Publications by authors named "Reza Shahriarirad"

66 Publications

Evaluation of post laparoscopic cholecystectomy pain after subcutaneous injection of lidocaine at port site versus lidocaine spray on gallbladder bed after cholecystectomy: a randomized controlled trial.

Langenbecks Arch Surg 2022 Aug 8. Epub 2022 Aug 8.

Department of Surgery, Arak University of Medical Sciences, Arak, Iran.

Purpose: The efficacy of intraperitoneal (IP) and incisional use of local anesthesia in laparoscopic cholecystectomy is a promising subject regarding post-operative pain control. In this study, we aim to compare these methods using lidocaine as the local anesthetic.

Methods: This study was a double-blinded randomized controlled trial. Eighty-two patients, candidates for laparoscopic cholecystectomy, were included. Participants were randomly divided into two equal groups; the instillation group and the infiltration group. In the instillation group, a 2% lidocaine ampule was instilled in the gallbladder bed after removal of the gallbladder. In the infiltration group, a 2% lidocaine ampule was injected subcutaneously into the port sites before making the incisions for the insertion of laparoscopic ports.

Results: The mean age of patients were 41.66 ± 14.44 and 48.05 ± 17.03 years in the instillation and infiltration groups, respectively. The etiologies recorded in this study were: acute calculous cholecystitis (29.3%), symptomatic gallstone (68.3%), and polyp (2.4). The pain severity, evaluated at six different times, from immediately after awakening from anesthesia to 24 h after the operation, was not significantly different between the two groups (p-value = 0.329). Consumption of nonsteroidal anti-inflammatory drugs and narcotics, were statistically lower in the instillation group (p-value = 0.013 and 0.003, respectively). However, hospitalization period, time spent to return to normal bowel movements and oral diet, and postoperative nausea/vomiting were not significantly significant between the groups.

Conclusion: IP instillation of lidocaine following laparoscopic cholecystectomy offers post-operative pain relief and is associated with lower analgesic consumption in comparison to subcutaneous injection of this agent at the port site.
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http://dx.doi.org/10.1007/s00423-022-02645-yDOI Listing
August 2022

Subscapular elastofibrolipoma treated with marginal resection: two case reports.

J Med Case Rep 2022 Aug 2;16(1):296. Epub 2022 Aug 2.

Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.

Background: Elastofibroma dorsi is a rare benign tumor of soft tissue, typically under the lower angle of the scapula. Its specific location and distinctive clinical symptoms can provide enough information for diagnosis. Nevertheless, pathological confirmation by biopsy may be needed to rule out other malignancies.

Case Presentation: Here, we present two cases of 63-year-old and 49-year-old female Asian patients who came to us with the chief complaint of pain and bulging in their shoulders. Both patients had rubbery and mobile masses. Also, shoulder movements were not restricted in the examination; however, the patients expressed pain during movements. Computed tomography scans were compatible with the diagnosis of elastofibroma dorsi. Surgical excision was performed for both cases owing to the symptomatic nature of the masses, and histopathological findings confirmed the diagnosis.

Conclusion: Elastofibroma dorsi is a benign pseudotumor presenting with an uncomfortable feeling in the shoulder with movement in older females. In typical symptom-free cases of elastofibroma dorsi, observation is sufficient, while in symptomatic patients or if there is suspicion of malignancy, complete resection with marginal resection is the treatment of choice.
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http://dx.doi.org/10.1186/s13256-022-03522-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344634PMC
August 2022

Promising results of captopril in improving knee arthrofibrosis and cartilage status: an animal model study.

J Exp Orthop 2022 Jul 28;9(1):72. Epub 2022 Jul 28.

Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Purpose: Several cytokines and growth factors start and progress the destruction process of joint hyaline cartilage and fibrosis formation. Captopril is classified as an Angiotensin-converting enzyme inhibitor in which several studies revealed that captopril significantly decreases fibrosis formation in some organs like the liver, heart, and kidney. This study aimed to evaluate the use of captopril in reducing the possibility of arthrofibrosis and osteoarthritis in an animal model.

Method: In this in-vivo animal model study, the anterior cruciate ligament of 24 rabbits was transected to induce osteoarthritis and arthrofibrosis. The control group contained 11 rabbits and the second group consisted of 13 rabbits. The second group was treated with 10 mg/ kilogram/day captopril through a nasogastric tube. The control group was treated with normal saline in the same way. Cartilage damage and osteoarthritis were evaluated by Osteoarthritis Research Society International (OARSI) scoring system. After 30 days, animals were sacrificed, and arthrofibrosis and cartilage damage were evaluated microscopically and macroscopically.

Results: According to macroscopic and microscopic evaluation, captopril dramatically reduced arthrofibrosis formation based on visual scoring and the Masson trichrome staining system. Cartilage damage was lower in the intervention group compared to the control group.

Conclusions: Captopril is an angiotensin-converting enzyme inhibitor that demonstrated to significantly decreases the possibility of arthrofibrosis. Although the beneficial preventive effect of captopril on osteoarthritis was not proved statistically, better results may be obtained if the route of administration or drug dosage is changed.
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http://dx.doi.org/10.1186/s40634-022-00516-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9334488PMC
July 2022

Prediction of Patients with COVID-19 Requiring Intensive Care: A Cross-sectional Study Based on Machine-learning Approach from Iran.

Indian J Crit Care Med 2022 Jun;26(6):688-695

Shiraz University of Medical Sciences, Student Research Committee, Shiraz, Iran.

