نشریه دانشگاه علوم پزشکی البرز
سال سیزدهم شماره 1 (زمستان 1402)

Usually, patients with femur fractures, including peritrochanteric fractures, have associated comorbidities, which increase the duration of hospitalization, increase the rate of complications, and increase mortality. The aim of this study was to determine the average time between hospitalization and surgery and discharge of patients over 60 years old with peritrochanteric fracture in Shahid Madani Hospital in 2022.

The current study is a cross-sectional study. Demographic information, underlying diseases, BMI, length of time between hospitalization and surgery, surgery and discharge, and hospitalization and discharge were collected. The relationship between prognostic factors and length of hospitalization was investigated and the significance level of p value was less than 0. 05 was considered.

A total of 250 patients (114 women and 136 men) with an average age of 75.6 ± 98 years were included in the study. The average time between hospitalization and surgery was 60.7 ± 23.8 hours, and the time between surgery and discharge was 24. 63.3 ± 4 hours and the time between hospitalization and discharge was 124.1 ± 35.9 hours. In female gender, age over 75 years and suffering from diabetes, cardiovascular disease, hypertension and respiratory disease, the time between hospitalization and Surgery was significantly higher. In female gender, age over 75 years, increased BMI, diabetes and respiratory disease, the duration between surgery and discharge was significantly higher. In general, increasing the length of time between hospitalization and discharge was significantly related to female gender, age over 75 years, increased BMI and diabetes, cardiovascular disease, hypertension, and respiratory disease.

Conducting this study led to the identification of risk factors that can be adjusted in patients, so that by reducing the complications of fracture and surgery, as well as reducing the duration of hospitalization, the chances of recovery and faster return to daily life can be increased.

Introduction and goal:

 With the aging of the population, hip fracture in the elderly has become a growing medical and social concern. Whether early surgery is beneficial in such patients is a long-standing debate and a constant clinical concern in the management of patients with hip fracture. Is What seeming necessary is to review the guidelines on how to deal with such patients in different health care systems. Therefore, this study was conducted with the aim of investigating factors affecting the delay in surgery and the increase in one-month mortality of patients with proximal femur fractures in patients referred to Shahid Madani Alborz Hospital during 2020-2021.

This cross-sectional analytical study was conducted on 126 patients in Shahid Madani Hospital in Karaj city during the years 2013-1400. Patients were divided into six groups according to the time taken until surgery (less than 24 hours to more than 120 hours). After that, the death and its cause in one month after the surgery were investigated by phone calls and examination of patients' files in the clinic. Data were collected using pre-designed forms and information recorded in patients' files, as well as using the same device and operator for each patient.

Among the 126 patients included in the study, 103 (81.74) were women and 13 (18.26) were men. 4 patients (2.5%) underwent urgent surgery. 17 patients (13.8%) underwent surgery within 24 hours after admission and 82 patients (64.9%) underwent surgery more than 48 hours after admission. The results showed that the mortality rate increases significantly with a delay of more than 120 hours. Lack of available operating room for planned surgery (60.3%) was the most common cause of surgical delay. Older age, dementia, and the need for assistance with activities of daily living before the fracture were also associated with higher rates of medical complications.

In summary, our study showed that very long delays increase the patient's stay in the hospital and thus may increase the risk of mortality and some medical complications.

A 66-year-old male suffering from dysphagia with progressive severity of about three months’ duration was admitted to the Emergency department. During the last week, he had drooling and hoarseness. In the past week, he described two times of syncope. And he indicated chronic cough and mild sputum recently. An incidental chest radiography showed evidence of marked dilation of the aortic arch and deviation of trachea. Echocardiography revealed LVEF of 55% and a grade 1 left ventricular diastolic dysfunction. Also, aneurysmal dilation of thoracic aortic curve containing crescentric form thrombosis with calcification mostly suggestive of thrombosis within aneurysm was seen. With 100% stenosis of LAD, Major Diagonal and RCA, he was recommended for CABG. Aneurysm of the thoracic aorta is a very rare cause of dysphagia and it must be differentiated from other causes, since proper managements can significantly reduce the morbidity and mortality of this disease. Discussion Etiologies of esophageal dysphagia include neuromuscular disorders (such as achalasia and scleroderma), intrinsic structural lesions (like esophageal carcinoma, esophageal rings and webs and eosinophilic esophagitis) and extrinsic structural lesions (like mediastinal lesions and vascular compression).Aneurysm of the thoracic aorta is a very rare cause of dysphagia and it must be differentiated from other causes, since proper managements (like urgent surgical interventions if needed) can significantly reduce the morbidity and mortality of this disease. Treatment of dysphagia caused by aortic aneurysm can be conservative, surgical or palliative depending on the severity of the symptom. By accurate management, prognoses of the patients are almost always good. In coping with dysphagia, gastrointestinal disorders should not be the only complications that is payed attention and dysphasia must be considered as a rare sign of aneurysms. The case report on this rare cause should contribute to better diagnosis of dysphagia aortica and swallowing difficulties in general.

