax, and abdomen trauma were significantly related to a high mortality rate. Age, trauma mechanism and type, ISS, and the necessity for surgery were significantly associatedwith the mortality rate of injured patients. The severity of the trauma, particularly head injuries and themechanism of damage were important determinants in concern for surgery the necessity.

To evaluate the presence/severity of depression, anxiety, and stress among health care workers(HCWs) who work on the specially allocated COVID-19 ward (Group A) and HCWs on the other wards(Group B). This questionnaire-based study was conducted from January 25 to February 28, 2021. The mentalstatus was assessed using the Persian version of the 42-item Depression, Anxiety, and Stress score (DASS-42).Gathered data was analyzed using SPSS version 25. The independent T-test and Chi-square tests were used tocompare quantitative and qualitative variables. Two-hundred and twenty two questionnaires were eligible for analysis. Group A consisted of 33HCWs, and 189 (85.1%) individuals were working on the other wards. No statistically significant differenceswere seen regarding the Socio-demographic features except for the marital status (p=0.005). The depressions’mean score was comparable between group A and B (p=0.102). The mean scores of anxiety and stress weresignificantly lower in group A than group B (p=0.006), although the frequency of DASS-42 parameters did notdiffer between these two groups (p>0.05). Contrary to our assumptions, this study showed that the DASS-42 parameters were not higher inHCWs working on the COVID-19 wards. This might be justified by developing coping mechanisms, being onthe honeymoon phase of the disaster, compassion satisfaction, promising vaccine news, and working on theless impacted hospital.

To evaluate the effect of COVID-19 pandemic on the incidence and mortality rate of road trafficinjuries in Shiraz, Iran. This cross-sectional study was performed on the data of patients who admitted by road trafficaccidents 18 months before the outbreak of COVID-19 and 18 months after COVID-19 in the largest providerof trauma level 1 care services in southern Iran. SPSS 19 software was used to analyze the data. A significant decrease of 12.8% was observed in the number of patients admitted by road trafficaccidents during the COVID-19 pandemic period compared to the same period before the pandemic (p<0.0001).But the death toll from road traffic accidents has increased significantly during the COVID-19 pandemic periodcompared to the same period before the pandemic (p=0.01). Due to the COVID-19 restrictions, it seems that factors such as restrictions on suburban travel,closure of public and recreational spaces, reduction of intra-city traffic, people staying at home and a significantreduction in injuries caused by traffic accidents, is reasonable. On the other hand, these restrictions, quarantines,and COVID disease itself can lead to confusion, anxiety, fear of infection, and thus avoid or delay the searchfor health care and increase mortality. Therefore, planning and policy-making is essential in order to preparethe correct guidance for seeking treatment.

Trauma is considered an important issue in most countries. Identification of the factors affecting the length of stay (LOS) in the intensive care unit (ICU) plays a crucial role in controlling the costs and complications of prolonged hospitalization.

This study aimed to identify the factors affecting the LOS of trauma patients in the ICU using stepwise and new penalized variable selection methods in count data regression.

The patients’ information was evaluated in Emtiaz Hospital and Shahid Rajaee trauma center in Shiraz from March 2016 to September 2017. Count regression model was used to determine the factors affecting the LOS of patients in the ICU using penalized variable selection including, Enet, Snet, and Mnet.

The mean age of the patients (n=382) was obtained at 36.7±16.7 years, and the majority (88.4%) of the patients were male. The mean LOS in the ICU was determined at 6.2±6.6 days. Mnet with a negative binomial distribution outperformed the other penalized variable selection methods. A Glasgow Coma Scale (GCS) of less than 9 (IRR=1.7), blunt brain trauma (IRR=1.8), chest trauma (IRR=2.2), and oxygen saturation of less than 90 (IRR=1.2) increased the LOS of trauma patients in the ICU.

Penalized variable selection methods effectively ignore or control the existing correlations between predictors. Amongst the penalized models, Mnet provided more acceptable results with smaller Akaike information criterion and fewer predictors. According to this penalty, the most important factors affecting the length of stay were chest trauma, blunt brain trauma, GCS, and oxygen saturation rate. Most clinical studies on trauma have also shown the importance of these factors.

To investigate the effects of sesame oil extracted from tahini (Ardeh) on pain severity in patients with upper or lower limbs trauma. This double-blinded randomized clinical trial study was conducted on 120 patients with upper or lower trauma in Shahid Rajaee Hospital, Shiraz, Iran, from May the 1st through November 30th, 2016. The patients were randomly assigned to two groups using block randomization. The intervention group received topical sesame oil extracted from tahini (Ardeh) and the placebo group received cooking oil. Pain severity, pain sensitivity and heaviness of painful site were assessed. Overall, we included 90 patients with traumatic limb injuries in this study who were randomized to two study groups. The mean age of the patients was 28.3 ± 6.8 (ranging from 25 to 35) years and there were 63 (70%) men and 27 (30%) women among the patients. In the sesame oil group, the mean changes in the pain severity (-1.53 ± 0.57, P<0.001), pain sensitivity (-1.45 ± 0.64, P<0.001) and heaviness of painful site (-1.56 ± 0.68, P<0.001) were significantly lower when compared to the placebo group in the second day of the intervention. None of the patients experience adverse drug effects. Our findings suggest that the topical use of sesame oil extracted from Tahini has a pain reliever effect on the skin after bruising and it helps prevent skin discoloration in patients with traumatic injuries of limbs. Clinical Trial Registry: IRCT20171017036838N1