Background: Prioritizing the patients requiring intensive care may decrease the fatality of coronavirus disease-2019 (COVID-19).

Aims And Objectives: To develop, validate, and compare two models based on machine-learning methods for predicting patients with COVID-19 requiring intensive care.

Materials And Methods: In 2021, 506 suspected COVID-19 patients, with clinical presentations along with radiographic findings, were laboratory confirmed and included in the study. The primary end-point was patients with COVID-19 requiring intensive care, defined as actual admission to the intensive care unit (ICU). The data were randomly partitioned into training and testing sets (70% and 30%, respectively) without overlapping. A decision-tree algorithm and multivariate logistic regression were performed to develop the models for predicting the cases based on their first 24 hours data. The predictive performance of the models was compared based on the area under the receiver operating characteristic curve (AUC), sensitivity, and accuracy of the models.

Results: A 10-fold cross-validation decision-tree model predicted cases requiring intensive care with the AUC, accuracy, and sensitivity of 97%, 98%, and 94.74%, respectively. The same values in the machine-learning logistic regression model were 75%, 85.62%, and 55.26%, respectively. Creatinine, smoking, neutrophil/lymphocyte ratio, temperature, respiratory rate, partial thromboplastin time, white blood cell, Glasgow Coma Scale (GCS), dizziness, international normalized ratio, O saturation, C-reactive protein, diastolic blood pressure (DBP), and dry cough were the most important predictors.

Conclusion: In an Iranian population, our decision-based machine-learning method offered an advantage over logistic regression for predicting patients requiring intensive care. This method can support clinicians in decision-making, using patients' early data, particularly in low- and middle-income countries where their resources are as limited as Iran.

How To Cite This Article: Sabetian G, Azimi A, Kazemi A, Hoseini B, Asmarian N, Khaloo V, Prediction of Patients with COVID-19 Requiring Intensive Care: A Cross-sectional Study based on Machine-learning Approach from Iran. Indian J Crit Care Med 2022;26(6):688-695.

Ethics Approval: This study was approved by the Ethical Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1399.018).
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http://dx.doi.org/10.5005/jp-journals-10071-24226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9237161PMC
June 2022

Gallbladder Agenesis without Additional Biliary Tracts Abnormality.

Case Rep Gastrointest Med 2022 23;2022:3209658. Epub 2022 Jun 23.

Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.

Background: Gallbladder agenesis (GA) is a very uncommon disorder of the biliary system. Diagnosis of GA can be difficult and may result in unnecessary procedures. In this case report, we will discuss our experience with an intraoperative accidental diagnosis of GA in a middle-aged woman that was effectively treated. A 46-year-old woman presented with abdominal pain, nausea, vomiting, and intolerance to meals. Laparoscopic surgery was conducted based on sonographic imaging and a preliminary diagnosis of chronic cholecystitis. No gallbladder was seen during laparoscopy, and the patient was diagnosed as a case of GA. The laparoscopy was terminated, and the patient was referred for magnetic resonance cholangiopancreatography (MRCP) to confirm the diagnosis. Finally, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy were performed to alleviate symptoms. After one year of follow-up, the patient's overall condition is satisfactory and symptom-free.

Conclusion: Our case exemplifies this common blunder. Therefore, we are reporting a case of GA discovered intraoperatively to increase surgeons' awareness and preparedness for this possible differential diagnosis and minimize unnecessary operational intervention.
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http://dx.doi.org/10.1155/2022/3209658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246627PMC
June 2022

Mediastinal thymoma in a patient with previous rectal and breast cancers: A report of a case with multiple primary cancers and review of literature.

Clin Case Rep 2022 Jun 21;10(6):e5987. Epub 2022 Jun 21.

Department of Pathology Abu Ali Sina Hospital Shiraz Medical School Shiraz University of Medical Sciences Shiraz Iran.

A 42-year-old female patient with intellectual disability was presented to us as a newly diagnosed case of thymoma. She was identified as a case of multiple primary cancers, including adenocarcinoma of the rectum, carcinoma of the breast, and mediastinal thymoma, in a 15-year period, who underwent chemotherapy, radiotherapy, and surgical resection.
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http://dx.doi.org/10.1002/ccr3.5987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210131PMC
June 2022

Evaluation and Comparison of Mucormycosis Patients' Features Undergoing Functional Endoscopic Sinus Surgery Prior to and during the COVID-19 Pandemic: A Case-Control Study.

Int J Clin Pract 2022 7;2022:1248325. Epub 2022 Jun 7.

Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Rhinocerebral mucormycosis is a serious invasive fungal infection that is one of the most aggressive and lethal of invasive mycoses. The coronavirus disease (COVID-19) has been linked to immune dysregulation, and patients with COVID-19 have been reported to be at risk for developing invasive fungal infections. This study is conducted to evaluate the concurrence of mucormycosis among COVID-19 patients.

Methods: In this retrospective, cross-sectional study, hospital records of patients with mucormycosis, as well as COVID-19 admitted to Khalili Hospital, as the major referral center for functional endoscopic sinus surgery (FESS) in southern Iran, were collected. Demographic and clinical information was extracted and subsequently analyzed.

