Iranian Red Crescent Medical Journal
Year:2021 | Volume:23 | Issue:2|Papers Count:12

Background: Delirium is a psychiatric syndrome observed among patients with critical psychiatric disorders. Haloperidol is now one of the first-line drugs for the treatment of delirium. However, quetiapine can be considered as an appropriate substitute in patients with a high risk of extrapyramidal symptoms or long QT syndrome. Objectives: This study aimed to compare the effectiveness of intramuscular haloperidol and oral quetiapine to control delirium in patients in the emergency department and intensive care unit. Methods: This randomized clinical trial was performed during 2017-2018 on patients with delirium who were referred to the emergency department and intensive care unit of Imam Reza Hospital (referral center), Mashhad, Iran. Patients were divided into two groups of 100 patients per group through a random allocation technique. In this study, 5 mg of intramuscular haloperidol every 12 hours and 25 mg of oral quetiapine were prescribed daily for the patients in the control and intervention groups, respectively. The delirium severity score of each patient was evaluated before and three days after the intervention through Delirium Rating Scale-Revised-98. Results: In this study, the mean± SD age of participants was 60. 2± 14. 1 years. The findings indicated that no significant difference was observed between haloperidol (22. 7± 1. 9) and quetiapine (22. 7± 2. 2) groups in terms of the baseline delirium severity score (P=0. 95). The mean delirium severity scores of patients in haloperidol and quetiapine groups were 25. 6± 2. 1 and 25. 2± 2. 5, respectively. Based on the obtained results, the difference between the delirium severity scores of both groups was not statistically significant (P=0. 24). Conclusion: Based on the results, oral quetiapine has a similar effect as intramuscular haloperidol and can be used as a substitute to this medicine for controlling the symptoms of patients with delirium.

Background: It is generally believed that the anticholinesterase effect is induced by the organophosphate insecticide parathion only through its bioactive metabolite (i. e., paraoxon) that is created in the liver. Objectives: This study aimed to evaluate the intrinsic anticholinesterase effect of parathion, compared to its main metabolite. Methods: This study has been conducted to prepare the isolated chick biventer cervicis nerve-muscle using the twitch tension recording method. Results: According to the results, paraoxon (0. 1 µ M) induced a highly significant increase (more than 100%) in the twitch height, while higher concentrations (0. 3 and 1 µ M) induced partial or total contractures. Furthermore, parathion induced almost the same percentage of increase in the twitch height at 1 µ M and partial or total contractures at 3 and 10 µ M. It should be noted that pralidoxime (2-PAM), at 300 µ M, reversed the effects of paraoxon and its parent (i. e., parathion). Conclusion: These results demonstrate that both parathion and its metabolite inhibit the acetylcholinesterase enzyme which can be reactivated by pralidoxime, whereas parathion is about 10 times less potent, compared to its metabolite. Therefore, the intrinsic toxic effects of parathion, regardless of its metabolite, should be considered in future studies.

Background: MicroRNAs have been recently declared to be contributed to the various aspects of osteosarcoma cells, including growth and survival, apoptosis, invasion, and chemoresistance. Objectives: The present study aimed to investigate the potentiating effects of miR-129 on the chemosensitivity of Saos-2 osteosarcoma cells to methotrexate (MTX) and underlying mechanisms. Methods: Saos-2 cells were transfected with miR-129 mimics for 48 h. The cytotoxic effects of miR-129 and MTX on Saos-2 cells were measured using MTT assay. Moreover, a scratch wound healing assay was used to evaluate cell migration, and the apoptosis rate of cancer cells was also measured using ELISA Cell Death Assay and flow cytometry. Eventually, the mRNA expression levels of target genes were measured using quantitative RT-PCR. Results: The findings of the study revealed that miR-129 mimic transfection significantly increased the expression levels of this miRNA in Saos-2 cells (P<0. 05) and that the combination of MTX with miR-129 transfection led to the enhanced cytotoxic effects of MTX in lower concentrations. miR-129 significantly increased MTX-induced apoptosis levels and decreased the invasive behavior of Saos-2 cells. Eventually, the mRNA expression levels of c-Myc, K-Ras, CXCR4, MMP9, and ADAMTS, as the main genes involved in chemoresistance and cell invasion, were downregulated in miR-129 transfected cells. Conclusion: The obtained results revealed the important role miR-129 plays in the sensitivity of osteosarcoma cells to MTX and its underlying mechanisms. Therefore, miR-129 might be an appropriate candidate for reversing MTX resistance in osteosarcoma cells.

