فهرست مطالب ehsan kazemnejad-leili

Postoperative rehabilitation protocols, such as immobilization and non-weight-bearing periods during the acute phase after anterior cruciate ligament (ACL) surgery vary depending on the surgeon or the institution and lack clear standardization. Weight bearing (WB) after ACL reconstruction (ACLR) is critical. This study compares the results of WB immediately after surgery and partial WB with a brace after ACLR.

In this randomized clinical trial, the block random sampling method was used to select 84 patients who were divided into two groups. Group 1 was allowed to have full WB after surgery and Group 2 was asked to use braces after surgery, and they were divided into partial WB for one month and then full WB. Meanwhile, demographic information was recorded. The Lachman test, anterior knee pain, and kneeling pain before and one month after the surgery were also recorded. Knee function was evaluated using the international knee documentation committee, knee injury and osteoarthritis outcome score, and Lysholm scales before surgery and 1, 3, and 6 months after surgery. The data were analyzed using the SPSS software, version 20, and the Fisher exact test, the chi-square test, the Friedman test, and repeated measures analysis of variance.

Most of the patients were men under 30 years of age. There was no statistically significant difference in the demographic information of the patients in the two groups. Kneeling pain, anterior knee pain, and the Lachman test did not differ between the two groups one month after the surgery. There was no difference between the two groups in the scores using the international knee documentation committee, knee injury and osteoarthritis outcome score, and Lysholm score in the 6-month follow-up. All the examined indicators in each group improved over time.

WB immediately after surgery compared to partial WB at 1, 3, and 6 months after ACLR do not differ; therefore, patients can bear full weight if they tolerate it.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with an increased risk of acute cerebrovascular disease.

In this study, we compared the relative frequency of ischemic stroke (IS) and intraparenchymal hemorrhage (IPH) during the SARS-CoV-2 pandemic with a similar period in the previous year.

This comparative cross-sectional study was conducted on patients with acute ischemic stroke and IPH. They were admitted to an academic stroke referral hospital in Guilan Province, Iran, between December 2019 and June 2020 (COVID-19 pandemic period) and a similar 6-month period in the previous year. This study compared the patients’ demographic data, clinical information, risk factors, comorbidities, and outcomes.

A remarkable reduction of 28.6% in the relative frequency of stroke admission was observed during the COVID-19 pandemic period compared with the same period in the previous year (P<0.001). The ratio of ischemic stroke to hemorrhagic stroke decreased from 2.6 in the corresponding period during the last year to 2.2 during the SARS-CoV-2 pandemic period. However, this change was not significant (P=0.232).

This study revealed that the relative frequency of stroke significantly declined at the pandemic’s peak compared to the same time in the previous year despite cerebrovascular complications associated with COVID-19. However, the ratio of ischemic stroke to hemorrhagic stroke did not change significantly.

This study aimed to assess whether weight gain predicts the outcome of childhood leukemia.

This is a cohort study on patients with leukemia aged 2 to 19 years. Data was gathered by a form consisting of age, sex, baseline and final weight, height, Body Mass Index (BMI), and poor outcome (mortality plus occurrence). We used the Receiver Operator Characteristic (ROC) curve and the Area under the Curve (AUC) to define the cut-off points. Data analysis was performed in SPSS software version 19.

114 patients enrolled in the study, including 68 (59.6%) boys and 46 (40.4%) girls. Ten patients (8.7%) died, and 14 (12.2%) experienced a recurrence. Overall, 16 (14.1%) patients had poor outcomes. In this study, most patients had annual weight gain (95.6%), and all had height gain. AUC of weight and height gain at the diagnosis and the end regarding poor outcome were 0.672 and 0.718, respectively. The cut-off points of weight and height gain for poor outcomes were 1.2 % per month (14.5% annual weight gain, and 0.32 % per month (3.8% annual height gain), respectively. Besides, 60% of patients with weight loss had poor outcomes, and the results revealed that weight loss of more than 12% per year causes poor outcomes.

According to the results, weight and height gain during the treatment period can be related to a better outcome in children and adolescents with leukemia, irrespective of weight, height, and BMI at the diagnosis. Therefore, anthropometric indices may be associated with outcomes

Many factors affect the hypertensive patients’ quality of life. Identifying the factors related to the quality of life can help to promote the quality of life in hypertensive patients. This study aimed to determine the predictive role of illness acceptance and social, individual factors in the hypertensive patients’ quality of life.

