Medical Journal of The Islamic Republic of Iran (MJIRI)

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This study was conducted to assess the incidence of abnormalities of ventricular depolarization (late potentials) in children with sinus rhythm after open heart surgery and their relation to spontaneous ventricular tachycardia. Open heart surgery, particularly operations involving ventriculotomy, may predispose patients to the development of ventricular tachycardia (VT) or ventricular fibrillation (VF). Previous studies on children with right bundle branch block (RBBB) have shown that late potentials may be a risk factor for developing VT or VF following open heart surgery. After corrective surgery for congenital heart defects, scars may create fractionation and delay of the electrical signals in the heart muscle, providing a substrate for arrhythmias and sudden cardiac death. To find normal values of signal averaged EKG (SA-EKG) indices in children and their changes following open heart surgery, we studied 20 normal children and 20 children with congenital heart disease (CHD) following total correction of heart defects without ventriculotomy. All patients were in normal sinus rhythm and did not have RBBB. The mean age was 8.8±2.6 years for the control group and K 1±2.1 years for the operated patients. SA -EKG was performed for the operated group on the day before and on the 2nd and 4th days after operation. Noise level was less than 1 microvolt. The SA-EKG parameter values were as follows: control group: filtered QRS-duration 40Hz (F. QRS-d), 84.2±9.5 ms high frequency low amplitude signals (HFLA) , 18.9±9.5 ms rootmean square 40 (RMS 40), 181.0±89.4 µv patients: F.QRS-d, 97.2±19.3*, 116.4±21.2* and 122.2±220.4before operation, 2nd day post-op and 4th day post-op, respectively HFLA, 205±22.3, 8.9±7.0*, and 15.4±16.4ms,respectively RMS40, 146.4±11O.9,92.1±65.9,and 112.8±60.3, respectively. Values marked with an asterisk are statistically significant. Except for a significant difference between the QRS duration of normal children and pre-op values of operated patients (p<0.05), there was no remarkable difference between the SA-EKG values pre- and postoperatively. This study in which there was no RBBB, contrary to previous studies, shows that SA-EKG indices are not a predictive value for VT or VF postoperatively. Increased thickness of the ventricular myocardium may be a reason for the increased QRS duration before operation.

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Human growth hormone (hGH) genomic sequence containing 5 exons and 4 introns was cloned in pcDNA-3 and the constructed plasmid was subsequently used for transfection ofNlli-3T3 cell line using lipofection technique. Expression of hGH in stably transfected cells was assayed using ELISA. Total RNA was extracted from transfected cells and hGH cDNA was amplified by RT-PCR using specific primers. The product thus obtained was cloned in pGEM-T vector and the presence of the growth hormone coding region was verified by restriction enzyme analysis and Southern blotting. The hGH cDNA fragment was cloned in pQE-30 and the expression of hGH gene in E. coli was assayed using ELISA and immunoblotting. In this experiment 20.9 µg/mL purified rhGH was obtained.

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Background: Carotid artery stenting (CAS) has recently been recommended as an alternative to carotid endarterectomy (CEA) by some clinicians. Objective: This study was designed to evaluate the success rate and in-hospital and 30-day adverse events in our first experiences in Iran for CAS with protection devices, to document our results and guide further use of CAS. Methods: From December 2003 to December 2004 we performed 21 consecutive CAS procedures. 16 were men and 5 were women with mean age of 62 years (range 46-78 years). Indications for CAS included primary lesions in all patients with stenosis >50% in symptomatic and stenosis >80% in asymptomatic patients. Results: CAS was technically successful in a1l 21 patients. Mean severity of stenosis before CAS was 85%+14% compared with 15%+10% after CAS. No periprocedural death occurred. No in-hospital and 30-days minor or major stroke/ death was seen. Conclusion: Our data suggest that percutaneous stenting of the carotid artery when a cerebral protection device is used is feasible and effective but not without technical difficulties and potential complications. We recommended CAS for high-risk patients for carotid endarterectomy, but this technique has a learning curve for those willing to perform the procedure with a low rate of complications.

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 Abstract

 Background: There are a large number of patients with penetrating abdominal trauma who have normal vital signs and negative abdominal examination when referred to trauma centers. Agreat deal of controversy exists between authorities about screening these patients for emergency explorative laparotomy. Many references have reported more than 90% sensitivity for DPL as a diagnostic method to determine whether intraabdominal injuries were present and emergent laparotomy is indicated or not. This study is for reassignment of this sensitivity according to our own evidence.