Results: Among 59 mucormycosis patients undergoing FESS, 41 (69.5%) were during the COVID-19 pandemic, while 18 (30.5%) were during one year before the COVID-19 pandemic. The average age was 49.33 ± 20.52, and 64.4% had diabetes mellitus, while 62.7% had COVID-19. The most common presentation was periorbital edema (56.9%), followed by necrotic tissue (48.3%). Although the total number of cases increased during the COVID-19 period compared to the case before the pandemic, the overall pattern and features of the patients had no significant difference, except regarding a significant increase in the presentation of necrotic tissue and also the use of corticosteroids. Most cases developed mucormycosis two weeks after COVID-19. The overall mortality was 36.8%, which is not statistically associated with COVID-19.

Conclusion: Even in the absence of comorbidities, physicians should be aware of the risk of secondary fungal infections in patients with COVID-19 who were treated with corticosteroids.
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http://dx.doi.org/10.1155/2022/1248325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9175093PMC
June 2022

Evaluation of Crossover Sign in Pelvis Models Made with a Three-Dimensional Printer.

Adv Orthop 2022 26;2022:4665342. Epub 2022 May 26.

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Investigation of the crossover sign (COS) in different degrees of tilt in pelvises made by three-dimensional printing of CT scans among patients with normal hip versions was carried out.

Methods: Radiology CT scans of 8 normal pelvises reconstructed in 3D and the effect of sequential tilting on the presence of the false-positive COS in 48 radiographs were investigated.

Results: The COS was seen in 77% of the AP radiographs during tilt changes. The average distance between the tip of the coccyx and the symphysis pubis was 32.06 ± 10.99 mm. Also, COSs were present in all radiographs from 6 degrees tilt and above.

Conclusion: Minor tilting of the pelvis can result in a false-positive crossover sign on AP plain radiographs.
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http://dx.doi.org/10.1155/2022/4665342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9162839PMC
May 2022

Tracheal myoepithelioma resected by using rigid bronchoscopy: a case report and review of the literature.

J Cardiothorac Surg 2022 May 23;17(1):125. Epub 2022 May 23.

Department of Anesthesiology, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Endotracheal tumors are rare in the respiratory system. Myoepitheliomas are benign tumors, which are rarely reported in the respiratory system. Herein, we report a rare case of endotracheal myoepithelioma, which was resected by rigid bronchoscopy.

Case Presentation: A 36-year-old man, presenting with chest pain, dyspnea, stridor, and hemoptysis, was referred to our center with radiological features of near-total tracheal obstruction due to mass. Fiberoptic bronchoscopy with argon plasma coagulation and rigid bronchoscopy with grasper forceps was utilized to resect the mass. Pathological evaluation of the mass demonstrated myoepithelioma. The patient was discharged in good condition. Now, after 6 months, the patient is symptom-free with no evidence of tumor recurrence or re-growth.

Conclusions: Despite being extremely rare, myoepithelioma should be considered a possible differential diagnosis for endotracheal tumors. Fiberoptic and rigid bronchoscopy management is an effective method for the resection of endotracheal tumors.
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http://dx.doi.org/10.1186/s13019-022-01880-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128258PMC
May 2022

Simultaneous retrograde venous and anterograde arterial bullet embolism: a case report.

J Med Case Rep 2022 May 22;16(1):198. Epub 2022 May 22.

Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Bullet embolus is a rare condition following gunshot injuries and represents a clinical challenge regarding both diagnosis and management.

Case Presentation: We report the case of a 35-year-old Iranian (Middle-Eastern) male patient with a shotgun injury to both buttocks, which traveled to the heart and the popliteal area through the femoral vein and superficial femoral artery, respectively. Surgical intervention was applied for the popliteal pellet, and the patient was discharged without further complications.

Conclusion: Although bullet emboli can be a clinical challenge, with the advent of modern procedures, removal has become safer. X-ray, computed tomography, and transthoracic and/or transesophageal echocardiography may be used as adjuncts to help establish the diagnosis.
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http://dx.doi.org/10.1186/s13256-022-03414-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124398PMC
May 2022

Effects of neuromodulation on treatment of recurrent anal fissure: A systematic review.

Int J Surg 2022 Jun 11;102:106661. Epub 2022 May 11.

Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Background: Anal fissure is a linear tear in the distal anoderm most frequently occurring in the posterior midline. Lateral internal sphincterotomy is considered the gold standard for the treatment of this condition. To this date, several pharmacological and neuromodulatory therapies have been tried out as alternative non-invasive treatments for anal fissures, however, the efficacy of some of these methods remains to be understood.

Objective: the primary aim of this study was to review available literature on neuromodulatory treatments for recurrent anal fissure as a potentially effective cure for this condition.

Data Sources: A search was conducted among five main online databases Embase, PubMed, Web of Science, Scopus, and Scholar.

Study Selection: All published human studies in English literature addressing neuromodulation for the treatment of recurrent anal fissure were selected.

Intervention: neuromodulation for the treatment of anal fissure. We chose to include all articles in which the authors stated that the procedure they performed was via neuromodulation technique, or that the described technique used in their study resembled the technique.

Result: Among a total of 3487 evaluated studies, seven represented the effects of neuro modulation on treatment of recurrent anal fissure, among which two were randomized controlled trials and the rest were prospective studies. A total of 186 patient were evaluated in these studies. The mean age of the participants was 46.97 ± 8.2. The average VAS score before intervention was 7.77 ± 2.13, which decreased to 0.31 ± 1.13 after intervention.

Limitations: limitations of this study include the lack of related articles, and data regarding this subject.

