فهرست مطالب zahra mirzaasgari

the purpose of this study is to investigate the prevalence of burnout among medical interns of Iran University of Medical Sciences in 1400.

In this descriptive-analytical cross-sectional study, all interns of Iran University of Medical Sciences in 1400 were investigated. Demographic information such as age, gender, marital status was asked and recorded. Then the name of the hospital, the number of working hours per week and the number of months since the beginning of the internship were asked. Next, the consumption of cigarettes and narcotics and the duration of consumption or the previous history of consumption were checked. Then, a questionnaire was presented in the field of factors affecting job burnout (MBI-HSS). This scale has 22 items and measures three areas of burnout (emotional burnout, depersonalization, and lack of Personal success).

In this study, 262 interns were examined, of which 144 people (55%) had emotional burnout, 65 people (24.8%) had depersonalization, and 160 people (61.1%) had no personal success. The mean burnout score was 62.96 ± 17.04 and 241 people (92%) had burnout in general. Women had more job burnout than men, but there was no significant relationship between job burnout and gender (p value>0.05). Also, severe burnout was more in singles, but burnout was not related to marital status (p value>0.05). There was no significant relationship between smoking and drug use and job burnout (p value>0.05), but this relationship was significant with alcohol use (p value=0.01).

the results of our study showed that burnout is a very common problem among interns. Risk factors such as being single, working long hours per week, drinking alcohol and to some extent smoking make this worse. In addition, job burnout has led to the neglect of personal life and success in it.

The present study aims to investigate the effects of repeated transcranial magnetic stimulation (rTMS) on the cognitive functioning of policemen with post-traumatic stress disorder (PTSD). 

This is a quasi-experimental study with a pre-test/post-test design. The study population included all male police officers referred to the neuropsychiatric department of Imam Sajjad Hospital in Tehran, Iran, in 2022. Of these, 30 policemen diagnosed with PTSD were selected using a convenience sampling method and randomly divided into two groups of control and intervention. Their PTSD was diagnosed using a diagnostic interview by a psychiatrist and an expert clinical psychologist. Cognitive functions were evaluated using Rey’s visual memory test (VMT), Rey’s auditory-verbal learning test (AVLT), Tower of London test (TLT), Stroop test, and Wisconsin card sorting test, which were performed at the pre-test and post-test phases for both groups. The intervention group received 20-Hz rTMS at 10 sessions, including 5 seconds of stimulation and 20 seconds of rest interval between each stimulation (1000 pulses per session). The data were analyzed by multivariate analysis of covariance in SPSS software, version 22.

The intervention group showed better scores in the VMT, AVLT, TLT, residual error, number of card designs, interference score, interference time, congruent error, and incongruent  error compared to the control group

The high-frequency rTMS has a positive effect on the cognitive functions of policemen suffering from PTSD.

Head injury is a silent epidemic in developed countries and is one of the leading causes of death and disability. Determining the precise and early prognosis of head injury, especially in severe cases, is essential and will help define treatment actions and rehabilitation plans and counsel other family members. The purpose of this study was to determine the relationship between electroencephalographic findings and prognosis in patients with decreased levels of consciousness due to head injury.

This is a retrospective descriptive-analytical study on patients with reduced levels of consciousness due to head injury, referred to Tir Hospital (Tehran) in the first half of 2018. Overall, 52 patients were studied and divided according to their GCS into two groups: favorable prognosis (30 patients, 57.7%) and poor prognosis (22 patients, 42.3%). We tried to find the relation between EEG findings such as voltage, electrographic seizures, periodic and rhythmic patterns, and the prognosis.

Normal voltage was associated with a favorable prognosis, with a high specificity (95%) and a less robust sensitivity (63%). The isoelectric voltage (electrocerebral shutdown) was associated with a poor prognosis. Normal and isoelectric voltages were good predictors with 95% and 100% Positive Predictive Values (PPV), respectively. There was a statistically significant relationship between EEG frequency range and prognosis.  

This study showed that EEG parameters might provide valuable data regarding the prognosis of decreased consciousness of patients with a head injury, also for the guidance of physicians and informing the patients’ family.

