فهرست مطالب mahdiamir dosara

 It remains unclear which formulation of the corticosteroid regimen has the optimum efficacies on COVID-19 pneumonia.

 The aim of this study was to compare the clinical outcomes of 2 different regimens in the treatment of acute respiratory distress syndrome (ARDS) caused by COVID-19: Methylprednisolone at a dose of 1 mg/kg every 12 hours (low-dose group) and 1000 mg/day pulse therapy for 3 days following 1 mg/kg methylprednisolone every 12 hours (high-dose group).

 In this randomized clinical trial, patients with mild to moderate ARDS due to COVID-19 were randomly assigned to receive either low-dose (n = 47) or high-dose (n = 48) intravenous methylprednisolone regimens. Two groups were matched for age, gender, body mass index (BMI), comorbidities, leukocytes, lymphocytes, neutrophil/lymphocyte, platelet, hemoglobin, and inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and ferritin). Both regimens were initiated upon admission and continued for 10 days. The clinical outcome and secondary complications were evaluated.

 Evaluating in-hospital outcomes, no difference was revealed in the duration of intensive care unit (ICU) stays (5.4 ± 4.6 vs. 4.5 ± 4.9; P = 0.35), total hospital stays (8 ± 3.1 vs. 6.9 ± 3.4; P = 0.1), requirement rate for invasive ventilation (29.2% vs. 36.2%; P = 0.4) or non-invasive ventilation (16.6% vs 23.4%; P = 0.4), and hemoperfusion (16.6% vs 11.3%; P = 0.3) between the low- and high-dose groups. There was no significant difference in fatality due to ARDS (29.2% vs. 38.3%; P = 0.3) and septic shock (4.2% vs. 6.4%; P = 0.3) between the low- and high-dose groups. Patients in the high-dose group had significantly higher bacterial pneumonia co-infection events compared with those in the low-dose group (18.7% vs 10.6%; P = 0.01).

 The use of adjuvant pulse therapy with intravenous methylprednisolone did not result in improved in-hospital clinical outcomes among patients with mild to moderate ARDS due to COVID-19. A higher risk of bacterial pneumonia should be considered in such cases as receiving a higher dose of steroids.

One of the main objectives in neurosurgical procedures is the prevention of cerebral ischemia and hypoxia leading to secondary brain injury. Different methods for early detection of intraoperative cerebral ischemia and hypoxia have been used. Nearinfrared spectroscopy (NIRS) is a simple, non-invasive method for monitoring cerebral oxygenation increasingly used today.

The aim of this study was to systematically review the brain monitoring with NIRS in neurosurgery. Data Sources: The search process resulted in the detection of 324 articles using valid keywords on the electronic databases, including Embase, PubMed, Scopus, Web of Science, and Cochrane Library. Study Selection: Subsequently, the full texts of 34 studies were reviewed, and finally 11 articles (seven prospective studies, three retrospective studies, and one randomized controlled trial) published from 2005 to 2020 were identified as eligible for systematic review.

Meta-analysis was not possible due to high heterogeneity in neurological and neurosurgical conditions of patients, expression of different clinical outcomes, and different standard reference tests in the studies reviewed.

The results showed that NIRS is a non-invasive cerebral oximetry that provides continuous and measurable cerebral oxygenation information and can be used in a variety of clinical settings.

Coronavirus disease 2019 (COVID-19) has been pandemic and has caused a great burden on almost all countries across the world. Different perspectives of this novel disease are poorly understood. This study sought to investigate the clinical and epidemiological characteristics of COVID-19 to efficiently assist the health system of Iran to conquer the outbreak.
This retrospective observational study was performed on 394 patients with a diagnosis of COVID-19. The patients should have a history of hospitalization at Loghman-Hakim hospital, Tehran, Iran, for 10 weeks, beginning from the first official report of the disease in Iran. In the subsequent step, the baseline demographic and clinical and paraclinical information of the patients was documented. Finally, the patients were assessed if they had exhibited any morbidity or mortality.
The epidemiological examination of the COVID-19 population suggested a bell diagram pattern for the hospitalization rate, in which the 4th week of the study was the peak. The highest rate of secondary adverse events due to the virus was observed at the 6th and 7th weeks of the study course. On another note, clinical evaluations resulted in identifying specific abnormalities, such as bilateral opacity in chest computed tomography scans or low oxygen saturation in laboratory data.
This study provides evidence concerning the clinical and epidemiological characteristics of COVID-19 in the first phase of the virus outbreak in Iran. Further studies comparing the disease features in the subsequent phases with findings of this study can pave the way for additional information in this regard.

