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Showing 73 results for Mohammad Reza
Diagnosis and treatment of diabetic foot infections: adopted IWGDF guidline
Mohammad Reza Amini , Mohammad Reza Mohajeri-Tehrani, Neda Mehrdad, Mahnaz Sanjari, Maryam Aalaa, Neda Alijani,
Volume 79, Issue 2 (May 2021)
Abstract
Background: Diabetic foot infection is the most common complication of diabetic foot ulcer (DFU) leading to amputation. The treatment requires special attention to disease conditions, proper diagnosis, appropriate sampling for cultures, careful selection of antibiotics, rapid determination of the patient’s need for surgical intervention, and wound care. Clearly a systematic approach or, if possible, an evidence-based approach by using clinical guidelines about diabetic foot infections will lead to better outcomes. In this regard, this article aims to adopt the IWGDF clinical practice guideline on DFU infection.
Methods: In this study, the adoption of the international evidence-based clinical guidelines on the DFU infection was carried out using the ADAPTE methodology, which involved three stages of setup, adoption, and finalization. AGREE II tool was used to evaluate the quality of the selected clinical guideline.
Results: The results of this adopted clinical guideline according to the national facilities and access to equipment are described with 26 recommendations along with related reasons for the diagnosis and treatment of diabetic foot ulcer infections. The recommendation categorized into six different categories including Classification/ Diagnosis, Osteomyelitis, Assessing severity, Microbiological considerations, Surgical treatment, Antimicrobial therapy.
Conclusion: The mentioned recommendations in the diagnosis and treatment of diabetic foot ulcer infections extracted based on the methodology of systematic review studies. Actually the opinion of experts have been prepared and adjusted according to the limitations, equipment and facilities in the country. But in general, there are some challenges in diabetic foot infections should be considered as well. So monitoring the treatment of infection, optimal duration of antibiotic treatment, optimal treatment of infection in low-income countries, time and type of imaging studies, selection of medical or surgical treatments and hospitalization conditions are some of these challenges. However the definition and practical clinical application for the concept of bacterial bioburden of the wound for wound healing, evaluating the cost-effectiveness of new technologies in improving treatment and appropriate interpretation of microbiological (genotypic) microbiological tests are important too.

Renal Ewing's sarcoma with the spread of tumor thrombosis to the inferior vena cava: case report
Mohsen Ayati, Mohammad Reza Nowroozi, Amirreza Fotovat, Erfan Amini, Faeze Salahshour, Laleh Sharifi ,
Volume 79, Issue 2 (May 2021)
Abstract
Background: Ewing's sarcoma/Primitive neuroectodermal tumor (PNET) is a group of tumors with small round cells that originate from nerve stem cells. They are generally more common in children and often occur in the soft or bony tissues of the limbs, trunk, head, and neck. Ewing's sarcoma is a rare disease in the kidney and its tumor thrombosis into Inferior Vena Cava (IVC) is assumed as a very rare condition.
Case Presentation: The patient was a 14-year-old boy who underwent an MRI of the thoracic and lumbar vertebrae due to paresthesia of the lower limbs, which showed the presence of the mass in the vertebrae of T3, T4, T5, and concurrently right kidney. The pathology report confirmed the diagnosis of Ewing’s sarcoma, PNET. The patient underwent T4 laminectomy and bone mass resection and then received 4 courses of chemotherapy with VAC + IE. In the next stage of treatment, the patient had abdominal MRI and MR Venography (MRV) that demonstrated a mass in the middle of the upper right kidney with a 10 cm length tumor thrombosis into IVC with extension to the suprahepatic area and involvement of several aortocaval lymph nodes. In January 2020, the patient was operated in Imam Khomeini Hospital Complex, Tehran by a midline incision, at first, the kidney artery and vein were controlled, and without thrombectomy, the IVC was controlled from above and below the liver, then the tumor thrombosis was removed. The right kidney underwent a radical nephrectomy. Three days later, the patient was discharged in good general condition and referred for chemotherapy.
Conclusion: Because Ewing's sarcoma is a rare condition in the kidney, this case is considered a very rare case due to its tumor thrombosis. This case study showed that despite the advanced stage of the disease, early diagnosis and treatment of patients with Ewing's sarcoma, along with adjuvant treatments can play an important role in the survival of these patients.

