mohammad javad fallahi

Spontaneous subarachnoid hemorrhage (SAH) is one of the most common and acute cerebrovascular events. The cause of this bleeding is often brain aneurysms or arteriovenous malformations (AVM). Co-incidence of these two vascular lesions is associated with an increased risk of cerebral hemorrhage. The purpose of the current study is to investigate the prevalence of cerebral aneurysm along with AVM in patients with spontaneous SAH based on computed tomography (CT) angiographic findings.

In this cross-sectional and retrospective research, 122 patients were studied. SAH was confirmed based on the results of the CT scan or lumbar puncture. Causes such as coagulation disorders and trauma were considered as the exclusion criteria. Vascular lesions have been investigated as a possible cause of SAH using CT angiography.

The results of the CT angiography images indicated the prevalence of arterial aneurysm in 18 patients (14.7%), AVM in 11 patients (9%), and simultaneous aneurysm and AVM in 4 patients (3.3%). In addition, there was a significant correlation between the presence of vascular lesions and intraventricular and intraparenchymal hemorrhage.

CT angiography results showed a co-incidence of aneurysm and AVM in 3.3% of cases. Also, cerebral vascular lesions are associated with higher degrees of cerebral hemorrhage and multiply the possibility of intraventricular and intraparenchymal bleeding. Awareness of the prevalence of this co-incidence is essential for timely diagnosis and choosing the appropriate therapeutic approach in these patients.

Chest computed tomography (CT)-derived findings pose clinical value in detecting high-risk COVID-19 patients.

This retrospective cohort study aimed to assess poor hospital prognosis in COVID-19 patients using on-admission chest CT findings.

This study included 166 hospitalized COVID-19 patients with a confirmed diagnosis of COVID-19 from October to December 2020 in Southern Iran. Demographic variables, on-admission clinical and laboratory data, and on-admission high-resolution chest CT (HRCT) such as visual lung involvement score, distribution, area, main pattern, and related features, as well as short-term follow-up during the hospital stay, were extracted. Poor prognosis was defined as ICU admission, need for invasive mechanical ventilation, development of acute respiratory distress syndrome, or death.

The COVID-19 patients with poor prognosis had a significantly higher visual lung involvement score compared to those without poor prognosis (20 [IQR: 14, 23] vs. 13 [IQR: 10, 17]; P < 0.0001). The two groups were not statistically different for other HRCT findings. In a multivariable model, lung involvement score was the only statistically significant independent variable for in-patient COVID-19 poor prognosis (odds ratio: 1.197 [95% confidence interval: 1.064, 1.348]; P = 0.003).

On-admission chest CT findings can potentially be utilized to evaluate prognosis and guide the treatment strategy of hospitalized COVID-19 patients as early as during the emergency ward stay.

Ascitic fluid infection (AFI) is the most common bacterial infection in patients with cirrhosis and has several variants, including spontaneous bacterial peritonitis (SBP), bacterascites (BA), and culture-negative neutrocytic ascites (CNNA).

To date, there has been disagreement about the differences in clinical features and outcomes of these variants of AFI, and there are still few studies in this area.

A cross-sectional study was conducted at a referral hospital from June 2018 to September 2022. All cirrhotic patients with ascites were evaluated for the presence of AFI. Patients with AFI were divided into SBP, BA, and CNNA variants. Non-AFI participants were also evaluated as a comparison group. The outcomes, as well as the clinical and laboratory characteristics of the variants of AFI, were compared. Kaplan-Meier curves and Cox regression analysis were used for survival analysis.

A total of 466 patients were studied, of which 132 (28.33%) were in the AFI group and 334 (71.67%) were in the non-AFI group. In the AFI group, 64 (48.48%) had SBP, 43 (32.58%) had CNNA, and 25 (18.94%) had BA. The most common bacteria causing AFI was Escherichia coli . SBP (HR 2.43; 95% CI 1.36 - 4.36; P = 0.003) significantly increased the risk of mortality, while CNNA and BA did not significantly increase this risk. The presence of hepatic encephalopathy and female gender also significantly increased the risk of mortality.

The mortality risk was higher in patients with SBP compared to other types of AFI. This study also showed differences in clinical characteristics and laboratory parameters among the three types of AFI. Further research is recommended.

Lung cancer (LC) is the second most common and deadliest cancer in the world. Despite the control of the progressive course of LC in developed countries, studies indicate an increase in the incidence of the disease in developing countries. We designed a stepwise approach?based surveillance system for registering LC in our region (fars lung cancer registry “FaLCaRe” Project).

