Journal of Analytical Research in Clinical Medicine
Volume:11 Issue: 1, Winter 2023

 Tramadol is a unique opioid and the most prescribed opioid worldwide. Tramadol-related overdose and death have been increased in several countries. Due to the high level of tramadol use, misuse, and overdose in Iran, and considering the cost and time spent doing laboratory tests for all patients, this study aimed to investigate the possible relationship between changes in laboratory findings of patients poisoned by tramadol and their neurological manifestations to evaluate the need for these tests.

 This was a cross-sectional descriptive study of patients with acute tramadol poisoning who were referred to the Emergency department of Sina hospital, Tabriz, Iran from March 2020 to March 2021. Lab tests taken from the patient in the emergency department were recorded. Meanwhile, the patients’ neurological symptoms were noted. And demographic information of patients was collected in a predesigned checklist and was analyzed by IBM® SPSS® 20.0 release software.

 A total of 95 patients including 76.8% male and 23.2% female with an average age of 28.26±10.57 were admitted to the emergency department. The most common symptoms of neurological impairment experienced by patients were seizure (32.6%) and decreased level of consciousness (38.8%). There was no relationship between the neurological symptoms of tramadol poisoning with neither arterial blood gas characteristics nor hematological factors (P>0.05).

 The neurological manifestations of tramadol poisoning were not related to arterial blood gas characteristics such as PH, PCO2, PO2, and HCO3−. Also, there was no relationship between hematological factors including white blood cell (WBC), red cell distribution width (RDW), platelets (Plt), sodium (Na), potassium (K) and blood sugar (BS), and neurological symptoms caused by acute tramadol poisoning. Therefore, requesting these tests during tramadol poisoning should be reconsidered.

Family caregivers play a large supportive role in the care of patients suffering from special conditions, such as trauma and stroke. This makes them to be at risks of variety of mental disorders such as anxiety and depression. Effective communication and nursing consulting can play an important role in managing anxiety and depression in family caregivers. The aim of this study was to investigate the effect of tele-counseling on the improvement of depression and anxiety in family caregivers of patients with trauma and stroke.

This is a clinical trial study with 80 caregivers of stroke survivors discharged from Hospital. Inclusion criteria included being the primary caregiver, over 15 years of age, lack of cognitive impairment (dementia and delirium), lack of mourning experience for the past 6 months, and patient care for at least 2 months at home. Study tools included Beck Anxiety and Depression Inventory. The data were analyzed using t test, Mann-Whitney U, Wilcoxon and ANOVA tests in SPSS software.

In the experimental group, there was a significant decrease in levels of depression and anxiety of family caregivers of traumatic patients, but no significant difference was observed in the control group before and after the intervention.

Nursing telephone consulting reduced the level of depression and anxiety of family caregivers of traumatic patients. Therefore, the development of desirable p

Kidney transplantation is accepted as the first choice treatment of chronic renal failure. While urologic complication is the most common surgical complication after kidney transplantation, femoral nerve injury is very rare, which in our department with 1500 kidney transplantation experiences between 1992 and 2019, we had only two reported cases of femoral mononeuropathy. A 55 years old woman with a duration of 4 years’ dialysis (her donor was her son) and a female with the age of 45 years and duration of 3 years’ dialysis (her donor was a cadaver) instantly after kidney transplant operation symptoms of femoral nerve injury were detected, which were the loss of knee jerk reflex, reduced resistance of knee and not being able to give the flexion position to the knee when standing or walking. The femoral nerve injury may be self-limited and it looks preventable with a careful handling of the pelvic iliac artery and gentle placement of the retractor and less time of ischemic and careful hemostasis.

Fahr’s disease is a rare condition characterized by the symmetrical calcification of basal ganglia and dentate nuclei of the cerebellum calcification. It is usually manifested by involuntary movements and psychiatric symptoms. Ataxia has been reported as an uncommon manifestation of Fahr’s disease. Herein we introduce a 41-year-old man presenting with progressive gait disturbance who was finally diagnosed with Fahr’s disease.

Statins are the most important lipid lowering drugs and their protective effects in primary or secondary cardiovascular diseases (CVDs) have been well documented. However, various number of evidences have revealed that the beneficial effects of statins regarding the CVDs are not only due to their blood cholesterol lowering properties but also because of their pleiotropic effects such as inhibition of isoprenoids synthesis, immunomodulation and neuroprotection. Type 2 diabetes mellitus (T2DM) is a systemic disease with inflammatory properties and micro/macro-vascular complications. Despite the beneficial effects of statins to lower blood cholesterol level, mortality decrease due to CVD and stroke, dyslipidemia improvement, and their anti-inflammatory and anti-coagulatory properties have not well been studied, especially in T2DM. In this review, we discuss the pharmacology, pleiotropic effects, dose prescribing and side effects of statins with a focus on type 2 diabetes.

 The coronavirus disease 20149 (COVID-19) may be associated with the elevated liver enzymes including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in which the disease has been associated with more severity. Liver stiffness (LS) is associated with the increased liver enzymes. Liver elastography is a non-invasive technique that is used to evaluate LS. This study aimed to evaluate the functional status of liver and its relationship with liver elastography results in the patients with COVID-19.

 In this cross-sectional study, 90 patients with COVID-19, whose diagnosis was confirmed by polymerase chain reaction (PCR) test, were included. Levels of liver enzymes were measured and the patients underwent liver elastography. Liver size and interquartile range-median (IQR/M) of LS were also measured. Six months later, the patients underwent another liver elastography and measurement of liver enzymes.

 The frequency of fatty liver in the case group was significantly higher compared to the control group but no significant difference was observed in the frequency of liver fibrosis between two groups. In patients with COVID-19, the LS and IQR/M values at the beginning and six months after recovery were significantly higher in the group with the increased liver enzymes (case) compared to the group without the increased enzymes (control). P value was 0.001.

