Pedunculated focal nodular hyperplasia of the liver in a healthy child born following in vitro fertilization: a case report and review of the literature.

BACKGROUND: Focal nodular hyperplasia is a common nonmalignant liver mass. This nonvascular lesion is an uncommon mass in children, especially those with no predisposing factors, namely radiation, chemotherapy, and hematopoietic stem cell therapy. Exophytic growth of the lesion further than the liver margins is not common and can complicate the diagnosis of the lesion. This report observes a focal nodular hyperplasia as a pedunculated lesion in a healthy child. CASE PRESENTATION: We describe a 9-year-old healthy Persian child who was born following in vitro fertilization complaining of abdominal pain lasting for months and palpitation. Employing ultrasound and computed tomography, a mass was detected in the right upper quadrant compatible with focal nodular hyperplasia imaging features. The child underwent surgery and the mass was resected. CONCLUSION: Diagnosing focal nodular hyperplasia, especially pedunculated form can be challenging, although magnetic resonance imaging with scintigraphy is nearly 100% sensitive and specific. Thus, a biopsy may be needed to rule out malignancies in some cases. Deterministic treatment in patients with suspicious mass, remarkable growth of lesion in serial examination, and persistent symptoms, such as pain, is resection, which can be done open or laparoscopic.

Perceived stigmatisation and reliability of questionnaire in the survivors with burns wound: A systematic review and meta-analysis.

Perceived stigmatisation (PS) can cause different effects on burns survivors such as depression, low self-esteem, body image disturbance, and social anxiety. Current systematic review and meta-analysis aimed to determine the average PS among the burns survivor population and the average reliability of the PS questionnaire (PSQ). A comprehensive systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Stigmatisation", "Burns", "Reliability", and "Questionnaire" from the earliest to February 1, 2023. The COSMIN and the Joanna Briggs Institute (JBI) checklists were applied to evaluate the risk of bias. Data analysis was performed in STATA V.14 and JAMOVI v 2.3.24 software. The analysis consisted of two sections. Firstly, the overall weighted average of PS was calculated based on mean and standard deviation. Then, the reliability average of PSQ was calculated with the reliability generalisation method based on the alpha coefficient, questionnaire items, and sample size of each study. Finally, eight articles were included in the quantitative analysis. The results showed the weighted average of PS was 2.14 (ES: 2.14, 95%CI: 1.77-2.51, Z = 11.40, I2 :97.8%, P < 0.001). The average of PS in the factors of confused/staring behaviour, absence of friendly behaviour, and hostile behaviour was 2.36 (ES: 2.36, 95%CI: 2.05-2.67, Z = 14.86, I2 :92.7%, P < 0.001), 2.13 (ES: 2.13, 95%CI: 1.87-2.39, Z = 16.22, I2 :93.8%, P < 0.001) and 2.07 (ES: 2.07, 95%CI: 1.67-2.47, Z = 10.05, I2 :96.5%, P < 0.001), respectively. The analysis showed that the overall coefficient alpha of the PSQ was 0.88 (ES: 0.88, 95%CI: 0.851-0.910, Z = 58.7, I2 : 95.04%, P < 0.001). Also, the alpha coefficient of factors including confused/staring behaviour, absence of friendly behaviour, and hostile behaviour were 0.847 (ES: 0.847, 95%CI: 0.770-0.924, Z = 21.6, I2 :99.13%, P < 0.001), 0.860 (ES: 0.860, 95%CI: 0.808-0.912, Z = 32.4, I2 :98.02%, P < 0.001) and 0.899 (ES: 0.899, 95%CI: 0.829-0.968, Z = 21.33, I2 : 0.0%, P < 0.001), respectively. In sum, the current study showed that the average PS was 2.14 out of 5 points. Most survivors and parents reported confused/starring behaviour as a common perceived behaviour from different individuals. Also, the average reliability of PSQ was 0.88, and it had acceptable reliability. More studies are required to better judge the level of PS among different age groups. Also, the psychometric properties of PSQ in different cultures are an essential issue.

Boerhaave's syndrome in a patient with achalasia: A rare case report.

