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Hepatic epithelioid hemangioendothelioma (EHE) is an uncommon vascular endothelial cell tumor of the liver with numerous symptoms and features. The median affected age is 41, and females are more frequently affected than men. In the following article, a 37-year-old nurse is presented who was referred to the hospital with severe right upper quadrant pain. She had been misdiagnosed with hepatic hemangioma for years, which finally turned out to be hepatic EHE. Liver transplantation has been recognized as the therapeutic method of choice due to the considerable extent of liver involvement and nonresponse to medications. [ABSTRACT FROM AUTHOR]

Background: Hypothyroidism is a cause of left ventricular diastolic dysfunction especially in cases with positive history of coronary artery disease. It is suggested that cardiac dysfunction may be improved with thyroxin replacement therapy. However, it is controversial. Hence, in this study the efficacy of levothyroxine therapy on diastolic dysfunction in patients with subclinical hypothyroidism was assessed. Materials and Methods: In this, randomized clinical trial 40 consecutive patients with subclinical hypothyroidism attending to Loghman Hospital in 2018 for the treatment were enrolled. The treatment was 25- 50 microgram per day of levothyroxine for one year. During this period, the patients were followed up with visit or phone call with a monthly manner. The echocardiography indices were rechecked after one year beside the thyroid tests by initial lab and operators. Results: The mean BMI was significantly decreased (P=0.001). The T3 and TSH were significantly differed but The T4 had no significant alteration (P>0.05). Among the echocardiographic indices the MV.E, MV.A to MV. E ratio, EF, E' septal, E' lateral had significant increase and the MV.A and PV. Adur had significant reduction. After intervention among 40 patients, there were 17 cases with normal diastolic function. The BMI, MV. A, PV Adur, E' Septal, E' Lateral, and E to E' ratio showed significant correlation. Conclusion: Totally, according to the obtained results, it is concluded that diastolic dysfunction as a common problem in patients with subclinical hypothyroidism may be treated with administration of levothyroxine. In addition, screening for diastolic dysfunction in patients with subclinical hypothyroidism is recommended to decrease the burden of problem. [ABSTRACT FROM AUTHOR]

Background: In the present study, we aimed to evaluate the effects of medroxyprogesterone on hospital short clinical outcomes and ABG parameters in patients with chronic obstructive pulmonary disease (COPD) exacerbation under treatments with noninvasive ventilation (NIV) treated with progesterone 15 mg in comparison with placebo. Materials and Methods: This is a double-blinded clinical trial that was performed in 2020–2021 in Isfahan, Iran, on 60 patients with COPD exacerbation that require NIV. All patients received short-acting beta-agonists, short-acting anticholinergics, systemic corticosteroids, and NIV. Patients in the intervention group received tablets of progesterone 15 mg, every 6 h for 5 days and the control group received a placebo; patients in both groups received routine clinical cares. We collected data regarding the days requiring NIV, hospitalization duration, intubation, intensive care unit (ICU) admission, and death. Furthermore, blood pH, PCO2, O2 saturation, dyspnea score, and NIV hours usage per day were evaluated at the time of admission, 3 and 5 days during admission. Results: Hospital short clinical outcomes were not differently distributed between the two groups (P > 0.05). Comparing two groups during hospitalization in terms of short clinical outcomes including duration hospitalization, using NIV per day, ICU admission rate, and need to intubation showed that they are comparable (P > 0.05). PH in both groups improved during follow-up (P < 0.001) and patients in intervention groups showed higher improvement (P = 0.006). Mean PCO2 decreased significantly in the intervention group (P < 0.001) but not in the control group (P = 0.198) and totally intervention showed significant improvement in PCO2 compared with the control group (P = 0.047). Although mean O2 saturation was increased in both groups during follow-up period (P < 0.001, for both groups), two groups showed comparable (P = 0.910). Mean NIV using (hours/day) was decreased significantly in the intervention group (P = 0.023); however, it was not significantly higher than that was seen in the control group (P = 0.706). The mean dyspnea score was decreased in both groups (P < 0.001), although a greater decrease was seen in the intervention group (P < 0.001). Conclusion: Administration of medroxyprogesterone in patients with COPD exacerbation that required NIV was associated with significant improvements in blood pH, PCO2, dyspnea, and daily duration of NIV using after 3 and 5 days following hospitalization. [ABSTRACT FROM AUTHOR]

Background: Considering the diagnostic and therapeutic costs of patients with dyspepsia and the importance of diagnosis during gastrointestinal malignancies, in this study, we investigated the necessity of gastric mucosal biopsy in dyspeptic patients with normal upper endoscopy in Modarres hospital and their 6 months follow up. We studied their endoscopic biopsies changes and some of the involved risk factors this duration. Materials and Methods: In this clinical trial study, 115 patients with dyspepsia, were referred from gastroenterology clinic of Modarres hospital during 2017-2018, were evaluated. Patients were enrolled in a study that did not have any ulcer and mass or deep mucosal lesion in the early endoscopy Surface erosions were no exception and could be included. Five biopsy samples were obtained from different stomach sites. After the pathology results, the patients who had malignancy reports, excluded from the study and other patients were treated with anti-acid drugs and, if necessary, eradicated Helicobacter pylori. After 6 months, they were again subjected to endoscopy and biopsies were taken. Data were analyzed by SPSS software version 22. Results: The rate of Helicobacter pylori in patients with endoscopic dyspepsia without mucosal lesions after 6 months of treatment was reduced compared to pre-treatment p<0.05, 20.9% vs 12.2%. The severity of chronic gastritis mild to moderate in patients with endoscopic dyspepsia without mucosal lesions after 6 months of treatment was reduced compared to pre-treatment p<0.05, 89.6% vs 80%. There was a significant difference between metaplasia in patients with endoscopic dyspepsia without mucosal lesions before and 6 months after treatment p<0.05, 33%, vs 20%. Female gender, negative family history of GI cancer and not using alcohol were factors that significantly improved the results of biopsy chronic gastritis/H. pylori/metaplasia after 6 months. Conclusion: Regarding the reduction in the severity of chronic gastritis, Helicobacter pylori and metaplasia in this group of patients after 6 months of treatment, it is recommended that refraining from unnecessary follow-up and biopsy and imposing cost to the patient and the medical system and be limited to high-risk groups. [ABSTRACT FROM AUTHOR]