Three years after the announcement of the 2019 coronavirus disease (COVID-19) as an epidemic, the investigation of its signs and symptoms in different body systems continues. These clinical manifestations can be investigated both at the acute level and at the complication level. Within the respiratory system, the most common manifestation is pneumonia, which is often characterized bilaterally and involves the periphery of the lung, coming to the center of the lung, which is often accompanied by leukopenia and lymphopenia. Several cases of spontaneous pneumothorax have been reported in the context of Covid-19, this study aims to provide more comprehensive information by reviewing past studies that are often case reports of spontaneous pneumothorax.

Anesthesiologists and surgeons strive as a team to minimize postoperative patient reported pain scores by using modern multimodal pain management protocols. This study was designed to examine the effects of adding different doses of adjuvant tramadol to bupivacaine solution in interscalene block (ISB) in patients undergoing shoulder arthroscopic surgery.

In this prospective controlled randomized double-blinded trial, 60 consecutive eligible subjects candidate for arthroscopic shoulder surgery were assigned randomly into 3 groups. The patients were assigned to receive one of the specific doses of tramadol in bupivacaine mixture in their preoperative ultrasound-guided ISB. In the control group (T0), the ISB was performed with 30 ml solution of perineural 0.25% bupivacaine and epinephrine. The block was performed with the same solution mixed with 100 or 200 mg of adjuvant tramadol with a total volume of 30 ml in patient in T100 and T200 groups, respectively. The required postoperative duration of analgesia, 24 hours postoperative analgesic consumption, observational and patient-reported pain scores, and side effects were recorded in the recovery room and up to 24 hours.

Mean postoperative analgesia duration was significantly longer in group T200 (681 ± 270 min) than in Group T100 (501 ± 298 min) and Group T0 (402 +/- 223 min) (P =0.006). A statistically significant difference was found in the first 24 hour postoperative cumulative opioid consumption among groups T200 (5.5 +/- 3.2 mg), T100 (9.0 +/- 4.5 mg) and T0 (9.30+/- 4.78 mg) (P=0.009).  There was no intergroup difference in intraoperative analgesic consumption, postoperative sedation score, and complications due to ISB or tramadol adverse effects.

There is a dose-dependent prolongation of ISB with adjuvant tramadol for arthroscopic shoulder surgeries.

Acute pulmonary embolism (PE) is an emergency and life-threatening disease that despite its relatively high prevalence in ICU patients, is still difficult to diagnose due to non-specific signs and symptoms. Symptoms such as shortness of breath and chest discomfort are completely non-specific and overlap with the diagnosis of acute coronary syndrome (ACS).

EKG changes associated with acute pulmonary embolism are highly variable and can resemble acute coronary syndromes. Recently, changes in precordial leads in the form of inverted T wave have been described as a diagnostic clue of PE, although these changes are also seen in acute coronary syndrome.

In this article, we report a 92-year-old man with dyspnea and progressive hypotension. Which was initially wrongly diagnosed as acute coronary syndrome due to diffuse inverted T in precordial leads V1 to V6, and pulmonary embolism was confirmed after cardiac ultrasound evaluation at the bedside.

In this article, we will talk about the diagnosis of this case and the review of related texts, emphasizing the limitations of EKG and the importance of using cardiopulmonary ultrasound at the bedside.