Methods & Materials: 

This correlational, cross-section study was conducted in 2020-2021 on 245 hypertensive patients referred to a hypertension clinic in Lahijan selected by the convenience sampling method. Data were collected by a questionnaire, including demographic information, Acceptance of Illness Scale and the WHO's Quality of Life-Brief questionnaire. Data were analyzed by multiple linear regression at a 95% confidence level using the SPSS software version 23.

The mean score for the quality of life was 65.32±12.18 (0-100) and for the acceptance of illness was 31.83±4.98 (8-40). Age, sex, employment status, marital status, monthly income, family arrangement and the acceptance of illness were identified as the predictors of quality of life in hypertensive patients (P<0.001). According to the coefficient of determination (R2=0.401), the variables of the final regression model explained about 40% of the quality-of-life changes among hypertensive patients.

Given that the acceptance of illness and some social, individual factors can affect the hypertensive patients’ quality of life, focus on the strategies to promote the acceptance of illness and paying attention to social, individual factors can help improve the quality of life among hypertensive patients.

The most important diagnostic indicator of Acute Coronary Syndrome (ACS) is typical clinical symptoms, like chest pain, but many patients may experience nonspecific (atypical) symptoms. Understanding these symptoms and their associated factors results in early diagnosis and more appropriate treatments.

We aimed to determine atypical clinical symptoms and their predictors in patients with Acute Coronary Syndrome.

This cross-sectional study was conducted on 1167 patients with ACS hospitalized at a specialized hospital in Rasht City, Iran, between December 2019 and October 2020. The research samples were selected by a consecutive sampling method. Data were collected through a researcher-made questionnaire by interview, in which sociodemographic characteristics, risk factors, disease-related factors, and symptoms of patients with ACS were collected. Data analysis was done by descriptive statistics and multiple logistic regression by the backward LR (likelihood ratio) method. The significance level was set as P<0.05.

In this study, 56.3% of the patients were male. The Mean±SD age of the patients was 60.9±11.1 years. About 28.1% of the patients experienced atypical clinical symptoms. The most common atypical symptoms were shortness of breath (29.4%), back pain (18.3%), and left shoulder pain (12.7%). The predictors of atypical symptoms were age (OR=0.98, 95% CI; 0.975 - 0.999, P=0.047), alcohol use (OR=1.86, 95% CI; 1.047 - 3.303, P=0.034), brain diseases (OR=2.36, 95% CI; 1.463 - 3.811, P=0.001), blood diseases (OR=1.45, 95% CI; 1.059 - 2.002, P=0.021), and gastroesophageal reflux (OR=1.31, 95% CI; 1.006 - 1.719, P=0.045)

Since more than a quarter of ACS patients have unusual symptoms, detecting these symptoms and related factors can help in early diagnosis and conduct more appropriate medical treatment.

 To investigate the therapeutic effects of PRP injection + conservative treatment as the intervention group versus normal saline injection + conservative treatment as the control group.

 This study we determined the effects of underlying factors, including age, gender, and Body Mass Index (BMI), on the therapeutic effects of PRP.

 In this single-blinded randomized clinical trial, 60 patients with grade 2 knee OA with an age of 40 - 65 years were enrolled. In the intervention group, leukocyte-poor PRP with double spinning, and in the control group, normal saline was injected with a similar protocol. All patients in both groups were also provided with a conservative protocol, including oral celecoxib 100 mg BID for four weeks, modifying physical activity, and 15 sessions of physiotherapy.

 Demographic characteristics (age, gender, and BMI) and pre-treatment scores were similar between the two groups (all P > 0.05). The WOMAC score was improved from pre-treatment to first week post-treatment in both groups (from 54.89 ± 3.4 to 64.9 ± 3.7 in the intervention group and from 53.7 ± 3.1 to 63.8 ± 3.9 in the control group). It means that PRP + conservative treatment was effective, similar to normal saline + conservative treatment. After adjusting BMI as an underlying variable, it was indicated that in the patients with lower BMI, PRP + conservative provided a better outcome in comparison to saline + conservative treatment (P = 0.014 and P = 0.019, respectively). Also, the comparison of functional scores changes with age as an underlying variable, demonstrating that younger cases obtained a better response from PRP + conservative rather than normal saline + conservative (P = 0.012 and P = 0.007, respectively).

 PRP seems to be an appropriate choice for treatment of moderate osteoarthritis, especially in younger patients and those with lower BMI.

