Paraclinical Symptoms Research Articles

Evaluation of the Clinical and Paraclinical Symptoms of Children Intoxicated With Amphetamines in Akbar Hospital of Mashhad, Iran 2021-2022.

Amphetamine poisoning in children is a significant public health concern due to its potential for severe adverse effects on physical and mental health. In this article, we describe a case series of 29 children under the age of 14 presenting with sympathomimetic toxidrome due to confirmed amphetamine poisoning. In this cross-sectional study, children (1 month to 14 years old) who were hospitalized in the emergency and pediatric departments of Imam Reza and Akbar Hospital in Mashhad from the beginning of April 2021 to September 2022 were identified with the diagnosis of amphetamine poisoning. Their demographic, clinical, and paraclinical (laboratory and electrocardiogram) information, which was included in the relevant checklists, were analyzed and reported. Out of 29 children included in the study, 18 (62%) were male and the rest were female. The average age of children was 44.75 ±43.9 months; most of them were less than 4 years old. In all patients, glasgow coma scale (GCS) was 15. In 25.92% of cases (8 patients) blood pressure was above the 90% percentile for age and sex, 82.60% (24 cases) were tachycardia, 72.41% crying (21 cases), 86.20% were restless (25 cases), 10.34% tremor (3 cases), 10.34% had body pain (3 cases), and 6.89% (2 cases) had delusions. None of the subjects had a seizure. The serum level of creatine phosphokinase was on average 771.99 ± 966 units/L. All children had an increase in creatine phosphokinase (CPK) and 25.9% of children had an increase in CPK to more than 1000 units/L. Based on the results, in children with symptoms such as restlessness, crying, and tachycardia, poisoning with amphetamine group substances should be included in the differential diagnosis list, and also measuring CPK and investigating the possible occurrence of rhabdomyolysis in cases of poisoning of children with amphetamine seems necessary.

CLINICAL AND SUBCLINICAL CHARACTERISTICS OF CARDIAC ARRHYTHMIAS IN CHILDREN AT CAN THO CHILDREN’S HOSPITAL

Introduction: Cardiac arrhythmia is a common cardiovascular emergency with diverse clinical and paraclinical characteristics. Arrhythmias can be harmless, asymptomatic, or have mild symptoms. However, some arrhythmias can cause discomfort with aggressive clinical and paraclinical manifestations, sometimes threatening the patient's life. This disease has very different clinical and paraclinical symptoms between types of arrhythmia. Objectives: Describe the clinical and paraclinical characteristics of arrhythmias in children at the Cardiovascular Department of Can Tho Children's Hospital. Subjects and Methods: A case series study was conducted on 45 children with arrhythmias at the Cardiovascular Department of Can Tho Children's Hospital, with consent obtained from their parents or caregivers to provide accurate information. All children 0 - 15 years old were diagnosed with arrhythmia based on ECG criteria or other investigation methods at the time of first examination or discovered during research at the Department of Cardiology in Can Tho Children's Hospital, whose parents or caregivers agree to provide accurate and clear information. Results: The ratio of men to women was equal (1.1/1), with the ≥60 months age group having a higher rate compared to the <60 months group. Rapid pulse accounted for the highest rate (64.4%) among children with arrhythmias, while chest pain and palpitations accounted for the lowest rates at 11% and 13%, respectively. Most of the electrolytes did not have many disturbances. There was 1 case of hypernatremia (accounting for 2.2%) and 1 case of hypokalemia (accounting for 2.2%). There were no cases of chloride disorders. Echocardiograms mostly had abnormal results in pediatric patients with arrhythmias. The most common kind of abnormal result was mitral incompetence (26.7%). Sinus tachycardia accounted for the highest proportion (64.4%) of electrocardiography. Conclusion: The majority of children with arrhythmia were in the age group ≥60 months. Rapid pulse accounted for the highest rate among children with arrhythmias. Most of the electrolytes did not have many disturbances. Cardiac morphological and functional testing mostly had abnormal results in pediatric patients with arrhythmias.

