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Aim: Thyroid nodules are one of the most common clinical findings, with a prevalence of 68% in adults. Thyroid cancer is the fifth most common cancer in women. background: Thyroid nodules are one of the most common clinical findings with a prevalence of 68% in adults and thyroid cancer is the fifth most common cancer in women. Introduction: The purpose of this study is to evaluate the diagnostic efficacy of Thyroid Imaging Reporting and Data Systems proposed by the American College of Radiology (ACR-TIRADS) for the diagnosis of malignancy in surgically resected thyroid nodules Methods: In this retrospective study, patients who underwent thyroid nodules resected surgically from 2018-2020 were included. Before resection, an ultrasound was performed for TIRADS scores, and after resection histopathology, thyroid mass was obtained. The outcomes of the two systems were statistically compared. method: In this retrospective study patients who underwent thyroid nodules were resected surgically from 2018-2020 were included. Prior to resection, ultrasound was performed for TIRADS scores and after resection histopathology thyroid mass was obtained. The outcomes of the two systems were statistically compared. Results: The mean age of the 146 included patients was 47.6 ± 14.08 years, of which 109 (74.7%) were female. Based on TIRADS, 47 patients (32.2%) were in TI-RADS TR3, 36 patients (24.7%) were in TIRADS TR2, 34 (23.3%) in TIRADS 4, 24 (16.4%) in TIRADS TR5 and 5 patients (3.4%) were in TIRADS TR1. The overall sensitivity was 79.9% when ACR-TIRADS TR4 was set as a diagnostic cutoff value. Considering the total of TIRADS TR4 and TIRADS TR5 as predictors of thyroid malignancy, the sensitivity was 74.5% and the specificity was 76.8%. The positive and negative predictive value was 60.3% and 76.8%. Conclusion: ACR-TIRADS 4 and 5 can be considered good predictors of malignancy in thyroid nodules. More studies, including larger samples, are required to obtain a better conclusion. other: Due to the different results obtained regarding the sensitivity, specificity, and accuracy of the ACR-TIRADS guideline in various studies, further studies with a much higher number of samples and considering the size of the nodules can be very important.

Objectives Patients presented with penetrating trauma are immediately given an initial x-ray scan followed by the desired treatment. Intercostal nerve block in chest trauma patients is effective in pain management. The aim of this study is to investigate the need of second chest x-ray in penetrating chest trauma patients, following intercostal nerve block and evaluation of pain and other clinical parameters. Method In this a randomized controlled trail, 100 patients with thoracic trauma were examined from June 2019–December 2019. All patients who entered the study underwent an intercostal nerve block by 5 mg of lidocaine. The results from normal and abnormal chest x-ray groups were compared following the block, in terms of the VAS (Visual Analogue Scale) score and hemodynamic parameters. Result Among the two groups, normal second x-ray vs delayed hemopneumothorax, systolic blood pressure, rate of respiration and heart rate were not significantly at the time of admission and the time following the nerve block. However, this difference was significant in terms of visual analog scale score among the two groups.We also report that the VAS difference of more than 2.5 points has the specify of 76.5 and a sensitivity of 92.8 for the diagnosis of normal/stable patients. Conclusions Intercostal nerve block reduces pain in patients who are not presented with hemopneumothorax, whereas, patients otherwise are presented with the significant pain. Second x-ray in patients with reduced pain in response to the nerve block, might not be necessarily required.

