fazeleh majidi

The effects of ginseng on fatigue have been proven in patients with multiple sclerosis (MS), which have several similar manifestations to neuromyelitis optica spectrum disorder (NMOSD) patients. This study was designed to evaluate the effects of ginseng on fatigue in NMOSD patients.

In this double-blinded randomized controlled clinical trial, 64 patients were recruited and were allocated into two study groups (ginseng or placebo) via block randomization. The participants received either 250-mg ginseng or placebo twice daily for a 3-month period. Also, the measurement of outcome was performed using the valid and reliable Persian version of fatigue severity scale (FSS) questionnaire, which was filled by patients once after enrollment in the study and once at the end of the study post-intervention.

In total, 58 patients finished the study with no major side effects. There were no significant differences in demographic, clinical, as well as FSS between two study groups (p>0.05). Ginseng supplementation significantly reduced fatigue (40.21±13.51 vs. 28.97±14.18; p˂0.01), while patients in the placebo group showed significantly higher fatigue score after 3 months post-intervention (35.03±13.51 vs. 38.79±12.27; P: 0.02). The extent of changes in the fatigue score in the ginseng group was significantly greater than in the placebo group (p ˂0.01).

This study revealed positive effects of ginseng on reducing fatigue in NMOSD patients with no major side effects. In this regard, further studies are warranted to evaluate and clarify the effects of ginseng on fatigue in NMOSD.

This study aimed to investigate the clinical and angiographic characteristics of patients with ST-elevation myocardial infarction who experienced primary percutaneous coronary intervention failure. This retrospective observational study was derived from the Primary Angioplasty Registry of Sina Hospital (PARS). A total of 548 consecutive patients with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention between November 2016 and January 2019 were evaluated. Percutaneous coronary intervention failure was defined as Thrombolysis in Myocardial Infarction (TIMI) flow ≤ 2 or corrected TIMI frame count (cTFC) ≥ 28. The study population consisted of 458 (83.6%) males and 90 (16.4%) females with a mean age of 59.2 ± 12.49 years. TIMI flow 3 was achieved in 499 (91.1%) patients after the procedure, while 49 (8.9%) patients developed TIMI ≤ 2. The findings showed that cTFC ≥ 28 was present in 50 (9.1%) patients, while 489 (89.2%) patients had cTFC < 28. Multiple regression analysis shows that age 1.04 (1.01, 1.07), duration of pain onset to first medical contact time 1.04 (1.00, 1.18), and left anterior descending artery involvement 3.15 (1.21, 8.11) were independent predictors of TIMI ≤ 2. Even though TIMI ≤ 2 was uncommon among the study population, it was associated with adverse in-hospital outcomes. The results indicate that earlier emergency medical service arrival and shorter transfer time to the referral center can dramatically reduce the primary percutaneous coronary intervention failure rate.

Remdesivir, an antiviral medication, became an early promising therapeutic candidate for coronavirus disease 2019 (COVID-19) due to its ability to inhibit the virus in vitro. Current evidence about remdesivir treatment has been very controversial, so we aim to evaluate remdesivir to improve our knowledge about COVID-19 management and its long-term effects. In this retrospective cohort study using registered data derived from the Sina Hospital COVID-19 Registry with a 9-month follow-up, we enrolled patients receiving remdesivir and then matched a "control group" which did not receive remdesivir based on age, gender, and severity using propensity score matching. We used multivariant Cox regression to evaluate the remdesivir effect on patients' 9-month and in-hospital survival. We enrolled 227 patients, 116 in remdesivir and 111 in the control group. 213(93.8%) patients developed the severe disease, 88(38.8%) died during the 9-month follow-up, and 84(37.0%) died during hospitalization. In multivariate analysis, remdesivir did not affect the 9-month all-cause mortality and in-hospital mortality. Remdesivir was associated with increased in-hospital survival only in severe patients with diabetes (HR: 0.32; 95% CI: 0.14-0.75; P:0.008), and there was a trend for better 9-month survival in severe patients with diabetes (HR: 0.47; 95% CI: 0.20-1.09; P:0.080). We concluded that remdesivir treatment did not increase the 9-month survival rate either in patients with COVID-19 or patients with severe disease and underlying diseases. On the other hand, we found that remdesivir treatment could increase in-hospital survival only in patients with severe COVID-19 and a history of diabetes mellitus.