Pediatric Ischemic Stroke: Clinical and Paraclinical Manifestations—Algorithms for Diagnosis and Treatment

Childhood stroke can lead to lifelong disability. Developing algorithms for timely recognition of clinical and paraclinical signs is crucial to ensure prompt stroke diagnosis and minimize decision-making time. This study aimed to characterize clinical and paraclinical symptoms of childhood and neonatal stroke as relevant diagnostic criteria encountered in clinical practice, in order to develop algorithms for prompt stroke diagnosis. The analysis included data from 402 pediatric case histories from 2010 to 2016 and 108 prospective stroke cases from 2017 to 2020. Stroke cases were predominantly diagnosed in newborns, with 362 (71%, 95% CI 68.99–73.01) cases occurring within the first 28 days of birth, and 148 (29%, 95% CI 26.99–31.01) cases occurring after 28 days. The findings of the study enable the development of algorithms for timely stroke recognition, facilitating the selection of optimal treatment options for newborns and children of various age groups. Logistic regression serves as the basis for deriving these algorithms, aiming to initiate early treatment and reduce lifelong morbidity and mortality in children. The study outcomes include the formulation of algorithms for timely recognition of newborn stroke, with plans to adopt these algorithms and train a fuzzy classifier-based diagnostic model using machine learning techniques for efficient stroke recognition.

Laboratory, Clinical, and Para-clinical Symptoms of Children with Covid-19: A Gender-based Cross-Sectional Study

Background Children show milder symptoms of COVID-19 with lower mortality rates. The manifestation of COVID-19 in the pediatric population is an understudied topic. Our aim was to investigate the clinical and para-clinical manifestations of SARS-CoV-2 in children in the Central province of Iran. Materials and Methods We investigated the clinical and para-clinical manifestations of children referred to all hospitals in the Central Province of Iran from March 2019 to June 2020. Results We surveyed 96 pediatric patients hospitalized in hospitals in the Central Province of Iran. The average age of the patients was 110 months. 53% of patients (51 people) were male. The analysis did not show a significant relationship between the laboratory results and the gender of the patients. Conclusion Male and female pediatric patients had the same condition in terms of clinical manifestations, laboratory results and antibiotic use.

Evaluation of the results of laparoscopic surgical treatment for acute appendicitis in elderly patients

Objectives: The aim of this study was to evaluate the clinical and paraclinical characteristics and results of treatment of acute appendicitis in elderly patients. Methods: A prospective study was conducted on 189 patients, including 42 of them over the age of 60, diagnosed with acute appendicitis or peritonitis due to appendicitis based on clinical and paraclinical symptoms and treated with laparoscopic surgery from April 2022 to June 2023 at the Department of Digestive Surgery, Hue University of Medicine and Pharmacy Hospital. Results: Elderly patients with acute appendicitis admitted to the hospital had an average age of 69.3 years. The time from symptom onset to hospital admission in elderly patients was 30.1 hours compared to 19.1 hours in the non-elderly group. The elderly group had a rate of peritonitis of 40,5% compared to 13.6% in the non-elderly group (p < 0.001). The mean time for passing initial gas in elderly patients was 18,1 hours compared to 13.3 hours in the non-elderly group (p = 0.004). Postoperative hospital stay in elderly patients was 4.7 days compared to 3.5 days in the non-elderly group (p < 0.001). Postoperative complications in the elderly patient group were 2.4% compared to 0% in the non-elderly group (p = 0.222). There were no complications during surgery or 30-day mortality. Conclusions: Elderly patients with acute appendicitis were hospitalized later, had a higher rate of peritonitis and had a longer postoperative hospital stay than non-elderly patients. Laparoscopic surgery to treat acute appendicitis in the elderly is a safe method. Key words: acute appendicitis, elderly, laparoscopic appendectomy, appendicitis peritonitis.

