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Resistant cervical lymphadenitis in a 10-year-old child: case report
Zohreh Shalchi, Katayoun Borhani, Hamid Eshaghi, Mahmoud Khodabandeh,
Volume 79, Issue 2 (May 2021)
Abstract
Background: Purulent cervical lymphadenitis presents with different manifestations such as fever and Erythema of the skin at the site of infection. The appropriate treatment for purulent lymphadenitis are antibiotics. If there is no response to antibiotic treatment, other causes should be considered, including uncommon infectious causes (for example Mycobacterium infections or fungal infections), malignancy and Kawasaki diseases, etc. This study aimed to introduce a child with suspected purulent cervical lymphadenitis, who was initially presented with purulent lymphadenitis and was treated with broad-spectrum antibiotics. Due to the lack of response to treatment, further laboratory and clinical examinations were performed for him, then he was diagnosed with Kawasaki disease.
Case Presentation: A 10-year-old boy with fever and severe cervical lymphadenitis was referred to Tehran Children's Medical Center Hospital in May 2018. He had leukocytosis in his lab test and the acute reactant phase was high. He was diagnosed with purulent lymphadenitis and he was treated with broad-spectrum antibiotics. But no therapeutic response was observed, the patient's fever continued and erythrocyte sedimentation rate (ESR) increased in the laboratory tests. The patient's knee developed arthralgia, and Inflammation of the neck spread to the chest wall. Therefore echocardiography was performed. The patient's left anterior descending artery (LAD) had ectasia in echocardiography (LAD>2/5 SD). The patient was diagnosed with atypical Kawasaki disease, therefore the appropriate treatment was started for him and a dramatic clinical response was seen. His fever stopped and the patient's cervical lymphadenitis had completely improved. In the follow-up, the patient's left anterior descending artery (LAD) ectasia was resolved.
Conclusion: Kawasaki disease is one of the causes of cervical lymphadenitis in children. If a patient with suspected purulent lymphadenitis is treated with appropriate antibiotics but no adequate response is seen, Kawasaki disease should be considered and the patient must be re-evaluated for Kawasaki disease.
 

Controlling the costs of the Iranian health system: letter to the editor
Mohammad Hadian, Touraj Harati-Khalilabad, Mohammadreza Sheikhy-Chaman,
Volume 79, Issue 4 (July 2021)
Abstract

A systematic review and meta-analysis of medical malpractice studies in Iran
Navid Kalani, Naser Hatami, Mohammad Zarenezhad, Alireza Doroudchi , Mahdi Foroughian, Esmaeil Raeyat Doost ,
Volume 79, Issue 5 (August 2021)
Abstract
Background: Medical malpractice is a serious problem in the health care system. This study aimed to review the medical negligence in Iran.
Methods: Based on the PRISMA checklist, a search for scientific records was done separately by two researchers. All the articles that had selection criteria were evaluated in terms of methodological quality. Medical malpractice was assessed in four main divisions including negligence, Lack of skill, Carelessness and non-compliance with government regulations). The bias test was performed using the Egger’s test. Revman software was used to analyze the data.
Results: In the present study, 25 studies that examined the country's medical malpractice from April 1994 to March 2018 were included in the meta-analysis. Negligence has been implicated in 1,105 cases of the 2,068 claims. Lack of skill in 255 out of 2068 cases, 432 cases of carelessness and 244 cases of non-compliance with government regulations Were recorded the results of the meta-analysis showed that OR negligence was 0.76 (CI 95%: 0.66-0.87), lack of skill was 0.61 (CI 95%: 0.49-0.76), carelessness was 0.62 (CI 95%: 0.50-0.76) and non-compliance with government regulations was 0.66 (95% CI: 0.60-0.73). In the review of the confirmed negligence ratio of the registered complaint files, only 19 studies mentioned this ratio. The results of the meta-analysis of these 19 studies showed that the OR ratio of the confirmed negligence of complaints was 0.6 (95% CI: 0.41-0.86). From all claims, General surgeons had OR of confirmed medical malpractices, equal to 0.47 (CI 95%: 0.37-0.60), gynecologists with OR equal to 0.49 (CI 95%: 0.36-0.66), general practitioners with OR equal to 0.43 (CI 95%: 0.30-0.63) and orthopedic specialists with an OR of 0.44 (CI 95%: 0.32-0.61).
Conclusion: The results of this study help to understand the current position of medical negligence studies in the country to identify the cause of the malpractice and develop new studies for the future.

