JOURNAL OF RESEARCH IN CLINICAL MEDICINE
Year:2020 | Volume:8 | Issue:1|Papers Count:38

Introduction: We investigated the effect of education on the knowledge and decision-making of medical interns, based on emergency severity index (ESI) triage. Methods: In this pre and post-interventional study, 155 medical students who were passing their internship course of the emergency ward were enrolled with convenience sampling from July 2018 to June 2019. The students were randomly classified into two groups (103 cases and 52 controls). The questionnaire was administered twice in the control group (before initiating the educational class and 1 month after completion of the educational course). In the case group, the test was conducted at three times (before the educational class, immediately after completion of classes, and one month after completion of the educational course). The data were analyzed by using t test and ANOVA. Results: The total score of the students in the case group in the pre-and post-training stage (posttest 1) was 17. 13 ± 4. 26 and 24. 93 ± 3. 20 respectively, which had a significant difference (P < 0. 001). The total score of the students in the posttest 2 was 23. 38 ± 5. 66. Statistical test showed that there was a significant difference between the two groups of the students in terms of the test in the one month after completion of the educational course (P < 0. 001) except for undertriage (P = 0. 236). Conclusion: The findings indicated that education based on ESI triage was effective on the knowledge and decision-making of medical interns. Based on the results of this research and given the importance of triage, theoretical and practical educational courses are proposed for medical students.

Background: Isolated intracranial Rosai-Dorfman disease (RDD) is an extremely rare, idiopathic histo-proliferative disorder. RDD is associated with the proliferation of histiocytes and emperipolesis. Case Presentation: we report a case with isolated intracranial RDD. A 47-year-old man presented with a dizziness, falling, and then secondary generalized seizure, hemiparesis and right hemisensory deficit. This case preoperatively was misdiagnosed with meningioma. Histopathological examination revealed pale histiocytes displaying emperipolesis which were positive for S-100 and CD68 proteins and negative for CD1a marker. BRAF V600E mutation was negative. Conclusion: In this case, total resection was performed and clinical symptoms were regressed completely.

Diagnostic and predictive value of white blood cell count, erythrocyte sedimentation rate, and coagulation tests in patients with blunt head trauma

Introduction: Cardiac glycosides are widely used in critical cardiac diseases despite their unexplained mechanisms on cardio-respiratory system and other autonomic complications within both intra-uterine and post-natal life. The aim of this study is to investigate if digitalis overdose could cause a result in such complications by a destructive effect on blood-brain barrier (BBB). Methods: Twenty-five male Sprague Dawley rats weighing 300– 350 g were divided into the following groups: control (n=5), sham (isotonic) (n=5), therapeutic dose (n=5), arrhythmogenic dose (n=5), and lethal dose (n=5). The animals were euthanized and their brains were extracted. The brains were histopathologically and immunohistochemically examined to evaluate BBB morphology in the superior temporal cortex. Results: One animal died because of experimental procedures on the first day. Macroscopic examination of brains revealed brain edema, subarachnoid hemorrhage (SAH), and narrowed cisterns in toxic doses of digitalis-treated animals. Brain histopathological examination of these groups revealed bloody subarachnoid and cisternal spaces, cortical arteriolar vasospasm, neurodegeneration, and even peri-arteriolar neuroglial component fragmentation; these changes induced BBB destruction in the high-dose digitalis-treated animals. Conclusion: Digitalis should not be used with overdoses if the cardio-respiratory arrhythmia is unexpectedly appearing in low doses against the possibility of defected or disrupted BBB.

Introduction: Because of increasing the population of premature infants due to improving neonatal care we try to find other independent criteria in addition to birth weight and gestational age to reduce the number of infants who need a retinopathy of prematurity (ROP) screening examination. Methods: This is a retrospective cross-sectional study, included 150 preterm infants with gestational age of ≤ 32 weeks or birth weight ≤ 1500 g or receives oxygen therapy for more than 2 days, who were examined from the fourth week of life for ROP in Tabriz Al-Zahra hospital’ s neonatal intensive care unit (NICU), from March 2017 to January 2018. All infants with other risk factors such as multi gestational pregnancy, blood transfusion or exchange, phototherapy, underlying disease, cerebral hemorrhage, chronic lung disease and sepsis were excluded from the study. Infants divided to two group ROP (n = 47) and non-ROP (n = 133) and their 5-minute Apgar score was Apgar score was compared as an independent risk factor. Exploratory data analysis was performed using descriptive measures with independent samples t tests. Kolmogorov-Smirnov tests were used to test the normality of data distribution. Results: The mean 5-minute Apgar scores were statistically lower in ROP group (5. 4 ± 2. 3) than non-ROP group 6. 2 ± 2. 1 (P value = 0. 041). Conclusion: Apgar score was statistically significant, but in light of the very close results obtained, it seems prudent to consider an independent risk factor.