Conclusion: Posterior tibial nerve stimulation (PTNS) provides rapid pain relief and fissure healing especially in short-to mid-terms with little to no complications, however, using this treatment, symptoms of anal fissure do not improve as well as LIS, especially in the long-term.
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http://dx.doi.org/10.1016/j.ijsu.2022.106661DOI Listing
June 2022

The effect of suture techniques on the outcome of tracheal reconstruction: An observational study and review of literature.

Surgeon 2022 Apr 30. Epub 2022 Apr 30.

Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Tracheal resection and anastomosis surgery is a safe operation and is used to treat various benign and malignant diseases of the trachea. However, tracheal stenosis is among the main anastomotic complications following this procedure. Surgeons use both the continuous and the interrupted suture techniques for tracheal anastomosis, but contradicting results in each technique's complications have been reported in various studies. In this study, we aimed to compare the outcome of these two different suture techniques and a relevant literature review.

Methods: Surgical records during a period of 15 years (2005-2019) were screened for tracheal reconstruction surgery in affiliated hospitals of Shiraz University of Medical Sciences, Shiraz, Iran. A total of 82 patients were evaluated based on surgical and suture features, along with their follow-up bronchoscopy for anastomotic complications.

Results: Post-operational subclinical restenosis occurred in 8 (15.3%) out of 52 and 10 (33.3%) of 30 patients who underwent continuous and interrupted suturing techniques, respectively. Also, 6 (20%) patients in the interrupted group developed symptomatic restenosis, while in the continuous group, only one patient was clinically symptomatic. The patients with continuous suture technique had a shorter surgery time than patients whose interrupted technique was used (P < 0.001).

Conclusions: Based on our results, we conclude that restenosis is significantly reduced when the continuous technique is applied for tracheal anastomosis; However, the results are contradicting in relevant literature and due to the retrospective nature of our study, further human studies and clinical trials are warranted.
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http://dx.doi.org/10.1016/j.surge.2022.03.008DOI Listing
April 2022

Comparison of Oral Sirolimus, Prednisolone, and Combination of Both in Experimentally Induced Peritoneal Adhesion.

J Surg Res 2022 08 25;276:168-173. Epub 2022 Mar 25.

Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Peritoneal adhesion formation is a challenging postoperative complication. We aim to evaluate the effect of orally administered sirolimus, prednisolone, and their combination to prevent this entity.

Methods: Eighty female albino underwent intraperitoneal injection of 3 mL of 10% sterile talc solution to induce peritoneal adhesion, and were subsequently and randomly divided into four groups (each n = 20); including a control group; 1 mg/kg oral prednisolone daily in the morning; 0.1 mg/kg oral sirolimus daily; and a combination group which received both drugs, with the same dosage. On the 29th day, abdominal cavities were explored, and classification was done based on Nair classification.

Results: All rats were healthy on the 29th day, in which exploration was performed. The rats in the control group had extensive intra-abdominal adhesions, while 17 (85%) rats in the control group had substantial adhesion; however, the prednisolone, sirolimus, and combination group had lesser adhesion formation. Also, 14 (70%) rats of prednisolone group, 13 (65%) of sirolimus group, and 16 (80%) of combination group had insubstantial adhesion. The decrease in the grade of peritoneal adhesion bands was highly significant in the combination group (P > 0.001).

Conclusions: The combination of sirolimus and prednisolone was effective for preventing peritoneal adhesions in rats.
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http://dx.doi.org/10.1016/j.jss.2022.02.047DOI Listing
August 2022

A comparison between effectiveness of gluteal trigger point and epidural steroid injection in lumbosacral canal stenosis patients: a randomized clinical trial.

Br J Neurosurg 2022 Feb 7:1-7. Epub 2022 Feb 7.

Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.

Background: Lumbosacral Spinal Stenosis (LSS) is a degenerative spine disease and a major cause of pain and disability, especially in geriatrics. Primary symptom control in patients with LSS includes conservative treatment and non-surgical methods. In this study, we aimed to compare the effect of steroid injection via epidural and gluteal trigger point techniques.

Methods: Patients aged 40-75 years old who had pain and other clinical signs of spinal stenosis in the last 6 months were included in our study and divided into two groups of gluteal trigger point (TP) or epidural steroid injection (ESI). The patients were evaluated based on the visual analog scale (VAS), Roland-Morris Disability Questionnaire (RDQ), Oswestry Disability Index (ODI), and the Quebec back pain disability scales during their pre-injection period and 2 weeks after follow-ups till 8 weeks. A P value of less than 0.05 was considered significant.

Results: A total of 44 patients were included in our study. The TP group had a significant decrease in comparison with their follow-ups; however, in the epidural group, the significant decrease was only observed compared to the pre-injection period and the scores did not have any significant decreases after the second week regarding the ODI, RQM, and VAS scales. The TP group demonstrated significantly higher scores of decreases of ODI and Quebec score compared to the epidural group at weeks 4 and 8. Regarding RQM, the TP groups demonstrated significantly higher scores of decreases compared to the epidural group at weeks 2, 4 and 8. ( < 0.001  = 0.008, and  < 0.001, respectively).

Conclusion: Both epidural and TP steroid injection significantly reduced the patients' pain and improved their QoL and function; however, more satisfactory results were observed in the TP group during the patients' follow-ups, while the epidural group demonstrated only statistically significant improvement during the short-term follow-up.
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http://dx.doi.org/10.1080/02688697.2022.2033698DOI Listing
February 2022

Antineutrophil cytoplasmic antibody-associated vasculitis in presence of positive antiphospholipid antibody: a case report.

J Med Case Rep 2022 Jan 24;16(1):28. Epub 2022 Jan 24.