The head's position during mask ventilation on the time of anesthesia induction in children may improve the lung ventilation.

Current study was designed to verify whether lateral head rotation improves face mask ventilation efficiency during anesthesia induction in children.

Fifty-six patients aged 1-4 years, candidate for elective surgery, were randomly divided into two equal groups. During induction of general anesthesia, face mask lung ventilation of patients continued with pressure-controlled mode, at a peak pressure level of 10 cmH2O for children 13-24 months and 14cmH20 for children 24-48 month. In patients in the N group, the head position during ventilation was initially in the neutral position for one minute, then the head was axially rotated 45-degree to the right position for one minute and pulmonary ventilation continued in this position, then the head was rotated again to the neutral position and ventilation continued for one minute. In group R patients, mode and time of ventilation was the same, but the order of head placement was first in the lateral rotated to the right, then neutral and then lateral rotated to the right. The primary outcome was the measurement of expiratory tidal volume in each position.

Generally, the mean measured expiratory tidal volume did not change in the neutral position compared to laterally rotated head position, 256.6 vs. 233.5 ml: difference -23.1 [95% confidence interval: 10.8 to 39.4 ml]. Also, the change of head position from lateral to neutral position did not show a significant change in the mean expiratory tidal volume, 232.28 vs.247.86 ml: difference -15 .82 (p= 0.4).

The rotation of the head to the lateral position during induction of anesthesia in apnoeic children 1-4 years old could not improve the efficiency of mask ventilation relative to the neutral head position.

Since the initiation of the new coronavirus (COVID-19) in February 2020 in Wuhan, the Health Care System (HCS) has tolerated a lot of morbidities and mortalities all around the world. While the COVID -19 is spreading out the whole world, HCS carries almost all the burden as the first line. However, countries like Iran suffer from a lack of infected Health Care Workers (HCW) population data and statistics, especially the major hospitals for COVID-19 referrals. 

In this single-center cross sectional study, we studied the healthcare personnel infected by COVID-19, from February 2020 to August 2020, in a major tertiary hospital of Tehran, Iran.

Of total 1595 HCW working in Sina hospital, 389 (24%) with the mean age of 35.43 ± 8.2 years were infected by COVID-19, almost one fourth. 238 (61.2%) were women, though 92.5% of the population used Personal Protective Equipment (PPE). 140 (36%) of them were personnel of the wards assigned to the COVID-19, Personnel went on sick leave for 7.76 ± 4.64 days. 51(13.1%)  personnel had an exacerbation of symptoms, and only one of the personnel experienced COVID-19 almost twice in four months.

COVID-19 infection risk is considered to be very low for HCWs in case suitable PPE and social distancing are regarded. In our study, more than 92% of the infected personnel utilized PPE, which indicates that they might have failed to use PPE properly or might not have taken hand-hygienic precautions well. It is necessary to limit working hours and prevent excessive workload so that the staff could adhere more to hygienic precautions in hospitals or in society.

 COVID-19 has become a pandemic since December 2019, causing millions of deaths worldwide. It has a wide spectrum of severity, ranging from mild infection to severe illness requiring mechanical ventilation. In the middle of a pandemic, when medical resources (including mechanical ventilators) are scarce, there should be a scoring system to provide the clinicians with the information needed for clinical decision-making and resource allocation.

 This study aimed to develop a scoring system based on the data obtained on admission, to predict the need for mechanical ventilation in COVID-19 patients.

 This study included COVID-19 patients admitted to Sina Hospital, Tehran University of Medical Sciences from February 20 to May 29, 2020. Patients' data on admission were retrospectively recruited from Sina Hospital COVID-19 Registry (SHCo-19R). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify the predictive factors for mechanical ventilation.