Characteristics of clinical, paraclinical and treatment results of children liver abscess in Children’s Hospital No. 2

Liver abscess (LA) is one of the most common cause of morbidity in children. Vietnam located in an area with a high infection incidence of fascioliasis in the world. LA due to fascioliasis is progressing in recent years. Objectives: To determine clinical and paraclinical features and results of treatment of LA. Subjects and research methods: This was a retrospective study. The duration was from January 2016 to January 2021. All the patients with LA were included in this study. Results: Clinical and paraclinical symptoms are in remission or returned to normal, especially liver damage on imaging. Results: There were 60 patients. Patients >5 years old account for 70.0%. LA due to parasitic, pyogenic,amoebic and unknown were 53.3, 5.1, 5.0 and 36.6%, respectively. The diameter of the LA is less than 5 cm accounting for a high rate (70%). Clinical manifestations with right upper quadrant pain, hepatomegaly, fever, nausea and vomiting were 95.0, 75.0, 25.0 and 25.0%, respectively. The values ofeosinophilia, C-reactive protein (CRP), and white blood cells were mostly increased in LA at 68.3, 65.0 and 65.0%, respectively. The rate of remission and cure is 95.0%. Conclusions: LA of unknown cause still accounts for a high proportion of research, so testing to find the agent should be early conducted, for timely treatment to bring the best effect to the patient.

Results of Minimally Invasive Distal Metatarsal Osteotomies (Dmmo) Limited to the 2nd and 3rd Rays: About 112 Cases

Category: Lesser Toes Introduction/Purpose: The objective of this study was to evaluate the clinical and radiological results of DMMO limited to the second and third rays in patients suffering from metatarsalgia with lesion of the plantar plate of the second ray associated with a hallux valgus. Our hypothesis was that this gesture allowed an improvement of the clinical and paraclinical symptoms Methods: For this retrospective, single-center, single-operator study, 112 patients (mean age 65.52 years, 91% women, 127 feet) operated between June 2015 and October 2020 were included based on the following criteria: metatarsalgia complicated by lesion of the plantar plate with hallux valgus. Secondary metatarsalgia, congenital malformation, pes cavus, Freiberg's disease, gastrocnemius retraction were excluded The surgery began with DMMOs of the 2nd and 3rd metatarsals, then a minimally invasive chevron osteotomy adjusted the length of the 1st metatarsal in relation to the lateral rays. The position of the toes was guided by a bandage for 2 weeks relayed by a molded orthoplasty for 4 weeks. Support was complete with a rigid flat shoe. At a mean follow-up of 3 years (14-80 months), the AOFAS functional score and radiographic measurements (Maestro criteria, bone consolidation) were evaluated. Results: The clinical improvement was significant with an AOFAS score going from 44.9 to 91.8 (p>0.05)We observed 8.7% of complications: 4 transfer metatarsalgia on the 4th or 5th metatarsal, 1 asymptomatic callus under M4, 1 asymptomatic nonunion of M2, 5 spontaneously resolving delayed consolidation, 1 algodystrophy.The radiographic improvement was significant on our morphotypes which were disharmonious in 92% with M45 hypoplasia in 76% and long M23 in 16%.Indeed, the DMMO limited to the 2nd and 3rd metatarsal allowed a significant reduction in the difference in length between the 3rd and 4th metatarsal (p>0.05)Our 4 cases of transfer metatarsalgia under M4 or under M5 were not explained radiologically by relative length anomaly. Conclusion: Performing DMMO limited to the 2nd and 3rd metatarsals appears to be a reliable solution in the management of metatarsalgia by lesion of the plantar plate associated with hallux valgus, the risk of transfer metatarsalgia was not increased compared to the data of literature.

Evaluation and comparison of vitamin A supplementation with standard therapies in the treatment of patients with COVID-19.

Incomplete data are often presented for determining the role of vitamin A supplement therapy for improving treatment outcomes in patients with COVID-19. We compared treatment effects between a group that received vitamin A added to the standard COVID-19 treatment and another group that received the standard drug treatment alone. Participants in this triple-blind controlled trial comprised 182 COVID-19 outpatients in Saveh City, Markazi Province, Islamic Republic of Iran, in 2020. Patients were randomly divided into experimental (n = 91) and control (n = 91) groups. Patients in the control group received the national standard treatment for COVID-19 (hydroxychloroquine), and those in the intervention group received 25 000 IU/d oral vitamin A for 10 days in addition to the standard treatment recommended by the national protocol. We evaluated the clinical symptoms, paraclinical criteria, and hospitalization status before and after 10 days of interventions. The treatment groups did not differ significantly in clinical and paraclinical symptoms before the intervention. However, clinical symptoms such as fever, body ache, weakness and fatigue, paraclinical symptoms, white blood cell count, and C-reactive protein showed significantly greater decreases in the experimental group 10 days post-intervention compared with the standard treatment alone (P < 0.05). Vitamin A supplementation demonstrated efficacy in improving some clinical and paraclinical symptoms in patients with COVID-19. Future studies should evaluate vitamin A supplementation with a larger sample size and compare different dosages, especially in hospitalized patients.