INTRODUCTION AND IMPORTANCE: Boerhaave's syndrome (BS) is a rare spontaneous perforation of the esophagus with a high rate of morbidity that results in death in the case of delayed diagnosis and treatment. Here, we describe a patient with achalasia who was diagnosed with BS. CASE PRESENTATION: This present case is a 63-year-old man with a previous history of achalasia and with a complaint of sudden onset of severe right chest pain, epigastric pain, etc. to Razi hospital, Rasht, Iran in March 2022. CLINICAL DISCUSSION: Due to the clinical findings of the patients, the diagnosis was BS and the patient's condition was reported to be good at the two-month follow-up. CONCLUSION: Early diagnosis of BS results in more effective treatment. Also, stenting is suggested to be effective to reduce the rate of morbidity and mortality in patients with BS.

A systematic review of social support and related factors among burns patients.

Burn injuries, as a major public health problem, can lead to high morbidity and mortality. Burns is considered as one of the most devastating injuries globally and the fourth most common injury after traffic accidents, falls and interpersonal violence. Burn injuries can affect human life, such as physical and mental health, functional skills, and performance. Changes in appearance, social isolation, stress, anxiety, depression, low self-esteem, unemployment, financial burden and family problems can occur in these patients. These burn complications can be exacerbated without adequate social support. This systematic review evaluated burn patients' social support and related factors. A systematic search was performed on the international electronic databases such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Burns', 'Social support', 'Perceived social support' and 'Social care' from the earliest to 30 April 2022. The quality of the included studies in this review was assessed using the appraisal tool for cross-sectional studies (AXIS tool). A total of 1677 burn patients were included in this review from 12 studies. Mean score of social support in burn patients based on multidimensional scale of perceived social support, Phillips's social support questionnaire, social support questionnaire, social support scale and Norbeck social support questionnaire were 5.04 (SD = 1.59) of 7, 22.06 (SD = 3.05), 78.20 (SD = 15.00) of 95, 82.24 (SD = 13.70) and 4.14 (SD = 0.99), respectively. Factors such as income, educational attainment, burn surface area, reconstructive surgery, quality of life, self-esteem, socialisation, posttraumatic growth, spirituality, and ego resilience had a significant positive relationship with social support of burns patients. Social support in patients with burn had a significant negative relationship with factors such as psychological distress, having children, life satisfaction, neuroticism and post-traumatic stress disorder. Overall, patients with burns had moderate levels of social support. Therefore, it is recommended that health policymakers and managers make it easier for burn patients to adapt to burns by providing psychological intervention programs and the social support needed by burn patients.

A systematic review of caregivers' knowledge and related factors towards pressure ulcer prevention.

This systematic review aimed to examine the knowledge of caregivers regarding pressure ulcer (PU) prevention. A thorough, methodical search was conducted from the earliest date to February 1, 2023 using keywords extracted from Medical Subject Headings such as "Caregivers", "Knowledge", and "Pressure ulcer" in various international electronic databases such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex and Scientific Information Database. The quality of the studies included in this systematic review was evaluated using an appraisal tool for cross-sectional studies (AXIS tool). In total, 927 caregivers participated in the eight studies. The average age of the participants was 40.50 (SD = 12.67). Among the participants, 61.87% were women. The average caregiver's knowledge of PU prevention was 53.70 (SD = 14.09) out of 100, which suggests a moderate level of knowledge. Factors such as level of education, age, occupation, information about PUs, attitude, and practice had a significant positive relationship with caregivers' knowledge related to the prevention of PUs. Knowledge had a significantly negative relationship with age. In addition, marital status, type of relationship, age, gender, occupation, level of education, and inpatient wards had a significant relationship with caregivers' knowledge regarding PUs prevention. Therefore, managers and policymakers in the medical field can help increase caregivers' knowledge by providing an online or in-person educational platform relevant to PU prevention.

Prevalence of pressure ulcer and related factors in orthopaedic wards: A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis is to provide an overview of the prevalence of pressure ulcers (PU) in orthopaedic wards. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Prevalence", "Pressure ulcer", "Pressure sore", and "Orthopaedics" from the earliest to February 1, 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. Finally, 11 studies were included in the final analysis. The results indicated that the prevalence of PU in orthopaedic departments was 18% (ES: 0.18, 95% CI: 0.10-0.26, Z = 4.53, I2 : 99.09%). Although the odds ratio of PU was lower in men than women, it was not statistically significant (OR: 0.91, 95% CI: 0.74-1.11, Z = 0.95, I2 : 17.4%, P = .34). Also, results showed the prevalence of PU was higher among studies with a sample size of more than 200 (ES: 0.19, 95% CI: 0.10-0.28, Z = 4.07, I2 : 99.1%), Europe region (ES: 0.20, 95% CI: 0.14-0.26, Z = 6.7, I2 : 93.0%) and prospective design (ES: 0.23, 95% CI: 0.18-0.27, Z = 9.47, I2 : 83.3%) when compared with other sub-groups. In sum, considering the 18% prevalence of PU in the orthopaedic department, it is recommended to focus on detecting risk factors and design interventions to reduce PU in the patients admitted orthopaedic department.