To study the anti-inflammatory and antioxidant effects of flaxseed oil and olive oil on inflammatorymarkers for facilitating wound healing. One hundred and twelve patients were randomly selected to four groups with a total burn surfacearea (TBSA) of 20-50%. The four groups includes olive oil (OO), flaxseed oil (FO), mixture of olive oil andflaxseed oil (OF), and control group and received 30g of oils for three weeks. Serum high-sensitivity C-reactiveprotein (hs-CRP), ferritin and albumin level as inflammatory markers, as well as cholesterol, triglyceride,high-density lipoprotein (HDL) and low-density lipoprotein (LDL) as the lipid profile were explored. Woundhealing was assessed by photographing on days 2, 8, 15, and 22 (during three weeks of intervention) and wereanalyzed in imageJ software. The greatest reduction in the level of hs-CRP and ferritin was observed in the OF (-21.38±44.41)(-132.79±165.36), while the lowest reduction was reported in the control group (-36.36±79.03) (141.08±262.36).Compared to control group, OO significantly increased albumin (0.88±0.65). Reduction of wound healing at theend of the first week of intervention was not significant in the study groups. However, the stereology examinationshowed significant improvement in wound healing at the end of the second and third weeks in the OF. Based on the findings, combination of herbal oils reduce inflammation and improve wound healingand showed positive effects on the size of wounds in burn patients.

Neuronal ceroid lipofuscinoses (NCL) is a rare progressive neurodegenerative disorder caused by more than 530 mutations of at least 13 different genes (CLN 1-14). NCL is a part of the lysosomal disease characterized by the presence of neuronal and extraneural autofluorescent lipopigment accumulations that leads to motor and mental deterioration, developmental regression, seizure, vision loss, and premature death. NCL is classified into four main groups based on the different clinical manifestations and age of presentation. In this study, we aimed to report an unusual presentation of NCL with CLN6 mutation without retina involvement.

We reported a 10-year-old boy with mixed types of seizures, developmental delay, cognitive problems, unsteady gait, and speech disorders. Although after a thorough assessment, CLN6 mutation was diagnosed, he had all symptoms of this mutation, except the visual impairment.

According to recent NCL case reports from Asia, full familiarity with its presentation by pediatricians and neurologists is obligatory. Children with developmental regression or refractory seizures, who also have visual or other neurological symptoms such as ataxia and other cerebellar symptoms, even at older ages, should be evaluated for NCL. Attention to ophthalmological examinations and neurological signs and confirming the diagnosis by biopsy or genetic analysis is desirable to prevent missed diagnosis.

Uremic pruritus or chronic kidney disease?associated pruritus (CKD?aP) is a frequent compromising symptom in end?stage renal disease. Despite the little attention paid to drugs used among hemodialysis (HD) patients, investigating medications used in this population of patients and examining the status of CKD?aP may lead to the identification of medications that improve or worsen the pruritus condition. We aimed to assess the role of underlying diseases?related drugs on CKD?aP in HD patients.

We performed a case ? control study on HD patients aged over 18 years old. The  emographic data and clinical parameters including HD parameters, drug history, dermatologic assessments, and laboratory examination were assessed.

We compared 128 patients with CKD?aP as cases and 109 patients without CKD?aP as controls. Cases were on the longer course of dialysis (44.69 ± 43.24 months for cases vs. 38.87 ± 50.73 months for controls; P = 0.02). In multiple analyses of variables related to CKD?aP, backward LR logistic regression revealed that only  torvastatin (P = 0.036) was considered to be a predictive factor associated with  KD?aP. Thus, the use of atorvastatin reduced the index of CKD?aP (95% confidence interval: 0.256–0.954, odd’s Ratio = 0.494).

Atorvastatin was associated with decreased frequencies of CKD?aP among HD patients in our study. This knowledge may guide further clinical trials to evaluate atorvastatin’s immunomodulatory and  nti?inflammatory effects on the CKD?aP in HD populations. Key words: Amiodarone, atorvastatin, chronic kidney disease, hemodialysis, pruritus, valsartan Address for correspondence: Dr. Narges Alizadeh, Department of Dermatology, Skin Research Center, Razi  ospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. E?mail: [email protected] Submitted: 20?Jul?2021; Revised: 05?Mar?2022; Accepted: 20?Jun?2022; Published: 25-Nov-2022Access this article online Quick Response Code: Website: www.jmsjournal.net DOI: 10.4103/jrms.jrms_633_21 How to cite this article: Azimi SZ, Alizadeh N, Ramezanzadeh E, Monfared A, Leili EK. The impact of underlying diseases

Graft type selection is still a controversial issue in anterior cruciate ligament (ACL) reconstruction. The type of graft is a determinant of return to sport and its quality.

