Search

Background: Considering that few studies have investigated the differences in clinical, laboratory, and imaging symptoms of patients with coronavirus disease 2019 (COVID-19) during different peaks of the disease in Iran, the present study compares the patients who were admitted to the COVID-19 departments of Imam Reza Hospital during the first, second, and third peaks of the disease. Methods: In this cross-sectional study, data were collected by reviewing the files of patients with a definite diagnosis of COVID- 19 based on the RT-PCR test in Imam Reza Hospital in Mashhad. The patients were divided into three groups based on the time of admission: The first peak from March 2020 to June 2020, the second peak from July to September 2020, and the third peak from October to December 2020. The variables evaluated in this study included demographic information, clinical signs and symptoms, and laboratory and radiological findings. Descriptive qualitative data were reported using frequency tables, while quantitative descriptive data were reported using measures of central tendency and dispersion. A comparison of qualitative data among the three peaks was conducted using the chi-square test, while for quantitative data, the ANOVA test was used followed by appropriate post-hoc tests. Results: A total of 561 patients with an average age of 58.90 ± 16.80 years were included in the study, of which 336 (59.9%) were male. Regarding underlying diseases, significant differences were found in age (P < 0.001), smoking (P < 0.001), diabetes (P = 0.003), high blood pressure (P < 0.001), asthma (P = 0.025), and ischemic heart disease (P < 0.001). For vital signs, significant differences were observed in heart rate (P < 0.001), respiration rate (P < 0.001), diastolic blood pressure (P = 0.010), and SPO2 (P < 0.001). In clinical characteristics, significant differences were found in fever (P < 0.001), nausea (P = 0.011), vomiting (P = 0.031), headache (P < 0.001), weakness (P < 0.001), and sore throat (P < 0.001). In laboratory characteristics, significant differences were observed in white blood cell (WBC) count (P = 0.024), neutrophil percentage (P < 0.001), lymphocyte percentage (P < 0.001), and C-reactive protein (CRP) (P = 0.001). The CT score values of the patients were significantly different between the three peaks. Patient mortality was significantly different across the three peaks. Less than 15% of hospitalized patients died in the first peak, while over 24% died in the second peak and nearly 40% of inpatients died in the third peak. In our study, the first and third surges and the second and third surges had different mortalities. Conclusions: The third and first peaks had the highest and lowest mortality rates, respectively. Underlying diseases and unstable vital signs were more common in the second and third peaks. Patients in the second peak had significantly higher CT scores compared to the other peaks. [ABSTRACT FROM AUTHOR]

Background & Objective: Incomprehensive studies have examined the therapeutic and side effects of curcumin on the treatment of debilitating diseases, such as Rheumatoid Arthritis (RA). This study aimed to explore the antiinflammatory effects of curcumin on RA. Materials & Methods: This double-blind clinical trial was carried out on 64 RA patients with an erythrocyte sedimentation rate (ESR)-Disease Activity Score (DAS)- 28>2.6. The patients were then randomly divided into two groups of intervention and control. In addition to the routine treatment, the intervention group was treated with 80-mg/day capsules of curcumin (nano-micelles). Further, the patients were followed up for three months, and clinical-laboratory examinations were recorded in this study. Results: There was no significant difference between the intervention and control groups regarding the trends of the disease activity indicators, including DAS-28, disability index, physician assessment, and the number of tender joints (P>0.05). Further, a significant difference was found between the two groups in terms of pain score changes and the number of swollen joints. Additionally, the curcumin-treated subjects obtained lower mean pain and fewer swollen joints, compared to those in the control group (P<0.05). Conclusion: The present study revealed that curcumin had no significant therapeutic effects on reducing the activity of RA; however, no significant side effects were observed on the patients, and it also showed its analgesic effect well. [ABSTRACT FROM AUTHOR]

