Journal of Analytical Research in Clinical Medicine
Volume:9 Issue: 1, Winter 2021

Indirect hyperbilirubinemia is one of the most common causes of hospitalization in the neonatal period and its potential association with brain damage is well established. This study was conducted to determine neurodevelopmental outcome of children who had severe indirect hyperbilirubinemia in neonatal period and received intensive phototherapy with or without double volume exchange transfusion for its management.

This descriptive analytical study was performed in healthy infants with the history of severe indirect hyperbilirubinemia and need intensive phototherapy with or without exchange transfusion. We invited the enrolled infants at their 2-3 years age. Neurodevelopmental assessment was performed by a trained nurse using Ages and Stages Questionnaire.

The mean total serum bilirubin (TSB) of studied children was 26.4±4.1 mg/dl at their neonatal period. The estimated rate of severe hyperbilirubinemia with the TSB of 25-30 mg/dl was 48.7/100,000 live born infants and 11.4 /100,000 for hyperbilirubinemia higher than 30 mg/dl. The most common cause of jaundice in patients with exchange transfusion was ABO incompatibility. At their follow up examination, the classic form of bilirubin induced encephalopathy (Kernicterus) was diagnosed in 3 neonates. Two of them had sensory neural hearing loss too. Eleven children had low score based on ASQ in at least one area. The score was less than 2SD in 3 patients.

Severe hyperbilirubinemia and kernicterus is still occurring in term and late pre-term infants. Early detection and management of severe hyperbilirubinemia may improve the neurodevelopmental outcome in high risk infants.

Primary cardiac tumors (PCT) are rare with high mortality rate and low survival. There are several treatment approaches in the PCT management. Complete surgical resection is the main base of treatment and there is disagreement on adjuvant chemotherapy or radiotherapy after surgical resection. In this case report, complete remission of the relapsed non-metastatic cardiac synovial sarcoma was observed after salvage chemotherapy and complete surgical resection.

Body vision is a novel method which examines postural indices through photogrammetric essentials. Nevertheless, its reliability and validity has not been appraised till now. We aimed to evaluate the reliability and validity of body vision system for posture assessment

This was a cross sectional study in which two examiners evaluated photographs of 71 subject using body vision system twice with two-week interval. The Body Vision system involves a Grid wall and a camera fixed in front of the grid wall at about 390 cm distances. Three standing photographs (anterior, right lateral, and posterior view) were captured for participants.

The results for inter-rater reliability analysis showed most of the parameters (74%) had excellent 95% Confidence Interval (CI), 10 % had good to excellent 95% CI, 13% had moderate to good 95% CI, and 1% had poor to moderate 95% CI (Table 2). The results for intra-rater reliability analysis showed 70-72% of the parameters had excellent 95% Confidence Interval (CI), 6-9% had good to excellent 95% CI, 12-13% had moderate to good 95% CI, and 9% had poor to moderate 95% CI. The comparison between known distances and angles on grid wall and those obtained from photogrammetric measurements showed there is no statistical significant difference (p > 0.05). Also the regression analysis showed there is a significant and positive relationship between them (R2 = 1, p < 0.05).

The results of this study showed that body vision system is a valid and reliable tool for measuring postural parameters.

Contrarily to SARS and MERS, the evidence suggests that thromboembolic events are common in patients with COVID-19 pneumonia. The clinical course of severe COVID-19 patients can be complicated with coagulopathy, causing fatal thromboembolic events and requiring adequate treatment with anticoagulant therapy. However, the clinicians should be alerted about the increase of bleeding related to aggressive anticoagulation protocols, especially in critically ill patients who undergo traumatic maneuvers. Here, we reported the case of a 55-year-old woman with symptomatic COVID-19 pneumonia, admitted to the ICU and treated with anticoagulant therapy complicated by major bleeding, probably related to prone position for ARDS treatment.

The risk of sudden cardiac death (SCD) and atrial fibrillation (AF) increase in smokers. This study aimed to determine the relationships between the repolarization and depolarization predictors of SCD in routine electrocardiography (ECG) in smokers.

Between January and August-2019, ninety-eight healthy patients smoking for more than five years were included in the study group by simple random sampling. The control group consisted of one hundred twenty-two non-smokers. In the study and control group, following a routine physical examination and blood tests, P wave dispersion in the right precordial leads (PWdR) and the left precordial leads (PWdL), T peak-end interval in the right precordial leads (Tp-eR) and the left precordial leads (Tp-eL), QRS dispersion in the right precordial leads (dQRSR) and the left precordial leads (dQRSL), and QRS duration values in the right precordial leads (QRSR) and the left precordial leads (QRSL) were calculated in routine 12-lead ECG + right precordial leads.

There was a statistically significant moderate positive correlation between dQRSRxTp-eR/QRSR-value and smoking time in the study group. Also, there was a statistically significant weak negative correlation between dQRSLxTp-eL/QRSL-value and smoking time in the study group (Respectively, R=0.52, and P<0.01, R=0.41 and P<0.01). There was a significant difference between correlation ratio of dQRSRxTp-eR/QRS-value and smoking time and dQRSLxTp-eL/QRSL-value and smoking time in the study group (Z=5.73, p<0.01).

