Background: The best arteriovenous access in diabetic patients under dialysis is crucial to attain better therapeutic outcomes and improved prognosis in the patients. The purpose in this study was to compare the primary patency and maturation rate of antecubital artriovenous fistula for dialysis in diabetic patient with two methods: regional block with Ropivacaine 0.5% and local anesthesia with lidocaine 2%. Methods and Materials: In this randomized clinical trial, 40 consecutive diabetic patients under dialysis in 2016 and 2017 in a training center were enrolled and the primary patency and maturation rate of antecubital artriovenous fistula were compared with regional block with Ropivacaine 0.5% versus local anesthesia with lidocaine 2%. Results: The results in this study demonstrated that all factors of final arterial and venous diameter, blood flow, and patency were higher in group under regional block with Ropivacaine 0.5% and all except patency showed significant difference (P < 0.05). The complications rates were alike across the groups (P > 0.05). Conclusion: Totally, according to the obtained results, it may be concluded that regional block with Ropivacaine 0.5% is superior to local anesthesia with lidocaine 2% leading to higher patency rate and shorter maturation time and also higher arteriovenous diameter and blood flow.
Background: The current COVID-19 pandemic has created significant health consequences for the world population. Therapies and drugs are being continuously developed in an effort to implement the most effective treatment. G6PD deficiency is the most prevalent human enzymatic defect, affecting more than 500 million people worldwide, but is infrequently taken into consideration in healthcare practice. Purpose: The aim of this review is collecting and assembling the most relevant information about safety of current drugs and nutraceuticals, proposed or already used for COVID-19 treatment, with regard to G6PD deficient people, in order to know possible drug-induced adverse effects. Methods: An extensive literature search was performed through scientific papers, unsafe drug lists, drug datasheets, drug databases, National Public Health institutional websites. Results: Methylene blue, ozone, chloroquine and hydroxychloroquine administration should be avoided in G6PD deficient patients. The other reviewed drugs should be administered at therapeutic doses under medical supervision. Conclusion: The list of drugs and nutraceuticals for use in COVID-19 here provided, usefully brought to Healthcare personnel’s and patients’ awareness before any drug administration, may allow you to avoid or at least manage any possible drug-associated symptoms - particularly hemolytic crisis, which is a potentially fatal risk for G6PD deficient patients.
The world is having COVID 19 pandemic currently. Early diagnosis is a challenge as the COVID 19 illness has variety of presentations. In this regard knowledge about spectrum of clinical presentation may be very helpful. This case report was about presentation of COVID 19 illness as isolated left eye conjunctivitis in a 58 years old male patient. By early diagnosis and appropriate treatment, the patient was recovered completely as well as his positive contacts were also isolated immediately. The study also highlighted the need of awareness among clinicians about isolated left eye conjunctivitis presentation of COVID 19.
Since the beginning of the COVID-19 pandemic, Hydroxychloroquine is being prescribed by the doctors all over the world for the treatment as well as prevention of COVID-19 with varying results. As we know damage in severe COVID-19 disease occurs mainly via the immunological mechanism. There is an assumption that HCQ has immunomodulatory property and thus may have a beneficial role in severe COVID-19 disease. In this retrospective study, we describe our experience of using low dose of HCQ (200mg/day) in 27 hospitalized severe cases of COVID-19 disease. We found, though the use of HCQ resulted in improvements in chest X-rays, there was no significant reduction in the deaths in the cases where HCQ was used.
Background and Purpose: Colorectal cancer is the third leading cause of cancer death worldwide. MicroRNAs are a group of post-transcription regulators whose expression are altered in various cancers and affect the expression of different genes and contribute to cancer progression. According to studies, the expression of miR-193a-5p in some cancers, including colorectal cancer, is reduced. But so far, the main effects and mechanisms of miR-193a-5p in colorectal cancer are ambiguous and unknown. The purpose of this study was to investigate the effects of miR-193a-5p mimic transfection on HT-29 cell line and investigate the expression of vimentin molecule on these cells. Materials and Methods: First, the HT-29 cell line from colorectal cancer was cultured in RPMI-1640 culture media. Then, miR-193a-5p was transfected with Jet-PEI reagent and using the qRT-PCR technique, the expression of miR-193a-5p and vimentin gene was evaluated in miR-193a-5p transfected HT-29 cells and control group. Statistical analyzes were performed using GraphPad Prism 6 statistical software. Results: In this study, the simultaneous effect of miR-193a-5p mimic on HT-29 cells was investigated. Expression levels of miR-193a-5p was increased after transfection, and then, vimentin expression was altered, which was evaluated by using qRT-PCR. Conclusion: The results of this study revealed that miR-193a-5p may act as a tumor-suppressor by affecting the molecules such as vimentin. This microRNA has an important role in tumor metastasis. Therefore, it may be suggested as a potential therapeutic target in the treatment of colorectal cancer.
Objective: MicroRNAs are involved in the regulation of many physiological and pathological processes, such as atherosclerosis. Genetic polymorphisms in microRNA may affect its biogenesis and function. The aim of this study was to examine whether microRNA polymorphisms (mir-196a rs11614913 and mir-499 rs3746444) contribute to the risk of ischemic stroke.
Methods: Genotyping was performed in 85 patients and 105 normal control, using polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) method.
Results: In respect of rs11614913, significant association was observed between CC (P=0.003; OR= 0.41; CI=0.21 – 0.79), and TT (P=0.025; OR=2.22; CI=1.04 –4.8) genotypes. The inheritance of T allele increased the risk of ischemic stroke. There was a significant association between the GA genotype frequency of rs3746444 (P=0.01; OR= 0.41; CI=0.23– 0.87). T
Discussion: The present study provided evidence that the mir-196a and mir-499 polymorphisms are associated with a significantly increased risk of ischemic stroke in Iranian population. The common genetic polymorphism in pre-microRNAs may be contributed to the pathogenesis of ischemic stroke and represented as novel markers for stroke susceptibility.
Background: Stroke is the third leading cause of death worldwide. Data on the epidemiology of stroke, patterns and risk factors in recent years in our region are brief.
Methods and Material: This retrospective study from 2014 to 2015 on stroke patients was conducted. The NIHSS, the MRS and the Barthel index were used at admission and discharge. Patient’s demographic data and checklist used to identify risk factor
Findings: A total of 230 stroke patients, 122 (53%) was female. 194 patients (%84) was ischemic type vs 36(%16) hemorrhagic, P
Introduction: Fluoride is one of the naturally occurring mineral elements which has an effective role in preventing dental caries and its consolidation. Fluoridation of water is a simple technique and the most effective method approved for preventing dental caries. Accordingly, this research was carried out with the aim of investigating the level of fluoride in the urban water of cities in Western Azerbaijan province in 2017. Materials and Methods: In this descriptive-cross-sectional study, the level of fluoride in urban water reservoirs of 17 towns of Western Azerbaijan province was examined in different reservoirs. The information of the reservoirs was collected from water and wastewater organization of the province, where a 250-cc water sample was collected from each reservoir. The prepared samples were thenT sent to the laboratory to measure the level of fluoride. Determination of the concentration of fluoride ion in water samples was carried out using spectrophotometric method. Eventually, the data obtained from this study were examined by statistical-descriptive methods using SPSS 17. P <0.05 was considered as statistically significant. Results: The results obtained from the study indicate that the level of fluoride in the samples investigated in Shooth and Poldasht town was larger than the optimum level, while the rest of towns had a level lesser than the optimum value. Furthermore, the median of the investigated population (the median fluoride of the towns of Western Azerbaijan province) was 0.227 ppm, when based on statistical tests, it had a significant difference with the optimal fluoride value (1 ppm) (p-value<0.05). Conclusion: Considering the median of fluoride concentration in towns of Western Azerbaijan province (0.227 ppm), it can be stated that the level of fluoride in drinking water of this province is low, elucidating the addition of supplementary fluoride to the drinking water of reservoirs.