Introduction: The acute coronary events are one of the most common problems which are accounted to higher mortality and morbidity rate around the world. The underlying mechanism is related to occlusion, and the best therapy is to reopen the affected vessels. Many factors can influence the outcomes of percutaneous coronary intervention (PCI). Methods: This cross-sectional study was conducted on 845 cases with acute myocardial infarction (AMI) undergoing PCI for evaluation of the “ No-Reflow” phenomenon who were referred to Shahid Madani hospital in 2018. All demographic, laboratory and angiographic studies were evaluated. The obtained data were recorded and analyzed by SPSS 21. Results: Among 845 patients with STEMI, the incidence of angiographic no-reflow was 28% (n = 245). The older cases with co-morbid diseases and cardiac-related risk factors were considered as vulnerable to no-reflow after PCI. The other parameters were partially decisive factors for the prediction of no-reflow and mortality rate, such as higher MPV and MPV to lymphocyte ratio. Conclusion: The coronary artery involvement is a troublesome event because of the established heart risk factors, and sometimes treating it with PCI could be complicated due to no-reflow. The simple predictors (i. e., MPV to lymphocyte ratio) could help us reduce morbidity and mortality.

Introduction: This study aimed to evaluate the relationship between the serum level of melatonin, 8-hydroxy-2-deoxy guanosine, and vitamin-D in patients with osteoarthritis (OA). Methods: This study enrolled 47 patients with OA and 40 healthy controls. Serum levels of melatonin and 8-hydroxy-2-deoxy guanosine (8-OH-dG) were assessed. Also, serum levels of bone turnover biomarkers such as calcium, phosphorus, vitamin D, and alkaline phosphatase (ALP) were measured in OA patients and controls. Results: The serum level of melatonin was significantly lower in OA patients than the controls (6. 18 ± 2. 25 vs. 11. 57 ± 3. 87 pg/mL, P < 0. 05). In contrast, the serum level of 8-OH-dG was significantly increased in OA patients compared to controls (65. 21 ± 16. 12 vs. 22. 51 ± 5. 3 ng/dL, P < 0. 001). There was a negative correlation between serum melatonin and 8-OHdG levels in OA patients (P < 0. 05). There was a positive correlation between serum melatonin and vitamin D levels in OA patients (P < 0. 05). We found decreased calcium and vitamin D levels, and increased phosphorus and ALP levels in OA patients compared to controls (P < 0. 05). Conclusion: Decreased levels of melatonin and elevated levels of 8-OH-dG might play a role in the pathogenesis of OA. Therefore, melatonin might be involved in decreasing DNA damage and exerting a preventive function in OA.

Introduction: The aim of this study was to evaluate the demographic characteristics and radiotherapy schedules of patients for whom palliative radiotherapy for brain metastasis was administered. Methods: This was a retrospective study that evaluated the patients who received palliative radiotherapy for brain metastases between January 2011 and December 2019. Patient treatment files and the hospital information management system were used to collect the data. Results: In this study, 4107 patients who received radiotherapy for any brain tumors were evaluated. Of these, 2910 had metastatic brain tumors. In the metastatic group 1736 (60%) patients were male and 1174 (40%) were female. Primary diagnosis was lung cancer (38%), breast cancer (20%), primary unknown (15%), gastrointestinal cancers (12%), and other cancers (15%). 1643 (52%) patients received whole-brain radiotherapy (WBRT), 535 (18%) received WBRT with stereotactic radiosurgery (SRS) and 706 (29%) received SRS without WBRT for brain metastasis. Radiotherapy data of 26 (1%) patients could not be accessed. Conclusion: Both WBRT and SRS are good palliative treatment options for brain metastasis. SRS without WBRT can be considered as a treatment option in selected cases.

Introduction: Topical clotrimazole and sertaconazole may be effective in the treatment of erythrasma, a superficial skin infection developed by a group of aerobic microorganisms. This study aimed to compare the effect of clotrimazole and sertaconazole on erythrasma. Methods: In this double-blinded randomized controlled trial, 40 age-matched patients with confirmed erythrasma diagnosis were divided into two equal groups; one treated with topical 2% sertaconazole and the other with topical 1% clotrimazole. The clinical features of erythrasma were monitored for two weeks (baseline, day 7, and day 14) and compared. Data were analyzed using SPSS v16 software. Results: On day 7, in clotrimazole group, reduction in erythema and pigmentation were more prominent in comparison to the sertaconazole group (P = 0. 02 and P = 0. 005, respectively), but there was no difference considering scaling reduction between groups. On day 14, in terms of erythema reduction, the clotrimazole group performed better compared to the sertaconazole group (P = 0. 04). Both groups had a significant reduction in erythrasma symptoms during their treatment period (P < 0. 001). Conclusions: Regarding the results, both clotrimazole and sertaconazole are effective medications for erythrasma treatment. Still, clotrimazole has a faster recovery process in comparison to sertaconazole, but no significant difference is observed in outcomes after two weeks of treatment.