In the current smokers, dQRSRxTp-eR/QRSR and dQRSLxTp-eL/QRSL values significantly higher than in the control group.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its effects on the organ systems have been summarized in recent literature with predominant pulmonary characteristics as a hallmark of the COVID-19 virus. Considering its accelerated appearance from Wuhan, China, in December 2019, extrapulmonary effects have been reported globally of SARS-CoV-2 involving the central nervous system (CNS), cardiovascular, gastrointestinal, renal, and hematologic systems; thus, the potential mechanisms, pathophysiology, clinical characteristics, management, outcome, and case reports per organ system are summarized in depth. The authors interpreted articles composed of case reports, case-series, meta-analysis, cohort studies, retrospective studies, and narrative reviews focusing on COVID-19 confirmed cases and their effects on the organ systems. Prevalent clinical organ system complexities include pneumonia, acute respiratory distress syndrome (ARDS), pulmonary hypertension, pulmonary embolism, hypertension, cardiac arrhythmias, myocarditis progressing to fulminant myocarditis, anorexia, nausea, vomiting, diarrhea, liver dysfunction, encephalopathy, encephalitis, meningitis, intracerebral hemorrhage, acute kidney injury, and hypercoagulability causing stroke and disseminated intravascular coagulation (DIC). This comprehensive literature review article will help clinicians and researchers gain insight about SARS-CoV-2 and its diverse effects on multiple organ systems involved, therefore help implement prospective management and preventative measures.

Guillain-Barré syndrome (GBS) and Miyastenia gravis (MG) are common neurological autoimmune diseases. With this study, we aimed to compare the patients’ complaints, clinical course and laboratory parameters of both diseases.

This study was carried out as a retrospective file scan. The study covers the dates between April 1, 2017, and April 20, 2020. The GBS and MG patients were compared in terms of sociodemographic characteristics, application complaints, clinical course, laboratory findings, treatments and outcomes.

In this study, 51 patients from both groups were included. The mean age of GBS and MG patients was 52.1 ±19.4 and 43.6 ±15.8 years, respectively. Respiratory involvement of the patients was 23.5% in GBS and 17.6% in MG. When the treatments of the patients were compared, it was observed that 78.4% of GBS patients and 98% of MG received IVIG treatments. Only two patients from GBS group were found to be ex. When the laboratory results were compared, it was found that lactate, vitamin D, transferrin and total iron binding capacity results were lower in GBS patients, whereas, vitamin B12 and ferritin results were lower in MG patients and this difference was statistically significant (p <0.05).

The clinical presentation of GBS and MG is diverse and the prognosis can vary significantly among patients. Within the scope of the data obtained from the study, it was concluded that wide anamnesis and laboratory analyzes are necessary and useful for the differential diagnosis of these two diseases.

Spina bifida is a birth defect that occurs due to the disruption of the formation of the neural tube with an incidence of 1–10 cases per 1000 live births. Spina bifida can appear as an occulta or aperta type, and the latter consists of meningocele, myelomeningocele, and myeloschisis. We reported a case of a term male newborn who was presented with lethargic, bradypnea, suction reflex abnormalities, and paralysis of lower extremities. A defect was found in the spine in the thoracolumbar region showed a placode with no meningeal and skin covering, suggestive of a myeloshisis. The patient was treated in the neonatal intensive care unit, was placed on non-invasive ventilation with successful weaning, parenteral nutrition, systemic antibiotics regimen, and wound care. The patient was consulted with a neurosurgeon and was subjected to an ultrasound examination of the head that led to hydrocephalus. After experienced clinical improvement and oral tolerance, the patient was allowed for discharged and scheduled for surgery.

Sepsis refers to a set of systemic inflammatory responses to infection that cause harmful effects on the human body. Myoglobin can be used as a beneficial marker in determining the status of patients with sepsis. This study aims to investigate the changes in myoglobin and its effect on the severity and outcome of sepsis in the hospital.

In this study, patients were divided into three groups: sepsis, severe sepsis, and septic shock. Data about their age, gender, myoglobin level in 4 different times (entrance time, 6, 12 and 24 hours later) and sofa index was obtained and compared. Blood culture was taken for all patients and results were evaluated for gram-positive or gram-negative.

The patients of the three groups were not significantly different in terms of age (P=0.59) and heart rate (P=0.18). While in terms of myoglobin, there was a significant difference in every 4 times (P=0.00), hospital days (P=0.01), fever (P=0.00), and SOFA (P=0.00) so that with increasing sepsis severity, this Variables rate increased. There is no significant difference in the gender distribution ratio between groups (P>0.05). The highest rate of involvement in each group of patients is related to the respiratory tract. The outcome of patients (survival/death) in different groups is significantly different (P=0.00). A higher percentage of the cultures was gram-negative and the frequency of cultures was not significantly different between different groups. (P-value=0.86).

The level of myoglobin measured in patients had an increasing trend. Elevated myoglobin levels were also significantly associated with sepsis and mortality.

Bronchopulmonary sequestration (BPS) is a rare congenital anomaly of the lung that has two different types as intralobar and extralobar. In this study, we aimed to present six cases of intralobar sequestration with atypical findings in terms of feeding, drainage and, localization.

Patients diagnosed with intralobar pulmonary sequestration in our clinic between 2015-2019 were evaluated retrospectively. Demographical features and atypical Computed Tomography (CT) findings of the patients were presented by literature.

Among 45 patients with intralobar sequestration, six ones (13.3%) (5 males and 1 female) with a mean age of 43.5±25.4 (0-78) years old) had atypical pulmonary findings on CT images. Atypical features regarding arterial supply was detected in 8.9%, venous drainage in 2.2%, location in 4.4%, radiological appearance ın 4.4% and co-existing lesion in 2.2% of the patient with intralobar sequestration.

Typical and atypical features of pulmonary sequestration must be well-known for differential diagnosis of solid or cystic pulmonary lesions.

Asthma is a chronic pulmonary inflammation occurred in response to different allergens, leading to respiratory system insufficiency. The production of different inflammatory factors and enhanced immune system response may affect the function of other organs. The aim of this study was to investigate the expression of inflammatory microRNAs in cardiac tissue in asthmatic rat model.