Multi-electrode arrays technology for the non-invasive recording of neural signals: a review article
Mohaddeseh Vafaiee, Raheleh Mohammadpour , Manouchehr Vossoughi, Pezhman Sasanpour,
Volume 79, Issue 6 (September 2021)
Abstract
The recording of electrophysiological activities of brain neurons in the last half-century has been considered as one of the effective tools for the development of neuroscience. One of the techniques for recording the activity of nerve cells is the multi-electrode arrays (MEAs). Microelectrode arrays (MEAs) are usually employed to record electrical signals from electrogenic cells like neurons or cardiomyocytes. MEAs consist of an array of planar or three-dimensional electrodes that act as electrical interfaces and record cellular signals or stimulate cells. These platforms can be used in different applications including neuroscience studies, prostheses and rehabilitation, deep brain stimulation (DBS), cardiac pacemakers, retinal and cochlear implants, or for brain-computer interfaces (BCI) in general. Multi-electrode arrays are known as long-term recording and non-invasive devices. The MEA structure includes arrays of electrodes with micrometer and nanometer dimensions which are designed to stimulate and record the electrical activity of cells, and are fabricated using micromachining technologies. MEAs should be biocompatible to serve as a substrate for cell growth. On the other hand, they must have low impedance to be able to provide a high signal-to-noise ratio, and small size to offer a suitable spatial resolution for recording. MEAs are usually fabricated on glass substrates patterned with high-conductivity metals such as gold, iridium or platinum, which are insulated with a biocompatible layer. Despite fast progress, current multi-electrode arrays for neural applications still face limitations such as low signal-to-noise ratio and spatial resolution. To achieve better spatial resolution and lower noise levels and therefore more accurate signal, it is necessary to develop arrays with smaller sizes and lower impedance. Meanwhile, many nanostructures such as graphene, carbon nanotubes, gold nanoparticles, and also conductive polymers have become attractive candidates for this application due to their interesting properties. In this paper, the technology of multi-electrode arrays, how it works and its various parts are introduced, and finally, the challenges and developments in this field are investigated. Multi-electrode array technology is used for neuroscience research, neural network analysis, drug effects screening, and neural prosthesis studies.
 

A comparison between two groups of diabetic and non-diabetic patients regarding complications during laparoscopic cholecystectomy
Alireza Sarmadi, Ahmad Kachoei, Mostafa Vahedian, Enayatollah Noori , Mojdeh Bahadorzadeh, Amrollah Salimi , Mohammad Hossein Assi,
Volume 79, Issue 9 (December 2021)
Abstract
Background: Cholecystectomy is one of the most common abdominal surgeries and its preferred method is laparoscopy. The difficulty of laparoscopic cholecystectomy in diabetic patients is not clear and the preferred method of cholecystectomy in these patients is still under controversy. Therefore, this study was performed to evaluate the difficulty of laparoscopic cholecystectomy in diabetic and non-diabetic patients.
Methods: This retrospective analytical study was performed in Shahid Beheshti Hospital and Forghani Educational and Medical Center from April 2019 to April 2020. Samples were easily selected and 86 people in two groups of diabetic and non-diabetic patients were included in the study. All patient records were reviewed based on inclusion and exclusion criteria for factors such as age, sex, diet, duration of surgery, bleeding, adhesions, and open surgery, and finally, diabetes as a risk factor. It was compared between the two groups. Data were analyzed in SPSS software version 22, an independent t-test was used to analyze quantitative data and the chi-square test was used to analyze qualitative data. In this study, a significance level of less than 0.05 was considered.
Results: Abdominal scar, palpable gallbladder and gallstone were not significantly different between the two groups (P=0.33). But the history of cholecystectomy attacks was significantly different between the two groups (P<0.05). Laboratory values were not significant (P>0.05) . Hard operations in diabetic patients were more than nondiabetic
patients and even two cases of open surgery were seen in the group of diabetic
patients, but there was no significant relationship (P=0.09). Intraoperative bleeding was
statistically significant between the two groups (P=0.02), But adhesion during the
operation was not related (P=0.38).
Conclusion: Finally, our study showed that diabetes can be a predictive risk factor for the difficulty of cholecystectomy.

Comparison of the prevalence of pericardial effusion and cardiac tamponade after cardiac surgery with and without chest tube suction in patients referred to Chamran hospital, Isfahan
Mahmoud Saeidi, Zahra Eshaghian Dorcheh ,
Volume 79, Issue 10 (January 2022)
Abstract
Background: Pericardial effusion is one of the most important complications of cardiac surgeries. Administration of a low-power suction to the mediastinal or pleural chest tube of patients helps better and constant drainage of pericardial or pleural secretions after surgeries. This technique might change the secretion and discharges of patients and might change the outcomes of surgeries.
Methods: This clinical trial was performed in 2017-2018 from April to March in Chamran Hospital of Isfahan on 91 patients who were candidates of cardiac surgeries. Patients are selected according to inclusion and exclusion criteria and finally, the study population is formed. In all patients after cardiac surgery, two Chest tubes were inserted, either in pericardial space or one in pericardia space and the other in left or right pleural space. After inserting chest tubes in patients and after sutures, patients were divided into two groups. In the first group, their chest tube was attached to the low power suctioning device, which resulted in active blood withdrawal or discharge of the site of surgery, the second group was also treated normally without binding to the suction device. The diagnosis of pericardial effusion or tamponade in patients who were hospitalized was made by clinical symptoms, portable chest graph as well as echocardiography, and in patients who had been discharged it was diagnosed by being referred to a specialist, clinical symptoms, chest radiography as well as echocardiography. Data regarding surgery duration, intubation duration, the prevalence of pericardial effusion, and cardiac tamponade were collected and analyzed.
Results: Administration of a low-pressure suction to the chest tube of patients was associated with decreased frequency of pericardial effusion (P=0.01). The frequency of tamponade was also significantly lower in patients with suction on chest tubes (P=0.04). Duration of intubation after ICU admission of patients was significantly lower in patients with suctions (P<0.001).
Conclusion: Generally, we indicated that the use of suction in cardiac surgeries is associated with decreased intubation time and of course decreased recovery time and decreased pericardial effusion. Therefore, this method could be used in cardiac surgeries.