Aim: In this study, patient’s satisfaction with complete denture made in prosthodontics department of Tabriz dentistry faculty was evaluated based on the residual alveolar ridge.Materials and methods: This retrospective study was carried out on 60 patients referred to the Prosthodontics Department of Tabriz Dentistry School by through completing questionnaires and clinical examination. Data from the study were analyzed using SPSS 17 software. In this study, p-value less than 0.05 were considered statistically significant. Results: In this retrospective study, 61.5 % of participants were male and mostly in the age group of 30 to 40 years. 43.3 % of patients had Ridge Class II, 56.7 % Class had ridge class III. None of the studied patients, had class four or one ridge. The results of present study showed well that satisfaction of patients, in some cases, has a significant relation according to the residual ridge conditions of the patient one and three months after delivery of prosthesis. Satisfaction rate was higher in patients with ridge class II. Moreover, satisfaction of patients showed an increase in three-month intervals.Conclusion: 38.4 % of patients sowed satisfaction with their new teeth three months after prosthesis delivery. Satisfaction of patients was because of chewing soft food; overall capability of chewing, talking easily, the retention of dentures and denture satisfaction was higher in patients with Class II boats.
Aim: The aim of this study is to investigate the relationship between side occlusion with temporomandibular joint problems (TMD) and parafunctional habits among Dentistry Students of Tabriz University of Medical Sciences. Materials and Methods: In this cross - sectional study, 98 students from the School of Dentistry of Tabriz University of Medical Sciences were randomly selected, and the occlusion was also examined. Data from the study were analyzed using descriptive statistics and chi-square test software SPSS 17. Results: In this study, 16.33 % of population had Group function occlusion, 13.23 % had Anterior Group function occlusion and 70.4 % had canine raise occlusion. 3.1% of people had functional Paralympic symptoms of Bruxism and 6.1 % were marked with Parafunctional clenching. The study population consisted, all patients with Group function occlusion that had para-functional habits. However, in patients with canine raised occlusion, 63.3 % para-functional habit parameters, 2 % has Bruxism and 1.5 % had clenching. Conclusions: a significant relationship was not observed between side occlusion with parafunctional habits and TMD problems among students of Tabriz University of Medical Sciences.
Two-dimensional (2D) echocardiography is a powerful tool for assessment of mitral regurgitation (MR) . However, it bears several major disadvantages. Evidence suggests that measurement of the vena contracta area (VCA) via a three-dimensional (3D) method is significantly more accurate than 2D methods in the quantification of MR since the 2D method is not sufficiently reliable in calculation of VC diameter because of circular assumption of VC area . VCA direct planimetry (DP) and multiplanar reconstruction (MPR)-derived VCA are direct and reliable methods to quantify MR severity, and their results are comparable with those of 2D integrative method [2, 3]. It is strongly recommended that these methods especially DP can replace 2D methods in the quantification of MR in the clinical practice, as it is more accurate and easy to perform .
Three-dimensional (3D) transesophageal echocardiography (TEE) is a powerful tool for assessment of mitral valve area with multiplanar reconstruction (MPR) or direct planimetery in patients with rheumatic mitral valve stenosis. Two dimensional transthorasic echocardiography (2D TTE) is a well-known conventional method in these patients which is used routinely. This method is less accurate than 3D TEE because mitral valve is saddle shaped and 2D images cannot image this valve correctly [1-7]. Exact method for 3D mitral valve area measurement is not determined yet and MPR was used as an accurate method. Direct planimetery by 3D TEE emerged as a novel method to evaluate mitral valve area with least variability .
Introduction: Patients with Down syndrome (DS due to relative macroglossia and dynamic airway collapse) are vulnerable to significant upper airway complications. Obstructive sleep apnea (OSA) is a common condition and noted in about 79% of these children . Children with OSA, with or without DS, are sensitive to respiratory depression by drugs such as sedatives, opioids and hypnotics. Abnormalities of the cardiovascular system are also common in Down syndrome. Case Report: A nine_ day old male preterm newborn with DS (e.g. gestational age of 35 weeks) was brought to operation room (OR) for insertion of central venous line and surgery of duodenal atresia. During transportation to NICU, in OR he arrested and then after 45 minutes resuscitation, he returned to life. Conclusion: The placement of CVL could precipitate triggers of cardiac arrest, particularly in preterm newborn.
Objective: This study was done for comparing efficiency of Intravenous Heparin and Oral Aspirin among patients who had cerebral thrombi embolitic vascular accidents. Effectives of Heparin and Aspirin on prognosis and recovery of these patients were evaluated.
Method: This study was a clinical randomized trial. Patients were classified randomly in one of the heparin (n=40) and one group Aspirin (n=40) treatment. At first in the Heparin treatment group, patients were medicated by Heparin 100 IU/kg and then it was followed by 1000IU/hour for 48 hours. In the Aspirin treated group, whom took 325mg/day for 48 hours. The effectiveness of both treatments were evaluated after 48 hours on neuro-muscular, speech, vision, and sphincter function.
Results: The results showed that both treatments were effective on improvement of neuro-muscular, speech, vision, and sphincter function, while Heparin effectiveness was more than Aspirin. Improvement of Nervous function in the Heparin group was 53.2% in compare of 31.2% for Aspirin (p=0.40). In addition, in the Heparin treatment group 59.6% of muscular dysfunction was attained optimum muscular function in compare of 30.7% with Aspirin (p=0.001). It was found significant relation for improvement of speech function in Heparin treatment group (P=0.01). There were not a significant finding relation for improvement of vision, and sphincter function between Heparin and Aspirin treated groups.
Conclusion: Beginning primary medication with Heparin would be effective for achieving optimum function among patients with cerebral thrombi embolitic vascular accidents.
