To differentiate benign from malignant thyroid nodule comparison of sonography with FNAC findings.

OBJECTIVES: To evaluate the diagnostic accuracy of sonography and Fine Needle Aspiration Cytology (FNAC). METHODOLOGY: This follow-up study was approved by review board and conducted at Endocrine Clinic and Radiology Department of Imam Reza, Kermanshah. The patients were diagnosed to have thyroid nodule examined by FNA and Sonography suspicious malignant cases underwent surgery. RESULTS were entered in SPSS 11.5 chi-Square and Fisher exact test applied to compare malignant and benign nodule characters. RESULTS: In this study 144 patients were examined and 14 cases (9.7%) had malignant nodule. Most of malignant nodules were single (p=0.001), solid (p < 0.001), hypo-echo (p=0.001), with irregular margins (p < 0.001) and with calcification (p=0.041). There was no significant relationship between malignancy and nodule size of larger than 15 mm (p=0.395). Compared with surgery, FNA sensitivity and specificity were calculated as 92.8% and 100% respectively. CONCLUSION: Based on the result of this study, thyroid nodule size must not be considered as a criterion for malignancy and thyroid nodules of any size must be suspected as malignant. Important criteria for malignancy include irregular edges, being solid, hypoechogenicity and being a single nodule respectively. Compared with Surgery, FNA Sensitivity and specificity were calculated as 92.8% and 100% respectively.

Improving Animal Model of Induced Colitis by Acetic Acid in Terms of Fibrosis and Inflammation Incidence in the Colon.

METHODS: Fifty rats were randomly separated into five groups (n = 10) with different durations (30 s, 5, 10, and 20 min) of exposure of the colon to 4% acetic acid and colitis was investigated for 0-9 days. The extent of the mucosal ulcers, colon tissue thickening, and mucosal bleeding were scored by the Gerald classification system score. Slides of tissues were prepared for pathologic assay using the modified Wallace method. RESULTS: In all groups, inflammation was severe three days after the colitis induction, but no inflammation was observed in the 30 s group after five days. Acid contact with the colon surface did not result in fibrosis for the 30 s and the colon fibrosis was mild in 5 min group and severe in 10 and 20 min groups. The tissue damage was higher in groups of 20, 10, 5 min, and 30 s, respectively. Over time, the recovery rates in the 30 s and 5 min groups were higher than other groups. CONCLUSION: Our results showed that the evaluation of the disease process from 3 days to nine days after a 10 min contact of acid to the colon is a suitable model that mimics the histological features of the disease.

Acute hepatitis with portal and mesenteric vein thrombosis revealing SARS-CoV-2 infection: Case report and literature review.

Novel coronavirus disease 2019 (COVID-19) is a single-stranded RNA virus identified for the first time in Wuhan, China, and it unfurls quickly worldwide. The corona virus 2019 is a systemic disease which develops a prothrombotic environment, and has an extensive spectrum of clinical presentations in the gastrointestinal and hepatobiliary systems. Ischemic hepatitis (hypoxic hepatitis) is one potential mechanism behind lessened perfusion of the liver. The portal and mesenteric vein thrombosis are extremely rare complications and unusual main manifestations of COVID-19. We report the case of a patient presented acute hepatitis with portal and mesenteric vein thrombosis revealing a SARS-CoV-2 infection. In addition, we discuss the most characteristic elements of the Impact of COVID-19 on liver Injury, and the mechanisms of this damage and the formation of thrombus in portal and mesenteric vein.

Plasma lipids and lipoproteins in children and young adults with major ß-thalassemia from western Iran: influence of genotype.

To determine the plasma lipid and lipoprotein profiles and their possible association with the type of ß-thalassemia mutation we studied 103 major ß-thalassemia patients including 71 children and 32 young adults compared to 102 healthy subjects consisted of 90 children and 12 young healthy adults. The plasma lipid and lipoprotein levels were measured by conventional methods. Considering all of the patients the levels of total cholesterol (TC), LDL-cholesterol (LDL-C), and HDL-cholesterol (HDL-C) were significantly lower compared to controls. However, the level of TG was significantly higher in cases than controls. Comparing thalassemic patients homozygous for a ß0 type of mutation with those homozygous for a ß+ type of mutation (IVSI.110 G:A) indicated that the levels of LDL-C, TC were significantly increased and TG concentration tended to be higher in the latter patients. In conclusion, our study indicates that hemolytic stress results in hypocholesterolemia in major ß-thalassemia patients and the presence of more severe genotype in patients is correlated with more reduction in TG, TC, and LDL-C levels.

