Tehran University Medical Journal

The relationship between stroke and physical activity: effects of exercise on prevention and rehabilitation: a review article

Mohammad Ali Gharaat

Stroke is a medical condition in which occluded blood flow to the brain causes cell necrosis. The main types of stroke are ischemic (due to lack of blood flow with much higher prevalence) and hemorrhagic (due to bleeding with low prevalence). Ischemic stroke is caused by the reduction of blood to the brain tissue or complete occlusion of brain vessels by a blood clot following arterial plaques rapture of cerebral arteries due to atherosclerosis, cerebral myocardial infarction and small vascular lesion infarction. Inflammatory reactions, increased oxidative stress, cell death and autophagy are the most aggravating factors in this condition. Instead, hemorrhagic stroke is caused by spontaneous intracranial hemorrhage and subarachnoid hemorrhage, highly common in men. To prevent the possible causes of stroke, investigators attempted to study about the ways that may decrease the risk factors such as trauma, high arterial hypertension, alcohol, low-density lipoprotein and glycerides, tobacco and drugs. Physical activity is a potent inhibitory factor which reported to be effective in prevention of stroke and post-stroke rehabilitation. Aerobic, combined or strenuous activities protect brain tissue by balancing apoptotic and anti-apoptotic pathways, stimulating angiogenesis, reducing oxidative stress, increasing antioxidant activity, optimizing Integrity and preservation of the blood-brain barrier, improving nerve functions and preventing neuronal death. The mechanisms involved in rehabilitation after ischemic stroke with physical activity mostly refer to improved dendrites and synapses, synaptic flexibility, regulation of inotropic receptors with glutamate, increased BDNF, GAP43 and insulin-like growth factor. In patients with cognitive impairments following acute ischemic stroke, high intensity exercise improves processing timing and attention allocation, self-independence, walking ability, aerobic power and reduces memory degradation. Moreover, early start of physical activity after ischemic stroke inhibits the initial physiological response to stroke and prevents optimal recovery. In contrary, reports show positive effects of onset of physical exercise a day after stroke. In hemorrhagic stroke, exercise reduces systolic blood pressure, moderates resting blood pressure via parasympathetic regulations and triggers angiogenesis in the nervous system. Light to moderate or long-term physical training is recommended in comparison to short-term high-intensity training. In addition, early onset of physical activity during recovery after stroke may be beneficial.

Preventable risk factors of hospital readmission in stroke patients: an integrative review

Amir Mirhaghi

Background: Despite advances in medical treatments, readmission of stroke patients remains high and has been reported between 31% and 56.1% during the first year after discharge. The difference between the risk factors of readmission and the risk factors of stroke is not clear. The purpose of this study is: 1) to determine the preventable risk factors associated with stroke readmission and 2) to provide a conceptual model for preventable factors that effective in the readmission of stroke patients.

Methods: This integrated review was performed according to Whittemore and Knafl (2005) method in five stages including problem identification, literature search, data evaluation, data analysis, and presentation. In order to find relevant articles, PubMed, Web of Science, CINAHL, Scopus databases and Google Scholar search engine were searched. The search was conducted using the keywords "stroke," "readmission," "recurrence," "re-hospitalization," "review," and "systematic review," for the period between January 2023 and September 2023, following the PRISMA guidelines. In addition to providing a qualitative synthesis of readmission factors categorized into categories, a conceptual model of these factors was also presented.
Results: Out of a total of 3785 article titles, 38 articles were included in the study for the final analysis after screening and removing duplicates. The most important risk factors for readmission in four categories: (1) knowledge deficit about the comorbidities (such as hypertension, atrial fibrillation, diabetes), (2) unhealthy diet and medicine, (3) high-risk behaviors (smoking, alcohol consumption, and tobacco use disorder), and (4) psychological distress (depression and worry about the future). In addition, the conceptual model showed that the most important preventable factor in readmission of stroke patients is of knowledge deficit about comorbidities (especially hypertension).
Conclusion: The most important preventable risk factors that are effective in the readmission of stroke patients are knowledge deficit regarding clinical risk factors, especially high blood pressure, high-risk behaviors and unhealthy diet and medicine. Therefore, more detailed care and follow-up programs should be designed for stroke patients after discharge.

