Clinicopathological Pattern of Endometrial Specimens in Women with Abnormal Uterine Bleeding and Ultrasonography Correlation.

BACKGROUND: Abnormal uterine bleeding (AUB) refers to any symptomatic deviation from normal menstruation. AUB is a common gynecological disorder in non-pregnant women of reproductive age, accounting for approximately 33% of gynecological outpatient visits. The early diagnosis and management cause of AUB is important because of increased incidence of endometrial carcinoma with rapid growth. Transvaginal ultrasound is non-invasive imaging technique used to find endometrial carcinoma before referring patients for invasive techniques. Dilatation and curettage (D&C) and endometrial biopsy are surgical procedures that scrape the endometrial lining of the uterus for diagnosis and treatment. The aim of this study is to describe the clinicopathologic pattern of endometrial specimens in women with AUB and ultrasonographic correlation. METHODS: Tissues from endometrial biopsy and curettage of 411 patients with AUB who referred to Shahid Mohammadi hospital were prospectively selected from 2021 to 2023. Patients were divided into three groups based on age and menstrual status including: premenopausal (18-39 years), perimenopausal (40-49 years) and postmenopausal (≥50 years). The results were correlated to patient's age and other data and evaluated with statistical analysis. RESULTS: During the two-year study period, a total of 411 endometrial specimens with clinical diagnosis of AUB were submitted and the results were analyzed. The youngest patient presenting with AUB was 21 years old, while the oldest was 77 years old. The most common complaint was menorrhagia in 201 (48.0%) out of 411 patients. The most common pathology finding in three groups was polyp in 100 (24.3%) cases. Hormonal effect was the next commonly observed pattern seen in 70 (17.0%) cases. P value was calculated as 0.003 which was significant using chi-square for the trend seen in age. CONCLUSION: Endometrial sampling is a useful tool for evaluation of women with AUB and referring patients for treatment. Histopathological evaluation of the endometrium is very useful in detecting the etiology of AUB. Transvaginal sonography has high sensitivity in detecting polyps.

Diagnostic challenge in a 2-year-old boy poisoned with carbon monoxide: A case report.

Key Clinical Message: Carbon monoxide poisoning diagnosis is sometimes very difficult and should be considered in the differential diagnosis list of children's consciousness disorders even in summer. Abstract: Carbon monoxide poisoning is very dangerous, and sometimes, it is difficult to diagnose. Especially, this poisoning may have non-specific manifestations in children and can be confused with other diseases. Here we present a 2-year-old child who suffered a disturbance of consciousness during the summer season. He and his family were travelers who had come to Mashhad from Kerman and were staying in a hotel room, after various investigations. It has been found that he was poisoned with carbon monoxide gas due to the leakage of carbon monoxide gas from the chimney pipe of the engine room related to the hotel's water heating into the room. After receiving oxygen and supportive treatments, he recovered and was discharged with good health. Poisoning with carbon monoxide gas is very dangerous, and the awareness of health and medical personnel in this field is essential.

Weakness and diplopia in a 4-year old boy. An unusual Diagnosis.

Ptosis, diplopia, and overall weakness in children may have serious underlying causes such as myasthenia, botulism, Guillain-Barré syndrome, and poisoning, which require a systematic and timely evaluation and proper management.(1,2,3) In pediatrics, clinical presentations may be atypical, and diagnostic overlap sometimes makes the final diagnosis challenging. This can be addressed through taking accurate history, performing a physical exam, conducting a comprehensive assessment, and using appropriate diagnostic algorithms.

Loss of consciousness in a little traveler.

BACKGROUND: Loss of consciousness in children can be caused by a wide spectrum of factors, including infection, metabolic disorders, trauma, and poisoning which requires timely and accurate evaluation. CASE PRESENTATION: In this paper, we introduce a three-year-old boy who was first referred to the Emergency ward of Mashhad Imam Reza Hospital due to unconsciousness. Having spent a few days in a hotel, this boy, who was a visitor to Mashhad, lost consciousness. During evaluations, hypotension and severe high anion gap metabolic acidosis was observed. Finally, the patient was diagnosed with ethylene glycol poisoning. CONCLUSION: Poisoning should be considered as one of the most likely diagnoses in children with loss of consciousness. The identification of the clinical symptoms and the use of appropriate diagnostic algorithms is essential for timely diagnosis and appropriate treatment of specific cases of toxicity.

Arterial Blood Gas Analysis of Patients with Tramadol-induced Seizure; a Cross Sectional Study.

