Original Article

Background and Aims: This study aimed to assess the association between the low maternal serum of pregnancy-associated plasma protein-A (PAPP-A) during the first trimester and pregnancy outcomes.

Materials and Methods: We conducted a prospective cohort study of 118 pregnant women undergoing first-trimester screening between 2016 and 2017 at Taleghani and Imam Hussein hospital in Tehran, Iran. We recorded demographic data and blood samples were to analyze the value of PAPP-A, based on which we divided the participants into two groups: PAPP-A>10 percentile as a control group and PAPP-A≤10th percentile as a study group. The pregnancies underwent follow-up observations for obstetric complications during pregnancy. Chi-square or Fisher exact test and Mann-Whitney U test were applied to analyze data by SPSS 26.

Results: In this study,118 pregnant women were enrolled. Our results show a significant association between low PAPP-A (<10th percentile) and preterm labor, small for gestational age (SGA), hypertension, preeclampsia (P<0.05), but no statistically significant difference was found between low PAPP-A and stillbirth. Demographic data, including age, gravida, parity, BMI, had no relationship with low PAPP-A, significantly (P>0.05).

Conclusion: Low PAPP-A is associated with adverse outcomes; thus, measuring the PAPP-A within the first trimester is suggested for timely management.

Benefit Assessment of Low-Fat Diet in Patients Undergone Laparoscopic Cholecystectomy

Mostafa Dastgiri, Esmaeil Haji Nasrollah, Fatemeh Ebrahimi, Fairborz Rashnoo

School of Medicine Students' Journal, Vol. 2 No. 4 (2020), , Page 5-8

Background and Aims: This Gastrointestinal complications are common after cholecystectomy (open and laparoscopy), including anorexia, heartburn, abdominal pain, nausea, vomiting, flatulence and abdominal distension, and diarrhea. Currently use of low-fat regimen is suggested. The purpose was to determine the benefit of low-fat diet in patients undergone cholecystectomy.
Materials and Methods: In this interventional study that was done as a randomized clinical trial, 80 consecutive patients undergone cholecystectomy in Loghman Hospital in 2019 were enrolled and randomly assigned to receive either low-fat (25%) or routine regimen. After two months, the results were assessed by comparing the responses to a questionnaire including anorexia, heartburn, abdominal pain, nausea, vomiting, flatulence plus abdominal distension, and diarrhea as items, with total score of 21 points.

Results: The results in this study demonstrated that 60% of the patients showed significantly different response according to Chi-Square test (P=0.041). Age, sex, and obesity had statistically significant effect on results (P > 0.05).
Conclusion: Altogether, according to the obtained results, it may be concluded that low-fat diet consumption is beneficial in patients undergone cholecystectomy and it may be practiced according to the patient’s condition and physician’s opinion.

Prognosis of Mechanical Ventilation in Very Low Birth Weight Neonates: A Single-Center Study in Tehran.

Fereshteh Karbasian, Sara Jafarian, Ali Zafari, Niloufar Bineshfar, Seyed Abolfazl Afjehi, Amirhossein Hosseini, Minoo Fallahi

School of Medicine Students' Journal, Vol. 2 No. 4 (2020), , Page 13-18

Background and Aims: Approximately 4–7 percent of all live births are led to a very low birth weight (VLBW) situation where the morbidity and mortality rate are very high. A large number of VLBW newborns in intensive care unit (ICU) require mechanical ventilation due to various conditions. To reduce mortality in this group, identification of risk factors is important. This study aimed to determine the prognosis of mechanical ventilation in VLBW neonates at Mahdiye hospital in Tehran.

Materials and Methods: This study is a prospective cohort study. VLBW neonates who consecutively were put on mechanical ventilation during the study period were enrolled.  Then, the enrolled neonates were divided into two groups: neonates who died after implementing the ventilator were in group-I and neonates who survived after receiving mechanical ventilation were in group-II. Demographic, clinical and paraclinical variables were gathered to find out the predictors of mortality of ventilated neonates. The data were analyzed by SPSS software version 21.

Results: During the study period, a total of 177 neonates were ventilated due to different causes. 56% were male with a male to female ratio 1.27:1. Mean birth weight and gestational age were 1024.8 ± 247.5 grams and 27.9±2.2 weeks respectively. Out of 177 mechanically ventilated VLBW neonates enrolled for this study, 53% died. Significant factors determining mortality rate were mean weight, mean gestational age, pulmonary hemorrhage, advance resuscitation and duration of hospital stay (p<0.05). APGAR score, gender, Pneumothorax, IVH>II, Sepsis and Maternal Disease were not significantly associated with mortality in VLBW neonates requiring mechanical ventilation (P>0.05).

Conclusion: This study showed that among the analyzed factors weight <1000gm, gestation <28weeks, pulmonary hemorrhage and complications during ventilation were the most significant predictors of mortality in ventilated VLBW neonates in the intensive care unit.

Case Report

Intussusception in adults is an uncommon entity with various clinical manifestations and complications such as acute gastrointestinal bleeding. We reported a 30-year-old man who referred to our hospital with loss of consciousness and developed two separate courses of acute gastrointestinal bleeding after admission. During second surgery, we came across a jejunojejunal intussusception as the main cause of gastrointestinal bleeding. Hereby, we reviewed and analyzed our experience in the management of this disease and also compared our findings with respective literature and other studies. 

Foreign body aspiration leading to complete lung collapse due to left bronchus obstruction: A Case Report

Mahtab Teimouri, Muhammadhosein Moradi, Sara Ansari, Maryam Teimouri, Ebrahim Jafari

School of Medicine Students' Journal, Vol. 2 No. 4 (2020), , Page 19-21

Foreign body aspiration(FBA) is a common life-threatening condition in pediatric emergency medicine that can lead to airway obstruction, asphyxia, and severe respiratory distress. An 18-month old female infant referred with the complaint of dry cough and wheezing with a sudden onset of dyspnea. At the time of admission, her oxygen saturation was  89%. Chest X-ray (CXR) showed a significant opacity in the left lung and the mediastinum shifting to the left side. Complete collapse seen in the left lung was associated with consolidation in the residual lung parenchyma. Rigid bronchoscopy revealed the corn kernels, which were taken out accordingly. The air trapped in the involved lung parenchyma was absorbed, and signs of shrinkage and collapse as consequences of the obstruction occurred in distal parts of the obstruction point. An emergent therapeutic decision is crucial in the early stages of management.