The effects of selenium and other micronutrients on the antioxidant activities and yield of corn (Zea mays L.) under drought stress.

The effects of selenium (Se) on plant growth under drought stress and in the presence of micronutrients are yet to be investigated. Hence, in a field experiment in 2007 the effects of Se and micronutrients including iron (Fe), zinc (Zn), copper (Cu), manganese (Mn), boron (B) and molybdenum (Mo) were evaluated on corn (Zea mays L.) grain yield under drought stress. Main- and sub-plots were devoted to irrigation (control and water stressed at the eight-leaf, blister and grain filling stages) and micronutrients treatments, respectively. Micronutrients were foliarly applied at 2 l ha(-1) at the six-leaf stage, one week before tasseling, using a corn fertilizer, called biomin containing (on the basis of dry weight percentage) Fe (2.6), Zn (4.1), Cu (1.5), Mn (2.6), B (1.5), Mo (0.5) and Mg (4.1). Se was used as sodium selenite (Na2SeO3), at the rate of 20 g ha(-1) two weeks before treating the plants with drought stress. Effects of drought stress on plant growth were determined based on the activity or level of antioxidants. With increasing the stress level, addition of Se or micronutrients significantly enhanced the antioxidant activity and level as well as corn grain yield. The interaction effects between Se and micronutrients adversely affected antioxidant activity as well as corn grain yield. Se addition at the grain filling stage resulted in the highest grain yield under drought stress. The single but not the combined use of Se or micronutrients can alleviate the unfavorable effects of drought stress on corn yield by affecting plant metabolism including antioxidant activity.

Protective and Therapeutic Effects of Aloe Vera Gel on Ulcerative Colitis Induced by Acetic Acid in Rats.

Ulcerative colitis (UC) is a chronic intestinal inflammation. Common clinical symptoms are weight loss, diarrhea, ulcers, and inflammation. Aloe vera (AV) has several medicinal properties including antioxidant, anti-inflammatory analgesic, and improvement of gastric and skin ulcers. This study aimed to investigate the protective and therapeutic effects of AV gel on acetic acid-induced UC in rats. UC was induced in 48 rats by injection of 4% acetic acid into the rectum. Protective and treatment groups received treatments 7 days before and after the induction of colitis, respectively. The negative control group, the positive control group, and AV groups received distilled water, sulfasalazine, and 50 and 300 mg/kg of gel extract, respectively. Water and food intake and body weight changes were recorded. The extent of the mucosal ulcers, colon tissue thickening, and mucosal bleeding were scored by the Gerald classification system score (microscopy observations). Slides of tissues were prepared for pathologic assay using the modified Wallace method (macroscopic observations). The results of the macroscopic and microscopic examination showed protective and therapeutic effects of 50 mg/kg dose of AV on acetic acid-induced colitis in rats which reduces the inflammation, ulcers and tissue damage compared with negative control (p < 0.05). There were no significant changes in the amount of water and food intake, body weight changes, and colon weight in protective and treatment groups. Based on the results, AV gel could be used to improve the symptoms of UC, as well as prevent people who are susceptible to the UC.

Comparison of the risk factors and HPV types in males with anogenital warts with and without involvement of the urethral meatus in western Iran.