Study Background: Plasmodium spp., (Protozoan) and Wuchereria bancrofti (Nematode) are transmitted by mosquitos to cause insect borne diseases known as malaria and Lymphatic filariasis/Elephantiasis. Apart from the social implication of these parasitic infections the infections can also elicit immune responses. Aim and Objective: This work was therefore designed to determine the pattern of mosquito borne parasitic infection in the night blood samples of patients with elevated TNF-α of > 5.0 pg/ml. Materials and Methods: Seventy (70; aged 31 – 76 years; Male- 35; Female-35) volunteers with plasma TNFα of 5.8 ±0.7 pg/including age-matched control participants ( n= 50 ; TNFα of 2.2 ± 0.3 pg/ml). All participants were negative to Acid Fast Bacilli, ant-HCV, HBsAg and HIV tests were recruited for the study. Night blood samples and sputum samples were obtained from the participants. Blood sample was used for determination of TNFα, HIVp24ag-Ab, anti-HCV, HBsAg by ELISA and identification of Plasmodium and Wuchereria by Geimsha thick blood film staining while sputum samples were used for the demonstration of Acid Fast Bacilli by Ziehl Neelsen staining. Results: The results showed a frequency of Plasmodium spp., in individuals with plasma TNF-α of 5.8 ±0.7 pg/ml as 31.4%(22) as against a frequency of 18%(9) in subjects with plasma TNF-α of 2.2 ± 0.3 pg/ml.. The results also showed a frequency of 5.71%(4) and2%(1) Wuchereria bancrofti in subjects with plasma TNF-α of 5.8 ±0.7 pg/ml and TNF-α of 2.2 ± 0.3 pg/ml. respectively. The overall frequency of parasitic infection obtained in both test and control subjects include: 33.3% (40)Plasmodium spp., and 4.2%(5) Wuchereria bancrofti.The overall results from both test and control subjects also showed a gender distribution of 20%(24) and 13.3%(16) Plasmodium spp.,in female and males respectively while a distribution of 1.7%(2) and 2.5%(3) Wuchereria bancrofti in females and males respectively. Conclusion: This work revealed increase in the frequency of Plasmodium spp. and Wuchereria bancrofti infections with increase in plasma TNF-α while the overall frequency of parasitic infection obtained in both test and control subjects was found to be 33.3% (40)Plasmodium spp., and 4.2%(5) Wuchereria bancrofti with possible variations in regional and gender distributions. Mosquito borne parasitic infection of Plasmodium spp., was found to be more prevalent in patients with elevated TNF-α of> 5.0 pg/ml.
Dissection refers to a serious condition that begin as a tear or rupture in the inner layers of large vessel wall. Tear allows the blood to surges through the layers, leads to intramural hematoma or an aneurysmal dilatation, either of which can be a source of thromboembolism. Ischemic symptoms in surrounding structures are more often secondary to embolism. Dissections are labeled spontaneous in the absence of major blunt or penetrating trauma. The incidence rates for spontaneous carotid artery dissection have been reported to be 2.5 to 3 per 100,000 population. The average annual incidence for vertebral artery dissection were calculated to be 1 to 1.5 per 100,000. Typical clinical features seen with dissection include unilateral headache, ipsilateral Homer's syndrome, oculosympathetic palsy, prominent neck and facial pain, retinal ischemia, and symptoms of focal brain ischemia due to the site of dissection. The reason of dissection occurrence is still unknown but numerous factors e.g. connective tissue disorders, hyperhomocystinemia, ﬁbromuscular dysplasia, recent infection, etc. may underlie spontaneous or minor trauma dissections. Patients with Spontaneous dissection are more susceptible to developing to stroke and its morbidity and mortality.
In this retrospective study, we evaluate the clinical features, risk factors, treatment and outcome of spontaneous dissection in 70 patients (31 female and 39 male), referred to Namazi hospital between September 2012 and September 2016. The diagnosis of arterial dissection was established by qualified physicians according to radiological and clinical features. Patients with traumatic dissection and a history of major or minor head and neck injury were excluded. Subjects were observed for multiple risk factors such as age dependent risk factors, family history of venous thrombosis, history of trauma, coagulopathies, infectious diseases, systemic disorders, arterio-venous malformations and autoimmune diseases. We also investigated for any history of OCP administration in female patients.
The collected data was evaluated using SPSS 16. Chi-square test were performed for the comparison of qualitative variables. And p
Stroke is considered as the second and first factor contributing to the mortality and morbidity, respectively, in the developing countries like Iran. Thanks to the development of the public health awareness and establishment of the required infrastructures, the incidence of the communicable diseases has declined immensely in Iran. On the other hand, the mean age of the population is increasing; this increase is inevitably accompanied by the augmented impact of the other stroke risk factors such as hypertension, hyperlipidemia, smoking etc. Consequently, not only the incidence of stroke has increased but also the onset age has decreased significantly; according the latest population-based study in Iran, the incidence of stroke has increased to 20-150 in 100000, yet the onset age is 10 years less than Europeans or Americans.
Fortunately, serious and abundant measures have been taken within the recent years through social movements, conferences, mass media, social networks, and beneficiary associations. The integrated program of developing Stroke Units all over the country is seriously being monitored by the Iranian Stroke Association, Medical Sciences Universities and neurologists from all over the country. Stroke is currently the center of attention of the researchers and academia in Iran and numerous large studies in this regard are currently being conducted.
The 9th Iranian Stroke Congress was held after many years of the endeavor of Iranian neurologists to promote stroke treatment in their home county despite numerous obstacles. After 2 years of a continuous national campaign, they started and are to pursue modern standards in stroke treatment on a nation-wide scale. Throughout this event, some achievements of this campaign such as promoting the knowledge of neurologists and other medical professionals active in the field of stroke treatment were further reviewed. To achieve further educational goals, educational courses and lectures in the fields of stroke medicine, neurosonology, and interventional neurology were provided. We hope that these educational goals have been realized with the assistance of the prominent lecturers from all over the world and also participants from all other countries.
Introduction: Acute surgery abdomen was one of the most common causes of emergency surgery in worldwide and a major cause of severe abdominal pain and sometimes harrowing and intolerable patients are presenting to the emergency department. The duty of every physician especially Emergency physician reduction of pain of patients that is considered as a major priority in new emergency medical treatment. The aim of this study was evaluation of effect IV Acetaminophen on abdominal pain in patients referred to emergency ward. Methods: In a double blind clinical trial that performed in emergency department on patients with abdominal pain, effect IV Acetaminophen on abdominal pain in patients referred to emergency ward evaluated. Results and Conclusion:155 of patients were male and 85 of them were female. Mean age of patients in acetaminophen group was 45.45 ± 20.47 and in Morphine group was 50.99 ± 19.40 year(P=0.0054). Mean of pre injection pain score in male was 8.69 ± 1.29 and in female patients was 9.17 ± 1.27(P=0.848). Mean of pre injection pain score in Morphine group patients was 8.80 ± 1.35 and Mean of post injection pain score in Morphine group patients was 4.06 ± 1.71(P<0.001). Mean of pre injection pain score in acetaminophen group patients was 8.92 ± 1.25 and Mean of post injection pain score in acetaminophen group patients was 6.46 ± 2.25(P<0.001). Mean of post injection pain score in acetaminophen group patients was significantly higher than patient’s of Morphine group. Significant liner direct correlation was found between pre injection and post injection pain score in the studied patients.
Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality .
OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking.
Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic) aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes.
Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism.
AMPHETAMINE AND other psychostimulants:
In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two.