The effect of simulated weightlessness and short-term light-dark cycle on retinoic acid levels in serum and hippocampus of rats
Mohammad Hossein Mirzaii Dizgah, Mohammad Reza Mirzaii Dizgah, Iraj Mirzaii Dizgah ,
Volume 79, Issue 3 (june 2021)
Abstract
Background: spacecrafts rotate around the Earth every 90 minutes, so the 24-hour cycle turns to 90 minutes. Retinoic acid, an active metabolite of vitamin A, plays a role in regulating the circadian rhythm and its deficiency can impair the biological clock function and consequently impair the circadian rhythm of locomotor activity. The goal of the study was to assay the effects of simulated spaceship conditions on serum and hippocampal retinoic acid levels in rats.
Methods: The tail-hanging, hindleg-weightlessness rat model was applied to mimic the microgravity conditions from June to September 2017 in the zoo of the Aja University of Medical Sciences. Thirty-two male Wistar rats weighing 200-250 gr/in an experimental study were randomly assigned into 4 groups (n=8): 1) control animals with 12/12 h day-night rotation, 2) animals with 12/12 h day-night rotation under 14 days unloading, 3) control animals with 45/45 min day-night cycle, and 4) animals with 45/45 min day-night cycle under 14 days unloading. At the termination of the simulation step, rats were anesthetized, and blood samples were collected and the entire brain was removed and each brain was segmented into Hippocampus. ELISA assays were used to detect retinoic acid in the serum and homogenized hippocampus. Data were statistically assayed using two-way ANOVA and Bonferroni as a post hoc test. P<0.05 was considered significant.
Results: The circadian cycle of 45/45 min compared to the 12/12 h dark cycle increased the levels of retinoic acid in serum (F=4.901, P=0.037) and hippocampus (F=5.793, P=0.029) in rats. But simulated weightlessness had no effect on retinoic acid content in serum (F=0.149, P=0.703) and hippocampus (F=0.004, P=0.952).
Conclusion: It seems that retinoic acid content in serum and hippocampus is affected by circadian cycle change, and weightlessness has not affect.

Evaluation of cumulative kidney activity in pediatric nuclear scan of the bladder using conjugate view method and four different techniques for correcting background radiations
Mohammad Reza Salamat , Ali Ebrahimi, Masoud Moslehi,
Volume 79, Issue 7 (October 2021)
Abstract
Background: At present, in nuclear medicine to calculate the cumulative activity of various organs, different techniques are being used to correct the background radiations in the conjugate view method. Each of these techniques considers the effect and weight of background radiations to a different extent. These background radiations can cause errors in cumulative activity calculations. The purpose of this study was to evaluate and compare different techniques of correcting background radiations to each other in calculating kidney cumulative activity during the nuclear scan of the bladder in children.
Methods: This study was Cross-sectional and performed for patients who were referred to Isfahan Shahid Chamran Hospital between December 2019 and June 2020. In this study using Foley, 1 mCi of TC-DTPA radio-pharmaceutical that was diluted with normal saline was injected into the patient's bladder, then images recorded by gamma cameras were extracted at 2, 5, 10, and 20 minutes, Finally with ROI drawing around kidney with having vesicoureteral reflux, Cumulative renal activity was calculated with four correcting background radiations techniques such as without correction of background radiation, conventional method, Buijs method, and Kojima method Eventually, the data was Eventually, the data was compared to each other to determine how much weight each of these techniques consider for background radiations.
Results: Cumulative kidney activity after calculation with four correcting background radiations techniques such as without correction of background radiation, conventional method, Buijs method, and Kojima method were 14.970±4.776, 13.544±4.357, 13.885±4.451, 13.879±4.449 mCi.min. respectively After comparing the calculated cumulative activity without correcting the background radiations with the cumulative activity calculated by the three techniques of correcting the background radiations such as the conventional method, Buijs method, and Kojima method, the value (P<0.05) was obtained in all cases, which shows that elimination of background radiations is significantly meaningful in the calculations of cumulative activity in the conjugate method for nuclear exams
Conclusion: after comparing correcting background radiations techniques to each other, it was determined that the conventional method technique considers the effect and weight of background radiations more than the two other techniques such as the Buijs method and Kojima method in cumulative activity calculations.

