Acta Medica Iranica
Volume:61 Issue: 1, Jan 2023

Laryngeal cancer is the most common malignant neoplasm in respiratory tract after lung cancer. The incidence is very different and male to female ratio has been decreased in previous decades. Different characteristics of laryngeal cancer in men and women have been described based on previous studies, so we decided to study its characteristics in Iranian women. This study's design is cross-sectional retrospective from 2010 to 2019 in Amir-Alam Hospital, Tehran University of Medicine. All patients with laryngeal cancer admitted to this hospital, were included. Females` records were studied exclusively. Among 1456 patients included in this study, 1391 were male and 65 were female(M/F=21.4:1). The mean age of males was 60.6 years and for females was 56.6. From 65 females, 60 were Squamous cell carcinoma and 5 were Sarcoma. Findings of 60 female SCC patients: The main risk factors were cigarette smoking and opium abuse. The subsite of tumor was supraglottic in 40%, glottis in 31% and transglottic in 29%. Treatment options were surgical (55%) and non-surgical (45%). Survival rates for one, two and five years were 84.3%, 67.4% and 44% respectively. Two-year survival of surgically treated patients is significantly better than non-surgically treated patients (P=0.048). The mean age of females was less than males. Two-year survival rate was better in surgically treated patients. The five-year survival of female patients was 44% and there is an emerging need for survival studies of male patients for comparison.

Since the ancient times when human beings started to teach and learn, effective teaching is a matter of attention. In this regard, considering effective teaching in graduate courses and programs is critical and there are key points that must be considered by the faculty members and educational institutes. The present study is an attempt to investigate the experiences of faculty members of medical education regarding effective teaching in the medical education Ph.D. program offered in Iran. In this qualitative research, the study participants were faculty members of two national public medical universities of Iran who taught at the medical education centralized Ph.D. program developed by Iran Ministry of Health and Medical Education. The data were collected through semi-structured interviews and the gathered data were analyzed via conventional content analysis. The data analysis indicated five general categories including “the philosophy and characteristics of the Ph.D. program”, “concept of effective teaching in the Ph.D. program”, “facilitating factors of effective teaching and learning”, “inhibiting factors of effective teaching” and “An educational design appropriate for the Ph.D. program”. Based on the views of teachers of medical education, for effective teaching in this Ph.D. program there are diverse requirements such as familiarity with the philosophy, mission, vision, and characteristics of the program, facilitating and inhibiting factors of effective teaching and learning in the Ph.D. post-graduate program, and choosing an appropriate strategy to promote teaching and learning via the program.Based on the findings of this study, to conduct faculty development teacher training programs, training of medical instructors is not only an absolute need but also is severely recommended.

Given the strong evidence of direct invasion of coronavirus to myocardial tissue, as well as increasing the patient's susceptibility to inflammatory and thrombotic phenomena, it has been hypothesized that elevated levels of cardiac enzymes can predict disease severity and its poor prognosis. We aimed to determine the value of cardiac prognostic biomarkers along with other laboratory parameters in predicting in-hospital mortality of COVID-19 patients. This prospective study was performed on 30 consecutive patients with the definitive diagnosis of severe COVID-19. On admission, along with recording demographic characteristics, intravenous blood samples were extracted from the patients after at least 8 hours of fasting to evaluate other laboratory parameters. Comparing laboratory parameters across the survived and non-survived groups showed significantly higher mean CK-MB level in non-survived group than alive group (70.90±29.79 versus 43.56±22.02, P=0.020). Also, positive troponin I was reported in 38.1% of non-survived group, while in none of the patients in survived group (P=0.031). Using the logistic regression model, raised CK-MB could effectively predict in-hospital death among COVID-19 patients (OR=1.047, P=0.043). Area under the ROC curve analysis showed high value of raised CK-MB for predicting in-hospital death among COVID-19 patients. Raised CK-MB level on admission can predict in-hospital death in patients with severe COVID-19.

Calculation of dietary fiber quantity (content or amount) at 100 mL or 100 g, 100 kcal, or the reference amount customarily consumed (RACC) improperly indicates the quantity of dietary fiber for some foods. So, choosing some foods in accordance with those quantities may raise the risk of some chronic diseases. Calculation of dietary fiber quantity and assessment of proper dietary fiber levels in accordance with the Codex Alimentarius Commission (CAC), U.S. Food and Drug Administration (FDA), and the suggested method were accomplished in 8,027 foods. Choosing some foods in accordance with the CAC at 100 g or CAC and FDA at serving (the serving is taken from the RACC) to attain enough dietary fiber overstepped energy necessities and could cause obesity or overweight. Choosing some foods in accordance with the CAC at 100 g or CAC at 100 kcal to attain enough dietary fiber did not fulfill dietary fiber necessities and could cause dietary fiber deficits. Some foods that fulfilled dietary fiber necessities were not proper food options in accordance with the CAC at 100 g to attain enough dietary fiber. In the suggested method, the calculation of dietary fiber quantity and assessment of proper dietary fiber levels in foods are accomplished with consideration of RACCs and the energy quantity of foods. Hence, choosing foods in accordance with the suggested method fulfilled dietary fiber necessities and did not overstep energy necessities.

