پیش آگهی

Breast cancer is the most common cancer diagnosed in women. Epidemiological studies have led to the hypothesis that vitamin D may reduce the risk of breast cancer. This study aimed to investigate the association between vitamin D deficiency and breast cancer.

This case-control study was conducted on 59 patients referred to Khatam Al-Anbia Comprehensive Cancer Clinic in Jahrom city between May 2021 and March 2022. Thirty patients with pathologically confirmed ductal or lobular breast cancer in situ or invasive in one or both breasts, with no previous history of the disease and within two months of their breast cancer diagnosis, were considered as the case group. Thirty women without breast cancer who had been referred for breast screening examination were considered as the control group. Both groups were matched for demographic characteristics and age. The data collection tools in this study included demographic information and clinical history of the patients and serum vitamin D levels. Data analysis was performed using SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and descriptive statistics (mean, percentage, and standard deviation) and inferential statistical tests (logistic regression, Kolmogorov-Smirnov). The significance level was considered to be P<0.05.

The mean age of the patients participating in the case group was 52.17±10.6 and in the control group was 51.24±9.7. There was no statistically significant difference in age (P=0.654). There was also no significant difference between the two groups in terms of body mass index and different body index classifications, menopause age, and age of onset of menstruation. The number of months of breastfeeding in the control group was significantly higher than the case group (P=0.001). The results of logistic regression showed that, on the other hand, there was no significant relationship between the type of pathology of the disease and serum vitamin D levels.

The results of the present study showed that vitamin D deficiency can be a poor prognostic factor in the course of breast cancer.

Hyperglycemia usually occurs in critically ill patients, including COVID-19 patients, and may be related to their prognosis. The aim of this cross-sectional study is to examine the severity of hyperglycemia in COVID-19 diabetic patients hospitalized at Shahid Beheshti Hospital in Hamadan in 2022 and its impact on their prognosis. In this cross-sectional study, 378 patients with diabetes who were hospitalized due to confirmed cases of the novel corona virus (Covid-19) at Shahid Beheshti Hospital in 2021 were evaluated. These patients were assessed based on clinical and paraclinical findings, and the severity of the disease and outcomes were analyzed alongside their demographic and clinical characteristics. ANOVA was employed to compare the blood glucose status of patients based on age and length of hospital stay, while the chi-squared test was used to compare the blood glucose status of patients based on gender, type of ward, outcomes, underlying diseases, and the need for mechanical ventilation. Out of 1665 hospitalized COVID-19 patients, 378 (22.7%) were diagnosed with diabetes. Among the 378 patients, 215 (56.9%) were female, 331 (87.6%) were married, and 320 (84.7%) were residents of the city. The average age of the patients was 65.3 ± 12.5 years, blood glucose level was 220.2 ± 120.1milligrams per deciliter, and their hospital stay duration was 8.7 ± 5.9 days. Unfortunately, 96 patients (25.4%) succumbed to COVID-19 in the hospital. Of those, 116 (30.9%) had intensive blood glucose control, 60 (15.7%) had appropriate blood glucose control, 74 (19%) had poor control, and 128 (33%) had very poor control. Patients who passed away in the hospital had significantly worse controlled blood glucose levels compared to survivors (272.8 ± 158.6 vs. 202.3 ± 97.9 milligrams per deciliter) (P=0.001). Based on the findings of this study, hyperglycemia in COVID-19 patients is associated with an increased risk of mortality; therefore, it is necessary to monitor and manage blood sugar in these patients.

Acute pancreatitis (AP) is considered a gastrointestinal disorder that may lead to a systemic inflammatory response and requires urgent hospitalization. Currently, the bedside index of severity in acute pancreatitis (BISAP) scoring system is used to estimate the severity of the disease. This study sought to investigate the significant relationship between the infectious inflammatory components of the neutrophil-to-lymphocyte ratio (NLR), which can only be obtained by a simple blood test. Then, this ratio was compared with the BISAP scoring system.