The combination of atlantoaxial joint dislocation and fracture of the odontoid process is a rare but serious spine injury that causes instability. The estimated frequency of this combined  injury is less than 2% among upper cervical spine dameges. Few clinical cases of mentioned damage has been reported in scientific resources. In this article, we present the prognosis of a patient with atlantoaxial joint dislocation along with odontoid fracture and discuss how to manage this type of combined injury.

A 19-year-old man presents with a fracture of the C2 axis in the odontoid process and posterior displacement of the atlas vertebra (C1) relative to C2 due to motor vehicle accident. posterior displacement was observed with bilateral dislocation of the lateral joints. Conservative treatment consisted axial traction with a halo head brace was performed to reduce the atlantoaxial dislocation. Because traction failed, we decided to perform surgery to reduce the dislocation and fix the C1-C2 joint.postoperative X-ray and CT scan were satisfactory. At the 6 months follow-up, the clinical picture was stable and the patient had no major functional problems. Dynamic X-ray Showed good range of motion in flexion and extension.

The combination of  atlantoaxial joint dislocation and fracture of the odontoid process is a rare spine injury that is considered serious due to causing  instability. First, we treat the dislocation, then the treatment of the fracture of the odontoid appendage is determined based on the results of displacement and its stability. Conservative treatment of dislocation includes axial traction with a halo head brace. If traction fails, an open reduction should be performed through the posterior approach  with C1-C2 Magerl fixation. If this approach is not possible, occipitocervical fixation is performed. The rarely-used lateral approach has an advantage in this indication, because the atlantoaxial joint exposure is excellent and the option exists to perform anterior transarticular fusion.

Brain injury is a prevalent problem in emergency department. Assessing traumatic brain injury (TBI) usually needs imaging, of them Computed Tomography scanning (CT scan) is very useful for detecting brain pathology in these patients. On the other hand in mild TBI patients, CT imaging may be used without indication which leads to overuse and unnecessary harm to patients and also waste of resources. Due to the lack of data in Iran, the study aimed to assess the compatibility of Brain CT Scans with valid guidelines criteria in mild traumatic brain injury patients in emergency department of Madani medical education center in Karaj.

A cross-sectional design study were used to assess compatibility of CT scans with different guidelines. A convenient sample of patients with mild TBI who referred to the emergency department of Madani medical education center and had underwent CT scan, entered the study. Patients with other accompanying injuries excluded from the study. Demographic data, mechanism of injury, signs and symptoms of patients were gathered using a check list. Indications for doing CT scans in adults were checked using Neworleans and Canadian guidelines. PECARN guideline also used for children. Data analyzed using SPSS software.

267 patients with the mean age of 35.13 (±22.502) years were evaluated. 168 (62.9%) patients were male and 99 (37.1%) were female. 35 (13.1%) patients according to PECARN+Neworleans guidelines and 127 (47.6%) patients according to PECARN+Canadian guidelines did not have any indication. Only 14 (5.2%) patients had abnormal CT findings. All of them had indications of performing CT scan. It could be estimated that 43 or 157 thousand brain CT scan are performed without indication, which result in wasting more than 23 or 84 billion rials of health system budget.

The results of this study indicate the use of valid guideline criteria reduce unnecessary brain CTs, thus preventing the loss of cost, time, manpower and depreciation of devices and also causes reduction of disease caused by the complication of CT scan radiation.

Although anesthesia and surgery have become less complicated and more successful in the present age than in the past, surgical anxiety and postoperative complications remain strong. The education given to patients can reduce these complications. Therefore, this study was conducted to investigate the effective factors involved in post-surgery training to patients admitted to different surgical wards.

This study is a retrospective descriptive-analytical study that conducted in 1399 on 268 patients who underwent surgery in Nekouei, Hedayati, Forqani hospitals were informed with informed consent and in a questionnaire by an impartially trained staff through interviews with Patients were completed at the time of their discharge and the quality of education was assessed and the factors involved were investigated. The personal information of these patients remained completely confidential, so it is not clear which questionnaire belongs to which patient, and in addition, the name of the surgeon remained confidential.