This study aims to evaluate results and rate of return to sport using quadriceps autograft compared to hamstring autograft.

The present prospective cohort study investigated the results of using quadriceps and hamstring autografts in athletes with an ACL tear. Our variables included age, sex, and body mass index, type of sports activity, infection, meniscus tear and chondral lesion, time and quality of return to sport, range of motion, KT-1000, Lachman and knee injury and osteoarthritis outcome score, international knee documentation committee grade, and Lysholm score.

A total of 71 out of 139 studied patients were operated on hamstring autografts and 68 patients by quadriceps autografts. The patients showed no significant differences (P>0.05) in terms of age, sex, body mass index, sports group, and meniscus tear. In the final follow-up, the chondral lesion was 26.47 vs 16.90, anterior knee pain was 5.8 vs 2.81, and the return to sport was 71.64 vs 78.87 in the quadriceps group vs the hamstring group. The extension loss involved 2 patients per group. The scores of the international knee documentation committee and knee injury and osteoarthritis outcome, the Lysholm test, KT-1000, and the Lachman test had no significant differences in the two groups.

The results of the present study indicated that the use of both quadriceps and hamstring autografts was appropriate for the ACL tear. Also, the orthopedic surgeon should be responsible for deciding to select one of the two grafts.

Determining the severity and site of rotator cuff tear (RCT) is very important for choosing a treatment method. In this study, the diagnostic value of indirect magnetic resonance arthrography (I-MRA) and magnetic resonance imaging (MRI) were compared.

This cross-sectional study was performed in 36 patients attending an orthopedic clinic in 2020. Patients with clinical suspicion of RCT were initially treated conservatively for six weeks. If there was no response, first, imaging was performed by MRI and I-MRA and then the patients underwent arthroscopy for final diagnosis and treatment. The images were then evaluated one week apart by a musculoskeletal radiologist.

The results of both imaging methods were in line with the arthroscopic results and the amount of I-MRA agreement (k= 0.104 ± 0.698) was higher than MRI (k= 0.115 ± 0.606). Sensitivity, specificity, positive predictive value (PPV), negative (NPV), and accuracy of MRI and I-MRA in diagnosing partial RCTs were 78.28, 84.62, 90.00, 68.75, and 80.55 vs. 86.96, 92.3, 95.24, 80.00, 88.89, respectively. In detection of full-thickness RCTs, the sensitivity, specificity, NPV, PPV, and accuracy of the two methods were similar (88.89, 92.59, 80.00, 96.15, and 91.67, respectively). Sensitivity, specificity, NPV, PPV, and accuracy on MRI and I-MRA in diagnosis of subscapularis tears were 50.00, 96.87, 66.67, 93.94, and 91.67 vs. 50.00, 100, 100, 94.14, and 94.44, respectively.

I-MRA has more diagnostic value than MRI in detection of partial and subscapularis tears of rotator cuff.

 The clinical outcomes of rotator cuff repair (RCR) surgeries vary because each method has its own advantages and limitations.

 This study aimed to compare the short-term outcomes of arthroscopic RCR (ARCR) and mini-open RCR (MRCR).

 In this study, we included 49 patients with a diagnosis of full rotator cuff tear who had undergone ARCR and MRCR at Poursina Hospital of Rasht and Akhtar Hospital of Tehran from 20 March 2017 to 20 March 2020. The patients were divided into ARCR (n = 24) and MRCR (n = 25) groups. The two surgical procedures were compared with each other before surgery and three and six months after surgery in terms of shoulder function based on UCLA, disability based on QUICKDASH, range of motion (ROM), and pain based on Visual Analogue Scale (VAS). Data were analyzed by chi-square, independent t-test, and repeated measures analysis of variance (ANOVA).

 There were no differences between the groups in terms of demographic details. The mean duration of surgery was significantly higher in the ARCR group compared to MRCR group (125.5 vs. 70.42 minutes). The short-term outcomes in the two groups on three measurement occasions showed a significant improvement in shoulder function, disability, and ROM in both groups along with a reduction in pain severity (P < 0.05); however, there was no significant difference between the two groups on any of the three occasions (P > 0.05).

 Shoulder function, disability, ROM, and pain were not different between the two groups, but duration of surgery was less in MRCR group. Therefore, under the same conditions, MRCR is a better choice than ARCR due to its short duration of surgery.