Evaluation of the success rate and quality of teaching of tracheal intubation to medical students by using video laryngoscope
Pejman Pourfakhr, Mohammad Amin Mirzaie , Farhad Etezadi , Reza Shariat Moharrari , Mohammad Reza Khajavi ,
Volume 79, Issue 12 (March 2022)
Abstract
Background: Training of airway management and tracheal intubation skill in emergencies for resuscitation of patients are basic skills for medical students. However, the success rate of beginners in this skill is low. Video laryngoscopes are new devices that can increase the success of endotracheal intubation training.
Methods: This clinical trial was conducted with 30 medical students who came to learn anesthesia care at Sina Hospital in 2020. After dividing the students into two groups (n=15) of glide scope and Macintosh, the glide scope group first performed laryngoscopy and tracheal intubation with a glide scope on the manikin 10 times. Then, in the operating room they were trained for endotracheal intubation on 5 patients by glide scope. The Macintosh group first got trained for intubation on the manikin, 10 times and then on five patients in the operating room with a Macintosh laryngoscope. Then all students in the operating room intubated two patients with a Macintosh laryngoscope and their performance was assessed and scored by an anesthesiologist. They evaluated the training course with a questionnaire. The duration of laryngeal access and the time spent for tracheal intubation were compared in the two groups.
Results: In the glide scope group, 76% of students were able to see the epiglottis and larynx in 20 seconds, but in the Macintosh group, 43% of students were able to see the larynx in 20 seconds. In terms of endotracheal intubation time, 72% of the students in the glide scope group were able to successfully perform endotracheal intubation within 40 seconds in their first attempt, but in the Macintosh group, 44% completed endotracheal intubation within 40 seconds (P=0.00). In the evaluation of the quality of skill, the average score of the students in the Macintosh group was 15.30±0.56, while the average score in the glide scope group was 17.20±0.83 (P=0.00). The scores and satisfaction of the students in the glide scope group were higher than the Macintosh.
Conclusion: The use of video laryngoscope in teaching of intubation in trainees will increase the speed, and accuracy of their training and satisfaction compared with the Macintosh laryngoscope.
 

