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Background: Occipitocervical fusion (OCF) is a rare and often challenging surgical procedure. Several methods have been introduced to obtain the best measures for occipitocervical alignment. The mandible-C2 angle was first introduced in 2020. In this study, we aimed to evaluate the out-of-sample validity of these measures. Methods: We retrospectively studied 274 lateral cervical radiographs of patients aged 1 to 87 years with no cervical pathology evident on X-ray. A board-certified radiologist and a second-year radiology resident performed the measurements on five specific angles as suggested by Bellabarba. The five angles measured consisted of: 1) anterior C2 body/anterior mandible angle (AB/AM), 2) anterior C2 body/posterior mandible angle (AB/PM), 3) posterior C2 body/anterior mandible angle (PB/AM), 4) posterior C2 body/posterior mandible angle (PB/PM), and 5) occipito-C2 angle (OC2A). Results: Inter-rater correlation data were calculated for single and average measures. The inter-rater agreement for individual angle measures of O-C2A, AB/AM, AB/PM, PB/AM, and PB/PM were 0.49, 0.11, 0.25, 0.33, and 0.49, respectively. The intraclass correlation coefficient (ICC) for average measures of O-C2A, AB/AM, AB/PM, PB/AM, and PB/PM were 0.66, 0.20, 0.40, 0.50, and 0.66, respectively. Conclusion: Our study did not find statistically significant evidence to confirm that these angles were dependable indicators of occipitocervical alignment, except for the PB/PM angle, which showed a validity comparable to our reference angle. [ABSTRACT FROM AUTHOR]

Background: The management of locally advanced cervical cancer (stages IB2 to IIB) remains controversial, particularly in regions with limited radiotherapy (RT) resources. While chemoradiation therapy (CRT) is the standard treatment in many Western countries, neoadjuvant chemotherapy followed by radical surgery (NACT-RS) has emerged as an alternative approach. Objectives: The comparative effectiveness and safety of NACT-RS versus CRT in terms of side effects and recurrence rates remain unclear, necessitating further investigation. Methods: A cohort study was conducted from 2020 to 2023, involving 68 patients with cervical carcinoma (stages IB2 to IIB). The patients were stratified into two treatment groups: Neoadjuvant chemotherapy followed by radical surgery (N = 17) and CRT (N=51). The study compared pathology reports, short-term treatment complications, and one-year recurrence rates between the two groups. Results: Minor complications occurred in 41.2% of the NACT-RS group and 39.2% of the CRT group (P = 0.886), while major complications were observed in 23.5% and 25.5% of the groups, respectively (P = 0.872). All NACT-RS patients responded to chemotherapy with significant tumor size reduction (47.7 ± 8.0 vs. 11.2 ± 8.6, P < 0.001) and resolution of vaginal involvement. During the one-year follow-up, no recurrences were observed in the NACT-RS group, compared to eight out of 51 (16.7%) in the CRT group (P = 0.186). Conclusions: The similar short-term complication rates and potentially lower one-year recurrence rate in the NACT-RS group suggest that this approach may be a viable alternative to CRT, particularly for young patients with bulky tumors and in areas with limited RT facilities. [ABSTRACT FROM AUTHOR]

Objective: The standard surgery for endometrial cancer can be deferred in some situations, including morbid obesity, comorbidities, and the patient's desire for fertility. One of the options to improve patients' circumstances is bariatric surgery. Case report: This study presented two patients with stage IA, grade I endometrioid endometrial adenocarcinoma. Both patients had morbid obesity and had comorbidities. In case 1, because of fertility preservation, and in case 2, because of severe comorbidities, hormone therapy was started, followed by bariatric surgery after counseling patients. Both patients had acceptable changes in body mass index during follow-up, so cancer surgery through laparoscopy was done. Both patients did not need adjuvant therapy; months after cancer surgery, there is no recurrence, and their body mass index is also decreasing. Conclusion: Bariatric surgery can improve outcomes in patients with morbid obesity who suffer endometrial cancer. [ABSTRACT FROM AUTHOR]