This cohort study was conducted at Imam Reza Hospital of Tabriz University of Medical Sciences in 2017‒2018. A total of 98 hospitalized patients with our desired criteria were included in the study. A complete blood count differential was obtained, and the BISAP score was calculated and analyzed, along with demographic data.

The NLR and the age of patients had a significant relationship with the BISAP variable (P < 0.05). For one unit (year) increase in patients’ age, the chance of being placed in the higher categories of the BISAP score increased by 1.14 and 1.09 times, respectively. Gender, smoking, and underlying diseases had no significant relationship with the BISAP score (P > 0.05).

  The initial values of the NLR can be used to determine the prognosis and severity of the disease in patients with acute pancreatitis in a quick, easy, and accessible way.

This study aimed to investigate the clinical and histopathological characteristics of oral and maxillofacial malignancies and their association with the 5-year survival rate of patients in an Iranian population.

Methods and Materials:

 This cross-sectional study analyzed data from 99 patients diagnosed with an oral or maxillofacial malignancy. Patients had admitted to the Pathology Department of Mashhad Dental School from January 2015- January 2019 and their records were retrospectively reviewed. Patients were followed until 5 years after their initial diagnosis and their current status was documented. The patients’ demographic data were collected. The type of malignancy, based on the clinical and histopathologic diagnoses, was recorded. Patient mortality rate and survival time were also calculated. Statistical analysis was performed using Chi-square, Fisher's exact test and Mann-Whitney-U test. Survival analysis was conducted using the Kaplan-Meier method. P-value less than 0.05 was considered statistically significant.

A total of 99 records were reviewed. Gender distribution frequency consisted of 58 male and 41 female patients. Patients had a mean age of 56.8±17.16 years. A total of 48 (48.5%) of patients had died due to oral cancer. The most common malignancies were low-grade SCC (28.3%) and high-grade SCC (25.3%). The most common site of involvement was the tongue (31.3%). The mortality rate in high-grade SCC (68%) was higher than low-grade SCC (35.7%). There was a statistically significant correlation between the type of malignancy and mortality rate (P=0.039). The greatest and lowest median survival time was observed in patients with adenoid cystic carcinoma (60 months) and mucoepidermoid carcinoma (16.8 months), respectively. 

This study provides valuable information about the pattern of oral malignancies, factors related to prognosis, and survival rates in the studied population. The type of malignancy was the only significant factor associated with mortality.

Meningitis is an inflammation of the protective membranes, called meninges, that cover the brain and spinal cord. Aseptic meningitis is one of the most common diseases of childhood and infancy. Unlike bacterial meningitis, it is non-purulent, culture-negative, and often occurs due to viral infections. This study aimed to investigate the clinical manifestations and prognosis of children with aseptic meningitis.

This descriptive analytical study was performed on children aged 2 months to 18 years with aseptic meningitis who were hospitalized at Tabriz Children's Hospital over six years, from 2011 to 2016. A total of 138 patients were examined. Children with bacterial meningitis, encephalitis, systemic inflammatory, or metabolic disorders were excluded from the study. General information, including age, gender, clinical symptoms, laboratory findings, and the final status of the child, was recorded in a questionnaire, and the data were analyzed.

We evaluated 138 children diagnosed with aseptic meningitis, of whom 100 (72.5%) were male and 38 (27.5%) were female. A positive vaccination history within the last month was reported in 65.2% of the patients. Fever was observed in 94.2%, vomiting in 49.3%, and headache in 15.2%. Seizures occurred in 64.5% of the patients. On examination, 3.6% of the patients were drowsy, and 5.8% had neck stiffness. Kernig's sign was negative in all patients, while Brodzinski's sign was positive in 2.2%. Cerebrospinal fluid smears and cultures were negative in all patients, and blood cultures were positive in 0.7%.

Based on this study, fever and seizures are the most common symptoms in children with aseptic meningitis. Most of the patients had received MMR vaccination within the past month. All patients were eventually discharged without significant complications. The findings of this study can aid in the accurate diagnosis and treatment of aseptic meningitis.