A questionnaire was designed and agreed upon by the steering committee using the Delphi method. Variables innine fields were divided into three groups based on their importance:  ore, expanded core, and optional. The web?based data bank software was designed. The informative site about LC and team services was  esigned and launched for professional and community (www.falcare.org) educational purposes.

545 variables in nine fields were  esigned (20 core variables). Primary data of 39 LC patients (24 men and 15 women) with a mean age of 62 years were analyzed. Twenty?six patients had a history of smoking. Moreover, 39% and 26% of patients had a history of hookah smoking and opium use, respectively. Adenocarcinoma was the most prevalent pathologic findings in cases. More than 80% of patients were diagnosed in stages 3 and 4 of cancer.

FaLCaRe Project with the capabilities seen in it can be used as a model for national LC registration. With continuous valid data registry about LC, it is possible to make decisions at the national level for control and management its consequences while drawing the natural history of the LC.

 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has affected over 200 million individuals worldwide, and finding a treatment to control and eradicate the disease is considered a critical issue. Different drugs and therapies have been used since the beginning of the pandemic; however, effective infection control has not been achieved. Convalescent plasma (CP) that contains immune factors (neutralizing antibodies and inflammatory) can be an effective way to treat some infections, as it was previously used to control the pandemic.

 the present study aimed to assess the effect of CP infusion on some clinical indicators of coronavirus disease 2019 (COVID-19).

 This study investigated the effects of CP treatment on some clinical factors, such as C-reactive protein (CRP), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), and D-dimer among 125 patients in two groups, including a CP-treated group and a non-treated control group, in Ali-Asghar Hospital of Shiraz, Iran.

 Mortality rate analysis between CP-treated and control groups showed a 31% reduction (53% and 84% mortality in CP-treated and non-treated control groups, respectively). In addition, the clinical factor analysis of CP-treated patients showed a significant change in D-dimer on the seventh day (P = 0.036) and oxygen saturation (SpO2) (P = 0.00), lymphocyte count (P = 0.00), platelet (P = 0.005), and ESR (P = 0.007) between the first and fourth days of treatment. Moreover, CP-treated patients were separated into two age groups. It was observed that on the fourth day, the rate of SpO2 and lymphocyte count were significantly different in patients under 50 years compared to patients ≥ 50 years (P = 0.004 and P = 0.011, respectively); a similar finding was shown for lymphocyte count on the seventh day after CP infusion (P = 0.012). The results also revealed a significant difference between males and females in lymphocyte count after CP treatment on the fourth and seventh days (P = 0.006 and P = 0.042, respectively).

 The results demonstrated the potential impact of CP infusion on the laboratory data of COVID-19-infected patients. Accordingly, this method could have a practical effect on reducing and even suppressing inflammation, infection, and mortality rate among these patients. However, further studies are needed to obtain more accurate results.

Malignant pleural effusion is one of the most common complications of advanced malignancies, leading to decreased quality of life and life expectancy. With the advent of new therapies, patients with malignant pleural effusion appear to be living longer than previously thought. In this cohort study,26 patients, with malignant pleural effusion at the initial diagnosis of primary cancer, who were referred to the Lung Cancer Clinic of Shahid Motahari Clinic affiliated with Shiraz University of Medical Sciences , were studied Information on age, sex, tumor type, mortality, survival rate after malignant pleural effusion, EGFR mutation (in lung cancer patients), and metastasis were evaluated. In the present study, 12 patients (46.2%) were male and 14 patients (53.8%) were female. The median survival of patients was 2 years (interquartile range 1-3 years). Five patients (19.2%) had breast cancer, 19 patients (77.1%) had lung cancer, and two patients (7.7%) had lymphoma. The highest survival after diagnosis was related to one of the lymphoma patients (five years). In lung and breast cancer patients, the median survival was two years (interquartile range 1.5, 3) and one year (interquartile range 1, 2.5), respectively. Although the present study was a small single-center study, due to the appropriate lifespan of malignant pleural effusion patients with new therapies, more comprehensive studies are needed to re-evaluate the survival of patients with malignant pleural effusion.

