Raynaud's Phenomenon as a Presenting Feature of Hypothyroidism: Case Report.

Raynaud's phenomenon is manifested clinically by demarcated color changes the skin of the digits or extremities, typically may be an early clue to the diagnosis of hypothyroidism. In this report, we describe the 8-year-old patient with diagnosed primary hypothyroidism presenting with ceasing the treatment for 1 month that presenting with Raynaud phenomenon.

Langerhans cell histiocytosis presented as bilateral otitis media with effusion, a rare case report.

Background: Langerhans cell histiocytosis (LCH) or histiocytosis X is considered as a rare disease that may have effect on multiple organs. The initial presentation of LCH is varied. The signs and symptoms of otologic histiocytosis can be the same as the acute or chronic infectious ear diseases. Definitive diagnosis of LCH is confirmed by biopsy and immunohistochemically staining of S-100 protein and CD1a antigen. Chemotherapy is the main mode of treatment. Case presentation: In this report, we explained the clinical manifestation, diagnosis and treatment of a case of 15 month-old girl with diagnosed of LCH that initially presented with otitis media with effusion (OME). Conclusion: LCH is a rare disease that presented with variable sign and symptoms and have an effect on multiple organs. LCH should be regarded in cases with recurrent ear infection without response to medical treatments. Moreover, biopsy with IHC is the gold standard of diagnosis and chemotherapy is the main form of treatment.

Benign Fibrous Histiocytoma of Larynx: A Rare Case Report.

The Fibrous histiocytoma is one of the mesenchymal tumors that can present as malignant or benign. We reported a 30 years old male, a rare case of benign fibrous histiocytoma of larynx and evaluated the clinical and histological aspect of this patient.

Epidemiology of Sleep Disorders Among Adolescents in Kerman, Iran, in 2019.

It is an important fact that the onset of adolescence is a time of both physiological and social changes that affect sleep. In this study, the prevalence of sleep disorders in adolescents and the association between them were investigated. Anthropometric dimensions (such as height and weight) of individuals in Kerman in 2019 were also assessed. A total of 451 adolescents (mean age: 14.72 years; 51.88% females) of Kerman, Iran, took part in this cross-sectional study. Participants completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and then demographic (age, gender) and anthropometric data (weight and height) were collected. The prevalence of sleep disorders in this population was 31.9%. Among those with self-rated sleep disorders, 53.5% were males. Participants with sleep disorders were younger and showed lower anthropometric values such as height, weight, and body mass index. However, there was no difference between sleep disorders and gender (P-value > .05). This study revealed a relatively high prevalence of sleep disorders among adolescents. This research was done with the aim of encouraging the healthcare organization to design educational programs to evaluate and reduce sleep disorders.

Laryngeal adenoid cystic carcinoma: a rare case report.

Laryngeal adenoid cystic carcinomas (LACC) are extremely rare and only account for less than 1% of all malignant laryngeal tumors. This tumor commonly occurs in the subglottic region of larynx, so dyspnea and hoarseness are its most common presenting symptoms. Adenoid cystic carcinoma is characterized by slow progression, late recurrence, and late distant metastasis. Total or partial laryngectomy is its treatment. Although it does not respond to radiotherapy completely, adjuvant radiotherapy or chemotherapy may be considered. In this study, we report a 41 year-old man, who had a rare recurrence of LACC, and we evaluate his clinical and pathologic characteristics.

Epidemiology of Sleep Disturbances Among Primary School Students in Kerman, Iran, in 2019.

Primary sleep disturbances are common in both children and adults and can lead to cognitive problems and educational and psychological disorders. In this study, we evaluated the epidemiology of sleep disturbances among children in Kerman, Iran, in 2019. This cross-sectional study was done in 2019 with 561 children in elementary schools of Kerman, Iran. Data were collected by a Pittsburgh Sleep Quality Index (PSQI) questionnaire that was filled out by parents and analyzed statistically. A total of 561children with a mean age of 9.54 ± 1.55 years were enrolled. The ratio of boys to girls was 1.01 and consistent across age groups. The prevalence of sleep disturbances in this population study was 26.7% (150 patients); 51.3% of them were girls. Sleep disturbances were associated with mothers' lower education level and parents' higher job positions (P < .05). This study showed the relatively high prevalence of sleep disturbances among children in this region. It can be reduced by a program such as sleep training or by promoting the level of parents' education. We recommend some educational programs and preschool screening to evaluate sleep disturbances and educating the parents to increase their responsiveness.

Risk Factors for Unfavorable Outcome in Aneurysmal Subarachnoid Hemorrhage Revisited; Odds and Ends.

OBJECTIVES: To evaluate the odds for unfavorable outcome of each risk factor and a combination of them in patients with aneurysmal subarachnoid hemorrhage (SAH) undergoing surgical clipping in Southern Iran. METHODS: A total of 367 patients who were operated between March 2007 and March 2016 due to aneurysmal SAH were analyzed according to patients' factors, aneurysm characteristics and intra-operative data. Correlation between outcomes of patients measured by modified Rankin Scale at 6-months with each factor were analyzed. Market Basket analysis was also used to identify the odds of unfavorable outcome for combinations of factors. RESULTS: A total of 367 patients, including 199 females and 168 males with a mean age of 47.27± 11.53 years, who underwent operation between March 2007 and March 2016 due to aneurysmal SAH were analyzed. Unlike gender, higher age was associated with unfavorable outcome. Ischemic heart disease, Duration of operation and amount of bleeding were also found to increase the odds of unfavorable outcome (p=0.01, 0.02, 0.04 respectively). DM, Cigarette smoking and opium addiction as well as the location and multiplicity of aneurysms did not have an adverse effect on outcome. (p≥0.05). CONCLUSION: Among the numerous risk factors presumed to result in unfavorable outcome in aneurysmal SAH, only older age, duration of operation more than 60 minutes, previous known history of ischemic heart disease, poorer clinical grade and intra-operative bleeding more than 500 mL were found to be significant factors.

The influence of the acromioclavicular joint degeneration on supraspinatus outlet impingement and the acromion shape.

PURPOSE: To assess the anatomic association of acromioclavicular joint degeneration to supraspinatus outlet impingement and the acromion shape. METHODS: Sagittal oblique magnetic resonance images of 49 shoulders in 49 patients were reviewed. 29 of them (mean age, 59 years) underwent surgery for impingement with or without rotator cuff tear (group 1), whereas the 20 controls (mean age, 27 years) were treated for shoulder instability without rotator cuff disease or acromioclavicular joint derangement (group 2). The supraspinatus outlet and the acromion shape of the 2 groups were compared. RESULTS: The difference in the mean supraspinatus outlet between groups 1 and 2 was 11% (514 vs 577 mm[2], p=0.095) and between the subgroup (of group 1) with full thickness rotator cuff tears and group 2 was 17% (481 vs 577 mm[2], p=0.036). Six of the acromions in group 1 were type III (hooked) compared to none in group 2. CONCLUSION: In severe acromioclavicular degeneration, distal clavicular excision is recommended, even in cases with an asymptomatic acromioclavicular joint, so as to prevent further osteophyte formation.