Survey of norA and mecA genes in methicillin–resistant Staphylococcus aureus strains isolated from wound and blood samples

Monireh Rahimkhani

Background: Today, Methicillin-Resistant Staphylococcus Aureus (MRSA) has become one of the public health concerns due to its resistance to antimicrobial drugs, and this problem makes treating patients with infections caused by this bacterium difficult. Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) strains are pervasive in both community and hospital settings, primarily attributable to Staphylococcus aureus' capacity to colonize areas like the nose or skin. In this study, with the aim of comparing phenotypic (disc diffusion method) and genotypic (PCR) methods, to detect methicillin-resistant Staphylococcus aureus isolated from patients of hospitals under supervision of Tehran university of medical sciences, and also detection of nor A, that is the one of the most important genes in efflux pump cluster genes.
Methods: The present research was a cross- sectional study that was conducted from February 2022 to September 2023. In this research, 43 isolated strains of Staphylococcus aureus from wound discharge and blood samples, were collected from different departments of Tehran hospitals and had submitted to the research laboratory of the school of allied medical sciences in Tehran university of medical sciences. After identifying the strains, the resistance of the isolates to 14 types of antibiotics was checked by disk diffusion method.

Results: Staphylococcus aureus diagnostic tests including gram staining on colonies, catalase, coagulase, DNase tests were performed and it was found that all strains were Staphylococcus aureus. In the next step, all samples were resistant to Cloxacillin by disc diffusion method, and the presence of mec A gene in them was confirmed by PCR method, thus the presence of MRSA strains was confirmed from the genotypic point of view. Of the 43 Staphylococcus aureus strains, 26 samples were identified as having the nor A gene by PCR and electrophoresis.
Conclusion: The results of the present research have shown that the prevalence of Staphylococcus aureus bacteria in hospital samples is significant and resistance to methicillin and ciprofloxacin has increased in the strains of this bacteria.

Determining the impact of stoic resilience training on operating room staff

Hossein Karimi Moonaghi

Background: In health care, the well-being and flexibility of the operating room staff are of great importance due to the hard and stressful nature of their work. Therefore, this study was conducted to determine the effect of Stoic resilience training on the resilience of operating room staff.

Methods: The present study was a semi-experimental pre-test-post-test intervention study with a control group. A study was conducted among 67 people operating room staff working in Imam Ali and Imam Hassan hospitals in Bojnord city in September 2023 In this research, the demographic check list and the Connor and Davidson standard resilience questionnaire were used to collect information. The educational intervention was also implemented using the “SeRenE” Stoic education package. This training package includes 4 exercises, which were used only 3 exercises per day and for 6 consecutive days (45 minutes per day) due to the resilience variable. Statistical analysis was done using SPSS version 24 and at a significance level of 0.05.
Results: Based on the results, the total resilience score increased after the Stoic training (72.03±8.31) and showed a statistically significant difference with the control group (65.03±11.16) (P>0.05). The results showed that after Stoic training, mean of subscales of competence, trust in one’s instincts, tolerance of negative affect, positive acceptance of change and secure relationships, control as well as the total score of resilience increased in the training group. Although the mean score of spiritual influences dimension increased after the training, this increase was not statistically significant (P=0.097).
Conclusion: The findings show that Stoic training had a positive effect on various aspects of resilience among operating room staff, whose effects are more obvious in some subscales such as trusting individual instincts, tolerance of negative emotions, and positive acceptance of change. In general, the results showed that people's resilience increased after Stoic training. It is recommended to include Stoic training programs in the training of health personnel and caregivers.