Effects of non-pharmacological interventions on pain intensity of children with burns: A systematic review and meta-analysis.

Pain is one of the complications associated with burns, which can lead to anxiety and sleeplessness in children. Various studies evaluated the effects of non-pharmacological interventions on burn wound care. The present study was conducted to determine the effects of non-pharmacological interventions on pain intensity of children with burns. A comprehensive systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Non-pharmacological', 'Virtual reality', 'Pain', 'Burn', 'Wound' and 'Child' from the earliest to December 1, 2022. The risk of bias in the final articles was also assessed with the Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Finally, a total of 1005 burn patients were included in 19 studies. The age range of the patients was from 0.5 to 19 years. Of the participants, 50.05% were in the intervention group. All studies had a randomised clinical trial design. The results found that non-pharmacological interventions significantly reduced pain intensity in children (ES: -0.73, 95% CI: -1.08 to -0.38, Z = 4.09, I2 :79.8, P < .001). Virtual reality (VR) (ES: -0.54, 95% CI: -1.19 to -0.18, Z = 2.90, I2 :72.9%, P = .004) and non-VR (ES: -0.86, 95% CI: -1.45 to -0.27, Z = 2.86, I2 :91.4%, P = .04) interventions decreased pain intensity significantly in children based sub-group analysis. Non-pharmacological interventions significantly reduced the pain intensity of dressing removal (ES: -0.77, 95% CI: -1.34 to -0.20, Z = 66.3, I2 :91.8%, P = .008), dressing application (ES: -0.53, 95% CI: -0.97 to -0.09, Z = 2.37, I2 :60.8%, P = .02), and physical therapy (ES: -1.18, 95% CI: -2.10 to -0.26, Z = 2.51, I2 :88.0%, P = .01). Also, interventions reduced the pain of burn wound care (ES: -0.29, 95% CI: -1.01 to 0.44, Z = 0.78, I2 :72.6%, P = .43), but it was statistically insignificant. In sum, the result of the present study indicated that using non-pharmacological interventions significantly reduced pain intensity in children. The reduction of pain intensity was greater in non-VR than in VR interventions. Future studies should focus on comparing VR interventions with non-VR and single versus multi-modal distraction to clarify the effectiveness of each.

Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study.

Hospital-acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross-sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. The SPSS software package (version 16.0, SPSS Inc., Chicago, IL, USA) was used to analyse the data. Quantitative and qualitative variables were presented using mean (standard deviation) and number (percentage). The Shapiro-Wilk test was used to evaluate the normality of the data in this study. The data did not have a normal distribution. Hence, χ2 and Fisher's exact tests were used to evaluate the relationship between variables. Surgical wound infection occurred in 4.7% (24 cases) of patients with a mean age of 59.34 (SD = 14.61) years. Preoperative (>3 days) and postoperative (>7 days) hospitalisation, history of immunodeficiency (P < 0.001), and interns responsible for changing dressings (P = 0.021) were associated with surgical wound infection incidence. About 9.5% and 4.4% of surgical wound infection cases were significantly associated with pre- and postoperative antibiotic use. Gram-positive cocci were the most prevalent strains isolated from 24 surgical wound infection cases (15/24, 62.5%). Among these, Staphylococcus aureus was the predominant species, followed by coagulase-negative staphylococci. In addition, the most common Gram-negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection-associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.

MUTYH and KLF6 gene expression fluctuations in tumor tissue and tumor margins tissues of colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) is one of the most important cancers in the world, and its prevalence varies depending on the geographical area. Genetically, tumor regeneration in CRC as a multi-step process involves activating mutations in protocogenes and losing the function of tumor suppressor genes as well as DNA repair and recovery genes. Occur in this way, our goal was to investigate the expression of KLF6 genes as a tumor suppressor and MUTYH involved in the DNA repair process in colorectal cancer. METHODS: This research was conducted during the years 2019-2018 in Razi Hospital, Rasht. The subjects included 30 tumoral and 30 non-tumoral tissues of colorectal cancer and 20 healthy controls. The real-time PCR method was used to investigate the gene expression. For data analysis by SPSS, parametric statistical tests ANOVA and T test and regression analysis were used and p value values less than 0.05 were considered significant. RESULTS: The expression of KLF6 gene in tumoral tissues showed a significant decrease compared to non-tumoral tissues (P = 0.04). Also, the expression of MUTYH gene in tumor tissue showed a significant decrease compared to non-tumoral (P = 0.02) and this decrease in MUTYH gene expression had a significant relationship with increasing tumor stage (P = 0.01). CONCLUSION: These findings suggest that decreased expression of KLF6 and MUTYH genes in the study population has a significant relationship with colorectal cancer and can be considered as tumor marker in diagnostic purpose.

