Iranian Red Crescent Medical Journal
Year:2020 | Volume:22 | Issue:7|Papers Count:22

Background: Lipid disorders are a well-documented risk factor for chronic kidney disease (CKD), but the impact of lipid abnormalities in the progression of the disease remains mixed. Objectives: The current study aimed to extend the existing knowledge about the effect of lipid disorders in disease progression from moderate to severe stage using Flexible parametric survival models. Methods: This retrospective cohort study included 308 moderate CKD patients who received the nephrologist follow-up visits at the nephrology clinic, Ilam (Iran), from 2012 to 2019. The survival time was determined based on the time medically diagnosed with moderate stages (GFR = 59-55 mL/min per 1. 73m2) to the time of progression to the severe stage (GFR = 29-25 mL/min per 1. 73m2) hazard using flexible parametric survival models. Results: In univariate analysis, high levels of TG, LDL, and cholesterol were important risk factors which affect the CKD progression. The hazard of patients with TG > 200 mg/dL was 1. 69 times higher than patients with desirable TG levels (P = 0. 09). Moreover, for patients with LDL > 160 mg/dL, the hazard was 2. 12 times higher than patients with desirable LDL levels (P = 0. 01). The hazard of patients with total cholesterol levels > 240 mg/dL was 2. 10 times higher than patients with desirable cholesterol levels (P = 0. 003). The adjusted model was shown to better fit the PH model. Cholesterol levels > 240 mg/dL remains a significant risk factor for CKD progression (P = 0. 03). Conclusions: Effective treatment programs should pay closer attention to screening and treatment of hyperlipidemia in patients diagnosed with moderate CKD.

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has necessitated the alteration of the organization of entire hospitals to try to prevent them from becoming epidemiological clusters. The adopted diagnostic tools lack sensitivity or specificity. Objectives: The aim of the study was to create an easy-to-get risk score (Ri. S. I. Co., risk score for infection with the new coronavirus) developed on the field to stratify patients admitted to hospitals according to their risk of COVID-19 infection. Methods: In this prospective study, we included all patients who were consecutively admitted to the suspected COVID-19 department of the Bufalini Hospital, Cesena (Italy). All clinical, radiological, and laboratory predictors were included in the multivariate logistic regression model to create a risk model. A simplified model was internally and externally validated, and two score thresholds for stratifying the probability of COVID-19 infection were introduced. Results: From 11th March to 5th April 2020, 200 patients were consecutively admitted. A Ri. S. I. Co lower than 2 showed a higher sensitivity than SARS-Cov-2 nucleic acid detection (96. 2% vs. 65. 4%; P < 0. 001). The presence of ground-glass pattern on the lung-CT scan had a lower sensitivity than a Ri. S. I. Co lower than 2 (88. 5% vs. 96. 2%; P < 0. 001) and a lower specificity than a Ri. S. I. Co higher than 6 (75. 0% vs. 96. 9%; P < 0. 001). Conclusions: We believe that the Ri. S. I. Co could allow to stratify admitted patients according to their risk, preventing hospitals from becoming the main COVID-19 carriers themselves. Furthermore, it could guide clinicians in starting therapies early in severeonset cases with a high probability of COVID-19, before molecular SARS-CoV-2 infection is confirmed.

Introduction: Sertoli cell tumors (SCTs) of the testis are relatively rare neoplasms that originate from the sex cord and interstitial stromal cells of the testis. Magnetic resonance imaging (MRI) can be used for characterization, particularly recommended when clinical and ultrasonography (US) features are indeterminate for the staging of local lesions. Scrotal MRI may also help in the imaging-based differential diagnosis of a wide range of testicular neoplasms and prevents unessential radical orchiectomy in cases of benign lesions. Accurate and early diagnosis will play a key role in keeping the viability of testicle and fertility. Case Presentation: We present the case of a 46-year-old male with a 1-year duration of a left painless testicular tumor that has had some recent enlargement. He has been admitted to the Department of Urological Surgery, Shenzhen Bao’ an people’ s hospital, Shenzhen, Guangdong Province, China, on Dec 2nd, 2018. Laboratory tests were within normal limits. A well-defined margin (pseudocapsule) can be found both on US and pre-contrast MRI, but organ-sparing surgery is not advocated for the suspicious malignant features, including recent enlargement, intratumoral hemorrhageand necrosis, and contrast-enhancing solid tissue with indistinct and irregular marginss on MRI. Finally, this patient proceeded with radical orchiectomy after a sufficient preoperative assessment. Conclusions: The low incidence rate of SCTs and their similar clinical features to those of other testicular tumors make their preoperative diagnosis challenging, but the identification of the tumor’ s extent, morphologic information, signal component, adjacent relationship, and distant metastasis on MRI images can be vital to make a differential diagnosis, establish reasonable intervention plans, and predict the prognosis.