Investigation of epidemiological and histopathological features of central nervous system tumors in the samples referred to the pathology department of a referral hospital in the east of iran in a 10-year period

Masoumeh Gharib

Background: Identifying the epidemiological aspects of central nervous system (CNS) tumors is the first step in implementing management protocols to control the condition of these tumors. We aimed to examine the epidemiology and histopathology of both benign and malignant tumors of the CNS in one of the referral and university centers in the east of Iran.

Methods: This cross-sectional study was conducted on all files of patients admitted to Qaem Hospital in Mashhad City, Iran, in a period of 10 years from March 2009 to February 2018 with a definitive diagnosis of benign or malignant tumors of the CNS, including tumors of the brain, cerebellum, spinal cord, or meningeal membranes. Information sources included the patients' physical files and the hospital information system (HIS). The statistical software SPSS version 28.0 for Windows (IBM SPSS, Armonk, New York, USA) was used for the statistical analysis.
Results: In total, 775 patients with benign and 771 patients with malignant CNS tumors were included in the study. Regarding epidemiological aspects of benign tumors, the incidence rate of women was almost twice that of men (68.47% versus 31.53%), with an overall average age of 45.31±19.81 years. The most common benign tumors were meningioma (72.77%), followed by schwannoma (13.67%). Regarding malignant brain tumors, the mean age of affected patients was 36.64±19.67 years, with males accounting for 53.04% of cases and females for 46.96%. The most frequent type of tumor was glioblastoma (32.68%), followed by diffuse astrocytoma (16.47%). Both benign and malignant CNS tumors were associated with significant hospital mortality; in-hospital mortality rates for benign and malignant tumors were 10.1% and 17.5%, respectively. Tumor type and its grade were the main determinants of early death in malignant CNS tumors.
Conclusion: The epidemiological characteristics of benign and malignant tumors in our study community were similar to the reports presented in other communities. Knowledge of these characteristics provides the possibility of managing patients and reducing morbidity and mortality related to these tumors.

Seasonal impact analysis on COVID-19 severity: insights from homogeneous epidemiological hospital data using the jaccard correlation coefficient

Alireza Salehan

Background: Coronaviruses were discovered in 1960. Large-sized living organisms from the Coronaviridae family, with single-stranded RNA of animal origin. Coronaviruses in humans can cause mild respiratory illness or severe respiratory illness. In 2020, the World Health Organization declared COVID-19 a global pandemic. The aim of this study is to use the Jaccard similarity coefficient to determine the similarity of COVID-19 behavior patterns in different seasons of the year.

Methods: This study used machine learning systems and similarity metrics to determine the behavior pattern of COVID-19 in different seasons of the year. The location of research was the Mousa ibn Ja'far Hospital in Mashhad, and the time was from May 2020 to August 2021. The symptoms of affected patients were compared with the compiled dataset, and the similarity of patients was prepared in a similarity matrix, and the Jaccard correlation coefficient was calculated on the data. Finally, the analysis of strains from the beginning of emergence to the latest strain was examined. The performance indicators of the algorithm in the Jaccard similarity method showed a recall metric with a value of 0.94, a precision metric with a value of 1, an F1 score with a value of 0.86, and remove accuracy metric with a value of 0.76. The most important factors in the investigation include white blood cells, platelets, RT-PCR, CT SCAN, shortness of breath, fever, SPO2, and respiratory rate.
Results: The transmission of the COVID-19 virus depends on several factors, including human interaction. The evidence of the collected data shows that people with COVID-19 have low lymphocyte count and it is very consistent with the results of recent studies. Due to the lack of a dataset, a comparative study was conducted and a dataset was collected.
Conclusion: This study, leveraging machine learning algorithms, identified a clear seasonal correlation in the spread of COVID-19. Considering geographical and seasonal variations among patients, distinct symptoms were observed in each season corresponding to the prevalent strain during that period.