Use of Probiotics in Infants with Cow’s Milk Allergy: A randomized, placebo controlled trial

Background: One of the most common food allergies in infants is cow’s milk allergy (CMA). There is no available effective therapeutic strategy for this issue. It's important to develop effective approaches to reduce the risk of cow’s milk allergy. The purpose of this study was to investigate the effect of probiotics in infants with cow’s milk protein intolerance. Materials and methods: This study was a randomized clinical trial in full-term infants with CMA diagnosis. These patients were divided into case and control groups (receiving placebo and probiotic). Clinical symptoms such as diarrhea, abdominal pain and etc. were evaluated in 2, 4, 8, 12 and 16 weeks after receiving probiotics. Results: During 16 weeks of the study, a significant decrease was observed in clinical and paraclinical findings in both groups. There was a statistically significant decrease in times of mucosal, bloody and daily defecation of patients on 4th, 8th and 12th week. Also, a significant difference was found between both groups for diarrhea and abdominal cramps from the 4th week. Conclusion: The consumption of probiotics for a short time in infants with CMA significantly decreased the clinical and paraclinical symptoms.

Whipple's disease? A case report and discussion.

Whipple's disease (WD) is a rare chronic systemic disease caused by the Gram-positive bacillus Tropheryma whipplei. Despite over 100 years of observation and study history of this disease, it still remains a difficult diagnostic and therapeutic challenge. Authors report the case of a 38-year-old man with long-time PPIs treatment because of GERD and no other clinical and paraclinical symptoms. Endoscopic slightly enlarged villi, accumulation of whitish matter at the tip of the villi of distal duodenal mucosa and periodic acid-Schiff staining positive inclusions in the stromal tissue may be typical signs of Whipple's disease. In discussion the possible explication of this case are presented. It is still a challenge to diagnose Whipple's disease. Histological findings may confirm the diagnosis in patients with a combination of typical clinical manifestations, but histological signs alone are not pathognomic, and are not enough for a definitive diagnosis.

Особливості клінічного перебігу хвороби Вільсона в дітей

Purpose — to discover peculiarities of Wilson disease course in children dependently on the variant of liver affection. Materials and methods. Anamnesis of the disease and clinical and paraclinical peculiarities of the course of the disease with consideration of liver affection severity have been studied in 50 children aged 5–17 years. Results. It was estimated that in 52% of children the disease had a form of chronic hepatitis with minimal clinical symptoms, 44% of patients had liver cirrhosis with predominant signs of edematous and ascitic syndrome and 4% had fulminant hepatitis in a debut of the disease. Complicated family anamnesis was detected in 4% of patients. Syndrome of cytolysis predominated in patients with liver damage in the form of chronic hepatitis (р&lt;0.05). Typical biochemical changes in cirrhotic patients were hepatocellular insufficiency with hypoalbuminemia and coagulopathy, hyperbilirubinemia and minimal hypertransaminasemia (р&lt;0.05). Children with cirrhosis in contrast to patients with chronic hepatitis had reliably lower serum ceruloplasmin concentration and reliably higher excretion of copper with urine. Specific for Wilson disease Kayser—Fleischer rings were found out in 36% of patients only. Conclusions. Wilson's disease in children is characterized by progressing course in the form of either chronic hepatitis or liver cirrhosis or, rarely, fulminant hepatitis. Clinical and paraclinical symptoms of the disease are estimated by the severity of liver affection and vary from a course with minimal symptoms in patients with chronic hepatitis to edematous and ascitic syndrome and hepatocellular insufficiency in patients with cirrhosis and fulminant hepatitis. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Wilson's disease, children, chronic hepatitis, liver cirrhosis, course of the disease.