Colorectal cancer (CRC) is one of the most common cancers globally. Prevention, precise early detection and diagnosis, selecting the best treatment strategy, and correct prediction of prognosis are essential to reduce the burden of CRC and to improve the patients’ survival and quality of life. Along with the explosion of available clinical, omics, pathological, and radiological data, artificial intelligence (AI) has shown a great potential in CRC clinical management, and has provided clinicians with new auxiliary approaches to identify high-risk patients, to select personalized treatment strategies, and to predict prognosis. This review is a comprehensive study on the research progress and clinical applications of AI in management of CRC, including screening, diagnosis, treatment, and prognosis. In short, this review demonstrates the current status of the AI in CRC management. Limitations, challenges, and future prospects of AI in the clinical management of CRC are also discussed.

In late December 2019, pneumonia originating from nCOV-2019 spread rapidly around the world, and in March 2020, the World Health Organization officially declared it a pandemic and chose the name "COVID-19" for the resulting disease. A significant proportion of COVID-19 patients experience severe pulmonary complications and life-threatening conditions that necessitate respiratory support and admission to the intensive care unit (ICU). Since the detection of the first case of COVID-19 in Iran, the country has experienced several waves, with different strains of the coronavirus prevailing in each wave. According to the studies conducted in this field, in the first wave, the alpha strain (B.1.1) 7), the second wave of the beta strain (B.1.351), the third wave of the gamma strain (P.1), the fourth wave of the delta strain (B.1.617.2) and in the fifth wave the Amicron strain (B.1.1.529) of the strain were dominant in patients. This study aims to evaluate the clinical and paraclinical findings, as well as the outcomes, of COVID-19 patients admitted to the intensive care units at a referral teaching hospital in northern Iran during the first through fifth waves of the pandemic.

This research is a descriptive-analytical retrospective study that was conducted on all patients with COVID-19 who were hospitalized in the ICU of Razi Qaemshahr Hospital (Infectious Diseases Referral Center of Mazandaran Province) in first to fifth waves. Personal information, underlying diseases, time from the onset of symptoms to a hospital visit, laboratory tests, and length of stay of the patient in the intensive care unit was collected through dossier reading and spss25 software was used for statistical analysis.

Out of the 304 patients admitted to the ICU during the first through fifth waves of the COVID-19 outbreak, 50.3% were male. The age range of the patients was from 22 years to 98 years with an average of 65.14±15.08. 244 patients had at least one underlying disease. So 41% of the patients had diabetes and 50% had blood HTN. Among 244 patients with underlying disease, only 28 patients recovered and 216 patients died, which difference was significant (P=0.01). The second wave had the highest number of patients (25.7%), while the third wave had the lowest (16.4%). The average hemoglobin level differed significantly between the second and fourth waves, being 1.37 units lower in the fourth wave. The mortality rates varied significantly across the different waves (P<0.001), with a rate of 100% in wave 1, 85.9% in wave 2, 82% in wave 3, 64.3% in wave 4, and 93% in wave 5. Regarding underlying health conditions, no significant differences were observed among patients across waves 1 to 5. Notably, among the 244 patients with underlying diseases, only 28 recovered, while 216 passed away (P= 0.01).

Male Gender and underlying conditions, particularly diabetes and heart failure, are influential factors in determining the prognosis and severity of the disease. The mortality in the fourth wave has decreased significantly and the maximum rate of recovery of patients was in this wave.

As with other diseases during COVID-19, there are psychiatric aspects that require monitoring. The main objective of this study was to investigate the variation of psychiatric consultations requested in hospitalized patients with COVID-19 and the relationship between these consultations and patient prognosis.

In this cross-sectional study, the patients included those were  from admitted to the COVID-19 departments of Arak University of Medical Sciences. DSM-5 criteria were reviewed.

This study has shown that approximately 5.9% of COVID-19 patients admitted to hospitals have experienced psychiatric disorders, with delirium being the most common manifestation, especially among older individuals. The occurrence of delirium is significantly associated with higher mortality rates and low blood oxygen levels (p<0.05). The relationship between gender and specific psychiatric disorders was also investigated, revealing a significant correlation with anxiety, depression, and delirium (p<0.05). Moreover, concerning delirium disorder, a meaningful correlation was found with the prevalence and a history of neurological and psychiatric disorders (p<0.05).

