جستجوی مقالات مرتبط با کلیدواژه « Clinical Presentation » در نشریات گروه « پزشکی »

Pancreatic neuroendocrine tumors (P-NETs) constitute a subset of pancreatic mass lesions characterized by diverse clinical presentations. Despite their inherent malignant potential, the timely identification and treatment of these tumors are critical for achieving favorable clinical outcomes. This study aims to shed light on the heterogeneous tumor biology of P-NETs and the management strategies employed at a tertiary care center in Pakistan.

A retrospective study encompassing all patients with a biopsy-confirmed diagnosis of P-NETs at Shifa International Hospital between January 1st, 2016, and June 30th, 2021, was conducted. Meticulous data extraction from pathology records and thorough searches of medical records were performed to gather relevant demographic and clinical information.

A total of 24 patients were retrieved from our database, with 13 (54%) female patients. The mean age was 49.5 ± 16.3 years. Eight out of the 24 patients presented with abdominal pain. Most patients (14 out of 24) had lesions in the pancreatic head region. In three cases, lesions exhibited multicentricity. The mean lesion size measured 4.4 ± 2.3 cm. Three of the 24 patients displayed distant liver metastasis at the presentation time. 19 out of the 24 patients underwent surgical resections, while endoscopic ultrasound (EUS)-guided biopsy was performed in 4 out of 24 cases. EUS-guided tissue biopsy yielded accurate diagnoses in all four cases.

Most P-NETs are non-functional, and there is an almost equal distribution between male and female patients. Solitary lesions predominate, and metastasis is uncommon at initial presentation. EUS-guided fine needle biopsy stands out as a dependable diagnostic modality for P-NETs.

The most important diagnostic indicator of Acute Coronary Syndrome (ACS) is typical clinical symptoms, like chest pain, but many patients may experience nonspecific (atypical) symptoms. Understanding these symptoms and their associated factors results in early diagnosis and more appropriate treatments.

We aimed to determine atypical clinical symptoms and their predictors in patients with Acute Coronary Syndrome.

This cross-sectional study was conducted on 1167 patients with ACS hospitalized at a specialized hospital in Rasht City, Iran, between December 2019 and October 2020. The research samples were selected by a consecutive sampling method. Data were collected through a researcher-made questionnaire by interview, in which sociodemographic characteristics, risk factors, disease-related factors, and symptoms of patients with ACS were collected. Data analysis was done by descriptive statistics and multiple logistic regression by the backward LR (likelihood ratio) method. The significance level was set as P<0.05.

In this study, 56.3% of the patients were male. The Mean±SD age of the patients was 60.9±11.1 years. About 28.1% of the patients experienced atypical clinical symptoms. The most common atypical symptoms were shortness of breath (29.4%), back pain (18.3%), and left shoulder pain (12.7%). The predictors of atypical symptoms were age (OR=0.98, 95% CI; 0.975 - 0.999, P=0.047), alcohol use (OR=1.86, 95% CI; 1.047 - 3.303, P=0.034), brain diseases (OR=2.36, 95% CI; 1.463 - 3.811, P=0.001), blood diseases (OR=1.45, 95% CI; 1.059 - 2.002, P=0.021), and gastroesophageal reflux (OR=1.31, 95% CI; 1.006 - 1.719, P=0.045)

Since more than a quarter of ACS patients have unusual symptoms, detecting these symptoms and related factors can help in early diagnosis and conduct more appropriate medical treatment.

 Ovarian tumors are mostly detected in advanced stages. Early diagnosis of malignant ovarian germ cell tumors is so vital to keep life and fertility of the patients. We aimed to find out different presentations of malignant ovarian germ cell tumors based on age, parity and histology to help early diagnosis of the tumors. 

 In this study, malignant ovarian germ cell tumors admitted in a referral center of gynecology oncology were studied 2001-2018. The symptoms and signs of the patients were collected and analyzed according to age, parity and specific histology. 