To evaluate the diagnostic mismatch (discrepancy) of pathology reports in consulted specimens referred for second opinion. This cross-sectional study was conducted at a major cancer center, Omid Hospital. In this study, 350 primary pathology reports and 350 reviewed pathology reports were extracted from the archives of Omid Hospital from 2011 to 2020 and assessed in terms of the extent of discrepancy, by two pathologists and one oncologist. The required data for each sample were entered into a checklist and then statistically analyzed. Cases with the same diagnosis on both reports were assigned to the matched group and the rest were assigned to the minor or major mismatch (discrepancy) group. Minor mismatches included changes in diagnosis that did not lead to changes in treatment (may lead to changes in prognosis or provide additional information to the oncologist) and major mismatches included changes in diagnosis leading to changes in treatment or remedies. Two hundred seven cases (59.1%) out of three hundred fifty cases had concordant results between the diagnosis of the first pathologist and the reviewing pathologist. In one hundred forty-three cases (40.9%) mismatch (discrepancy) was observed, including eighty- two cases (23.4%) with minor mismatches (discrepancy) and sixty-one cases (17.4%) with major mismatches (discrepancy). In the major mismatch group, fifteen cases (4.3%) changed from malignant to benign, eighteen cases (5.1%) changed from benign to malignant, two cases (0.6%) changed from one stage to another stage of Disease and twenty-six cases (7.4%) had changes in the type of malignancy. In this study, it was found that there was no significant relationship between anatomical areas of sampling and diagnostic mismatch (p = 0.254). The study also found that the rate of diagnostic mismatch in specimens obtained by resection or excisional biopsy was greater than that of small biopsies (eighty cases (22.8%) and sixty-two cases (17.7%, respectively)). There was no significant relationship in this regard (p = 0.077). Compared to most similar studies, the present study reported the highest discrepancy between the diagnosis of the first pathologist and the reviewing pathologist (40.9%). [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most frequent malignancy and the leading cause of cancer-related death among women all around the world. In Iran, the mean age of the patients is approximately 10 years younger than that in other countries. We conducted the present study to assess the risk factors of breast cancer among Iranian women in Mashhad. Method: This case-control study was carried out between February 2016 and January 2018 on 460 women (230 cases and 230 controls) in the academic hospitals of Mashhad. The data from our cases and controls were collected and analyzed using SPSS version 18.0 software (SPSS Inc., Chicago, IL, USA). We employed logistic regression models and frequency tables to estimate odds ratio (OR) and to examine the predictive effect of each factor on breast cancer risk. P < 0.05 was considered to be significant. Results: According to multivariate analysis, there was significant associations between breast cancer risk and body mass index (BMI) (Odds ratio (OR), 1.1; 95% Confidence interval (CI), 1.0-1.2), age at menarche (OR, 0.56; 95% CI, 0.47-0.68), menopausal age (OR, 1.1; 95% CI, 1.0-1.1), family history of non-breast malignancies (OR, 7.9; 95% CI, 2.2-21.1), and oral contraception pills (OR, 3.1; 95% CI, 8.34- 1.16). Conclusion: This study revealed that age at menarche, family history of non- breast cancer malignancies, BMI, menopausal age, and oral contraception pills were significantly associated with breast cancer. [ABSTRACT FROM AUTHOR]