Introduction: Knee osteoarthritis (KOA) is the most common degenerative joint disease resulting in bone pain and disability. The aim of current study is to determine diet quality by healthy eating index (HEI)-2015 in association with pain and functional status among a sample of participants with primary knee OA. Methods: In this cross-sectional study, 220 patients with knee OA were recruited via convenience sampling in the outpatient clinics of Tabriz University of Medical Sciences between April and September 2018. The HEI-2015 score was calculated from dietary data collected using a Food Frequency Questionnaire (FFQ). Visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index and the SF36 quality of life (QoL) questionnaire were applied to measure the pain intensity, functional status and QoL in the participants, respectively. Participants were categorized based on the quintile cutoff points of HEI score including 42-62, 63-69, 70-75, 76-78 and 79-100. Results: The mean score of HEI was 70. 62 ± 10. 18 (range: 42– 89). Participants with greater HEI-2015 scores had higher total energy intake (P = 0. 008) and greater dietary intake of carbohydrates (P = 0. 01), protein (P = 0. 009), monounsaturated fatty acids (P = 0. 01), polyunsaturated fatty acids (P = 0. 007) and fiber (P = 0. 009) and lower intake of saturated fatty acids (P = 0. 005). Participants in higher quintiles of HEI had significantly lower pain intensity (P = 0. 001) and higher scores of physical function (P = 0. 001), pain (P = 0. 001) and role limitation due to physical problems (P = 0. 005) subscales of SF-36 QoL questionnaire in comparison with participants in lower quintiles of HEI-2015. Conclusion: The HEI-2015 score is associated with pain intensity and two domain of QoL in patients with knee OA.

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0. 1 mg/kg + 5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0. 2 mg/kg + 5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P > 0. 05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P = 0. 03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

Introduction: Urinary incontinence (UI) is a multifactorial and prevalent disorder among aged women. Physical activities are believed to have challenging roles in the deterioration of the UI. The aim of this study was to examine the effect of standardized weightlifting on urodynamic parameters in the urinary continent and incontinent individuals. Methods: Twenty-four UI morbid and 21 control subjects participated in a standardized weightlifting task while undergoing multichannel cystometry tests in two empty and full bladder conditions. Maximum weightlifting force (MWF) and vesical and abdominal pressures (APs) were measured to calculate the detrusor pressure. Results: Findings showed that the UI participants with full bladder have significant higher abdominal, vesical and detrusor pressures in comparison to the controls; but in empty bladder condition, only the AP of the UI morbid group was significantly greater. The MWF was not significantly changed between the UI and control groups. The MWF was also not correlated with the detrusor pressure among the UI participants and full bladder controls. Conclusion: Weightlifting till the subject’ s maximum force can neither produce incontinence in healthy subjects nor deteriorate the UI patients’ conditions.

Introduction: Platelet large cell ratio (P-LCR) test is one of the test parameters that is routinely calculated in the hemogram test, and expressed as the ratio of platelets with platelet volume greater than 12 fL. Large platelets are relatively younger and contain more intracellular granules, meaning that platelets have more thrombogenic potential. In the literature investigating the relationship between the acute coronary syndrome and P-LCR levels, the use of aspirin in patients and its effects on platelet parameters were ignored. In our study, for the first time in the literature, the relationship between P-LCR levels and acute coronary syndromes were investigated by means of including the patients before they took aspirin which ensures that P-LCR test is not affected by aspirin. Method: Retrospectively, patients aged 18-70 years were screened and those whose hemogram tests were completed before aspirin usage were included. A total of 109 patients diagnosed with unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) were included and compared in the study. Results: The mean P-LCR values were 23. 61% (95% CI: 21. 97-25. 25) in UA patients, 28. 34% (95% CI: 24. 86-31. 83) in NSTEMI, and 25. 71% (95% CI: 22. 07-29. 35) in STEMI patients. There was a statistically significant difference between the P-LCR values among the groups (p = 0. 022). Conclusion: The increase in P-LCR, free of aspirin effects, was found to be statistically significant in acute coronary syndromes.

Introduction: We aimed to investigate the efficacy of Hounsfield unit (HU) attenuation measured on computed tomography (CT) as a non-invasive method for pleural effusion characterization. Methods: Patients with pleural effusion who underwent thoracic CT imaging and thoracentesis within a maximum of three days were included in this retrospective study (15 transudate and 36 exudate). By drawing a circular region of interest (ROI) on the section with the thickest pleural effusion in terms of anteroposterior diameter in the upper-medial-lower zone on axial images, a total of three HU values, one from each level, were averaged. An independent t-test was applied to the CT attenuation (HU) values for the transudate-exudate differentiation. A receiver operating characteristic (ROC) analysis was then made. Results: The mean attenuation ± standard deviation (minimum-maximum) value for the patients with transudate was 2. 17 ± 3. 76 ((-7. 5)-7. 5) HU, whereas the mean HU value for the patients with exudate was 8. 38 ± 6. 2 ((-6)-22). The independent t test made for the transudate-exudate differentiation revealed a statistically significant difference (P = 0. 001). In the ROC analysis carried out to determine the cut-off value of the attenuation value of pleural effusion in the transudate-exudate differentiation, the area under the curve was found to be 82. 8%. When the cut-off value was taken as 2. 75HU for the area under the curve, sensitivity was found to be 84%, and specificity was 60%. Conclusion: Although CT-HU values are statistically significant in the differential diagnosis of transudate-exudate, there is still a need to establish a correlation with other tomographic findings and clinical laboratory findings.

