Effect of ultrasound parameters of benign thyroid nodules on radiofrequency ablation efficacy.

BACKGROUND AND AIM: Ultrasound-guided radiofrequency ablation (RFA) is a minimally invasive therapy for thyroid nodules (TNs). Understanding the determinants of RFA efficacy can improve treatment and prognosis. This study aims to investigate the relationship between ultrasound parameters of benign TNs and the efficacy of RFA. METHODS: A pretest-posttest interventional study was conducted in 2021 on 250 randomly sampled patients with benign TNs, receiving RFA. For this purpose, the volume reduction (VR) and the VR ratio (VRR) of the nodules were measured at the 1-, 3-, 6-, and 12-month follow-up periods after the RFA completion. The technical success rate (TSR) of this procedure was then categorized into four states, including low (VRR < 25%), moderate (VRR = 25-49%), high (VRR = 50-74%), and very high (VRR ≥ 75). Ordered logistic regression (OLR) was further utilized to investigate the effect of the ultrasound parameters of TNs on the TSR. The analyses were notably performed using Stata 14.2. RESULTS: The VRR at the 1-, 3-, 6-, and 12-month follow-up periods were 38.7%, 53.6%, 59.3%, and 59.9%, respectively. The mean VR was also statistically significant at all follow-ups (p < 0.001). At the 1-, 3-, and 6-month follow-up periods, the VR of over 50% was observed in 28.2%, 52.1%, and 65.2% of the nodules, respectively. The odds ratios (ORs) of the RFA success were found to be 4.3 times higher for the nodules in the left lobe compared to the right lobe (OR: 4.31, p = 0.002), 6.3 times greater for isoechoic nodules compared to hyperechoic nodules (OR: 6.39, p < 0.001), 6.2 times higher for hyper-vascular nodules compared to hypo-vascular nodules (OR: 6.25, p = 0.005), and 2.3 times greater for mixed nodules compared to solid ones (OR: 2.37, p = 0.049). CONCLUSION: The ultrasound parameters of TNs had a statistically significant effect on the efficacy of RFA. Small-sized, isoechoic, and hyper-vascular nodules, as well as those with mixed tissue, were observed to respond better to RFA, leading to a better prognosis in terms of VR after treatment.

Relationship between hysterectomy and severity of female stress urinary incontinence.

BACKGROUND: Stress Urinary Incontinence (SUI) is one of the most reported health dilemmas of women suffering from lower urinary tract symptoms. AIM: To determine the relation between hysterectomy and severity of female SUI using Valsalva Leak Point Pressure (VLPP). METHODS: This case-control study was conducted at a public urology clinic in Tehran in 2015. The study population was all female with SUI complaints who visited the clinic during 2015. We compared Valsalva leak point pressure in two groups of female SUI patients with and without hysterectomy history. The inclusion criteria were: not taking any alpha-blocker or anti-cholinergic medicines two weeks prior to the urodynamic test as well as no history of pelvic surgery or cesarean delivery in their lifetime. All qualified patients were invited to participate in the study randomly, and among them, 120 qualified patients agreed to participate by filling out the informed consent form. Data was gathered through direct interview, and double checked by patients' medical records. All the study variables including age, BMI, delivery number, hysterectomy and UTI history were entered and analyzed by estimating ordered logistic regression and by using Stata14.1 software. RESULTS: The mean of VLPP was 70.17 cmH2O in the group with hysterectomy history, and 94.55 cmH2O in those without hysterectomy history. The difference of VLPP pressure between the two studied groups were significant (p<0.05), even after control of confounding variables. Also, the odds of severe SUI among hysterectomy group patients was 6.3 times more than no hysterectomy (OR=6.32, p<0.001). CONCLUSIONS: Our study confirms significant relation between hysterectomy and SUI severity measured by Valsalva leak point pressure. Hysterectomy patients are more likely to suffer from more severe grades of SUI.

Could Urinary Tract Infection Cause Female Stress Urinary Incontinence? A Clinical Study.

BACKGROUND: Stress urinary incontinence (SUI), the most common type of urinary incontinence (UI), is usually defined as leakage of urine during movement or activity which puts pressure on the bladder, such as coughing, sneezing, running or heavy lifting. It is reported in most countries that 15% to 40% of women struggle with SUI and its severe implications for daily life, including social interactions, sexuality, and psychological wellbeing. OBJECTIVES: The aim of our study was to assess the relationship between urinary tract infection and the severity of stress urinary incontinence (SUI). PATIENTS AND METHODS: This research was a cross-sectional study conducted in a public urology clinic in Tehran. The study population was all females with complaints of SUI who visited the clinic during 2014. We compared Valsalva leak point pressure (VLPP) in two groups of patients, with and without history of urinary tract infection (UTI). RESULTS: According to the findings of our study, the mean VLPP was 83.10 cm H2O in the group with UTI history, and 81.29 cm H2O in those without history of UTI. The difference in VLPP between the two groups was not significant (P < 0.05), even after controlling for confounding variables including age, body mass index, history of hysterectomy and number of deliveries. CONCLUSIONS: Our study did not confirm a significant relationship between UTI and severity of SUI as measured by VLPP. A decisive opinion would require extensive future studies by prospective methods.

A study on the factors affecting the prescription of injection medicines in Iran: a policy making approach.

BACKGROUND & AIM: Inappropriate prescribing injection medicines can reduce the quality of medical care, patient safety, and leads to a waste of resources. Sufficient evidence is not available in developing countries to persuade policy-makers to promote rational drug prescription. The objective of this study is to assess some factors affecting the prescription of the injection medicines in Iran. METHODS: In this descriptive-analytic study, the data of 91,994,667 selected prescription letters were collected by the Ministry of the Health and Medical Education (MOHME) throughout the country at the year 2011 which were analyzed through a logarithmic regression model. RESULTS: Results of the study show that the percentage of the prescription letters containing injection items varied from 27 percent (in Yazd) to 57 percent (in Ilam). Also the impact of price on the prescription of the injection medicines was not significant (P=0.55). But the impact of the prescription of antibiotics and corticosteroid on injections were significant (P>0.05) and equal 0.44 and 0.65 respectively. CONCLUSION: Increasing price of injection medicines as a policy towards reducing consumptions cannot be a successful policy. But reducing the use of antibiotics and corticosteroids can be a more effective policy to reduce the use of injection medicines.