Comparing the diagnostic accuracy of bedside ultrasound with wound exploration in diagnosis of nerve and tendon injuries in upper extremities: a brief report
Marzieh Khademi, Maryam Masaeli, Mehdi Azarmnia, Masoud Shahabian, Maziar Karamnejad, Mohammad Reza Azimi Aval , Azadeh Asghari Birbaneh,
Volume 80, Issue 4 (July 2022)
Abstract
Background: Trauma is one of the most common causes of death in all ages. Considering the prevalence of trauma in the general population, and its costs and complications, it is important to use aiding tools to accelerate the diagnosis in order to act in time. The aim of this study was to evaluate the efficacy of ultrasound in diagnosing nerve and tendon injuries in the upper extremities.
Methods: This study is a cross-sectional study, which was carried out at the emergency department of the Besat Hospital, Tehran from march 2018 to march 2019. The statistical population was all patients who had been referred with deep lacerations in upper extremities and had injuries in the superficial or deep compartments (nerves/ tendons). For all the patients who met the inclusion criteria, bedside sonography with 11 Mhz Linear probe was performed by the researcher and under the supervision of the radiologist. The results were compared with the results from local exploration of the wounds. Local exploration of the wounds was also done under the surgeon's supervision. After completing the sample size and data collection, SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) was used for statistical analysis
Results: In this study, from 144 patients with penetrating trauma in the upper extremities, 56 patients were suspected with nerve injuries and 50 patients were suspected with tendon injuries. After evaluation with an ultrasound probe, 21 out of 23 cases suspected of nerve injuries were confirmed by local exploration. Local exploration confirmed that 27 out of 28 cases were suspected of tendon injuries. The accuracy of ultrasound in the assessment of nerve damage was estimated at 99.64% and in tendon damage at 92%, and the sensitivity of ultrasound in the diagnosis of nerve damage was 91.30% and in the diagnosis of tendon damage was 96.42%.
Conclusion: By the results of this research it can be concluded, that ultrasound leads to a faster diagnosis. It provides a wider field of view, can reduce possible secondary injuries and increases the accuracy of the diagnosis.

Development of clinical guideline for early detection of critical congenital heart diseases at birth by pulse oximetry
Alireza Ahmadi , Mohammad Reza Sabri , Zohreh Sadat Navabi, Mehdi Ghaderian , Bahar Dehghan,
Volume 80, Issue 5 (August 2022)
Abstract
Background: Congenital heart defects (CHD) are the most common type of birth defects. The main screening tests used to identify babies with congenital heart defects include prenatal echocardiography and postnatal clinical assessment. Routine pulse oximetry has been reported as an additional screening test that can potentially improve the early diagnosis of critical congenital heart disease (CCHD).
Methods: This study is a multi-stage evolutionary study that was conducted for 12 months from March 2021 to March 2022 at Pediatric Cardiovascular Research Center in Cardiovascular Institute, Isfahan, Iran. In the first phase, after identifying the topic and aims of the present study, questions were designed through the PICO method including (population, intervention, control, and outcomes). Then conducting systematic searches, the quality of all existing clinical guidelines (CG) of this field were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and a committee consisting of pediatric cardiologists and neonatologists in the field. Next, based on the opinions of experts, the quality of 1 out of 6 clinical guidelines for early detection of critical congenital heart disease at birth by pulse oximetry was assessed as optimal. Finally, the clinical guidelines draft was evaluated using the Delphi method and the panel of experts. After expert panel meetings and consensus between members, the final version of the guideline for early detection of critical congenital heart diseases at birth by pulse oximetry was developed.
Results: In the present study, criteria of clinical practice regarding the stages of newborn screening by pulse oximetry at birth were determined based on the evidence and health conditions and were presented in twenty-eight recommendations and six sections. The final recommendations were presented in the results section.
Conclusion: The finding of the present study showed that physicians, nurses, and midwives can apply the recommendations of this clinical guideline for the early detection and referral of neonates with critical congenital heart disease.