Decongestants and diet pills:
Phenylpropanolamine (PPA), an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA) with amphetamine like can induce ischemic or hemorrhagic strokes.
Crack cocaine: medical complication of crack cocaine is stroke. Parenteral cocaine users are at risk of stroke related to infectious endocarditis and also experience stroke caused directly by the drug itself.
Introduction: Thrombus formation on a disrupted atherosclerotic soft plaque is a key event that leads to atherothrombosis. Atherothrombosis is one of the leading causes of acute coronary syndrome and ischemic stroke. Our ability to test new protocols for the treatment of atherothrombotic stenosis in humans is limited for obvious ethical reasons; therefore, a precise understanding of the mechanism of atherothrombotic occlusion in human carotid artery, which give rise to thrombosis, emboli and stroke, requires a suitable animal model that would mimic the same characteristics well.
Aims: The aim of this study was to generate an easily reproducible and inexpensive experimental rabbit carotid model of atherothrombotic occlusion with morphological similarities to the human disease and the subsequent assessment of the reliability of new computerized B- mode ultrasound image processing technology in the study of lumen area stenosis in this model.
Methods: Briefly, male New Zealand white rabbits were submitted to common carotid artery atherothrombotic occlusion by primary balloon injury followed 1.5% cholesterol- rich diet injury for eight weeks and finally perivascularly severe cold injury. All of the rabbits' arteries were imaged by B-mode ultrasound weekly, after which the rabbits were sacrificed, and their vessels were processed for histopathology. Ultrasound longitudinal view images from three cardiac cycles were processed by a new computerized analyzing method based on dynamic programming and maximum gradient algorithm for measurement of instantaneous changes in arterial wall thickness and lumen diameter in sequential ultrasound images.
Results: Histopathology results showed progressive changes, from the lipid-laden cells and fibrous connective tissue proliferation, fibrolipid plaque formation, resulting in vessel wall thickening, remodeling, neovascularization and lumen narrowing (before perivascularly severe cold injury using liquid nitrogen) up to atherothrombotic occlusion (after perivascularly severe cold injury using liquid nitrogen) in the treatment group respect to other groups (P < 0.05).
Conclusion: In conclusion we successfully developed a new rabbit carotid artery model of atherothrombotic occlusion, which is not only quickly and easily reproducible and inexpensive, but also without mortality and similar to the condition seen in patients. The merits of our model render the evaluation of carotid artery atherothrombotic stenosis and its treatment strategies more feasible in humans. This condition in rabbits can be properly assessed by our new computerized B-mode ultrasound image processing technology.
Several types of stroke in myopathies are described: ischemic, metabolic, or cryptogenic. Ischemic stroke may be categorized as cardioembolic, angiopathic, hemodynamic, or thrombophilic. Cardiac involvement in the form of atrial fibrillation/flutter, dilated cardiomyopathy, or non-compaction Cardioembolic could ensue in stroke. Angiopathic stroke occurs provided that there is atherosclerosis or mitochondrial disorders. Thrombophilic stroke may happen in polymyositis or dermatomyositis along with anti-phospholipid syndrome. Metabolic stroke usually manifests as stroke-like episode and is a distinct feature of various mitochondrial disorders, principally MELAS syndrome. The clinical manifestations are as a result of a vasogenic edema, demonstrating as hyperintensity on T2, DWI, and apparent diffusion coefficient mapping. Differentiation between ischemic and metabolic stroke is essential in terms of diagnosis, therapy, and prognosis. In conclusion, ischemic stroke attributable to cardioembolism, arteriopathy, or thrombophilia are occasional events in myopathies, but metabolic stroke is a frequent feature of mitochondrial disorders.
Background: Investigating and analyzing the dental artery space during a mixed dentition period is very important because it is used in orthodontic treatments planning. The main purpose of this study is to compare the standard Tanaka-Johntson method and simple visual observation in the space analysis in a mixed dentition period and realizing the accuracy of the simple visual observation. Methods Materials: The present study follows a double blind cross-sectional study. Three patients who were in the mixed compare period were selected and six samples were collected from the upper and lower Maxilla duplicate casts. Data were analyzed using ICC and correlation and paired t-test with SPSS 22 software. Results: The general analysis result of the estimated sizes by specialists and residents and the obtained sizes from the Tanaka-Johntson method shows only 28% of the agreement between these two methods. The announced agreement for the sizes was 31% by residents and 22 % by specialists. According to the obtained data, the average difference between specialists and residents was at least one hundredth of a millimeter and the maximum difference was ninety-seven hundredths of a millimeter. Conclusion: The results of the present study show that the estimation of space difference in a simple visual observation method has not an acceptable accuracy in comparison with the Tanaka-Johntson method. In addition, the conducted estimations by residents were also slightly more accurate than that of the specialists.
Tracheal intubation and confirming correct placement of tracheal tube is one of the most important subjects in patients who need airway management (1). Gold standard method of confirmation is capnography, but it is just applicable in patients with tangible cardiac output. Other methods of confirming endotracheal intubation such as hearing gurgling sounds in epigastria, auscultation of lungs sounds, esophageal detector device, and chest radiography can be used for this purpose (2). Recently an exact real time, contrary to other methods, method of confirming endotracheal intubation has been developed which is direct visualization of tracheal tube passage through trachea with sonography. Considering the advantages of sonography, it is strongly recommended for the confirmation of endotracheal intubation(3).
Background: Acetaminophen is a simple analgesic and antipyretic administered in varied formats and from different routes. The purpose of this study was to compare the efficacy of intravenous (IV) and rectal acetaminophen (RA) for controlling post-tonsillectomy pain. Methods: In a double-blinded randomized clinical trial, 70 children scheduled for adenotonsillectomy were randomly allocated into two groups, each containing 35 patients.In the first group, 40 mg/kg of rectal acetaminophen and in the second group, 15 mg/kg of IV acetaminophen was administered at the end of surgery before extubation. Systolic and diastolic blood pressure and heart rate were measured every 15 minutes after intubation. Face pain score was recorded for every 30 minutes between extubation and discharge from recovery room. The data from both groups were analyzed using SPSS program. Results: All demographic findings (age, gender and weight), the size of used endotracheal tubes, initial heart rate, systolic and diastolic blood pressure were comparable in both groups.The pain intensity was reduced in both groups. But this decrease was more prominent in the group who received IV acetaminophen (P=0.006). The changes in systolic blood pressure were not significant in both groups, as well as the changes in systolic blood pressure in recovery room and the ward. Diastolic blood pressure increased both in the recovery room and the ward. The changes were not significant in the ward; whereas, the changes in diastolic blood pressure in recovery room were statistically significant (P=0.008). Heart rate decreased significantly both in the recovery room (P=0.001) and in the ward (P=0.002). Conclusion: Intravenous acetaminophen is more effective than rectal acetaminophen for attenuating post adenotonsillectomy pain in children.