In this study, the animals were allocated into Control and Asthmatic rats (n=8). To induce asthma, rats were challenged with ovalbumin. 14 days after induction of asthma, rats were euthanized and Hematoxylin-Eosin staining was performed to assess pathological changes in pulmonary tissue. Serum levels of cardiac enzymes were measured using ELISA kits. Finally, transcription level of inflammatory miRNAs, miRNA-146a and -155, were measured using real-time PCR analysis.

Based on our findings, histological examination indicated the existence of pathological changes in pulmonary tissue after asthma induction. Bright-field analysis revealed an existence of inflammatory response and cytotoxicity in cardiac tissue. Also, the serum levels of CpK-MB, ALT, and AST were significantly higher in the serum of asthmatic group compared to control group (p<0.05). Finally, asthmatic condition induced the expression of (2-fold) miRNA-146a and (1.5-fold)-155 in cardiac tissue, respectively.

As a conclusion, it could be concluded that asthmatic condition induces systemic inflammation in cardiac tissue. On a more general note, we propose that therapeutical approaches directed to inflammatory pathway may be required to preserve cardiac injuries caused of asthma.

Various fetal surveillance tests are proposed to reduce the rate of stillbirth in diabetic mothers, however there is no sufficient evidence to support this.

The purpose of the present systematic review was to assess the effects of fetal testing on reducing fetal mortality in pregnancies with diabetes.

The databases were searched to find English and Persian articles published from 1975-2018 about antenatal fetal assessment in pregnancies complicated with diabetes. Relevant sources cited in the selected publications were also searched manually. Keywords were GDM, pregnancy, fetal testing, fetal surveillance, NST, BPP, CTG. A total of 1954 studies were identified. Of these, 1913 were excluded on the basis of title and abstract review.

Among the 41 studies retrieved for detailed full-text analysis, a total of 10 fulfilled the inclusion criteria for the analysis. Still birth rate was 5.6/1000, cesarean rate was 418/1000. In diabetic pregnant women (gestational and overt diabetes) with well controlled blood sugar who did fetal surveillance tests the intrauterine fetal death rate isn’t different with general population.

As this systematic review suggests, fetal mortality is rare with fetal surveillance tests in pregnant diabetic women with good blood sugar control. No randomized clinical trial has been conducted to investigate this claim.

Intravascular volume is the most important factor in determining patients' hemodynamic status. This present study aimed to assay the predictive value of aorta artery diameter and inferior vena cava (IVC) diameter in trauma patients with hemorrhagic shock.

This was a cross-sectional study conducted on 69 trauma patients who referred to Imam Reza Hospital in Tabriz. Inclusion criteria were all trauma patients with hemorrhagic shock. Patients with diseases such as liver disease,cardiovascular,coronary heart disease and concurrent dehydration were excluded. Odds ratios and Adjusted odds ratios for the risk of events were obtained using cumulative logit ordinal regression model with version 15 of Stata software.

There were 58 men (84/1%) and 11 women (15/9%) with an average age of 36.4±12.4 year. Findings showed that for one unit increase in the diameter of the aorta by controlling the effect of other variables, the odds of mortality decreased for 2% compared with hospitalization in ward or intensive care unit (ICU). The reduction was also statistically significant (P=0.037). Furthermore, by modifying the effect of other variables, one unit increase in the diameter of IVC during inhale and exhale, increases the odds of hospitalization in ward or ICU.

This study showed that the diameter of the aorta and also the diameter of IVC during inhale and exhale can be used to predict the outcome of trauma patients with hemorrhagic shock and eventually to take steps for emergent and effective treatment.

Rapid and accurate diagnosis of the disease can have many effects on the healing and recovery of patients, so we decided to investigate the accuracy of Brucella capture diagnosis with Coombs-Wright in patients with brucellosis.

The present study was descriptive and on patients who were referred to clinics with symptoms of brucellosis. Blood samples were taken from all patients. Patient information including age, sex, response to Coombs, Coombs Wright, and Brucella capture tests, as well as patient response to treatment, were entered into a pre-prepared checklist. After obtaining laboratory tests for serological tests, patients were finally included in all patient information, including demographic information, laboratory tests, and analyzed by SPSS v16.

This study was performed on 91 patients with brucellosis with a mean age of 34.6 years and 75.8% male. In this study, 84.6% of patients showed a positive Coombs test and 26.4% of patients showed a titer of 1.80. 85.7% of the patients showed positive Coombs Wright test and 29.7% of the patients had a titer of 160.1. In the study of Brucella capture tests in patients, 98.9% of patients showed a positive test, of which 34.1% had a titer of 1.60% of the test.

The results of this study showed that the Brucella capture test is a powerful test for the diagnosis of brucellosis, and in the same condition, patients are more likely to be diagnosed with two Wright and Coombs-Wright tests.

Considering the mixed results reported about partial nephrectomy with and without pedicle clamping, this study aimed to compare the impacts of these two techniques on renal functional outcome.

this descriptive analytical study was conducted on 40 patients with renal cancer who underwent partial nephrectomy. They were randomly assigned to pedicle clamping (20 patients) and non-clamping groups(20 patients). The day before surgery, the routine tests as well as DTPA scan were carried out and some questions were asked from them; during the surgery, the amount of blood loss and the duration of pedicle clamping were measured; and after the surgery, the needed tests were performed for all of the patients. Also, 3 months after being discharged from the hospital, DTPA scan was carried out for all of the patients once again. Finally, the obtained data were all fed into SPSS v18 and the needed statistical analyses were performed.