Lean individual’s non-alcoholic fatty liver disease: a review article
Naser Ebrahimi Daryani , Mohammad Reza Pashaei ,
Volume 80, Issue 6 (September 2022)
Abstract
Nonalcoholic fatty liver disease (NAFLD) is defined by steatosis in more than 5% of liver cells, in the absence of a secondary cause such as drugs, alcohol, or other causes. The incidence of NAFLD is increasing every day; almost a quarter of the world's adult population is affected by this disease. The burden of NAFLD is affected by the epidemics of obesity and type 2 diabetes (T2DM), and therefore, we do not expect the prevalence of this disease to decrease in the future. The world is now in the process of passing on health to non-chronic diseases, like NAFLD. The most common cause of chronic liver disease worldwide is non-alcoholic fatty liver disease. About 25 percent of the world's population is affected by the disease, and it ranges from simple steatosis to cirrhosis. 1 in 4 individuals with NAFLD is a person with non-alcoholic steatohepatitis, which is associated with complications and significant mortality and morbidity due to complications such as liver cirrhosis and hepatocellular carcinoma. Non-alcoholic fatty liver disease is closely related to metabolic syndrome, and it can be said that the liver is an integral part of obesity. Diagnostic methods for this disease include laboratory tests, imaging studies and liver biopsy. Although NAFLD is observed predominantly in obese persons or type 2 diabetes, an estimated 7% to 20% of people with NAFLD have lean body habitus. Recent studies have shown that fatty liver can occur in lean individuals, even without abdominal and visceral fat. Fatty liver in lean people (Lean NAFLD) is a relatively new concept that has attracted many people to find the differences between lean and obese people. The pathophysiological mechanisms of lean NAFLD are still poorly understood. Studies have shown that NAFLD without obesity is more closely related to factors such as environmental, genetic susceptibility, and epigenetic regulation. In addition to lifestyle modifications such as weight loss, diet and physical activity, only a few NAFLD-specific drug treatment options such as vitamin E and pioglitazone are considered. This article discusses the pathogenesis of fatty liver in lean individuals, its treatment, prognosis, and its relationship with metabolic syndrome.

The success of simultaneous balloon dacryoplasty and stenting in failed congenital nasolacrimal duct intubations and its indications
Mansooreh Jamshidian Tehrani , Haniyeh Zeidabadinejad, Fereshteh Tayebi, Mohammad Reza Khalili, Bita Momenaei ,
Volume 80, Issue 12 (March 2023)
Abstract
Background: Congenital nasolacrimal duct obstruction (CNLDO) is one of the most prevalent orbital diseases in children and treatment of recalcitrant cases is always challenging. The purpose of this study is to identify the effectiveness of balloon dacryoplasty and stenting in persistent congenital nasolacrimal duct obstruction following previous intubation of nasolacrimal duct.
Methods: Our study was an interventional study from January 2015 to January 2018 on 16 lacrimal systems of 11 patients (5 males and 6 females) with congenital obstruction of the lacrimal duct (CNLDO) and a history of unsuccessful probing and stenting, in Farabi Hospital of Tehran (affiliated to Tehran University of Medical Sciences). Children who presented to our hospital and had previously been probed with or without intubation by another surgeon first underwent reprobing and re-intubation with a Crawford tube. Endoscopy of the nasolacrimal system was performed in suspected cases of false stent passage or in the presence of a history indicating nasal pathology. Crawford's Monoka tube was removed after two months. Balloon dacryoplasty with intubation was performed as the third surgery in cases who did not respond to probing and stenting after 3-6 months. The success after six months was evaluated using fluorescein dye disappearance test (FDDT) and also the resolution of the patients' symptoms.

Results: The age of the patients was 67±35.01 months (range: 26-121). The site of the canalicular stenosis in our patients was in the common canaliculi or within 2-3 mm from it. After 6 months, surgery was successfully performed in 13 lacrimal systems (81.25%). One patient with congenital lacrimal duct obstruction and Down syndrome and two other patients did not respond to balloon dacryoplasty and stenting and subsequently underwent dacryocystorhinostomy (DCR).
Conclusion: Balloon dacryoplasty combined with Monocrawford intubation is an effective surgical procedure that should be considered in cases of congenital nasolacrimal duct obstruction who have not responded to the probing and stenting of the lacrimal system.