Introduction: Considering that portal hypertension is principally caused by hepatic fibrosis, some studies postulated the predictive value of serum liver fibrosis indices in the diagnosis of portal hypertension. In this study we assessed the prognostic value of serum indices in the diagnosis of portal hypertension in cirrhotic patients. Methods: One hundred two cirrhotic patients were selected according to inclusion/exclusion criteria. Cirrhosis and the Child-Pugh score was determined by the gastroenterologist. Portal hypertension was diagnosed by the radiologist using the color Doppler method. The fasting blood sample was drawn and different serum indices were determined. The following indices were calculated: FIB4, Fibroindex, APRI, FORNS, LOK. Results: The patients mean age was 54. 39 ± 6. 60 years. About 52. 94% of the patients were women. The mean liver enzymes level was higher in patients with portal hypertension. In 50. 98% of patients, the etiology of cirrhosis was viral hepatitis. Significant differences was observed between the two groups regarding the studied indices (P < 0. 05). According to the results of the ROC curve, the FORNS index was a better predictive marker of portal hypertension in cirrhotic patients. The maximum AUC (area under the curve) was for the FORNS index. According to the results of diagnostic tests, the FORNS index had adequate sensitivity and specificity in the diagnosis of portal hypertension with the cut-off value of 8. 51. Conclusion: The results of the present study showed that the FORNS index is a better predictor of portal hypertension in cirrhotic patients.

Background: Since light scattering has a great impact on visual performances, this study was conducted to compare the effects of color filters and anti-reflective coating on contrast sensitivity (CS) in normal people under glare condition. Methods: This semi-experimental study was conducted on 40 medical students (aged 19-25 years). Ophthalmologic tests including visual acuity and refractive error measurement, biomicroscopy, fundoscopy, and CS assessment were conducted for all participants. CS was determined using Pelli-Robson chart at a distance of one meter. To measure the effect of glare on CS, we used an additional lighting source (60 W tungsten filament incandescent lamp) in the patient’ s visual field. Thus, at an intensity of 2000 lux, the light source was placed at a distance of 18. 5 cm from the patient’ s eye in a way that it was 10 degrees above the subject’ s visual axis. Monocular CS measurements were performed with and without glare. Monocular CS was evaluated again under glare conditions with the yellow and pink filters, with the transmission rate of 85%, and anti-reflective coating. Results: The mean log CS of subjects under glare (1. 48 ± 0. 09) was lower than that in the absence of glare (1. 71 ± 0. 09) (<0. 001); moreover, repeated measures ANOVA showed the yellow filter (1. 48 ± 0. 10), pink filter (1. 47 ± 0. 10), and anti-reflective coating (1. 47 ± 0. 09) had no significant impact on improving visual performance under glare condition (P = 0. 471). Conclusion: Colored filters and anti-reflective coatings are not effective in enhancing the vision of young normal individuals under glare conditions and at low spatial frequencies.

Introduction: The studies have been equivocal about the association of Helicobacter pylori infection with chronic urticaria (CU) given some controversial evidence in recovery of urticaria following H. pylori eradication. Methods: In this clinical trial, 120 patients between the ages of 4 and 20 with intractable CU were recruited. They were grouped into two categories based on urea breath test (UBT) result. UBT positive group received treatment and UBT was repeated after two months while being evaluated for clinical course over a six-month period. On the other hand, UBT negative group received standard treatment for urticaria. Results: All participants with CU have been studied as 40 cases of UBT positive and 80 cases of control group with negative UBT, consisted of 42 (35%) male and 78 (65%) female. Patients had suffered from urticaria on average 29. 9 (± 26. 6) months prior to diagnosis. Statistically significant difference was noted between two groups, in terms of severity of urticaria, frequency of episodes, abdominal pain and duration of being symptomatic prior to diagnosis. After receiving treatment for H. pylori infection, among case group, 27(67. 5%) of individuals achieved complete recovery of urticaria and 13 (32. 5%) cases demonstrated partial resolution of urticaria, meanwhile 59 cases (73. 8%) of control group became completely symptom-free, while 21 (26. 3%) of the remaining individuals were in incomplete recovery. In comparison of response to treatment between the above-mentioned groups, there was not any statistically significant difference (P = 0. 47) Conclusion: Our findings reveal that H. pylori infection might contribute to developing CU which highlights the significance of H. pylori eradication as an approach for CU.