By examining the patients, variety of consultations were divided into three categories: depression disorders, anxiety disorders, and delusions. It was found that the most common category which was clearly related to the death of patients was delusions.Therefore, the history of delirium disorder in the patient as well as the occurrence of delirium during hospitalization are important risk factors for patient mortality.

  There are very limited studies about the relationship between the presence of autoimmune disease and the patients’ outcome with Covid-19. Therefore, this study aimed to investigate the prevalence of various autoimmune disorders in patients with Covid-19 and its relationship with the prognosis of this group of patients.

 In this retrospective cohort study, the sample size included 264 patients with autoimmune disease who were hospitalized in Tehran Army hospitals due to Covid-19 disease. Moreover, 283 patients with non-autoimmune disease were considered as the control group. Patients' information was achieved using their hospital records. Demographic and information about disease history and their ultimate outcome were recorded. Finally, descriptive statistics indicators of mean and standard deviation were used to describe data. Furthermore, data were analyzed using SPSS software version 24 through independent t-Test and K2.  

In the group with autoimmune diseases, the mean age of patients was 55.32 ±7.63 years old. The most common disease was rheumatoid arthritis (21.2%) followed by psoriasis (12.9%). Mortality rates were significantly higher in the group with autoimmune disease compared with patients in the control group (18.9% vs. 11.3%, p = 0.012). The frequency of admission in the intensive care unit and intubation in the group with autoimmune diseases was significantly higher than control group (p <0.0001). Based on logistic regression, the presence of autoimmune disease increases the chance of death (Odds Ratio = 1.484) and it increases the chance of admission to the intensive care unit lonely (Odds Ratio = 1.487) (P <0.05). 

The results indicate that, based on modeling, autoimmune diseases significantly increase the chance of death and they also increase the chance of admission to the intensive care unit compared with healthy people.

Vascular endothelial growth factor (VEGF) induces proliferation of endothelial cells and angiogenesis. VEGF overexpression has been associated with poor clinical outcome in many malignancies. Also, several studies have reported increased expression of VEGF in papillary thyroid carcinoma. So, present study aimed to evaluate VEGF expression and its association with prognostic markers in papillary thyroid carcinoma.

In this cross-sectional study, totally 80 formalin fixed- paraffin embedded samples from papillary thyroid carcinoma patients referred to Shahid Mostafa Khomeini hospital, Tehran during 2017 to 2021 were immunohistochemically stained by VEGF marker. VEGF expression intensity in tumor cells scored as mild (Less than 25%), moderate (25-50%) and strong (more than 50%). Relation between VEGF expression grade with age, gender, tumor size, capsular invasion and lymph node metastasis was analyzed by SPSS software version 16.

Average of patient's age was 40.56±14.48 years and 58 patients (72.5%) were female. Mild, moderate and severe expression of VEGF was seen in 21.3%, 35% and 43.8% respectively. There was no significant relationship between VEGF expression with age, gender and tumor size. Increased expression of VEGF was significantly associated with increased rate of capsular invasion and lymph node metastasis (P<0.001).

VEGF overexpression is frequently seen in papillary thyroid carcinoma. Increased expression of VEGF is an independent prognostic factor for capsular invasion and lymph node metastasis and could be considered as a poor prognostic and potential therapeutic factor in papillary thyroid carcinoma.

Considering the importance of disease prognosis for evaluating the disease and determining the treatment protocol, as well as for defining an accurate and appropriate nursing diagnosis to establish a care plan and identify patients at risk, counting the number of blood cells may be of help due to its convenience and cost-effectiveness.

The population of this descriptive correlational study was all patients with gastric cancer referred to Imam Sajjad Ramsar Hospital during 2012-2017. Patient demographics were used to calculate the duration of disease-free survival and overall survival.