INTRODUCTION: Tramadol is an active analgesic drug that is commonly used to treat moderate to severe pain. The present study aimed to assess the arterial blood gas (ABG) analysis of patients with tramadol-induced seizure (TIS). METHODS: This prospective cross-sectional study was performed on 50 TIS cases that were referred to emergency department within a maximum of one hour after their last episode of seizure. The results of ABG analysis on admission were collected and their association with dosage and time interval between ingestion and admission was assessed. RESULTS: 50 cases with the mean age of 35.10 ± 9.62 years were studied (80.0% male). The mean dosage of ingestion was 1122.00 ± 613.88 (400 to 3000) mg and the mean time interval between ingestion and admission was 7.16 ± 2.18 hours. ABG analysis on admission showed that 49 (98.0%) patients had pH < 7.35 and PaCO2 > 45 mmHg (respiratory acidosis). There was a significant association between ingestion to admission time interval and both PaCO2 (r = -0.330, p = 0.019), and PaO2 (r = 0.303, p = 0.032). The dose of ingestion was negatively associated with respiratory rate (r = -0.556, p = 0.001), arterial pH (r = -0.676, p = 0.001), and PaO2 (r = -0.514, p = 0.001), but was positively associated with PaCO2 (r = 0.461, p = 0.001). Higher doses of tramadol led to more severe hypercapnia and need for intubation (OR = 1.12, 95% CI: 0.88 - 1.26; p = 0.045). 5 (10.0%) cases needed mechanical ventilation. All patients improved after supportive care with no in-hospital death. CONCLUSION: Based on the findings, 98% of TIS cases had respiratory acidosis. Higher doses of ingested drug and longer time interval between ingestion and admission were associated with severity of ABG disturbances.

Status of clinical toxicology education and ethics in medical care of poisoned patients in the Islamic Republic of Iran and a comparison with other countries.

Clinical toxicology is not recognized as a clinical speciality in Iran. After the chemical war gas attack by the Iraqi army against the Iranian troops in the 1980s, health professionals and Iranian authorities noticed the importance of this field in clinical medicine. Collaboration between the clinical toxicologists and toxicologists of pharmacy schools resulted in the establishment of the Iranian Society of Toxicology and Poisonings in 1991 and the National Board of Toxicology in 1993. Clinical toxicology fellowship was also formed as a joint collaboration between the toxicology and internal medicine boards in 2010. Medical doctors who specialized in clinical medicine are eligible to take the entrance examination of the fellowship. In spite of the advancement of clinical toxicology and increased number of acute poisonings and drug abuse, undergraduate teaching in this field is still lacking and being taught as part of the forensic medicine curriculum since 1952. There is a lack of an efficient national poison information and control centre (s) in Iran, and no action plan and practical efforts have been done for poisoning prevention. Therefore, the number of drug abuse and acute poisonings has increased over the past four decades and induced cultural, social and health problems. According to Iranian legal medicine organization reports, poisoning is the second-most occurring cause of unnatural death. The suicidal attempt is the most common method of acute poisoning in adults. Suicidal attempt including self-poisoning is not accepted in the Islamic point of view, and thus self-poisoning is mostly neglected and may not be treated appropriately in time in some regions of Iran. Accidental poisoning in children is also common in Iran and estimated to be between 20 000 and 25 000 cases annually over the recent years. In addition, social, cultural and economic problems have induced more health problems such as drug abuse and addiction even in children. Adulterated opium to lead for economic gaining has produced thousands of cases of lead poisoning over the past few years in nearly all opium addicts, which is still a major health problem in Iran. Ban on alcoholic beverages leads some people to make their own home-made spirits, which is unfortunately contaminated with methanol. Thousands of cases of methanol poisoning and even some epidemics have occurred over the past four decades in some parts of the country. Lack of availability of essential antidotes such as succimer and fomepizole has been a major problem for the effective treatment of poisoned patients. Despite the well-known fact that cases of poisoning and drug overdose constitute a significant proportion of hospital admissions in some developing countries, clinical toxicology education and medical care of the poisoned patients are lacking. Therefore, policymakers and health authorities should realize the importance of toxicology in clinical medicine. The Iranian Ministry of Health, medical care and Medical Education should implement clinical toxicology courses for medical students; establish effective national poisons information and control centres and advance clinical toxicology services for appropriate management of poisoned patients to improve public health and the overall health policy goals.

Misdiagnosis of spider bite in a 3-year-old child.

