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Background Wilms tumor (WT) is the most common malignant renal tumor in children. This study investigated the clinical features, pathological findings, and outcomes of children with malignant renal tumors in Southern Iran. Factors associated with recurrence and mortality were assessed. Methods Electronic files of children with malignant renal tumors from 2009 to 2023 were reviewed. The 5-year overall survival (OS) and event-free survival (EFS) were reported. Results Eighty-three patients (44 males) with a median age of 40 months (range: 3-122) were included. WT was the most common pathological variant (94%). Anaplasia was found in 17.3% of patients. Upfront chemotherapy followed by nephrectomy was performed in 54.2% of the patients. Ten patients (12%) experienced relapse, and five patients (6%) died during the 14-year follow-up. The 5-year OS and EFS were 90.75% (95% CI, 78.64–96.16%) and 81.9% (95% CI, 70.10-89.38%), respectively, and were comparable between the two treatment strategies (upfront chemotherapy vs. upfront nephrectomy). Metastasis and residual disease were associated with relapse, whereas tumor recurrence was the only predictive factor of survival. Conclusion WT is a curable disease with excellent outcomes if diagnosed and treated promptly. The timing of nephrectomy does not affect OS and EFS. Patients with low-stage tumors and those with complete surgical excision are at a lower risk of tumor recurrence. Relapse is the primary risk factor for death.

Background: Drug–drug interactions (DDIs) are frequent and potentially harmful in pediatric cancer patients due to polypharmacy and complex chemotherapy regimens. However, data on DDIs in hospitalized pediatric oncology patients remain limited, particularly in Middle Eastern settings. Methods: In this prospective study, we analyzed prescriptions for hospitalized pediatric oncology patients in Iran to assess the prevalence, severity, and nature of potential DDIs (PDDIs). Chemotherapy and supportive medications were analyzed using two validated databases (Lexi-Interact™ and Drugs.com™) between November 2019 and June 2020. Results: Of 80 patients (median age 8.9 years), 21.2% had at least one documented PDDI. We identified 197 total PDDIs involving 42 unique drug pairs. The most common DDIs included acetaminophen and granisetron (severity rating: moderate). Methotrexate and vincristine were the most frequent antineoplastic DDI pair. Methotrexate alone accounted for 156 interactions. Conclusions: This is the first prospective study from Iran—and the largest in the region—investigating PDDIs in pediatric oncology. The dual-database screening approach improved PDDI detection. Clinical teams should routinely evaluate medication profiles in pediatric cancer patients to minimize avoidable harms from DDIs.

Background Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of excessive inflammation. We aimed to describe the clinical and laboratory findings of HLH patients secondary to Visceral leishmaniasis (VL) and their treatment outcome during a 4-year follow-up period compared to primary HLH. Method Forty children with primary HLH confirmed by genetic study and 20 children with HLH secondary to VL confirmed by a blood or bone marrow polymerase chain reaction from 2014 to 2018 in Shiraz, Fars province, Southern Iran, were enrolled. Results The median age at diagnosis was 11.5 months (range 1–170), and 56.7% were male. Fever and splenomegaly were the most frequent clinical presentations. 93.3% of the subjects had an HScore > 169, which had a good correlation with HLH-2004 criteria ( r  = 0.371, P  = 0.004). Patients with primary HLH experienced more thrombocytopenia ( P  = 0.012) and higher alanine transaminase ( P  = 0.016), while patients with VL-associated HLH had higher ferritin ( P  = 0.034) and erythrocyte sedimentation rate ( P  = 0.011). Central nervous system (CNS) involvement occurred in 38.3% of patients. The mortality rate was higher in patients with CNS disease (61% vs. 35%, P  = 0.051). The 3-yr overall survival rate was 35.9%. (24% in primary HLH and 100% in VL-associated HLH, P  < 0.001). In Cox regression analysis, platelet count < 100,000/ μ l (hazard ratio 4.472, 95% confidence interval 1.324–15.107, P  = 0.016) correlated with increased mortality in patients with primary HLH. Conclusion VL is a potential source of secondary HLH in regions with high endemicity. Treatment of the underlying disease in VL-associated HLH is sufficient in most cases, with no need to start etoposide-based chemotherapy.