In the present study, 134 patients were examined. Regarding the age group, 16 patients were <50 years old and 118 patients were >50 years old. The number of lymphocytes <2000 and the number of monocytes >2000 and the absolute number of lymphocyte to monocyte ratio (LMR≥ 4.8) were associated with non-metastatic gastric cancer.

The frequency of absolute low lymphocyte count, high monocyte count and lymphocyte to low monocyte ratio was significantly higher in patients with higher stage disease and lymph node involvement than in other patients. These results can be used to review and define nursing diagnoses to inform decisions for care and treatment interventions for patients with gastric cancer.

Early diagnosis is one of the most important factors in cancer patients’ treatment. Early detection of cancer requires the discovery of sensitive and specific biomarkers. These biomarkers include proteins (i.e., enzymes, receptors, antibodies and peptides), nucleic acids (DNA- based, such as cell-free DNA (cfDNA) or could be RNA-based, such as microRNA or other non-coding RNAs).  In this review, we investigated the role of circulating tumor DNA (ctDNA) biomarker in the diagnosis of cancer.

In order to find articles related to the purpose of the research, keywords ctDNA and cancer and diagnosis were searched in Google Scholar, PubMed and Web of Science databases. After reviewing 312 found articles, the articles without exact subject and purpose relevance were excluded from the study. Finally, 174 related articles were included in the study. After linking the findings, the articles were read and the desired content was adapted.

It seems that cfDNA is the result of DNA fragmentation after apoptosis, necrosis, active secretion and damage or death of cells and different tissues and is released into the bloodstream. cfDNA is also used as a biomarker for the diagnosis, recurrence and prognosis of some cancers. Also, ctDNA is a part of cfDNA, which includes small pieces of DNA with a length of less than 200 nucleotides. ctDNA is derived from tumor cells circulating in the bloodstream and lymphatic system. Also, ctDNA may be released directly from cells in the tumor site that are dying due to apoptosis and necrosis, or through active release from healthy tumor cells in the bloodstream and lymphatic system. The amount of ctDNA in different people is different and depends on the type of tumor, its location and for cancerous tumors, the stage of the cancer. Assessing the amount of ctDNA, tracking its mutations and investigating the occurrence of aberrant methylation of ctDNA are important biomarkers in diagnosis, determining prognosis, and the course of treatment for cancer patients. Controlling cancers by measuring dynamic ctDNA in blood, plasma or serum is a new and developing area of research.

It seems that despite the challenges in the clinical application of ctDNAs, they can be used in the early diagnosis of cancer.

Usually, patients with femur fractures, including peritrochanteric fractures, have associated comorbidities, which increase the duration of hospitalization, increase the rate of complications, and increase mortality. The aim of this study was to determine the average time between hospitalization and surgery and discharge of patients over 60 years old with peritrochanteric fracture in Shahid Madani Hospital in 2022.

The current study is a cross-sectional study. Demographic information, underlying diseases, BMI, length of time between hospitalization and surgery, surgery and discharge, and hospitalization and discharge were collected. The relationship between prognostic factors and length of hospitalization was investigated and the significance level of p value was less than 0. 05 was considered.

A total of 250 patients (114 women and 136 men) with an average age of 75.6 ± 98 years were included in the study. The average time between hospitalization and surgery was 60.7 ± 23.8 hours, and the time between surgery and discharge was 24. 63.3 ± 4 hours and the time between hospitalization and discharge was 124.1 ± 35.9 hours. In female gender, age over 75 years and suffering from diabetes, cardiovascular disease, hypertension and respiratory disease, the time between hospitalization and Surgery was significantly higher. In female gender, age over 75 years, increased BMI, diabetes and respiratory disease, the duration between surgery and discharge was significantly higher. In general, increasing the length of time between hospitalization and discharge was significantly related to female gender, age over 75 years, increased BMI and diabetes, cardiovascular disease, hypertension, and respiratory disease.

Conducting this study led to the identification of risk factors that can be adjusted in patients, so that by reducing the complications of fracture and surgery, as well as reducing the duration of hospitalization, the chances of recovery and faster return to daily life can be increased.