BACKGROUND: Human papillomavirus (HPV)-induced lesions rarely develop in the urethral meatus (UM); however, their eradication can be problematic. METHODS: A total of 22 patients with anogenital warts (AGWs) in the UM region and 22 patients with AGWs located at other anatomical sites were included in this cross-sectional study. The presence of human papillomavirus (HPV) types in biopsy samples was determined using the HPV Easy typing kit (GenID GmbH, Germany). RESULTS: Although the patients in the AGW group with involvement of the UM had a higher incidence of reported multiple sexual partners (63.6% vs. 40.9%), larger meatus size (81.8% vs. 36.4%), and more frequent anal (36.4% vs. 18.2%) or unprotected sexual contact (68.2% vs. 36.4%) than those in the AGW group without UM involvement, only the duration of lesions (p = 0.04) and meatus size (p = 0.004) were significantly different in both groups. Low-risk HPV types were found in 75.0% and 69.2% of patients in the AGW groups with and without UM involvement, respectively. CONCLUSION: We found that a larger UM size was more prone to the development of meatus AGWs; however, being married, delaying sexual debut, and avoidance of multiple sexual partners seemed to be associated with a decreased risk of development of AGWs, especially within the UM region.

Plasma lipids in Iranians with sickle cell disease: hypocholesterolemia in sickle cell anemia and increase of HDL-cholesterol in sickle cell trait.

BACKGROUND: The metabolism of lipids may be altered in sickle cell anemia and beta-thalassemia patients. METHODS: Plasma lipids in 24 patients with sickle cell anemia (SS), 15 patients with sickle/beta-thalassemia (ST), 19 individuals with sickle cell trait (AS) and 62 healthy individuals (AA) were measured. RESULT: Total cholesterol concentrations in both sexes with sickle cell anemia (SS males: 104.7, SS females: 142.7 mg/dl) and sickle/beta-thalassemia (ST males: 116.7, ST females: 137.5 mg/dl) were lower (P<0.05) than AS (AS males: 171.5, AS females: 185.4 mg/dl) and normal individuals (AA males: 173.7, AA females: 183.0 mg/dl). The mean HDL-cholesterol in males with SS (35.6 mg/dl) and ST (40.7 mg/dl) were (P=0.001) lower than AS males (58.9 mg/dl). However, the mean HDL-cholesterol in females with SS (43.2 mg/dl) was lower (P<0.001) than AS females (62.7 mg/dl). The mean LDL-cholesterol of males with SS (53.8 mg/dl) was lower (P<0.01) than AS (89.4 mg/dl) and control males (115.9 mg/dl). Males with ST had a lower (P<0.001) LDL-cholesterol (58.0 mg/dl) compared to control males. In females with SS the LDL-cholesterol (78.3 mg/dl) was lower (P<0.001) than control females (124.3 mg/dl). However, females with ST had lower (P<0.05) LDL-cholesterol (61.6 mg/dl) than AS (101.7 mg/dl) and control females. There was no significant difference in total concentrations of cholesterol and triglycerides between males and females with AS and those with normal hemoglobin. However, the HDL-cholesterol in both genders with AS was higher (P<0.001) than normal subjects. Also, the concentration of LDL-cholesterol in both males and females with AS was lower than control males (P<0.05) and females. CONCLUSIONS: Hemolytic stress could be associated with a significant reduction in plasma lipids and lipoproteins. It appears that patients with sickle cell anemia and individuals with sickle cell trait are at a lower risk for coronary artery disease.

Thrombotic cardiac apex hydatid cyst.

Hydatid cyst (HC) is an endemic infestation in the cattle-breading countries such as in Iran. The involvement of heart by HC is rare; however, nesting of larva in the left ventricular apex with subsequent rupture to the systemic circulation and thrombus formation in the remaining cyst cavity is an exceedingly rare phenomenon. A 45-year-old man referred to our emergency cardiac room with chest pain and a transthoracic echocardiography (TTE) that showed a cardiac apex cystic lesion. The differential diagnosis of a cystic tumor, a HC, or aneurysm in the apex of the left ventricular walls was considered and evaluated by TTE and magnetic resonance imaging. However, the thrombotic HC was confirmed at the surgery. The cyst with its thrombotic component was excised surgically by on-pump cardiac surgery. The postoperative period was uneventful and the patient was discharged to home and treated with a full course of Albendazole therapy for 4 weeks. Six-month follow-up with TTE revealed complete healing of the apex defect without recurrence of the cyst.

Large cardiac hydatidosis bulging as a mass to pericardium-case report.