Introduction: Trauma has been recognized as the leading cause of mortality and morbidity among children in developed countries. Therefore, it is highly desirable to have a control program in this area. The aim of this study was determining epidemiologic feature and diagnostic outcome of traumatic pediatric patients referred to emergency department in 2016-2017. Methods: This descriptive cross-sectional study was conducted at emergency department, Imam-Reza hospital of Tabriz University of Medical Sciences in 2016-2017 on a total of 518 traumatic children. Variables of interest were age, gender, location of trauma, mechanism of trauma, type of transfer to emergency department, time of trauma, and outcome of the incident. Results: Among 518 traumatic children involved in the study, the most common age for trauma was 3-6 years, and 66. 4% and 33. 6% of the studied population were boys and girls, respectively. Falling (42. 5%) was the most common mechanism of trauma, and the most of traumas occurred during evening (56. 9%) and spring (38. 8%) time. In additions, 75. 5% of traumatic children were transferred to the emergency department by their family, and among them, only for two cases safety instructions had been considered. Conclusion: In general, the results of this study demonstrated that boys with the age of 3-6 years are the most vulnerable group against trauma. Falling and traffic accidents are the main causes of trauma in children, whereas safety devices were not used in the majority of accident cases. Thus, it is highly recommended to use safety equipment for children inside vehicles.

Primary cancer metastasis to thyroid gland is rare. The most common metastatic tumors of the thyroid gland are from lung, breast and renal cell carcinoma. In this case report, a patient with breast cancer metastasized to the thyroid gland is presented. A 38-year-old female patient was diagnosed with breast cancer, and positron emission tomography-computed tomography (PET-CT) imaging for breast cancer staging revealed fluoro-2deoxy-D-glucose (FDG) uptake in the thyroid nodule. Fine needle aspiration biopsy (FNAB) of the nodule revealed atypia of undetermined significance (Bethesda III). After neoadjuvant chemotherapy, simultaneous breast conserving surgery and total thyroidectomy were performed. Immunohistochemical staining of the pathological specimens revealed breast cancer that had metastasized to the thyroid gland. Immunohistochemical methods helped distinguishing primary thyroid cancer from metastasis. Also, nodules that showed activity involvement were detected randomly in PET-CT, and had to be evaluated in terms of malignancy.

Leptomeningeal metastasis (LM) also known as meningeal carcinomatosis is a rare but grave complication seen in the terminal stage of a known primary cancer. We report an uncommon case of LM in a 62-year-old male patient, presenting with neurologic signs and symptoms of increased intracranial pressure at least two months before any evidence of involvement of the primary focus in lung. The prognosis of the disease was poor due to the involvement of central nervous system and bones. It is important to have a high index of suspicion and to consider systemic diseases in differential diagnosis of the syndrome of intracranial hypertension.

Introduction: Trauma is the leading cause of mortality and disability in the countries. How to deal with a traumatic patient is one of the most important things and the individuals need to learn about it. The purpose of this study is to investigate the effect of problem-based education on improving the performance of medical trainees in the management of trauma patients, and identify students’ skills status in order to advance educational goals; and thus increase community health. Methods: In this randomized clinical trial, 76 Medical students were randomly divided into two intervention and control groups. Student performances were evaluated using standard checklists as a pre-test and post-test assigned. descriptive and statistical analysis of the acquired data was done using SPSS 20 software; and the parametric and non-parametric tests were used for the statistical analysis. Results: There was no statistically significant difference in age at 23 years (P = 0. 422). In terms of sex distribution, there was also no statistical difference (P = 0. 212). The scores in the intervention group were higher than in the control group, but no statistically significant difference was observed between the two groups. Conclusion: The results show that student-centered and cooperative methods have a greater impact on students’ learning than lecturing. On the other hand, one should know that learning problem-solving itself has many limitations and problems with implementation.

Hydatid cyst disease is one of the zoonoses caused by the larval stage of Echinococcus granulosus, mostly involving the liver and the lungs; but its complications can be seen in every site and organ. Sometimes it can cause suspicious and complicated cases that mimic malignancy. For instance, axillary involvement of hydatid cyst is very rare. It is important to differentiate hydatid cyst disease from cancer, since it may show malignant features when pulmonary or other distant organ involvement takes place. In this study, we present a case of multiple masses in the lungs and the axillary region in a 48-year-old woman. The ultrasonography was unable to detect hydatid cysts. Biological values were normal except for serum sodium (Na) and potassium (K); and enzyme-linked immunosorbent assay (ELISA) test was negative. Hydatid cyst was diagnosed while taking a biopsy from the axillary tumor.

Welcome to the Journal Research in Clinical Medicine, Volume 8. 2020 marks a milestone in the history of this journal because it comes with some profound enhancements. The first and the most important change in our journal was that we eliminated the obligation made by the word “ analytical” in the title and scope of our journal in attracting the articles. Moreover, by our new way of continuous publishing, fast publication of research papers is possible without delay....

