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Spontaneous pneumomediastinum is a rare condition, which is usually benign and selflimiting. Its main presentation is sudden retrosternal pain that may occur following valsalva maneuver, vomiting, frequent cough, heavy exercise, marijuana inhalation, trauma, and intubation. Given the low prevalence and importance of paying attention to spontaneous pneumomediastinum in screening patients presented to the emergency department with acute chest pain, here we will introduce a 17-year-old patient with chief complaint of chest pain and final diagnosis of spontaneous pneumomediastinum. [ABSTRACT FROM AUTHOR]

Background: Interleukin 8 increases in various types of meningitis, specifically acute bacterial meningitis inflammation, and it is important in the distinction between types of meningitis. The present paper aims at evaluation of the level of interleukin 8 in cerebrospinal fluid in acute adult bacterial meningitis. Methods: All adult patients’ with diagnosis of suspected meningitis with symptoms of fever, headache, neck stiffness, and consciousness disorder. Lumbar puncture was taken in between the third and fourth vertebra by a specialist physician for all patients suspected with meningitis. To determine the level of consciousness, the GCS of the patients was determined and the cerebrospinal fluid was cultured and sent to the laboratory for the analyses of cell count, diffraction, CSF fluid glucose, CSF fluid protein, LDH, or lactate dehydrogenase, and the level of interleukin 8. Results: The mean of IL-8 protein was 296.17±48.57Pg/ml in patients with aseptic meningitis and 1088.96±526.55Pg/ml in the group of patients with septic meningitis. There was a significant difference between the two groups in terms of the amount of interleukin 8 (p = 0.009). Cutoff was 297.6 Pg/ml for the detection of positive bacterial meningitis with a sensitivity of 92% and the specificity of 83.1% was 297.6 pg/ml. Conclusion: Interleukin 8 has a high sensitivity and specificity in the diagnosis of bacterial meningitis from aseptic meningitis, and along with the measurement of cerebrospinal fluid protein, it can be a good criterion for differentiation of bacterial from aseptic meningitis. [ABSTRACT FROM AUTHOR]

Background: Interleukin 8 increases in various types of meningitis, specifically acute bacterial meningitis inflammation, and it is important in the distinction between types of meningitis. The present paper aims at evaluation of the level of interleukin 8 in cerebrospinal fluid in acute adult bacterial meningitis. Methods: All adult patients’ with diagnosis of suspected meningitis with symptoms of fever, headache, neck stiffness, and consciousness disorder. Lumbar puncture was taken in between the third and fourth vertebra by a specialist physician for all patients suspected with meningitis. To determine the level of consciousness, the GCS of the patients was determined and the cerebrospinal fluid was cultured and sent to the laboratory for the analyses of cell count, diffraction, CSF fluid glucose, CSF fluid protein, LDH, or lactate dehydrogenase, and the level of interleukin 8. Results: The mean of IL-8 protein was 296.17±48.57Pg/ml in patients with aseptic meningitis and 1088.96±526.55Pg/ml in the group of patients with septic meningitis. There was a significant difference between the two groups in terms of the amount of interleukin 8 (p = 0.009). Cutoff was 297.6 Pg/ml for the detection of positive bacterial meningitis with a sensitivity of 92% and the specificity of 83.1% was 297.6 pg/ml. Conclusion: Interleukin 8 has a high sensitivity and specificity in the diagnosis of bacterial meningitis from aseptic meningitis, and along with the measurement of cerebrospinal fluid protein, it can be a good criterion for differentiation of bacterial from aseptic meningitis. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is one of the most common causes of emergency surgeries, but sometimes the physicians face difficulties in proper diagnosis and management. Counting white blood cells and (CRP) C-reactive protein were important factors along with related clinical symptoms. The purpose of this study was evaluate the diagnostic value of these two factors in the diagnosis of acute appendicitis. Methods: In this descriptive study patients with abdominal pain suspected of acute appendicitis were examined. In patients who received the results of clinical examinations and other diagnostic procedures (sonography, CT scan, etc.) to prove Acute appendicitis was ambiguous and non-determinant, and the score of Alvarado 6-4, a blood sample was taken for checking WBC, CRP and PMN, and was immediately sent to the lab. The laboratory kit used for the above measurements belonged to Bio System Reagents & Instrument Barcelona-Spain, and the sensitivity of this test was 0.15 mg / L according to the Bio System brochure. CRP>10 mg / L and PMN> 70%, WBC> 10000 / cu mm positive were considered. Results: A total of 251 patients with appendicitis with mean age of 26.48 ± 10.5 years were studied. Alvaro criteria in patients with acute appendicitis 3.95 ± 0.22 and 4.9 ± 0.27 in patients with normal appendix (P = 0.5). The result of the pathology were normal in 102 (40.6%) cases, acute appendicitis in 91 cases (36.3%), and aphthous aphastics in 58 cases (23.1%). And, 88 (35.1%) patients had normal WBC and 163 (64.9%) cases had WBC levels more than 10,000 Cumm. Also, 50 patients (19.9%) had normal CRP but in 201 cases (80.1%) the CRP was higher than 10 mg/L. WBC had a sensitivity, specificity, positive predictive value, and negative predictive value of 69.12 %, 59%, 16.19% and 52.27%, respectively in diagnosis of acute appendicitis. CRP had a sensitivity, specificity, positive predictive value, and negative predictive value of 69.12 %, 59%, 16.19% and 52.27% respectively in diagnosis of acute appendicitis. Conclusion: By measuring CRP and white blood cell count, a negative appendectomy can be reduced along with a clinical examination. [ABSTRACT FROM AUTHOR]