Background: The annual religious ritual of Arba’ een is the global largest mass gathering of pilgrims from different countries participating in a mass movement on an 80-km pathway to visit the Shrine of Imam Hussein, the grandson of Prophet Muhammad. The provision of health care for such a mass movement has always been an important vital issue for the health care system. Objectives: The current study investigated the common illnesses in addition to the quantity of health care services offered by temporary clinics and health stations located on the way to the shrine to such a mass gathering of on-feet pilgrims in Iraq in Arba’ een 2019. Methods: This cross-sectional study was conducted at temporary clinics and health stations where pilgrims in need of nursing, midwifery, and pharmaceutical care were provided with services by general and expert physicians on the way from Najaf to Karbala in Iraq during a week in October 2019. Results: Imam Reza Temporary Clinic offered services to a total of 26, 875 patients, including 9, 934 females (36. 96%) and 16, 941 males (63. 04%), on all days of the week. The most common chief complaint reported by the patients were musculoskeletal problems (n=11, 945; 21. 99%), foot blisters (n=11, 372; 20. 94%), and skin lesions (n=10, 662; 19. 62%). Conclusion: The present study highlighted the need for providing more organized services, especially in emergency health care, and necessity of paying further and closer attention to the significance of the health history of those pilgrims attending such religious mass gatherings in previous years.

Background: Congenital malformations are one of the most important and common types of anomalies in infants, which are one of the main causes of disability and mortality in children. Objectives: This study aimed to investigate the risk factors affecting the incidence of congenital malformations, as well as the number of different infant anomalies recorded in neonatal health data in Khoy, Iran, during 2017. Methods: In this study, all neonates born in the maternity wards of hospitals in Khoy, Iran, during 2017 were evaluated in terms of gender, weight, and parental consanguinity. Hurdle and Zero-inflation approaches were utilized for the double Poisson model. Moreover, the data were collected using some checklists, and the analyses were performed in R-3-6-1 software. Results: According to the results of the present study, the Hurdle approach was better than Zero-inflation. The birth weight and parental consanguinity affected the incidence of congenital malformations in infants. Conclusion: Given that a significant proportion of infants are born without any congenital malformations, it is important to use count regression models based on excess zero approaches to assess congenital malformations. It is also necessary to take steps to reduce consanguineous marriages and the number of infants with low-birth-weight to prevent congenital malformations.

Background: Coronavirus disease 2019 (COVID-19) can have a wide clinical spectrum. Objectives: The current study aimed to analyze the clinical and laboratory risk factors of the severe course of disease in patients with COVID-19. Methods: Consecutive patients with a diagnosis of COVID-19 pneumonia were included in the present study. The demographic characteristics, comorbid diseases, symptoms, chest computed tomography (CT) findings, laboratory data, oxygen saturation (SpO2), and body temperature of the patients were recorded. The coexistence of pulmonary infiltration in CT and SpO2 of ≤ %93 on fingertip pulse oximeter was defined as the severe course of the disease. Results: A total of 475 patients were included in the current study. The mean age of the patients was 52. 02± 15. 9 years, and 259 (54. 5%) participants were male. The disease was mild and severe in 80% (n=380) and 20% (n=95) of the study subjects, respectively. The age of > 50 years, coexistence of hypertension (HT) and diabetes mellitus (DM), neutrophil-to-lymphocyte ratio (NLR) of > 4, lactate dehydrogenase (LDH) of > 240 U/L, C-reactive protein (CRP) of > 8 mg/dL, and D-dimer of ≥ 1000 ng/mL were determined to be the risk factors for the severe course of the disease. Conclusion: Age, NLR, CRP, LDH, D-dimer, comorbidity, and coexistence of DM and HT were the independent risk factors for the severe course of the disease. The aforementioned factors should be taken into account during risk stratification and management of patients with COVID-19.