Fellowship of Rheumatology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Antineutrophil cytoplasmic antibody-associated vasculitis is dominated by inflammatory occlusion of small vessels, causing tissue ischemia in various organs. This disorder has rarely been associated with vasculopathy, such as antiphospholipid syndrome.

Case Presentation: We report a case of a 48-year-old Persian male presenting with distal digital gangrene along with inflammatory arthralgia. High titers of anti-proteinase 3 and antiphospholipid antibodies (anticardiolipin antibody) were detected in laboratory evaluation. Therefore, a diagnosis of antineutrophil cytoplasmic antibody-associated vasculitis and antiphospholipid syndrome was made and treated with anticoagulant along with monthly pulses of cyclophosphamide and a daily dose of 1 mg/kg prednisolone.

Conclusion: Our case, along with other reports, illustrates that these two entities can coexist. Therefore, monitoring antiphospholipid antibodies in patients with antineutrophil cytoplasmic antibody-associated vasculitis with or without clinical evidence of any thrombosis and ruling out thrombosis in cases that do not respond to proper treatment of vasculitis may be relevant to prevent irreversible or fatal organ damage.
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http://dx.doi.org/10.1186/s13256-022-03256-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8784220PMC
January 2022

Burn Injuries in People Who Used Drug, 2009-2017: A Case-Control Study in Shiraz, Southern Iran.

J Burn Care Res 2022 Jan 13. Epub 2022 Jan 13.

Department of Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, Iran.

Background: Burn injury is a critical health issue, which is associated with several morbidities and mortalities. Substance abuse, which is an important public health problem in Iran, can affect burn injury outcomes and etiologies in victims. This study was aimed to evaluate different aspects of burn injuries in people who used drug (PWUD) in two referral centers in the south of Iran.

Methods: This Case-Control Study was conducted on burn victims referred to Amir-al Momenin Hospital and Ghotb-al-din Hospital from 2009 to 2017. Patients with a history of drug consumption were selected from the database and compared to randomly selected burn victims with no history of drug use. Demographics, burn etiology, underlying disease, total body surface area, hospitalization duration, and also the outcomes were collected and recorded in both groups. Data analysis was done by SPSS software.

Results: A total of 5,912 inpatients were included in this study, which 2,397 of them (40.54%) were female. The mean age of the patients was 26.12 ± 19.18. Drug history was positive in 659 patients (11.15%). Familial issues and mental disorders were significantly higher in the PWUD group compared to the control group (P<0.001). Explosion etiology was significantly higher in the PWUD group (P<0.001). Psychiatric disorders (P<0.001), total body surface area (P=0.023), and hospital stay (P<0.001) were significantly higher in PWUD; however, the mortality rate had no statistically significant differences between the groups (P=0.583).

Conclusion: Substance abuse is a risk factor in burn victims, which can affect burn etiology and burn-related morbidities.
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http://dx.doi.org/10.1093/jbcr/irac005DOI Listing
January 2022

Prevalence of anxiety, depression, stress, and perceived stress and their relation with resilience during the COVID-19 pandemic, a cross-sectional study.

Health Sci Rep 2022 Mar 6;5(1):e460. Epub 2022 Jan 6.

Student Research Committee Shiraz University of Medical Sciences Shiraz Iran.

Background And Aims: Home quarantine and physical distancing at the time of coronavirus disease 2019 (COVID-19) had a severe effect on the mental health of the populations. Resilience has been reported previously to be a protective factor against anxiety, stress, and depression. This study evaluates the prevalence and severity of depression, anxiety, stress, and perceived stress and their relation with resilience associated with the COVID-19 pandemic among a sample of the general population in Southern Iran.

Methods: In this cross-sectional web-based survey, from April 12 to May 13, 2020, stress, anxiety, depression, perceived stress, and resilience were measured using the Persian version of Depression Anxiety and Stress Scale (DASS-21), Perceived Stress Scale (PSS-14), and Connor-Davidson Resilience Scale (CD-RISC). Statistical analyses were carried out using the IBM Statistical Package for Social Sciences. Mean ± standard deviation (SD) and frequencies were used to describe demographic data. Independent sample -test, Spearman correlation, and the Pearson correlation coefficient were performed to examine anxiety, depression, stress, and resilience.

Results: Among a total of 538 participants, the overall prevalence of moderate-to-extremely severe depression, anxiety, and stress was found to be 26.1%, 33.2%, and 5.8%, respectively. The overall median PSS and resilience score were 30 and 70, respectively. There was a significant association between higher age and perceived stress. Male and high income were related to higher resilience scores. Perceived stress positively correlates with resilience, whereas depression significantly correlates with anxiety and stress. Individuals with underlying disease demonstrated significantly higher scores for depression and anxiety. Also, perceived stress had a significant but weak, positive correlation with age and the number of quarantine days.

Conclusion: The occurring COVID-19 pandemic could be the culprit of psychological distress, anxiety, and depression of large population quantities. Our results showed a subordinate overall resilience in the general Iranian population during the COVID-19 pandemic.
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http://dx.doi.org/10.1002/hsr2.460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8733840PMC
March 2022

A machine learning-based system for detecting leishmaniasis in microscopic images.

BMC Infect Dis 2022 Jan 12;22(1):48. Epub 2022 Jan 12.

Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Leishmaniasis, a disease caused by a protozoan, causes numerous deaths in humans each year. After malaria, leishmaniasis is known to be the deadliest parasitic disease globally. Direct visual detection of leishmania parasite through microscopy is the frequent method for diagnosis of this disease. However, this method is time-consuming and subject to errors. This study was aimed to develop an artificial intelligence-based algorithm for automatic diagnosis of leishmaniasis.

Methods: We used the Viola-Jones algorithm to develop a leishmania parasite detection system. The algorithm includes three procedures: feature extraction, integral image creation, and classification. Haar-like features are used as features. An integral image was used to represent an abstract of the image that significantly speeds up the algorithm. The adaBoost technique was used to select the discriminate features and to train the classifier.

Results: A 65% recall and 50% precision was concluded in the detection of macrophages infected with the leishmania parasite. Also, these numbers were 52% and 71%, respectively, related to amastigotes outside of macrophages.

Conclusion: The developed system is accurate, fast, easy to use, and cost-effective. Therefore, artificial intelligence might be used as an alternative for the current leishmanial diagnosis methods.
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http://dx.doi.org/10.1186/s12879-022-07029-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754077PMC
January 2022

A large undifferentiated sarcoma of the liver in a 13-year-old girl treated with anatomical resection: a case report and review of the literature.

BMC Gastroenterol 2022 Jan 3;22(1). Epub 2022 Jan 3.

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Undifferentiated embryonal sarcoma of the liver (UESL) is a rare liver tumor accounting for 6-13% of primary liver tumors. Accurate preoperative diagnosis is difficult, with a rather high misdiagnosis rate. Herein, we reported a very large UESL treated with anatomical resection. Our case is amongst the largest pediatric UESLs in the literature.

Case Presentation: Herein, we report a 13-year-old girl presenting with right upper quadrant abdominal pain, postprandial vomiting, and abdominal distention, in which radiographic imaging demonstrated a huge UESL (28 × 20 × 12 cm). The patient was treated with partial hepatectomy and the 5 kg tumor was removed. The patient was discharged in good condition, with no significant complaints in her follow-up.

Conclusions: Although different treatment strategies have been reported for UESL cases, anatomical resection is still the main treatment approach, especially for large tumors.
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http://dx.doi.org/10.1186/s12876-021-02076-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8722022PMC
January 2022

Serosurvey and Molecular Detection of in Dogs in Rural Areas of Kazeroun District, Fars Province, Southern Iran.

J Parasitol Res 2021 15;2021:4499086. Epub 2021 Dec 15.

Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

is an intracellular protozoan parasite responsible for systemic disease in a wide range of warm-blooded animals. The current study is aimed at evaluating the prevalence of infection in dogs, using serological and molecular methods in rural areas in Kazeroun Township, Fars province, southern Iran. Blood samples were obtained from 60 clinically healthy dogs with an age range of 1 to 7 years in three rural areas of Fars province, southern Iran. Sera and buffy coats were used to assess the infection using both modified agglutination test (MAT) and real-time PCR. . Antibodies against were detected in 5 out of 60 (8.3%) dogs by the MAT method, and DNA was detected in 17 out of 60 (28.3%) studied animals. There was no significant association between sex and seropositivity to ( > 0.05). Fair agreement (kappa = 0.27) was seen between molecular and serological findings where three dogs with positive serological results had a positive molecular test. Findings of the present study show a relatively high prevalence of infection in dogs in rural areas in Fars province, southern Iran. Finding the parasite genotype in dogs deserves further study.
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http://dx.doi.org/10.1155/2021/4499086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8695019PMC
December 2021

Transportal versus all-inside techniques of anterior cruciate ligament reconstruction: a systematic review.

J Orthop Surg Res 2021 Dec 23;16(1):734. Epub 2021 Dec 23.

Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Background: Transportal (TP) and all-inside techniques (AIT) are the most commonly used anterior cruciate ligament (ACL) reconstruction procedures in current clinical practice. However, there is an ongoing debate over which procedure is superior. Therefore, the purpose of this systematic review was to evaluate and compare the clinical outcomes and complications of these two techniques to propose recommendations for future application. Our primary hypothesis was that AIT is a superior ACLR technique compared to TP.

Methods: A systematic literature review, using PRISMA guidelines, was conducted using PubMed, Medline, Google Scholar, and EMBASE, up to February 2021 to identify studies focusing on AIT and TP techniques of ACL reconstruction. We excluded animal experiments, cadaveric studies, retrospective studies, case reports, technical notes, and studies without quantitative data. Patients' characteristics, surgical technical features, along with postoperative follow-up and complications were extracted and reported accordingly. Methodological quality of the included studies was assessed using the Modified Coleman Methodology Score (MCMS).

Results: A total of 44 studies were selected for this review, of which four were comparative studies. A total of 923 patients underwent AIT and 1678 patients underwent the TP technique for ACLR. A single semitendinosus graft was commonly used in the AIT compard to combined semitendinosus and gracilis graft in the TP group. The postoperative increase in International Knee Documentation Committee (IKDC), Lysholm, KT-1000, and Short Form-12 (physical and mental) scores were similar in the AIT group and the TP group. Contrastingly, the VAS pain score was significantly lower in the AIT group compared to the TP group. Furthermore, the pooled complication rates from all studies were similar between the two groups (AIT: 54 patients, 8.26% vs. PT: 55 patients, 6.62%). However, the four studies that prospectively compared AIT and TP techniques showed lesser complications in the AIT group than the TP group.