Asthma is one of the most common chronic diseases that cause respiratory problems. Different training programs can effectively alleviate its symptoms and minimize the complications. This study aimed to determine the effect of a training program on asthma control.
This interventional study was performed on patients referred to clinics affiliated with Shiraz University of Medical Sciences. Cases were selected by convenience sampling and divided into two intervention and control groups, each consisting of 29 patients. Before the training program, data were collected using an asthma control questionnaire and a spirometry test, and they were analyzed using statistical tests and software.
The results showed that after the intervention, the mean of all spirometry test indices and asthma control scores of the questionnaire increased in the experimental group. Alterations in the mean scores of the clinical manifestations and spirometry indices (FEV1, FVC, FEV1/FVC, and FEF25%-75%) before and after the intervention in the experimental group were significant. After the intervention, all spirometry indices were increased in the experimental group compared to the control group (p<0.05).
The results showed the effectiveness of teach-back training in managing asthmatic patients. Therefore, this intervention can be used as an effective method to control asthma along with other methods such as exercise and medications.

The predictive equation of the six-minute walk test designed for one population cannot reliably be used for another population. Despite introducing multiple prediction equations, there is no local such equation for our country, Iran, presently.

In this cross-sectional study, we included 116 (65 males) healthy Iranian adult subjects to measure six-minute walk distance (6MWD), define influential factors, and formulate a native predictive equation. All the studied cases aged between 20 to 50 years old. We performed 6MWT according to the guideline of American Thoracic Society.

The mean value of 6MWD was 629.98 ± 81.38 meters, (ranged 421 to 729). On average, men walked 114.29 meters more than women that was statistically significant. Moreover, 6MWD had a direct correlation with subjects’ height (r = 0.627, P < 0.001); however, it had an inverse correlation with their age (r = -0.303, P < 0.001) and weight (r = -0.218, P = 0.019). Multiple regression equation derived this formula: 6MWD = 485.25 – (99.42 × sex male = 0, female = 1) + (2.791 × height cm) – (1.614 × weight) – (1.273 × age year), which explained 61% of variability. We observed that most other countries’ predictive equations could not be reliably applied to our population.

In this study, we measured 6MWD in a healthy middle-aged Iranian population and proposed a native predictive equation, which might trigger further research and application of this simple and inexpensive test in our country.

 Pulmonary thromboembolism (PTE) is a leading cause of maternal mortality. However, diagnosis of PTE can be challenging during pregnancy, and there is no consensus regarding the best diagnostic approach.

 The current study aimed to evaluate the applicability of clinical symptoms and diagnostic tests in ruling in or ruling out PTE during pregnancy.

 In this one-year, cross-sectional, descriptive study, we evaluated pregnant or postpartum (six weeks postpartum) women suspected of PTE, who were admitted to the internal medicine intensive care units (ICUs) of hospitals (Namazi and Shahid Faghihi hospitals), affiliated with Shiraz University, Shiraz, Iran, during August 2016-July 2017. The participants underwent electrocardiography (ECG), serum troponin-I and D-dimer measurements, chest X-ray, color-doppler sonography (CDS) of the lower extremity venous system, transthoracic echocardiography, pulmonary perfusion scan, or pulmonary computed tomography angiography (CTA). The participants’ clinical manifestations were also assessed.

 A total of 103 women, with the mean age of 30.37 ± 5.35 years, were included in this study. Seventy-seven women underwent pulmonary CTA or pulmonary perfusion scan. PTE was documented in nine cases. Dyspnea was the most common symptom. The respiratory rate, cough, dizziness, and fever on admission had significant correlations with the final diagnosis of PTE (P = 0.01, 0.03, 0.007, and 0.04, respectively). The ECG study of one case with PTE showed right axis deviation, while the ECG findings of the other eight cases showed no specific pattern. The chest X-ray findings had no significant correlation with the final diagnosis of PTE. Overall, 38 women underwent CDS, one of whom presented with deep vein thrombosis. The serum D-dimer level was positive in three cases with documented PTE (normal in one patient with PTE), and the serum troponin-I level was positive in one case with the final diagnosis of PTE (normal level in two patients with PTE).

 Based on the findings, clinical symptoms and biochemical tests alone are not reliable for ruling in or ruling out PTE during pregnancy, and CTA and pulmonary ventilation/perfusion scan should be performed for these cases.

 Cirrhosis, as the end stage of a variety of chronic liver diseases, can affect oxygenation in patients and make them hypoxic through hepatopulmonary syndrome or portopulmonary hypertension. However, we observed that some patients referring to our center for liver transplantation had high arterial oxygen saturation.

 This study was designed to investigate the presence and association of hemoglobin oversaturation in cirrhotic patients candidate for liver transplantation.