Background: The use of an appropriate contrast agent performs a major role in brain magnetic resonance imaging (MRI) of multiple sclerosis (MS) patients. Objectives: The present study aimed to make a comparison between the diagnostic values of Gadovist and Magnevist considering the successive imaging times in contrast-enhanced brain MRI of MS patients. Methods: A total of 62 relapsing-remitting MS patients (56 females, mean age of 31 years) were enrolled in the present study. All of them underwent two sessions of standard contrast-enhanced brain MRI upon enrollment and 48 h later. The participants were randomly assigned to each contrast agent. T1-weighted (T1W) images were taken 30 sec, as well as 5, 10, 15, and 30 min after the contrast injection. For all of the images, two neuro-radiologists who were blinded to the contrast type counted the number of plaques in the brain. In addition, for the enhanced plaques larger than 10 mm, the signal intensity (SI) was determined using its region of interest. Results: The mean plaque number significantly increased from 30 sec to 15 min for both contrasts separately (P<0. 001). Nonetheless, the slight increases in the mean plaque number from 15-30 min for both Gadovist and Magnevist were not statistically significant (both PValues>0. 25). The mean plaque number in the Gadovist group was higher, compared to that in the Magnevist group at both 15 and 30 min, and the differences were statistically on the borderline (both P-Values=0. 07). The mean SI of enhanced plaques gradually increased in the course of imaging in both contrast groups. Except for 30 sec, in all other time sessions, the mean SI was higher in Gadovistenhanced MR images, compared to Magnevist-enhanced MR images (P<0. 01). Conclusion: As evidenced by the obtained results, Gadovist showed a relatively better diagnostic value for brain MRI of MS patients. Furthermore, the findings suggested that it is cost-effective to take MRI only up to 15 min (instead of 30 min) after contrast injection in both agents.

Background: Repetitive transcranial magnetic stimulation (rTMS) is recommended as an effective treatment for both major depressive disorder (MDD) and treatment-resistant depression. Objectives: According to the possible impact of rTMS on cognitive psychological characteristics, this study aimed to determine the effectiveness of rTMS in meta-worry and neuropsychological functions among MDD patients. Methods: This quasi-experimental study was conducted on 30 patients with MDD referring to Atieh Clinical Neuroscience Center, Tehran, Iran, in 2019. The participants were randomly divided into two groups of intervention and control (n=15 each). The data collection tools included the Beck Depression Inventory, meta-worry subscale of the Anxious Thoughts Inventory, and Cambridge Neuropsychological Test Automated Battery. Results: The comparison between the two groups showed that the scores of the meta-worry scale improved after the intervention in patients undergoing rTMS, compared to those in the control group (Z=-3. 41; P=0. 002); however, no difference was observed between the two groups in the follow-up (Z=-2. 02; P=0. 053). The assessment of neuropsychological functions among the patients undergoing rTMS and those in the control demonstrated that neuropsychological functions (i. e., Minimum Spanning Tree, Rapid Visual Information Processing, and Spatial Working Memory) were significantly different immediately after the intervention and in the follow-up (P<0. 05) except for the Difficulty Maintaining Sleep (DMS) subtest. In addition, the mean depression score was significantly different between the two groups (Z=-4. 17; P<0. 005). There was a significant relationship between depression and all the subtests of neuropsychological functions except for DMS (P>0. 05). Conclusion: In summary, the results of the current study indicated that the use of rTMS was an effective method in the improvement of neuropsychological functions except for DMS in patients with depression. However, the obtained findings did not demonstrate the persistent effect of multiple rTMS on meta-worry.

Background: Myofascial pain syndrome (MPS) is one of the most frequent causes of chronic musculoskeletal pain which is characterized by myofascial trigger points (MTrPs). Hence, it is of crucial importance to identify practical approaches for the treatment of these points. Upper trapezius muscle (UT) is highly susceptible to the development of MTrPs that are commonly resulted from overuse and micro-trauma. Objectives: The present study aimed to compare the effects of dry needling (DN) and low-level laser therapy (LLLT) regarding the reduction of pain and muscle thickness and improvement of the range of motion (ROM) and pressure pain threshold (PPT) in patients with latent MTrPs (LTrPs) in their UT muscles. Methods: In total, 60 patients with LTrPs in UT muscle participated in this randomized clinical trial. The subjects were randomly divided into two treatment groups of DN and LLLT. The PPT was evaluated by visual analog scale (VAS) and algometer while ROM and muscle thickness were assessed using goniometer and ultrasonography, respectively. It should be noted that the variables were evaluated before the first and after the sixth sessions. Finally, the collected data were analyzed using independent and paired t-tests. Results: Based on the results, the VAS and muscle thickness significantly reduced, while the PPT and cervical ROM increased in both groups after treatment (P<0. 001). The independent t-test revealed a statistically significant improvement in the DN group in terms of PPT (9. 9-14. 17, P=0. 009) and ROM (37. 33-42. 67, p=0. 005), compared to the LLLT group. Nevertheless, no significant difference was found between the two groups regarding VAS and muscle thickness variables (P>0. 05). Conclusion: The DN and LLLT effectively improved symptoms in the UT muscles of patients with LTrPs. However, the DN was more effective in the improvement of ROM and PPT variables.