 Methods: All of the patients with abdominal stab wounds and normal vital signs plus negative abdominal examination who were referred to Shohada-e-Tajrish hospital between March 2004 to December 2005, underwent local wound exploration and those confirmed to have peritoneal penetration, underwent emergency laparotomy. In the operating room and prior to surgery, under general anesthesia, DPL was performed. Then DPL results were compared with laparotomy findings and DPL sensitivity was assigned.

 Results: Of the total number of 34 patients, 8 had a positive DPL and positive laparotomy 2 had a positive DPL and negative laparotomy 8 had negative DPL and positive laparotomy, and 16 patients had negative DPL and negative laparotomy.

 Conclusion: According to our study, DPL sensitivity is much less than mentioned in trauma texts (approximately 50%). So, it is not a valuable tool to discriminate between operative and conservative approaches in penetrating abdominal trauma. We suggest more sensitive modalities. Laparotomy is the most sensitive approach but at the price of a high negative laparotomy rate.

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  Abstract

  Background : Cancer has not been elucidated in colerectal site. C-reactive protein

  (CRP) is a product synthesized in hepatocytes and has been reported to be up-regulated

  by such proinflammatory cytokines as interleukin-1 (IL-1), interleukin-6 (IL-6),

  and tumor necrosis factor (TNF). The significance of a preoperative serum elevation

  was evaluated using CRP as a predictive indicator for the malignant potential and

  prognosis.

  Methods: Forty consecutive patient with colorectal cancer whose local lesions

  were resected in our department, plus forty healthy volunteers, were selected. Any

  patient with inflammatory diseases such as infection or collagen disease was excluded

  from the current study. The preoperative serum CRP level and the control group

  were measured. The relationships between the serum elevation of CRP and both the

  clinicopathologic factors and prognosis of the patients was investigated.

  Results: The rate of patients with elevated serum CRP level was significantly

  higher in the colorectal cancer patients in comparison to the control group (55% versus

  2.5%). Furthermores the incidence of liver metastasis, peritoneal carcinomatosis,

  histopathologic lymph nodes metastasis, and tumor invasion in colorectal cancer patients

  with a preoperatively elevated serum CRP level were significantly more frequent

  than in those with a negative serum CRP level. The survival rates of the colorectal

  cancer patients without a preoperative elevation of the serum CRP proved to

  be significantly more favorable than that of the colorectal cancer patients with such

  an elevation (94.4% versus 59.1% P<0.001).

  Conclusion: Apreoperative serum elevation of CRP was thus found to be an indicator

  of the malignant potential of the tumor as well as prognostic factor for patients

  with colorectal cancer.

 

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 Backgrounds: There are controversies among surgeons about prophylaxis of deep vein thrombosis (DVT) in laparoscopic cholecystectomy. The aim of this study was the assessment of patients’ condition after laparoscopic cholecystectomy without any prophylactic measure.

 

Methods: 100 cases of laparoscopic cholecystectomy without DVT prophylaxis were followed by duplex scanning in the first postoperative day and by physical examination and patient history at the first to second postoperative week however no clinical sign was found for DVT.

 Results: Only one case of partially thrombosis (1%) was found by duplex scanning which was managed conservatively.

 

Conclusion: Laparoscopic cholecystectomy may consider as a low-risk procedure and routine prophylaxis may not be justified in the absence of other risk factor.

 

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  Background: Delay in diagnosis and treatment of perforated appendicitis may cause life-threatening complications. The aim of this study was to determine and compare pre-operative total and direct bilirubin levels in cases of simple and perforated acute appendicitis in order to improve the clinical decision making.

  Methods: This prospective observational study included eighty patients who underwent open appendectomy, during a one-year period from March 2010 to March 2011 in the surgical department of Hazrat-e-Rasool Akram Hospital, an academic teaching hospital in Tehran- Iran. Pre-operative total and direct levels of bilirubin were compared in two groups of histologically proved appendicitis (simple and perforated), each including 40 patients.

  Results: Eighty patients who underwent open appendectomy including 70% men and 30% women with a mean age of 34±11 years in Group I (perforated appendicitis) and 47.5% women and 52.5% men with a mean age of 33±14 in Group II (simple appendicitis) were included in this study. The mean bilirubin levels were higher for patients with perforated acute appendicitis compared to those with a non-perforated simple appendicitis (1.04±05 mg/dl vs 0.7±0.1 mg/dl) and this difference is highly significant (p<0.01).