We evaluated the levels of the tumor necrosis factor-α (TNF-α), interleukin- 1β (IL-1β), and caspase-3 in the cerebrospinal fluid (CSF) and serum of COVID-19 patients to improve our knowledge about underlying mechanisms caused by this virus in central nervous system involvement.

This case series study included six COVID-19 patients from March 26, 2020, to April 17, 2020, and six healthy control patients. CSF and serum levels of TNF-α, IL-1β, and caspase-3 have been assayed using monoclonal antibodies-based ELISAs. Patients with COVID-19 had significantly higher level of IL-1β, TNF-α, and caspase-3 in serum (239.16±35.73 pg/ml, 100.50±12.49 pg/ml, 3.58±0.11pg/ml, p < 0.001) and CSF (146.66±17.55 pg/ml, 63.16±14.68 pg/ml,3.22±0.03pg/ml, p<0.001), respectively as compared to control. In addition, our results showed that these biomarkers were significantly higher in serum compared with CSF of the COVID-19 patients (p<0.001).

This study provides essential information for understanding the pathogenesis of COVID-19 infection and sheds light on the potential mechanisms of virus transmission. The obtained data could be useful for designing new prevention and treatment strategies for COVID-19.

neurosurgery reoperation that occurs for various reasons such as complications of primary surgery, planned reoperation, emergency or unplanned reoperation, and increase the financial burden of the hospital and the patient, poor prognosis, and increase the length of stay in hospital and intensive care unit for the patient. Neurosurgery patients are among the patients in whom reoperations need to be evaluated. Determining the factors leading to reoperations in the Neurosurgery Intensive Care Unit determines the causes and improves the quality of the system to prevent preventable reoperations.

In this cross-sectional retrospective study, the information of patients undergoing reoperation including the type of disease and initial surgery, reasons for reoperation were identified. The frequency of each of the three variables was examined in pairs. All reoperations and returns to the operating room during 5 consecutive years were reviewed. Information of all patients including demographic information, underlying disease, smoking and alcohol, cause of primary and reoperation surgery, medical history, type of operation, complications of the surgery, postoperative care were examined.

In this study, it was found that age, sex, initial diagnosis, the distance between surgery and readmission, underlying disease, ICU admission, were not associated with the occurrence of neurosurgery reoperation. Variables associated with the occurrence of neurosurgery reoperation include open surgery, surgical disease including Cerebrovascular, duration of the first surgery, first emergency surgery, duration of further anesthesia in the first operation, bleeding rate and need for a packed cell, Need to receive FFP, some hospital complications

Determining the factors that cause neurosurgery re-operation, prevent such surgeries if possible and reduce costs and hospital load, and also patients suffer fewer complications and mortality

Similar to industrial units, hospitals comprise of production factors including capital, human resource, technology and management. Successful performance of hospitals depends upon the way in which resources and in particular beds are allocated to patients. Thus it is necessary to implement an effective bed management so that on-demand healthcare services are accessible. In the same vein, hospitals need business intelligence tools to increase productivity, predict resource and equipment capacity and upgrade the healthcare service level so that they can achieve an effective bed management. Thus present research aimed to design a business intelligence model for bed allocation based on patient prioritization and allocation of equipment and services.

First the primary model was provided for bed allocation based on prioritization in a business intelligence concept framework. Then according to the conceptual model, required data were collected from various databases of neurosurgical intensive care units (ICUs) of Loqhman Hakim hospital by using ETL process and building data warehouse. In the next step, data mining classification algorithms were used to classify patients and develop prediction model. Then, patient classes were prioritized and simulation model was used to identify the effect of this prioritization. At last, the final model was provided.