 128 cases of malignant germ cell tumors were detected. The primary symptoms included abdominal distension (45%), acute pain (40.95%), chronic pain (23.95%), menstrual irregularity (14.7%), sense of abdominal firmness and mass (7.72%), nausea (5.4%), fever (5.4%), lack of appetite (4.63%), virilization (3.1%), depletion of weight (3.1%), and 9.27% detected incidentally. Abdominal distension, and acute pain decreased after 24. Menstrual disorders and incidental detection in multiparas were significantly more than nulliparous (p<0.05). Abdominal distension was the prominent sign in dysgerminomas (50%). Almost 45% of immature, yolk sac, and mixed tumors referred with acute abdominal pain. The data showed that 85% of the patients had been suffering from some discomforts for days to months prior to the diagnosis. 

 The majority of cases are symptomatic for a long time before the first visit although aging and parity can lessen their severity. Late diagnosis can lead to acute abdomen in some histology types. Young women and health providers should be warned about concerned presentations of ovarian tumors.

APECED is a rare autosomal recessive disease, caused by mutations in the AIRE-gene resulting in a failure of T-cell tolerance, clinically characterized by multiple autoimmunopathies. The objective of the study was to determine the clinical and genetic features and consequences of APECED in a single-centre Ukrainian cohort of patients.

Out of five families, eight patients with APECED were included in the study. Family history and clinical information of each patient was collected; laboratory studies aimed at identifying endocrine disorders, other autoimmunity, and infections was done. Genetic testing by NGS was performed in four out of five families. Patients were included in the study after the written informed consent had been signed by their parents/legal guardians.

In most patients, the onset of the disease was noted in childhood with manifestations of hypoparathyroidism and/or candidiasis. Adrenal insufficiency was associated later. Diabetes mellitus, hypothyroidism and hypogonadism were observed as other endocrinopathies. Five of eight patients (62.5%) developed autoimmune hepatitis, two patients suffered from autoimmune lung lesions, and two developed enteropathy. Two patients were diagnosed with brain damage: psychosis and autoimmune encephalitis. All the patients that we examined were homozygous carriers of the Finn major mutation R257X (c.769C> T) of the AIRE gene.

One or two endocrinopathies in combination with recurrent candidiasis are the key to a diagnosis of APECED. Most patients also develop organ autoimmunopathy. The mutation R257X (c.769C> T) of the AIRE-gene is predominant in the population of western Ukraine.

The Novel coronavirus, sars-cov-2, is responsible for the recent pandemic. Although it mostly affects adults, children of all ages, including neonates, can become ill with Covid-19, as well. The real prevalence rate of coronavirus disease 2019 (COVID-19) in children is unknown. However, the severity of symptoms in children and neonates is less than in adults. Regarding the new presentation of this disease, the current study has reported a case series of COVID-19 in neonates.

In this article, 10 neonates with COVID- 19 admitted to our neonatal intensive care units are reported. All reported neonates had general suspicious symptoms of COVID- 19 with positive results for SARS-CoV-2 assessed by polymerase chain reaction (PCR) from the nasopharynx area or nose of the patients. All neonates, except for two of them, were term neonates. One case had open-heart surgery for congenital heart disease (transposition of the great arteries (TGA)). The mean patients age was 7.8 days on admission. The most frequent symptom was fever. Severe respiratory symptoms were reported in two cases. Also, abnormal radiologic findings in the chest X-ray were detected in two cases. Regarding the lack of significant respiratory symptoms in most of the patients, the lung computed tomography (CT) scan was taken just from one neonate. Leukopenia (WBC < 5000/mm3) was detected in one case, with no lymphopenia in all neonates. The positive C-reactive protein test was not found in all cases. No patient was treated by special anti-viral agents for COVID-19, and usual antibiotic treatment for neonatal sepsis was administered for all cases. All patients, except for one, survived with no significant sequela of the disease.

This study demonstrated that clinical manifestations, as well as laboratory and radiologic findings of COVID-19, are milder in neonates than in the older ages. Hence, it can be argued that the prognosis of COVID-19 in the neonatal period is generally good.