 The use of elastography to evaluate LS in the patients with COVID-19 can be significantly effective in assessing the status of liver damage and inflammation of liver tissue. Since elastography is an inexpensive and non-invasive available tool, it can be used mainly in most medical centers.

 Erythropoietin (EPO) is reported to have a minimizing effect on the ischemic condition, but the detailed association between EPO and the ischemic upshot is still not clearly understood. We aimed to evaluate the effect of EPO on inflammatory response and ischemic brain damage after carotid artery clamp in rats.

 In this experimental, animal trial study, which was conducted at the Animal Facility and laboratory at Tabriz University of Medical Sciences, 50 adult male Wistar rats with (250 to 300 g) were randomly allocated to intervention and control groups. The intervention and control groups were administered intraperitoneally with equal volumes of EPO (5000 U/kg) and normal saline, respectively. Both groups had common carotid arteries clamped for 20 minutes. Using the Nissl staining technique, the slides of brain ischemic areas were observed and the rate of ischemic injury in both groups was determined. The blood level of inflammatory cytokines was also measured.

 The levels of inflammatory markers including creatine phosphokinase (CPK), interleukin (IL)-6, IL-1B and tumor necrosis factor alpha (TNF)-α in the intervention group were significantly lower than that of control group. Mean percentage of the ischemic area in the intervention group with an amount of 4.30±2.15%, was significantly lower than that of control group (11.20±2.35%, P=0.023).

 Findings of this study showed that the injection of EPO before carotid clamping is effective in preventing cerebral ischemic injury in rats.

 The objective of the present report is to perform the first comprehensive bibliometric analysis of oncolytic virotherapy research publications.

 Scopus was employed as a major database. The total number of publications was found to be 4369, majorly comprising of research articles (n=2895) and reviews (1082). The ANOVA F-test and Welch F-tests were performed to determine the significance (P=0.05).

 In all publications (3751), the total numbers of authors were 11418 and 10480 different organizations, departments or institutes. We specifically selected seven different viral strains and provided details about the co-authorship network. We also provided details about the top 10 most cited documents.

 This may provide a quantitative overview about the trends and publications in oncolytic virotherapy research.

 Delivering bad news (DBN) is an essential communication for all doctors. There are many benefits of DBN, for both the patient and the healthcare team looking after the patient. Having a general perspective of the ability of medical students in DBN can help us to improve educational programs in the future; therefore, the purpose of this study was to investigate the ability of final-year medical students to DBN.

 150 final-year medical students, who were undergoing their internship in different clinical courses, participated in this study. The translated questionnaire of SPIKES guidelines was used to measure the skill of senior medical students in DBN to patients, which includes 16 questions. Student t-test was used to compare quantitative variables and a chi-square test was used to compare qualitative variables.

 The mean age of participants was 26.19±.94 years with a minimum age of 26 years with a median of 29 years. (36%0) males and 96(64%) females formed the study population. the total score and the environmental score of DBN are significantly higher in female students. Also, according to the Pearson test, no significant correlation was observed between the age of the final year and the fields of ability in DBN (P=0.512, r=0.021).

 Due to the lack of sufficient training on how to communicate with patients and deliver bad news, adding a training program to increase the skills of medical students in DBN to the general medical training curriculum can be useful in improving the academic aspects of general practitioners.

 The purpose of this study was to evaluate the effects of positive end expiratory pressure (PEEP) on respiratory parameters and abdominal pain in patients ventilated with a laryngeal mask during cataract surgery.

 This clinical trial study included 80 patients in need of cataract surgery (40 in the group without PEEP and 40 in the group with PEEP at 5 cmH2O) who underwent laryngeal mask ventilation during general anesthesia. The parameters of dynamic compliance, pressure peak (Ppeak), tidal volume, SpO2, EtCO2, heart rate, non-invasive blood pressure, and abdominal pain were recorded at intervals of 1, 5, 10, and 20 minutes after the start of anesthesia and were compared between the two groups.

 Respiratory parameters, heart rate and systolic and diastolic blood pressure were not significantly different between two groups, and only the mean tidal volume at 5, 10, and 20 minutes was significantly higher in the group without PEEP.

 Application of 5 cmH2O PEEP during ventilation with laryngeal mask in patients undergoing cataract surgery had no significant effect on improving respiratory parameters and pain in the gastric area.

 At the beginning of the novel coronavirus disease COVID-19 pandemic, many countries around the world closed their centers and imposed restrictions on urban and interurban traffic. This situation had a significant impact on the occurrence of road traffic accidents. The present systematic review aimed to determine the prevalence of road accidents during the COVID-19 implemented lockdowns.

 This systematic review and meta-analysis were conducted based on the Joanna Briggs Institute (JBI) instructions. Two independent reviewers screened articles based on the inclusion criteria for the review and eligible studies for methodological quality using an appropriate appraisal checklist based on the study type. The statistical analysis was performed using the Comprehensive Meta-Analysis (CMA) software. Considering the heterogeneity among studies, a random effect model was adopted to estimate the pooled effect with 95% CI for binary outcomes.

 The initial search of databases yielded 849 potentially relevant articles, of which, 44 studies were included in this systematic review and of them, 36 were considered for metaanalysis. The random effect model showed an overall prevalence of injury before the lockdown of 24.9% (95% confidence interval: 20.0%-30.5%). Also, the prevalence of injury during the COVID-19 lockdown was 18.8% (95% CI: 14.7%-23.6%). Begg and Mazumdar’s correlation found no publication bias in the meta-analysis.

 Road traffic injuries, as one of the main causes of death worldwide, took on a new face with the advent of COVID-19. We have found that there is a relatively high prevalence of road traffic accidents before COVID-19 compared to pandemic period.