Hospital-acquired infections can increase the rate of morbidity and mortality as well as medical costs. Nosocomial infection is spread by various ways such as surgical, intravenous catheters, surface contact (like as hands) and also through the air. Some interventions include appropriate hand and surface decontamination, sufficient staffing, improved ventilator management, usage of coated central venous and urinary catheters have all been linked with considerably lower rate of nosocomial infection. Multiple interventions simultaneously are required for comprehensive infection control and multiple actions may be given better outcome rather than a single action. Some multiple infection control protocols will possibly show more effective result instead of employing a single or few strategies. Several non-pharmacological interventions to prevent HAIs will reduce the requirement for prolonged or multiple-drug antibiotic courses for infected patients. And lower antibiotic usage will decrease risk of antibiotic-resistant organisms and may improve effectiveness of antibiotics therapy to patients with acquired infections.
Cerebrovascular diseases (stroke) ranked the second cause of death worldwide. This research aimed at investigating the effectiveness of mirror therapy on artery therapy by ARAT (ARAT) score. The research was carried out by the clinical trials study towards 32 acute ischemic stroke patients who were divided into an experimental group got the combination of mirror therapy and standard therapy, and the control group only got the standard therapy. The level of the motor action was tested by Action Research Arm Test (ARAT) score. The research then compared the ARAT score difference between the two groups. The result of the research reveals that the ARAT score differences on the group who gets the combination of mirror therapy and standard therapy (15.56±4.38) higher than the group who only gets the standard therapy (7.69±1, 66). By using T-test, it is obtained the significant difference of P <0.05 (0.001).
Background and Objective: Acute appendicitis is one of the most common and at the same time lethal if not treated promptly. Failure to treat this medical condition in a timely manner then it can lead to major complications that endanger the patient’s health. In these cases, surgical treatment can be done in an open or laparoscopic method. Despite some limited studies comparing the results of these two therapies, there is still insufficient information in patients with this complicated situation. The aim of this study was to evaluate the results of these two therapies in patients with complicated acute appendicitis. Materials and Methods: In this randomized controlled clinical trial, 52 patients with complicated acute appendicitis in the laparoscopic surgery group and 56 patients in the open surgery group were studied. Primary outcomes in this study were duration of surgery and secondary outcomes including wound infection, intra-abdominal abscess, postoperative pain, miscarriage, hospitalization, and need for re-surgery that were compared between the two groups. Results: Both groups were matched for age (mean 31.0 years in laparoscopic surgery group, 30.5 years in open surgery group, p = 0.81) and gender (28 men in laparoscopic surgery group, 32 men in surgical group, p = 0.73). The mean duration of surgery in the laparoscopic group was significantly longer (mean 66.8 vs. 55.1 min, p <0.001). In contrast, mean duration of hospitalization (85.2 vs 98.6 hours, p <0.001) and mean postoperative pain severity (6.3 vs 7.2, p <0.001) was more significant high in open surgery group. In other cases there was no significant difference between the two groups. Conclusion: Although in surgical treatment of complicated acute appendicitis the duration of laparoscopic surgery is longer than the open method, but the duration of hospitalization and pain intensity in laparoscopic method is significantly reduced.
Stroke is the leading cause of adult disability and remains the third most common cause of death in industrialized nations. The concept of neuroprotection mainly came from the studies of the pathology and pathophysiology of ischemic brain injury. Greater understanding of the pathophysiology of neuronal damage in ischemic stroke has generated interest in neuroprotection as a management strategy. Neuroprotective agents in stroke treatment, have generated long-term interest that have the potential to preserve brain tissue and improve overall outcome. One arm of neuroprotective agents limits acute injury to neurons in the ischemic penumbra. Many of these agents modulate neuronal receptors to reduce release of excitatory neurotransmitters, which contribute to early neuronal injury. Other neuroprotective agents prevent potentially detrimental events associated with return of blood flow. Returning blood contains leukocytes that may occlude small vessels and release toxic products. In fact they should act targeting excitotoxicity, oxidative and nitrosative stress, and inflammation. The past few decades have produced a plethora of negative neuroprotective trial results. The questions of feasibility and practicability cannot be resolved simultaneously. In the future, optimal therapy may be achieved by combining neuroprotective agents with complementary mechanisms. Relevant areas of interest include the search for safe and effective treatment strategies that combine neuroprotection reperfusion, better use of advanced brain imaging for patient selection, and wider implementation of prehospital conducted clinical trials.
Stroke is a leading cause of mortality worldwide. Unfortunately its incidence is more and the age of occurrence is one decade earlier in our country, Iran. About 75-90 percent of stroke etiology is ischemic. The only approved drug treatment for eligible acute ischemic stroke (AIS) patients is thrombolytic therapy by recombinant tissue plasminogen activator (tPA). Related level of evidence is the highest (1a) and it has been approved by FDA following NINDS study since 1996. First golden time for use of tPA was less than 3 hours but later it has extended to 4.5 hours following re-analysis of the data since 2009. In the beginning, related exclusion criteria was strict considering many absolute items, however, some of them changed or removed as relative exclusion criteria by practicing and performing researches and analysis of results and it is going to be more simplified. For example, in 2013 there were 15 absolute and 10 relative exclusion criteria for intravenous thrombolysis in AIS in less than 4.5 hours period from onset of symptoms but in 2016 following publishing American heart and Stroke Association (AHA/ASA) scientific statement this criteria was more clarified and some of relative exclusion criteria removed. And finally new published researches extended this therapeutic time window to 6 hours by using mechanical thrombectomy in defined patients not responding to IV thrombolysis. In the ninth national Iranian Stroke Congress this updated criteria will be discussed.
Objective: Current study was conducted to develop a pain control protocol by Morphine Sulfate (MS) Suppository in triage ward with the main primary outcomes of first analgesic administration time, patients' satisfaction and also the changes in pain intensity.
Methods: In this randomized clinical trial, 318 consecutive patients attending to an academic tertiary health care center in Tehran, Iran in 2011 and 2012 were enrolled. The patients were randomly assigned to receive either routine pain control by emergency medicine residents in emergency department (n=132) or pain control protocol in triage level by nurses (n=186). Those with pain in control group were treated with conventional pain control program and those in intervention group with pain intensities higher than four were treated with suppository stat 10 mg dose of MS administered by nurses in triage ward.
Results: The mean change in pain intensity was significantly (P
Stroke remains one of the main public health issues worldwide. It is the third leading cause of death in the United States, with more than 200,000 people dying from strokes each year. Approximately 80% of all acute ischemic strokes are due to intracranial artery occlusion, most commonly thromboembolic clot occlusion. Revascularization of occluded territories is the cornerstone of acute ischemic stroke and Thrombolysis for ischemic stroke has been systematically studied in large randomized trials only since the 1990s. To date, thrombolytic therapy for ischemic stroke has been investigated in 21 randomized controlled clinical trials enrolling more than 7,000 patients. The advent of modern imaging and endovascular tools and technologyhas revolutionized treatment of stroke. In this talk, I will review current clinical trials published in The NEJM (ESCAPE, MR Clean, EXTENDED IA, ….) regarding superiority of the endovascular treatments, especially, the stent retrievers, over Iv tPA. I will also go over all endovascular techniques used in the endovascular treatment of acute stroke using my Canadian and American experiences.