Clinical and Paraclinical Characteristics of 57 Deceased COVID-19 Patients in Tehran, Iran: A Retrospective Observational Study

Background and Aims: In 2019, a novel coronavirus called SARS-COV-2 spread throughout the world, causing a pandemic a few months later. As the virus is not well-known and highly contagious, it is important to observe patients for all possible symptoms and comorbidities. This study aimed to demonstrate some demographic, clinical, and paraclinical features of the deceased patients with COVID-19 in Iran. Materials and Methods: A retrospective observational study was designed to demonstrate the clinical and paraclinical features of deceased patients who had a positive real time-polymerase chain reaction test result for COVID-19. The study included all COVID-19 patients who visited Shariati Hospital, Tehran, Iran, from February 20th until May 20th, 2020. All data were analyzed using IBM SPSS version 21 (Mann-Whitney or Fisher’s test). Results: The patients had a mean age of 63.86 ± 16.428, and most were males (59.65%). Diabetes and hypertension were the most frequent comorbidities. The most common symptoms among the patients were dyspnea (64.91%), weakness (61.40%), fever (60.71%), and having ground-glass opacities in the CT scans (85.96%). There was also a rise in lactate dehydrogenase, serum ferritin, D-dimer, and procalcitonin. Conclusions: Older COVID-19 patients are more likely to get more severe forms of the disease. Most of the deceased COVID-19 patients had ground-glass opacities in their CT scans. Dyspnea, fatigue, and fever were the most frequent symptoms. Hypertension and diabetes were the most important comorbidities. There was almost no significant difference between the two genders regarding clinical and paraclinical symptoms.

The combined effect of Algomed and a quadruple herbal brew of Iranian traditional medicine on the severity and outcome of COVID-19; a randomized controlled clinical trial recruiting inpatients

Introduction: Given the importance of coronavirus disease 2019 (COVID-19) as a worldwide issue and its health, psychological and social effects and some serious complications and consequences, it needs to find appropriate treatment for this emerging disease. Objectives: To evaluate the effectiveness of combination of Algomed and Mentha longifolia, Matricaria recutita, Althaea rosea and Malva sylvestris on the severity and outcomes of COVID-19. Patients and Methods: In a Randomized clinical trial we included 68 participants with confirmed COVID-19 through PCR tests and/or CT scan, who were admitted to non-ICU wards. The intervention group received four 300-mg Algomed tablets daily, and the quadruple herbal brew three times a day additionally while the control group received routine treatments. The brew was prepared using a large teabag containing 6 g of the four herbs (2 g of Mentha longifolia, 2 g of M. recutita, 1.4 g of Malva sylvestris and 0.6 g of A. rosea). The patients were compared daily from their admission to the end of the third day in terms of clinical and para-clinical symptoms, and outcomes. Results: The two groups were not significantly different in terms of age (P=0.657) and gender (P=0.798). The median and inter-quartile range of length of stay were respectively 3 and 2-4 days in the intervention group and 5 and 3-9 days in the controls, significantly higher in the control group (P&lt;0.001). Comparing the two groups in terms of the difference between the third and the first day values showed a significant difference in white blood cells count, a reduction of 432.9 in the intervention group vs. an increase of 65.5 in the controls (P=0.049). Except for diarrhea, which happened more in the control group (P=0.020), the two groups were not significantly different in terms of other variations. Conclusion: The present study results indicated the effects of a combination of Algomed and the brew of M. longifolia, M. recutita, A. rosea and Malva sylvestris on reducing the length of stay. It is suggested that the findings of this research should be confirmed by more detailed study with bigger sample size. It is also recommended that same or similar research should be conducted in different geographic locations of the world to confirm the outcome of this research. The main limitation of this study is that it was performed only on hospitalized patients who had a milder form of the disease in terms of disease severity. Therefore, the benefits of the interventions cannot be generalized to all patients. Trial Registration: Registration of trial protocol has been approved by Iranian Registry of Clinical Trials (#IRCT20151228025732N51, https://en.irct.ir/trial/46828, ethical code#IR.SEMUMS.REC.1398.325).