Conclusion: Since the future trend in orthopedic surgery is toward less invasive and patients' satisfaction with good outcomes, AIT is a good alternative method considering preserving bony tissue and gracilis tendon with less post-operative pain, along with more knee flexor strength and equal outcomes compared to conventional ACL reconstruction surgery. Level of Evidence II.
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http://dx.doi.org/10.1186/s13018-021-02872-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8705139PMC
December 2021

Socioeconomic Features of Burn Injuries in Southern Iran: A Cross-sectional Study.

J Burn Care Res 2022 07;43(4):936-941

Division of Plastic and Reconstructive Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.

Burn injuries are among the most traumatic incidences which could be associated with substantial morbidity and mortality. The incidence of these injuries differs based on population socioeconomic characteristics. In this study, we aim to evaluate the distribution of burn injuries based on socioeconomic and causative factors. Relative features from the targeted population were obtained and evaluated. Data were extracted in August 2019 and statistical analysis of the data was conducted from February 2020 to April 2020. This cross-sectional record-based study was conducted from 2008 to 2016 in a main referral center for burn injuries in the southern Iran. Participants included burn survivors and burn patients who were registered as outpatients or inpatients. A total of 4919 burn cases with a mean age of 31.91 ± 17.33, including 2926 (59.5%) males and 1993 (40.5%) females was reported. The majority of our cases had an educational level of under diploma (40.72%). A significant correlation between age, gender, and percentage of burn with the level of education was recorded (P < .001). The most frequent cause of burn injuries was flame with 2537 (51.9%) cases. The most susceptible population to burn injuries were reported to be poorly educated individuals, which emphasizes the preventive role of education.
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http://dx.doi.org/10.1093/jbcr/irab227DOI Listing
July 2022

Management of Asymptomatic Perforation of a Pediatric Rectal Foreign Body into the Peritoneal Cavity Retrieved with Laparoscopy: A Case Report and Review of the Literature.

Case Rep Med 2021 28;2021:5851967. Epub 2021 Nov 28.

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Rectal foreign body insertion has had an increasing trend throughout the years, whereas it is rarely reported in pediatrics. The management and treatment of these cases can become challenging, since it also can present with atypical or even no symptoms in physical evaluation. A 14-year-old boy was referred to our hospital with a history of insertion of a paintbrush into his anus four weeks before the admission. The paintbrush had perforated the colon and was in the abdominopelvic cavity; however, no symptoms of peritonitis were observed. Rectal examination, sigmoidoscopy, and colonoscopy were unremarkable. Exploratory laparoscopy was performed, and the paintbrush was taken out completely. The patient was discharged in good condition. In cases with rectal foreign body insertion, perforation without causing peritonitis or acute abdomen is possible. In these conditions, imaging examinations play an essential role in managing the patients, and laparoscopy can be a proper procedure for retrieving the foreign body.
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http://dx.doi.org/10.1155/2021/5851967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8645393PMC
November 2021

Management of pleural empyema in a 12-year-old obese patient with COVID-19: a pediatric case report.

BMC Pediatr 2021 11 30;21(1):531. Epub 2021 Nov 30.

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: With the ongoing coronavirus disease (COVID-19) pandemic, along with the development of new mutations of the virus and an increase in the number of cases among pediatrics, physicians should be aware and alerted on the atypical presentations of the disease, especially in less expected individuals.

Case Presentation: Here we present a 12-year-old obese boy (BMI = 37.5 kg/m) who presented with empyema, which was following SARS-CoV-2 infection. The patient had no history of fever. Due to the onset of dyspnea, a chest tube was inserted for him which was later altered to a pleural drainage needle catheter.

Conclusion: Our case is the first report of COVID-19 presenting as empyema among pediatrics. Pleural empyema should be considered as a rare complication of COVID-19. Since there is still no guideline in the management of empyema in the context of COVID-19, delay in diagnosis and intervention may cause morbidity and mortality in children.
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http://dx.doi.org/10.1186/s12887-021-03007-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8630417PMC
November 2021

Evaluation of the therapeutic regimen in COVID-19 in transplant patients: where do immunomodulatory and antivirals stand?

Virol J 2021 11 22;18(1):228. Epub 2021 Nov 22.

Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The management of COVID-19 in organ transplant recipients is among the most imperative, yet less discussed, issues based on their immunocompromised status along with their vast post-transplant medication regimens. No conclusive study has been published to evaluate proper anti-viral and immunomodulator medications effect in treating COVID-19 patients to this date.

Method: This retrospective study was conducted in Shiraz Transplant Hospital, Iran from March 2020 to May 2021 and included COVID-19 diagnosed patients based on SARS-CoV-2 RT-PCR positive test who had been hospitalized for at least 48 h before enrolling in the study. Clinical and demographic information of patients, along with their treatment course and the medication used were evaluated and analyzed using multiple regression analysis.

Results: A total of 245 patients with a mean age of 49.59 years were included with a mortality rate of 8.16%. The administration of Remdesivir as an anti-viral drug (P value < 0.001) and Tocilizumab as an immunomodulator drug (P value < 0.001) could reduce the hospitalization period in the hospital and the intensive care unit, as well as the mortality rates significantly. Meanwhile, the patients treated with Lopinavir/Ritonavir experienced a lower chance of survival (OR < 1, P value = 0.04). No significant difference was observed between various therapeutic regimens in clinical complications such as bacterial coinfections, cardiovascular and gastrointestinal adverse reactions, and liver or kidney dysfunctions.