 

Efficacy of treatment in children and adolescents with vasovagal syncope in the long term: an 8-year follow-up study
Mohammad Reza Sabri, Bahar Dehghan, Mahsa Rafiee Alhossaini ,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Syncope is a temporary loss of consciousness with a loss of postural tone. Medicinal treatment of reflex syncope has shown to have no significant effect in reducing the recurrence of syncope. A 36-month follow-up of our pilot cohort showed that non-pharmacological treatments alone were effective in reducing relapse rates. The purpose of this study is to investigate long-term results and 8-year follow-up of previous patients.
Methods: The current study is a continuation of a prospective pilot cohort which was done between August 2013 and 2014 in two academic hospitals in Isfahan (Dr. Chamran heart center and Imam Hossein children hospitals). This current study examines the 8-year follow-up results of children with reflex syncope who were treated with non-pharmacological treatments alone or with drugs. Therefore, the patients who participated in the pilot study were enrolled (30 patients in the pharmacologic group and 40 patients non-pharmacological group). Finally, on 26 patients in the pharmacologic group and 31 patients in the non-pharmacological group (after applying the exclusion criteria), the incidence of syncope and pre-syncope attacks was compared between these two groups of patients using the Chi-square test.
Results: Our study showed that within 5 years after the last follow-up, the incidence of syncope and pre-syncope in patients with a history of vasovagal syncope who did not continue the diet or tilt exercises was different between the two groups of patients (without medication and drug recipient) was not significantly different, even the incidence of presyncope increased significantly again in both groups. The incidence of syncope in the period of 5 years after the last follow-up from the previous study was slightly increased in the group of patients without medication compared to the previous periods, but in the group of patients receiving medication, this incidence decreased slightly.
Conclusion: In order to prevent recurrence, the use of non-pharmacological methods is effective, but for the stability of this recovery, follow-up and continuation of these methods is necessary.

Assessment of STIR and contrast-enhanced MRI sequences in detection of diabetic foot osteomyelitis
Somayeh Zamani, Mohammad Reza Sasani , Mahdi Saeedi-Moghadam ,
Volume 81, Issue 4 (July 2023)
Abstract
Background: MRI is the imaging modality of choice for the detection of diabetic pedal osteomyelitis. The aim of this study is to compare the STIR sequence, as the most important fluid-sensitive sequence, with contrast-enhanced images for diagnosing diabetic pedal osteomyelitis.
Methods: Medical images were compared. Moreover, the effect of adding T1W image findings to the STIR sequence was evaluated. This cross sectional study was collected and analyzed at Namazi Hospital, Shiraz University of Medical Sciences, from 20 March 2016 to 22 September 2017.
Results: The final diagnosis of osteomyelitis was confirmed for 47 bones (78%). 13 bones (22%) didn't have osteomyelitis. The specificity of contrast-enhanced and STIR sequences was 92.3% and 53.8%, respectively; whereas the sensitivity of the two sequences was similar (100%). Records of 48 diabetic patients suspected of having pedal osteomyelitis referred to one of the university hospitals, who underwent foot MRI with and without contrast injection, were assessed. Overall, 48 Patient MRIs and 60 separate bony parts were evaluated. Diagnoses were confirmed by clinical correlation. Finally, sensitivity, specificity and diagnostic accuracy of STIR sequence and contrast-enhanced images were compared. Moreover, the effect of addition of T1W image findings to STIR sequence was evaluated.
Conclusion: This study was performed to suggest a pulse sequence that doesn’t need contrast media injection for diagnosing diabetic pedal osteomyelitis since the previous studies showed that gadolinium-based contrast media shouldn’t be applied in patients with renal failure (glomerular filtration rate<30 ml/min/1.73m2. According to the results STIR images had the same sensitivity as T1 post-contrast images; therefore, it can be concluded that contrast media injection can be avoided using this pulse sequence. The specificity of the STIR pulse sequence was lower than that of post-contrast images which was due to the lower ability of this pulse sequence to detect secondary symptoms of osteomyelitis such as cortex disruption, sinus path, and abscess. Using the T1 pre-contrast images, specificity and diagnostic accuracy increased. Finally, it can be concluded that MRI without contrast including STIR and pre-contrast T1W images is a reliable modality for the detection of osteomyelitis in suspected diabetic patients who are more prone to renal disorders.