Background: Two previous studies, which investigated transcranial direct current stimulation (tDCS) use in motor recovery after acute ischemic stroke, did not show tDCS to be effective in this regard. We speculated that additional left dorsolateral prefrontal cortex (DLPFC) stimulation may enhance post stroke motor recovery.
Methods: In the present randomized clinical trial, 20 acute ischemic stroke patients were recruited. Patients received real motor cortex (M1) stimulation in both arms of the trial. The two arms differed in terms of real vs. sham stimulation over the left DLPFC. Motor component of the Fugl-Meyer upper extremity assessment (FM) and Action Research Arm Test (ARAT) scores were used to assess primary outcomes, and non-linear mixed effects models were used for data analyses.
Results: Primary outcome measures improved more and faster among the real stimulation group. During the first days of stimulations, sham group’s FM scores increased 1.2 scores per day, while real group’s scores increased 1.7 scores per day (P = 0.003). In the following days, FM improvement decelerated in both groups. Based on the derived models, a hypothetical stroke patient with baseline FM score of 15 improves to 32 in the sham stimulation group and to 41 in the real stimulation group within the first month after stroke. Models with ARAT scores yielded nearly similar results.
Conclusion: The current study results showed that left DLPFC stimulation in conjunction with M1 stimulation resulted in better motor recovery than M1 stimulation alone.
Stroke remains one of the main public health issues worldwide. It is the third leading cause of death in the United States, with more than 200,000 people dying from strokes each year. Approximately 80% of all acute ischemic strokes are due to intracranial artery occlusion, most commonly thromboembolic clot occlusion. Revascularization of occluded territories is the cornerstone of acute ischemic stroke and Thrombolysis for ischemic stroke has been systematically studied in large randomized trials only since the 1990s. To date, thrombolytic therapy for ischemic stroke has been investigated in 21 randomized controlled clinical trials enrolling more than 7,000 patients. The advent of modern imaging and endovascular tools and technology has revolutionized treatment of stroke. In this talk, I will review current clinical trials published in The NEJM (ESCAPE, MR Clean, EXTENDED IA, ….) regarding superiority of the endovascular treatments, especially, the stent retrievers, over Iv tPA. I will also go over all endovascular techniques used in the endovascular treatment of acute stroke using my Canadian and American experiences.
Background &Aims: Ischemic stroke is the most common cause of stroke ,and paralysis and movement disorders are the most symptoms of stroke. Therefore, it is important to find a method for improving the disorders. This study aimed to examine the clinical efficacy of frankincense in patients with the acute ischemic stroke.
Methods: In this clinical trial, 60 patients with ischemic stroke were randomly allocated into the treatment and control groups (n=30). In the treatment group, in addition to routine treatment of stroke, four capsules containing 500 mg powdered frankincense was given daily , but in the control group, was performed only the treatment of stroke (no frankincense). The treatment lasted for 1 month. The NIHSS scale (for assessment of speech and muscle strength) at the beginning, the seventh day and end of the study for each patient was completed. Statistical analysis was performed using independent t-test, chi-square, mann withney in SPSS software.
Results: Results showed that only improvement of muscle strength in patients left limb increased significantly in stage II in the treatment group than the control group.
Conclusion: Adding frankincense to treatment of patients with stroke can be effective on improvement muscle strength in patients with muscle weakness and non-dominant side in acute neurological disorders. While that is not effective on improving muscle strength of the right limb or speech.
Pelvic organ prolapse (POP) is a common disease which present as symptomatic descent of the anterior or posterior vaginal wall prolapse, uterus or apical prolapse subsequent to hysterectomy, and entrocele. Since, social and cultural factors have impact on interval between symptoms incidence and seek for medical care, diagnosis method and treatment process, it was important to prepare a guideline for management of the Iranian women with POP.
Introduction: One of the most common treatments for chronic and recurrent tonsillitis is a tonsillectomy. It must considered patient satisfaction and quality of life before and after tonsillectomy are two key factors in evaluation of successful surgery. The aim of this study was to investigate the effect of adenotonsillectomy on quality of life for adultsover 14 years.Materials and methods: 40 adults with more than 14 years old were studied with chronic or recurrent tonsillitis in a cross-sectional study. The standardized questionnaire was used to assess the quality of life before and after surgery (GBI andGHSI). Questionnaires were completed before surgery and during the postoperative follow-up for each patient.Results: Total score of quality assessment questionnaire, public health subscale and social health subscale weresignificantly different before and after surgery. Quality of life after surgery has increased considerably. There was no significant difference in physical activity before and after surgery.Conclusions: Tonsillectomy in adults with recurrent and chronic tonsillitis can effectively improve the quality of life ofpatients. Keywords: chronic tonsillitis, tonsillectomy, quality of life
Conventional teaching modalities like Didactic lectures if practised alone fails to transfer concepts as effectively as active learning approaches. Active learning methods like Quizzing leads to active participatory involvement of students, motivates them by increasing interest in the subject and act as a driving force for more effective learning. The purpose of this study was to evaluate the effectiveness of Quiz as an adjunctive teaching modality in clinical microbiology for undergraduate medical teaching and to compare it with conventional teaching methods like Didactic lectures. In this interventional study conducted in the Dept. of Microbiology of a Govt. Medical College of Central India, Second MBBS students were divided into two groups. The topic Universal precautions was split and covered through two modules. One module was administered through lecture to one group and through Self study followed by Quiz to another group. Cross over was done for the second module. To evaluate the students performance pretest and post test were conducted for both the methods. In case of both the groups a significant absolute learning gain was observed for both the modalities. However in both the groups the learning gain and effect size were towards much higher side for Quizzing as compared to didactic lectures. Our study has shown the positive impetus of the active teaching learning modalities like Quizzing on self directed learning, and an added advantage of this approach on the learning gain as compared to the conventional teaching.
One of the most frequently consumed herbal remedies available today is the chamomile preparations prepared from Matricaria chamomilla (MC). The medicinal preparations of MC are composed of several classes of biological active compounds with inhibitory effects on inflammation including essential oil and flavonoids. Apigenin, quercetin and luteolin are the major flavonoids of MC which exhibit their anti-inflammatory effects through different mechanisms. Apigenin exhibits anti-inflammatory activity via inhibition of proinflammatory cytokines production, whilst luteolin suppresses production of nitric oxide (NO), prostaglandin E2 and expression of inducible NO synthase and cyclooxygenase-2 all of which are associated with inflammatory responses. However, there are also some additional components of the MC preparations which have a role on the anti-inflammatory actions of the plant through other pathways. The mentioned mechanisms are in reference with the authors' concept that MC would be of value in alleviating inflammation and pain in rheumatoid arthritis.