Background Trauma is known as a third leading cause of mortality among all-aged patients. Objective The aim of this study is to investigate pre-trauma physiological factors and trauma-related factors that can increase the risk of mortality among the adult and geriatric patients. Method In this longitudinal data analysis study, 500 non-penetrating adult trauma patients who were referred to (Shahid Madani Hospital) from January 2019–December 2019 were enrolled. Information such as age, sex, occupation, place of residence, hospitalization and surgical history, underlying illnesses, medications (such as antihypertensive drugs, etc.), lab findings (complete blood cell and creatinine levels) were recorded in the form of a questionnaire. The patients were divided in group A (aged 65 and above) and group B (aged below 65 years). The data obtained was analyzed statistically using SPSSv18. Result The mean age of all patients under study was 51.6 years. Among all participants, 68% (341) were male and 32% (159) were female. Regarding the cause of trauma, group A had significantly greater incidence (p-value = 0.001). The two groups were also significantly different in terms of the region of the injury (p-value = 0.014). Furthermore, underlying diseases were also statistically significant among the two groups (p-value = 0.0093). There was a significant difference between the two groups in terms of smoking and drugs (p-value = 0.01 and 0.001, respectively). Finally, the mortality rate in patients older than 65 years old (4.3%) was significantly higher than those in patients under the age of 65 years (2.9%) (p-value = 0.0001). Conclusion The results of this study showed that among the trauma patients aged below 65 years and those aged 65 years and above, underlying illness, mortality rate, usage of drugs, cause of trauma, type of injury, vital signs, white blood cell count and platelet count, hemoglobin and serum creatinine vary significantly.

Insulin resistance is associated with a number of postoperative complication and delays recovery. Carbohydrate rich drinks given preoperatively may decrease these deleterious effects. This study evaluated the clinical effects of a preoperative carbohydrate loading in patients undergoing laparoscopic cholecystectomy.In this a randomized clinical trial conducted at (XXX) Medical Center located, patients undergoing elective cholecystectomy were included. Patients were randomly divided into fasting and dextrose-receiving groups. The outcomes of this study are the pain, pre- and postoperative blood sugar, fasting blood sugar, insulin, cortisol, albumin, CRP (c-reactive protein), and wound conditions such as wound infection and the amount of fluid discharge from the drain. The data was statistically analyzed using SPSS v22.Patients who received carbohydrates before surgery experienced less pain on the day after surgery (P-value0.05). Insulin resistance, CRP, CRP to albumin ratio and cortisol levels were significantly reduced in dextrose group (P-value0.05) However, difference in glucose levels and albumin was not significant in the two groups.The present results show that although carbohydrate loading is associated with reduced postoperative pain and reduction in inflammatory factors along with insulin resistance.

Background: Cardiac penetrating trauma is a medical emergency that mostly affects young people. Based on the type of injury and associated complications, it can present as a surgical challenge and can lead to mortality. Objective: The aim of this study is to evaluate the complications of penetrating heart trauma among patients referred to Shahid Madani Hospital. Methods: In this retrospective descriptive study, the data of penetrating cardiac trauma patients referred to Shahid Madani hospital, Karaj, Tehran, from 2016-2019, were investigated. Information, including age, sex, cause of trauma, traumatized area and complications, was extracted and recorded in a data collection form. The data were evaluated statistically using SPSS v18. Results: A total of 44 patients were included in the study, where the mean age of the patients was 25 years. 73.3% of these patients were men and 26.7% were women. Knife stab wounds were the most prevalent cause of the trauma, present in 93.3% of patients. 73.3% of the patients had cardiac tamponade and 20% had a pneumothorax. The right ventricle was the most common site of the injury in 46.7% of the patients. A mortality rate of 3.4% was reported in this study. Conclusion: The results of this study showed that the highest penetrating heart rate trauma occurred among young people, and the most common cause of the trauma was a knife stab. The most common area of the injury was the right ventricular, and cardiac tamponade was the most common complication.