Background: Papillary thyroid cancer is the most common type of thyroid malignancies. For a more accurate diagnosis, immunohistochemistry has been used widely in recent years. Epithelial membrane antigen has been detected in several benign and malignant lesions, and its use as a marker of malignancy has been sought in some studies. Objectives: The current study aimed to determine the presence and level of expression of epithelial membrane antigen in papillary thyroid carcinoma and multinodular goiter. Methods: Eighty-five samples of papillary thyroid carcinoma and 40 cases of multinodular goiter were stained histochemically for epithelial membrane antigen. The intensity of staining was classified in a semi-quantitative manner (1+ to 4+). Demographic data of the index cases, history of metastasis, and lymph node involvement, if any, were collected as well. Results: All PTCs and 87. 5% of MNGs were positive for EMA. EMA was expressed more strongly in PTCs than in MNGs (P < 0. 00). EMA reactivity was directly associated with lymph node involvement, capsular invasion, and size of the tumor (P = 0. 008, P < 0. 001, and P < 0. 001, respectively). The intensity level of 2 or higher had high specificity for differentiating PTC from MNG. Conclusions: Strong expression of EMA may be a good marker of malignancy in differentiating PTC from MNG. This marker may also be regarded as an index of invasive behavior of PTC.

Context: Self-expandable metal stents (SEMSs) are commonlyused in the treatment of malignant biliary obstruction. We performed a meta-analysis to compare the efficacy of covered self-expandable metallic stents (CSEMSs) and uncovered self-expandable metallic stents (UCSEMSs) for patients with malignant distal biliary obstruction. Methods: A comprehensive search was conducted using PubMed, Embase, Cochrane, and CNKI databases from 2010 to 2019. All randomized controlled trials, which compared the use of the CSEMSs and UCSEMSs for the treatment of malignant distal biliary obstruction were included in this study. Results: This meta-analysis included 1, 539 patients enrolled in 13 trials. There was no difference between the two groups in terms of patients’ survival (hazard ratio (HR) 0. 96, 95% confidence interval (CI): 0. 87-1. 07; I2 = 32. 6%), stent patency (HR 0. 92, 95% CI: 0. 69-1. 22; I2 = 56. 3%), and the overall complication rate (relative risks (RR) 1. 35, 95% CI: 0. 82-2. 23; I2 = 0%). In particular, the CSEMSs group presented a lower rate of tumor ingrowth (RR 0. 30, 95% CI: 0. 15-0. 57; I2 = 58. 5%) than the UCSEMSs group. However, the CSEMSs group exhibited a higher rate of tumor overgrowth (RR 1. 63, 95% CI: 1. 00-2. 66; I2 = 0%), sludge formation (RR 2. 28, 95% CI: 1. 36-3. 82; I2 = 0%), and migration (RR 5. 14, 95% CI: 1. 90-13. 88; I2 = 0%). Conclusions: Our meta-analysis indicated that there was no significant difference between the two stents, and each one had its advantages and disadvantages.

Introduction: Primary colorectal angiosarcoma is a highly rare malignant tumor. There is no standard treatment method for this disease. No treatment of rectal angiosarcoma with apatinib has been reported so far. Case Presentation: In the current study, an 87-year-old male presented with the symptoms of frequent defecation for more than one month in Hangzhou, China, in 2018. The patient was initially diagnosed with a rectal stromal tumor. The patient underwent ultrasound-guided transrectal mass puncture in the next treatment. However, immunohistochemical examinations confirmed the initial diagnosis of rectal angiosarcoma. The patient had advanced age and rectal angiosarcoma with metastasis; he had no surgical indications, and we tried to use apatinib 250 mg/d treatment to control the progression of the lesion. Then, he received apatinib, a novel tyrosine kinase inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2). The patient has been stable to apatinib with a dose of 250 mg daily by now. Conclusions: Apatinib may play an important role in the treatment of unresectable angiosarcoma.