Conclusion: The administration of Remdesivir as an anti-viral and Tocilizumab as an immunomodulatory drug in solid-organ transplant recipients could be promising treatments of choice to manage COVID-19.
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http://dx.doi.org/10.1186/s12985-021-01700-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607221PMC
November 2021

Profunda Brachii Pseudoaneurysm following Supracondylar Fracture of Humerus Repair in an 8-Year-Old Boy: A Case Report and Review of Literature.

Case Rep Orthop 2021 31;2021:1768529. Epub 2021 Oct 31.

Research Center for Bone and Joint Diseases, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Arterial pseudoaneurysm can manifest in almost all arteries, but peripheral ones such as brachial artery pseudoaneurysm are rare and typically happen after trauma or infections. We describe an 8-year-old boy who presented with a large nonpulsatile soft tissue mass-like lesion 20 days after supracondylar fracture of the humerus which was fixed using Kirschner wire. The neurovascular examination was normal; CT angiography revealed a large pseudoaneurysm arising from the left profunda brachii artery. The patient went under surgical repair and was discharged from the hospital with an uneventful postop course. A high index of suspicion is necessary in cases with humeral fractures for the early diagnosis of pseudoaneurysm where the delayed diagnosis may cause fatal outcomes.
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http://dx.doi.org/10.1155/2021/1768529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572625PMC
October 2021

Multisystem Inflammatory Syndrome with Features of Atypical Kawasaki Disease during the COVID-19 Pandemic.

Case Rep Pediatr 2021 8;2021:9950588. Epub 2021 Oct 8.

Rheumatology Department, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Although Kawasaki disease (KD) is the most common self-limited systemic vasculitis in pediatrics, the exact etiology of the disease, its association with other diseases, and pathogens is still unknown. In order to achieve a better understanding and management of the disease, documentation and reporting of atypical cases is justified, particularly with the growing number of children with inflammatory syndrome with clinical features simulating KD during the COVID-19 pandemic. Here, we present a case of an atypical case of KD presenting as multisystem inflammatory syndrome (MIS) during the COVID-19 pandemic. . The patient is a 7-year-old girl who developed fever (39°C) and erythematous multiform rash on the abdomen and along with erythema and edema on the extremities. Laboratory evaluation revealed neutrophilia and lymphopenia along with elevated C-reactive protein, erythrocyte sedimentation rate, troponin, lactate dehydrogenase, ferritin, and D-dimer. Although the patient did not fulfill the KD criteria, based on approved guidelines and approaches regarding atypical KD and multisystem inflammatory syndrome in children (MIS-C) during the COVID-19 pandemic, intravenous immunoglobulin along with aspirin was administered for the patients. The patient's symptoms resolved with an uneventful postdischarge course.

Conclusion: Early diagnosis and treatment of patients meeting full or partial criteria for KD are critical to preventing end-organ damage and other long-term complications, especially during times of public crisis and global health emergencies, such as the novel coronavirus pandemic.
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http://dx.doi.org/10.1155/2021/9950588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502244PMC
October 2021

Epidemiological factors in patients with dermatologic conditions referring to the clinic of traditional Persian Medicine: A cross-sectional study.

Int J Clin Pract 2021 Nov 13;75(11):e14788. Epub 2021 Sep 13.

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Many patients with chronic diseases often use traditional medicine, as well as conventional medicine. The aim of this study was to evaluate the epidemiological factors of patients with dermatological conditions referring to traditional Persian Medicine (TPM) clinic.

Materials And Methods: In this cross-sectional study, we reviewed all the patients' medical documents, from March 2018 to March 2019, with dermatological conditions referred to the TPM clinic at Shiraz, Southern Iran. Then, the epidemiological factors of the patients were recorded in a researcher-made data collection form. SPSS software version 22 was used to analyse the data.

Results: Overall, 631 patients consisting of 151 (23.9%) males and 580 (76.1%) females were enrolled in the study. Most of the patients were aged from 31 to 40 years, 347 (55%) patients were married, and most of them were housewives. The frequency of patients in the spring was higher than in other seasons. Furthermore, most of the patients were university educated. Acne, eczema and hair loss were the three most complaints of the patients who were referred to the traditional medicine clinic. 301(47.7%) patients reported gastrointestinal problems as another complaint concomitant with their skin problems.

Conclusion: It seems that women with skin problems, including acne, eczema, and hair loss, were more likely to refer to the TPM clinic. Therefore, the development of TPM clinics in the dermatology field as a scientific and academic approach can be effective in the treatment of patients with dermatological conditions accompanied by traditional medicine.
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http://dx.doi.org/10.1111/ijcp.14788DOI Listing
November 2021

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

JPEN J Parenter Enteral Nutr 2022 05 2;46(4):946-957. Epub 2021 Sep 2.

Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, 7193711351, Shiraz, Iran.

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.
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http://dx.doi.org/10.1002/jpen.2231DOI Listing
May 2022

ROHHAD Syndrome an Inconspicuous Cause of Hypernatremia, A Case Report.

Iran J Kidney Dis 2021 07;15(4):319-321

Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, and autonomic dysregulation (ROHHAD) syndrome is a rare, life threatening disease with unknown etiology. Dysnatremia is a common finding in these patients. Here we present a 12-year-old boy with multiple admissions due to hypernatremia and was repeatedly misdiagnosed. An eventual diagnosis of ROHHAD syndrome was made by integration of the previous ignored findings of sleep apnea and obesity. The diagnosis of this rare but potentially fatal syndrome should be considered in patients with dysnatremia associated with obesity and sleep apnea disorders.
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July 2021
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