The primary model for bed allocation based on prioritization in business intelligence concept framework was tested by data collection from 420 patients, data mining to classify them using decision tree technique with %87.02accuracy, prioritization of patient classes using PROMETHEE technique and simulation of 14 ICU beds based on collected data. Finally, it was estimated that the monthly number of hospitalized patients with and without prioritization were 76 and 86 respectively, Discussion and

After observing the positive results of the primary model for bed allocation based on prioritization including a 13 percent increase in monthly admission numbers and in turn, increased productivity proving model effectiveness, the next step was to develop a comprehensive business intelligence model for bed allocation based on prioritization of patients. The model was designed in business intelligence framework using online data collected from patients. The information provided by this model cAan be an effective decision making support for physicians and healthcare service providers in choosing patients in admission process.

The scientific evidence concerning pathogenesis and immunopathology of the coronavirus disease 2019 (COVID-19) is rapidly evolving in the literature. To evaluate the different tissues obtained by biopsy and autopsy from five patients who expired from severe COVID-19 in our medical center.

This retrospective study reviewed five patients with severe COVID-19, confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and imaging, to determine the potential correlations between histologic findings with patient outcome.

Diffuse alveolar damage (DAD) and micro-thrombosis were the most common histologic finding in the lung tissues (4 of 5 cases), and immunohistochemical (IHC) findings (3 of 4 cases) suggested perivascular aggregation and diffuse infiltration of alveolar walls by CD4+ and CD8+ T lymphocytes. Two of five cases had mild predominantly perivascular lymphocytic infiltration, single cell myocardial necrosis and variable interstitial edema in myocardial samples. Hypertrophic cardiac myocytes, representing hypertensive cardiomyopathy was seen in one patient and CD4+ and CD8+ T lymphocytes were detected on IHC in two cases. In renal samples, acute tubular necrosis was observed in 3 of 5 cases, while chronic tubulointerstitial nephritis, crescent formation and small vessel fibrin thrombi were observed in 1 of 5 samples. Sinusoidal dilation, mild to moderate chronic portal inflammation and mild mixed macro- and micro-vesicular steatosis were detected in all liver samples.

Our observations suggest that clinical pathology findings on autopsy tissue samples could shed more light on the pathogenesis, and consequently the management, of patients with severe COVID-19

 External ventricular drains (EVDs) infection is a life-threatening complication.

 To investigate the rate of EVDs infection and its predictive factors in neurosurgery patients hospitalized at a tertiary teaching hospital in Iran.

 In this survey, all patients referred to a subspecialty hospital in Tehran (Iran) with an external ventricular drain (EVDs) from Jun 23, 2018, to Jun 23, 2019, are monitored within 30 days of EVDs placement for infection. Data on demographic information, underlying diseases, number of EVD replacements, length of hospital stay, type consumed antibiotic before neurosurgery, length of tunneling, type of airway, duration of mechanical ventilation, duration of surgery(hours), surgeon name, APACHE II score, length of intensive care unit stay are collected. The diagnosis was based on the Center for Diseases Control and Prevention criteria for meningitis/ventriculitis and clinical vision of infectious or critical care specialists. A logistic regression model was developed to identify factors that can predict the infection.

 Of 81 patients with EVDs, 39 (48.1%) were infected. The mean age of patients was 44.33 ± 19.5 years, and 55.6% of them were male. According to the multiple logistic regression analysis, mechanical ventilation for more than 6 days (OR: 2.5, 95% CI: 1.6 - 3.56, P = 0.04) and length of tunneling > 5 cm (OR: 1.98, 95%CI: 1.87 - 4.76, P = 0.02) were identified as factors that could predict EVD infection. Also, consuming ceftazidime + vancomycin, as a prophylaxis agent, had a lower odds ratio for EVD infection (OR:0.4, 95% CI: 0.08 - 0.84, P = 0.04).

 Regarding the predictive factors of EVDs infection, either in the present study or other studies, there should be strategies to manage this life-threatening infection in neurosurgery patients.