Assessing the role of enema in improving outcomes and complications of benign gynecological laparoscopy: a randomized clinical trial
Zahra Asgari, Azam Barkhordarinasab, Reihaneh Hosseini , Alireza Hadizadeh, Venus Chegini, Sara Farzadi,
Volume 79, Issue 11 (February 2022)
Abstract
Background: mechanical bowel preparation (MBP) is a common practice before laparoscopic gynecologic surgeries but the role and efficacy of preparation have been questioned. this study assesses visualization and bowel handling in a group of patients who receive MBP and the control group and thereafter; compares the results.
Methods: We designed and conducted this randomized, single-blinded and controlled trial on patients who underwent advanced gynecologic laparoscopic surgeries. This clinical trial was carried out between July 2020 and January 2021. The patients were enrolled from l the laparoscopic office. 120 women aged 18-65 years undergoing level 2 and 3 benign gynecologic laparoscopic surgeries were randomized to bowel preparation with a normal saline enema (n=60) or non-bowel preparation (n=60) groups. Our patients underwent level 2 and 3 of benign laparoscopic gynecologic surgeries with or without MBP. The visualization and bowel handling were assessed by the primary surgical team and a questionnaire was later obtained. The outcomes included intraoperative surgical view and bowel handling, preoperative and post-operative patient signs and symptoms. The patients were also assessed in respect to discomfort prior and after the surgery, this assessment was obtained using a questionnaire. The gathered data was analyzed using IBM’s SPSS v26 software.
Results: there was no difference in intraoperative visualization and bowel handling between the two groups. We also found no clinical improvements in respect to discomfort and symptoms. MBP even increased the distention rate amongst patients (P-value=0/04). We tried to evaluate whether MBP had any effects on haemorrhage and blood loss during the surgery and to assess this we compared hemoglobin levels before and after the surgery. We compared the subtracted values between the two groups and found no significant difference (T-test=1.135, P=0/259) (see table 4). However, hospitalization duration was about 5 hours longer in the group who received MBP.
Conclusion: MBP with normal saline enema does not improve intraoperative visualization and bowel handling. And it also does not reduce patient complication rates and post-operative symptoms either. MBP also increases hospitalization duration and puts extra pressure on the healthcare system. Therefore, a normal saline enema is not recommended before benign gynecologic laparoscopic surgeries.
 

Early prediction of COVID-19 mortality risk based on demographic, vital sign and blood test
Ahmad Shalbaf , Nasrin Amini, Hadi Choubdar, Mahdi Mahdavi, Atefeh Abedini, Reza Lashgari,
Volume 79, Issue 12 (March 2022)
Abstract
Background: Early prediction of the outcome situation of COVID-19 patients can decrease mortality risk by assuring efficient resource allocation and treatment planning. This study introduces a very accurate and fast system for the prediction of COVID-19 outcomes using demographic, vital signs, and laboratory blood test data.
Methods: In this analytic study, which is done from May 2020 to June 2021 in Tehran, 41 features of 244 COVID-19 patients were recorded on the first day of admission to the Masih Daneshvari Hospital. These features were categorized into eight different groups, demographic and patient history features, vital signs, and six different groups of laboratory blood tests including complete blood count (CBC), coagulation, kidney, liver, blood gas, and general. In this study, first, the significance of each of the extracted features and then the eight groups of features for prediction of mortality outcomes were considered, separately. Finally, the best combination of different groups of features was assessed. The statistical methods including the area under the receiver operating characteristic curve (AUC-ROC) based on binary Logistic Regression classification algorithm were used for evaluation.
Results: The results revealed that red cell distribution width (RDW), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and mean corpuscular volume (MCV) in CBC features have the highest AUC with values of 85.29, 80.96, 79.94 and 79.70, respectively. Then, blood oxygen saturation level (SPO2) in vital features has a higher AUC with a value of 79.28. Moreover, combinations of features in the CBC group have the highest AUC with a value of 95.57. Then, coagulation and vital signs groups have the highest AUC with values of 85.20 and 83.84, respectively. Finally, triple combinations of features in CBC, vital signs, and coagulation groups have the highest AUC with the value of 96.54.
Conclusion: Our proposed system can be used as an assistant acceptable tool for triage of COVID-19 patients to determine which patient will have a higher risk for hospitalization and intensive care in medical environments.