Background: Methamphetamine dependence is a growing global problem. Currently, there are no approved pharmacotherapy options for the management of methamphetamine dependence. One of the alternatives to manage this addiction is the use of N acetylcysteine (NAC) due to its capacity to restore homeostasis in the brain glutamate systems disrupted in addiction and its ability to reduce craving and the risk of relapse. Methods: Methamphetamine-dependentvolunteersundermethadonetreatment (n=38)wererandomizedto receive daily doses of 1200 mgof NAC, or placebo. The participants were followed for 12 weeks (two visits weekly). Craving and Beck Inventory Depression (BDI) was determined at the beginning of the study and also after one month, two months, and three months. Addiction severity index (ASI) was recorded at the beginning of the study and after three months. The data were analyzed via SPSS version 16. 0 (SPSS Inc. Chicago, Illinios, USA) Results: The mean score of craving and BDI reduced after two months with NAC treatment. ASI (e. g., substance, familial, and psychiatric categories) was significantly reduced at the end of the study in the NAC group compared to placebo (P < 0. 001). The success of the treatment in groups of NAC and placebo were 84% and 73%, respectively (P = 0. 001). 63. 2% of the NAC group patients avoided substance use for more than a month, but this was 10. 5% in the placebo group (P = 0. 001). Conclusions: The NAC showed good efficacy in suppressing methamphetamine craving, addiction severity index, and depression. It may be a useful pharmacological treatment for methamphetamine dependency.

Background: The incidence of limb fractures in children depends on environmental factors and socioeconomic backgrounds. Objectives: This study aimed to evaluate the epidemiology of limb fractures in 1 to 15-year-old children in Ilam City, Iran. Methods: This retrospective study enrolled all children aged 15 and below admitted to the Emam Khomeini Hospital of the Ilam University of Medical Sciences between July 2012 and March 2018. Data including age, sex, injury mechanism, and injured organs were recorded in SPSS software and analyzed using a chi-square test. Results: Out of 4877 children, 74. 3% were boys, and 25. 7% were girls, with the men to women ratio of 2. 87 and the mean age of 9. 10  4. 3 years. Elbow and forearm with 39. 35% and leg with 21. 61% were the most common sites of fractures. Home, street, and sports fields were the commonplaces of injury with 50. 7%, 28. 3%, and 7. 2%, respectively. The age range of 8-15 years, with 3693 cases (75. 72%) was the most vulnerable age group. Fractures occurred mostly in spring and summer and less frequently in the other seasons. Conclusions: Specific attention should be paid to the home environment and its safety for controlling injuries in preschool children. This includes increasing parents’ knowledge of preventive measures. Moreover, improving the physical condition of pavements and crosswalks in the streets is necessary for the prevention of injuries.

Background: Hypertension is one of the most serious global concerns since it has affected over 1. 2 billion people. Objectives: The present study aimed to determine the effect of vitamin D supplementation on blood pressure, fasting blood sugar, and lipid profile in hypertensive patients with vitamin D deficiency. Methods: In this double-blinded randomized placebo-controlled clinical trial study, 116 hypertensive patients (intervention and placebo groups, 58 each) with vitamin D deficiency (< 30 ng/mL with ECL) for 14 weeks, started from the beginning of autumn 2019 in Seyed-al-Shohada Educational Hospital in Urmia City. Fifty-five patients (49%) were male with the mean vitamin D 15. 89  5. 09 ng/mL and 57 females with 17. 29 6. 31 ng/mL. In a stratified blocked randomization scheme, the patients were randomly allocated into similar sized intervention and control groups based on body mass index (BMI), then the randomization with four block size was performed in each of strata by random allocation software. The intervention group received six doses of 50, 000 IU vitamin D supplements for 6 weeks, then two supplements for two following months (one capsule per month). Blood pressure (24/h blood pressure measured by an ambulatory blood pressure monitoring device), vitamin D, FBS, and lipid profile (HDL, LDL, CL, and TG) were all measured at baseline and end of the study. Physical activity (measured by short IPAQ questionnaire), sun exposure using a questionnaire, dietary intake of vitamin D using three 24-hour recalls during the intervention, and anthropometric indices were measured at baseline, middle, and end of the study. Fifty-six patients in each group completed the study. The study was approved by the Ethics Committee of the Urmia University of Medical Sciences (ethics code: IR. UMSU. REC. 1398. 192). Results: The office blood pressure, 24-h systolic blood pressure (SBP) and diastolic blood pressure (DBP), nighttime SBP and DBP were significantly reduced in the intervention group compared to the control group, whereas the reduction of daytime SBP and DBP was not statistically significant. Vitamin D supplementation significantly decreased serum triglyceride, cholesterol, and LDL levels. Conclusions: VitaminDsupplementation had positive effectsonblood pressure, triglyceride, cholesterol, and LDL levels in patients with low serum vitamin D.