Influencing factors in the comparison of renal stone size measurements between CT scan and ultrasound
Mohammad Reza Sasani , Leila Fazlollahpour , Mahdi Saeedi-Moghadam ,
Volume 81, Issue 5 (August 2023)
Abstract
Background: Ultrasound is widely used to detect renal stones. A no-contrast CT scan is the most accurate modality for stone examination. Considering that determining the size of a stone is the main criterion in treatment planning, the purpose of this study was to compare ultrasound and non-contrast CT scans in determining renal stone size.
Methods: In this cross-sectional study, 140 patients were assessed from June to October 2017 at Namazi Hospital of Shiraz University of Medical Sciences. A radiologist compared the CT scans of patients with their ultrasound images. The ultrasound and CT scan results in terms of stone size were assessed. The correlation rate of stone size in ultrasound and CT scans in different subgroups was assessed by categorizing the stone size into three subgroups. The impact of stone location and the CT window on measuring stone size were evaluated.
Results: The mean stone size measured by ultrasound and CT scan was 11.23±5.26 and 9.48±4.7mm, respectively, which was significantly different. The highest rate of correlation was observed in the stones>10mm (81%) and then in 5-10mm (69.3%). The lowest agreement was observed in stones <5mm (37.5%).
Conclusion: Using ultrasonography as a screening test or a primary test for detecting the renal stones is recommended. However, considering the importance of a precise assessment of stone size in choosing the treatment method and the limitations of sonography in the evaluation of small stones, a CT scan should be considered as a standard diagnostic tool if there is no contraindication. In CT images, the application of BW might underestimate the stone size in comparison to SW. Considering the results of previous studies, it is better to use magnified BW to assess the stone size on CT scan images. Although the axial view in a CT scan is more routine, for measuring the stone size it is better to use coronal or sagittal views together with axial views.

Evaluation of obstacles to receive tissue plasminogen activator in patients with acute ischemic stroke in Imam Khomeini Hospital of Urmia
Hamidreza Mehryar, Payman Atabaki, Abass Riyahi, Mohammad Reza Amiri Nikpour,
Volume 81, Issue 11 (February 2024)
Abstract
Background: The emergence of thrombolytic drugs has opened new horizons in the treatment of patients with acute ischemic stroke, and this study was conducted with the aim of evaluating the barriers of receiving tissue plasminogen activator in patients with acute ischemic stroke in Imam Khomeini Hospital of Urmia.
Methods: This descriptive-analytical, cross-sectional study was conducted from April 21, 2015 to March 19, 2016 on patients with acute ischemic stroke referred to the emergency department of Imam Khomeini Hospital in Urmia using census sampling method. To collect data, a checklist containing demographic information was used. After collecting the data, it was entered into SPSS 18 and analyzed with the help of descriptive statistics.
Results: In this study, the results showed that out of 100 patients, most of the participants were male (58%)58 and the rest were female, and the average age was 63.71±17.3 years, and 86% were in the age range of 18-80 years, which was the appropriate age to receive or thrombolytics. and the rest were over 80 years old. The fastest visit time was 25 minutes and the latest was 10080 minutes (168 hours). Among these 40 people, only four people (40%) were in the golden time period of thrombolytic drug, i.e. Three hours from the onset of symptoms to the final evaluation. Among the four people who were placed in the golden time, in 50% of the cases there was a history of taking anticoagulants, in 25% a history of head injury, in 50% of the blood sugar less than 50 and finally 1 person (25% of the people placed in the golden time) that is, 1% of all patients were eligible to receive rtPA. About 24% of patients had NIHSS<4 and 2% had NIHSS>25, and the average number obtained was 10.
Conclusion: The most important obstacle in the timely initiation of thrombolytic therapy is the delay in visiting the emergency room. Therefore, public education in order to improve the level of general awareness of the society can be effective in reducing this time delay.

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