Experiences with intestinal failure from an intestinal rehabilitation unit in a country without home parenteral nutrition.

OBJECTIVE: For the first time, we reported experiences with an intestinal rehabilitation unit (IRU) from a country without home parenteral nutrition (HPN). METHODS: We included patients with a diagnosis of intestinal failure (IF) since the establishment of our IRU from February 2018 to February 2020. We further report on our protocols for management of enterocutaneous fistulas (ECFs), short-bowel syndrome (SBS), chronic intestinal pseudo-obstruction and motility disorders. RESULTS: Among a total of 349 patients who have been admitted, 100 patients had IF and were included . Mean (SD) age of patients was 46.3 ± 16.1 years. Most common cause of IF was ECFs (32%), SBS (24%), and SBS + fistula (22%). Most common causes of SBS were mesenteric ischemia (63.3%) and repeated surgery (22.4%). Median (interquartile range [IQR]) duration of parenteral nutrition (PN) for patients was 32 (18-60) days. The most common reconstructive surgery performed was resection and anastomosis (75.4%), followed by serial transverse enteroplasty procedure (10.5%) and closure of ostoma (7%). Patients were hospitalized for a median (IQR) of 33 (17.5-61) days. Most common complications were sepsis (45%), catheter infections (43%), and catheter thrombosis (20%), respectively. At the final follow-up, 61% stopped receiving PN, 23% became candidates for transplantation, and 16% died. CONCLUSION: Considering that most countries lack facilities for HPN, by establishing IRUs using specific treatment protocols and autologous gastrointestinal reconstruction techniques will provide a means to manage patients with IF, thus decreasing death rates and number of patients who require intestinal transplantations due to IF.

Clinical Manifestations and Characterization of COVID-19 in Liver Transplant Recipients: A Systematic Review of Case Reports and Case Series.

BACKGROUND: This systematic review is conducted to explore available information on clinical presentations, laboratory finding and outcomes of SARS-COV-2 in liver transplant patients. METHODS: We searched four databases for relevant terms related to COVID-19 and liver transplantation and collected both case reports and case series on liver transplantation published up to the end of September 2020. RESULTS: After initial screening of irrelevant articles, 25 studies were included and analyzed in this review. Among the 59 patients included, 78.3% were over 50 years old, and 71.6% were males. The majority of patients (93.3%) were hospitalized. The most common presenting symptoms were fever (72.9%) followed by dyspnea and cough (54.2%). The majority of patients revealed a high level of CRP (64.3%). Moreover, high level ALT, AST and ALP were reported in 64.3, 37.5, 30.5 and 22.2% of patients. A total, 9(15.3%), of cases died as a result of complications of COVID-19. Chest radiographs were reported in 72.9%(43/59) of cases that 94% demonstrated radiologic evidence of abnormality. CONCLUSION: The results demonstrated that the most prevalent symptoms and signs were fever, dyspnea and cough. Moreover, most patients were males and hospitalized. The rate of mortality and high level of CRP, ALT/AST and ALP is similar within the non-immune suppressed and general population. However, early detection of high level of serum CRP, ALT/AST and ALP combined with a clinical COVID-19 symptom and finding of CT scan may be used as an index for the presence and severity of the disease.

Risk of hepatic failure in COVID-19 patients. A systematic review and meta-analysis.