There are limited data on the possible association between conventional and advanced magnetic resonance imaging (MRI) findings and cognitive function in patients with multiple sclerosis (MS). Therefore, this systematic review and meta-analysis aimed to explore the correlation between MRI-derived metrics and cognitive tests in patients with MS. An electronic literature search of the PubMed, Web of Sciences, Embase, and Scopus databases was performed to identify related studies. The correlation coefficients of the MRI indices and cognitive tests were pooled. Thirteen studies were selected for inclusion of 824 patients diagnosed with MS. Most evaluated patients (60.44%) had relapsing-remitting MS (RRMS). The Paced Auditory Serial Addition Test (PASAT-3), Brief Visuospatial Memory Test (BVMT), and Symbol Digit Modalities Test (SDMT) were inversely correlated with the mean diffusivity (MD) of the brain with pooled correlation coefficient of -0.225, -0.361, and -0.438, respectively (P<0.0001). The SDMT test positively correlated with fractional anisotropy (FA) with a correlation coefficient of 0.351 (P<0.0001) and inversely correlated with T2 lesion volume with a correlation coefficient of -0.367 (P<0.0001). In the case of other tests, there was low number of studies with significant correlations being reported. We found significant correlations between some neuropsychological tests and MRI findings in patients with MS. Brain atrophy might disrupt the process of correct registration between anatomical and MRI diffusion scans. However, we did not have enough studies with exactly matched anatomical areas to evaluate correlations and we recommend that histological validation of diffusion tensor imaging (DTI) findings for brain atrophy is needed as a basis for picture processing procedures and correlation with cognition status.

 Most patients undergoing eye surgery are elderly adults with underlying cardiovascular diseases. One of the complications during recovery is gastric insufflation, which can cause detrimental effects on cardiovascular patients. The present study compares two methods of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV).

 The study enrolled 81 patients undergoing cataract surgery (41 in the PCV group and 40 in the VCV group). According to the American Society of Anaesthesiologists (ASA) classes I and II received general anaesthesia and laryngeal mask airway (LMA) ventilation using VCV or PCV. Maximum pressure (Ppeak), dynamic compliance, expiratory tidal volume, Spo2, non-invasive blood pressure, heart rate, and pain in the epigastrium and umbilical region were monitored at intervals of 1, 5, 10, and 20 minutes after the initiation of anaesthesia and the results of two groups were compared.

 The means of Ppeak and tidal volume in the PCV group as well as the means of dynamic compliance and end-tidal carbon dioxide (EtCO2) in the VCV group were significantly high. The mean diastolic blood pressure was significantly different between two groups at 20th minute. There were no significant differences in heart rate, mean systolic blood pressure, arterial oxygen saturation, or abdominal pain between two study groups.

 VCV had a lower Ppeak and a higher dynamic compliance, but PCV had a larger tidal volume and lower EtCO2. There were no differences in terms of abdominal and umbilicus pain, as well as hemodynamic parameters, between two groups.

 Flipped classrooms make learners eager to learn actively. it is based on learner-based and active learning methods. The flipped classroom is an educational strategy and a kind of hybrid learning that turns education into a learner-based model in which the class time is spent exploring topics and creating engaging learning opportunities.

 During an interventional quasi-experimental research, 90 medical students entered the study. The intervention and control group received flipped classroom and traditional education, respectively. The knowledge and skills of the participants were assessed by a standard checklist approved by the Ministry of Health. Data analysis was done by analytical statistical test after data collection.

 the mean score of students’ knowledge in performing adult examination, obtaining medical history, and pediatric examinations in all three areas between the two groups after the intervention and two months later was statistically significant (P<0.001). there was a statistically significant difference between the mean scores of students’ skills in performing adult examinations in all three areas (P≤0.001) so that the mean skill score of adult examinations was higher in the intervention group than the control group. there was a statistically significant difference between the mean scores of students’ skills in obtaining medical history (P≤0.001) so that the mean skill score of obtaining medical history was higher in the intervention group than the control group. Also, there was a statistically significant difference between the mean scores of students’ skills in performing pediatric examinations (P≤0.001) so that the mean skill score of pediatric examinations was higher in the intervention group than the control group.

 Flipped classroom increases knowledge, improves skills in instructing practical semiotics to medical students of physiopathology grade.

 Diagnosis of acute appendicitis is based on clinical manifestation .Some patients have atypical clinical symptoms, and diagnosis is difficult. Red blood cell distribution width (RDW) is a measure of heterogeneity in the size of circulating red blood cells. The aim of this study was to evaluate RDW values in diagnosis of appendicitis.

 This is a retrospective case-control study, in which 399 patients with pathological diagnosis of appendicitis were divided into two groups of acute appendicitis and complicated appendicitis and compared with 400 healthy controls for appendicitis. RDW, white blood cell (WBC), platelet count (PLT), and hemoglobin changes were compared in three groups of patients.

 In all three groups, the ratio of men was significantly higher than women (P<0.05). WBC (P=0.00), PLT (P=0.01), and RDW (P=0.01) had a significant difference between the three groups. However, there was no significant difference in the hemoglobin level between the three groups (P=0.3). RDW level was significantly higher in complicated appendicitis compared to acute (P=0.09) and control group (P=0.012).

 The results of this study showed that RDW value in three groups were significantly different. However, these values are not clinically useful for detecting appendicitis due to the slow progression of RDW value in patients.

 Breast cancer is one of the most common cancers in women. Involvement of regional lymph nodes by breast cancer has shown to be a significant marker in the overall diagnosis of patients. In this study, we aimed to investigate the role of gray-scale ultrasound and elastography in discriminating benign from malignant axillary lymph nodes in patients with breast cancer.