 In a cross - sectional study, cirrhotic patients referring to Shiraz Organ Transplantation Center were included from 2013 to 2015. The exclusion criteria were other disorders that might affect O2 saturation and other causes of liver transplantation except for cirrhosis. Also, we excluded all patients with chest X - ray abnormality. Hemoglobin saturation was measured by arterial blood gas analysis. Patients were divided into two groups, oversaturated patients (Hb sat O2 ≥ 98%) as the case group and patients with Hb sat O2 < 98% as the control group. We compared the case and control groups for the cause of cirrhosis, sex, smoking status, age, spirometry, model for end - stage liver disease (MELD) score, and the place of residence’s altitude. After univariate analysis, logistic regression models were used for multivariate analysis and adjusted for significant and near significant (P value < 0.2) covariates.

 Of 495 patients, 18.6% were oversaturated. Moreover, 64.5% of the control group patients were males versus 58.7% of the case group. The mean age of the control group (40.6 ± 14.7) was significantly higher than that of the case group (36.8 ± 15.7) in univariate analysis (P value = 0.02). Hemoglobin oversaturation was significantly higher in patients with auto - immune hepatitis (AIH) than in patients with other causes of cirrhosis (P value = 0.001). There was no significant difference between the case and control groups in other causes of cirrhosis or other factors. In multivariate analysis, just AIH remained statistically significant in the models (odds ratio = 2.03; 95% confidence interval = 1.13 - 3.65; P value = 0.01). After finding an association between AIH and oversaturation, the drugs routinely used for the treatment of AIH were compared between the case and control groups. No significant difference was found between them in using prednisone, azathioprine, and cyclosporine (P values = 0.5, 0.6, and 0.6, respectively).

 Based on our research, there was an association between oversaturation in cirrhotic patients and AIH. The association was not related to the drugs used for the treatment of AIH.

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Most patients present with steroid hormone excess or abdominal mass effect. Pure androgen-secreting ACCs are rare, while hypoglycemia is an unusual presentation of this malignancy. We present a 26-year-old woman with hypoglycemia and history of adrenalectomy due to a large adrenal mass which was diagnosed as nonfunctional adrenal adenoma. She was admitted in our hospital 10 days after her fetal loss with repeated episodes of severe hypoglycemia. She had a high serum dehydroepiandrosterone sulfate (DHEA-S) and her hypoglycemia was associated with low insulin and C-peptide levels. Imaging revealed liver metastasis and immunohistochemical studies of the biopsied lesions confirmed the diagnosis of ACC.

Some studies show tuberculosis (TB) seasonal pattern. There are only two reports addressing TB seasonal pattern in Iran.

The current retrospective analysis aimed at determining the seasonal distribution pattern of all registered pulmonary TB cases over the recent six years in Fars province of Iran.

All patients with pulmonary TB in Fars province diagnosed from 2006 to 2011 were investigated in terms of gender, age, and the month of definitive diagnosis. Patients with clinical symptoms suggestive of pulmonary TB with at least one documented positive culture or smear for acid-fast bacilli were included.

A total of 934 patients with pulmonary TB with a mean age of 44.3 ± 21 years were studied, of whom 319 (42.2%) were male. The highest proportion of patients were diagnosed in May (10.7%) and June (10.2%) (P = 0.033). More than 29% of the TB incidents occurred during spring. The proportion of patients presenting in spring decreased from 39.7% in 2006 to 28.4% in 2011. Similarly, percentage of patients recorded in summer significantly decreased during the study (P = 0.008).

Pulmonary TB is a seasonal disease in Fars province with peak incidence in warm seasons independent of patients’ age and gender though seasonal fluctuations decreased over the study period.

Jean de La Fontaine – the French poet and author – is one of the most effective literal characters in the world in his era. The literary critics and the researchers know him as one of the greatest fable writers in the world with the aim of educational and instructive works. Ahmad Showqi – the Arab behaviorist poet – who owns many educational and instructive works, is known as a brilliant poet. His Divan contains the fables which were created with educational aims for people, to transmit the behaviors, patriotism and protecting the social values. The present article studies some of these two literary men’s fables.