Ranking the factors affecting the care and provision of health services to patients in medical centers using the VIKOR dempster-shafer method: a brief report
Mahsa Salehinejad Gilchalan , Mehdi Sadeghzadeh,
Volume 79, Issue 12 (March 2022)
Abstract
Background: Determining the rank of important parameters in ranking health care and providing health services to patients in medical centers.
Methods: The research method is descriptive-analytical and applied in terms of classification. The data is from the database of the Faculty of Health and Medicine of the University of Tehran, which was collected as an archive from April 1998 to May 1999. The statistical population were all experts, specialists and experts of the Faculty of Health 29 of whom completed the questionnaire. The weight of the criteria was evaluated using the AHP method and in the next stage, the medical centers were ranked using the DS-VIKOR method. The analysis method in this study consists of the following steps steps:
• Implementing a simple VIKOR method.
• Implementing the Dempster-Shafer and Vicker method.
• Implementing the AHP method
• Implementation of the Topsis method.
• Comparing the proposed methods to review and compare which ones work best.
Results: The weight of medical centers was assessed by AHP method and then the combined centers were ranked by Dempster-Shafer and VIKOR combined methods  using the information of four medical centers, the DS-Vikor approach was implemented. The purpose of six criteria and three experts was used for evaluation. The results show that the effectiveness of care and treatment process is more important from the experts' point of view. Dempester-Schaefer and Vicor The medical centers in question are ranked. For validation, at the end, the medical centers were ranked by TOPSIS method.
The integrated system includes various subsystems giving caring and providing health services to patients in medical centers that can be built and configured and are ranked.
The model can investigate the effectiveness of giving caring and providing health services to patients in medical centers.
Conclusion: By combining the two methods of Dempster-Shafer and Vicker, the confidence in the whole uncertainty is improved and the results are more reliable. This approach can help reduce the uncertainty caused by people's cognition to increase the level of decision-making, allowing us to overcome the problem of choosing the right level of uncertainty and to deal with uncertainty in a practical and justified way.

Providing a model for predicting blood pressure fluctuations after induction of general anesthesia with data mining: a brief report
Monireh Hosseini, Zahra Manouchehri ,
Volume 79, Issue 12 (March 2022)
Abstract
Background: Fluctuations in blood pressure after induction of general anesthesia have played a significant role in complications of surgery. Therefore, the present study was performed by identifying the causes of blood pressure fluctuations after induction of anesthesia, predicting and preventing them.
Methods: For this study which is a retrospective cohort, data mining methods in the data set including the information related to 3150 patients who underwent anesthesia and surgery from April 2018 to September 2019 in Imam Khomeini Hospital in Kermanshah were used. The data set included patients aged 18 years and older (age range of 18 to 96) who underwent a general anesthesia induction test using Propofol and subsequently endotracheal intubation for non-cardiac surgery. If patients did not have intubation, data were missing, or patients underwent intubation after repeated trials, they got excluded. In total, 2640 patients were included in this analysis. Preoperative patient clinical information was collected from pre-anesthesia evaluation records. Intraoperative data were obtained from computer anesthesia records. This data from the patient monitoring system and the anesthesia machine was automatically stored in the anesthesia files, while drug doses and anesthesia techniques were recorded manually. The data were then pre-processed using SPSS software, version 26 (IBM SPSS, Armonk, NY, USA).
Results: In this study, 53 features of patients' records were used (The maximum number of features used in previous studies were 48 features, which compared to them, 5 new features were included in the study) for which a P-value was calculated. Finally, features with a P<0.05 (Indicates the level of significance of the variable) were selected. Then, three data mining algorithms, logistic regression, neural networks and decision tree (the most repetitive data mining algorithms based on previous studies) were used to predict blood pressure. Also, using the criteria of accuracy, precision, sensitivity and F function, the performance of three prediction algorithms in data mining was evaluated.
Conclusion: Six features with P<0.05 were selected that the logistic regression model was more accurate, which was presented as the final model for predicting increased blood pressure fluctuations with path coefficients.
 