Introduction: Recent studies suggest that smoking exposure in pregnancy period might be a risk agent for childhood overweight and obesity. We examined associations between maternal smoking in pregnancy period and children’ s weight and the possible obesogenic effects of maternal smoking. Methods: The present study was designed as a cross-sectional analysis of a survey. A 31-question survey was administered to mothers to learn the nutrition and smoking habits in Turkey from January to March 2020. Also, a 25-question survey was administered to children to study their diet. Participants were classified as underweight, normal, overweight, or obese. The smoking status of mothers was also recorded. The data were analyzed using SPSS. Results: The research group consisted of 454 participants (227 mothers, Mage = 38. 73 ± 6. 23 years and 227 children, Mage = 10. 39 ± 4. 96 years). In this study, 60. 3% of children were underweight, 27. 9% normal, 8. 8% overweight, and 2. 9% obese. Overall, 6. 3% of children had smoking exposure and were overweight, whereas 1. 4% were obese. Our results show that the relationship between maternal smoke exposure and body mass index (BMI) was non-significant (P > 0. 05). Children whose mothers did smoke in pregnancy period were at low risk for obesity (odds ratio [OR] = 0. 66, 95% CI: 0. 07, 6. 11) compared with children whose mothers never smoke. Conclusion: In this study, we found that the BMI of children not increased with maternal smoking exposure. In future, taking into consideration the health of mother and child, new studies should be performed to investigate the relationship between maternal or paternal smoking exposure and childhood overweight or obesity.

Pain is the most common symptom in patients referred to the emergency department (ED), so its rapid and effective relief can increase patients’ satisfaction as well as decrease their physical and mental complications. 1 Morphine is the most commonly used opioid in emergency medicine (EM) to relieve pain in patients. Despite its accessibility and its ability to alleviate pain, it has side effects such as excessive sedation and increased respiratory depression, and also its effectiveness in cases of severe pain is controversial.....

Coronavirus disease 2019 (COVID-19) was found first in Wuhan (China), which was considered as an infectious disease caused by severe acute respiratory syndrome coronavirus 2. Hence, in order to prevent an increasing infectious disease risk, current management strategies against COVID-19 should strictly comply for stopping-up the spread of COVID-19 outbreak. There is a major challenge in the timely diagnosis (by kits, etc. ) to prevent COVID-19 infection outbreak until proper drugs or vaccines for treating COVID-19 patients are introduced. Therefore, it is essential to demand personal protective manners for each person in against of COVID-19 infection. In this article, the symptoms of COVID-19 and the effect of handwashing in against of COVID-19 are mentioned, as well as its benefits in the COVID-19 infection prevention are understood more clearly.

The outbreak of new coronavirus disease-2019 or COVID-19 infection has become a global health emergency at the beginning of this year. Currently, no specific vaccines and therapeutic medications are available to treat this disease. Even though several vaccine candidates are under investigation, it will take some time to make them available for the mass population. Hyperinflammation due to excessive cytokine release in COVID-19 infected patients with other inflammatory diseases makes lethal effects, including multiorgan failure and even death. The increasing gain of insight about the pathophysiology of this novel coronavirus enables experts to consider some commonly available anti-inflammatory drugs as potential immunomodulatory candidates for the cytokine release syndrome (CRS) treatment in COVID-19 infection. This review was conducted to discuss all the possible signalling pathways involved in COVID-19 related hyperinflammation. It also emphasized on the efficacy of both synthetic and natural therapeutic drugs for immunomodulation in the COVID-19 related CRS treatment.

Introduction: There are many different therapeutic approaches to control colorectal cancer (CRC) which is recognized as one of the deadliest diseases in the world today. One of the most recent of which is the probiotic interventions to change the gut microbiome. Probiotics can be related to the control of gastrointestinal cancers in a variety of ways. Therefore, the present study aimed to investigate the relationship between supplement use with macroscopic and physiological changes of tumor in 1, 2-dimethylhydrazine (DMH)-induced rats. Methods: The male Wistar rats were divided into three groups. Lactobacillus paracasei X12 was administrated (40 weeks) to the DMH-induced rats. DMH injection (30 mg/kg BW) was used for 12 weeks to induce CRC. The “ AgNOR method” was applied for the evaluation of cell proliferation. Real-time polymerase chain reaction (PCR) was used to measure the gene expression of apoptotic markers. Results: The findings of this study indicated that L. paracasei X12 intake prevented weight loss caused by CRC (P = 001), and probiotic consumption could significantly prevent tumor growth. Additionally, a significant correlation was observed between apoptosis markers and weight of animals, and a strong negative correlation (P = 000) between apoptosis parameters and tumor characteristics (incidence, volume, and multiplicity of adenomas). A close association between cell proliferation and tumor characteristics was illuminated as well (P < 001). Conclusion: This study revealed a strong correlation between tumor incidence and growth and probiotic intake in CRC. Moreover, it could be believed that cancer prevention is a far more essential and cost-effective way than its cure.