  Conclusion: Assessment of preoperative total bilirubin is useful for the differential diagnosis of perforated versus acute simple appendicitis and total bilirubin should be used as an independent parameter in the early diagnosis of appendix perforation.

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  Background :Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of perforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters including white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of procalcitonin as a predictor of diagnosis and severity of appendicitis in order to improve the clinical decision making, since other studies have been unable to demonstrate a diagnostic value for PCT elevation in acute appendicitis.

  Methods: One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean age of 28 years were included in this study. Procalcitonin values were measured by an immunofluorescent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including ˂0.5ng/ml, 0.5-2 ng/ml, 2-10ng/ml and more than 10ng/ml.

  Results: The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery.

  Conclusions: Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute appendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic marker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml.

 

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  Solitary Fibrous Tumors (SFTs) are rare primary pleural neoplasms which have recently been reported in extra-thoracic sites. In this report, solitary fibrous tumor arising in an intra-thoracic goiter with no evidence of cervical mass in a 74-year-old obese man who was found to have a large superior mediastinal mass with tracheal deviation on Chest X-Ray is presented.

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Background: Icterohemorrhagic form of leptospirosis has a high mortality rate.  In this study, the clinical manifestations, epidemiologic and laboratory findings and outcome of Weil’s disease were investigated.

Methods: A descriptive cross- sectional study was conducted on 66 consecutive patients with icterohemorrhagic leptospirosis who were admitted to Razi Hospital (The Therapeutic Center of Infectious Diseases in the North of Iran) in 2013. The inclusion criteria were as follows: All patients who had clinical and epidemiological data suggestive of leptospirosis and displayed icterohemorrhagic form at the time of admission or during hospitalization. All patients were visited on admission, one, two and six weeks later. Demographic data, clinical, laboratory features and complications were evaluated, and statistical analysis was performed using SPSS version 13.0.

Results: Among 66 patients, 89.4% (n = 59) were male, 60% (n = 40) were farmers and 9.1% (n= 6) had a history of swimming in rivers. The most common complaints were fever and jaundice, respectively. The most common clinical symptoms were fever (90.9%), myalgia (75.8%), chills (70.8%) and headache (65.1%). Hyponatremia and hypernatremia were seen in 7.6% and 72.8% of the participants, respectively. Also, hypokalemia was observed in two patients (3%). Approximately, half of the cases had leukocytosis and 90% had thrombocytopenia.  Rise of AST, ALT, ALP and bilirubin were seen in 95.2%, 93.6%, 76.2% and 100% of the patients, respectively. Of the patients, 42.4% experienced complications of icterohemorrhagic leptospirosis including acute renal failure (30.3%) pneumonia (25.8%), pancreatitis (4.5%), subarachnoid hemorrhage (1.5%) and gastrointestinal bleeding (1.5%). Three cases (4.5%) died, 42 cases (63.7%) were discharged with residual effects and 52 patients (78.8%) had positive serology.

Conclusion: The most significant biochemical abnormalities were thrombocytopenia, hyperbilirubinemia, hyponatremia and hypernatremia and azotemia and the latter remained stable in 2% of the patients at least until the end of the 6-week period.

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Background: Socioeconomic status (SES) is a major determinant of health inequality in children and adolescents. The aim of this study was to evaluate the association of SES of family and living region with self-rated health (SRH) and life satisfaction (LS) among children and adolescents.

  Methods: This study was a part of the fourth survey of a national surveillance program, which was conducted in 30 provinces of Iran in 2011-2012. LS and SRH were assessed by a questionnaire based on the World Health Organization-Global School-based student Health Survey (WHO-GSHS). Family SES was estimated using principal component analysis (PCA) and based on family assets, parental education and occupation, and type of school. Region SES was calculated using PCA and some variables including literacy rate, family assets and employment rate.

  Results: Out of 14,880 invited students, 13,486 (participation rate: 90.6%) completed the survey; of whom, 49.2% were girls, and 75.6% were from urban areas with the mean ± SD age of 12.47±3.36 years. In the multivariate model, SES of family and living region was associated with LS and good SRH. In the full models, in addition to all potential confounders, family and living region SES were included simultaneously. However, only the association of family SES with LS, and good SRH remained statistically significant.