The length of hospital stay is an important indicator that can be useful for financial and management planning of hospitals. If patients who are going to stay in the hospital for a long time can be identified immediately after admission, Appropriate resources can be made available to try to speed up health care right from the start. Therefore, due to aging and on the other hand, the long queue for using ICU beds, the present study was conducted to determine the factors related to the length of stay of patients in the neurosurgery ICU of Loghman Hakim Hospital.

This is a retrospective descriptive study. The studied samples were extracted from 543 computer files of patients admitted to the ICU of Neurosurgery of Loghman Hakim Hospital affiliated to Shahid Beheshti University of Medical Sciences in the period 2016-2017. Then, using Spss software version 25, the relationship between each of the variables and the length of stay was analyzed using the chi-square test.

Based on the results of the study, the statistical population consisted of 543 patients with a mean age of 18.07±43.34, including 42.4% female and 57.6% male. The mean length of stay was 5/86±6/33days and the factors related to the length of stay of the 15 variables included: diagnosis, hypertension, type of surgery and postoperative complications: pneumonia, meningitis, epilepsy.

Using the information obtained from the analysis of the patient length of stay in hospitals, the goal of better allocation of resources and hospital beds and optimal productivity of existing beds can be achieved. According to the findings of this study and by better identifying and managing factors related to length of stay, the length of stay index can be improved and steps can be taken to reduce costs and waste resources.

 Bispectral Index (BIS) was introduced in 1960 to monitor the depth of anesthesia in the operating rooms. It has been recently used to monitor the sedation in the critically ill patients hospitalized in intensive care and neurocritical care units (NCCU).

 Patients in the NCCU, particularly those with prolonged mechanical ventilation require appropriate adjustments in the administration of sedative drugs. Similarly, those who require neuro protection with barbiturates need to be closely monitored in the depth of their coma.

BIS may be a useful tool in this situation, and it can also help shorten the duration of mechanical ventilation by determining the appropriate time to eliminate patients from mechanical ventilation. We conducted a literature search to evaluate the utility of BIS monitoring in the NCCU patients with subarachnoid hemorrhage, intracranial hemorrhage, coma, cerebral hypoxia, status epilepticus and traumatic brain injury.

BIS monitoring may be a useful adjunct to take care of the patients. However, further studies with a larger population and better design are required to substantiate the role of BIS monitoring in the care of NCCU patients.

Platelet volume indices (PVIs) are low on price and easily accessible criteria in today’s medicine. However, the impact of PVIs on seizure characteristics in epileptic patients is not clear.

To assess the level of PVIs in seizure affected patients and to see if there is a relationship between these results and the clinical status of patients.

The current study enrolled patients with the epileptic seizure (ES) to evaluate the PVIs for investigating whether a relationship exists between PVIs levels with duration, frequency and type of seizure. In this survey, the platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet count (PLT) were calculated for the patient.

A total of 199 patients were included in the study period, for which 59 attacks were focal seizures and 149 attacks were generalized convulsive seizures. The platelet counts and PCT were significantly higher in focal seizure than in generalized convulsion seizure. In generalized onset, MPV was significantly higher as compared to the focal onset.

The acquired data indicated that the high level of MPV and low level of PLT and PCT in generalized seizures might substantially contribute to the clinical signs of epileptic patients.

Platelet volume indices (PVIs) are inexpensive and readily available parameters in intensive care units (ICUs). However, their association with mortality has never been investigated in the post-neurosurgical meningitis (PNM). This study was designed to investigate the association of PVIs with mortality in PNM patients. This retrospective study was conducted in the adult patients undergone various neurosurgical procedures in a neurosurgery department at a tertiary educational medical center in Tehran from 2016 to 2017. In this study, platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet count were measured on ICU admission. A total of 37 patients were included, 18 of whom survived (mortality rate: 50%). PDW and MPV values were significantly higher in non-survivors than in survivors. In non-survivor patients, platelet count was significantly lower and PDW was higher at diagnosis and discharge when compared to on admission. Also, there was no significant linear correlation between Charlson comorbidity index (CCI) and platelet indices. The means of these parameters showed no significant differences in CCI categories between the two patient subgroups. The obtained data revealed that the high levels of MPV and PDW in PNM are not associated with the increased risk of mortality, whereas the decrease in plateletcrit was not associated with increased risk of mortality.