Introduction: Considering the important role of early detection of malnutrition in patients with cancer and its negative effects on the outcome, as well as the lack of any published article (to the best of our knowledge) about the dietary quality index in head and neck cancer patients treated with chemoradiotherapy, we decided to evaluate the nutritional status and dietary quality index in these patients. Methods: In this study, thirty-seven volunteer patients with head and neck cancer were recruited. Nutritional status of the patients was evaluated by Mini Nutritional Assessment (MNA) questionnaire. Dietary diversity score, dietary variety score, and diet quality index– international were calculated to assess the dietary quality of the patients. Results: Our findings indicated that about half of the patients were well nourished and 48. 6% were at the risk of malnutrition. We did not find any significant differences between various dietary quality indices and nutritional status of the patients. However, a significant reverse correlation was observed between dietary quality indices and nutritional status of the patients. Conclusion: According to our findings, the evaluation of nutritional status and the prediction of the patients at higher risks of chemoradiotherapy-induced adverse events, may have a major role in the prevention of treatment gaps.

Introduction: On 31 December 2019, a cluster of pneumonia cases with unknown etiology was reported in Wuhan city, Hubei province of China. A novel coronavirus (SARS-CoV-2) was later detected as the causative agent and the clinical condition was called coronavirus disease 19 (COVID-19). The SARS-CoV-2 infection has a wide clinical course that can progress from mild symptoms such as fever, sore throat, cough to pneumonia and acute severe respiratory failure. The S protein of SARS-CoV-2 is thought to bind to the host cell angiotensin-converting enzyme 2 (ACE2) receptor and cause the disease. . . .

Introduction: The vagal network has a major potential role in the immune-life of Peyer’ s patches, but there is no satisfying information if vagal ischemia causes Peyer’ s patches (PP) disruption following subarachnoid hemorrhage (SAH). Methods: Twenty-two rabbits were used as control (GI, n = 5), “ sham” (GII, n = 5), and SAH (GIII, n = 12) groups in this experiment. 0. 5 cc saline for GII and 0. 5 cc autologous blood for GIII was injected into cisterna magna of the rabbits. Four weeks later, they were euthanized. Their brains, vagal nerves, nodose ganglia, Peyer’ s patches, and intestines were examined, using stereological methods. The Peyer’ s patches volumes (PPVs)/intestine volume per cubic millimeter was accepted as PP injury score based on a total of 10 points. Results: The mean degenerated neuron densities of the nodose ganglia and degenerated axon densities of vagal nerves were 5 ± 2/mm3 and 6 ± 2/mm2 in the GI, 13 ± 4/mm3 and 89 ± 16/mm2 in the GII and 321 ± 83/mm3 and 293 ± 88/mm2 in GIII. The mean PPVs and PP score were 8 ± 1×106 μ m3/mm3 and 0-3 in the GI, 10 ± 3×106 μ m3/mm3 and 4-7 in the GII, and 21 ± 5×106 μ m3/mm3 and 8-10 in GIII. P < 0. 0001 in PPV/PP score/degenerated axon densities of vagal nerves; P < 0. 0005 in PPV/PP score/degenerated neuron densities of the nodose ganglia between GI/GIII; P < 0. 001 in (PPV/PP score)/degenerated axon densities of vagal nerves; P < 0. 005 in PPV/PP score/degenerated neuron densities of the nodose ganglia between GII/GIII; and P > 0. 05 in GI/GII were noted. Conclusion: Vagal ischemia/insult may be responsible for PP denervation, and injury-induced dangerous intestinal immunodeficiency following SAH.

Introduction: The present study was an attempt to evaluate the role of ultrasonography on decreasing the number of attempts, failed punctures, time needed to perform the procedure and patients’ pain. Methods: This study is a prospective case-control. Patients were divided in two groups randomly. A two-dimensional probe was used to localize intervertebral space in the ultrasound guidance (US group). In manual palpation (MP group) however, insertion level was determined using the standard technique by manual palpation. The number of attempts (needle insertion) required for a successful tap and successful/unsuccessful attempts were considered as the primary outcome measures. Results: Male patients with an average age of 44. 08 ± 15. 83 years accounted for 60% (30 individuals) of the population. Success rate was 92% in the US group and 34% in the MP group (P < 0. 001). It took 79. 64 ± 19. 91 and 85. 4 ± 11. 62 minutes to identify the proper location in US and MP groups respectively (P = 0. 21). In the first attempt, it took 6. 33 ± 0. 95 and 6. 87 ± 0. 7 minutes to collect cerebrospinal fluid (CSF) in US and MP groups respectively (P = 0. 02). Average time taken to localize the sites in two attempts were 8. 28 ± 2. 44 and 13. 17 ± 3. 32 in US and MP groups respectively (P < 0. 001). Average number of attempts made in the US and MP groups were 1. 08 ± 0. 27 and 1. 64 ± 0. 66 (P < 0. 001) respectively. Conclusion: Ultrasonography has reduced the time needed for locating puncture to collect CSF, pain management in patients, determining the number of attempts, and defining the risk of traumatic puncture. Moreover, this technique is characterized by a higher success rate. Using ultrasonography in obese patients and people with lumbar problems is more important.