Background: Botulism occurs periodically or in outbreaks in Iran. Botulism is lethal and accordingly a considerable issue in environmental health, although it is uncommon. This study was performed to evaluate the potential predictive factors in foodborne botulism in a 10-year span. Materials and methods: All medical records from patients with foodborne botulism admitted to Imam Reza Hospital in 10 years (2005-2015) were analyzed retrospectively. Results: 61 cases were included (38 men, mean age ± SD 28.93 ± 19.14 years). All cases were treated with antitoxin. 6.6% of cases died. Canned beans were correlated with the admission to intensive care unit (ICU), and also, it increased the length of ICU stay significantly (P = 0.007 and 0.023, respectively). The incidence of dizziness and diplopia significantly induced excess demands for higher doses of antitoxin (P = 0.038 and 0.023, respectively). Risk of dysphagia was remarkably higher in cases with ptosis (P = 0.039, odds ratio: 3). While in this study, time elapsed between the onset of clinical manifestations and antitoxin administration was correlated with the occurrence of dysphagia, constipation, and blurred vision, and early treatment did not improve the outcomes. Multiple analysis of potential variables by a logistic regression model disclosed that the independent significant factors affecting mortality were the need for mechanical ventilation (P = 0.000), dyspnea (P = 0.044), general weakness (P = 0.044), and lack of consciousness (P = 0.008) at the time of admission. Conclusions: Taking clinical signs and symptoms into account upon patient arrival is important and, of course, is a key to further management in the emergency setting. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to identify the characteristics of suicidal ideation (SI), suicidal plan (SP), and suicide attempt (SA) in patients who had survived suicide attempts. Methods: In a one-year cross-sectional design in Khorasan Razavi province, all suicide attempters who were referred to urban and rural health care centers, hospital's emergency rooms and agreed to participate in the study were included. The previous twelve-month SI, SP and lifelong SA (prior to the current suicide attempt) were obtained. Results: The mean age of 856 included individuals was 24.2±8.3 years. The majority (652,76.4%) were females. Half of them were first-time suicide attempters. The mean age of first SI was 22±7.7; SP 22±7.9; and SA 22.2±8 years. The twelve-month prevalence of SI and SP prior to the current suicide attempt was 30% and 26.7%, respectively. Males, unlettered, wedded, and employees were significantly older at their first time SI, SP, and SA (all p less than 0.001). SI (25,44.6%), SP (25,47.2%) and SA (34,75.6%) were more prevalent in widow/divorced individuals (all p-values less than 0.02). SI (OR=53.4, CI 95%=33.6-85) increased the risk of SP, and SP (OR=6.7, CI 95%=4.5-9.9) increased the risk of SA. Conclusion: SI seems to be a more important predictor of suicide compared to SP, however, the fact that a significant number of attempters had not any previous detectable suicidal ideation or plan, indicates particular clinical considerations. We need to have some presuppositions about the factors leading to unplanned and unthoughtful suicide attempts. [ABSTRACT FROM AUTHOR]

Background: The high levels of bilirubin in patients with periampullary cancers may increase the morbidity or mortality after curative surgery. Objectives: We aimed at evaluating the predictive power of preoperative serum total bilirubin for the outcomes after pancreaticoduodenectomy (PD) in resectable periampullary cancers. Methods: The data of 80 patients, who had undergone PD, were retrospectively analyzed. Regarding the preoperative bilirubin, we opted for 20 mg/dL as the cut-off value to divide patients into two groups to be subjected to simple and multiple logistic regression. Results: A total of 80 patients with a mean age of 54.90-14.33 years underwent PD. The median preoperative bilirubin level was 4.7 mg/dL and the majority of cases (88.8%) had bilirubin< 20 mg/dL. While there was no significant difference in the mortality between bilirubin groups (P = 0.266), bilirubin≥20 mg/dL remarkably increased the postoperative morbidity (P = 0.012, Odds ratio = 3.04); 57.5% of cases underwent biliary drainage before surgery, which did not impact the mortality and morbidity. Multiple analysis by a logistic regression model disclosed that the only statistically significant variable for mortality was the total operative time (P = 0.038) and among all factors, total bilirubin level was the only independent predictor for the morbidity status (P = 0.009). Conclusions: This study suggested that preoperative biliary drainage should only be limited to patients with high bilirubin levels (≥ 20 mg/dL) or expected delayed surgeries. [ABSTRACT FROM AUTHOR]