Background: This study aimed to summarize the baseline and radiological characteristics of patients with COVID-19 and investigate the correlation between clinical outcomes and radiological findings in the first week after admission. Materials and Methods: A single-center retrospective study was carried out on confirmed cases of COVID-19 based on RT-PCR and chest CT scan findings according to Iran’s National Guidelines for defining COVID-19 in patients admitted to Imam Hossein Hospital, Tehran, Iran. Baseline and chest CT scan characteristics of patients were investigated, and their correlation with the change in clinical outcome was reported. Results: 72 patients (50%) with a mean age of 54.65±16.2 years were in two periods of time including the first day of diagnosis and 6.0±3.4 days later. Based on CT scan Severity Score (CTSS) changes (decrease/no change or increase) during the study, patients were divided into two groups of CTSS progression (n=47) and CTSS no-progression (n=25). Diabetes mellitus (20%) and hypertension (19.1%) were the most frequent comorbidities among the patients in the non-progression and progression groups, respectively. There was no significant difference in demographic features including age and gender, and comorbidities (P>0.05). On the first day of diagnosis, there was no significant difference in blood tests and radiological findings and the number of patients who managed out-patients or in-patients in both groups. However, on the second evaluation day, patients in the progression group had significantly higher CTSS in comparison with the non-progression group (13.11±4.7 vs. 9.48±4.2, P=0.003), and the clinical situation in 15 patients in progression changed from out-patient to in-patient (p=0.033). Only chest CT imaging score was a potential parameter associated with the change in clinical progression (P=0.030, RR=10.18, 95, CI=1.25-89.72). Conclusion: Increasing CTSS is a strong predictor of worsening clinical outcomes during hospitalization in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Carotid intima media thickness (CIMT) and carotid plaque can predict premature coronary heart disease (PCAD) in patients hospitalized due to coronary artery disease or undergoing therapeutic interventions. This study aimed to determine the relationship between intima media thickness and carotid plaque characteristics with the incidence and severity of premature coronary artery disease. Materials and Methods: The current study was an analytical cross-sectional study conducted on patients referred to Imam Hossein Hospital in 2021-2022 who underwent coronary angiography. Patients were classified into two groups with coronary artery involvement and the group without evidence of significant coronary involvement. Then the data of patients, such as sex, age, risk factors of cardiovascular diseases, and clinical history of individuals, were collected through interviews and aspects related to carotid intima media thickness and plaque formation through a specialized review of reports. Results: A total of 59 women (%59) and 41 men (%41) participated in this study. The mean age was 51.50±9.54. The results of this study showed that there was a direct (positive) and significant correlation between carotid intima media thickness factors, including right and left carotid intima-media thickness, right and left carotid intima media thickness scores, and the number of carotid plaques with increasing severity of coronary artery involvement (P-values<0.05). There was a statistically significant correlation between carotid plaque number and severity of coronary artery disease (P-value<0.05). Conclusion: CIMT has a significant correlation with PCAD, and in patients at risk of PCAD, measurement of CIMT was a suitable method. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Although papillary squamotransitional cell carcinoma is an uncommon variant of cervical squamous cell carcinoma, due to the complex papillary structure and the challenge in detecting stromal invasion, its timely diagnosis and treatment are very important. Papillary squamotransitional cell carcinoma (PSTCC) is extremely rare and presents with a spectrum of morphologies. PSTCC may present as an in situ tumor with or without an invasion, but usually, it displays both features. Here we report a 60‐year‐old woman, diagnosed with PSTCC of the uterine cervix. [ABSTRACT FROM AUTHOR]

This research aimed to evaluate the clinical features and computed tomography (CT) scans associated with poor outcomes in COVID-19 patients with acute kidney injury (AKI). A total of 351 COVID-19 patients (100 AKI, 251 non-AKI) hospitalized at Imam Hossein Teaching Hospital affiliated to Shahid Beheshti University of Medical Sciences were included. To investigate the factors associated with in-hospital mortality in COVID-19 patients developing AKI, COX univariate and multivariate regression models were applied after controlling other confounding variables. C-reactive protein CRP, lactate, and procalcitonin levels were significantly higher in AKI patients than in non-AKI patients (P < .05). In addition, AKI patients had higher frequencies