Although COVID-19 in pregnant women and their neonates has been verified, its impact on neonates born to infected mothers has remained unclear and there is not enough evidence about how this vertical transmission occurs.

In this case report, we explained that a neonate girl was born to a mother with COVID-19 infection. Our main goal was to focus on the follow-up and outcome of the neonate. The neonate was at GA = 28 weeks who was born by cesarean section due to respiratory distress of her mother. Also on day 18, she experienced recurrent unilateral seizures so the sample of her cerebrospinal fluid (CSF) was examined.

The neonate had a positive reverse transcription polymerase chain reaction (RT-PCR) test for COVID-19, while this neonate after birth, due to mother’s positive PCR, immediately was isolated from the operating room. The neonate’s nasal sample was positive for more than 18 days. Twenty-six days after birth, the neonate was re-evaluated for clinical laboratories, all of which were normal and she had favorable outcomes.

In our case report despite the neonate was premature and had seizures, she had favorable outcomes because we quickly started treatment and supportive measures. It is recommended; Symptomatic neonates born to infected mothers must be evaluated for COVID-19 to start proper treatment and quarantine. Additional studies are needed to evaluate the outcomes of COVID-19 in neonates and how to minimize the risk of this disease in neonates.

Oral cancer is a major public health issue worldwide; it remains a highly lethal and disfiguring disease, it is primarily a disease of epithelial origin, it has various clinicopathological pictures. is to demonstrate various clinical and pathological presentations of oral squamous cell carcinoma in Iraqi population.

A total of 80 cases of histologically diagnosed squamous cell carcinoma collected from the main centers of Sulaymaniyah teaching hospital/Hiwa cancer center Hospital/Sulaymaniyah/Iraq were analyzed according to age, sex, site, clinical, and pathological presentation of oral squamous cell carcinoma at the time of presentation, and histological grading.

Patients in their sixth decade of life were the most commonly affected with a male-tofemale ratio of 1.4:1. The tongue was the most frequently affected site, followed by the floor of the mouth. The most common clinical presentation is ulceration and swelling. More than 40% of the cases were well-differentiated squamous cell carcinoma.

Oral cancer is increasingly seen as a major health problem, in line with the general trend in the region, the need for inter-professional health care delivery approaches for reducing oral cancer mortality and improving patients’ quality of life.

 The aim of the present study was to assess clinical characteristics, management, and in-hospital outcomes of COVID-19 among oil refinery workers in a single referral center.

 This cross-sectional study was conducted in a non-COVID single referral center from March to August 2020. At the Naft Grand Hospital, a COVID-19 specimen collection and molecular detection unit was established, and staff were trained how to collect suitable samples (sufficiently deep swabs), store, pack, and transport them. The diagnosis of COVID-19 infection (SARS-CoV-2) was confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR).

 Overall, 500 patients with confirmed COVID-19 infection were included, among whom the most common comorbidities were hypertension (52.2%) and diabetes (45.6%). Moreover, 298 patients (59.6%) had one to three comorbidities; 148 patients (29.6%) had four to six comorbidities, and two patients (0.4%) suffered from seven and more comorbidities. Out of these, 23 patients (4.6%) had cancer, and 206 (41.2%) suffered from other diseases. Most of the patients (390, 78.8%) received Kaletra, and 387 (78.02%) were treated with Azithromycin. Overall, PCR results were positive in 377 (75.4%) patients; computed tomography scan (CT-scan) was positive in 413 (82.6%), and CRP test rendered positive results in 335 patients (67%).

 Most referred cases were survivors with mild to moderate symptoms, and a few of them were unfortunately non-survivors. This could be due to the appropriate responses to treatment and institutional isolation of people with mild COVID-19 symptoms. Thus, good and evidence-based clinical care combined with intense public health interventions will save the lives of thousands, if not millions, worldwide.