Based on the desired surgical group, it was observed that the gender of the patients (P=0.001), the age of the patients (P=0.001), and the type of surgery in them (P=0.001) had a statistically significant relationship with their surgical group, which It is due to the difference in indicators in different surgical groups and the difference in their patients (Table 2). On the other hand, by evaluating and comparing the education status of patients with the information evaluated in them, it was observed that only education (P=0.12) and age of patients (P=0.48) had a statistically significant effect on their education status, so that With the increase in the level of education, the number of trained people has decreased, and the highest frequency and prevalence of trained people are in the age group of 18 to 50 years.

Based on the results of this evaluation, some factors affecting the results of patient education are identified, based on this and by relying on these results, the results of education of these patients can be improved.

One of the most common psychological complications in Covid-19 care nurses is stress and anxiety, especially anxiety disorder. This type of anxiety can be considered as one of the important psychological diagnoses in nurses. One of the positive psychological mechanisms in the treatment of diseases and control of resilience anxiety is resilience. Resilience ensures people's mental health by modifying and minimizing factors such as anxiety. The aim of this study was to determine the role of resilience in anxiety symptoms of corona nurses of Alborz University of Medical Sciences. 

The present study is cross-sectional and correlated with the statistical population of nurses involved in Covid-19 wards. Data gathering done by sample characteristics using Beck Anxiety Questionnaire for measuring the clinical anxiety symptoms in the subjects. Using the Connor and Davidson Resilience Questionnaire to measuring resilience of the samples.

28 female and 14 male nurses participated in this study. The average rate of resilience in the studied nurses was 71.05 indicates the high resilience of these people. The average anxiety of the subjects is 7.43.

The results showed that the general health scores of the nurses did not have a good health status. Resilience rate is high in the nurses. The results show that the average anxiety of the subjects is not high on average. In statistical studies, the results showed that the distribution of scores in the sample in anxiety was normal.

Adult T-cell leukemia/lymphoma (ATLL) is a cancer with a very poor prognosis. ATLL has four subgroups, acute, chronic, lymphoma, and smoldering, with very different prognoses. In this study, we tried to better understand the pathogenesis of ATLL and the differences between its subgroups by using gene expression data and bioinformatics methods.

Genes with altered expression were identified among different types of ATLL. In order to determine the key genes, the network of protein interactions between the resulting genes was constructed. After screening the hub genes based on the network centrality indices, the cell signaling pathways related to them were identified.

Comparing the acute type with the chronic and silent types, the cell signaling pathways involved in regulating the function of the immune system are expressed differently. In comparison of acute and chronic type with healthy people, genes related to malignancy are involved. In comparing the silenced type with healthy individuals, the pathways related to infections are disrupted. In the secondary comparison, it was found that the genes related to cell proliferation and malignancy in the acute form were expressed more and the genes related to the immune system were less expressed in these patients than in the rest of the population.

It seems that manipulations by the virus resulting in immune escape and also in increased proliferation of infected cells have a decisive role in the occurrence of the aggressive type of the disease. Further investigations can lead to the development of new diagnostic methods, determining prognosis and even the detection of targets for gene therapy.

Diffuse large B-cell lymphoma is the most common invasive non-Hodgkin's lymphoma. There is a strong relationship between Helicobacter pylori infection and the occurrence of this malignancy. It has been seen that some patients with DLBCL in the early stages respond well to Helicobacter pylori eradication treatment, but others are resistant to it. Due to the lack of sufficient knowledge about the occurrence of this resistance, it is necessary to identify mechanisms of resistance.

The gene expression data of sensitive and resistant patients were obtained from GEO site. After determining the genes with altered expression, in order to identify the key genes, the protein interaction network was constructed and the important genes were filtered based on the network centrality indices. Finally, cellular signaling pathways associated with key genes were determined.

CXCL8, EGFR, FN1, ICAM1, IL1B, TLR2, TLR4, TNF and VEGFA genes were identified as highly important genes according to the network analysis and the results obtained from the pathway enrichment analysis. Key genes showed a significant relationship with functions related to the regulation of immune cells activation.

The results obtained from this study show the significant role of cell functions related to surface receptors and also the regulation of immune cells activation in the occurrence of resistance to treatment. The genes and cellular pathways identified in this study can be used as therapeutic targets and biomarkers for diagnosis, determination of the appropriate treatment method for the patients and prognosis.