 In this analytical study, patients with breast cancer who were referred to sonography ward of a tertiary medical educational center and found to have suspicious lymph nodes were investigated. Formal properties were evaluated by grayscale ultrasound and tissue properties were assessed by elastography. Biopsies were performed on all cases and suspicious tissues were removed.

 This study was conducted on 50 patients with the mean age of 48.54±10.58 years. 52% of patients had a mass in their right breast and the most prevalent type of breast cancer was intra-ductal carcinoma. 60% of the lymph nodes were reported to be malignant. In 56% of the lymph nodes, grayscale ultrasound tests demonstrated unusual findings and the most common finding was the removal of fat from lymph node hilum. Moreover, elastography results indicated that 36% of the cases have grade 4 (blue) lesions.

 This study indicated that grayscale ultrasound and elastography have high sensitivity and specificity in detecting metastatic lymph nodes. This finding was in line with the findings reported in many of the previous studies.

 Although there are many forms of education, learning by doing is one of the most efficient ways of learning in the field of medicine. In Turkey, intern doctors can perform and observe many emergency interventions in the presence of supervisors during their emergency service internship. This study aimed to examine whether intern doctors have developed the necessary emergency response skills concerning some vital situations after emergency medicine internship involving their applied training and observation.

 This prospective cross-sectional study was conducted between June 2, 2022, and September 1, 2022, in the emergency department of a tertiary hospital. In the study, the emergency response skills of intern doctors were measured with a questionnaire prepared using scenarios in which emergency situations were described.

 The participants’ emergency response skills were improved in the most of emergencies described in the questionnaire. However, there was no significant improvement in emergency intervention skills related to the approach to ventricular tachycardia and multi-trauma patients (P=0.771 and P=0.45, respectively).

 Doctors doing internship in the emergency medicine clinic receive both theoretical and applied training, which increase their ability to respond to emergency situations. However, there is a need to identify emergency situations in which internship training does not sufficiently improve intervention skills and try new methods to improve the related skills.

 The coronavirus disease 2019 (COVID-19) epidemic was confirmed as global pandemic by the World Health Organization (WHO) by 11 March 2020.

 Data was collected from all the emergency medicine staff working in two referral main centers for COVID-19 affiliated to Tabriz University of Medical Sciences, Iran. The participants were enrolled in the study six months after the first COVID-19 hospitalization and the COVID-19 Anxiety Scale (CDAS) was used.

 According to our results, while 46 (20.7%) participants had a moderate anxiety score, 26 (11.7%) had a severe anxiety score.

 The results of this study showed that emergency department staff are at risk of developing an Illness Anxiety Disorder (IAD). During the COVID-19 pandemic, more research should be done on these groups.

This study investigated the paracrine therapeutic effects of intra-tracheal administration of bone marrow-derived c-Kit+and c-Kit- cells on the T helper (Th)1/Th2 balance in ovalbumin-induced acute asthma in male rats.

Forty male Wistar rats were randomly allocated into four experimental groups; healthy (group C) and sensitized (group S) rats received PBS (Phosphate-buffered saline); sensitized rats received PBS containing c-Kit- (group S+c-Kit- ) and c-Kit+cells (group S+c-Kit+). Total and percentages of differential leukocytes were calculated in bronchoalveolar Lavage. The lung cellular contents of interleukin (IL)-4, IL-10, and interferon gamma (IFN-γ) mRNAs were measured quantitatively. Moreover, the existence of excessive collagen deposition in pulmonary interstitial space was evaluated through Masson’s trichrome staining.

The results showed the successful homing of c-Kit+cells into the asthmatic niche. The significantly increased total number of leukocyte, eosinophil, neutrophil, and IL-4 mRNA levels, as well as decreased lymphocyte count, IL-10, IFN-γ mRNAs, and IL-4/IFN-γ ratio, were observed in asthmatic rats compared to C group (P<0.001). C-Kit+cells, but not c-Kit- cells, had the potential to participate in these changes (P<0.001 to P<0.05). The deposition of collagen fibers in the asthmatic pulmonary tissue decreased after administration of both c-Kit+and c-Kit-cells, which were more prominent in the S+c-Kit+group.

The results of the current experiment highlighted the therapeutic capacity of c-Kit+cells in the alleviation of asthmatic changes at the cellular level.

 The purpose of this study was to compare the GlideScope and Macintosh laryngoscopes for cardiovascular response to laryngoscopy and endotracheal intubation in elderly patients undergoing gynecological procedures.

 In this clinical trial, endotracheal intubation was performed using a GlideScope (study group; n=35) and Macintosh laryngoscope (control group; n=35). Hemodynamic parameters were recorded, before induction of anesthesia (baseline), 30 and 15 seconds after starting the laryngoscopy, and every minute up to 5 minutes after intubation. Intubation time and complications of laryngoscopy and intubation were compared between two study groups.

 Systolic blood pressure (SBP) in 1 (P=0.002), 2 (P=0.003) and 3 (P=0.003) minutes were significantly lower in the study group than that of the control group. The duration of laryngoscopy and intubation was not statistically different between two study groups. The frequency of hypertension after endotracheal intubation in the study group (20%) was significantly lower than that of patients in the control group (45.7%) (P=0.02). There was no significant difference in terms of postoperative complications related to laryngoscopy and intubation (hoarseness and sore throat) between two study groups (P>0.05).

 This study showed that the use of GlideScope better attenuated cardiovascular responses to laryngoscopy and intubation compared to Macintosh laryngoscope in elderly patients undergoing gynecologic surgery. Also, the frequency of hypertension following laryngoscopy and endotracheal intubation was lower with GlideScope compared to Macintosh laryngoscope. Durations of laryngoscopy, intubation and postoperative complications related to airway management (hoarseness and sore throat) were similar.

 We aimed to analyze the frequency and risk factors of pneumothorax and pulmonary hemorrhage caused by Computed Tomography (CT) guided needle biopsy.