Introduction Coronavirus pandemic-initiated Wuhan city, Hubei Province, China. It mainly involves respiratory system and cause fever, cough. However, it has other manifestations such as GI system, CNS and skin involvement. It is transmitted mostly through respiratory system, but some researchers claim that in can potentially spread by oral, fecal or intestinal gas. During colorectal surgeries such as volvulus sigmoid, surgeons are at risk of exposure to intestinal gas. Case presentation A 57-year-old mentally retarded man came to our emergency department with complain of abdominal pain, constipation, obstipation, nausea, vomiting and abdominal distention. His vital sign was stable and his laboratory data revealed no abnormality. His abdominal x-ray showed intestinal obstruction with suspicious of sigmoid volvulus. His PCR for COVID 19 was positive and his chest CT scan has manifestations of lung involvement. He was proceeded for surgery. Conclusion Owing to odds of spread of coronavirus through intestinal gas, in this case, sigmoid colon was removed without evacuation of intestinal gas., Highlights • Covid-19 involves respiratory system and cause fever, cough. • COVID19 is a strong pathogenic virus which mainly transmit throw respiratory system. • It there are potential way of transmission such as oral-fecal and throw intestinal gas. • We introduce a new technic in sigmoid volvulus surgery to reduce risk of contamination.

Objective Sternal fracture may be associated with major and serious injuries. In this study, the complications associated with isolated sternal fracture in trauma patients are evaluated based on radiographic and cardiac findings. Methods This retrospective study was performed on patients with isolated sternal fractures admitted to the emergency department of (XXX) Madani Educational-Medical. Data regarding demographic information, mechanism of trauma, length of hospitalization, electrocardiography (ECG), cardiac enzyme, and chest radiography were recorded in the questionnaire for each patient. Results The mean age of patients 41.2 + 11.04 years and 63.9% were male. The most common cause of the trauma was car accidents in 41% (25 cases). The mean duration of hospitalization was 1.54 ± 0.90 days. The mechanism of trauma was not associated with x-ray and computed tomography findings, p = 0.53 and p = 0.86, respectively. ECG findings were significantly related to x-ray and computed tomography outcomes, p 0.5 cm and hematoma are likely to require cardiac consultation., Highlights • Sternal fracture may be associated with major and serious injuries. • Approximately, 10% of all trauma cases are blunt trauma. • Patients with isolated sternal fracture and hematoma are likely require cardiac consultation. • The type mechanism of trauma may not predict radiographic findings.

Background and Objectives: Pilonidal sinus is a disease in the sacrococcygeal region diagnosed through the purulent discharges of the above-said region. Although the exact pathology and etiology of those suffering from pilonidal is not clear yet, the presence of hair seemingly plays a major role in the process of infection and the granulation tissue. Several techniques have been identified for pilonidal surgery. These techniques primarily fall within two categories: Primary repair and Lay open. One of the setbacks of the primary repair method is the creation of a dead area under the wound which can result in blood accumulation and seroma. To solve the problem of removing the dead space, there are two solutions. The first method utilizes a close suction drain, when the wound discharges are over, the drain is removed. The second technique is called Tie-over where different layers of the wound are pushed close to one another and the dead region vanishes. The present research seeks to compare Tie-over and Closed Suction Drainage methods through random clinical trial in order to introduce the superior technique for faster recovery and reduction of the economic load on the patient. Methods: Some 64 patients suffering from sacral plonidal sinus aging from 15 to 50 in Shohadaye Ashayer Hospital of Khoram Abad in 2013 were selected for the research based on the inclusion criteria. The demographic information of them was collected through questionnaires. The patients were randomly divided into two groups undergoing (A) Tiover and (B) Closed Suction Drainage surgeries. Other information such as return to normal activity and total recovery time was also completed through the questionnaire. SPSS software was used to conduct statistical analysis. Results: The results of the statistical analysis showed that the two groups were similar to one another in terms of age, gender, marital status, job, and literacy. A significant difference was observed only between the level of satisfaction (P-value = 0.035) in groups A and B concerning the factors studied after the operation. The post-operation recurrence of pilonidal sinus among those who smoked cigarettes and had undergone Closed Suction Drainage was significantly greater than the non-smokers (P-value=0.011). As of the group undergoing Tie-over surgery, the difference between the patients’ satisfaction in terms of their age was statistically significant and the highest level of satisfaction was observed among those aging 25 to 34 (90%) (P-value=0.023). Conclusion: In sacrococcygeal pilonidal cyst surgery, no difference was observed except for the difference in the level of satisfaction. More satisfaction was observed using the Tiover method.