Factors associated with outcome in patients with acute upper gastrointestinal bleeding in a tertiary referral center in Northern Iran

Background: Upper gastrointestinal bleeding [UGIB] is a major healthcare problem and is the most frequent gastrointestinal reason for admission to hospital. We aimed to investigate the prognosis of patients with UGIB referred to a referral hospital in northern Iran in 2013

Methods: All patients with UGIB who admitted to Sayyad Shirazi Hospital, in Gorgan, northern Iran, in 2013 were enrolled. The patients' demographic data as well as data about admission, diseases, drug history, and patients' prognosis were collected by structured questionnaire using information in hospital files. The relationships between different factors with the proportion of mortality and recurrence were assessed using Chi-square test

Results: In total, 168 patients were enrolled of whom 109 [64.9%] were male. The mean [SD] age of the patients was 59.4 [18.2] years. Mortality and recurrence occurred in 23.2% and 34.5% of the subjects, respectively. We found significant relationships between older age and diagnosis of malignancy with mortality [p =0.03 and p <0.01] and recurrence [p<0.01 and p <0.01]

Conclusion: We found relatively high rates of mortality and recurrence among patients with UGIB. Our results suggested older age and diagnosis of malignancy as the most important indicators of mortality and recurrence in such patients. Considering these factors in clinical settings may result in better and more effective management of patients with UGIB

Conservative management of placenta increta: case report and literature review

Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and beta-hCG assessment. Serum beta-hCG levels were undetectable after 8 weeks of therapy. A scan at 6 months showed complete involution of the uterus. Review of the literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with placenta increta

The reliability and distinguishability of ultrasound diagnosis of ovarian masses.

Background: For any radiologist, intra-observer agreement in observing and decision making in diagnosis of any disease is of great importance, and so is observing and reading ultrasound pictures of ovarian masses and distinguishing amongst their categories. Aims: In this study, the reliability and consistency of ultrasound diagnosis of ovarian tumors have been evaluated. Settings and Design: Two experienced and three less experienced radiologists assessed ultrasounds of 40 patients of Mirza Koochak Khan Hospital in Tehran, Iran, in 2005. Materials and Methods: In this prospective observational study, the ultrasounds were performed by an expert radiologist, with a single apparatus. These ultrasounds have been evaluated separately and independently in two periods (with a 1-week interval). Statistical Analysis Used: Weighted kappa was used to calculate intra-observer agreement (reliability), and two statistical models were applied to assess category distinguishability (consistency). SPSS version 10, SAS version 8, and EXCEL 2003 have been used to do an appropriate statistical analysis. Results: Mean of weighted kappa was 0.81, and mean of distinguishability was 0.995 for our experienced radiologists, due to their superior results. Because of weaker results obtained by the less experienced radiologists, mean of weighted kappa and mean of distinguishability were 0.65 and 0.967 respectively. Overall mean of distinguishability for benign and borderline categories was 0.969; and for malignant and borderline categories, it was 0.987. Conclusion: Although experienced radiologists functioned better than the less experienced radiologists, all of them showed appropriate distinguishability and intra-observer agreement in diagnosis and categorization of the ovarian masses. Distinguishing benign category from borderline was more difficult than distinguishing malignant category from borderline. In general, experienced radiologists showed better results compared to less experienced radiologists.