Context: Hypertension events are the dominant adverse events observed in patients receiving the antivascular endothelial growth factor (anti-VEGF) monoclonal antibodies bevacizumab and ramucirumab treatment, which severe hypertension, particularly hypertensive emergencies, may cause acute target organ injury and major cardiovascular events, that has limited the administration of anti-VEGF monoclonal antibodies. The current meta-analysis aimed to examine the relative risk (RR) of hypertension associated with anti-VEGF monoclonal antibodies. Evidence Acquisition: PubMed, EMBASE, ASCO Abstracts, ESMO Abstracts, Cochrane Library, and Clinical Trials. gov were searched until July 2019 for relevant phase II and III randomized controlled trials (RCTs). Statistical analyses were performed to examine the RR (with 95% confidence intervals (CIs)) of hypertension associated with the anti-VEGF monoclonal antibodies. Results: Ninety four RCTs and 51088 patients were included in the current meta-analysis. According to the results, compared with the control arms, anti-VEGF monoclonal antibodies increased the risk of all-grade (RR: 3. 45, 95% CI: 2. 98-4. 00) and high-grade (RR: 5. 63, 95% CI: 5. 05-6. 26) hypertension. In the subgroup analyses, the risk of high-grade hypertension varied significantly with cancer type, so that the highestRRwas for patients with ovarian cancer (17. 27, 95% CI: 8. 50-35. 08), whereas the risk of all-grade hypertension did not vary significantly. When stratified based on drug types and drug dose, no significant difference was discovered. Conclusions: Anti-VEGF monoclonal antibodies significantly increased the risk of hypertension. The risk may vary with tumor type. Clinicians should be aware of the adverse reaction and clinical monitoring as well as effective management of such situations, particularly for high-risk patients.

Background: Coronavirus is a single-stranded RNA virus, causing an epidemic of pneumonia and acute respiratory distress syndrome (ARDS) worldwide in late 2019. Objectives: In addition to the clinical symptoms, laboratory diagnosis can greatly help diagnose the diseases; therefore, this study aimed to analyze laboratory parameters in patients with COVID-19. Methods: In this cross-sectional study, the laboratory data of 2563 patients with COVID-19 admitted to hospitals affiliated with Mazandaran University of Medical Sciences were extracted from hospital information systems (HIS). The data were recorded on Excel and analyzed through t-test, chi-squared, and Fisher’ s exact tests in SPSS 19 at the significance level of P < 0. 05. Results: Out of 2563 patients with a mean age of 55. 1  16. 7 years, 1409 (55%) were male, and 1154 (45%) were female with a mean age of 55. 7  16. 8, and 54. 3  16. 6 years, respectively. As the most frequent clinical findings, ESR, CRP, and LDH were increased by 83. 5%, 71%, and 69. 3% of the patients, respectively. Other research findings included lymphopenia, disturbed INR, abnormal SGOT, abnormal alkaline phosphatase (ALP), and increased lactate dehydrogenase (LDH), which were significantly higher in men than in women and was different between age groups. Conclusions: Conducting simple, convenient, and inexpensive laboratory tests can be helpful in the diagnosis of COVID-19.

Background: Exposure to radiation is a major risk factor for skin cancer so that 65 to 90% of skin cancers can be attributed to the exposure with sunlight. Objectives: The current study aimed to investigate the association between the human development index and the incidence of UV-related melanoma. Methods: This is an ecological study. Data on the incidence of UV-induced melanoma were extracted from the GLOBOCAN estimates (GLOBOCAN 2012), and data on the human development index were extracted from theWorld Health Organization (WHO) database. Data analysis was conducted by Stata software (Ver. 14). The descriptive analysis involved mean and standard deviation. The correlation method was used to evaluate the association between the population attributable fraction (PAF) of melanoma for ultraviolet (UV) and the HDI components. A P value < 0. 005 was considered as statistically significant. Results: The results revealed a significant positive association between UV-attributable melanoma cancer and HDI in women (r = 0. 401, P < 0. 0001), men (r = 0. 488, P < 0. 0001), and both sexes (r = 0. 455, P < 0. 0001). In Americas (r = 0. 452, P < 0. 05) and Europe (r = 0. 740, P < 0. 05), a significant positive correlation was observed between UV-induced melanoma and HDI, but this association was not significant in Asia (P > 0. 05). In Africa, a negative correlation was observed, though it was not statistically significant (r =-0. 301, P > 0. 05). The results of the analysis of variance (ANOVA) showed a significant statistical relationship between the incidence of UVrelated melanoma and the levels of development (F = 25. 1, P < 0. 0001) so that the higher the score of HDI, the higher the incidence of this cancer. Conclusions: Since there is a positive correlation between UV-related melanoma and HDI, further attention should be paid to this risk factor, especially in countries with a high HDI to reduce the UV-induced melanoma cancer.