Trauma is among the injuries associated with a high prevalence of pain and little treatment for it. Pain can change vital signs and especially cause tachycardia due to sympathetic activity. This can distort our assessment of the patient’s shock; therefore, the present study evaluates the effect of prescribing analgesics on vital signs and hydration in trauma patients with extremity or pelvic fractures. 325 trauma patients over the age of 16 with extremity or pelvic fractures and GCS score of 14 or 15 were evaluated regarding changes in vital signs and receiving crystalloid in 2 groups of with and without analgesic administration. 325 patients were divided into 2 groups of with (263 patients) and without (62 patients) analgesic administration. 80.9% of the patients received analgesics. In the group receiving analgesics, on average heart rate decreased from 103 to 95 (p < 0.001). However, it did not affect blood pressure and the respiratory status of the 2 groups receiving analgesics or not showed a significant difference. The group receiving analgesics received more crystalloids. Pain management in trauma leads to improvement in tachycardia and probably our better understanding of presence or absence of shock in the patient. Therefore, it is recommended to move the evaluation and treatment of acute trauma pain from the secondary survey in trauma to the D phase of the primary survey.

To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness (LOC).
This prospective cross-sectional study was conducted over a six-month period at Shahid Rajaee Trauma Hospital, Shiraz, Iran. We included hemodynamically stable blunt abdominal trauma patients with a decreased LOC (Glasgow Coma Scale ≤ 13) who were referred to the neurosurgery ICU ward. Included cases underwent 1 contrast-enhanced CT scan and two-time ultrasonographic study of the abdomen with an interval of 48 hours. The diagnostic accuracy of the ultrasonography was determined according to the CT-scan results.
Overall 80 patients with mean age of 37.75 ± 18.67 years were included. There were 17 (21.3%) women and 63 (78.8%) men among the patients. Compared with the CT-Scan, the first ultrasonography showed a sensitivity of 60%, specificity of 80%, PPV of 16.60%, NPV of 96.80%, and a diagnostic accuracy of 70%. The same values for the second ultrasonographic study were 80%, 79%, 20%, 98%, and 79%, respectively. In 4 (5%) patients whose first ultrasonography and CT scan results were negative, the second ultrasonography was positive for injury.
In patients with blunt trauma to the abdomen, when the only indication of abdominal CT scan is a decreased LOC, two ultrasonographic studies can replace a CT imaging.

Pain could potentially affect all aspects of patient admission course and outcome in emergency department (ED) when left undertreated. The alleviation of acute pain remains simply affordable but is usually, and sometimes purposefully, left untreated in patients with trauma. This study challenged the conventional emergency department policies in reducing the intensity of acute pain considering the pharmacological treatments. In this case-control study, the prevalence and intensity of pain in 200 patients were evaluated on admission (T1) and 24 hours later (T2) based on the valid, standardized 10-point numeric rating scale (NRS 0-10) for pain intensity. A group of patients received analgesic drugs and others did not. Changes in painpatterns regarding different aspects of trauma injuries in these two groups were compared. The pain prevalence was high both on admission and 24 hours later. 51.5% of the study population received analgesics and 77.6% of them reported a decrease in the intensity of their pain. Only half of the patients, who did not receive any medication, reported a decrease in their pain intensity after 24 hours. The most beneficial policy to manage the acute pain was a combination therapy of the injury treatment and a supplementary pharmacological intervention. Pharmacological management of pain in patients with trauma is shown to be significantly beneficial for patients as it eases getting along with the pain, and still seems not to affect the diagnostic aspects of the trauma. Pain management protocols or algorithms could potentially minimize the barriers in current pain management of patients with trauma.

To determine the correlation between the success rates of the cardiopulmonary cerebral resuscitation (CPCR) and the team’s leader education and skill level in Shiraz, southern Iran. This cross-sectional study was conducted during a 6-month period from October 2007 to March 2008 in Nemazee hospital of Shiraz. We included all the patients who underwent CPCR due to cardiopulmonary arrest in emergency room of Nemazee hospital during the study period. We recorded the rates of return of spontaneous circulation (ROSC) and discharge rate (DR) of all the patients. The correlation between these two parameters and the team leader’s education and skill level was evaluated. Overall we included total number 600 patients among whom there were 349 men (58.1%) and 251(41.8%) women with mean age of 58.9±42.6. We found that 270 (45.1%) patients had ROSC, while 330 (54.9%) patients died. Overall 18 (6.6%) patients were discharged from hospital (3% of all participants). We found that the ROSC was significantly higher in those with specialist leader (anesthesiologist or pediatrician) when compared to those in whom CPCR was conducted by technicians (55.2% vs. 30.7%; p=0.001). Conducting CPCR by persons with higher medical degrees resulted in higher rate of ROSC but not in more discharge rate. Inspite of the fact that the rate of ROSC following CPCR was closely analogous to that of developed countries, discharge rate was lower. This indicates that in our region, much more attention needs to be paid to post-resuscitation care and organizing training programs and to cover more resuscitation by CPCR team, conducted by the specialists.