  Conclusion: The effect of families’ SES on SRH and LS is more important than regional SES. The presented patterns of SRH and LS may be useful in developing better health policies and conducting complementary studies in this field.

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Background: Improper nutritional knowledge is one of the most important causes of nutritional problems, which can affect practice and cause more complications. The aim of this study was to assess the association between nutritional knowledge, attitude and practice (KAP) of Iranian households with socioeconomic status (SES).

  Methods: The study population was 14,136 households (57 clusters of 8 individuals in each province) who lived in urban and rural regions of 31 provinces of Iran. The sample size of the study was selected using multi-stage cluster sampling technique. A structured questionnaire and interview with the qualified person in each family was used to collect data. The questionnaire included demographic, SES and nutritional KAP questions. Using principle component analysis, some variables including household assets, occupation and education level of the heads of the families and respondents and the number of family members were used to construct family SES. The SES was categorized as good, moderate and weak. Pearson’s Chi-square test was used to analyze categorical variables.

  Results: The percentage of knowledge about growing up, acquiring energy and being healthy as reasons for eating food was 24.1%, 44.8% and 54.7%, respectively. Only 69.7%, 60.5% and 52.5% of the participants had knowledge of identification of meat and legumes, grain and dairy group, respectively. More than 97% of the participants had a favorable attitude toward importance of nutrition in health. The nutritional knowledge linearly increased with increasing SES. Families with good SES significantly consumed more fruit, vegetable, dairy group, red meat, chicken and poultry, fish and egg while sugar consumption was significantly higher in families with weak SES (p<0.05).

  Conclusion: SES can influence the rate of nutritional KAP. Some policies should be considered to increase nutritional KAP especially in lower SES group in the society.

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Background: Central fat deposition seems to be a risk factor for developing metabolic and cardiovascular diseases in overweight and obese individuals. Ultrasound is an accurate and non-invasive tool for measuring abdominal fat thickness and can precisely separate subcutaneous from visceral fat. This study was conducted to apply ultrasonography as a simple and reliable method to measure subcutaneous and visceral abdominal fat thickness and evaluate the relationship between this measured abdominal fat thickness and metabolic risk factors.
   Methods: A total of 80 overweight and obese women were included in this study. Anthropometric indices and abdominal fat thickness were measured using ultrasound. The association between abdominal fat thickness and metabolic risk factors with anthropometric indices was assessed using correlation coefficient.
   Results: The mean (± SD) of subcutaneous and visceral fat thickness was 2.71±0.92 and 5.46±1.88, respectively. There was a relationship between waist circumference and visceral and subcutaneous fat thickness. Also, there was a relationship between ultrasound–measured visceral fat thickness and fasting blood glucose and triglyceride.
   Conclusion: Ultrasonography is a simple and reliable method to measure abdominal fat thickness as an important predictor of metabolic diseases.
 
 

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Background: According to the World Health Organization, hospitals should assess their internal wards to improve health promotion services using self-assessment tools. To achieve this goal, standards of health promoting hospitals have been developed by the World Health Organization, and measurable elements and indicators have been defined to facilitate the practical application of these standards in planning, implementation, and evaluation of health promotion in hospitals. Moreover, a form has been developed for this self-assessment. Considering linguistic and cultural differences in various countries, standards must be written in equivalent texts and, then, their content and face validity should be examined.
Performing this process in a systemic and scientific way can guarantee that the same tools have been used, and thus the results obtained from different hospitals are comparable.
   Methods: After the preparation phase (considering research aim, obtaining permission from the original designers, and determining the time), the following activities were done: translating the form from its original language to the target language, combining and compiling initial translations to a single translation, reversing the final version of the translation from the target language to the original language, obtaining cognitive information, revising and concluding, and determining the content and face validity of the translated form and final report.
After filling in the form, face validity was calculated using impact score formula. Content validity was measured using content validity ratio (CVR) and content validity index (CVI).
   Results: After calculating the impact score, all 40 items showed a high impact score greater than 1.5, representing the fact that all items are important. The minimum value of CVR for each of the 40 items was estimated to be 0.64; CVI of all items was greater than 0.79.
   Conclusion: Given the input of the standards of health promoting hospitals affiliated to the World Health Organization in National Accreditation of Iranian hospitals, the form was translated and found to be valid according to content and face validity and is available in Persian to be used in Iranian hospitals (Appendix 1).
 