Background: Insufficient physical activity, particularly in low-and middle-income countries, plays an important role in the spread of non-communicable diseases. Objectives: The purpose of this study is to investigate the insufficient physical activity and its relationship with the human development index (HDI) in the world. Methods: This is an ecological study, and the study data, including the human development index and the incidence of insufficient physical activity, were extracted from the World Bank’ s database. The descriptive analysis included mean and standard deviation. The inferential analysis consisted of two-way correlation and ANOVA at a significance level of less than 0. 05. The analyses were performed using Stata-14 software. Results: The highest insufficient physical activity in both sexes (39. 26 [37. 42, 40. 95]) was found in the Americas, especially in highincome regions. There was a significant positive correlation between the incidence of insufficient physical inactivity and HDI in the world (r = 0. 446, P < 0. 0001). This correlation was also significant in Asia and Africa (P < 0. 05). The results showed a positive correlation between components of HDI (i. e., gross national income per 1000 capita, mean years of schooling, life expectancy at birth, and expected years of schooling) and insufficient activity (P < 0. 0001). The results of ANOVA also exhibited a significant relationship between the mean prevalence of physical inactivity and the level of development (P < 0. 0001). Conclusions: Given the significant correlation between the incidence of insufficient physical inactivity and HDI, understanding this correlation and its components, especially in low-and middle-income countries can alleviate the impact of physical inactivity epidemics in the future, thereby contributing to the effective global prevention of non-communicable diseases.

Context: COVID-19 has turned into a pandemic, threatening the lives of millions of people worldwide. Research has found thatsome COVID-19 patients will suddenly aggravate, resulting in a cytokine storm, respiratory distress syndrome, and death. It is necessary to articulate the mechanism of cytokine storm and propose a Chinese medicine treatment strategy for COVID-19. Evidence Acquisition: A literature search was conducted using five databases on April 30, 2020, including PubMed, Google Scholar, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data with the keywords of “ cytokine storm AND Chinese medicineANDCOVID-19 “ , “ cytokine stormANDChinese medicineANDSARS-CoV-2” . Theoutcomeof interestwasthe concept and mechanism of cytokine storm, the characteristics, and the Chinese medicine treatment of COVID-19 cytokine storm, etc. A total of 43 articles were retrieved after removing duplicate articles. Results: The cytokine storm is also called cytokine cascade. The body overreacts with positive feedback without negative feedback, making a variety of abnormal cytokines accumulations, triggering a cytokine storm. COVID-19 cytokine storm does not occur in the early stages, but only after a period of development, it attacks not only the lungs but also the heart, kidneys, and other organs. The key pathogenesis is “ toxins and blood stasis, lung failure” in Chinese medicine. The treatment is detoxification, removing blood stasis, and nourishing the lung. Chinese medicine should comprehensively regulate multiple targets and multiple pathways to intervene in the immune regulation of the body to intercept the progress of inflammation and focus on the integration of Chinese medicine withWestern medicine to combine anti-virus and anti-inflammatory therapy. Conclusions: The immune response caused by cytokine storm is a complex signal network with multiple targets and pathways and various cytokines acting together. Immunomodulation can balance the excessive inflammatory response and effectively control the replication and spread of SARS-CoV-2. Returning the immune response to a balanced state is an ideal method for treating COVID-19 cytokine storm. Chinese medicine can achieve overall coordination and balance. Nevertheless, the pharmacology of Chinese medicine must be further studied, and the mechanism of cytokine storm treatment should be thoroughly clarified.