Clinical, Radiological, and Laboratory Findings in Patients Infected With 2019 Novel Coronavirus (SARSCoV-2)

The outbreak of a novel coronavirus disease 2019 (COVID-19) began in China in December 2019 and spread worldwide. The current review summarized clinical, radiological, and laboratory findings of patients infected with COVID‐19. Based on many studies, the main symptoms of the disease include respiratory symptoms, fever, cough, and dyspnea; there is also a wide range of biochemical, hematological, and radiological changes in the patients. The signs (or symptoms) and other variables in the early stage or the mild stage of the disease appear in a highly heterogeneous and non-specific manner. Identifying the clinical and paraclinical symptoms of COVID-19 can be effective in controlling it.

Uveitis – Possible adverse reaction to secukinumab in a patient with rehabilitation treatment for ankylosing spondylitis (case report)

Introduction. Ankylosing spondylitis (AS) is a chronic inflammatory disease that predominantly affects the spine, but also peripheral joints, the major characteristic of the disease being the early involvement of the sacroiliac joint. The most common extra skeletal manifestations are ocular disorders and appear to 25-30% of the patients, being more frequent to HLA B27 positive patients. Episodes of previous acute uveitis, known as iridocyclitis, may precede or may occur during or after inflammatory joint manifestations. Materials and Methods. We present a 41-year-old patient diagnosed 11 years ago with Ankylosing spondylitis, on its axial form, without extra-articular manifestations, periodically treated with anti-inflammatory drugs and balneary treatment, but with inefficient clinic and biological response. Since November 2019, his treatment with Secukinumab, started to improve the clinic and paraclinical symptoms. Secukinumab is a fully human monoclonal antibody, the first care that selectively targets IL-17A, an essential cytokine treatment that produces inflammation, and bone remodeling, characteristic of AS. Results. In January 2020, the patient presents increased pain and redness in the right eye area, subsequently diagnosed as anterior acute uveitis. Conclusions. This anterior acute uveitis, may be an extra-articular manifestation in the context of the natural evolution of the disease insufficiently controlled by the recently introduced therapy, or it may be an adverse reaction to Secukinumab, being known that the optic malfunction is a less common side effect. Keywords: Ankylosing Spondylitis, Uveitis, Secukinumab, extra-articular manifestations, rehabilitation, treatment,

The relationship between serum VCAM-1 level and lupus nephritis in patients with systemic lupus erythematosus

Introduction: Nephritis is a frequent inflammatory autoimmune complication in systemic lupus erythematosus (SLE). Detecting the nephritis state of SLE patients using non-invasive biomarkers seems to be necessary. Objectives: This study aimed to evaluate role of vascular cell adhesion molecule-1 (VCAM-1) as a noninvasive method in the assessment of lupus nephritis. Patients and Methods: This study was conducted at Imam Reza hospital in Mashhad, Iran, during 2017-2018. A total of 114 SLE patients diagnosed based on the lupus diagnosis criteria including the clinical and paraclinical symptoms that were referred to the rheumatology or nephrology clinics and were enrolled in the study. After obtaining informed consent, a blood sample was taken to determine serum VCAM-1 levels. All patients were evaluated for glomerular hematuria and proteinuria in addition to testing for serum C3, and C4, anti-nuclear antibody (ANA) and anti-ds DNA levels. The serum urea and creatinine levels as well as 24-hour urine protein were measured. Finally, the patients were designed into two groups of SLE with and without nephritis. A renal biopsy was performed in lupus patients with nephritis to determine the class of the disease. The association between serum levels of VCAM-1 and activity of SLE disease [systemic lupus erythematosus disease activity index (SLEDAI)], anti-dsDNA serum level, glomerular hematuria, proteinuria, and lupus nephritis class were evaluated. Results: According to statistical analysis there was no significant relationship between SLEDAI and VCAM-1 levels was detected (P&gt;0.05). Additionally, no significant relationship between VCAM-1 levels and lupus nephritis classes was detected (P&gt;0.05); however the serum VCAM-1 levels were significantly lower in patients with hematuria (P= 0.021). Conclusion: There is no correlation between serum VCAM-1 levels and classes of lupus nephritis. Our data however requires further investigation on its clinical implications.