Background: The increased level of the airway and systemic inflammation, worsened clinical symptoms, and impaired lung functions are regarded as the characteristics of chronic obstructive pulmonary disease (COPD). The COPD may cause right/left ventricle dysfunction, pulmonary hypertension, and cor pulmonale. Objectives: The current study aimed to assess atrial electromechanical delay (AEMD) and echocardiographic changes and their relationship with inflammatory markers in subjects suffering from COPD during acute and stable periods. Methods: This prospective study was carried out on a total of 45 patients (including 22 and 23 female and male participants, respectively) suffering from COPD exacerbation. The stable phase of the participants was considered the control group. The first and second echocardiography was conducted in the first 24 h and following 3 months, respectively. Conventional and Tissue Doppler Imaging was utilized for the evaluation of atrial conduction times and systolic-diastolic functions of the right-left heart. The inflammatory markers, including the c-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio, were also measured in this study. Results: In the stable period, there was a significant reduction in lateral/tricuspid, lateral/mitral, and septal AEMD. The evaluation of right ventricle basal, mid and vertical diameters, tricuspid annular plane systolic excursion, Amax tricuspid, tricuspid regurgitant velocity, systolic pulmonary arterial pressure, tricuspid annular systolic motion, left atrium diameter, left ventricle end-diastolic diameter, interventricular septum thickness, mitral early diastole/atrium systole ratio, systolic mitral motion, systolic septal motion, and heart rate showed significant differences after 3 months. In addition, there was a significant decrease in C-reactive protein, CAR, and NLR. Conclusion: In the stable period, a significant reduction was observed in AEMDs and there was an improvement in the systolic functions of the right-left heart. No correlation was observed between AEMDs and inflammatory markers.

Background: There have been no studies investigating the association of serum calcium level upon admission with long-term cardiovascular outcome among patients suffering from acute coronary syndrome (ACS). Objectives: This study aimed to explore the correlation of serum calcium level upon admission with cardiovascular outcomes among ACS patients. Methods: This longitudinal study included 105 ACS or suspected ACS patients who were referred to the Coronary Care Unit from June 1 st, 2015, to August 31 st, 2016. Serum calcium was measured upon admission, and the patients were followed up until November 30 th, 2016. Cardiovascular death or cardiovascular re-hospitalization was the study's end. Results: According to the median of serum calcium, the patients were divided into two groups of lower (n=47) and higher serum calcium level (n=58). The results of the Kaplan-Meier analysis revealed that patients with lower serum calcium obtained a significant decrease in cardiovascular event-free survival (log-rank χ 2 =5. 594, P=0. 018), compared to those with higher serum calcium level. Furthermore, lower serum calcium level (HR=0. 265, 95% CI=0. 072-0. 981, P=0. 047) independently correlated with poor cardiovascular outcome in ACS or suspected ACS patients after adjusting the potential confounders in the multivariable C ox model. Conclusion: Lower serum calcium level upon admission independently correlated with poor long-term cardiovascular outcomes in patients with severe coronary artery disease.

Background: Identification of the factors contributing to the errors of medical staff and examining the causal relationships among those factors can help better manage and design more effective policies and practices. Objectives: This study aimed to identify the causes and factors affecting medical error management and determine a model for better management of such errors. Methods: This descriptive-analytical study was conducted in two qualitative and quantitative phases. In the quantitative part of the study, the factors related to medical error management were identified and validated through reviewing previous studies and interviewing some specialists. Following that, the fuzzy decision-making trial and evaluation method was used for structural modeling of the factors and investigating the causal relationships among them in the quantitative part. Results: In this study, the results showed that the "education and learning from error" subfactor had the most significant impact on the system. The second highly effective subfactors in the management of medical errors were "organizational communication and improved information access", "safety culture and climate", and "policies, procedures, and guidelines". In addition, the "safety culture and climate" was the most important factor that had the most critical impact on the system. Moreover, the "handoff conversations and communication" subfactor was mostly influenced by the other factors, followed by the "incident reporting system", "error prevention and corrective measures", "safety culture and climate", and "individuals' participation". Conclusion: According to the results of this study, the health care industry should take into consideration both organizational and individual factors in error management. In order to achieve better planning and higher performance in error management, increase patient safety, and ultimately improve the quality of hospital services, it is suggested to consider the causes and factors affecting the system.