 Dengue fever is caused by any one of four types of dengue viruses (DEN1-DEN4), spread mainly by Aedes aegypti. India had the largest number of dengue cases, with about 33 million apparent and another 100 million asymptomatic infections occurring annually. The patients typically present with the sudden onset of fever, frontal headache, retroorbital pain. The laboratory diagnosis can be made by IgM ELISA or by NS1 antigen-detection ELISA during the acute phase. This research was conducted from January 2018 to December 2018 at Sir T. hospital and Government Medical College in Bhavnagar, Gujarat. The patients having complaints of fever, headache, myalgia, arthralgia or rash, were clinically examined, and laboratory investigated for dengue with NS1 and/or IgM dengue antibody. A total of 536 patients was screened, of which 112 patients were diagnosed as dengue fever at 21% dengue positivity rate, based on detection of NS1 (46/304, 15%), and anti-dengue IgM (66/232, 28%) in their sera. The majority of the patients were males (77/112, 69%). The majority of patients were in 11–30 years’ age group (66/316, 21%). Fever (100%) was the chief presenting complaint, followed by headache (83, 93%), and myalgia (79, 89%). The highest number (28) of dengue patients was observed in the month of October 2018. According to this study results, the physicians in the dengue-endemic area should be aware of dengue in acute febrile illnesses and use the appropriate laboratory tests such as NS1 antigen and IgM antibodies for early dengue diagnosis. This can help clinicians to prevent morbidity and mortality associated with dengue.

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.

The Human Immunodeficiency Virus (HIV) has long been known to alter the clinical presentation of tuberculosis (TB), which varies according to the time of occurrence of TB infection and the level of immunodeficiency. Identifying variations in clinical features in HIV-TB coinfection might be helpful in settings with limited diagnostic facilities. The aim of this study was to assess the clinical presentation of TB in HIV coinfection and associate clinical findings with level of immune suppression (CD4 count). In this prospective, cross-sectional observational study 110 patients having TB-HIV co-infection were assessed for clinical presentation and correlation with CD4 count. The study setting was a tertiary care teaching hospital. Patients were categorized in three group based on CD4 counts as group I: ≤ 100 cells/cmm, group II: 101-200 cells/cmm and group III: > 200 cells/cmm. 110 patients were enrolled, 70% had CD4 cell count < 200 cells/mm3. Mean age and CD4 cell were 33.82±8.79 years and 181.7cells/cmm, respectively. Most common form of tubercular involvement was pulmonary (56.4%) followed by combined pulmonary and extra-pulmonary involvement (28.2%) and exclusively extra-pulmonary (15.5%). No significant intergroup difference was observed in site of involvement among three groups (p=0.700). Cough (91.8%) followed by low grade fever (85.5%), anorexia (82.7%) and weight loss (66.4%) were the commonest presenting symptom without any significant inter group difference. 70.9% patients were in undernourished category and 53.6% were febrile on examination. Sputum negative TB was noted 53.8%. 72.0% of patients with CD4 counts ≤100 had sputum negative TB as compared to sputum positive TB (28%). Due to varied clinical presentation of TB in HIV patients, ample knowledge of the clinical spectrum at different levels of immunosuppression is absolutely necessary to identify such patients early. Key words: HIV infection, TB, Clinical presentation, Immune-suppression, Acid Fast Bacilli

Chediak-Higashi syndrome (CHS) is an inherited primary immunodeficiency with an autosomal recessive pattern which is usually identified by partial albinism and frequent pyogenic infections. Herein, we report the interesting case of childhood onset with the main presentation of chronic diarrhea which was treated with dexamethasone and various antibiotics for achronic fever. The patient was givenetoposide once a week and intravenous immunoglobulin monthly thereafter, which caused partial shrinkage in the size of the liver and spleen and improved the patient’s clinical condition. Since CHS is invariably lethal after entering the accelerated phase and early diagnosis may facilitate bone marrow transplantation as the only curative treatment, careful examination in unusual patients without multiple recurrent infections or diagnosed hemophagocytic lymphohistiocytosis should be considered.