Sigmoid colon volvulus in pregnancy: a case report
Leila Pourali, Atiyeh Vatanchi , Arezoo Sedaghati, Farnaz Hadavi , Mohammad Taghi Rajabi Mashhadi,
Volume 79, Issue 12 (March 2022)
Abstract
Background: Sigmoid volvulus is a rare complication in pregnancy. The clinical presentation is similar to that of non-pregnant volvulus, although the symptoms can be masked by the enlarged uterus and physiological changes during pregnancy and it can be challenged and delayed in diagnosis and treatment. Delay in diagnosis can also lead to ischemia, necrosis and perforation of the intestine, which can have adverse maternal and fetal outcomes.
Case Presentation: A primigravid woman with gestational age of 31 weeks was admitted to a 3rd level center with abdominal pain and abdominal distention. From the beginning of pregnancy, the patient complained of bloating and epigastric pain, And had used herbal medicine for defecation. The patient's constipation had worsened since six days before admission to the hospital. She had no vomiting and her general condition was good. Abdominal Supine X-rays were reported completely dilated sigmoid and she was treated with a possible diagnosis of ileus. Due to the progression of symptoms and abdominal distension, rectosigmoidoscopy was performed for her, and scattered mucosal erythema was seen. Discoloration of the purple mucosa was seen from a distance of about 35 cm from the annulus and the secretions inside the sigmoid lumen were seen as blood. Ischemic necrosis and sigmoid volvulus were strongly suggested for the patient and she was immediately transferred to the operating room. The abdomen was opened with a midline incision. A 30 weeks uterus was seen and sigmoid volvulus was confirmed. Detorsion and colostomy were done. Due to the unprepared intestine and the possibility of leakage from the site of anastomosis, sigmoidectomy was not performed. After 4 days, the patient was discharged in a good general condition and became a candidate for sigmoid colon resection after delivery.
Conclusion: All abdominal signs and symptoms during pregnancy, especially in late pregnancy have a complex interpretation and management, due to the impossibility of accurate abdominal examination. The most important factors in the proper management of sigmoid volvulus in pregnancy are fast diagnosis and treatment, hydration and antibiotic therapy.
 

Evaluation of Combination Treatment of BM-MSCs And Lotion containing honey, Aloe, propolis in the Healing of Second Degree Burns in Animal Models.
Tahere Abbasi Moayyer, Aziz Ghahhari,, Tayebeh Rastegar, Fateme Malek, Farzane Rezaei Yazdi, Kamyar Ghaffari Dafchahi, Nasrin Takzaree,
Volume 80, Issue 3 (June 2022)
Abstract
Background: One of the most important issues in medical science is the healing of burn wounds. The use of medicinal plants has been common for many years and today cell therapy offers new approaches to the management of skin wound healing. The present study aimed to evaluate the the combination treatment of lotion containing honey, Aloe, and propolis with BM-MSCs in the healing of second-degree burns in animal models.
Methods: this experimental study from October 2020 to November 2020, was performed in the animal house of Tehran University of Medical Sciences. 72 rats with an age range of 3-4 months and a weight of about 200-250 gr, after burns were randomly divided into 6 groups of 12 with study periods of 7, 14 and 21 days. The groups were as following: control (no treatment), Positive control (SSD1%), First experimental (Stem cells), Second experimental(lotion), Third experimental(Stem cells and lotion), and Fourth experimental (DMEM). To measure the percentage of healing from the wound surface on days 0, 4, 7, 10, 14, 17, and 21 photos were taken and the wound surface area was calculated by Image J software. After sacrificing rats, tissue samples were taken on days 7, 14 and 21 after burning induction. Samples were prepared for staining H&E and Trichrome Masson’s, as well as RT-PCR examination. The results were analyzed using Graph Pad Prism8 software and Tukey and one-way variance tests.
Results: Treatment preference was with the combination therapy group and then with the lotion group. According to macroscopic and microscopic images of H&E and Trichrome Mason, the highest amount of wound coverage and the presence of mature collagen fibers were also observed in the combination therapy group. The results of statistical analysis and scoring also showed increased epithelization, granulation tissue formation, collagen deposition, angiogenesis and fibroblast cell proliferation, and decreased inflammation in the combination therapy group. The combination therapy group also had the highest expression of the TGF-β gene. (P<0/05)
Conclusion: Due to its epithelialization, anti-inflammatory and angiogenesis properties, the lotion has healing properties in second-degree burn wounds and its simultaneous use with mesenchymal stem cells leads to healing and acceleration of burn wound healing.

Evaluation of the relationship between blood group and intubation and mortality rate in COVID 19patients.
Faranak Behnaz, Azita Chegini, Sogol Asgari,
Volume 80, Issue 3 (June 2022)
Abstract
Background: Coronavirus (COVID-19) represents a global public health crisis that is causing significant deaths and affecting health systems around the world. There are several risk factors for the severity of infection, complications and mortality of COVID-19. One of them is blood group. The aim of this study was to investigate the relationship between blood group and rate of covid 19 disease.
Methods: A cross sectional study was performed on 130 patients over 18 years of age admitted in ICU of Shohada Tajrish Hospital between August 2020 and April 2021.The positive COVID-19 diagnosis was confirmed by polymerase chain reaction (PCR) test. Blood groups were determined and then, we monitored and followed up the patients' outcome during staying in ICU, the need for intubation, recovery and death. Data were collected using a questionnaire and analyzed by Pearson correlation coefficient and stepwise multiple regression analysis. Results were determined based on Fisher’s exact test. P<0.05 was considered significant.
Results: 60 (46.1%) patients had blood type A, (20%) 26 patients blood type AB, 12 (9.2%) patients’ blood type B and (24.7%) 32 patients blood type O. Blood group A was significantly higher in these patients. 55 patients (42.3%) were female and 75 patients (57.7%) were male. Their mean age was 43.19±19.05. Totally, 43.1% of hospitalized patients were intubated regardless of blood type. The number of cases requiring intubation was higher in people with positive blood type A. The lowest need for intubation was seen in blood type B negative. Blood group A positive (39.6%) and then AB negative (33.3%) had the highest mortality rate. Death was not observed in blood group A negative, B negative, B positive and O negative.
Conclusion: The number of patients with COVID-19 with blood type A was significantly higher (46.1%). The most common blood group in these patients was A and the lowest was blood group B. The number of cases requiring intubation was higher in people with positive blood type A.