Background: Ischemic stroke is a major cause of disability and mortality in patients with type 2 diabetes mellitus (T2DM), and diabetic stroke has a high recurrence rate. Objectives: This prospective cohort study aimed at investigating the risk factors and establishing Cox’ s regression model and personal prognosis index for the recurrence of ischemic stroke at a two-year follow-up in T2DM patients. Methods: T2DM patients with ischemic stroke, who were consecutively admitted to the Neurology Department of North China University of Science and Technology Affiliated Hospital between January 1, 2015, and December 31, 2015, were retrospectively reviewed. These cases were followed up since the onset of ischemic stroke for 2 years. Univariate and multivariate Cox’ s proportional hazard regression model was used to analyze risk factors associated with the recurrence rate. Thus, a recurrence model and personal prognosis index were set up. Results: During the follow-up period, 44 cases relapsed. Furthermore, the 1-year recurrence rate was 16. 48%, while the 2-year recurrence rate was 24. 18%. The univariate and multivariate Cox proportional hazard regression model revealed that the independent risk factors associated with recurrence were TOAST criteria (X1) (RR = 1. 663; 95% CI = 1. 015-2. 760, P = 0. 032), hypertension grade (X2) (RR = 1. 897; 95% CI = 1. 097-3. 280, P = 0. 022), duration of diabetes mellitus (X3) (RR = 1. 151; 95% CI = 1. 009-1. 991, P = 0. 039), total cholesterol (X4) (RR = 1. 13; 95% CI = 1. 006-1. 876, P = 0. 035), and Essen stroke risk score (ESRS) (X5) (RR = 2. 055; 95% CI = 1. 357-3. 134, P = 0. 001). The personal prognosis index of the recurrence model was as follows: PI = 0. 504 X1 + 0. 640 X2 + 0. 345 X3 + 0. 759 X4 + 0. 823 X5. Conclusions: TOAST criteria, hypertension grade, duration of diabetes mellitus, total cholesterol, and ESRS were the independent risk factors associated with the recurrence of ischemic stroke with diabetes mellitus. The recurrence model and personal prognosis index equation were successfully established.

Introduction: Chronic active Epstein-Barr virus infection (CAEBV) is a rare, life-threatening disease entity involving multiple organs and systems. The disease could be presented in a single organ with atypical symptoms, be misdiagnosed at the early phase, and resolved without aggressive treatment. Previous studies reported favorable outcomes with early diagnosis and treatment, while in other cases, disease progressionandpresenting in other organs could result in a very poor outcome. Cliniciansfromanydepartment should be aware of the CAEBV entity when an unresolved systemic inflammation presents. Case Presentation: A 61-year-old female presented to the cardiology department due to edema and fatigue with the progression of symptoms, including fever, muscle weakness, andshortness of breath. MRimagesshowedmuscularedema, andultrasound analysis revealed massive pericardial effusion. Results of laboratory tests indicated hematological involvement, liver damage, and positivity for EBV DNA, and EBER in muscle and intestine by staining. She was first misdiagnosed with ulcerative colitis, but the disease evolved to the muscles and cardiovascular system later on. Altogether, the CAEBV infection with enteritis, myositis, and pericardial effusion was confirmed in the case. Although diagnosed, the treatment of the elderly population remains rather challenging in severe cases. The patient died after disease onset for less than three years. Conclusions: Elderly patients with CAEBV infection tend to have a poor prognosis. Early diagnosis would facilitate early treatment and the utilization of available options, which might reduce the disease mortality rate eventually. Individualized therapy and promising approaches should be further developed for CAEBV infection.

Objectives: We intended tomapthe geographical distribution of patients with acute strokewhocalled the TehranEMScenter based on the geographic information of the incident location on a map. The distributions of these centers and patients’ access within a standard period were evaluated. Methods: A cross-sectional study based on the registered data was conducted on suspected acute stroke patients > 18 years of age that were transferred by EMS. The analysis was performed based on pointing the patients’ locations and locating the hospitals in ArcGIS software plus a review of the polygons and focal points. Results: Totally, 1, 606 patients suspected to stroke with a mean age of 64. 89 17. 48 years were evaluated, of whom 947 (58. 6%) were male. The mean time of arrival of an ambulance in the patient’ s location from the EMS station was 11. 94  6. 67 minutes, and the longest time was 69. 32 minutes. The mean time from the patient’ s location to the stroke center was 17. 79 11. 42 minutes (range 2. 4-83. 70 minutes). Stroke centers in Tehran are not distributed in a balanced manner, and they are concentrated on the central and northern parts of Tehran, limiting access to hospital services. Conclusions: The multiplicity of hospitals in the west and center of Tehran led to an increase in access times in eastern Tehran. It emphasizes the necessity of revision of service locating, especially because the east of Tehran has a denser texture than the west.