The levels of operative blood loss(P=0.000) and blood transfusion(P=0.001) in non-pedicle clamping group were higher than other group. The mean duration of surgery in the clamping group was 139.2 minutes and non-pedicle group 149 minutes (P=0.258). The results of renal scans 3 months after the surgery indicated that the level of renal function decline in the pedicle clamping group was significantly higher than that in the non-pedicle clamping group(P=0.000).

The results of this study indicated that partial nephrectomy without pedicle clamping can lead to a better renal function in the short run.

Pancreatitis is considered as the most prevalent serious disorders of endoscopic retrograde cholangiopancreatography (ERCP). Different approaches have been suggested to prevent or reduce this complication. Therefore we aim to investigate them in the current study. This systematic review was performed in 2019 using Pubmed, Embase, google scholar and Cochrane library. Two reviewers selected eligible studies and outcomes of interest were extracted. Meta-analysis was done by using the random or fixed-effect models. I-square statistic test was used for heterogeneity analysis.

Totally, 2758 articles were searched. Thereafter duplicated and irrelevant articles were excluded, and six articles were entered to the present study. Six RCTs were considered eligible with a total participants of 1685.

The relative risk of PEP was not significantly different in NSAID and hydration groups (Pooled RR=1.19, 95%CI: 0.40 to 3.50, P-value=0.74). The random effect model indicated no significant differences between NSAID and NSAID+hydration groups regarding the incidence of PEP (Pooled RR=2.19, 95%CI: 0.70 to 6.88, P-value=0.17).

Additionally, the results of one study showed that rectal indomethacin alone appeared to be more effective for preventing PEP than no prophylaxis, PSP alone, and the combination of indomethacin and PSP. Using NSAIDs alone or the combination of NSAIDs and hydration can reduce the risk of post-ERCP pancreatitis. Lack of studies comparing different approaches of prophylaxis in post-ERCP patient or the reporting of different parameters among the existing studies seriously limited the possibility and quality of meta-analysis. Further well-designed studies with accurate reporting of data is necessary to provide more reliable conclusion.

In this study, we aimed to examine the Computed Tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) findings of the pulmonary hamartomas

Histopathologically (after surgical excisional, transbronchial, or transthoracic biopsy) proven pulmonary hamartomas in our institute between 2007 and 2013 were reviewed retrospectively. The CT and PET/CT images were interpreted regarding the lesion diameter, number, location, components and standardized uptake values (SUVmax).

A total of 22 (2 endobronchial and 20 parenchymal) hamartomas detected in 21 (11 males and 10 females) patients (an endobronchial and a parenchymal lesion in the same patient). Right lung (63,7%) involvement was common than left lung (36,4%) and upper lobes (50%) involvement than lower lobes (25%). 54,5% of the lesions has smooth margins while 40,9% have lobulated contour and 4.5% had irregular margins. Fat density was observed in 54,5% and calcification in 40.9%. In 18.2% of the lesions neither fat density nor calcification was seen. There was no FDG uptake in 5 lesions. Mean SUVmax value was 1.6±1.0 (range between 0 and 3,2). A SUVmax value > 2.5 was observed in 5 ones

Our results were generally consistent with previous reports. But we found a higher female/male ratio and and more common upper lobes involvement of pulmonary hamartoma

Calreticulin (CALR) is a 46 kDa protein in the endoplasmic reticulum and is one of the major proteins in ca2+ binding; it has a key role in oxidative stress, transcription factor activation, and as a chaperone in newly synthesized protein and glycoprotein folding. The high expression of CALR is pivotal for cardiac development in the embryonic period. It has been showed that mutation in exon 9 of CALR causes loss of C-terminal function and contributes to cardiovascular disease (CVD) development.

It could conceivably be hypothesized that in addition to the general risk factors, the specific gene defects which are less considered can contribute to CVD development. In this regard in this study the possible existence of CALR mutations in CVD development is determine in patients younger than 40.

Thirty patients younger than 40 were recruited for this study, 86.7% (26) were male, and just 13.3% (4) were female. The amplification refractory mutation system-PCR was used to identified mutation in exon 9. The CVD risk factors, including blood pressure, type 2 diabetes, dyslipidemia, history of smoking, alcohol drinking, and familial CVD development were evaluated.

In none of the patients, CALR mutations were detected. Since CALR defect causes accumulation of glycogen in the heart's cells and contributes to CVD development, our results confirm this, so that 76.7% of patients did not have diabetes.

The findings of the current study show there is no significant differences between exon 9 CALR mutation and CVD development.

The H antigen is the precursor substance for A and B antigens formation on red blood cells of an individual and absence of it is termed as H deficient phenotype. If H antigen is absent on both RBCs and secretions, and then the resulting blood group is a Classical Bombay phenotype with anti-H antibodies in their serum. If H antigen are absent on RBCs and present in secretions and plasma, the resulting blood group is Para-Bombay phenotype. Genetically Para-Bombay’s lack an active H gene (genotype is hh) but carry at least one Se gene (Secretor gene). Para-Bombay or red blood cell (RBC) H negative secretor individuals may or may not have anti-H in their serum. In both cases routine blood grouping is O.

Case Report:

Blood sample of 24-year-old female is submitting in blood bank, resulting her routine grouping O RhD positive. Complete blood grouping by Gel technology revels her forward grouping is Oh and reverse grouping B. Patient is secretor for B and H antigens. Absorption and elusion test is negative. Family grouping was also done to find out compatible blood and her family genesis.

Patient blood group is Para-Bombay B. Complete blood grouping (Forward and reverse) as well as saliva grouping and absorption /elusion test is advisable when there is a discrepancy in ABH grouping.