 Demographical features, pneumothorax and pulmonary hemorrhage frequencies/risk factors, characteristics of lesions of patients who underwent a CT-guided lung biopsy in our institution between January 2013 and August 2013 were reviewed retrospectively. The lesions were classified to the groups as nodular lesions≤3 cm in diameter, nodular lesions>3 cm and consolidated lesions. Pneumothorax and pulmonary hemorrhage frequencies among groups were compared using a chi-square test. A p<0.05 was accepted as statistically significant.

 A total number of 122 patients with a mean age of 61±13 (19-88) years were included. 28 (23%) patients were female and 94 (77%) were male. 30 (24%) lesions were nodular lesions≤3 cm in diameter, 57 (47%) were nodular lesions>3 cm, and 35 (29%) were consolidated lesions. Pneumothorax developed in 15 (12%) patients while a chest tube insertion was required in 4 (3%) of them. Pulmonary hemorrhage occurred in 14 (11%) patients. Hemoptysis and hemothorax were not observed in this study. Pleura-based lesions was significantly less associated with pneumothorax when compared with ones far from pleura (P<0.001). Usage of 17-gauge needle was significantly more associated with pneumothorax than 19-gauge (p:0.048). Pulmonary hemorrhage was significantly less observed during the biopsy of lesions>3 cm than<3 cm (P<0.001).

 Nodular lesions≤3 cm, location far from pleura and usage of 17-gauge needle tend to be associated with more frequent lung biopsy complications.

 Older adults’ problems and needs may be ignored and not considered a priority matter during disasters due to their complexities and differences from other age groups. This content analysis study was conducted to explain the older adults’ experience of living in tents after the Mianeh county earthquake.

 In this research, we used a descriptive qualitative approach. The key elements of Standards for Reporting Qualitative Research (SRQR) were applied to design the research. Data were collected in-depth and semi-structured interviews were done with potential eligible participants. We used heterogeneous purposive sampling (with a maximum variety of 16 older adults with ages in the range of 60–81 years in Mianeh, East Azerbaijan, Iran. The data were analyzed using the conventional content analysis technique.

 Four main categories emerged, including failure to provide basic physiological needs, poor management of public support, distress and survival attempts, and loss of life authority. The main themes extracted included psychological quality of life and meeting the basic needs (disabilities and inefficiencies).

 It is beneficial to consider the specific needs of vulnerable groups, such as the elderly population, during the program designing by counties’ crisis management teams.

 Mercury is a neurotoxic element that is released from dental amalgam restorations. Since circumstantial evidence exists that the pathology of multiple sclerosis (MS) disease might be in part caused or exacerbated by inorganic mercury, we conducted a systematic review and meta-analysis using a comprehensive search strategy.

 Data bases (PubMed, Google scholar, Cochrane, Embase, Scopus, Ovid, Proquest, and Web of Science) were searched systematically to find the relationship between dental amalgam and MS. Studies were screened according to a pre-defined protocol. The quality of the articles was evaluated by two individuals. The titles and abstracts of the articles were organized and duplicate articles were discovered with the help of Endnote X5 resource management software. Finally, 6 articles were included in the meta-analysis. Random effect model was chosen to conduct the meta-analysis.

 Pooled mean difference of restoration numbers between two groups was 0.58 (95% CI: 0.33-0.83, P value<0.001) with greater numbers in MS patients. The pooled OR was 1.02 (95% CI, 0.86-1021, P=0.81), which was slightly higher for those with amalgam so they were more likely to develop MS. This slight increase in risk was not statistically significant.

 Although those who underwent a large number of amalgam fillings were at higher risk for MS, the difference between the two groups of patients and controls was statistically insignificant. It seems that the number of amalgam fillings can be an influential factor in the possibility of developing MS.

 Due to the lack of comprehensive study about the differences between posterior circulation infarction (PCI) and anterior circulation infarction (ACI), this study is performed to determine the clinical consequences of PCI and ACI.

 The required information was retrieved from the Tabriz Stroke Registry. Modified Rankin Score (mRS), National Institutes of Health’s Stroke Scale/Score (NIHSS) for severity, and Acute Stroke Treatment (TOAST) classification for types of ischemic stroke as well as the data regarding the risk factors were considered.

 701 eligible patients were included in this study, of which 524 (74.75%) were patients with ACI stroke and 177 (25.24%) with PCI stroke. There was no statistically significant difference in terms of age (P=0.724), sex (P=0.559), and pre-stroke mRS (P=0.279). Cardioembolism (CE), undetermined etiology (ESUS), and large arterial stroke (LAA) showed higher incidence in ACI patients, where lacunar type was more prevalent in PCI patients (P=0.01). Hospital NIHSS were significantly different between ACI and PCI groups (P=0.001). Also, regarding the discharged NIHSS patients, there was a significant difference between the groups (P=0.023). Moderate stroke was prominent in both groups in hospitalized (PCI: 57.6% and ACI: 48.9%) and discharged NIHSS patients (PCI: 38.4% and ACI: 42.4%).

 ACI is about 3-times more prevalent than PCI. There is no relation between the incidence of ACI or PCI and the stroke risk factors. Three months’ mortality did not significantly differ between PCI and ACI.

 Osteoarthritis (OA) is a chronic disorder characterized by inflammation, cartilage degeneration and bone remodelling with molecular derangements followed by anatomic and physiologic elements. The aim of the study was to assess the alterations of biomarkers in patients who underwent total knee replacement (TKR) for OA.

 A cross-sectional retrospective analysis was carried out on 206 participants who underwent either unilateral or bilateral TKR for knee OA from January 2017 to December 2020. Data regarding medical and surgical history, demographic characteristics, X-ray findings, complete blood count (CBC), plasma glucose and high-sensitive C-reactive protein (hsCRP) were collected and analysed. Ethics approval was obtained. Based on the normality of distribution appropriate statistical tools were used. P value≤0.05 was considered statistically significant.

