Bacterial meningitis is an important disease world wide and if remains undiagnosed and not treated in time is associated with irreversible and serious complications and a high morbidity and mortality. This retrospective study was conducted on 90 patients who met the criteria of acute bacterial meningitis and who were admitted at the pediatric Medical center and lmam khomeini Hospitals between 1999-2000 . According to this survey, the important factors affecting the prognosis at discharge included age less than 12 weeks, no response to antibiotics 72 years after initiation of treatment, altered consciousness at the time of admission, focal neurological symptoms and a change in antibiotic regimen. No correlation was found between prognosis and other variables such as sex, antibiotic consumption before admission, duration of symptoms from their onset till the time of admission and the presence of other indices such as fever, seizures, meningism and use of corticosteroids in the treatment regimen.The overall mortality rate in our study was 10% and the incidence of complications on discharge as 13.3%. In conclusion, on the basis of the results obtained, despite the use of advanced supportive systems for these patients and also modern broad spectrum antibiotics and appropriate diagnostic methods, no obvious change in factors affecting prognosis compared to two decades back has been seen. Likewise because of the absence of follow up of patients following discharge, it appears that further teaching is needed about this disease among students and residents besides creating specific centers to prevent this disease.

This analytical cohort study was carried out to determine the rate of incidence rate, time of onset, and duration of post-traumatic diabetes insipidus, and their relationship with basal skull fractures. For this purpose, the records of 16 patients with post-traumatic diabetes insipidus (DI) identified at Imam Hossein hospital from 1992 to the mid 2006 were retrospectively reviewed and statistically analyzed. The patients were matched for the kind of head trauma, having a survival time of at least 2 weeks after trauma, having a neurogenic diabetes insipidus, diabetes insipidus being the main complaint, place of examination, diagnosis, and treatment Patients were evaluated for GCS scoring, skull X-rays, and CT-Scan findings. The statistical Chi Square-Fischer test was used. Out of the 16 patients so identified, 13 were male and 3 were female with a mean age of 20±11.4 years, ranging from 5 to 41. The rate of occurrence of post-traumatic DI was 1.45% and association of basal skull fractures with DI was found in 56% of patients. In 75% of patients, DI occurred within the first week (early) following head injury, while delayed occurrence (more than one week) of DI was observed in 25% of patients. A statistically significant relationship was found between the time of onset and the duration of DI (P<0.001). Meanwhile, early and late occurrence of DI was associated with shorter (less than 2 weeks) and longer (more than 2 weeks or permanent) duration of DI respectively. Basal skull fracture was also significantly correlated with early occurrence (P<0.01) and longer persistency (P<0.05) of posttraumatic DJ. In addition, no significant relationship was found between severity and duration of post-traumatic DJ.

Background: Uterine sarcomas are malignant mesenchymal neoplasms that represent three to five percent of all uterine tumors, and are classified into three major groups: 1) mixed mullerian sarcoma; 2) endometrial stromal sarcoma; 3) leiomyosarcoma. The purpose of this study is to determine the association of different prognostic factors with patient survival and tumor relapse.Methods: Twenty-seven patients with a previous diagnosis of uterine sarcoma were entered into this survival study. Inclusion criteria were presence of primary uterine tumor, confirmation of previous diagnosis in pathologic reassessment and availability for follow-up. We evaluated the association of overall and disease-free survival with eight factors, including FIGO stage, lymph node status, mitotic count per 10 high-power fields, vascular status, age, histology of sarcoma, myometrial depth of invasion and size of tumor.Results: The median age of our patients was 47 years, ranging from 18 to 73 years, and median time of follow-up was 28 months, ranging from 1 to 114 months. Five-year survival was 61% and the mean time of overall survival was 78 months, with a 95% confidence interval, ranging from 56 to 100 months. LSS histology type, in contrast to other subtypes, and a mitotic count of 0-9, in contrast to 20 and more, were two factors that significantly related to relapse of tumor (p<0.05). The three factors related to survival were FIGO stage (p=0.0039), mitotic count (p=0.0005) and LSS histology type in contrast to other subtypes (p<0.05). Relapse occurred mostly in the pelvic region or lung.Conclusion: From our findings and a review of other reports, the FIGO stage is associated with survival, although other factors discussed in the literature are controversial. Some factors had been reported to have significant association only within a restricted histological subgroup. However, due to the limitation of our number of cases in each subgroup, we could not make such an analysis. Future studies with adequate numbers of samples are recommended.

Background: Despite several years of intensive investigation, relatively few studies have been made of children with lupus nephritis. The prognosis of children with lupus nephritis is poor for those with diffuse proliferative glomerulonephritis and active interstitial inflammation. As newer treatment modalities become available for patients with severe lupus nephritis, it become increasingly important to identify patients at risk for renal failure. The aim of this study was to evaluate the clinical course, histopathology, serologic features and prognostic significance of some parameters, to identify the risk factors for renal failure and mortality in children with lupus nephritis. Materials and Methods: Retrospectively 30 children under 16 years of age with lupus nephritis from 1989 to 1999 were studied. All patients received renal biopsy and follow-up biopsies were performed in 3 children. Lupus nephritis was classified by the World Health Organization (WHO) criteria. The clinical and serologic parameters at the time of renal biopsy were recorded.Results: All children underwent renal biopsy within 1 year of disease onset. There were 1 (3.3%) patients with class II, 5 (16.7%) with class III, 21 (%70) with class IV, and 3 (%10) with class V nephritis based on initial biopsy according to the WHO classification. The mean follow-up time was 60 months. Follow-up biopsies were histologically stationary in 2 patients and progressive in one. The overall renal and patient 5- year survival rates were 46.66% (14/30) and 93.33 %( 2/30) respectively. They were 47.61% (10/21) and 95.21 %( 20/21), respectively, of patients with class IV proliferative glomerulonephritis. Children with renal pathology (class V in the WHO classification system) at initial biopsy, were at high risk for renal failure 66.66% (2/3) or morality %33.33 (1/3) despite aggressive treatment. The results revealed that those with persistent hypertension, anemia, and decreased creatinine clearance rate, nephrotic proteinuria, at initial biopsy were more prone to develop renal failure (P<0.01).Conclusion: The prognosis of children with class IV nephritis in our study was better than reported in other series in recent years. However, those with class V disease, persistent hypertension, anemia, low creatinine clearance and nephrotic proteinuria at the time of diagnosis are at increased risk for renal failure. The improved results may be due to initial histological classification, better supportive care and selective use of aggressive therapy such as methylprednisolone pulse therapy and intravenous cyclophosphamide for those with high risk factors.