To investigate the effects of intravenous infliximab in preventing the formation of peritoneal adhesions in an animal model of rat. This was an experimental study being performed in animal laboratory of Shiraz University of Medical Sciences during 2012. Sixty albino rats were randomly assigned in to three groups by Random Design Method. The first group received single infliximab injection (n=20), the second one received double infliximab injection (n=20) and the third received nothing (n=20), after receiving intra-peritoneal injection of talc for induction of peritoneal adhesions. All the animals were sacrificed after 6 weeks and the peritoneal adhesions were evaluated according to Nair classification. We observed that the mean adhesion grade was lower in those who received double dose of infliximib when compared to single dose and controls. However the difference did not reach a significant value (p=0.178). The grade of peritoneal adhesion was also comparable between the three study groups (p=0.103). The mean number of 1st WBC count was also comparable between three study groups (p=0.382). We observed that 2nd WBC count was also comparable between two study groups (p=0.317). Administration of intravenous infliximab after intraabdominal surgicalprocedures would not prevent the formation of peritoneal adhesions in animal model of albino rat.

Cancer is one of the chronic diseases, which increases the risk of depression. The main causes of depression among these patients are pain due to metastasis, limited social activities and disability. The aim of this research was to determine the prevalence of depression and relevant factors in patients with cancer referred to Shiraz Nemazee hospital for chemotherapy and radiotherapy.Patients and This was a cross-sectional study on 260 patients with cancer. To diagnose depression, the Beck questionnaire was used. To analyze data, logistic regression was more appropriate than the univariate analysis, because it simultaneously considers the effects of each of the predictors. The prevalence of depression was 47.4%. There was a statistically significant association between depression and income (P < 0.001), family history of depression (P = 0.001), satisfaction with her or his condition (P < 0.001), disease duration (P < 0.001) and education (P = 0.025). Logistic regression revealed that the main effective factors were disease duration more than five years (OR = 5.9, P = 0.013), lack of satisfaction with her or his condition (OR = 19.6, P < 0.001) and family history of depression (OR = 2.4, P = 0.049). Consultation sessions are necessary to reduce depression of patients with cancer. Since depression may reduce quality of life and reaction to treatment, curing depression may relatively reduce side effects of disease for patients to have less pain and problems.

To compare and evaluation of scores of trauma research center of Shiraz University of Medical Sciences in Iran with other trauma research centers in Iran. The assessment scores of each center were gathered from Iran medical research and Ministry of Health and Medical Education website. Each score is recorded in helical year which is defined from the 21th of March of every year until the 20th of March of the next. They are ranked and scored by knowledge production, capacity development, and research projects. The total evaluation scores of the trauma research center of Iran's Universities of Medical Sciences have increased from establishment. The highest increase in assessment scores was related to Tehran Trauma Research Center. An upward trend was observed in the total indicators of knowledge production index of all the trauma research centers from 2001/2002 to 2011/2012. An ascending trend was showed in the published articles score of Shiraz and Kashan Trauma Research Centers through the recent years. The increasing trend in scores of trauma research centers in Iran indicated a significant role in the knowledge production but it is need to find barriers of research and doing interventional projects to promote trauma care and prevention.

There are many descriptive studies on osteoporosis in Iran, mostly assessing the prevalence of the disease and its associations with various risk factors. In order to gain a better insight into the epidemiology of osteoporosis in Iran and its heterogeneity around the country, we systematically reviewed all the studies available and analyzed their findings using meta-analysis methods. All published papers in Iranian and international journals, final reports of research projects, papers presented in relevant congresses, and all dissertations of medical students were reviewed using standard methods and sensitive keywords. After Quality Assessment the main results of studies published during 2000-2008, which met the eligibility criteria, were extracted and Combined with the Random Effect Model, and were entered into meta-analysis. In 21 primary, eligible studies, minimum and maximim prevalence rates in the femur region were 1.5 and 43 respectively and in the Spinal Region these values were 3.2 and 51.3, respectively. The prevalence of osteoporosis in the femur using the Random Effect Model in Iranian Women was 18.9 CI (15- 22.7) and in the Spinal reqion was 18.91 CI (14.6- 23.2) in metaregrresion analysis, with place and sample size as the main heterogenous factors.(p<0.01) Osteoporosis, an important health challenge, increases with age and changes in life style. The prevalence of osteoporosis in Iran, compared to other countries, was lower.