Awareness, attitude and behavior toward using microwave in health care workers of shahid beheshti university

Zainab Moradi

Background: In the last decade, the use of microwave ovens throughout the world, including Iran, has increased significantly. Therefore, it is important to understand the knowledge, attitude, and behavior of microwave oven use among employees of the Eastern Health Center to promote safe and responsible practices in the workplace. Assessing their familiarity and attitudes with microwave ovens, this study aims to identify potential areas for improvement and training. This, in turn, can create a safer and more efficient work environment for all involved.

Methods: In this cross-sectional study in 2022, the study population was all employees working in the health center and comprehensive health service centers affiliated with the East of Shahid Beheshti University of Medical Sciences, numbering 162 people. The research tool was a questionnaire adapted from Nadiri's thesis (2015). After collecting the questionnaires, the data was obtained by SPSS 26 software and were analyzed using Pearson's correlation coefficient, multiple regression, independent t-test, and one-way ANOVA.
Results: Although the attitude (36.35±3.579) and the behavior (61.16±6.402) towards using microwave ovens are favorable, there is still room for improvement of knowledge and awareness. Knowledge has a positive and significant effect on behavior (P=0.002, B=0.245) and attitude (P=0.001, B=0.263), which shows that improving knowledge about the safe and responsible use of microwave devices can lead to behavior. and a more favorable attitude among employees. In addition, the attitude has a strong positive and significant effect on behavior (P=0.001, B=0.417), and promoting a positive attitude toward using microwave devices can also lead to more favorable behavior. However, the relatively weak effect of awareness on attitude indicates that other factors may also play a role in determining the attitude toward using microwave devices.
Conclusion: These findings highlight the importance of educational and awareness campaigns to promote the safe and responsible use of microwave devices among healthcare workers.

The relationship of serum iron and ferritin levels with mucormycosis infection in diabetic patients having acute COVID-19 during the year 2021 in Kermanshah University of medical sciences

Shayda Barat

Background: Mucormycosis is a rare and aggressive opportunistic fungal infection that has grown significantly in recent years. This infection is rarely seen in healthy people. Mucormycosis usually appears as an acute infection with manifestations in the rhino-cerebral, pulmonary and skin areas, and sometimes its manifestations can be seen as a widespread infection. The special importance of mucormycosis is due to its high mortality rate, which leads to death in 75 to 80 percent of cases. The specific susceptibility of some patients to mucormycosis points to the importance of iron absorption in the pathogenesis of mucormycosis, therefore, we decided to investigate the relationship between serum iron and ferritin levels and mucormycosis disease in patients with underlying factors predisposing to COVID-19.
Methods: This study is a case-control type, in which patients with mucormycosis after contracting COVID-19 and also with a history of diabetes mellitus as the case group and patients with COVID-19 and a history of diabetes mellitus are considered as the control group and the serum level of iron and ferritin will be measured and compared in both groups and the outcome of the study will be determined based on the obtained results.The study took place in hospitals of the Kermanshah university of medical sciences in the Kermanshah city from March 2021 to March 2022.

Results: In this study, 38 patients were examined in two groups of patients with mucormycosis along with COVID-19 and diabetes in the case group and patients with COVID-19 and diabetes in the control group with an average age of 63 years. In this study, there was no significant difference between the average age in the two studied groups. However, a significant difference was observed between serum iron and ferritin levels in two groups.
Conclusion: Hyperferritinemia is considered not only as an indicator of the systemic inflammatory process in the infection of COVID-19, but also indicates an increase in free iron level, which, as a result, contributes to the growth and spread of the fungus (mucormycosis).