Delayed Pneumomediastinum and Subcutaneous Emphysema in Covid-19 Patients: A Case Report

Coronavirus Disease 2019 (COVID-19) is a severe respiratory disease initiated on December 2019. Genome sequence analysis shows that the pathogen is a complex beta-coronavirus RNA, known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Spontaneous Pneumomediastinum and pneumothorax are rare clinical and radiological conditions associated with COVID-19. This study is case report of pneumomediastinum and subcutaneous emphysema in two patients with COVID-19, while investigating the clinical and paraclinical symptoms and the treatment process of two cases. Finding factors related to the severity of COVID-19 for improving the final outcome in patients is very important.

Explanation of Dry Liver Dystemperament (sue-mizaj) Concept in Iranian Traditional Medicine (Persian Medicine): A Qualitative Study

Background: Temperament (mizaj), prakruti and zheng are equivalent basic concepts in different traditional medical schools. In Iranian Traditional Medicine (ITM), Liver distemperament is one of the liver diseases not yet objectively defined. Objectives: The present study aims to explain the concept of dry liver dystemperament in Iranian Traditional Medicine. Methods: This study is a qualitative research based on a hybrid model of concept analysis. In literature review, 11 major academic textbooks of PhD students of ITM as well as, recent investigations were reviewed. In addition, 16 ITM experts were interviewed to collect empirical data. The data were analyzed using MAXQDA10 software and categorized based on conventional content analysis. Result: Here, dry dystemperament of the liver was classified into three main themes of systemic, local, and Para-clinical symptoms and 10 categories. Phenotypic features, skin color, dryness or stiffness in mucus, skin and subcutaneous tissue touch, general or gastrointestinal dysfunction; especially thirst and systemic impressibility speed were the most important clinical diagnostic criteria. Conclusion: In this study, a new definition was presented for dry liver dystemperament. Based on the results, there were some scattered symptoms in textbooks, which were of the same importance. However, in empirical phase, the experts of traditional medicine stated that in clinical diagnosis, some signs or symptoms are more important for them. The concept of dry liver dystemperament was classified into 10 categories which were the same as dysfunction in 10 categories that mentioned for general temperament.

Explanation of the Concept of Wet Liver Dystemperament (sue-mizaj) in Iranian Traditional Medicine (Persian medicine): A Hybrid Concept Analysis

Objectives: The semiology of liver dystemperament can help in predicting susceptibility to some diseases and improving the treatment process of the liver or general disease such as non-alcoholic fatty liver disease (NAFLD). Therefore, the aim of this study was to explain the wet liver dystemperament concept in Iranian traditional medicine (ITM) based on a hybrid concept analysis. Materials and Methods: The literature review of this qualitative study focused on evaluating 11 major academic textbooks from the 3rd to 19th century and some databases. In-depth, semi-structured, and face-to-face interviews were conducted with 16 ITM experts with a minimum of five years of clinical experience and maximum variations in terms of gender, age, and clinical experiences for empirical data gathering. Data were analyzed with MAXQAD10 and conventional content analysis. Results: In this study, wet liver dystemperament was classified into three main themes of systemic, local, and Para-clinical symptoms and 10 categories. Conclusions: This manuscript explains wet liver dystemperament as a disorder in general temperament and determines more important diagnostic criteria.

The Relationship Between Sonographic Findings, and Clinical and Paraclinical Symptoms in Henoch Schonlein Purpura

Background: Gastrointestinal (GI) manifestations are common in patients with Henoch Schonlein Purpura (HSP) and it seems that ultrasound is the first modality for detecting GI involvement. This study was performed to evaluate the relationship between sonographic findings and clinical, and paraclinical symptoms. Methods: All patients with HSP referred to our clinic in 2011 and 2012, were enrolled in the study. The data including sonographic and other lab tests were collected and analyzed, and the association between sonographic findings and clinical, and paraclinical symptoms were evaluated. Results: Among 112 patients (68 males and 44 females), 28 cases had abnormality in their sonography that was higher in patients with GI and renal symptoms. Furthermore, length of hospitalization and need for corticosteroids was greater in patients with positive sonographic findings. Conclusions: In patients with HSP, ultrasound is a valuable modality to determine the prognosis of the disease.