Abdominal pain is a common complaint among children with a vast differential diagnosis. Hip pain is also a nonspecific sign. Here, we present a case of a 3-year-old boy with a complaint of abdominal pain and pain in both hips, much on the right one. After evaluations, the diagnosis was a spider bite.

Challenges of OSCE national board exam in Iran from participants' perspective.

BACKGROUND: The national board exam for residents in Iran is held in two parts: Multiple-choice and Objective Structured Clinical Examination (OSCE). The OSCE is a suitable method for evaluation of residents' clinical qualifications. However, it requires experienced human resources, accurate planning, facilities and reliable evaluation tools. OBJECTIVE: To determine the challenges of the OSCE National Board Exam in Iran. METHODS: This cross-sectional study was conducted on all the final-year pediatrics and gynecology residents of Mashhad University of Medical Science, who participated in the board exam in September 2014. A questionnaire was designed to evaluate the residents' opinion on challenges of the OSCE. Data was analyzed with SPSS16. We used U Mann-Whitney test independent t-test, and Pearson correlation coefficient. RESULTS: Fourteen pediatrics and eleven gynecology residents participated. In the gynecology group, there was no significant statistical correlation between the individual marks and questionnaire scores. However, in the pediatrics group, there was a significant correlation (p=0.046, r=-0.763). Based on pediatrics residents' perspective, the main challenge of the OSCE part of the exam was the imbalance and disproportion between the allowed time and the task load in each exam stage. In other words, they believed that the tasks could not be fulfilled in the given time. In the gynecology group, the main challenge reported was the delay in announcing the exam results. In the pediatrics group, the main complaint was the disproportion of the allowed time and the task load in the exam stages. CONCLUSION: Some of the challenges of the board exam were associated with the examiners and the exam environment, and some of them were related to the home university where the candidates had studied. To solve the problems, both aspects should be considered.

Use of sedative drugs at reducing the side effects of voiding cystourethrography in children.

BACKGROUND: Imaging of the kidneys and urinary tract has a significant and critical role for diagnosis of genitourinary system diseases. Although technological progress goes toward less invasive approaches, some of the current methods are still invasive and annoying. Voiding cystourethrography (VCUG) is the best and most accurate method for diagnosis and grading of vesicoureteral reflux. VCUG is a distressful procedure that gives serious anxiety and pain in a large proportion of children and fear for parents; therefore, using effective sedative drugs with the least side effects is necessary and should be considered. MATERIALS AND METHODS: In this review article, importance and efficacy of different drugs before catheterization VCUG be compared in the base of literature survey on EMBASE, PubMed, and Cochrane source. RESULTS: We found that the treatment should be based on nonpharmacological and pharmacological methods; nonpharmacological treatment includes the psychological preparation before procedures as a safety precaution with little or no risk modality, as well as reassuring support. The presence of parents during painful procedures cannot alleviate children distress. Pharmacological methods include oral midazolam (0.5 mg/kg) and intranasal use (0.2 mg/kg) that had been used 10 min before the procedure can effect on anterograde amnesia and sedation without considerable effect on accuracy and grade of reflux. Nitric oxide has a shorter recovery time versus midazolam but has a potential risk for deep sedation and may interfere with the child's voiding phase. CONCLUSION: In summary, oral midazolam of 0.5-0.6 mg/kg or 0.2 mg/kg intranasal is acceptable drug that can be used before VCUG.

Comparison of serum Concentration of Se, Pb, Mg, Cu, Zn, between MS patients and healthy controls.

INTRODUCTION: Multiple Sclerosis (MS) is defined as one of the inflammatory autoimmune disorders and is common. Its exact etiology is unclear. There are some evidences on the role of environmental factors in susceptible genetics. The aim of this study is to evaluate the possible role of Selenium, Zinc, Copper, Lead and Magnesium metals in Multiple Sclerosis patients. METHODS: In the present analytical cross-sectional study, 56 individuals including 26 patients and 30 healthy controls were enrolled in the evaluation. The serum level of Se, Zn, Cu, Pb were quantified in graphite furnace conditions and flame conditions by utilizing an atomic absorption Perkin Elmer spectrophotometer 3030. The serum levels of Mg were measured by auto analyzer 1500 BT. The mean level of minerals (Zn, Pb, Cu, Mg, Se) in serum samples were compared in both cases and controls. The mean level of minerals (Zn, Pb, Cu, Mg, Se) in serum samples were compared in both cases and controls by using independent-samples t-test for normal distribution and Mann-Whitney U test as a non-parametric test. All statistical analyses were carried out using SPSS 11.0. RESULTS: As well as the Zn, Cu, and Se, there was no significant difference between MS patients and healthy individuals in Pb concentrations (p-value = 0.11, 0.14, 0.32, 0.20 respectively) but the level of Mg was significantly different (p= 0.001). CONCLUSION: All serum concentrations of Zn, Pb, Se, Cu in both groups were in normal ranges and there was no difference in MS patients compared with the healthy group who were matched in genetics. Blood level of Mg was significantly lower in MS patients. But it should be noted that even with the low level of serum magnesium in MS patients, this value is still in the normal range.