One of the main parts of the early treatment of Acute Ischemic Stroke (AIS) is the attitude and knowledge of Emergency Medicine (EM) specialists. This study aimed to investigate the knowledge and attitude of emergency physicians working in Iran about the prescription of tissue Plasminogen Activator (tPA) in AIS. This was a cross-sectional questionnaire-based study including EM physicians working in different cities of Iran in 2020. A previously used English questionnaire was translated into Persian. After face validity and reliability assessment, the final questionnaire was designed as a Google form and sent to 400 EM professionals. 128 physicians filled in the forms. 64.8% of participants had sufficient attitude and 68% had sufficient knowledge about tPA treatment in AIS. The knowledge regarding tPA treatment was higher in the age>40 years, male gender and physicians with up-to-date information (P<0.05), but no significant association was found for the attitude. Logistic regression analysis showed that the amount of information about tPA administration in AIS (OR=3.475, 95% CI =1.242-9.723, p=0.018) and age (OR=0.336, 95% CI = 0.130-0.865, p=0.024) had the greatest impact on the level of knowledge for tPA treatment. About two-thirds of EM professionals in Iran had sufficient knowledge and attitude about tPA administration in AIS. Having up-to-date information and age>40 years were the major predictors of higher knowledge of AIS treatment. Holding some training workshops together with strengthening infrastructures such as establishing intensive stroke units would help to increase the use of tPA in AIS in Iran.

For a while, coronavirus disease-2019 (COVID-19) has been a major global pandemic. It primarily affects the respiratory system but has extrapulmonary manifestations such as gastrointestinal and neurological symptoms. Data on myasthenia gravis (MG), as a complication of COVID-19, are limited. We herein report the manifestation of ocular MG as an initial symptom of COVID-19. In November 2020, a 31-year-old healthy woman was referred to Firoozgar Hospital (Tehran, Iran) with left upper eyelid ptosis and diplopia as well as general weakness, myalgia, fever, and nasal congestion for four days prior to admission. Although the acetylcholine receptor antibody in her serum was negative, increased jitter in several muscles led to the diagnosis of ocular MG. Nasal swab reverse transcription-polymerase chain reaction (RT-PCR) assay tested positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Computed tomography (CT) scan of the chest revealed bilateral ground-glass opacities and some foci of consolidation formation, but the thymus was normal. The patient was successfully treated with remdesivir and dexamethasone. The patient was eventually discharged in good condition and with improved neurological symptoms. A limited number of studies have suggested a possible association between MG and COVID-19. Therefore, further data are required to substantiate the proposed association. Clinicians should be aware of ocular MG during the COVID-19 pandemic to better diagnose and manage patients with SARS-CoV-2 infection.

The coronavirus disease 2019 (COVID-19) is the most terrible pandemic of a respiratory disease that we had in the past century. Most existing studies explore different manifestations in COVID-19. Few recent studies have described neurological manifestations of patients with COVID-19 but their associations with age, laboratory findings, and mortality rates have not been explored well.

This case-control study includes 263 patients with COVID-19 without neurological symptoms (control group) and all patients with COVID-19 with the central nervous system symptoms (n = 460, case group) hospitalized between February 2020 and April 2020. Data on demographic factors, medical history, symptoms, and laboratory tests, all are extracted from medical records.

Out of 723 patients with confirmed SARS-CoV-2 infection, 460 (63.6%) were identified to have at least one neurological manifestation. The mean ages of patients with and without neurological manifestation were 60.6 ± 18.0 and 60.8 ± 15.7 years, respectively. The most common symptoms were myalgia (41%), headache (20.3%), and loss of consciousness (LOC) (16.5%). Women were more likely to develop a neurological manifestation (P = 0.001). Moreover, smoking history was significantly more in patients with neurological manifestations (P = 0.03). Also, we compared two groups in terms of tracheal intubation. The need for tracheal intubation was 19% and 12% in patients with and without neurological manifestations, respectively. Furthermore, the prevalence of intensive care unit (ICU) admission was 28% and 24% in patients with COVID-19, with and without neurological manifestations, respectively. Some of the neurological manifestations such as LOC, limbs weakness, and seizure might need more ICU admission and tracheal intubation. The frequency of comorbidities and the laboratory test results were almost similar between the two groups.

Myalgia, headache, and LOC were the most common neurological manifestations and their distributions varied depending on age. Only a few neurological manifestations were related to mortality and morbidity rates, while some of them occurred in mild cases.