Liver injury has been reported to occur during the disease in severe cases. Therefore, this meta-analysis study aims to investigate the incidence of liver injury among published literature from 2019-Jan-01 to 2020-April-03 to provide an outline for further studies on the liver injury of COVID-19. Four databases including Pubmed, Embase, Web of Science, and the Scopus were searched for studies published from 2019-Jan-01 to 2020-April-03. Data analysis and drawing of charts were performed using the Comprehensive Meta-Analysis Software Version 2.2 (Biostat, USA). The search yielded 450 publications, of which 64 potentially eligible studies were identified for full-text review and 21 studies fulfilling the inclusion criteria remained. A total of 4191 COVID-19 patients were included in our meta-analysis. The pooled prevalence of liver injury was 19.5% (95% CI: 14.3-26.1). According to our results, there was significant heterogeneity among the 19 studies (X2 = 738.5; p < 0.001; I2 = 94.34%). Among 288 death cases, the pooled prevalence of liver injury was 22.8% (95% CI: 11.7-39.8). In summary, the COVID-19 disease itself can result in severe and even fatal respiratory diseases and even may lead to ARDS and multiple organ failure. The results of this systematic review highlight the importance of liver injury that may assist clinicians anywhere in the globe in controlling COVID-19-related infection and complications. Moreover, the prevalence of liver injury can be higher in severe cases than in mild cases.

Epigenetic profiling of MUTYH, KLF6, WNT1 and KLF4 genes in carcinogenesis and tumorigenesis of colorectal cancer.

Colorectal cancer (CRC) is distinguished by epigenetic elements like DNA methylation, histone modification, histone acetylation and RNA remodeling which is related with genomic instability and tumor initiation. Correspondingly, as a main epigenetic regulation, DNA methylation has an impressive ability in order to be used in CRC targeted therapy. Meaningly, DNA methylation is identified as one of most important epigenetic regulators in gene expression and is considered as a notable potential driver in tumorigenesis and carcinogenesis through gene-silencing of tumor suppressors genes. Abnormal methylation situation, even in the level of promoter regions, does not essentially change the gene expression levels, particularly if the gene was become silenced, leaving the mechanisms of methylation without any response. According to the methylation situation which has a strong eagerness to be highly altered on CpG islands in carcinogenesis and tumorigenesis, considering its epigenetic fluctuations in finding new biomarkers is of great importance. Modifications in DNA methylation pattern and also enrichment of methylated histone signs in the promoter regions of some certain genes like MUTYH, KLF4/6 and WNT1 in different signaling pathways could be a notable key contributors to the upregulation of tumor initiation in CRC. These epigenetic alterations could be employed as a practical diagnostic biomarkers for colorectal cancer. In this review, we will be discuss these fluctuations of MUTYH, KLF4/6 and WNT1 genes in CRC.

Giant thymolipoma of mediastinum and neck - initially misdiagnosed as liposarcoma by core needle biopsy.

Thymolipomas are rare benign tumors, constituting one of the differential diagnoses of an anterior mediastinal mass. These tumors may have an indolent, asymptomatic course, often achieving massive dimensions before presentation. When it is symptomatic, respiratory symptoms predominate. We report a case of thymolipoma in a 30-year-old male complaining of heaviness and constricting type of chest pain and neck swelling of 1-year duration. Computed tomography scan finding revealed a space-occupying lesion in the anterior mediastinum and extend to the right side of the mediastinum, neck, and left hemithorax. A sono-guided core needle biopsy was carried out which identified an atypical cell and was suspicious to liposarcoma. The tumor was completely excised through "posterolateral thoracotomy." Postoperative histopathological examination confirmed the diagnosis of thymolipoma. This is the second case we have reported from our institution.

Epidemiology of burn injuries at a newly established burn care center in rasht.

BACKGROUND: Advances in the care of burn injuries have resulted from the efforts of regional patient-based specialist teams at burn care centers. OBJECTIVES: We conducted this study to assess the four-year epidemiology of burn injuries in Rasht, Iran. MATERIALS AND METHODS: In this cross-sectional study, medical records of 2274 burn patients, treated at Velayat hospital from January 2007 to December 2010 in Rasht, Iran, were assessed. Age, sex, level of education, occupation, severity and degree of burn, burn surface area, burn cause and outcome of patients were evaluated. RESULTS: In our study the overall mortality rate was 8.7%; 65.7% of patients were men and 34.3% were women. Mean age of patients was 31.47 ± 22.67 years. Mean Total Burn Surface Area (TBSA) was 15.24 ± 18.4. Lowest TBSA was 0.5% and highest TBSA was 100%. Significant associations were observed between age (P = 0.0001), place of residence (P = 0.004), level of education (P = 0.0001), unemployment (P = 0.0001), marital status (P = 0.021), causes of burn (P = 0.0001), TBSA (P = 0.0001) and mortality rate. In our study, no significant difference was observed between age and sex (P = 0.071). CONCLUSIONS: Due to high prevalence of burn injuries in Iran, increasing the level of awareness of the society as well as adhering to safety procedures both at home and workplace is recommended via implementing effective national safety policies.