Having three orientations, the Health System Reform Plan (HSRP) has been administered to financially support and protect people, provide fair health services and promote the quality of health services. To be unsatisfied about health and medical services brings undesirable outcomes. The present investigation aimed to study the effect of Health System Reform Plan (HSRP) on the satisfaction level among medical doctors and nurses of Tabriz state hospitals, East Azerbaijan province, Iran in a period from 21th February; 2015 to 22th June; 2015. Statistical population included those patients who referred to Tabriz state hospitals. We used stratified sampling method. To collect data we used questionnaire being presented to the samples after assessing its validity and reliability. We also utilized descriptive and inferential statistics in a way that we used descriptive method to classify, summarize and interpret of obtained data. Then after demonstrating the abnormality of data by Kolmogorov-Smirnov test we used linear and multiple regressions to test research hypothesis and effect from the perspective of inferential method. Obtained results confirmed the research hypothesis and explained that the administration of HSRP affected medical doctors’ level of satisfaction. Also, according to the results of multiple regression tests, doctors and nurses’ satisfaction level was placed at the top of most affected issues from HSRP.
Fibrinolytic therapy has a crucial role in decreasing morbidity and mortality of patients who suffer from ischemic stroke.
The primary goal of therapy in acute ischemic stroke is to preserve tissue in the ischemic penumbra, where perfusion is decreased but sufficient to stave off infarction. Tissue in this area of oligemia can be preserved by restoring blood flow to the compromised area and optimizing collateral flow.(4).
Recombinant tissue-type plasminogen activator or TPA is a well-known medication for improving neurologic outcome in these patients.
We present an acute ischemic stroke case, whom we started loading dose of TPA in the Emergency Room and continued maintenance dosage in the assigned Stroke ICU. She made a great recovery when she discharged from the hospital after one week and became independent in her daily activity when we met her after few months.
Introduction: The analysis of causes of death in the hospital and identification and dealing with the causes of death, in one of the best strategies to increase longevity. This study, with the aim of better understanding of the causes of death and by taking into account all hospital wards, describes the causes of hospital mortality occurred in Sina educational and clinical hospital of Tabriz, in order to investigate demographic ,clinical and cause of death variables for each disease separately. Method: This study is done by the sectional descriptive method in 2018 in Sina educational and clinical hospital of Tabriz. This hospital is the most important center for admissions of poisoning and burns in the North West of Iran. For this purpose, after obtaining a license, records of all patients who are admitted to hospital since 21 March 2018 until 19 March 2019, were extracted from the archives center in an elective and emergency form. Demographic and clinical variables were extracted from records and recorded in the questionnaire. The sample in counting the mortality occurred during one year was 626 cases according to documentations, that 88 cases were eliminated from study due to containing incomplete information. The data were analyzed by descriptive tests and SPSS18. Findings: The mortality rate in this study was 1%. 56.5% of those who died were male. Most deaths occurred among patients of over 75 years old. Among the under-15 age group the highest mortality rate were for burns. The most common causes of mortality, were, respectively, burns (19.33%), cancer (16.86%), and infectious disease (16.57%) .Most deaths occurred in the special wards. In 61%, chronic and underlying diseases are reported. Conclusion: Since this hospital is the largest and most important teaching hospitals for burns, in the province, the most common causes of death in this study are result of burns. The high percentage of deaths from burns in children and young people shows the importance of informing the dangers of burn for preventing the occurrence of burns and control its effects.
Background: APACHE Score is an important criterion for determining the patient prognosis, especially in critically ill patients. According to significantly changes in the serum levels of thyroidal hormones in patients, especially in critically ill patients, the aim of the present study was to evaluate the relationship between thyroid function and APACHE 4 score in the prognosis of the traumatic patients admitted in surgery ICU. Method & Material: In a descriptive-analytical study, 90 patients with multiple trauma were studied. Thyroid hormones and APACHE 4 Score were evaluated on 1st, 5th and10th days of admission for each patient. Their clinical features and duration of hospitalization, either in trauma unit or ICU, elation between thyroidal hormones and APACHE 4 Score, duration of hospitalization, and survival of patients were evaluated. Results: This study included 90 patients. A statistically significant relation was detected between thyroid hormones (TT3) and APACHE 4 Score and duration of hospitalization. Conclusion: TT3 might be utilized as a prognostic factor in the traumatic patients admitted to ICU.
Background: Developing countries are challenging with stroke as the third cause of death in developed countries and the most popular neurologic disease which results in disability. This study was designed to assess the relationship between demographic factors and early outcome in adult patients with difference type of stroke. Methods and Materials: A retrospective register review was performed from March 2017 to March 2018. ED medical document (chart) were reviewed by a neurologist or physician to obtain the clinical diagnosis, patient characteristics. Their demographic data (such as age, gender), NIHSS score and MRS score were filled in questionnaire. the significant variables were verified in a multivariable model to achieve an attuned estimate of effect. Results: A total of 861 patients with stroke were included in the analysis; the male and female sex in the statistical population were 56% and 43%; the mean age of the patients was 14.32 ± 61.74. The mean NIHSS (16.08±10.51) & MRS (3.66) scores were evaluated, respectively 47% severe stroke (NICHSS>16). There was no significant relationship between age increase and NIHSS increase (P = 0.86). Conclusion: Aging has a significant relationship with increased stroke. Gender and age differences in risk of stroke outcomes are mostly described by variations in physical characteristics and stroke severity of the patients.
Stroke is defined as a clinically syndrome consisted of neurological symptoms with early or sudden onset, lasting more than 24 hours, happening because of clot or blockage in brain arteries or vascular dissociation leading to brain hemorrhage.
CVA is totally categorized in two types of hemorrhage and ischemic.Ischemic type has two subsets: thrombotic and emboli whereas hemorrhage stroke is studied in two types of SAH and ICH based on part of brain which is bleeding.
National institutes of health stroke scale (NIHSS) is designed to fill within 5-8 minutes. One of the most common methods of classifying of acute stroke is NIHSS, that with a structured neurological examination is valuable for diagnosing.About half of all strokes are attributable to established causal and modifiable factors. This finding encourages not only intervention on established etiological factors, but also further study of less well established factors. public education is needed to increase awareness of the warning signs and risk factors of stroke. Stroke management is extremely demanding for patients, and Prevention of stroke and correct management as soosn as possible is the key to reduction of morbidity and mortality.
Purpose: As a higher cognitive function is controlled Executive function by frontal cortex. It is consisted of Decision-making، planning، inhibition، organization and working memory. According to high prevalence of executive dysfunction in adults with neurological disorders such as Dementia and stroke and considering to applying appropriate tests in neurological patients and aging people in order to diagnose executive dysfunction quickly and correctly، In this study we aimed to review common and quick executive function tests.
Methods: This research was a review study on common and quick executive function tests in adults. A search was conducted using some databases including Iran medex، SID، Magiran، Google scholar، Medline، Science Direct، Scopus and Web of Science. The tests were investigated regarding to the date of publishing، method of administration، target populations، subscales، time administration and psychometric features.
Results: According to inclusion and exclusion criteria of this study، we found 26 common and quick tests، Most of them were in English and just one of them was a Persian version. Thirteen tests of them were translated or modified version of original English test. Ten tests of them were very quick with average administration time about 10 minute and the other need 30 minute to administer.