Surgical site infection (SSI) is one of the most important complications of surgery and is known in quality improvement programs as a very important indicator for evaluating the performance of surgeons and hospitals. In recent studies, interesting effects for vitamin D such as antimicrobial effects, wound healing, immune regulation, etc. have been considered and the effectiveness of this vitamin on the above has been proven in laboratory environments and animal models. Therefore, the present study was designed and performed to evaluate the effect of vitamin D tablets before surgery on surgical site infection in patients referred to Shariati Hospital. This study was performed as a randomized controlled trial (RCT) on 200 patients who underwent surgery in Shariati Hospital in Tehran and in the general surgery department between 1397 and 1398. Patients were randomly assigned to two groups of 100 persons, including intervention and control. In all patients, vitamin D levels were measured and recorded 15 days before surgery. The intervention group included patients who received 2 tablets of fifty thousand units of vitamin D seven to ten days before the operation. The second group also included patients who did not undergo any intervention and only in order to maintain blindness of the same size and simultaneously with the first group. They received a placebo. Finally, all patients were followed at intervals of one, three, seven and thirty days after surgery and then compared to the extent of infection at the site of surgery and other desired variables. In this study, 200 persons with a mean age of 47.78 years were examined. 57.5% (115 persons) were female and the rest were male. Overall, 19 (9.5%) of the patients studied underwent surgery at the site of follow-up within one month of follow-up (14 in the control group and 5 in the intervention group). Detection between the two groups was observed in terms of infection (P=0.030). In general, based on the results of the analysis, in the present study, there was a statistically significant relationship between surgical site infection with low serum vitamin D level, increase in the number of hospital days, female gender, wound classification, ASA class of patients and vitamin D consumption before surgery. (P<0.05). The results of this study showed that there is a significant relationship between surgical site infection and consumption of edible vitamin D as well as serum vitamin D levels before surgery so that vitamin D deficiency can be considered as an independent risk factor for infection. Hospitals were considered, including surgical site infections. Therefore, performing preoperative tests as well as performing the required interventions can be very effective in improving this index and reducing surgical site infections.

One of the global crises that people are dealing with today is the COVID-19 pandemic. The outbreak of this disease as a social phenomenon has affected all aspects of life. This study aimed to identify adult people's experiences during the COVID-19 outbreak. This qualitative research was performed with a conventional qualitative content analysis approach in Mashhad, Iran, from April to November 2020. twenty-five participants were selected through a purposeful sampling method with maximum diversity until data saturation was reached. Data were collected using semi-structured face-to-face interviews with open-end questions and analyzed with MAXQDA10 software. Two main categories were extracted (1) difficulties in multiple domains (psychological and informational problems, social challenges, spiritual and religious challenges, and economic problems), (2) adaptation to the epidemic (purposive self-care, ignoring the disease and health instructions, faith in God and optimism). The participants faced extensive challenges, which were made worse by the confusion and ambiguity about the information, quarantine, and social isolation. To continue living, the participants tried to adapt to situations. These results provide a guiding framework for policymaking and intervention.

To determine the prevalence of alloantibodies in patients with thalassemia and its relationship with age, sex, and blood group. A cross-sectional study was conducted on thalassemia patients requiring a blood transfusion presenting to Children’s Medical Center and Bahmari Hospital in 2021. All patients who received blood transfusions in the first year of life were included in the study, and patients with sickle cell anemia and thalassemia intermedia were excluded. Blood samples were collected, and the level of alloantibodies was measured. One hundred and ninety-five patients were evaluated in this study, of whom 100 (51.3%) were male. The mean age of the subjects was 21.37±8.57 years (range: 1-42 years). The prevalence of alloantibody positivity was 16.41% (11.17-21.65) in all subjects, 19% (11.18-26.82) in males, and 13.68% (6.65-20.72) in females (P=0.318). The mean age of alloantibody positive and negative subjects was 18.94±9.7 and 21.85±8.29 years, respectively (P=0.079). The prevalence of alloantibody positivity was 21.88% (6.73-37.02) in Rh+ and 15.34% (9.75-20.93) in Rh- patients (P=0.364). The prevalence of alloantibody positivity was 13.46% (3.87-23.06) in blood type A, 26.67% (1.32-52.02) in blood type AB, 14.29% (3.25-25.32) in blood type B, and 17.44% (9.26-25.63) in blood type O, indicating no significant difference in this regard (P=0.625). The results showed that thalassemia patients were at risk for alloantibody positivity. Age, sex, and blood type had no significant association with the prevalence of alloantibody positivity. Considering the serious complications of these antibodies, these patients should be continuously screened for the presence of alloantibodies.

Arnold-Chiari type III malformation constitutes the rarest type of all the Chiari malformations. This extremely rare congenital anomaly shows poor prognosis and results in either early death or development of various severe neurologic deficits in the surviving patients. It is characterized by the herniation of hindbrain contents into an encephalocele sac through a bony defect located in the upper cervical or lower occipital region. Magnetic resonance imaging (MRI) is the preferred imaging modality in the diagnosis of this rare congenital anomaly, especially due to its multiplanar capability. In this case report, we described the imaging findings of Arnold-Chiari type III malformation in a newborn male infant. He presented with two huge encephalocele sacs containing dysplastic brain tissues in the upper cervical and lower occipital regions together with various findings related to the disease. Following a right-sided shunt insertion for hydrocephalus treatment, he has undergone a surgical procedure ensuring removal of the encephalocele sacs with primary closure of the bony defects.

Oncocytoma is a common benign kidney tumor. The size is often less than 5 cm. Oncocytomas may be misdiagnosed in clinic, radiology and histopathology for renal cell carcinoma. Different panels of immunohistochemistry (IHC) are suggested in the renal tumors with eosinophilic granular cytoplasm including oncocytoma, chromophobe and clear renal cell carcinoma. Here we report a large oncocytoma in a 64-year-old lady, that the mimickers ruled out by IHC.