Congenital hypothyroidism is a common inborn endocrine disorder. Asymptomatic presentation in majority of cases mean that its diagnosis may be missed especially in settings where newborn screening is absent. We present a case of delayed diagnosis of congenital hypothyroidism and emphasize on need for high level of suspicion to aid prompt diagnosis and treatment. Our case is a 3 year, 4 months old male, who was first seen at 5 months of age on account of poor growth. He passed meconium after day four of life, developed jaundice in first week of life, and slept a lot in neonatal period. He had coarse faces, protruding tongue, widened anterior fontanelle and herniation of umbilicus. He was started on oral levothyroxine 50 microgram daily. In resources limited settings where universal newborn screening is absent, healthcare workers should have a high level of suspicion in picking up the early signs of the condition.

Herniation of the bladder towards the inguinal canal is a rare condition. A 76-year-old male patient with long-term left groin swelling was admitted to the emergency clinic complaining of abdominal pain that started about 5 hours ago. The patient, whose abdominal examination was normal, had an incarcerated hernia in the left inguinal region. On superficial ultrasonography, intestinal loop herniation in the left inguinal canal and adjacent loculated fluid of 60x20 mm in size was observed. In the computed abdominal tomography, it was determined that the majority of the bladder had passed through the left inguinal canal and into the hernia sac. Lichtenstein method hernioplasty was applied to the patient who was taken to emergency surgery. Isolated bladder herniation is an extremely rare condition. Recognition of bladder herniation in the preoperative period may prevent possible complications during surgery.

Alveolar echinococcosis(AE) is a tumor-mimicking parasitic disease caused by Echinococcus multilocularis. We have aimed to present the radiological imaging findings of AE characterized by malignant features.

The radiological findings of 20 patients were evaluated retrospectively; who were admitted to our hospital in the Van province in the years between 2014 and 2020 and who were diagnosed with AE. Of these patients, 30% had been operated due to a preliminary diagnosis of a tumor. The study was conducted retrospectively by examining the drawback radiological images of patients from the radiological data archiving system. The diagnosis of AE was confirmed when lesions manifested the following radiological imaging

irregular margins, no contrast uptake in dynamic contrast images or late peripheral enhancement, presence of calcifications, and contralateral lobe hypertrophy.

The mean age of the patients at the time of diagnosis was 50.95 (12-86) years. Of the patients, 15 (75%) were women and 5 (25%) were men. Typical histopathological and radiological imaging findings were present in 8 (40%) and 17 (85%) patients, respectively. Only 12 (60%) out of 20 patients had seropositivity by ELISA. The remaining 8 (40%) patients were seronegative.

Radiological imaging examinations are essential in the diagnosis and the evaluation of the extent of the disease. Different radiological technic can be used to differentiate AE from other diseases. Early diagnosis is important for avoiding unnecessary or inadequate operations due to a misdiagnosis and for preventing potential complications.

Considering the importance of tetanus vaccination in children and adults, recognizing the necessities and priorities of tetanus vaccine injection is essential for health care providers. Medical interns have a crucial role in treating patients at hospitals and as future physicians. This study aims to evaluate Tabriz University of Medical Sciences medical interns' knowledge about tetanus vaccination in patients with trauma.

All interns of Tabriz University of Medical Sciences enrolled in the study. Interns who did not want to participate in the study and those on-call were excluded from the study. Eventually, 250 interns gathered in a conference hall, and a questionnaire of 10 questions was presented to them as a hypothetical traumatic event. Correct and incorrect answers to each question, age, and gender were analyzed.

Only in three questions, more than half of the participants answered correctly. These were questions 10, 1, and 2, with 67.2%, 59.2%, and 50.8% of participants answering them correctly, respectively. Also, in 5 questions, less than 20% answered correctly. The maximum overall score was 7. Analysis of these results between the two sexes did not show a significant difference in the number of correct answers and the percentage response to each question. Additionally, age was not indicated as a variable involved in the total score of the participants.

Regardless of the age and gender, Tabriz University of Medical Sciences’ medical interns’ knowledge about the precise indications of tetanus prevention in adults and children is poor.

Creutzfeldt-Jakob Disease (CJD) is a rare rapidly progressive neurodegenerative disease. The diagnosis of CJD is based on magnetic resonance imaging (MRI) findings, electro-encephalography (EEG), or 14-3-3 protein detection. We report a case of a previously-healthy 72 years old woman, with evidence of coronavirus disease 2019 (COVID-19), who complained of behavioral changes and rapidly progressive dementia. While hospitalization, she didn't have orientation to time and place and repeated an irrelevant sentence in response to questions. Also, anomia and impaired comprehension was observed. Myoclonic jerks, abnormal signal intensity at bilateral parieto-occipital cortices in MRI, periodic sharp wave complexes in EEG, and increased lactate dehydrogenase in cerebrospinal fluid (CSF), highly recommended CJD for her. This is the second case of CJD after COVID-19 during this pandemic, which can be an alarm to clinicians about the silent impact of COVID-19 on the central nervous system.

Focal liver lesions have a broad differential diagnosis. MRI with its improved soft tissue characterization and newer sequences can significantly narrow the differentials especially when discriminating benign from malignant lesions.

T1, T1 IN AND OUT OF PHASE, T2, LONG TE T2 AND Diffusion Weighted Imaging was done in 159 patients with USG documented focal liver lesion. Qualitative and quantitative assessment of ADC values and long TE images was done and a threshold for differentiating benign from malignant lesions was obtained. The MRI diagnosis was compared with final diagnosis obtained from histopathology in most cases or follow up and other tests (markers and RBC scan) were histopathology was not available. Sensitivity, specificity and accuracy of MRI sequences in differentiating various focal lesions were obtained.