of lymphopenia and leukocytosis (P < .05). The troponin levels and WBC were the most significant factors for predicting mortality in patients with AKI. Our findings showed that AKI per se is much more important than any other prognostic factor affecting non-AKI patients. However, AKI patients with higher CRP, PCT, and lactate levels had a poor prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Hyperinflammatory state has a role in the pathogenesis of COVID‐19. Anakinra could reduce inflammation and help to combat the condition. In this study, we aimed to assess the safety and efficacy of anakinra (PerkinRA®) in severe COVID‐19. Method: The study was an open‐label, randomized, controlled trial conducted in Imam Hossein Medical Center from May to July 2020. Patients with a confirmed diagnosis of COVID‐19 were included in this study. We administered anakinra 100 mg daily intravenously. All patients received COVID‐19 pharmacotherapy based on the represented national guideline. The need for invasive mechanical ventilation is considered the primary outcome. Results: Thirty patients were included in this study, and 15 of them received Anakinra. Nineteen patients were male (63.3%), and 11 were female (36.7%). The mean age of patients was 55.77 ± 15.89 years. In the intervention group, the need for invasive mechanical ventilation was significantly reduced compared to the control group (20.0% vs. 66.7%, p =.010). Also, these patients had a significantly lower length of hospital stay (p =.043). No significant higher rate of infection was recorded. Conclusion: Anakinra as an immunomodulatory agent has been associated with the reduced need for mechanical ventilation in patients admitted to intensive care units because of severe COVID‐19. The medication reduced the hospital length of stay. Furthermore, no increased risk of infection was observed. Further randomized placebo‐controlled trials with a larger sample size are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Over the past years, the issue of fire in transport tunnels has become an important concern. Fire safety is now one of the important elements in tunnel design. For this reason, many tunnels are equipped with longitudinal ventilation systems to control smoke in the event of fire. In this study, tunnel fire simulation is done with open-source software FDS, and study on the critical velocity is done in tunnel fire. The effects of geometrical parameters on the critical velocity is studied. Tunnel slope and blockage is studied to investigate the effects of geometrical parameters. In tunnel slope study part, propagation and behavior of smoke is studied for slopes between -10 and +10 degrees. In positive slopes of tunnel, ??ire plume is spread to the downstream of tunnel and in negative slopes of tunnel, fire plume is spread to the upstream of tunnel. It is observed that with increasing from negative slopes to positive slopes of the tunnel, the critical velocity decreases linearly with increasing tunnel slope. Tunnel blockage is studied for one vehicle and 30 vehicles. The results of study on vehicular blockage show that the critical velocity decreases with increasing percent of blockage. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) is one of the most common neurological disorders worldwide. We aimed to investigate the efficacy of high-dose vitamin D3 on inflammatory biomarkers in patients with moderate to severe TBI. Methods: Thirty-five moderate to severe TBI patients were randomly assigned to intervention and control groups. Patients in the intervention group received a single intramuscular (IM) dose of 300,000 IU vitamin D. The primary endpoints were interleukin levels (IL-1β and IL-6), and the secondary endpoints were changes in neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), Glasgow Coma scale (GCS), and Glasgow Outcome Scale-Extended (GOS-E) scores compared between intervention and control arms of the study. The linear Generalized Estimating Equations were used for trend analysis and evaluating the association of independent factors to each outcome. Results: The results revealed a significant decrease in IL-1β levels (-2.71±3.02, in the intervention group: P=0.001 vs. -0.14±3.70, in the control group: P=0.876) and IL-6 (-88.05±148.45, in the intervention group: P=0.0001 vs. -35.54±175.79, in the control group: P=0.325) 3 days after the intervention. The improvement in the GCS score (P=0.001), reduction in NLR (P=0.001) and PLR (P=0.002), and improvement in the GOS-E score (P=0.039) was found to be greater in the vitamin D3 arm of the study than the control group. Conclusion: Administration of high-dose vitamin D3 in the acute phase of TBI could be effective in lowering the inflammatory markers and improving the level of consciousness and long-term performance outcomes. Trial registration number: IRCT20180522039777N2. [ABSTRACT FROM AUTHOR]