A 47-year-old man presented as a dyspnea and fatigue. A transthoracic echocardiography (TTE) performed to assess valvar heart disease and left ventricular (LV) function showed a large hydatid cysts in the inter ventricular septum bulging to posterior of heart and compressing its overlying muscle as whitish round mass. The patient underwent elective surgery by evacuation of septal hydatid cysts from posterior inter ventricular aspect of septum and capitonnage of cavity. His postoperative course was uneventful. Post-operative albendazole for prophylaxis of procedures were recommended. The patient was scheduled for regular follow-up, to check for any recurrences or late complications.

Lack of association between MTHFR C677T and A1298C polymorphisms and risk of childhood acute lymphoblastic leukemia in the Kurdish population from Western Iran.

AIMS: Polymorphism in genes involved in folate metabolism may influence the susceptibility to acute lymphoblastic leukemia (ALL). The aim of the present study was to determine the role of the two most common polymorphisms of the 5, 10-methylenetetrahydrofolate reductase (MTHFR) gene, MTHFR C677T and A1298C, and their interaction on the susceptibility to ALL. METHODS: Seventy-two children with ALL and 109 age- and sex-matched healthy children from Western Iran were screened for MTHFR C677T and A1298C variants by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The frequencies of MTHFR 677T and 1298C alleles in patients were 29.9% and 43.1%, respectively, that were higher than those in controls (24.8% and 38.1%, respectively). Logistic regression analysis was performed and its result in the odds ratios (ORs) for possession of either MTHFR 677T or 1298C allele was found to be 1.98 [95% confidence interval (CI) 0.72-5.4, p = 0.18] and 1.48 (95% CI 0.59-3.69, p = 0.4), respectively. Also the concomitant presence of both MTHFR 677T and 1298C alleles was not associated with the risk of ALL [OR = 2.12 (95% CI 0.8-5.7, p = 0.13)]. CONCLUSION: Our results in a homogenous population with Kurdish ethnic background indicated that neither the MTHFR 677T allele nor the MTHFR 1298C allele is associated with increased risk of ALL.

Celiac disease in type-I diabetes mellitus: coexisting phenomenon.

BACKGROUND: This study aimed to determine the prevalence of celiac disease in type I diabetic patients and to compare the symptoms and complications of celiac in patients with diabetes and celiac with patients with diabetes only. METHODS: A total of 241 type I diabetic patients age ≥ 18 who needed insulin intake were recruited from diabetic patients attending the Diabetic Research Center in Kermanshah, Iran. Sample was screened for celiac disease by drawing 5cc blood for complete blood count (CBC), and anti-endomysial antibody test (AEA). Patients then were classified based on immunofluorescent method for the presence of AEA. Those with AEA positive underwent biopsy. The biopsy tissues were classified based on Marsh classification. RESULTS: Twenty one patients tested positive for celiac disease based on AEA test (8.7%) and 20 (8.3%) tested positive based on the biopsy. Prevalence of celiac among diabetic patients in comparison to normal population was 8.3% vs. 0.6%; and 70% were in the stages III and IV. Weight loss was significantly more prevalent among the celiac patients, who were 4 times more likely to lose weight. Other parameters such as anemia, mucocutaneous and cutaneous hemorrhage, milk intolerance, related oral aphthous, diarrhea and steatorrhea, alopecia, dermatitis herpetiform and alopecia were higher in celiac patients but not high enough to be statistically significant. CONCLUSIONS: There is a need to improve screening identification and treatment of celiac among all diabetic patients type I, especially in cases with uncontrolled diabetic or weight loss.

Diagnostic value of chemical shift artifact in distinguishing benign lymphadenopathy.

PURPOSE: Today, distinguishing metastatic lymph nodes from secondary benign inflammatory ones via using non-invasive methods is increasingly favorable. In this study, the diagnostic value of chemical shift artifact (CSA) in magnetic resonance imaging (MRI) was evaluated to distinguish benign lymphadenopathy. SUBJECTS AND METHODS: A prospective intraindividual internal review board-approved study was carried out on 15 men and 15 women having lymphadenopathic lesions in different locations of the body who underwent contrast-enhanced dynamic MR imaging at 1.5 T. Then, the imaging findings were compared with pathology reports, using the statistics analyses. RESULTS: Due to the findings of the CSA existence in MRI, a total of 56.7% of the studied lesions (17 of 30) were identified as benign lesions and the rest were malignant, whereas the pathology reports distinguished twelve malignant and eighteen benign cases. Furthermore, the CSA findings comparing the pathology reports indicated that CSA, with confidence of 79.5%, has a significant diagnostic value to differentiate benign lesions from malignant ones. CONCLUSION: Our study demonstrated that CSA in MR imaging has a suitable diagnostic potential nearing readiness for clinical trials. Furthermore, CSA seems to be a feasible tool to differentiate benign lymph nodes from malignant ones; however, further studies including larger numbers of patients are required to confirm our results.