T1 weighted images were useful for identifying fat, hemorrhage and iron within the lesions. T2 weighted imaging was able to correctly classify 82.0% lesions as malignant and 83.7% lesions as benign. Long TE T2 images were highly accurate in distinguishing haemangiomas and cysts from solid lesions. On diffusion-weighted (DW) imaging, 89.5% (i.e. 60 out of 67) lesions were correctly classified as malignant and 88.0% (i.e. 81 out of 92) lesions were correctly classified as benign. Threshold ADC value of 1.37 × 10-3 mm2/s is highly accurate for differentiating malignant from benign lesions.

DWI is a sine qua non in liver lesion assessment allowing improved detection and characterization. Long TE T2 weighted imaging can accurately detect haemangiomas and cysts and rule out metastasis.

With current technological development, finding and exploring novel chemical compounds from natural material sources can be one of significant purposes for researchers. Especially, saffron is known to be the highest-cost medicinal plant, a high-grade spice, and an outstanding dye. Concomitantly, the final saffron products truly affect much their quality to protect the rights for the consumer, as well as its available healthy benefits can be utilized for treating or preventing various diseases. Herein, the chemical characterization and health effects of saffron are shortly introduced and summarized through treatment and prevention of different diseases (i.e.: cancer, liver, ocular, diabetes, antidepressant, Alzheimer and gastrointestinal diseases), which can favor readers understanding clearly the saffron advantages through this short review. Moreover, it can provide relatively for choosing an effective drying method to maintain the product qualities and facilitate the industrial production of saffron.

In developing countries, which is an endemic region in terms of tuberculosis, there is an urgent need for fast, accurate, and inexpensive serological testing. The aim of this study was to determine the diagnostic value of patient serum IgG antibodies by ELISA in the diagnosis of Mycobacterium tuberculosis.

This case-control study was performed on patients with pulmonary tuberculosis in 2017-2020. After selecting the case (n = 30) and control (n = 30) subjects according to inclusion criteria, their blood samples were obtained and analyzed in the reference laboratory by standard kits for immunoglobulin G against 16, 36, and 40 kDa antigens of mycobacterium tuberculosis.

The mean age of the subjects was 47.07 (15.57%). The majority of participants were 46 (51.1%) women. There was no significant difference between the two groups regarding sex and age. serological examination of patients with pulmonary tuberculosis showed 25 positive results and only 4 of the control group had a positive result. Sensitivity, specificity, positive and negative predictive values of serology test were 83.3%, 86.67%, 86.20% and 87.88% respectively.

Despite the acceptable sensitivity of the serologic immunoglobulin G test, according to the statement of World health organization (WHO), it did not possess an acceptable specificity. It is recommended that a a wider range of different antigens to be studied also it is essential to evaluate the diagnostic value of the other immunoglobulins inpatient in different stages of the disease.

Recurrent cellulitis is one of the cutaneous tuberculosis mimickers. As the skin lesion can mimic other skin diseases, the diagnosis can easily be missed especially in immunocompetent patients without any other risk factors. We present a case of a 62-year-old lady with history of right hand extensor tenosynovitis presented with right hand and forearm swelling and pain, associated with fever. Clinically, her right hand and forearm were erythematous with a small nodule at the right elbow. She was treated for recurrent right upper limb cellulitis and thrombophlebitis complicated by septic shock needing several courses of antibiotics. However, she did not show any significant response to the treatment. Multiple septics work up were carried out and all were negative, except aspiration of her right elbow nodule was positive for Mycobacterium tuberculosis. Anti-tuberculous treatment was started but unfortunately, she succumbed due to nosocomial infection.

Umbilical granuloma so far can be treated with surgery or with silver nitrate. In limited facilities such as in remote areas where the surgeon is limited, pharmacological therapy with silver nitrate or topical steroid can be given. However, treatment with silver nitrate requires medical personnel and has unfavorable adverse effects if done by improper technique. This systematic review aimed to evaluate the effectiveness of topical steroid for treating an umbilical granuloma compared to silver nitrate therapy.

The literature search was done using search engines including PubMed, Embase, and Google Scholar. Literature selection was performed with limitations from 2000 to 2020 to get the novelty and written in the English language with a target population of infants less than 6 months were included. To retrieve the articles, topical corticosteroids, topical steroids, and umbilical granuloma were used as keywords.

The findings from the included studies show similar sample characteristics. The study conducted by Brodsgaard et al. had an older mean sample age than the study of Ogawa et al. (53.4 vs 31 days). The risk of topical steroid treatment failure on an individual study conducted by Brodsgaard et al. and Ogawa et al. was 3.0 (0.33–27.23, p = 0.33) and 0.94 (0.40–2.21; p = 0.33), respectively. Overall analysis, the risk of treatment failure was 1.09 (0.49–2.43, p = 0.82), there was no difference between the two interventions.

One of the umbilical granuloma treatment options that can be considered is topical steroids, such as clobetasol proprionate 0.05% or betamethasone valerate 0.12%. When compared to silver nitrate, topical steroids have a longer therapeutic healing time but with a better safety profile. The non-inferiority study of topical steroids to silver nitrate has not been met yet.