Purpose: In late December 2019, a series of unexplained cases of pneumonia were reported in Wuhan, China. On January 12, 2020, the World Health Organization temporarily named the virus responsible for the emerging cases of pneumonia as the 2019 coronavirus. Acute respiratory distress syndrome (ARDS) due to Covid-19 has rapidly spread around the world, and while no specific treatment or vaccine has been reported, mortality rates remain high. One of the suggested treatments for cellular damage in the pathogenesis of ARDS caused by the coronavirus is the administration of high doses of intravenous vitamin C. Considering the paucity of literature on the therapeutic effects of high doses of intravenous vitamin C in patients with ARDS resulting from the coronavirus, this study was conducted to assess this therapeutic supplement in these patients. Materials and Methods: This study was performed as a single-center clinical trial in patients with a documented diagnosis of COVID-19 pneumonia. 54 eligible patients with moderate to severe COVID-19 symptoms, based on specific inclusion and exclusion criteria, were included in the investigation and randomly divided into two groups. The control group consisted of 26 patients who received standard treatment, whereas the treatment group was comprised of 18 patients administered intravenous vitamin C at a dose of 2 g every 6 hours for 5 days in addition to standard treatment. Demographic characteristics, underlying diseases, length of hospital stay, and mortality rates were reviewed and collected. Oxygen saturation, respiratory rates, serum C Reactive Protein (CRP) levels, lymphopenia and lung parenchymal involvement on CT were investigated at the time of admission and on the sixth day after hospitalization. Results: Of these variables, the amount of oxygen saturation in the vitamin C group increased significantly from 86 ± 5% on the first day of hospitalization to 90 ± 3% on the sixth day of hospitalization (P value = 0.02). Also, the respiratory rate in the vitamin C group decreased significantly from 27 ± 3 on the first day of hospitalization to 24 ± 3 on the sixth day of hospitalization (P value = 0.03). Lung CT scans of patients in the two groups reported by two radiologists were also compared. Based on the report of the radiologists, the rate of lung involvement in the vitamin C group was significantly lower than in the control group at the end of treatment (P value = 0.02). Conclusion: Due to the effectiveness of high doses of intravenous vitamin C on reducing lung involvement and improving clinical symptoms, further studies with a larger sample size are recommended to demonstrate the effects of this drug supplement. [ABSTRACT FROM AUTHOR]

Background: Television as an external stimulation can precipitate epileptic seizures. Today this kind of epilepsy is known as television epilepsy. As children spend much of their time watching television, it is important to study this type of epilepsy in this age group. This study was designed to describe the clinical and some demographic characteristics of television epilepsy in Iranian children., Methods: Patients who were diagnosed as having television epilepsy with an age less than 12 years were recruited from outpatient neurology clinics in Isfahan, Iran, from September 2002 through September 2006. We collected the case-related information including electroencephalograms, radiologic findings, and patients' history., Results: Thirty patients with television epilepsy with the age less than 12 years were identified. Of whom 17 (56.7%) were females and 13 (43.3%) were males. The mean age at the onset of seizure was 9.9+/-2.1 years. Children had absence (3.3%), myoclonic (3.3%), and generalized tonic-clonic (93.3+/-) seizures in response to intermittent photic stimulations. Interictal epileptiform discharges in electroencephalograms were detected in 83.3%. In addition, neuroimaging findings were normal in 96.7% of the patients. In our study, 56.7% of the children had pure television epilepsy and 43.3% experienced other types of generalized seizure. During the follow-up period after initiation of variable drug treatments including valproic acid, carbamazepine, phenobarbital, clonazepam, ethosuximide, and lamotrigine all the patients had complete seizure remission., Conclusion: The clinical and demographic differences of our patients compared with other reports are probably due to genetic differences. In our study, it was demonstrated that carbamazepine could be used in children with television epilepsy because it had successfully terminated seizures in 43.3% of the patients.