A variety of factors, such as age and underlying diseases, affect the severity of covid-19 and its mortality rate. Identification of these factors is important to manage the disease in vulnerable people. The purpose of this study was to examine the association of outcome of covid-19 with demographic characteristics, underlying diseases, serum biomarkers, and level of care for inpatients.

This retrospective cohort study was conducted in Sina Hospital in Hamadan in 1400. All adult hospitalized patients with definite diagnosis of COVID-19 were included in the study by convenience sampling method during a three-month period. Demographic and clinical status data were collected using a designed questionnaire. Using SPSS software the data were analyzed by independent t, Mann-Whitney, and multivariate logistic regression analysis tests.

A total of 283 hospitalized patients with a mean age of 57.22 years participated in this study, of which 67 (23.7%) died. Among the deceased patients, 92.4% were over 50 years of age which showed a significant difference compared to the deceased patients under 50 years of age (P<0.001). People who died with any documented history of underlying diseases accounted for 83.3% of the deceased patients, and their proportion was statistically significant compared to the patients without any underlying disease (P 0.0005). Prevalence of severe acute respiratory distress syndrome (ARDS) was significantly different in the deceased patients (28.8%) compared to that in the survivors (3.9%) (P<0.001). According to the results of our study age, gender, history of underlying diseases, serum BUN level and severity of acute respiratory distress syndrome are predictors of death in the patients with Covid-19.

The findings of this study indicated the need to pay more attention to preventive measures in old people with underlying diseases. It can also help healthcare professionals to consider designing programs for prevention, appropriate care and treatment in relation to the predictors of mortality.

Glioblastoma multiform (GBM) is a highly malignant and aggressive primary brain tumor in adults, associated with a poor prognosis and short life expectancy following diagnosis. This 10-year retrospective study aimed to identify factors influencing the survival of patients with GBM in Kermanshah.

A retrospective cohort study was conducted, involving patients diagnosed with GBM who underwent surgery at Kermanshah's educational hospitals between 2008 and 2018. Demographic, clinical, and pathological variables were collected using a checklist extracted from patients' medical records. Patients were followed from the time of surgery until death. Data analysis was performed using Stata 14 software, employing the Cox regression model to assess factors influencing patient survival (p<0.05 considered significant).

A total of 153 patients with GBM were diagnosed during the 10-year period. The mean age of the subjects was 56.32 ± 9.22 years, with 60.8% being male. The average overall survival duration was 18.13 ± 6.84 months. Multivariable Cox regression analysis revealed that age, sex, tumor location, size of necrosis, extent of tumor removal during surgery, and reoperation in recurrence were not significant predictors of survival (p>0.05). However, tumor type, tumor pathology, and temozolomide (TMZ) consumption emerged as the most important factors associated with survival in these patients (p<0.05).

This study highlights tumor type, tumor pathology, and TMZ usage as critical factors influencing the survival of patients with GBM. Considering these factors can greatly contribute to the improved management of GBM patients.

Rheumatoid arthritis is an autoimmune, chronic and multisystem disorder. The present study was conducted with the aim of determining the prognosis of COVID-19 in patients with rheumatoid arthritis.

This cross-sectional study was conducted on 241 rheumatoid arthritis patients with covid-19 who had referred to medical centers in Kashan and Tabriz cities, Iran, in 2021. Rheumatoid arthritis disease activity score was measured based on the DAS28-ESR system. The prognosis of Covid-19 was calculated based on the CALL scoring system.

The mean age of the patients was 53.06±13.37 years and 82.2% were women. Based on the disease activity score, most patients (61.8%) were in the remission phase at the time of Covid-19 diagnosis. The underlying diseases of diabetes and hypertension and DAS28 score had a significant relationship with the prognosis of patients (P<0.05). Moreover, 92% of patients who were in the active phase of rheumatoid arthritis at the time of Covid-19 diagnosis had a poor prognosis, this percentage was significantly lower in patients who were in other phases of the rheumatoid arthritis disease (P<0.001).