 

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Background: Niemann-Pick diseases are rare inherited lipid storage disorders caused by mutations in the SMPD1, NPC1, and NPC2 genes. The aim of this study was to assess the mutation spectrum of a cohort of Iranian Niemann-Pick patients.
   Methods: A consanguineous couple with a child suspected of having Niemann-Pick disease type A (died at age 2) was screened for gene mutations in the SMPD1 gene. Sanger sequencing was performed for all exons and exon-intron boundary regions. A literature review on SMPD1, NPC1, and NPC2 genes mutations in Iran was conducted using published original papers on this subject.
   Results: A novel frameshift c.762delG (p.Leu256fs*) at a heterozygous state was identified in the parents. According to the review study, identified mutations in 39 Iranian patients were concentrated in exon 2 of the SMPD1 gene and exons 8 and 9 of the NPC1 gene.
   Conclusion: Niemann-Pick diseases genes mutation analysis (SMPD1, NPC1, and NPC2) in Iran shows the genetic heterogeneity of these diseases in this country. More studies with larger sample sizes should be conducted to further examine genetic changes associated with Niemann-Pick diseases in Iran.
 

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Background: Infection of burn wounds is one of the most important problems in the world. Lactobacillus plantarum is known for burn wound healing because of the immunomodulatory and anti-microbial roles. This study was performed to compare the effects of L. plantarum and imipenem – alone and in combination – on infected burn wound healing.
   Methods: Burn wounds were experimentally induced on 50 rats in three test groups (germ and supernatant of L. plantarum) and two control groups (n=10 each) and were inoculated with Pseudomonas aeruginosa. During a 14-day period, wounds in all groups were daily treated topically. The data were analyzed using one-way analysis of variance followed by Tukey–Kramer and LSD. A p-value of < 0.05 was considered as statistically significant.
   Results: The mean size of the wound on day 14 after the treatment in the probiotic group was significantly lower than the control and the supernatant treated groups (p<0.05).  The percentage of wound healing was significantly higher in the probiotic pellet treated group compared to the imipenem and the supernatant groups (by Anova test: 69.58%, p=0.022). The mean leukocyte count in the probiotic pellet group (12110) and supernatant group (13650) was significantly higher than the imipenem group (7670) (p=0.002 and 0.001, respectively). Wound cultures revealed that the percentage of cases where the pathogens had no growth was significantly different among the comparison groups. In all three test groups, P. aeruginosa was completely eliminated in comparison to the positive control group (p<0.05).
   Conclusion: The results of our study showed that L. plantarum and its by-products promote wound healing and can be used as an alternative to antibiotics to treat ulcer infections caused by resistant bacteria.

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Background: Myofascial pain syndrome is one of the most common complaints in patients referring to orthopedic treatment centers. The present study aimed to examine the effects of instrument-assisted soft tissue mobilization (IASTM) and dry needling (DN) on active myofascial trigger points (AMTrP) of the upper trapezius muscle (UTM).
   Methods: The current study was designed as a randomized clinical trial and a total of 81 patients, aged 18-40 years, with active myofascial trigger points in the upper trapezius muscle were randomly divided into 3 groups: group 1 (n = 30) received DN treatment, group 2 (n = 26) received IASTM treatment, and group 3 (n = 25) was considered as the control group (no intervention). The numeric pain scale (NPS), pain pressure threshold (PPT), active cervical contra-lateral flexion (ACLF), neck disability index (NDI), and muscle thickness (MT), according to rehabilitative ultrasonic imaging (RUSI), were measured at baseline, immediately after the last session (session 4 in week 2), and 1 month after the last session. The statistical analysis was conducted at a 95% confidence level. The P values less than .05 were considered as statistically significant.
   Results: Both techniques were effective in treating active trigger point of the upper trapezius (p<0.05), but there was no significant difference between the treatment groups in terms of any of the above variables except for ACLF (p>0.05)
Conclusion: Both IASTM and DN were determined to improve NPS, PPT, ROM, and NDI in participants with active trigger points in the upper trapezius, although IASTM was more effective in increasing ACLF in these patients.