 Body mass index was significantly higher in participants who underwent bilateral TKR rather than unilateral TKR. Females were affected at a younger age compared to males. Hypothyroid participants had unilateral than bilateral TKR. Neutrophil lymphocyte ratio was higher in bilateral rather than unilateral TKR (P=0.038). Males had higher monocyte lymphocyte ratio (P≤0.001), especially in individuals 61-80 years of age as well as in obese individuals.

 The use of markers such as total leukocyte count, differential count, neutrophil to lymphocyte (NLR), monocyte to lymphocyte ratios (MLR) and hsCRP are cost-effective and could predict the severity of the disease. These markers could be used to screen individuals at risk for developing OA of the knee and help in assessing the prognosis; thus allowing surgeons to decide on the appropriate management of the disease.

 In any clinical set up, the laboratory biomarkers are very important and can serve in determining the suitable treatment course. In this study, we assumed that considering a combination of biomarkers rather than individual items like lactate, C-reactive protein (CRP) and procalcitonin (PCT) along with qSOFA (quick sequential organ failure assessment) score would be better for predicting 28-day mortality in patients diagnosed with sepsis.

 A prospective observational study was conducted in a tertiary care centre in Jaipur, Rajasthan (western India) including 160 participants who were admitted in the intensive care unit (ICU) and diagnosed as sepsis. Detailed history and examination were performed, followed by blood investigations and qSOFA score calculations. Written informed consent was obtained from all participants and institutional ethics committee approval was taken at the beginning of the study. Statistical analysis was done after adequate data collection.

 Mean CRP [mg/L] was 9±1.41, mean PCT [ng/mL] was 1.6±0.56, mean lactate [mmol/L] was 2.1±1.97 among the study subjects. In this study, specificity (%) of qSOFA+biomarkers (serum lactate, CRP, PCT) was 98.9%, that was more than sensitivity of qSOFA score alone i.e., 40.62%. Although sensitivity (%) of qSOFA was 45.31% that was almost similar to the specificity of qSOFA+biomarkers i.e., 46.8%. Positive predictive value and negative predictive value was also higher in the qSOFA+Biomarker group.

 The predictive rate of combined method was better than that of qSOFA score alone.

 To the best of our knowledge, a new emerging viral infection induced by SARS-CoV-2 was named COVID-19 with high morbidity and mortality on a global scale. To date, COVID-19 is implied as a respiratory disease with varied manifestations from asymptomatic to long-standing complications. In this regard, discerning a potential prognostic value of critical outcomes in the early stages would be more appreciable to stratify the risk of disease severity and 28-day mortality. In this clinical study, we aimed to evaluate distinct laboratory biomarkers, including neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP), and lactate dehydrogenase (LDH), as reliable indicators to predict disease severity in COVID-19 patients admitted in a medical referral center.

 Following the COVID-19 diagnosis, all consecutive patients (n=685) with confirmed SARS-CoV-2 infection were included since September 2020 for one year. Data were collected using electronic medical records.

 Based on obtained results, NLR and serum level of LDH showed a positive correlation with length of hospital stay. Moreover, the mortality rate and MV required in patients with either positive CRP or the high levels of LDH were remarkably greater than that of the non-severe group (P=0.01). Finally, we could not find significant differences between female and male patients regarding the evaluated parameters.

 Our findings highlighted those high values of NLR, CRP, and LDH can be considered valuable clinical prognostic aids for risk stratification, identification of disease severity, and triage of patients at the time of admission.

 The potential association between cognitive functions, mood states, and their effect on driving behavior is complex and has been previously studied in most cases suggesting mood and emotion as possible factors in high-risk driving behaviors. However, their outcome measures are subjective and prone to biases. In this study, we add objective physiological data to explore the physiological and behavioral background of the relevance of mood in high risk driving by functional magnetic resonance imaging (fMRI).

 In this study, 28 male right-handed drivers, aged between 20 to 30 years will be randomly selected from records of drivers in the central traffic department and included in the study. Each participant will drive virtually in an fMRI-compatible driving simulator, after positive, negative, and neutral mood induction, and fMRI will be performed to explore driving-related brain activity alterations and the impact of mood state on these effects. All data analyses will be performed using MATLAB (MathWorks, Natick, MA) and the Statistical Parametric Mapping (SPM12) software package.

 This protocol study introduced a novel protocol to induce positive, negative, and neutral moods and study the impact of mood on driving.

 Comparing brain activity during driving after positive, negative, and neutral mood induction, this study will help to understand effects of different mood states on driving behavior. Furthermore, comparing the fMRI images of driving under different mood states will clarify the physiological foundation of the impact of mood states on driving behavior. The results of this study will help to introduce physiologically informed preventive or reinforcement strategies to control mood states while driving, and therefore might help to reduce a significant proportion of preventable car accidents.

 Myalgia is a common symptom in patients with COVID-19. NSAIDs perform pain suppression mechanisms by suppressing prostaglandin synthesis through inhibition of cyclooxygenase enzyme (COX). Thiocolchicoside activates GABA and Glycine receptors at the spinal level and exerts a myorelaxant effect. The aim of this study is to compare the analgesic efficacy of two drugs, the active ingredients of which are ibuprofen and flurbiprofen/ thiocolchicoside.

 The study was designed according to a multicenter, prospective, randomized, controlled clinical trial model. A power analysis was performed based on the study of Derosa et al. including patients with myalgia complaints(11). By accepting 80% power and 5% type-1 error, the number of patients to be included in each group was calculated as at least 68. We planned to include 100 patients in each group, taking into account data losses and patients who may drop out of the study during follow-up (n=200).