Background: Determining severity of mitral stenosis (MS) by planimetry of mitral valve orifice area (MVA) has been a challenging issue in clinical practice, especially for less experienced cardiologists. Mitral leaflet separation (MLS) has shown a good correlation with MVA measurements. However, it has never been validated against multiplane 3DTEE planimetry (MVA3D). We aimed to evaluate the accuracy of MLS index (MLSI2D) in predicting MS severity. Methods: We prospectively enrolled 144 patients with MS who underwent clinically indicated 2DTTE and 3DTEE. MLSI2D was yield by averaging the maximal leaflet tip distance in diastole, in parasternal long‐axis and apical four‐chamber views. MVA3D was used as the reference method. Results: MLSI2D showed an excellent discriminatory ability between different grades of MS (P < .001). There was a significant positive correlation between MLSI2D and MVA3D (r = .93, P < .001) irrespective of concurrent mitral regurgitation (r = .94, P < .001) and/or atrial fibrillation (r = .92, P < .001). By receiver operating characteristic (ROC) curves, MLSI2D ≤ 8.6 mm showed 100% sensitivity and 76% specificity for very severe MS. MLSI2D ≥ 11.2 mm determined progressive MS with 100% sensitivity and 82% specificity. The study population was then divided into a derivation group and a validation group. A regression equation for MVA by MLSI2D was derived in first group. Then, the MVA was calculated by this equation in validation group and was not significantly different from MVA3D. Conclusion: MLSI2D showed an excellent ability to assess MS severity and correlates well with planimetered MVA measured by 3DTEE. [ABSTRACT FROM AUTHOR]

Background: In women's health, literacy determines their participation in self and family health promotion. Low health literacy is as barrier for understanding medical recommendations, disease prevention and health care. Aim: To assess women's health literacy and relative factors in Mashhad (Iran). Methods: Women referring to healthcare centers in Mashhad in 2012 and 2013, participated in this crosssectional study by stratified sampling method. The validated Persian version of Rapid Estimate of Adult Literacy in Medicine-revised questionnaire was used. Vocabulary comprehension and reading scores of health literacy was assessed. Comparisons were done in demographic subgroups by ANOVA, Mann-Whitney U, Kruskal-Wallis, Pearson correlation coefficient, and Chi-Square tests. Results: In total, 250 women with a mean age of 32.1±10.23 years and the mean education level of 10.58±3.67 years were studied. The mean reading score was 11.58±2.51 and the mean vocabulary comprehension score was 17.24±4.73. Participants' health literacy score had positive correlation with age and education, and significant difference in health literacy scores between occupational groups was seen. Housewives' health literacy scores were lower than others (p<0.05). Conclusion: Low health literacy was a common problem amongst younger women, especially among women who had less education. These women are at risk of early marriage and child bearing and require more health care. Health care professionals should use effective methods for easier transfer recommendation, also, producing medical information booklets, texts, and videos for different community subgroups through public media or even in cyberspace with clear and common words consisting of essential information. [ABSTRACT FROM AUTHOR]

Background: Unhealthy days are defined as the number of days during the past 30 days that a woman has not had a feeling of wellbeing. Wellbeing includes the woman's judgments about the level of satisfaction and quality in her life. Assessment of a woman's perception of unhealthy days can be used to help her determine the extent of the burdens associated with mental and physical feelings that things are not going well in her life, job and relationship. This study was conducted to measure unhealthy days and the general health status in Iranian women of reproductive age based on their own perceptions. Methods: The participants of this study were women of reproductive age who were referred to health centers in Mashhad, Iran, in 2012. With the stratified random sampling method, 220 women were included in the study. The health-related quality of life-4 (HRQOL-4) questionnaire was used to assess the women's self-perceived unhealthy days. The data that were collected were analyzed by Kruskal-Wallis, chi-squared, Pearson correlation, and logistic linear regression tests with SPSS 11.5. Results: The mean age of the participants was 32.6 years, and the median number of the self-perceived unhealthy days was 7.1 days (per month). In the domains of physical, mental, and disability unhealthy days, the data indicated 2 days, 2.1 days, and 0.1 day in a month, respectively. Also, nearly half of the participants reported that their general health status was poor to fair. The Kruskal-Wallis test showed that there was a significant difference between unhealthy days in the different age groups (p=0.01) as well as for the physical (p=0.02) and mental domains (p=0.4). The results of the regression analysis showed that the number of physical unhealthy days increased with age, number of children, and education. The number of mental unhealthy days increased with age, and the number of disability days increased as the age at which they were married decreased (p<0.05). A significant inverse relationship was observed between physical unhealthy days and education, with the number of physical unhealthy days decreasing as the years of education increased (r=-0.19, p=0.005). Conclusion: Women with less education who were older than 40, who married at an early age, and had more children reported more unhealthy days. These results emphasize the importance of preventive and educational health interventions in these vulnerable groups based on their physical and mental needs. [ABSTRACT FROM AUTHOR]