Conclusion: Regarding to importance of evaluating of executive function in neurological patients especially individuals with Dementia beside existence of a lot of tests in other languages and lack of quick executive function tests in Persian , results of current study can help neurologist, speech and language pathologist and other experts to be familiar with common quick tests and their clinical application. These results also recommend researchers and clinicians to translate and adapt some of the quick and easy administer Executive function tests in Persian.
Stroke is in second place on a mortality list in the world. Also, stroke is a leading cause of disability. Approximately 20% of all strokes occur in Children and young adults. The etiology of stroke in Children and young adults is different from that in older patients, and has an influence on diagnostic evaluation and treatment, so knowledge about older patients cannot always be applied to these patients. The list of stroke etiologies among young adults and children is extensive. Ischemic stroke are more frequent than hemorrhagic strokes in both groups. Stroke in young adults had been thought to be associated with risk factors, including arterial (such as dissection, reversible cerebral vasoconstriction syndrome, inflammatory arteritis ,moyamoya ,migraine - induced stroke, genetic or inherted arteriopathy, premature atherosclerosis ) cardiac (such as patent foramen ovale, cardiomyopathy , congenital heart disease) and hematologic (such as deficiencies of protein S,protein C,or antithrombin;factor V lieden mutation) . Common risk factors for stroke in children include: Sickle-cell disease, diseases of the arteries, abnormal blood clotting, head or neck trauma. There are no specific recommendations or guidelines for primary or secondary stroke prevention in young adults. Primary prevention focused on identifying and managing known vascular risk factors, such as hypertension, disorders of lipid metabolism, and diabetes, and non-drug strategies and lifestyle changes, including smoking, reducing body weight, increasing regular aerobic physical activity, and adopting a healthy diet with more fruit and vegetables and less salt. For secondary stroke prevention, identification of the etiologic mechanism of the initial stroke and the presence of any additional risk factors is most important. It consists of optimal treatment of vascular risk factors administering antiplatelet or anticoagulant therapy, and if indicated, invasive surgical or endovascular therapeutic procedures. An integral part of this is lifestyle changes, emphasizing regular physical activity, a diet low in salt and saturated fat and high in fruit and vegetables, reducing overweight and quitting smoking.
The aim of this study was to investigate factors affecting exhilaration and their association with happiness of school elementary teachers in Shahrekord, Iran. The study population consisted of all elementary school teachers in Shahre-kord, Iran. 203 elementary teachers were surveyed through random sampling and using Morgan’s table. The data were collected by means of the self-made questionnaire covering factors affecting the exhilaration and Oxford Happiness Questionnaire. Result of this study indicated that the best predictors of exhilaration are economic factors, gathering, office hours, evaluation, and active teaching methodology. Based on beta coefficient, with 1% increase in teachers’ gathering, exhilaration increased by 0.308, office hours by 0.335, evaluation by 0.201, active teaching methodology by 0.202, and economic factors by 0.174. We found that the Ministry of Education should pay special attention to the mentioned items in order to increase the students’ self-confidence, efficiency, social and individual skills, and quality of life.
Background: Missing to detect an ischemic stroke in the emergency department leads to miss acute interventions and treatment with secondary prevention therapy. Our study examined the diagnosis of stroke in the emergency department (ED) and neurology department of an academic teaching hospital. Methods and Materials: A retrospective chart review was performed from March 2017 to March 2018. ED medical document (chart) were reviewed by a stroke neurologist to collect the clinical diagnosis and characteristics of ischemic stroke patients. For determining the cases of misdiagnosed and over diagnosed data, the administrative data codes were compared with the chart adjudicated diagnosis. The adjusted estimate of effect was estimated through testing the significant variables in a multivariable model. The comparisons were done with chi square test. Statistical significance was considered at P < 0.05. Results: Of 861 patients of the study, 54% were males and 43% were females; and the mean age of them was 66.51 ± 15.70. We find no statically significant difference between patient’s Glasgow Coma Scale (GCS) in the emergency department (12.87±3.25) and patients GCS in the neurology department (11.77±5.15). There were 18 (2.2%) overdiagnosed of ischemic stroke, 8 (0.9%) misdiagnosed of ischemic stroke and 36 (4.1%) misdiagnosed of hemorrhagic strokes in the emergency department. Conclusion: There was no significant difference between impression of stroke in the emergency department and diagnosis at the neurology department.
Introduction: Upper gastrointestinal bleeding (UGIB) is the most common cause of emergency admission in gastrointestinal disease. UGIB could accompany with adverse events if not treated timely. Different scoring systems have been suggested for diagnosing these patients, In this study we aimed to compare the predictive value of two scoring systems AIMS65 and Glasgow Blatchfors scale (GBS) in patients with UGIB. Methods: In this cross-sectional study, 153 patients (71.9% male with mean age of 56.72±21.64 years) with acute UGIB between April 2017 and September 2018 were included. Demographic findings, past medical history, laboratory findings, AMIS65 and GBS score, as well as, need for urgent endoscopy, transfusion and mortality were recorded. Both methods value in predicting the outcomes were measured using ROC curves. Results and Conclusion: Urgent endoscopy was performed in 44.4%. The most common finding was peptic ulcer with mostly clean base type. Rebleeding occurred in 15%, need for transfusion was in 44.4% and mortality rate was 5.2%. AIMS65 compared to GBS was superior in predicting mortality (AUC of 0.947 vs. 0.80) but was inferior compared to GBS in predicting need for transfusion (0.849 vs. 0.947). None of the systems could predict the need for urgent endoscopy. AIMS65 with cut off 2 and 0 and GBS with cut off of 12 and 8 could predict mortality and need for transfusion. GBS seems a better system in predicting the need for blood transfusion, while AIMS65 is better system for predicting in-hospital mortality in patients with UGIB.
ubmucosal resection and submucosal diathermy are common procedures in the treatment of inferior turbinate hypertrophy. Nonetheless, there is still a debate on the safety and efficacy between these two surgical techniques. We aimed at comparing the effectiveness and safety of submucosal diathermy and submucosal resection in the treatment of inferior turbinate hypertrophy. Sixty patients with nasal obstruction due to inferior turbinate hypertrophy were randomly divided into two groups; submucosal resection and submucosal diathermy groups. Gertner-Podoshin plate was used for measurement of nasal airflow before operation and 2 months postoperative. Significant resolution of the obstruction reported by the patients was similarly detected in diathermy (93.1%) and resection groups (96%, P>0.05). According to the Gertner-Podoshin measurements, both diathermy and resection techniques similarly resulted in good nasal airflow two month postoperative (86.2% vs. 89.2%, respectively; P>0.05). Postoperative bleeding was more common in the resection group compared with the diathermy group (P=0.002). Moreover, patients in the diathermy group suffered from pain more than the resection group (P=0.01). Both submucosal resection and submucosal diathermy techniques result in similar postoperative outcomes in treatment of inferior turbinate hypertrophy, although postoperative bleeding
and pain was more in submucosal resection and submucosal diathermy techniques, respectively.
Keywords: Inferior turbinate hypertrophy; nasal airflow; side effects; submucosal diathermy; submucosal resection