The aim of the study is to compare the results of anterior cruciate ligament reconstruction (ACL-R) in people aged more than 50 and under 30 years of age.

A total of 64 patients with ACL rupture were evaluated for eligibility. Thirty-two patients with ACL rupture, aged more than 50 years (54.38 ± 1.26) were matched in all of the background factors, with 32 patients suffering from ACL rupture under 30 years old. They were followed for clinical and functional results at six and on average 45.58 months after surgery. These evaluations included the Lachman test, KT-1000, International Knee Documentation Committee (IKDC) score, Lysholm knee score (LKS), return to exercise activity, post-operative satisfaction rate, and pain intensity based on Visual Analogue Scale (VAS) and rates of extension and flexion loss.

Our findings indicated that knee stability, return to exercise activity, LKS and IKDC scores, as well as pain intensity and satisfaction were significantly improved in both groups. Indeed, the satisfaction rate of patients over 50 years at six months after surgery was less than those under 30 years (P < 0.001); however, it was approximately similar to the group under 30 years of age in the final follow-up (P > 0.05). The rate of return to sports activity was also lower in patients over 50 years.

The comparable results at the patients with < 30 years demonstrated that arthroscopic ACL-R in patients over 50 years of age with no or mild DJD has good results.

Endometrial receptivity is one of the most important factors in vitro fertiliza - tion (IVF) success rate. Many different methods have been suggested to enhance the rate of implantation in IVF\ intracytoplasmic sperm injection (ICSI) cycles. Endometrial injury, as an intentional trauma aimed at improving the fertility results, has gained significant popularity among women seeking pregnancy. This study was conducted to determine the success rate of hysteroscopy and scratching before microinjection in cases of repeated implantation failure.

This prospective, randomized controlled trial consist of 228 women who were referred to the Al-Zahra Infertility clinic for fertility treatment with the history of fail - ure in at least two ICSI cycles. The patients were divided into two groups. The first group was treated by hysteroscopy without intervention, while the second group underwent hysteroscopy and scratching in the luteal phase of the menstrual cycle prior to microinjection cycle. The con- trolled ovarian stimulation (COS) was performed in all patients using the antagonist method. The success was considered based on the observation of the fetal heart activity in ultrasound.

The success rate of hysteroscopy and scratching (41.5%) was higher compared to hys- teroscopy alone (34.3%), but this difference was not statistically significant based on the Chi- square test (P=0.280). The rate of miscarriage in hysteroscopy plus scratching and hysteroscopy alone were 5.7% and 12.4%, respectively which were not statistically different (P=888). Fur - thermore, the effect of hysteroscopy and scratching on visualizing the fetal heart activity was not statistically different compared to hysteroscopy alone (P=0.223).

The results showed that the success rate in hysteroscopy plus endometrial scratching was not significantly different from hysteroscopy alone.

A series of criteria are developed to assess the patients' severity of illness in the ICU. Acute Physiology and Chronic Health Evaluation (APACHE) is a widely used scoring system (SS).  The current study aimed to determine the difference between APACHE II and APACHE IV scoring systems in predicting mortality rate and length of hospital stay in patients with head trauma referred to Poursina Hospital in Rasht. In this retrospective analytical study, medical records of patients hospitalized due to head trauma in the ICU of Poursina Hospital from February 25, 2009, to August 21, 2019, were studied.  The mortality rate of 1472 ICU patients was 39.3%. The predicted mortality rate by the APACHE II SS before and after surgery was 28.7% and 12.8%, respectively; While APACHE IV predicted 39% of deaths. The mean hospitalization duration of patients was 15±41.35 days. Also, the mean ICU hospitalization was 9.77±9.24 days. Although, the mean estimated length of stay based on APACHE IV was 6.23 67±.8 days. The APACHE IV SS underestimated the length of stay (p<0.001). According to the ROC chart, the best cut-off for APACHE IV was 66, with a sensitivity of 85.8% and specificity of 85.4%. For APACHE II, the best cut-off score was 20 with a sensitivity of 86.4% and specificity of 81.3%. Both APACHE II and APACHE IV SS can be used to predict the mortality of ICU patients, but APACHE IV is more effective and more accurate.

There are several methods like Kirschner wire, suture fixation, different plaque and etc. for surgical treatment of Neer’s type-II fractures of distal end of clavicle.