 According to the results of the study, the difference between baseline and 2nd day NRS and the difference between baseline and 3rd day NRS were found to be statistically significantly higher in the group using ibuprofen 800 mg retard TB (P<0.05).

 In the treatment and follow-up of patients with COVID-19 and myalgia complaints, ibuprofen 800 mg retard tb can be preferred primarily because its effectiveness is superior and no side effects are observed.

 Medical school education is effective in the professionalization development of students. In this study, it was aimed to evaluate the effectiveness of course training and to investigate the effect of interactions with simulated patients on the professional attitudes of medical students.

 The research is an intervention study designed in the pretest-posttest pattern. The sociodemographic questionnaire and Penn State College of Medicine (PSCOM) professionalism attitude scale were used as data collection tools. The scale was applied to the students three times: before the course (1), after the course (2) and after the simulated patient practice (3).

 The mean age of the students was 21.40±2.07 years and 54.8% (n=148) were female. The PSCOM scale scores of the students were 154.11±10.91, 158.59±10.48, and 164.64±10.81 respectively for score 1, score 2 and score 3, and, there was a statistically significant increase in score (P<0.001). The scale dimension’s scores all increased after the course and simulated patient (SP) practice. The difference between scores 1, 2, and 3 is statistically significant. The score increased significantly for all dimensions after training and SP’ practices, and the difference between scores 1, 2, and 3 was found to be statistically significant (P<0.001 for all). The female students had significantly higher total scores of 1, 2, and 3 than the male students (P<0.001 for scores 1 and 2, P=0.005 for score 3).

 Training and simulated patient practices increase medical students’ professionalism scores. The highest score was determined after simulated patient applications.

Changing the pattern of neonatal pathogens poses challenges to the management of neonatal sepsis. Profile and antimicrobial susceptibility of neonatal pathogens were evaluated in this prospective observational study in a tertiary center.

Neonates with risk factors and clinical features of sepsis were screened. Blood culture performed in positive-screen babies. Antimicrobial susceptibility was also evaluated. Statistical significance was tested by the chi-square test and t test accordingly. Univariate analysis was performed to study possible correlations in this regard.

Out of 431 suspected cases, 89 neonates (20.65%) had sepsis. The rate of early and late-onset sepsis (LOS) was 48.3% and 51.7%, respectively. The clinical spectrum included septicemia 68 (76.5%), congenital pneumonia 13 (14.7%), meningitis 5 (5.7%), and septic arthritis 3 (3.4%), respectively. Gram-positive bacteria constituted 61 (68.5%), while gram-negative was 28 (31.5%) (P<0.05). Staphylococcus aureus (23.6%) and methicillin-resistant S. aureus (MRSA) (22.5%) were the most common isolates. Acinetobacter (15.8%), coagulase-negative staphylococcus areus (CoNS) (11%), Klebsiella (7.9%), enterococci (8%), E. coli (4.5%), and ß hemolytic streptococci (1 case) were other detected pathogens. MRSA, Acinetobacter, and coagulase-negative S. aureus as a single entity involved in sepsis pathogenesis (50.6%) showed a positive correlation with inborn babies, pre-term, low birth weight, and early-onset sepsis (OR; 95% CI: 2.20; 0.94–5.20, 1.82; 0.79–4.22, 1.25; 0.55–2.89 and 1.05; 0.46–2.50 respectively). Susceptibility pattern was penicillin (12.3%), ampicillin (6.7%), cloxacillin (42.9%), cefotaxime (8%), cefazolin (37.9%), cefoperazone sulbactam (81.5%), piperacillin-tazobactam (68.9%), gentamicin (63.5%), amikacin (47.9%), vancomycin (88.9%), linezolid (88.6%), co-trimoxazole (55.4%), and clindamycin (50%).

Gram-positive pathogens and opportunistic pathogens like Acinetobacter predominate over the conventional gram-negative pathogens in neonates. Of note, penicillin, ampicillin, and cefotaxime are not suitable for the empiric treatment of neonatal sepsis.

 This study investigated the paracrine therapeutic effects of intra-tracheal administration of bone marrow-derived c-Kit+and c-Kit- cells on the T helper (Th)1/Th2 balance in ovalbumin-induced acute asthma in male rats.

 Forty male Wistar rats were randomly allocated into four experimental groups; healthy (group C) and sensitized (group S) rats received PBS (Phosphate-buffered saline); sensitized rats received PBS containing c-Kit- (group S+c-Kit- ) and c-Kit+cells (group S+c-Kit+). Total and percentages of differential leukocytes were calculated in bronchoalveolar Lavage. The lung cellular contents of interleukin (IL)-4, IL-10, and interferon gamma (IFN-γ) mRNAs were measured quantitatively. Moreover, the existence of excessive collagen deposition in pulmonary interstitial space was evaluated through Masson’s trichrome staining.

 The results showed the successful homing of c-Kit+cells into the asthmatic niche. The significantly increased total number of leukocyte, eosinophil, neutrophil, and IL-4 mRNA levels, as well as decreased lymphocyte count, IL-10, IFN-γ mRNAs, and IL-4/IFN-γ ratio, were observed in asthmatic rats compared to C group (P<0.001). C-Kit+cells, but not c-Kit- cells, had the potential to participate in these changes (P<0.001 to P<0.05). The deposition of collagen fibers in the asthmatic pulmonary tissue decreased after administration of both c-Kit+and c-Kit-cells, which were more prominent in the S+c-Kit+group.

 The results of the current experiment highlighted the therapeutic capacity of c-Kit+cells in the alleviation of asthmatic changes at the cellular level.

 The end-tidal CO2 pressure (PetCO2) monitoring which is a non-invasive method than PvCO2 (venous pressure of carbon dioxide), could determinate a graph depicting the carbon dioxide concentration in blood. The aim of this study was to investigate the correlation between PetCO2-PvCO2 in ventilated children.