Background Arthropathy is a common complication in patients with hemophilia. We examined the prevalence of this skeletal complication in patients with hemophilia who were registered at a Comprehensive Hemophilia Center in Shiraz, Southern Iran. Materials and Methods In this cross-sectional study, an orthopedic specialist visited 448 patients and conducted screenings for skeletal complications. The assessment included evaluating the type of hemophilia, disease severity, treatment modality, the presence of inhibitors, and the identification of skeletal complications. Results Ninety patients with hemophilia A, with a mean age (SD) of 31.6 (14.4) years, and 10 patients with hemophilia B, with a mean age of 30.5 (20.6) years, were assessed. The most frequently affected joints were the knee and ankle joints. In the univariate analysis, patients with severe disease were more likely to exhibit synovitis, a target joint, and bone disease compared to patients with non-severe disease. Additionally, a history of treated or active hepatitis and an annual bleeding rate showed significant associations with the target joint. In the multivariable logistic regression analysis, disease severity (OR 14.43, 95% CI 1.6–129.6) and a higher age at diagnosis (OR 1.06, 95% CI 1.00–1.13) increased the likelihood of developing osteoporosis. A history of hepatitis (OR 3.67, 95% CI 1.28–10.48) was identified as an independent risk factor for the target joint. Conclusion Skeletal complications are a common occurrence in hemophilia. Regular consultations with orthopedic specialists, focusing on bleeding control and hepatitis prevention, are essential for reducing the impact of this debilitating complication.

Prompt identification of COVID-19 patients through an advanced and dependable prognostic model can alleviate pressure on healthcare facilities by enabling safe home recovery for individuals who do not require hospitalization. In this study, we ascertained the validity of three different CT scoring systems as the main component of prognostic models. This retrospective cohort studied 566 COVID-19 patients hospitalized in three tertiary centers. In addition to demographic and clinical data collection, all the patients' chest CT images were evaluated by standard 15-, 20-, and 24-scoring systems introduced earlier for the prognosis of COVID-19. The outcome studied was mortality status. Using logistic regression analysis, four variables of age, sex, lymphocyte count, and CT severity score were investigated according to each model setup. To assess the goodness of fit, ROC curve analysis was also conducted. All models' highest odd ratio (OR) for mortality outcome was related to CT severity score. The 15-score model achieved the greatest OR, and the 24-score model the smallest OR (1.158 vs 1.086). All three CT severity scoring models can significantly distinguish between COVID-19 survivors and expired patients (P .001). However, the area under a ROC curve (AUC) was the highest for a 20-score severity model (20-score, AUC = 0.672; 24-score, AUC = 0.663; 15-score, AUC = 0.646). A chest CT scoring system where the sum of scores from five pulmonary lobes ranges between 0 and 20 is more effective in predicting mortality outcomes in COVID-19 patients.

Introduction: The wives of veterans are under great pressure because of their husbands ’physical and mental problems, and this can affect their mental health and quality of life. It seems that the training of some skills can have a significant impact on improving quality of life and reducing their mental burden. This study was conducted to determine the effect of spiritual care education in quality of life in wives of veterans with post-traumatic stress disorder (PTSD) that plays a major role in caring for them. Methods: This study was a quasi-experimental study in which 60 wives of PTSD-affected veterans in Ibn Sina hospital were selected and assigned randomly in two experimental and control groups. Spiritual care education was conducted in five sessions of two hours. Quality of life Questionnaire (SF-36) was used in this study. The questionnaire was implemented on participants of both groups in three stages: before, after and one months after the intervention (follow-up). Data were analysis using SPSS version 19. Results: The results of this study showed that spiritual care education could increase quality of life in the Wives of Veterans with Post Traumatic Stress Disorder and the subjects participating in the post-test had significantly higher quality of life. Conclusion: According to results of this, study that represent effect of spiritual care education on quality of life, so it is recommended spiritual care education can be used to improve the quality of life of people especially the families of veterans.

Severe coronavirus disease 2019 (COVID-19) accompanies hypercytokinemia, similar to secondary hemophagocytic lymphohistiocytosis (sHLH). We aimed to find if HScore could predict disease severity in COVID-19. HScore was calculated in hospitalized children and adult patients with a proven diagnosis of COVID-19. The need for intensive care unit (ICU), hospital length of stay (LOS), and in-hospital mortality were recorded. The median HScore was 43.0 (IQR 0.0–63.0), which was higher in those who needed ICU care (59.7, 95% CI 46.4–72.7) compared to those admitted to non-ICU medical wards (38.8, 95% CI 32.2–45.4; P  = 0.003). It was also significantly higher in patients who died of COVID-19 (105.1, 95% CI 53.7–156.5) than individuals who survived (41.5, 95% CI 35.8–47.1; P  = 0.005). Multivariable logistic regression analysis revealed that higher HScore was associated with a higher risk of ICU admission (adjusted OR = 4.93, 95% CI 1.5–16.17, P  = 0.008). The risk of death increased by 20% for every ten units increase in HScore (adjusted OR 1.02, 95% CI 1.00–1.04, P  = 0.009). Time to discharge was statistically longer in high HScore levels than low levels (HR = 0.41, 95% CI 0.24–0.69). HScore is much lower in patients with severe COVID-19 than sHLH. Higher HScore is associated with more ICU admission, more extended hospitalization, and a higher mortality rate. A modified HScore with a new cut-off seems more practical in predicting disease severity in patients with severe COVID-19.