Due to lack of gold standard in treatment of fractures of distal end of clavicle, this study was conducted to compare therapeutic outcomes of tension band wire (TBW) and suture fixation (SF) in treatment of this type of fractures.

This retrospective cross sectional-analytic study was performed on patient with confirmed unilateral unstable Neer’s type-II fracture of distal end of clavicle. Based on surgeon preferred protocol for fixation of fractures, for patients from 21 September 2010 to 20 March 2013 pin and wire were used (TBW group) and patients from 21 March 2013 to 23 September 2015, were enrolled as SF group. Demographic information were recorded separately for both groups. All patients were evaluated and scored based on constant score, VAS, symptomatic hardware, loss of reduction in 3 and 6 months  and final visit after surgery.

Among 85 patients, 41 and 44 patients were allocated in TBW and SF groups respectively. Mean of follow-up time was 36.7 months. Our findings showed that both groups in three follow-up periods were similar with regard to shoulder function based on constant score, VAS score, loss of reduction, and nonunion. But SF group had lesser symptomatic hardware rather than TBW group (P=0.001).

Although the results of pain intensity and function were similar in two groups, existence of symptomatic hardware and need of hardware removal in TBW method are weak points which should be considered.

Acute Coronary Syndrome (ACS) is one of the most common causes of death in patients with Cardiovascular Diseases (CVD). In addition to the known physical factors influencing the incidence of CVD, some psychologists have pointed to the role of psychological factors such as personality type.

This study aimed to determine the role of type D personality in ACS patients in Iran in 2019.

In a case-control study, 112 participants were included. A total of 56 patients with ACS were compared with 56 matched people without ACS. They were selected by the convenience sampling method. Type D scale 14 (DS14) was used to assess the type D personality. The Chi-squared test, independent t-test, and multivariate logistic regression were used to analyze the obtained data.

The Mean±SD age in the case group was 57.23±8.562 years, and in the Mean±SD age in the control group was 57.25±8.529 years. Also, most participants in both groups were men (71.4%). The result showed that type D personality was more prevalent in patients with ACS (26% vs 7.1%; P=0.006). Based on multivariate regression analysis and after controlling for demographic and clinical risk factors, type D personality was independently associated with ACS (OR=5.323, 95% CI; 0.987-28/712, P=0.052). Also, after investigating subscales, only social inhibition had a significant association with ACS (P=0.008).

Type D personality is an independent risk factor of the ACS. Thus, type D personality may make people vulnerable to the ACS. Therefore, besides medical interventions, clinicians must consider behavioral interventions to reduce the incidence of ACS.

In developing countries, the hemiarthroplasty surgical procedure is applied for many patients with hip fractures. These surgical interventions occur with a delay because of various reasons, including insufficient hospital facilities and the deficiency of the ICU beds. Therefore, this study aimed to assess the consequences and complications of delayed hemiarthroplasty in the elderly (>60 years of age) with intertrochanteric and femoral neck fractures, regarding a 1-year follow-up. 

This retrospective cross-sectional study evaluated 392 patients (59.2% female and 40.8% male; Mean±SD age: 69.9±4.7 years) according to the presence or absence of postsurgical complications, including the limbs shortening, infection, hematoma, symptomatic pulmonary embolism, Harris hip score, and the number of deaths following cemented bipolar hemiarthroplasty. 

The majority of the patients (82.9%) underwent surgery in public hospitals, and 34% of them had femoral neck fractures. The evaluation of the trauma-surgery time interval index revealed that 39% of patients had delayed surgery (24% of which received surgery on the third day and 15.1% on the fourth day after hospital admission). The trauma-surgery time interval was significantly associated with infection (6.6%), hematoma (4.1%), embolism (2.8%), and deep vein thrombosis (4.8%) (P<0.05). The mortality rate was 0.5% (2 cases), 1% (4 cases), and 1.3% (5 cases) in the first month, 1 to 6 months, and 6 to 12 months, respectively. Also, in the first month, this analysis showed a significant (P<0.05) association between mortality rate and increased trauma-surgery time interval. According to the functional outcomes, patients with delayed surgery represented the decreased levels of Harris hip score.

Rapid preparation of elderly patients for hemiarthroplasty is considered an effective factor to reduce morbidity and mortality rates.

Evaluating the abilities of emergency medical services (EMS) staff who are in the frontline of the diseases could be an excellent reflection of the accuracy of curriculum both before and after graduation. This study was done to determine the clinical competencies of Guilan EMS staff in responding to emergency conditions using Objective Structured Clinical Examination (OSCE).