The results of the present study show that the prognosis of COVID-19 in rheumatoid arthritis patients with severe activity was worse than those whose disease was inactive or had mild or moderate activity.

Background &

Early warning scores are commonly used by hospital care teams to assess patients and diagnose early signs of their deterioration and initiate further treatment. Due to the existing studies and the lack of sufficient evidence for burned patients, we decided to investigate the value of initial NEWS and MEWS in predicting mortality in burned patients.

After obtaining permission from the Ethics Committee of TUMS, patients who were candidates for hospitalization in the burn wards of Sina Hospital from July to March 1998 were included. All demographic information including age, sex, APACHE Type of discharge, comorbidities, percentage of burns, initial hospitalization in the burn ward, type and time of initiation and duration of antibiotic use, amount of serum and NEWS and MEWS scores for all patients were enrolled immediately after admission to the ward as well as before discharge from the ward. Data were analyzed after registration in SPSS software version 23.

In this study, 80 cases of burned patients were studied with a mean age of 37.94±18.85 years. The initial NEWS and MEWS indices have a good ability to diagnose burned patients (Area=0.79 and 0.78, p<0.001). The best cut- point based on the Youden index, for the initial NEWS and MEWS indices were obtained at 4.50 and 1.50, respectively.

In this study, for the first time, NEWS and MEWS were examined in predicting mortality in burned patients and it was found that these criteria can predict the prognosis of burned patients.

Influenza causes various seasonal respiratory diseases, resulting in significant morbidity and mortality in children. Influenza is a highly contagious disease causing global pandemics. This study aimed to investigate the frequency and outcome of influenza in children admitted to the Tabriz Children's Hospital.

This cross-sectional study included suspected influenza patients admitted to the Tabriz Children's Medical Center between 2014 and 2019 diagnosed with positive influenza through RT-PCR of pharyngeal secretions samples.

We evaluated 114 cases of influenza with a median age of 48 months (range: 2-156 months) and 53.5% were boys. A total of 87 cases (77%) were infected with subtype A/H3N2, which was the most frequent, followed by 2 cases (1.8%) of subtype A/H1N1, 23 cases (20.4%) of subtype B 23, and one case (0.8%) of uncategorized A subtype. The disease was common in winter with 63 cases (56.3%).

The frequency of influenza in children during five years was 8.95%, which is higher in males. Also, the highest frequency of influenza in the present study was observed in the age group of 1 to 5 years. The mortality rate of influenza in children during the last five years was equal to 7.9%.

Children under 5 years of age are more susceptible to influenza (especially type A subtype H3N2) and higher hospitalization rate and mortality, which can be prevented with a vaccine.

Identifying the prognostic factors of malignancies is of particular importance in therapeutic decisions and identification of high-risk patients. Since the papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, we aimed to investigate the expression and prognostic role of CD44 in patients with PTC.

This cross-sectional study was performed in patients with PTC who underwent thyroidectomy in Tehran Mostafa Khomeini Hospital, 2015-2019. Demographic information, and macroscopic and microscopic characteristics of the tumor were extracted from pathology reports. CD44 expression was classified from negative to extremely positive. We assessed the correlation between CD44 expression and patients' demographic characteristics and clinicopathological characteristics of the tumor.

Eighty PTC patients (58 females and 22 males) with a mean age of 40.85±4.59 years were studied. The frequency of lymph node and capsule invasion were 27.5% and 48.8%, respectively. The mean tumor size was 3.55±2.27 cm. All patients had more than 5% CD44 expression. Strongly positive and extremely positive cases of CD44 expression accounted for 43.8% and 21.3% of the cases, respectively. There was no significant difference in CD44 expression according to sex, age, and tumor size (P> 0.05). But, CD44 expression was found to be significantly associated with lymph node invasion (OR= 7.55) and especially capsule invasion (OR= 24.52).

Considering the relationship between CD44 expression and capsule and lymph node invasion in PTC, this biomarker can be used as a prognostic factor of more invasive disease in patients with PTC.