The effect of oral ibuprofen in doctus arteriosus closure in full- term neonates.
Manouchehr Soltani , Bahman Sadeghi Sedeh , Gholamali Fattahi Bayat , Parasto Mollai Tavana , Mojtaba Ahmadlou ,
Volume 80, Issue 3 (June 2022)
Abstract
Background: This study aimed to assess the efficacy and safety of the oral use of ibuprofen suspension in various doses in the treatment of PDA (Patent ductus arteriosus) in mature babies. Mature babies (37-42 weeks) aged more than 3 days who had been diagnosed with PDA were involved in this study. For the measurement of the ratio of left atrial to aortic root diameters (La/Ao) Color, pressure gradient and the internal ductal diameter, Doppler echocardiography (ECHO) was performed. This clinical trial was performed on 60 infants born born between August 2013 to August 2015.
Methods: This clinical trial study was performed on 60 infants were randomly born between August 2013 to August 2015 which Randomly divided into two groups: The first group, received oral ibuprofen in three doses (5, 5, 10 mg/kg at 24-hour intervals) and the second group received an early dose of OIS, in two doses of 10 mg/kg after 24 and 48 hours (totally 20 mg/kg). A follow-up ECHO was performed 48 hours and 2 weeks after treatment by the same pediatric cardiologist who was not aware of the study groups. Evaluation of changes in platelet count, blood urea nitrogen, creatinine and complications of thrombocytopenia, evaluation of elevated serum creatinine, and complications of gastrointestinal bleeding were compared between the two groups using statistical analysis.
Results: Seventy-three percent (73%) patients in the first group and seventy-six (76%) patients in the second group had successful PDA closure in the first 48 hrs. No statistically significant difference between the two groups (P=0.0001) was obtained and the highest response time was observed in the first 48 hours of treatment. After 2 weeks, the PDA closure in both groups was completely successful (100%). No specific side effects were observed between the two groups.
Conclusion: We conclude that higher doses of ibuprofen (20 and 2×510 mg/kg) do not show better results for PDA closure without renal or gastrointestinal complications.

Vagus nerve stimulation in the treatment of nervous system disease: a review article
Somayeh Nazari , Raheleh Rafaiee, Hamed Ghazvini , Elmira Beirami , Sara Chavoshinezhad , Seyedeh Masoumeh Seyedhosseini Tamijani ,
Volume 80, Issue 4 (July 2022)
Abstract
The vagus nerve (VN), the longest cranial nerve and an essential part of the parasympathetic system, connects the central nervous system to respiratory, cardiovascular, immune, gastrointestinal, and endocrine systems and is involved in the maintenance of homeostasis by controlling these systems. Vagus nerve stimulation (VNS) is related to any method that would stimulate the vagal nerve via electrical stimulation. VNS is a Food and Drug Administration (FDA)-approved treatment for medication-resistant depression, drug-resistant epilepsy, and migraine. However, VNS has also been studied for various other conditions, such as Alzheimer's disease and tinnitus, by targeting the VN in the neck and ear. Currently, there are two methods for VNS: a) invasive-VNS (iVNS), which requires surgical implantation of a pulse generator under the anterior chest wall, that is linked through a wire to an electrode cuff that wraps around a cervical vagus nerve, b) non-invasive transcutaneous VNS which is separated into cervical transcutaneous vagal nerve stimulation (ctVNS) and auricular transcutaneous vagal nerve stimulation (atVNS). The non-invasive transcutaneous VNS techniques are well tolerated and have no significant side effects, making them effective in clinical research for brain diseases. Because with these newer methods, the electrical stimulation is carried out through the skin.
The results of this study were collected using the advanced search in Scientific Information Database (SID), Google Scholar, PubMed, and Scopus between 2011 to 2021. Out of 671 articles surveyed, we used 53 articles in the study after the evaluation. Medical Subject Headings (MeSH) and Keyword Searching was carried out through the MeSH database. VNS has been shown to alter neural activity in multiple areas of the brain related to the regulation of the affective states. However, the precise mechanism of VNS action on the clinical consequences is still unknown. This study aimed to review the therapeutic effect of both methods of VNS in neuropsychiatric and neurological disorders such as depression, migraine, seizure, tinnitus and Alzheimer's disease and discuss several hypotheses on the mechanism of VNS, as a new approach, in the treatment of such disorders. It considers that a brain-mapping approach is needed to discover the therapeutic mechanisms of VNS in brain diseases.