In this descriptive study, 70 EMS staff from selected Emergency Centres in Guilan were recruited. Data were collected using a questionnaire and a checklist which included 9 different skills. Validity of the checklist was assessed by obtaining the opinions of 10 experts. The content validity index (CVI) and content validity ratio (CVR) of the checklist were 0.7 and 0.8, respectively. The reliability of the checklist was obtained using the test-retest method (r=0.89). In order to collect data, observations were done using the designated checklist. Data were analysed using SPSS software version 22 and descriptive statistical tests.

Findings showed that 56.3% of the paramedics got good scores for trauma competency but the mean scores for two competencies of spinal cord immobilization and vehicle extrication were low, indicating major skills problem. There was a statistically significant relationship between education (P=0.02) and work experience (P=0.03) as well as clinical skills in confronting trauma.

Although the EMS staff had an acceptable range of performance in most of the skills, it seems that there is a need for training of performance-based competencies in which paramedics had a poor performance.

The low level of pregnancy-associated plasma protein A (PAPP-A) has relationship with unfavorable outcomes in neonates. We aimed to evaluate the association between thickness and size of placenta in singleton pregnant women.

In this prospective cohort study, we investigated 102 women in 18-23 weeks and PAPP-A level at gestational age in 11 to 14 weeks with singleton pregnancy who referred to Al-Zahra Hospital, Rasht, Iran, between 2017 and 2018. Serum PAPP-A of pregnant women was measured in the first trimester of pregnancy. Patients who had PAPP-A ≤0.5 Multiple of the Median (MOM (were dedicated to exposed group and others to non-exposed group. Placental thickness and size were assessed during second trimester by ultrasound examination and described as abnormal high thickness if the thickness was > 4 cm or more than 50% of placental length and abnormally small size when the maximum length was < 10 cm. Then, placental thickness and size of the two groups were compared.

Sixty-eight patients had PAPP-A >0.5 and 34 patients had PAPP-A ≤0.5. Women with low levels of PAPP-A in the first trimester had an increased incidence of abnormal placental thickness in 13 cases, and small placental size in 7 cases, whereas this number in another group was 12 and 7 cases, respectively (P=0.023). The sensitivity and specificity of PAPP-A.

Based on the results, the size and thicknesses of placenta in women with a low level of PAPP-A (≤0.5) were abnormal.

 Adolescence is an important and vital period in the human lifespan. Adolescent girls’ health is affected by special cultural and social factors; investing in their health requires careful planning and effective intervention. For any planning, accurate knowledge of their needs is necessary.

 This study aims to assess the healthcare needs of adolescent girls in Iran.

This descriptive cross-sectional study was conducted on 850 female students who were studying in first- and second-grade high schools in Rasht, Iran. They were selected using a multistage cluster sampling technique. In this study, a demographic form and the Female Adolescents Health Needs Questionnaire (FAHNQ) were used for data collection. The collected data were analyzed in SPSS V. 21 software using descriptive statistics. 

 According to the participants, the top priority healthcare need was related to the emotional need (23.47±12.22%), followed by social (21.02±11.68%), educational (18.63±16.01%), physical (15.12±10.34%) and spiritual needs (13.86±11.99%).

 The decision-makers in the health sector should pay more attention to the emotional needs of adolescent girls to promote their primary health.

Junk food consumption is an unhealthy adolescent nutritional habit that is affected by family structure, peer groups, and socioeconomic status. The present study was conducted to determine the association between junk food consumption and personal, familial, and social characteristics considering high school students in Rasht, Iran.

This cross-sectional study was conducted on 341 students in their second year of high school in Rasht, Iran in 2017. They were selected using a two-stage cluster random sampling. Data was collected using a checklist. Data was analyzed in SPSS 16 using Mann-Whitney and Kruskal-Wallis tests at a significance level of 0.05.

Sweet snacks were consumed the most (27.3%). Frequency of junk food consumption was significantly higher in students whose fathers had a university degree (P=0.037) and those with monthly family income of more than 2 million Rials. (P=0.004).

The results indicate that students whose fathers have a higher education and income level have more tendencies toward junk food consumption; hence, it is worth considering the relevant factors in order to improve the adolescents' health.

Adherence to patients’ rights is one of the most important ethical issues in the hospital that should be considered. An efficient health system requires active participation and proper interaction between health care recipients and providers.

This study was conducted to determine the status of observing the charter of patients’ rights and related factors from the perspective of hospitalized patients in educational-therapeutic centers in Rasht City, Iran.