Multiple Sclerosis (MS) causes brain atrophy at the early stages of the disease which leads to progressive motor and cognitive dysfunction. Brain atrophy can be diagnosed indirectly by measuring the Third Ventricle Diameter (TVD) using Trans Cranial Sonography (TCS). The purpose of the current study was evaluation of TVD in MS patients using TCS to examine its possible correlation with cognitive dysfunction and Expanded Disability Status Scale (EDSS). Seventy-four patients with a definite diagnosis of MS were enrolled in this study. Transverse diameter of the third ventricle was measured using TCS. All patients were assessed by neurological examination and the level of disability was measured via EDSS. The cognitive performance was assessed by the Brief  International Cognitive Assessment for Multiple Sclerosis (BICAMS). Pearson’s correlation was performed to evaluate possible correlations and p-value<0.05 was considered statistically significant.  From the total 74 individuals, 58.1% were diagnosed with Relapse-Remitting MS (RRMS) (n=43) and 43.9% with Secondary-Progressive MS (SPMS) (n=31). The mean EDSS score was 1.81±1.38 (Range of 0-10). The mean TVD was 5.61±1.82 cm which had no statistical correlation with the EDSS score, but it was significantly wider in group with EDSS score>3 when compared to the group with EDSS score≤3 (p-value=0.0001). The mean BICAMS score was 0.65±0.57 and there was no statistical correlation between BICAMS score and TVD.  Measuring the diameter of the third ventricle using TCS appears to be an appropriate method to diagnose brain atrophy and is associated with cognitive dysfunction in the process of MS. Our data emphasized no association between the diameter of the third ventricle and cognitive dysfunction.

Carpal tunnel syndrome (CTS) is the most prevalent entrapment syndrome in the upper limbs, for which pregnancy is a known risk factor. CTS diagnosis is confirmed via nerve conduction studies (NCSs), which sometimes is expensive, and the electrical stimulation makes it an unpleasant diagnostic modality, especially for pregnant subjects. Recently, high-frequency ultrasonography (HF-USG) is known as a diagnostic method. This study is concerned with determining the diagnostic value of this modality for CTS among pregnant women.

This cross-sectional case-control study was conducted with 40 CTS cases and 40 matched controls. The HF-USG of wrists was performed bilaterally on all participants with a focus on the median nerve cross-sectional area (MNCSA) at the carpal tunnel (CT) inlet.

Mean MNCSA was statistically different between the CTS group (11.71 ± 1.86 mm2, range: 8 to 18 mm2) and the control group (6.75 ± 1.38 mm2, range: 4 to 11 mm2) (P < 0.001). The receiver operating characteristic (ROC) curve was drawn, and the cross-sectional area (CSA) cut-off point of 8.5 mm2 showed sensitivity and specificity of 98% and 93%, respectively. The positive predictive value (PPV) and the negative predictive value (NPV) were 95% and 98%, respectively, with the mentioned point as the diagnostic threshold.

HF-USG of the median nerve can be utilized as a preferable alternative to NCS (the current gold standard diagnostic method) in pregnant women, due to its convenience and lower cost, or at least, it can be used as a screening tool among pregnant women with suspicious symptoms.

Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy in patients with hypothyroid. The diagnosis of CTS is usually clinical and confirmed by electrodiagnostic (EDX) procedures. This study aimed to describe the diagnostic accuracy of high-resolution ultrasonography (US) as an alternative method to nerve conduction study (NCS) for the diagnosis of subclinical CTS in patients with hypothyroidism.
Between April 2013 and November 2014, from the patients with the diagnosis of hypothyroidism referring to the institute of endocrinology and metabolism of Firoozgar Hospital, Tehran, Iran, those who met our inclusion criteria entered this cross-sectional study. The patients divided into two groups of subclinical CTS with the age- and gender-matched control group. US measurements of the median nerve cross-sectional area (CSA) in the CT inlet were compared with the NCS results as the gold standard diagnostic test.
A total number of 152 wrists of 76 hypothyroid patients were examined in this study. The mean of median nerve CSA at the tunnel inlet was 9.96 ± 2.20 mm2 for the CTS group and 7.08 ± 1.38 mm2 for the control group (P According to our findings, US has an acceptable diagnostic value to confirm CTS in hypothyroid patients. However, it may not replace NCS due to low sensitivity.