Evaluating conservative treatments to reduce coccydynia symptoms: a systematic review
Tannaz Ahadi , Nima Khaje , Bijan Forogh , Labaneh Janbazi, Masumeh Bagherzadehcham.m@iums.ac.ir,
Volume 80, Issue 4 (July 2022)
Abstract
Background: There are many conservative interventions to reduce the symptoms of coccydynia, but it is not clear which treatment can be more effective. The aim of this review study was to evaluate the types of conservative interventions and the effectiveness of each of them in reducing coccydynia symptoms.
Methods: This systematic review was carried out based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) instruction. A search for research studies published up to October 2021 was conducted in Neuromusculoskeletal Research Center, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran, using Scopus, Science Direct, Web of Knowledge and Cochrane without data constraints. The search was carried out in October 2021 and continued for seven months. The quality of the articles was evaluated using the Physiotherapy Evidence Database scale (PEDro). All prospective randomized clinical trial studies in which participants suffered from coccydynia  and were treated with nonsurgical treatments  were included.
Results: 945 articles were found in the primary search of the databases. After eliminating 493 repetitive papers, 452 studies remained which were screened by the two researchers of this study in terms of the title and abstract. 40 studies were selected for full-text evaluation. Finally, 12 articles were included in the review study. Two papers used extracorporeal shockwave, two papers used impar ganglion block, three papers manual therapy, and four studies injection. The remaining four studies used iontophoresis with ketoprofen, biofeedback therapy, acupuncture, and physiotherapy with Kinesio taping.
Conclusion: Treatment with extracorporeal shock wave and impar ganglion block significantly improve tailbone pain and show more permanent effects on patients' symptoms. Manual therapies are mostly used in cases where the tailbone is stable. It seems that achieving the desired response requires more than six sessions, which is not pleasant for patients. Injections, especially those performed under fluoroscopic guidance, require high skill in addition to being unpleasant and painful. However, this procedure is done in one session, so there is no need for the next visit.

Evaluation of electrocardiogram changes in obese children and comparing it with normal weight children
Salma Aryanejad , Fatemeh Taheri Bojd , Atiye Riasi, Tayyebeh Chahkandi, Forod Salehi,
Volume 80, Issue 5 (August 2022)
Abstract
Background: Obesity and overweight are one of the components of metabolic syndrome and the cause of cardiovascular disease and sudden cardiac death. Obesity is associated with a wide range of electrocardiogram (ECG) abnormalities.
Methods: This case-control study was performed on 50 children and adolescents aged 9 to 18 years in Birjand from May to October 2020. In the control group, 25 people with normal weight and in the case group, 25 people with obesity or overweight were included in the study. Individuals with a body mass index of 85-95 percent were defined as overweight, ones with a body mass index above the 95th percentile were defined as obese, and individuals with a body mass index below the 85th percentile were defined as normal. After clinical examination, height, weight and electrocardiogram indices were measured and compared by using statistical tests by SPSS (Version 19) software.
Results: There were 15 boys in the control group and 17 boys in the case group. The mean age of the control and case groups was 11.28±2.13 and 10.96±1.97 years, respectively. The mean distance between the peak to the end of the T wave in the case group was 323.72±120.15 and in the control group was 79.20±13.06. The mean difference between the shortest and longest distance of TP-e in case group was 48±23.04 and in control group was 18.44±5.58, respectively. There was a statistically significant difference between the two indices (P<0.001). But in other variables, no statistically significant difference was observed between the two groups.
Conclusion: The results of the present study showed that obesity can have adverse effects on the ECG of children compared to normal-weight individuals. These changes are associated with an increased risk of arrhythmias. Given that these changes can be corrected with weight control, it is recommended to warn families and educate them to prevent and control overweight and obesity.