The present study was a cross-sectional analytical study conducted on 342 hospitalized patients during discharge in Rasht City in north of Iran educational-therapeutic centers in 2018. The samples were selected by stratified random sampling.  The study instrument was a researcher-made questionnaire with two sections: The first section was related to individual, social, and disease-related information, and the second section to determining the status of the patient’s compliance. The obtained data were analyzed using descriptive (Mean±SD) and inferential statistics (The Chi-Square test, Friedman, and logistic regression).

The status of observing the charter of patients’ rights from the patients’ point of view was desirable at 65.8% in general, 85.1% in case of receiving health services, 3.69% in receiving information, 57.6% in the patient’s right to choose and decide freely in receiving health services, 66.7% in providing health services based on the respect for the patient’s privacy and adhering to the principle of confidentiality, and 19% in access to efficient systems to handle complaints. Also, among the variables studied, the only reason for referral (the physician’s recommendation to emergency referral) was related to the status of observance of the charter of patients’ rights and was considered as a predictor (P=0.013), OR 1.9, CI95%; 1.150-3.233).

According on presenting the results to the health service managers, emphasizing the need to observe the charter of patients’ rights by the health system staff, measures can be taken to improve the status of patients’ rights and prevent any violation of their rights, who are considered vulnerable in society.

The intensive care unit is a stressful environment due to the high mortality rate of patients, the occurrence of moral problems and working in a tense atmosphere. Faced with these conditions, nurses may be exposed to moral distresses. Therefore, it is important to study the moral distresses that nurses face in these units.

This study aimed to determine the level of moral distress and related factors in nurses working in the intensive care units of Guilan Province, Iran.

This analytical cross-sectional study was performed on nurses working in all intensive care units in 20 hospitals affiliated to Guilan University of Medical Sciences. The study samples were 414 intensive care nurses chosen by census method in 2018. The data collection instruments were the individual-social factors questionnaire and the 21-item Corley’s moral distress scale standard questionnaire. Data were analyzed using descriptive and inferential statistics (Mann-Whitney, Kruskal–Wallis and Logistic Regression).

The majority of the studied samples were women (90.6%), married (67.4%), full-time employees (44.6%), undergraduate (90.3%) with Mean±SD work experience of 75.69±9.93 months in the intensive care units. The mean total score of moral distress was 91.30±65.03 (out of 0-332 scores). Based on the final logistics regression model, gender (OR=2.410, CI95%; 1.19-5.6, P=0.016) and work experience in the intensive care unit (OR=0.64, CI95%; 0.43-0.94, P=0.023) were identified as two factors related to moral distress.

The results of this study support the existence of moral distress in nurses in intensive care units, can be considered in planning to reduce the moral distress of nurses in the workplace and improve the quality of nursing care.

Ectopic pregnancy occurs during the first three months of pregnancy which leads to extensive mortality and disability. Early diagnosis and treatment of this type of pregnancy may be helpful in prevention and reducing its complications. This study was performed with aim to evaluate the endometrial thickness and sonographic endometrial patterns in ectopic pregnancy.

This case-control study was conducted on 179 patients (91 women with normal increase of serial βHCG and diagnosis of normal pregnancy and 88 with abnormal increase of serial βHCG and diagnosis of ectopic pregnancy) with positive pregnancy result and vaginal bleeding with or without abdominal pain at first trimester of pregnancy in Al-Zahra educational hospital, Rasht from March 20, 2016 to September 22, 2017. Patients underwent vaginal sonography by a gynecologist to rule out the ectopic pregnancy. Endometrial thickness and patterns were evaluated. Data were analyzed by SPSS software (version 17), and student t-test, and Chi-squared test. P < 0.05 was considered statistically significant.

In normal and ectopic pregnancy groups, endometrial pattern was homogeneous hyperechoic, heterogeneous hyperechoic and three-layered. Based on the results of student t-test, no significant difference was observed between endometrial ultrasound patterns in two groups (p>0.05). Mean endometrial thickness in normal pregnancy and ectopic pregnancy groups were 14.8±3.1 mm and 8.2±4.9 mm, respectively which was significantly higher in normal pregnancy group than ectopic pregnancy group (p<0.0001).

Use of endometrial thickness may be helpful as a diagnostic tool in ectopic pregnancy. Use of sonographic endometrial pattern has a low diagnostic value in distinguishing ectopic pregnancy from normal pregnancy.