Background: Stroke as a complication of open-heart surgery can be a cause of death and widespread disability. Objectives: This study aimed to determine the relationship between the SYNTAX Score and carotid artery stenosis and evaluate patients undergoing open-heart surgery in terms of postoperative complications and mortality in a six-month to two-year followup period. Methods: A cross-sectional study was conducted on 113 patients with CAD who underwent open-heart surgery at our hospital from 2016 to 2017. After collecting demographic data, the SYNTAX score, and color Doppler sonography report, the data were recorded and analyzed by SPSS22. Results: In our study, most patients were male and aged between 50 and 70 years. The mean SYNTAX score was 32. 667 + 13. 668 in the group with significant carotid stenosis, 33. 926 + 9. 387 in the group with no significant carotid stenosis, and 30. 868 + 9. 963 in the group without carotid stenosis. The results showed no significant relationship between carotid artery stenosis and the SYNTAX score (P = 0. 512) and no significant relationship between the SYNTAX score and surgical complications (P = 0. 666). Conclusions: According to the results, there is no significant relationship between the SYNTAX score and various indices related to heart disease, carotid artery stenosis, and postoperative morbidity and mortality. Thus, this index cannot be used to check and follow patients. However, further studies are needed to reach a definitive conclusion.

Background: Anxiety and depression are among the most important and common problems in patients admitted to the intensive care unit open-heart (ICU-OH). While the family plays a vital supportive role in decreasing these complications, patients are deprived of this supportive source during the important post-operative days due to visiting restrictions at these wards. Objectives: Therefore, this study aimed to evaluate the role of online video visitations on the anxiety and depression of patients at ICU-OH. Methods: This randomized clinical trial was carried out among 66 patients at ICU-OH of Imam Reza Hospital in Mashhad, Iran. The subjects were selected by the convenience sampling method and were randomly allocated to the intervention and control groups. Data were collected using a demographic characteristics checklist and HADS. In the intervention group, online video visitations with the family were carried out three times in the morning, evening and night on the second and third days of hospitalization in ICU-OH. In the control group, patients received the routine care of the ward and had no visitations with their families. Data were collected before the surgery, as well as 24 and 48 hours after admission to the ICU-OH. In addition, data analysis was performed in SPSS using independent t-test, Mann-Whitney U test, paired t-test, and Chi-square test. Results: No significant difference was observed between the intervention (7. 8  2. 2) and control (8. 3  2. 3) groups regarding the mean anxiety score 24 hours after the intervention (P = 0. 416). However, the mean anxiety scores 48 hours after the intervention were 6. 1 2. 3 and 7. 7 2. 6 in the intervention and control groups, respectively, showing a significant decrease in the intervention group, compared to the control group (P = 0. 010). However, the mean depression scores 24 and 48 hours after the intervention were estimated at 8. 0 2. 0 and 7. 1 2. 0, respectively, demonstrating no significant difference from the control group (P = 0. 933 and P = 0. 269). Conclusions: According to the study results, online video visitations decreased anxiety in patients at ICU-OH. Therefore, it is recommended that this method be used as an alternative to in-person meetings of patients at this ward.