Solitary rectal ulcer syndrome: Is it really a rare condition in children?

AIM: To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer. METHODS: Fifty-five children with a confirmed diagnosis of solitary rectal ulcer were studied in a period of 11 years from March 2003 to March 2014. All data were collected from the patients, their parents and medical records in the hospital. RESULTS: From 55 studied patients, 41 were male (74.5%) and 14 female (25.5%). The mean age of the patients was 10.4 ± 3.7 years and the average time period from the beginning of symptoms to diagnosis of solitary rectal ulcer was 15.5 ± 11.2 mo. The most common clinical symptoms in our patients were rectal bleeding (n = 54, 98.2%) and straining during defecation or forceful defecation (n = 50, 90.9%). Other symptoms were as follows respectively: Sense of incomplete evacuation (n = 34, 61.8%), mucorrhea (n = 29, 52.7%), constipation (n = 14, 25.4%), tenesmus and cramping (n = 10, 18.2%), diarrhea (n = 9, 16.4%), and rectal pain (n = 5, 9.1%). The colonoscopic examination revealed 67.3% ulcer, 12.7% polypoid lesions, 10.9% erythema, 7.3% both polypoid lesions and ulcer, and 1.8% normal. Most of the lesions were in the rectosigmoid area at a distance of 4-6 cm from the anal margin. Finally, 69.8% of the patients recovered successfully with conservative, medical and surgical management. CONCLUSION: The study revealed that solitary rectal ulcer is not so uncommon despite what was seen in previous studies. As the most common symptom was rectal bleeding, clinicians and pathologists should be familiar with this disorder and common symptoms in order to prevent its complications with early diagnosis.

Black henbane and its toxicity - a descriptive review.

Black henbane (BH) or Hyoscyamus niger, has been used as a medicine since last centuries and has been described in all traditional medicines. It applies as a herbal medicine, but may induce intoxication accidentally or intentionally. All part of BH including leaves, seeds and roots contain some alkaloids such as Hyoscyamine, Atropine, Tropane and Scopolamine. BH has pharmacological effects like bronchodilating, antisecretory, urinary bladder relaxant, spasmolytic, hypnotic, hallucinogenic, pupil dilating, sedative and anti-diarrheal properties. Clinical manifestations of acute BH poisoning are very wide which include mydriasis, tachycardia, arrhythmia, agitation, convulsion and coma, dry mouth, thirst, slurred speech, difficulty speaking, dysphagia, warm flushed skin, pyrexia, nausea, vomiting, headache, blurred vision and photophobia, urinary retention, distension of the bladder, drowsiness, hyper reflexia, auditory, visual or tactile hallucinations, confusion, disorientation, delirium, aggressiveness, and combative behavior. The main treatment of BH intoxicated patients is supportive therapies including gastric emptying (not by Ipecac), administration of activated charcoal and benzodiazepines. Health care providers and physicians particularly emergency physicians and clinical toxicologists should know the nature, medical uses, clinical features, diagnosis and management of BH poisoning.

Peganum harmala intoxication, a case report.

OBJECTIVE: Peganum harmala (P. harmala), "Espand" in Persian, has small seeds and has been used in traditional medicine as emmenagogue and an abortifacient. It has various pharmacological effects such as antifungal, antibacterial, hypothermic, anticancer, antinociceptive, and reversible monoamine oxidase inhibition. CASE DETAILS: This case was a 45 years old woman who ingested about 50 grams seed of P. harmala for hypermenorrhae. She suffered nausea, vomiting, dizziness, tremor, ataxia, and confusion. On physical examination, she had hypotension (BP=90/60 mmHg) with normal heart rate (60 beat/min) and impaired knee to heel test. Her consciousness was reduced without any hallucination. Her laboratory test was normal. She was discharged at good condition 18 hours later. CONCLUSION: In conclusion, physicians working in Iran and other regions that P. harmala is prescribed or used illegally, should know signs and symptoms of its toxicity in order to be able to deal with the emergencies, however, prognosis of these toxicity is not bad.