[Intra-aortic balloon counterpulsation, which complications may result from?]. / Le ballon de contre-pulsion intra-aortique, à quelles complications s'attendre ?

Bilateral renal infarction is a complication of intra-aortic balloon counterpulsation, ever described in the literature. We illustrate this complication by a clinical observation and underline the interest of taking a prevention action.

Factor V G1691A, prothrombin G20210A and methylenetetrahydrofolate reductase polymorphism C677T are not associated with coronary artery disease and type 2 diabetes mellitus in western Iran.

There are controversial results related to the contribution of factor V Leiden G1691A, prothrombin gene G20210A and methylentetrahydrofolate reductase (MTHFR) C677T mutations in the development of coronary artery disease (CAD) and their association with diabetes. To assess the distribution of these thrombophilic mutations in CAD patients with and without type 2 diabetes mellitus (T2DM), we studied 117 CAD patients [65 CAD patients with diabetes (CAD/T2DM) and 52 CAD patients without diabetes (CAD/ND)] and 59 age-matched and sex-matched healthy individuals without CAD from population of western Iran. Genotyping was done by polymerase chain reaction (PCR)-restriction fragment length polymorphism using Mnl I, Hind III and Hinf I for factor V Leiden, prothrombin G20210A and MTHFR C677T, respectively. The prevalence of prothrombin G20210A variant in CAD/T2DM, CAD/ND and control individuals was 3.1, 1.9 and 0%, respectively. Factor V Leiden G1691A was found in 4.6% of patients with CAD/T2DM, 3.8% of patients with CAD/ND and 3.4% of healthy individuals. The prevalence of MTHFR C677T was found to be 49.2, 32.7 and 44.1% in CAD/T2DM, CAD/ND and control group, respectively. Our results indicate that there is no significant difference between the prevalence of thrombophilic mutations of factor V Leiden, prothrombin G20210A variant and MTHFR C677T in CAD patients with or without diabetes compared with controls. Although a higher prevalence of these thrombophilic mutations was observed in CAD patients, especially in those patients with diabetes, it seems that these variants may not be considered as independent risk factors for CAD or diabetes in our sample. These findings are discussed in relation to available literature.

Cost--effectiveness of pap smear in Kermanshah, Iran.

OBJECTIVE: To determine the incidence of pre invasive and invasive cervical lesions and also cost- effectiveness of Pap smears in Kermanshah, Iran (2004-2007). METHODS: A descriptive, cross sectional study was performed between March 2004-March 2007 with all cytological smears analyzed according to the Bethesda II system. Efficacy was estimated as the ratio of HSIL and invasive carcinomas detected to all Pap smears. Data were analyzed with SPSS software and mean+/-SD for cost in each age. RESULTS: 148,472 smears were analyzed of which 99.7 % were negative, only 0.3% having cytological abnormalities. ASCUS, LSIL, HSIL and carcinoma positive rates were 205.4, 73.4, 21.6 and 5.4 per 100,000 Pap smears respectively. The incidence of HSIL and carcinoma in total was 26.9 per 100,000 women. Before age 35 there were no such lesions so that the effectiveness of Pap smear before age 35 was zero. The cost for one smear was 5 Euros and the cost for detection per HSIL or carcinoma was 18,559 Euros. The mean age of women for HSIL was 52.0+/-10.7 and for carcinoma 48.1+/-1.81 years. CONCLUSIONS: Since no HSIL or carcinomas were detected before age 35, and since for changing one LSIL to HSIL or carcinoma should take more than 5 years , the results of this study suggest that Pap smears before 35 years old is not effective and we suggest commencement of Pap smear in Iran from age 30.