Introduction: Considering the different treatment methods and their controversial efficacy and the importance of proper treatment with decreasing complications and costs for patients with acute Ileofemoral DVT, this study aimed to assess the success rate and complications of catheter-directed thrombolysis in patients with acute Ileofarmal DVT, referred to Razi Hospital in Rasht, 2017-2018. Objective: To evaluate the Success Rate and Complication after Catheter Directed Thrombolysis in Acute Deep Vein Thrombosis of Ileofemoral Vein Materials and Methods: This case-series study was performed onthe patients with acute Iliofemoral DVT underwent catheter-directed thrombolysis referred to Razi Hospital in Rasht, 2017-2018. All patients diagnosed with acute Iliofemoral DVT on the basis of color Doppler ultrasonography and venography were candidates for treatment. Patients with concomitant illnesses, such as diabetes mellitus, hypertension, underlying conditions such as malignancy and any other illnesses other than DVT, were excluded. The variables studied in this study were collected using a questionnaire. Results: In this study, 20 patients with acute Iliofemoral DVT younger than 60-year-old with the onset of symptomless than 2 weeks were studied. The mean age of the subjects was 39.15±12.07 years, 11 (55%) cases were male and the rest were female. 13 cases were affected by acute left Iliofemoral DVT. AS for initial symptoms, the highest frequency (65%) was related to pain, swelling, and tenderness. The results of the study showed that there was a 100% success rate, and none of the patients in the follow-up period of 6 months showed restenosis. Conclusion: Based on this study and comparison to other authors’ recommendations, it seems that the success ratein catheter-directed thrombolysis in patients with acute Ileofemoral DVT was100%. There were no complications in 75% of the patients. The most reported complication was pain and there was no statistically significant relationship between the complications of the patients during the treatment, the duration of admission and age and sex. [ABSTRACT FROM AUTHOR]

Background and Objectives: Lateral ankle sprain (LAS) is the most common sport injury and routine activities of life. The purpose of this study was to evaluate the EMG activation of posture stabilizer muscles during sudden acceleration to provide clinicians biomechanical perspectives of acute ankle sprains on muscle response. Materials and Methods: In a semi experimental method with case and controls. The sinker-card protocol was be used as a dynamic balance test with simulating fall upon 4 posture stabilizer muscles in two sides of the body after sudden acceleration in forward and backward directions study was done in 19 young adult men in two groups (9 LAS; 23.9 ± 2.03 yrs and 10 normal person; 26.4 ±3.2 yrs). The data were assessed by multivariate test and one-way ANOVA. Results: The results showed a significant muscle interaction. In forward direction higher bilateral TA activity was observed in LAS group than normal group. Higher MGR activity in normal group than LAS group in backward direction significantly showed. These findings suggest that compared two sides of the body in two directions for 4 muscles EMG activities between and within group for balance control recovery in simulating fall. EMG activations of two sides of the body in LAS patients were symmetric significantly. Conclusion: LAS not only create mechanical and functional instability, but also, have long-term biomechanical alternations for example different mechanisms of balance recovery on musculoskeletal system. [ABSTRACT FROM AUTHOR]