Medicinal mushrooms are known and used to be nutraceuticals for centuries to enhance health benefits as well as to treat several diseases. Among them, Ganoderma Lucidum (i.e.: G. Lucidum, or red Reishi, or Lingzhi) is appreciated as a medicinal mushroom or significant herbal food for treating diseases, extending life and developing drug. It is detected in different locations, likely contributed confusing concerning its classification. Concomitantly, it has utilized as tea, in alcoholic drinking, and as a complementary medicine to bestow numerous health benefits. Thereby, it is truly important to identify chemical constituents and provide its activities in health benefits regarding these products. Herein, we hope that it is likely a good and right approach for utilizing and encouraging this product, as well as its advantages will be shortly summarized in disease treatments.

Central serous chorioretinopathy (CSCR) is a condition of choroidal and retinal pathologies that may affect vision, so we assessed vision by the ocular wavefront in the acute form of CSCR.

This cross-sectional study included 21 cases (16-male, 5-female) of acute onset CSCR was referred to the retina clinic of Nikookari Eye Hospital. Visual acuity and ocular examination with and without pupillary dilation record. Central macular thickness and sub-foveal fluid height of all patients measured by spectral-domain optical coherence tomography (SD-OCT). All of them fulfilled binocular visual function analyzer by Tracy Technology after complete pupillary dilation. The items such as spherical equivalent, total root mean square, total lower-order aberration, total higher-order aberration, defocus, astigmatism, secondary astigmatism, coma, spherical aberration, trefoil, Strehl ratio in point spread function, the average height in the modulation transfer function, and root mean square error registered. Generalized Estimation Equations (GEE) were used to compare two groups of affected CSCR and normal contralateral eyes.

The mean uncorrected distance visual acuity in the CSCR eyes is (Decimal Notation) 0.82±0.17 and in the contralateral eyes is 0.95±0.09 (P=0.002). Analysis of macular OCT data CSCR group represents: central foveal thickness 485.9±165.12 μm and mean fluid height 284.3±165.42 μm. The mentioned optical parameters of ocular wavefront aberrations do not have significantly different results in the two groups.

Our study showed CSCR reduced uncorrected visual acuity but it did not detect significant ocular wavefront changes in acute CSCR

The World Health Organization (WHO) declared a pandemic in March 2020 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the neurotropism feature of the coronavirus and growing number of COVID-19 associated neurological disorders, including Guillain Barre syndrome (GBS), we conducted a systematic review to thoroughly describe the clinical features, diagnostic workup, and clinical outcome of COVID-19 associated GBS in 78 cases.

We identified case reports and case series of COVID-19 associated GBS by conducting a search in the PubMed/MEDLINE and EMBASE databases. We assessed the quality of studies using an appraisal checklist presented by Cochrane Murad et al. Extracted data included demographic characteristics, clinical presentation, diagnostic workup, and outcome.

The systematic search yielded a total of 60 articles reporting 78 patients with a diagnosis of COVID-19 associated GBS. The patients were mainly male (65.3%) with an average age of 57 years. The ascending symmetrical paresis was the most common presentation (79.4%), with demyelinating pattern in 54 patients (79.4%). The CSF analysis showed albuminocytologic dissociation in 48 patients (75%). The mortality of COVID-19 associated GBS was estimated as 6.4% attributable to progressive respiratory failure.

Given the associated morbidities such as respiratory failure in patients with COVID-19 associated GBS, its timely detection is crucial to prevent poor clinical outcomes. On the other hand, clinicians must be vigilant to identify the clinical findings of SARS-CoV-2 infection in newly diagnosed GBS patients, as this might be a neurological complication of the subclinical viral infection.

In recent years, there has been a growing concern about the lack of adequate nutrition Knowledge among nurses. Nutrition training in the medical curriculum and for healthcare professionals is contradictory, inadequate, and weak. Nurses are one of the most reliable sources of nutritional information for patients; and yet, little research has been done so far on nurses’ information regarding their important role in nutritional care. Our study is designed to assess the current level of Knowledge, attitudes, and practices of nurses in intensive care units (ICUs).

A four-part questionnaire was used in this study. This descriptive cross-sectional study was conducted from July 2019 to July 2020. The sample size consisted of 110 nurses based on the statistical data obtained from the nursing offices of two hospitals of Tabriz University of medical science including all the nurses working in the ICUs. Thereafter, all questionnaires were re-collected and data were finally analyzed.

Results showed that from 110 nurses which were included in this study, 73.6% had high Knowledge, 45.5% had moderate practices, and 58.2% had a positive attitude about nutritional support. Age and level of education had a significant correlation with their knowledge (P=0.005 and P=0.001, respectively). Nursing attitude had a significant correlation with age and the level of education (P=0.03 and P=0.003). And also, nursing practice had a significant relationship with age, work experience in the ICU, and the level of education (P=0.001, P=0.001 and P=0.004, P<0.05).

Nurses surveyed in this study had a high knowledge, moderate practice and a positive attitude regarding nutritional care in patients admitted to the ICU.

Background :

Parkinsonism as a group of movement disorders, exhibit similar clinical presentation. Therefore, clinically differentiating these diseases is difficult. We investigated the diagnostic value of 99m Tc-TRODAT-1 SPECT in this setting. Due to the fact that this modality has some limitations in imaging small organs like the sub-regions of basal ganglia, we also evaluated the use of anatomical MR imaging along with functional SPECT imaging in parkinsonism.

This follow-up diagnostic test evaluation study was performed with 40 patients with the clinical presentation of parkinsonism, and 10 healthy subjects as controls. After administration of the radiopharmaceutical, SPECT images were acquired, then co-registered on MRI. Uptake values were evaluated in basal ganglia semi-quantitatively.