 All children intubated in the PICU of Children hospital Tabriz, Iran from 2019 to 2020 using the census method were assessed in terms of initial diagnosis, age, sex, PetCO2, and PvCO2 during a prospective cross-sectional study. Associations between variables were calculated for total patients and patients in the subgroups. Descriptive statistics were used to describe the quantitative analysis of data and the Pearson correlation coefficient and Linear Regression Test were used for the evaluation of the relationship between variables and for assessing the predictive values of PvCO2 using SPSS.26. A P value<0.05 was considered statistically significant.

 Out of 61 samples, 42 (68.9%) patients were males with a median age of 48 months. The mean of PetCO2 and PvCO2 were 20.3±8.5 and 43±12.3 mm Hg, respectively. The correlation of PetCO2-PvCO2 was significant in total patients (P value=0.003, r=0.379) and group 1 (P value=0.009, r=0.374). Furthermore, the results presented the predictive values of PvCO2 for PetCO2 while for one unit increase in the PvCO2 variable, PetCO2 could increase 0.372 units (P value=0.005, Slope b=0.24, Beta coefficient=0.372).

 In most intubated children, PetCO2 may estimate the ventilation and change concentrations of CO2. It is necessary that the sample size of future studies will become large due to the weak correlation.

 This study assessed anxiety and depression scores based on the Hospital Anxiety and Depression Scale (HADS) questionnaire, inpatients recalled after mammography.

 In this cohort study, women referred for mammography completed the HADS questionnaire. In 2019, 84 patients who required recall based on the results of their previous mammogram were selected and then completed the HADS questionnaire for the second stage. The HADS questionnaire was used to examine psychological problems. SPSS was used to analyze the collected data.

 In this study, 86 women who were screened with mammography were evaluated. The mean age was 47.2±8.3 years. Based on the HADS questionnaire, the mean anxiety score before mammography was 10.2±4.8, and after the recall was 13.2±4.2, which was statistically significant (P<0.001). Also, the depression score in these patients before mammography was 10.7±3.8, and after the recall was 12.6±3.6 (P<0.001).

 Recalling patients after mammography can increase their anxiety and depression, which can decrease patients’ desire for follow-ups.

 Chronic kidney disease is irreversible and may result in end-stage renal failure (ESRF). The kidney replacement program is determined by calculating Kt/V ratios, one of the dialysis efficiency indicators in treatment planning in routine dialysis applications in ESRF patients. We aimed to investigate whether there is a correlation between flow rate and Kt/V ratio.

 All patients were evaluated by B-mode ultrasonography (US) and color doppler ultrasonography (CDUS). The anastomosis line diameter was measured in the B-mode US. The fistula flow rate was calculated in a spectral examination at the anatomical location where the fistulized flow was best obtained at the anastomosis level. Patients with a fistula flow rate above 300 mL/min in CDUS examinations were considered reasonable flow rates. The fistula flow rate in these patients was compared with the Kt/V ratios. Spearman’s rank correlation coefficient was calculated since the normal distribution condition was not met to determine the relationship between variables.

 The results of this study showed a high level (r=0.72, P=0.001) of positive and statistically significant correlation between flow rate and Kt/V ratio in upper arm arteriovenous fistula in patients with end stage renal failure.

 We found a highly positive and statistically significant correlation between fistula flow rate and Kt/V ratio. Low Kt/V ratios have different causes. Low fistula flow should be considered first in low Kt/V values.

Following the coronavirus disease 2019 (COVID-19) vaccination, complications are expected. In this regard, coagulopathy after COVID-19 vaccination has been reported. Here, we report a rare case of ischemic stroke subsequent to receiving the Beijing Bio-Institute of Biological Products - Coronavirus (BBIBP-CorV) vaccine (Sinopharm). Ten days after receiving the first dose of the BBIBP-CorV vaccine, a 76-year-old woman showed right central hemifacial weakness, balance disorder, and right hemisensory involvement with normal muscle force. Although the magnetic resonance imaging assessment revealed an acute lacunar stroke in her left thalamus, laboratory findings were normal. Based on our report, ischemic stroke may be a post-complication of BBIBP- CorV vaccination. However, further studies are needed to confirm this finding.

 Minocycline a semi-synthetic tetracycline is a potential therapeutic option for COVID-19 because of its anti-inflammatory and immunomodulatory effects. Moreover, its antioxidant, antiviral, and antiapoptotic effects have been proven. In this study, the efficacy of minocycline in the therapy of COVID-19 patients has been evaluated.

 A randomized double-blind placebo-controlled clinical trial was performed in Mashhad, Iran. 40 outpatients were randomized to either the treatment with the minocycline group or the placebo group, in a 1:1 ratio with 20 patients in each group. The Iranian National COVID-19 Therapy Regimen at the time was used in both groups and patients in the treatment group also received oral minocycline 100 mg twice day for 14 days. Patients in both groups were followed on days 3, 7, and 14 after initiating therapy for clinical symptom improvement, improvement of lymphocytes, leukocytes, C-reactive protein (CRP) and SpO2.

 A total of 40 patients with similar demographic and disease characteristics were enrolled. Results showed that the time interval until clinical symptoms improvement was significantly reduced in the minocycline group (6.85±0.79, day) compared to the placebo (10.95±1.18, day) group (P=0.006). Moreover, the time interval until leukocytes reaching normal limits was significantly reduced in the minocycline group (3.95±0.59, day) compared to the placebo (6.72±1.25, day) group (P=0.046).

 In this randomized double-blind placebo-controlled study, minocycline (100 mg, BID for 14 days) reduced the duration of clinical symptoms improvement as well as the duration of white blood cell (WBC) normalizing in outpatients of COVID-19 disease.