Background: Pain relief during labour is one of the major concerns in obstetrics; severe labor pain causes fear of the next pregnancy, and interferes with the mother's family relationship. Objective: The aim of this study was to evaluate the analgesic effects of Entonox during labor on reducing the need for pethidine (Meperidine) and fetal-maternal complications. Methods: This double-blind randomized clinical trial was conducted on pregnant women who were candidates for vaginal delivery in Educational Hospitals of Mashhad University of Medical Sciences, Iran between January 2014 and November 2015. After entering into the inactive phase of labor, participants were randomly allocated to receive inhaled Entonox gas (n=200) or inhale Oxygen (n=200) as a control group. Mothers inhaled the gas at commencement of pain, and ceased as soon as the pain diminished, up to the end of the second stage of labor which was the neonate's birth. Main outcomes were pain score based on NRS (numerical rating scale), duration of delivery, required pethidine, maternal complications and satisfaction during labour. Chi-square and Independent T-test were used via SPSS for data analysis and P-value less than 0.05 was considered statistically significant. Results: Four-hundred pregnant women with a mean age of 26.4±5.9 years were studied. Complications such as nausea, vomiting, dizziness, and drowsiness were reported in 25% of the Entonox group and 23% in the control group (p=0.640). Mean of pain severity score during labor in the Entonox and control groups was 4.5±1.2 and 5.2±1.4, respectively (p<0.001). Pethidine requirement, significantly was lower in the Entonox group (31.6±11.8 versus 35.7±12.4; p<0.001). Conclusion: In our study, Entonox significantly reduced pain during delivery without significant increase in maternal and neonatal complications. Trial registration: The trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2015102713159N6. Funding: This research has been financially supported by Research Council of Mashhad University of Medical Sciences. [ABSTRACT FROM AUTHOR]

Background and Aim: Gentle music has relaxing and pain reducing effects. In this study, the effect of music on patients' vital signs and pain was investigated before and after endoscopy. Methods: This clinical trial study was conducted on 100 children from seven to fourteen years of age in Gha'em Hospital, Mashhad in 2015. Children were divided into two equal groups (case group=50 and control group=50). The control group received endoscopy according to the standards, without any other procedure. For the case group, a classic musical piece by Clayderman was played during endoscopy (from the time of entering the endoscopy room to the end of the process). After conducting endoscopy, FALCC scale and Baker-Wong pain scale were filled for both groups. In addition, children's vital signs including: heart rate (pulse), diastolic and systolic blood pressure were measured before and after endoscopy for both groups. Data analysis was conducted using SPSS16 with the help of Mann-Whitney and Chi-square tests. Results: No significant difference was found in age, gender distribution of case or control groups (p>0.05). Heart rate and diastolic blood pressure was significantly lower in the music (case) group compared to the control group before endoscopy (p=0.012). In addition, pain score in patients of the music group was lower than the control group (p<0.05). Conclusion: Playing music for children during endoscopy can reduce pain and anxiety in patients before and after endoscopy. [ABSTRACT FROM AUTHOR]