Venous thromboembolism (VTE) exerts a considerable burden on the health care systems. Although many practice guidelines have been developed regarding prophylaxis and treatment of venous thromboembolism, there is a large gap between the recommendations and the medical practice in health care centers. In this study, we tried to assess adherence of the medical team to guidelines for venous thromboprophylaxis in medical and surgical wards of teaching hospitals affiliated to Shiraz University of Medical Sciences. In this cross-sectional descriptive study, a total number of 500 patients were recruited among hospitalized patients in neurosurgery, orthopedics, general surgery, internal medicine, and obstetrics & gynecology departments and surgical and medical intensive care units. Afterwards, adherence to thromboprophylaxis guidelines was assessed by comparing the medical records of patients with proper indications extracted from the American College of Chest Physicians Guidelines for VTE prophylaxis (ACCP, 9th edition). In other words, for each patient a comparison between proper indications of receiving thromboprophylaxis and the regimen used in practice was made. Out of 472 patients assessed with respect to the appropriateness of the administered prophylaxis, 212 (45.1%) had received proper type of thromboprophylaxis with regard to ACCP guidelines. Orthopedic surgical wards showed the highest rate of appropriateness while neurosurgical wards showed the lowest rate of adherence (76% vs. 1.8%). The overall rate of inappropriateness was 54.9% (260 patients). Inappropriateness was divided into 3 categories: 1) patients had absolute indications to receive thromboprophylaxis but were not provided with any type of prophylaxis in practice (171 patients, 36.2% of total), 2) in presence of absolute indications, incorrect type of prophylaxis was administered (52 patients, 11% of total), 3) in absence of indications for thromboprophylaxis, patients received some forms of prophylaxis (35 patients, 7.4% of total). The findings of the present study showed that prophylaxis are not properly utilized and physicians’ practices vary considerably among different specialties.

Chest tube (CT) or tube thoracostomy placement is often indicated following traumatic injuries. Premature movement of the chest tube leads to increased hospital complications and costs for patients. Placement of a chest tube is indicated in drainage of blood, bile, pus, drain air, and other fluids. Although there is a general agreement for the placement of a chest tube, there is little consensus on the subsequent management. Chest tube removal in trauma patients increases morbidity and hospital expense if not done at the right time. A review of relevant literature showed that the best answers to some questions about time and decision-making have been long sought. Issues discussed in this manuscript include chest tube removal conditions, the need for chest radiography before and after chest tuberemoval, the need to clamp the chest tube prior to removal, and drainage rate and acceptability prior to removal.

Pulmonary embolism is considered as a great masquerader due to its frequent nonspecific signs and symptoms. Typically pulmonary embolism is under-diagnosed or over-diagnosed. In this study a patient with pulmonary embolism is reported in which the patient exhibited two unusual manifestations namely; right upper quadrant abdominal pain and ST-T elevation in anterior precordial leads. Due to the fact that the patient did not display typical pulmonary embolism symptoms and its major risk factors, extensive workup to discern the cause was carried out. The examination included abdominal sonography, kidney ureter and bladder Computed Tomography scan (CT-scan) and coronary angiography. Eventually after a six-day delay, pulmonary embolism was diagnosed by spiral chest CT scan. This case and several other similar reports underlines the fact that while various other common causes may exist for right upper abdominal pain, one should always consider pulmonary embolism as a possible cause especially when backed up with ECG finding.

There is some evidence that showed intradialytic exercise increases dialysis efficacy and removes phosphate. This study examined the impact of intrdialytic exercise on dialysis efficacy, serum phosphate, control of blood pressure and hemoglobin level.In this clinical trial, 14 patient (47/13+/-14/6 years) on hemodialysis (6-180 months), after excluding contraindication, participated for eighth week exercise program in which they pedaled a bicycle at sub maximal workload. Total duration of exercise was one hour in the first two hours of HD. Patients divided into two groups: group A: two parts of 30 minutes exercise. Group B: six parts of 10 minutes exercise. Pre- dialysis blood pressure, URR (urea reduction ratio), sp Kt/V, serum phosphate, calcium and hemoglobin were measured initially, at the end of 4th week and 8th week of study.Two patients discontinued the study. sp Kt/V despite 20% increase at the end of study was not significant. Mean systolic blood pressure decreased 5.4 mmhg that was significant (Pv: 015). There is no significant difference between two groups except in the dose of phosphate binder at the end of first month and the end of study.One hour intradialytic exercise can cause significant reduction in systolic blood pressure. Clinical increase in sp Kt/V and slijht reduction in serum phosphate and hemoglobin level. Two part time of 30 minutes exercise program was more effective to lower the dose of phosphate binder drug. But comprehensive studies are needed to established definite benefits of intradialytic exercise and relative advantages of different exercise programs.