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Background: Lamotrigine (LTG) is an antiepileptic drug used in the treatment of seizures, mood disorders, and cognitive problems. The cardiac effects of LTG, such as LTG toxicity and SUEDP, have been studied. This is an in vitro study examining the effect of LTG on isolated atria of guinea pigs.
   Methods: The atria of 21 male Guinea pigs were isolated and stabilized in Krebs-solution and physiologic condition. The rhythm of contraction, contractile force, and heart rate were recorded. In 7 atria, LTG at the doses of 2, 4, 8, and 16 mg/mL were added and the contractile forces and heart rates were recorded and compared together. In the next step, in 14 atria, 8 were pretreated with LTG, and 6 without pretreatment were exposed to ouabain, and the times of the onset of effect, arrhythmia, and asystole were recorded. The statistical comparisons were made by using Student’s t test and repeated measure analysis of variance followed by the Bonferroni method.
   Results: Lamotrigine (4, 8, and 16 mg/mL) significantly decreased the heart rate and contractile force of the isolated guinea pigs’ atria (P < .001). Pretreatment with LTG significantly increased the mean time of onset of the effect of ouabain, the onset of ouabain-induced arrhythmia, and time of ouabain-induced asystole (P < .001).
   Conclusion: LTG reduces the heart rate and contractile force, and also inhibit ouabain induced-arrhythmia of the isolated atria of guinea pigs.
 

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Background: Infections caused by Streptococcus pneumoniae (S. pneumoniae) have remained a significant public health concern worldwide. In developed countries, the highest prevalence of S. pneumonia has been reported among the elderly. The aim of this study was to evaluate the coverage of genotypes in the 13-valent pneumococcal conjugate vaccine (PCV-13) in the Iranian elderly population.
   Methods: A total of 41 isolates of S. pneumoniae were collected in the current retrospective cross-sectional study. The samples comprised 33 inpatients hospitalized for pneumococcal pneumonia and 8 outpatients. Multiplex polymerase chain reaction assay was performed to categorize the bacteria isolated into specific genotypes. Statistical analyses were performed using SPSS software, and the chi-square test was used to assess the statistical significance in percentages.
   Results: A total of 68 genotypes were identified in this study, in which 39 isolates (57.3%) were associated with invasive infections. The most common genotypes were 6A/B [8 (19.5%)], 1 [7 (17.5%)], 14 [5 (12.2%)], and 19A [4 (9.75%)], respectively. The coverage rates of PCV-7, PCV-10, and PCV-13 vaccines were 51.17%, 70.7%, and 99.9%, respectively. According to our results, the pneumococcal coverage rate of PCV-7, PCV-10, and PCV-13 vaccine types is estimated to be 51.2%, 70.7%, and 99.9%, respectively. Furthermore, the trend of pneumococcal serotypes included in the PCV-13 was steadily increasing during the study period.
   Conclusion: It can be concluded that the most circulating pneumococcal serotypes were in accordance with specific serotypes included in the PCV-13 vaccine types. Therefore, including PCV-13 vaccines in immunization programs against pneumococcus in the elderly can effectively reduce the rate of infections.
 

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Background: NSAID-exacerbated respiratory disease (N-ERD) is a highly heterogeneous disorder with various clinical symptoms. The aspirin challenge test is a gold standard method for its diagnosis, and there are still no reliable in vitro diagnostic biomarkers yet. Oral challenge tests are time-consuming and may be associated with a risk of severe systemic reactions. This study aimed to evaluate whether patients with poor responses to medical management are more susceptible to being aspirin-sensitive.
   Methods: In this cohort study, after CT scanning of all patients and subject selection, conventional medical treatment was started as follows and continued for three consecutive months: at first, saline nose wash twice per day, intranasal beclomethasone spray one puff in each nostril twice per day, montelukast 10 mg tablet once daily, a ten-day course of oral prednisolone starting with the dose of 25 mg per day and taper and discontinued thereafter. Sinonasal outcome test 22 (SNOT22) was used for the evaluation of symptom severity. Statistical analyses were performed with SPSS version 23, and data were analyzed using an independent samples T-test, paired T-test, and Receiver operating curve analysis
   Results: 25 males and 53 females were enrolled in this study, with an average age of 41.56 ± 11.74 years old (18-36). Aspirin challenge test results were positive in 29 (37.2%) patients. The average SNOT22 scores before the treatment were 52.97 ± 17.73 and 47.04 ± 18.30 in aspirin-sensitive and aspirin-tolerant patients, respectively, and decreased to 27.41 ± 16.61 and 24.88 ± 16.72 in aspirin-sensitive and aspirin-tolerant patients after the treatment, respectively. There was no significant difference in SNOT22 scores between the groups.
   Conclusion: The severity of symptoms before treatment and clinical improvement after treatment are not good predictors of N-ERD.