The impact of high-intensity interval training (HIIT) combined with berberine supplementation on hematological parameters in middle-aged men with pre-diabetes: a randomized controlled trial

Valiollah Dabidi Roshan

Background: Exercise programs can lead to different physiological adaptations, but the effects of low-volume, low-frequency HIIT protocols with varying interval structures have not been thoroughly investigated. This study aimed to explore the impact of HIIT with high compression (HC) and low compression (LC), with or without berberine (BBR) supplementation, on hematological parameters in pre-diabetic men.
Methods: This semi-experimental study was conducted between October and December 2021 at Mazandaran University. Fifty-four overweight/obese men with a mean age of 48.6±6.6 years, a body mass index of 30.7±7.3 kg/m², and a body fat percentage of 34.4±4.3% were randomly and equally divided into one of six groups: HC, LC, HC+BBR, LC+BBR, BBR, and control. The HC group (2:1 work-to-rest ratio) and LC group (1:1 work-to-rest ratio) underwent training programs comprising 2-4 sets of 8 exercises at an intensity of 80-95% of their maximum heart rate twice a week for 8 weeks. Hematological responses to Bruce's incremental exercise test were measured before and after the intervention. Data were analyzed using a two-way ANOVA with Bonferroni's post hoc test, with a significance level set at P<0.05.

Results: Baseline hematological indices showed no significant differences between pre-diabetic and non-diabetic groups (all, P>0.05). Following the 8-week intervention, there were significant decreases in white blood cells (WBCs) in the LC and LC+BBR groups, and in lymphocytes across all intervention groups except BBR (all, P<0.05). Additionally, hemoglobin and hematocrit levels showed significant reductions in the HC and HC+BBR groups (both, P<0.05). However, in response to Bruce's incremental exercise test, a significant decrease in WBCs was observed in the LC and LC+BBR groups, with reductions of 18% and 25%, respectively (both, P<0.05).
Conclusion: The LC protocol, even without berberine supplementation, seems to provide better immunological benefits and result in less hemolysis compared to the HC protocol, as evidenced by reductions in white blood cell counts.

The presence of atrioventricular accessory pathway can cause heart failure due to the disorder of cardiac depolarization sequence: a case report

Babak Payami

Background: Wolff-Parkinson-White syndrome is a rare but well-known disease that predisposes a person to cardiac arrhythmias. But sometimes this syndrome is accompanied by heart failure in the affected person. Several causes have been proposed for this complication including recurrent or incessant tachyarrhythmias that are frequently found in symptomatic (especially children) Wolf-Parkinson-White syndrome patients causing heart dysfunction and dilation and dilated cardiomyopathy, and also pre-excitation-related dyssynchrony leading to progressive ventricular remodeling and dilation. In this report, a patient is introduced who has improved his heart failure by radio-frequency ablation of free wall type of this syndrome.

Case Presentation: A 35-year-old man who had a history of Wolff-Parkinson-White syndrome from 8 years ago and suffered from dilatation and reduced left ventricular ejection fraction in recent years was presented with a pre-excited atrial fibrillation attack at the emergency department. The initial surface ECG showed positive delta wave in all precordial leads and negative QRS complexes in interior leads with QRS duration of about 200 ms. He had undergone electrophysiology study and ablation at the left postero-lateral accessory pathway. After ablation of accessory pathway within the months (from November 2022 until June 2023), left ventricular function was gradually improved and the symptoms of the patient's shortness of breath were also decreased.
Conclusion: The existence of heart failure in patients with Wolff-Parkinson-White syndrome can be due to various reasons including the presence of an accessory pathway and the dyssynchrony of intraventricular contraction which is caused by premature excitation of the connected part of the left ventricle by accessory atrioventricular pathway. Although in order to rule out the possibility of the incidental association of the accessory pathway with primary dilated cardiomyopathy and to investigate the segmental dyskinesia, it is necessary to perform diagnostic measures such as echocardiography and cardiac computerized tomography and magnetic resonance imaging, ablation of such accessory pathway not only controls arrhythmic attacks but also leads to the improvement of the left ventricular systolic function even in a middle age patient.

Inspiring managers in the Iranian health system; now more than ever: a letter to editor

Mohammadreza Sheikhy-Chaman