Background: Noise is considered as one of the most significant and dangerous physical factors in work environments, and due to the advancement of industries, it has become a threat to physical and psychological health in the current era. In addition to its undesirable effects on the hearing system, noise can have harmful non-auditory effects that may cause physiological disorders and cognitive impairment. Objectives: This study aimed to investigate the relationship between hearing loss and workers’ cognitive performance in an industrial environment. Methods: A total of 300 individuals were enrolled in this study after their informed consent was obtained, and their compliance with the inclusion and exclusion criteria was confirmed. Based on the sound intensity level, the individuals were classified into two groups of exposure to > 85 dB (n = 196) and 85 dB (n = 104). To measure the individuals’ occupational exposure at an 8-hour equivalent level based on the ISO 9612: 2009 standard, the Testo device (Model CEL-815) was used with the precision of 0. 5 dB. The mostcommonweighting that is used in noisemeasurementis A-weighting. Like thehumanear, this effectively cutsoffthe lowerand higher frequencies that the average person cannot hear. The DANPLEX-AS54 device was also used to check audiometry. To investigate the workers’ hearing performance, two psychological tests, namely Stroop and TOL, were used as well. Results: Hearing loss was higher among workers exposed to a sound intensity level of > 85 dB than those exposed to a sound intensity level of  85 dB, and this difference was significant in all sound level frequencies (NIHL left ear: for  85 dB: 25. 92 and for > 85 dB: 27. 49) (NIHL right ear: for 85 dB: 27. 62 and for > 85 dB: 29. 50) (P value < 0. 05). The results showed a significant positive relationship between cognitive indicators and hearing loss (P value < 0. 05). Moreover, the study of cognitive indicators in the two groups revealed that the mean change of cognitive performance indicators was higher among subjects exposed to a higher sound intensity level (P value < 0. 05). Conclusions: The results of this study showed that noise-induced hearing loss in work environments had a significant positive relationship with cognitive indicators. In other words, an increase in the hearing loss level would result in changes in cognitive indicators such as number of errors and response time.

Context: Hepatocellular carcinoma (HCC) is a common malignant cancer and the second leading cause of cancer-related deaths around the world. Radiofrequency ablation (RFA) and laparoscopic hepatectomy (LH) have been adopted for the treatment of HCC. The aim of the meta-analysis was to explore the long-term efficacy of RFA compared with LH for small HCC (sHCC) patients in the East Asian population. Evidence Acquisition: We performed a systematic review and meta-analysis by the literature search on PubMed, Cochrane Library, EMBASE, Chinese Biological Medical Literature (CBM), Chinese National Knowledge Infrastructure (CNKI), andWanfang from their inception until October 10, 2019, for comparing the long-term efficacy outcomes of RFA with LH. Results: Fourteen retrospective studies with 1, 390 subjects were included in the meta-analysis. Compared with the LH-treated group, RFA could raise the local recurrence rate under median follow-up duration and reduce disease-free survival (DFS) rates at 1-3 years. However, it failed to affect 5-year overall survival (OS) and DFS rates. In the subgroup analyses, different RFA approaches had significantly higher local recurrence rates than the LH group. A similar effect on OS and DFS rates within five years for single early ( 3 cm) HCCs and on the 1-and 5-year DFS rates for nodules 5cmwere observed between the two groups, but RFA approaches could reduce the 3-y OS and DFS rates for single nodules 5 cm. The percutaneous radiofrequency ablation (PRFA) group had significantly lower 3-and 5-year OS and the 1-and 3-year DFS rates than the LH group, while no significant difference in OS and DFS rates in the laparoscopic radiofrequency ablation (LRFA) approach. The RFA approach improved the 3-year OS compared with the LH group in Japan, but reduced the 3-year OS and DFS rates within 3 years in China. Conclusions: Our results support that LH treating sHCC had a better long-term efficacy and a lower local recurrence rate than RFA in the East Asian population. Further high-quality prospective studies are required to confirm the long-term efficacy.

Background: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders that can disturb patients’ respiratory indices. Proton pump inhibitors (PPIs) such as omeprazole are currently the most common treatment in the patients. PPI-refractory GERD is a clinical problem constituting around 30% of patients with GERD. Objectives: The aim of this study was to investigate the effects of diaphragmatic breathing (DB) and omeprazole on respiratory indices (RI) and diaphragmatic excursion (DEX) in patients with GERD. Methods: This is a clinical trial conducted for eight weeks among 40 patients with severe GERD in Tehran in 2018. The block randomization method was designed to randomize 40 patients into two groups (DB and control) that resulted in equal sample sizes. The control group received omeprazole 20 mg once daily, and the DB group, in addition to omeprazole, performed DB. Respiratory indices, including (Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), Peak Expiratory Flow (PEF)), and DEX were evaluated before, immediately, and six weeks after the end of intervention by spirometry and ultrasonography; respectively. Results: There was no significant difference in the RI and DEX before the intervention between groups. FVC (P = 0. 04) and PEF (P = 0. 02) significantly changed in the control group, but FEV1 (P = 0. 001), FVC (P = 0. 002), PEF (P = 0. 001) and DEX (0. 001) significantly changed after DB. There was a significant difference in terms of RI between before and followed up in DB. Conclusions: Diaphragmatic breathing with omeprazole had more effects on RI and DEX than omeprazole alone. The positive effects of DB remain at least six weeks after the end of the intervention.