Assessment of the diagnostic capability of ultrasound in early diagnosis of nephrolithiasis: a feasibility study
Seyed Hamed Jafari, Mahshid Manuchehrinasab, Mahdi Saeedi Moghadam , Banafsheh Zeinali Rafsanjani ,
Volume 80, Issue 5 (August 2022)
Abstract
Background: CT is the gold standard method for diagnosing kidney and urinary tract stones. This imaging technique delivers radiation dose to patients, which increases the risk of cancer, especially in patients who need frequent assessment. The aim of this study was to compare the diagnostic ability of ultrasound in Iran compared to CT for diagnosing kidney stones in patients with colic pain.
Methods: The data of this cross-sectional retrospective study was gathered from the patients who were admitted to a University-affiliated hospital, Shiraz University of Medical Sciences from March 2019 to September 2019 suspected of nephrolithiasis and performed CT were collected along with their ultrasound reports. To compare sonography and CT, sensitivity, specificity, and positive and negative predictive values were calculated and the diagnostic percentage difference between the two modalities was evaluated. The diagnostic efficiency of ultrasound in stones of different sizes and locations was also evaluated.
Results: The sensitivity, specificity, and positive and negative predictive values of ultrasound in the initial diagnosis of stones were 83.47%, 62.15%, 85.94% and 57.58%, respectively. Ultrasound diagnosis was not significantly different from CT p=23 actually ultrasound diagnoses were different from CT in only 2.11% of cases. Ultrasound was the most successful in detecting bladder and urethra stones larger than 10 mm.
Conclusion: The results of this study showed that although ultrasound is less sensitive than CT in the diagnosis of nephrolithiasis, the use of ultrasound could be useful as a primary diagnostic test in patients with suspected nephrolithiasis. The important point is that the strategy of starting the evaluation with ultrasound, and performing additional imaging if necessary, leads to a reduction in the radiation dose of patients with nephrolithiasis. These patients have to do this procedure many times to diagnose and follow up the disease and clearly the offered method leads to reduction of the radiation absorbed dose and the possible effects of radiation, which is in line with the principle of ALARA, the basic principle of radiation protection.

Assessment of TUMS affiliated hospitals’ preparedness for dealing with Covid_19
Ebrahim Jaafaripooyan, Haniye Sadat Sajadi , Maryam Tajvar, Elham Ehsani Chimeh , Iman Falah, Farhad Habibi,
Volume 80, Issue 6 (September 2022)
Abstract
Background: The prevalence of emerging and re-emerging diseases has made the need for basic preparations for all health care organizations more crucial. Strengthening preparedness and formulating crisis strategies will have a great impact on reducing casualties. Given the importance of preparing hospitals to deal with such an outbreak and reduce the resulting mortality, the present study was conducted to assess their readiness against Covid-19.
Methods: The present study is a quantitative and descriptive cross-sectional research conducted from October to March 2019. Data collection used the standard checklists prepared by the European Center for the Prevention and Control of Coronavirus and the Centers for Disease Control and Prevention, consisting of eight domains and 21 components. The minimum score that each hospital could get in this checklist was 143 and the maximum was 429. The sampling method in the present study was a census, and nine reference hospitals for Corona were included in the study. All hospitals’ directors, managers, quality officers and crisis secretaries and others related to hospital readiness during Covid-19 were recruited by the census.
Results: On average, the hospitals scored 391 out of 429, indicating a fairly "high readiness" in dealing with Covid-19. The highest score obtained by the hospitals was 425 and the lowest score was 349. In terms of preparation areas, the hospitals’ readiness was higher than 80% in all areas. The highest readiness of hospitals was in the fifth  domain, i.e. Hand hygiene, personal protective equipment and hospital waste management. The 7th domain namely, patient placement and relocation, and patient visitor access was of the lowest preparation.
Conclusion: The hospitals were of fairly appropriate readiness to deal with Covid-19. This level of preparedness, despite being desirable, might not reflect the real capacity of hospitals to deal with this disease. Regular evaluation of the Covid referral hospitals could help make these hospitals more prepared. Also, the experiences of hospitals that were more prepared should be used to improve the condition of other hospitals.

The evaluation of the awareness level of patients with hemorrhagic stroke about their hypertension possibility and use of antihypertensive drugs
Mehran Kouchek, Niloufar Taherpour, Mirmohammad Miri, Roja Asadpour , Fatemeh Ilbeygi, Seyed Pouzhia Shojaei, Mohammad Sistanizad,
Volume 80, Issue 9 (December 2022)
Abstract
Background: Hypertension is an important and controllable risk factor for heart diseases, stroke, renal failure and peripheral vascular disease. The aim of this study was to determine the level of awareness of patients with hemorrhagic stroke to control blood pressure and to provide solutions to improve patients’ awareness.
Methods: This study is a descriptive cross-sectional study that was conducted to evaluate the knowledge of patients with hemorrhagic stroke about the use of antihypertensives. The study population consists of all patients with hemorrhagic stroke, who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran from September 2020 to March 2021. Data related to blood pressure awareness and drug history was completed by the researcher through the method of direct contact with the patients or their relatives. In this study, 17 patients diagnosed with hemorrhagic stroke due to hypertension who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran, were included. The extent of the exact treatment adherence was assessed using the Morisky questionnaire.
Results: In this study, the median of patients age was 67 and 10 (58.82%) of them were women. The median systolic and diastolic blood pressures were 170 and 95 mmHg on admission. 4(23.53%) subjects were not aware of the disease. Out of 13 people who were aware of their hypertension, 11(64.71%) were under the supervision of a physician. However, 7(63.64%) of the subjects, despite being under the supervision of a physician and acceptable drug adherence, did not have controlled blood pressure and expired.
Conclusion: This study is a warning for patients and health care providers to pay more attention to blood pressure control. Furthermore, educating the community as well as medical staff about the importance of timely diagnosis and accurate treatment of hypertension is highly recommended.

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