 A total of 681 patients were included in the study; 74 patients (10.9%) needed mechanical ventilation during hospitalization, while 607 (89.1%) did not. Multivariate logistic analysis revealed that age (OR,1.049; 95% CI:1.008-1.091), history of diabetes mellitus (OR,3.216; 95% CI:1.134-9.120), respiratory rate (OR,1.051; 95% CI:1.005-1.100), oxygen saturation (OR,0.928; 95% CI:0.872-0.989), CRP (OR,1.013; 95% CI:1.001-1.024) and bicarbonate level (OR,0.886; 95% CI:0.790-0.995) were risk factors for mechanical ventilation during hospitalization.

 A risk score has been developed based on the available data within the first hours of hospital admission to predict the need for mechanical ventilation. This risk score should be further validated to determine its applicability in other populations.

Urothelial neoplasm (UN) of bladder is a potentially lethal malignancy, particularly in locally advanced or metastatic cases. Development of molecular markers such as HER2 and Survivin may provide useful information on diagnosis and prognosis in UN of bladder.

We studied the immunohistochemical (IHC) expression of HER2 and Survivin in 84 radical/partial cystectomy and transurethral resection (TUR) specimens with different histologic grades and stages.  All samples were obtained from pathology department of Sina Hospital in Tehran, Iran from 2014 to 2018.

From the total number of 84 UN samples, 10 cases (11.9%) had papillary neoplasm of low malignant potential, 30 cases (35.7%) had low-grade papillary urothelial neoplasm, and 44 cases (52.4%) had high-grade papillary urothelial neoplasm. HER2 and Survivin expressions were seen in 44 (52.4%) (p =0.610) and 9 (10.7%) patients (p =0.046), respectively.Survivin expression showed a mild increase in high grade UN.

Our findings suggest that the IHC expression of Survivin and HER2 are not well associated with histological grades of Urothelial neoplasms of bladder. This may be partly due to relatively small sample size and various factors such as patient characteristics or antibody specifications.

A novel human coronavirus (COVID-19) was reported in China at the beginning of 2020 and then emerged as a pandemic. Due to this pandemic, surgical practices changed worldwide. First, postponing elective surgeries to the end of pandemic was suggested. Therefore, conducting safe surgeries became a critical concern. This is a multicenter prospective study. The data of 85 patients undergoing laparoscopic surgery in this pandemic era were recorded to evaluate their postoperative outcomes. Among all patients with mean age of 43.7±15.6 and mean surgical duration of 94.6 minutes, none of them showed any complication or any COVID-19 related symptoms after surgery or in follow up time. The mean hospital stay was 3.5 days. There was no increased risk of postoperative complications and COVID-19 infection for patients undergoing various types of laparoscopic surgery in this study and laparoscopy was safe for the patients.

Context: 

Based on current literature, there is no consensus regarding the proper emergency management of Pediatric Acute Ischemic Stroke (P-AIS). In other words, there are lots of considerable controversies in this regard. Therefore, the current review was conducted to provide a more comprehensive discussion on this topic. 

Evidence Acquisition: 

The search was conducted using the terms “pediatrics”, “stroke”, and “recombinant tissue plasminogen activator” in the PubMed database. English papers on the management of P-AIS published after 2000 were selected. An expert panel performed a critical appraisal to summarize the findings and make them applicable. Finally, the extracted data were categorized under proper subheadings, and the manuscript was prepared.

The related papers provided limited evidence on this topic. All extracted findings were categorized as follows: etiology and the underlying diseases, clinical presentations, diagnosis, management (thrombolytic therapy and thrombectomy), and outcome.

Although thrombolytic therapy is recommended in P-AIS, most cases are diagnosed outside the therapeutic window, so P-AIS is practically impossible, and they are candidates for mechanical interventions. On the other hand, the proper device may not be available to fit the size of the younger children’s vasculature.