Background and Objectives Mesenchymal stem cells (MSCs) are attractive cells for cell therapy. However, the efficacy of MSCs is limited because of low survival rate following translation. In this study, MSCs were preconditioned with sub-lethal doses of H2O2. The therapeutic potential of preconditioning MSCs was examined on acute liver failure in mice. Materials and Methods In the present experimental study, MSCs were isolated from bone marrow aspirate. Cells from passage four were treated with different concentrations of H2O2 for 24 hrs, and then were recovered in fresh medium for 7 hrs followed by exposure to lethal doses of H2O2 . Cell viability was measured with WST-1 assay. In the in vivo phase, acute liver failure was induced by CCl4; then, the regenerative potential of preconditioned-MSCs was evaluated using biochemical as well as histological methods. Results Survival rates were higher in the engrafted mice with preconditioned-MSCs in comparison to those who received normal MSCs. Three days after cell therapy liver enzymes reached the normal level in engrafted group with preconditioned-MSCs. Interestingly, histological results revealed a significant improvement in liver regeneration potential in transplanted groups with preconditioned-MSCs. Conclusions Preconditioning of MSCs with H2O2 not only enhances their survival but also increases the efficacy of MSC-based cell therapy in liver acute failure. [ABSTRACT FROM AUTHOR]

Background and Objectives A common polymorphism at codon 72 in the p53 gene has been associated with the increased risk for lung, oral, prostate, breast and colorectal cancers. We studied this polymorphism in acute myeloid leukemia specimen from Alzahra Hospital in Isfahan city. Materials and Methods In the present case-control study, 59 whole blood specimen from normal people and 59 acutemyeloid leukemia specimen were analyzed. p53 codon 72 genotypes were identified using allele-specific PCR. Chi-square test was used for the comparison of the frequency distribution of three genotypes of codon 72 in cases and control specimen. Results Resulting PCR products were either 177bp for proline allele or 141bp for arginine allele. The genotype distribution for p53 polymorphism showed 11.9%, 81.4%, and 6.8% for the Arg/Arg, Arg/Pro, and Pro/Pro genotypes in control samples and 33.9%, 61%, and 5.1% in acute myeloid leukemia specimen, respectively. The differences in the distribution of p53 codon 72 polymorphism between the cases and controls were statistically significant (p = 0.04). Conclusions Deferasirox is relatively more effective than deferoxamine in reducing iron content of the liver and heart. Moreover, deferasirox is more effective in reducing cardiac iron content relative to liver iron content. [ABSTRACT FROM AUTHOR]

Background: Early, complete, and stable coronary revascularization is the main criteria for standard treatment in patients with ST segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the safety and efficacy of integrilin as glycoprotein IIb/IIIa receptor inhibitor in treatment of STEMI patients undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: In this clinical trial study, 106 STEMI patients who complained of acute chest pain and were referred to Amir Al Momenin hospital, Arak, entered the study. Patients were randomly divided into two equal groups. The first group was treated with integrilin immediately before angioplasty. The 2nd group was treated with conventional percutaneous coronary intervention. Results: After receiving treatment and undergoing angioplasty, TIMI Frame Count was equal to 15.7±8.04 in the 1st group and 14.2±5.4 in the 2nd group which showed no significant difference between them (p=0.4). Ejection fraction in patients receiving integrilin was significantly more than control group in first (p=0.043) and third month (p=0.012) after treatment. Conclusion: Based on the results of the present study, it seems that using integrilin in standard time, causes long-term benefits for patients and reduces damage to the heart wall. [ABSTRACT FROM AUTHOR]

Background and Objectives: The overweighed cases like the patients with the injury of ankle sprain having problems with their Balance control system. The aim of this study was to investigate the effect of fatiguing exercise on the static and dynamic balance changes in athletes with the ankle sprain. Materials and Methods: In this Case- Control study, 30 active athletes and 14 cases with previous severe ankle sprain as case group and 16 healthy cases as control group were inverted in a treadmill running protocol in 2 experimental sessions. Center-of-pressure sway velocity in single-legged stance and time to stabilization (TTS) after a unilateral jump-landing task (first session) and maximum reach distance in the Star Excursion Balance Test (SEBT) (second session) were assessed before and immediately after the treadmill exercise. Results: In the unfatigued condition, between-groups the significant difference was found only in the anteriorposterior TTS (P< 0.5, ES<0.39). Group-by-fatigue interactions were found for mean SEBT (P<0.03, ES <0.43) and anterior-posterior TTS (P<0.02, ES<0.48). Conclusions: Prefatigue versus postfatigue SEBT and TTS tests differences were greater in previously injured athletes, whereas static sway velocity increased similarly in both groups. Fatiguing duo to running significantly affected static and dynamic postural control in participants with a history of ankle sprain. Fatigue-induced alterations of dynamic postural control were greater in athletes with a previous ankle sprain. Thus, even after successful return to competitions, ongoing deficits in sensorimotor control may contribute to the enhanced ankle reinjury risk. [ABSTRACT FROM AUTHOR]