Considering the fact that there are no reports about the clinical presentations and outcome of Guillain-Barré syndrome (GBS) in our region, we aimed to report some mentioned findings in children diagnosed with GBS in Isfahan, Iran.
In this retrospective study, pediatric patients diagnosed with GBS were enrolled.The following information were extracted from the medical files of patients; age, gender, early signs and symptoms of GBS, neurological features, sensory and motor and autonomic involvements, sphincter dysfunction, bulbar muscle involvement, respiratory failure, cranial nerve paralysis, delay time from onset to definite diagnosis and management of GBS and the outcome.
During this study, 57 children with GBS aged 1-13 years were evaluated. Frequency of GBS was significantly higher in boys than in girls (38.6% vs. 61.4%, P=0.01, OR=0.39). The most common clinical presentations were distal lower limb weakness (92.11%), reduced deep tendon reflex (DTR ) (82.46%) and neuropathic pain (75.44%). 92.9% of patients had complete recovery.
The findings of this study indicated that distal lower limb weakness, reduced deep tendon reflex and neuropathic pain are the main clinical presentation in children with GBS but in some patients DTR may be normal or even exaggerated in early stage of disease. This finding suggests that revising the diagnostic criteria for GBS may be necessary. Most of our patients had complete recovery. The only death was due to autonomic involvement.

Background/ The aim of the present preliminary study was to assess the demographic, clinical, paraclinical, microbiological, echocardiographic, and therapeutic profile as well as in-hospital outcome of patients with infective endocarditis at a referral center for various infectious diseases in Iran.
Required demographic, clinical, plausible complications and paraclinical data were collected from patients’ medical charts. Echocardiographic findings were obtained by performing transthoracic and/or transesophageal echocardiography as clinically indicated. In addition, details of management modalities and in-hospital outcome of patients were recorded.
During a 3-year period, 55 patients with definite or possible diagnosis of Infective endocarditis were admitted to the ward. Twenty one (38.2%) patients were injection drug users. Staphylococcus aureus and S. epidermidis were the most commonly isolated microorganisms. Management modalities of Infective endocarditis included antimicrobial therapy alone (48 cases) and the combination of antimicrobial therapy and surgery (7 cases).
The rate of negative blood culture in our cohort is high. S. aureus and S. epidermidis were the most commonly isolated microorganisms from positive blood cultures. Congestive heart failure was the most frequent infective endocarditis complication as well as indication for surgery. In-hospital mortality rate of patients was unexpectedly low.

To determine the epidemiological, clinical, laboratory characteristics as well as outcome of 411 patients with bowel obstruction in Southern Iran. This was a cross-sectional study being performed in Shahid Faghihi hospital of Shiraz between 2006 and 2012. We reviewed the medical charts of the 411 patients with initial diagnosis of bowel obstruction who were admitted to our center during the study period. The patients’ demographic, clinical and laboratory findings as well as their management and outcome was recorded in data gathering forms. The data were then analyzed according to the outcome and clinical characteristics. Among the 411 patients with initial diagnosis of bowel obstruction, 253 (61.5%) were men and 158 (38.5%) were women. The mean age of the patients was 48.2±19.7 years. Besides, 73.6% were observed and 26.4% were operated. Those who were operated had those who underwent operation had significantly lower frequency of obstipation (28.1% vs. 71.9%; p=0.045) and abdominal distention (32.3% vs. 67.7%; p=0.007). Intraoperative findings included adhesion band formation in 50 (48.1%), mass 18 (17.3%), and hernia 7 (6.7%). We found that the frequency of malignancy was significantly higher in those who were managed conservatively compared to those undergoing operation (64.3% vs. 35.7%; p=0.042). The mean hospital stay was significantly higher in those who underwent operation (8.1 ±7.5 vs. 2.6±2.2 days; p=0.035). The results of this study demonstrates although some signs and symptoms, such as abdominal pain, vomiting, abdominal tenderness, abdominal distention, and obstipation, were more common among the patients with bowel obstruction, they were not sensitive and specific enough for definite diagnosis. Due to the lack of positive predictive value of clinical signs and symptoms in diagnosis of bowel obstruction, a reasonable and logical modality is needed for bowel obstruction diagnosis with better accuracy.