In this study, 99mTc-TRODAT-1 SPECT was able to differentiate essential tremor and healthy subjects from progressive supranuclear palsy (PSP) and Parkinson’s disease (PD) with a sensitivity of 76.47% and specificity of 100% at a cut-off of 0.53; however, findings were not significant in differentiation of PD from PSP (p ˃0.05), and the results were similar in SPECT and co-registered MRI/SPECT images. In evaluation of the uptake pattern in basal ganglia, the lateralization of decreased uptake was only seen in PD; and in PSP, the dysfunction was bilateral in all patients.

99mTc-TRODAT-1 SPECT is sensitive and specific in diagnosing basal ganglia dysfunction; however, 99mTc-TRODAT-1 SPECT alone or co-registration on MRI are not adequate in differentiation of the etiologies of basal ganglia dysfunction.

Newborns’ incapability to self-regulate their body temperature exposes them torisk of many complications. Therefore, proper initiations of nursing interventions are crucial for ensuring early stabilization after birth. The present study aimed to evaluate the impact of a multi-method training program on knowledge and practices in neonatal nurses.

This quasi-experimental research was carried out with a pre-test–post-test and intervention-control groups design. The population consisted of 60 nurses working in the neonatal and neonatal intensive care unit (NICU) of two hospitals in Iran. The samples were selected using the convenience sampling technique. A researcher-made questionnaire was used. The validation and reliability of the questionnaire were confirmed. The nurses received a multi-method training for two weeks. They were evaluated three months later.

The mean knowledge score obtained in the pre-test was 30.33 ± 2.01, and it was47.73 ± 6.82 three months after the intervention. There was a statistically significant difference in the trend of changes in the scores of the two groups (F = 125.72, P < 0.001). The mean performance score in intervention group before the intervention was 60.63 ± 5.69 and after the intervention was 81.77 ± 6.37, indicating a significant difference in the trend of changes(F = 90.285, P < 0.001).The correlation between knowledge and practice was significant at the 0.01 level (r = 0.544,P = 0.002). The previous in-service training, individuals’ education, and thermoregulation knowledge were determined as predictors of performance (r = 0.651, P = 0.013).

According to the results, a multi-method training program improves the nurses’ knowledge and performance in the infants’ body temperature regulation care.

In this study, we aimed to evaluate computed tomography(CT) findings of peripheral pulmonary artery aneurysms(PPAA) associated with Behcet Disease(BD), Hughes Stovin Syndrome(HSS), and idiopathic origin.

Contrast-enhanced CT scans of the patients were retrospectively reviewed regarding PPAA. The patients with PPA were classified into BD, HSS, and idiopathic groups according to the etiology. The groups were compared for demographical features including age and gender, multiplicity, distribution thrombosis and accompanying pulmonary artery embolism(PAE), and deep venous thrombosis(DVT) history.

A total of 30 PPAA (25.4±13.4 (11-62) mm) were detected in 10(2.3%) (mean age 39.8±22-1.0[8-73] years, female/male:3/7) among 4391 patients reviewed. In 7 patients multiple aneurysms were detected while in 3 a solitary lesion was seen. Most commonly lower lobes (right 8-left 8, 53.2%) involvement was observed. A thrombosis was detected within 19(63.4%) aneurysms. Among 10 patients with PPAA 4(40%) ones have BD, 2(20%) HS and 4(40%) idiopathic origin. In 5(50.%) patients there was accompanying PAE and 3 (30%) DVT history. Patients with BD nad HSS tended to have multiple lesions than with idiopathic origin. Accompanying PAE was observed in 2(100%) of HSS, 2(50%) BD, and 1(25%) patient in the idiopathic group. A DVT history was recorded in 2(100%) of HSS, 1(25%) BD. None of in the idiopathic group had a DVT history. The only rupture was observed in the HSS group.

Vasculitic diseases lead to PPAA, including BD and HSS are more likely to be associated with complications and additional morbid conditions than idiopathic processes.

The present study aimed to evaluate the efficacy of plasma D-dimer levels in predicting early morbidity and mortality in patients with esophageal cancer.

for this purpose, 60 patients who did surgery for middle- (n=35) and lower-thoracic esophageal cancer (n=25) were recruited. Then, preoperative plasma D-dimer levels were measured in a quantitative and qualitative manner and their relation with postoperative outcomes in each type of cancer was assessed for six months.

With regard to the middle-thoracic esophageal cancer, complications were observed in 14 cases and deaths were reported in six individuals. Considering the lower type, morbidity was found in 11 cases and mortality was seen in five patients. In both types of cancer, plasma D-dimer levels were significantly higher in patients with complications or deaths compared with those who were not. Sensitivity, specificity, as well as positive and negative predictive value (P/NPV) of plasma D-dimer levels were 90.91%, 78.57%, 76.92%, and 91.67% for diagnosing morbidity of the lower-thoracic esophageal cancer and 80%, 85%, 57.14, 94.44% for predicting mortality in this type of cancer. Moreover, the given values were equal to 71.43%, 76.19%, 66.67%, and 80% for diagnosing complications of the middle-thoracic esophageal cancer and 83.3%, 72.41%, 38.46%, 95.45% in predicting deaths induced by this type of cancer.

It was concluded that elevated plasma D-dimer levels could be accompanied by adverse events and early poor postoperative outcomes for esophageal cancer.

This study aimed at evaluating the impact of Basic Life Support (BLS) on the knowledge and performance of high school students. During a semi-experimental study, 12068 ninth-grade high school students entered the study. Course content included BLS and airway maneuvers regarding foreign body aspiration. Students' level of knowledge and performance was assessed based on a questionnaire. The mean level of knowledge of students before training was 3(3-2) and after training was 5(4-5). Approximately 60% of students had excellent scores on practical activities. We conclude that resuscitation training can be effective in promoting public health.