Background and Objectives: Massive Pulmonary Embolism (MPE) is a life threating condition. MPE is defined as a 50% or more occlusion of the main pulmonary arteries or obliteration of two or more of lobar arteries. Patients often die at the primary hours as a result of right heart failure , therefore finding the signs of Right Ventricular (RV) dysfunction is helpful in early diagnostic concern of MPE in first studies for example spiral CT scans in patients with respiratory symptoms. The aim of this study was to determine the CT angiographic findings due to RV dysfunction in patients with acute MPE. Materials and Methods: We conducted analytic study. This study was performed on 80 humans by using of CT angiography for evaluation of findings due to RV dysfunction. They were obtained from CT Angiography Department of Madany Hospital in Tabriz City. Results: The mean of maximum short axis diameter of RV in case group is higher than control group and it is statistically significant (p<0.05). The mean of maximum short axis diameters of right and left ventricular ratio in case group is higher than control group and it is statistically significant too (p<0.05). The mean of superior vena cava and azygus veins diameter in case group is higher than control group and it is statistically significant (p<0.05). Conclusions: Evaluation of RV afterload findings by computed tomography could be effective in prediction of sever MPE, faster therapeutic management and resultant decreased mortality. [ABSTRACT FROM AUTHOR]

Introduction: Patients with acute myocardial infarction (MI) encounter to multiple stressors that may increase their anxiety and Impact negatively on their clinical course. This study was performed to determine the effect of Ducrosia Anethifolia (Barilax) on anxiety after myocardial infarction. Method:This is a clinical trial which was done on 90 patients with acute MI. After 24 hours, perl of Barilax 50 mg was prescribed twice per day for intervention group, and the same dosage of placebo was given to control group. Anxiety rate was measured by State-Trait Anxiety Inventory (STAI) 24 and 96 hours after MI. All data were analyzed by Chi-square and paired t-test. Results: The mean score of anxiety was 46.91±6.75 in intervention group and 46.24±6.95 in control group that there was no significant difference between them. Ninety hours after taking medication, the mean score of anxiety was 33.35±6.23 in intervention group and 36.48±5.33 in control group and there was significant difference between groups (p = 0.012). Conclusion: Oral administration of Ducrosia Anethifolia (Barilax) was effective on reduction of anxiety rate after myocardial infarction. So description of this medication as an effective drug to control anxiety after myocardial infarction is recommended. [ABSTRACT FROM AUTHOR]

Background and Objective: Acute appendicitis is the most common cause of emergency surgery. Diagnosis is based on history and physical examinations. The aim of this study was to investigate some factors which increase the likelihood of positive appendicitis. Materials and Methods: This descriptive study was conducted on 100 patients (65 males and 35 females) with clinical diagnosis of acute appendicitis in Zanjan in 2010-2011. Pathology report was our Gold Standard for diagnosis. Results: On the basis of pathology reports, 85% of the patients had appendicitis. Male gender and rebound tenderness indicated an increase in the likelihood of positive appendicitis up to 3.8 and 3.08 times, respectively. Sensitivity, specificity, PPV and NPV of sonography in diagnosis were 50, 83.3, 94.7 and 21.7%, respectively. Conclusion: In this study, accuracy of acute appendicitis diagnosis according to pathology results was 85%. Two factors including "male gender" and "rebound tenderness" appeared to have high diagnostic value on positive pathology. It is suggested to consider sonography as a rapid, non-invasive and available method in the diagnosis of suspicious cases of appendicitis. However, negative sonography can not rule out the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

Backgrounds and Objectives: Bacteremia in children should be diagnosed and treated as soon as possible. Yale observational scale (YOS) is one of this scales which there are controversy against its usefulness. Current study evaluates diagnostic significance of YOS in determining bacteremia in febrile inpatients aged 3-36 months. Materials and Methods: In this cross-sectional study, 112 febrile hospitalized patients aged 3-36 months (mean age 16.65±9.92 months) visiting emergency department was studied. Before giving antipyretics and antibiotics rectal temperature was recorded and Blood cultures were taken in all children. YOS score and culture results were recorded in all patients. ROC curve for YOS was plotted and its sensitivity, specificity, positive and negative predictive value (PPV and NPV), likelihood ratio (LR) in diagnosing bacteremia were calculated. Results: Bacteremia was detected in 14.3% of patients. Children with bacteremia had significantly higher body temperature (39.34±0.35 versus 39.04±0.36, p<0.001) and YOS score (20.87±4.31 versus 12.70±4.36, p<0.001). Sensitivity, specificity, PPV, NPV, positive LR and negative LR for YOS of greater than 15 were 81%, 71%, 32%, 96%, 2.79 and 0.26, respectively. Sensitivity and specificity for BT of higher than 39.25 in diagnosing bacteremia were 56% and 72% respectively. Conclusion: YOS is a simple and easy to administer and has acceptable sensitivity to predict bacteremia; however because of low specificity we could not completely rely on this scale. [ABSTRACT FROM AUTHOR]