Coronavirus disease 2019 (COVID-19), with high-transmission power, is spreading rapidly, and researchers are endeavoring to discover eligible medications for its efficacious prevention and treatment globally. According to the World Health Organization (WHO) reports, several multicenter clinical trials are launched to determine effective treatment protocols against COVID-19-associated pneumonia. In this article, we aimed to discuss some critical issues concerning novel coronavirus.

Introduction: AThe aim of this study was to evaluate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in the health care workers of emergency department of Imam Reza hospital, Tabriz, Iran Methods: In a total of 63 physicians and nurses in the emergency department of Imam Reza hospital, after obtaining written consent and completing a checklist, a sample of nasal mucosa was collected for microbiological examination and isolation of Staphylococcus aureus (SA) strain. Determination of resistance patterns (by diffusion method) was performed according to the standard methods of methicillin. Results: Out of 63 participants, 8 subjects (12. 7%) had colonization of S. aureus; 4 of them were physicians (17. 3% of the participated physicians) and 4 were nurses (10% of the participated nurses). Out of 8 isolated SA, 2 cases (25%) and overall 3. 1% were methicillin-resistant. In our study, there was a significant relationship between co-employment in other hospitals and patient care at home with SA colonization, but there was not a significant relationship with specialty, work experience, sinusitis, history of antibiotic use, history of skin disease, hand washing habits and use of personal protective equipment. Conclusion: Prevalence of MRSA was not high among health workers of emergency department.

Introduction: This preliminary study evaluates the possible responsibility of ischemia-induced vagosympathetic imbalances following subarachnoid hemorrhage (SAH), for the onset of autoimmune thyroiditis. Methods: Twenty-two rabbits were chosen from our former experimental animals, five of which were picked from healthy rabbits as control (nG-I = 5). Sham group (nG-II = 5) and animals with thyroid pathologies (nG-III = 12) were also included after a one-month-long experimental SAH follow-up. Thyroid hormone levels were measured weekly, and animals were decapitated. Thyroid glands, superior cervical ganglia, and intracranial parts of vagal nerve sections obtained from our tissue archives were reexamined with routine/immunohistochemical methods. Thyroid hormone levels, hormone-filled total follicle volumes (TFVs) per cubic millimeter, degenerated neuron density (DND) of vagal nuclei and neuron density of superior cervical ganglia were measured and statistically compared. Results: The mean neuron density of both superior cervical ganglia was estimated as 8230 ± 983/ mm3 in study group animals with severe thyroiditis, 7496± 787/mm3 in the sham group and 6416 ± 510/mm3 in animals with normal thyroid glands. In control group (group I), T3 was 107 ± 11 μ g/dL, T4: 1, 43 ± 0. 32 μ g/dL and TSH <0. 5, while mean TFV was 43%/mm3 and DND of vagal nuclei was 3± 1/mm3. In sham group (group II), T3 was 96 ± 11 μ g/dL, T4: 1. 21 ± 0. 9 μ g/ dL and TSH>0. 5 while TFV was 38%/mm3 and DND of vagal nuclei was 13 ± 4. In study group, T3 was 54 ± 8 μ g/dL, T4: 1, 07 ± 0. 3 μ g/dL and TSH >0. 5, while TFV was 27%/mm3 and DND of vagal nuclei was 42 ± 9/mm3. Conclusion: Sympathovagal imbalance characterized by relative sympathetic hyperactivity based on vagal insufficiency should be considered as a new causative agent for hypothyroidism.

The recent emergence of coronavirus disease-2019 (COVID-19), demonstrates the pandemic potential of COVID-19, the rapid spread of this virus across the world in only a few months highlights the transmissibility of this disease and the significant morbidity and mortality that it can cause, And these reasons make the importance of triage even more colorful at this point. Thus, we designed the principles for better emergency department triage of these patients and reducing the possible risks of transmitting this disease. We hope that with this study, we will be able to partially solve the triage problems of these patients and the problems of the healthcare staff.

Dear Editor The investigations about the association between coronary artery disease (CAD) and vitamin D deficiency are insufficient yet because there are paradoxical findings in several investigations; however, some of them have demonstrated this relationship between vitamin D deficiency and myocardial infarction (MI), heart failure and peripheral vascular disease. 1-3 Although various evaluations were performed about such relationship, the effects of deficiency on the results of angioplasty have not had clear results, yet. ...

Coronavirus disease 2019 (COVID-19) is an emerging global disease that severely affects patient’ s respiratory system and requires respiratory support through mechanical ventilation in the intensive care unit (ICU). The disease has also had effects on the pediatric community, even though its symptoms are found to be milder in children. In this study, an 8-year-old child’ s health management report, infected with COVID-19, is presented. The patient had a critically ill condition without a previous history of respiratory disease, and underwent mechanical ventilation in the pediatric intensive care unit (PICU). After performing the treatment protocols, the patient was discharged from the ICU after 12 days with a good condition, without any side effects.