Oxidative stress is a major mechanism contributing to the progression of β-thalassemia. To assess the effect of vitamin E and N-acetyl cysteine (NAC) as antioxidant agents on total oxidative stress (TOS) status and total antioxidant capacity (TAC) in patients with transfusion-dependent β-thalassemia (TDT). In this open-label randomized controlled trial, from May to August 2019, 78 eligible patients with TDT over the age of 18 were enrolled. All patients were registered at the Thalassemia Clinic of Shiraz University of Medical Sciences in Southern Iran. Patients were randomly allocated to the NAC group (10 mg/kg/day, orally), vitamin E group (10 U/kg/day, orally), and control group. The duration of the study was 3 months. The mean age of the participants was 28.5 ± 5.1 (range: 18–41) years. At the end of the study, TOS significantly decreased only in the vitamin E group (mean difference (MD), 95% confidence interval (CI): 0.27 (0.03–0.50), P = 0.026). TAC significantly decreased in both supplemented groups at the 3rd month of treatment (NAC group: MD (95% CI): 0.11 (0.04–0.18), P = 0.002 and vitamin E group: 0.09 (0.01–0.16), P = 0.022 respectively). Hemoglobin did not significantly change at the end of the study in each group (P > 0.05). Mild transient adverse events occurred in 4 patients of the NAC group and 5 patients of the vitamin E group with no need to discontinue the treatment. Vitamin E can be a safe and effective supplement in improving oxidative stress in patients with TDT. Moreover, it seems that a longer duration of using antioxidant supplements needs to make clinical hematologic improvement in TDT patients.

Background With the increasing survival rate of pediatric patients with leukemia, improving their quality of life (QoL) is the new challenge. Psychiatric disorders are among the significant confounding factors of the aforementioned patients’ QoL. Ninety-seven pediatric patients with leukemia were evaluated based on the Beck Hopelessness and SI scale while considering associated factors. We assessed the prevalence of suicidal ideation (SI) and hopelessness, as two of the most prevalent psychiatric symptoms of pediatrics with malignancy while assessing some of the associated factors to provide a plenary insight. Results Prevalence of SI and hopelessness were 7.2% and 87.6% respectively. Gender, education, the abode of living, time from onset of disease, and parents’ education level and income states of many were significantly related to the prevalence of the two studied psychiatric disorders. Multiple logistic regression determined a significant confounding role of abode of living, parent’s education, onset, and type of leukemia in hopelessness. As for SI, the result of the latter test determined more confounding factors such as age and patients’ education. Conclusion Both SI and hopelessness are noticeable disorders among children with leukemia with multiple manageable associated factors; hence, it is advisable to recommend psychiatric assessment of leukemic children.

Background Sleep disorders can be harmful to our health and treating them can also be expensive. Due to the widespread occurrence and impact of sleep disorders, it is valuable to investigate and study them from an epidemiological perspective. Therefore, this study aimed to determine the prevalence of sleep disorders among Iranian adults in 2022. Method This is a cross-sectional study that examines the prevalence of sleep disorders and problems in Iranian society. The participants were selected using a mixed sampling approach (utilizing virtual space and cluster sampling). A two-part package was used for evaluating participants sleep problems, which included a demographic profile form and the Holland Sleep Disorders Questionnaire. After collecting the data, appropriate statistical tests in SPSS version 25 were utilized for analysis. Results A total of 6013 questionnaires were fully filled out for this research, with participants answering the specific questions. The participants’ score on sleep disorders was 1.94, which means 44.1% of them suffer from sleep disorders. The results indicated that the prevalence of sleep disorders in this study was as follows: insomnia (35%), parasomnia (35.3%), circadian rhythm sleep disorder (38.4%), hypersomnia and excessive daytime sleepiness (39%), restless leg syndrome and leg movements during sleep (43%), and breathing disorders related to sleep (38.4%). The prevalence of sleep disorders among the study participants demonstrated a significant relationship with most of their demographic variables ( P  < 0.001). The Pearson correlation coefficient also revealed an inverse and significant relationship between the prevalence of sleep disorders in the study participants and their age, monthly household income, and BMI ( P  < 0.001). Conclusion Overall, the results depicted a relatively high prevalence of sleep disorders in the studied community. These findings emphasize the need for interventions to prevent and treat sleep disorders in society.