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Objective: Subarachnoid hemorrhage (SAH) is still considered a life-threatening medical condition witha high mortality rate, particularly in developing countries. Thus, the present study aimed to investigate theangiographic findings of non-traumatic or spontaneous SAH.Methods: This retrospective cohort study included 642 health records of patients with non-traumatic SAH overa 10-year period, from 2010 to 2020. The required data, including demographic information, aneurysm type,size, location, disease severity classification, and secondary complications, were extracted.Results: The study included 642 patients, with 262 (40.8%) being male. The mean age of the participants was54.72±13.51 years. The most prevalent type of aneurysm was saccular (89.1%), while serpentine (0.2%) anddissecting saccular (0.2%) aneurysms had the least prevalence. The most frequently involved arteries were theanterior communicating artery (ACoA; 38%), internal carotid artery (ICA; 27.6%), and middle cerebral artery(MCA; 13.4%). There was a significant correlation between sex and aneurysms occurring at ACoA and ICA(p< 0.0001), and ACoA – A1 (p=0.02). Patient age and sex were also significantly correlated with one another(p

IntroductionPancreatic cancer is a truculent disease with limited treatment options and a grim prognosis. Immunotherapy has shown promise in treating various types of cancer, but its effectiveness in pancreatic cancer has been lacking. As a result, it is crucial to identify markers associated with immunological pathways in order to improve the treatment outcomes for this deadly cancer. The purpose of this study was to investigate the diagnostic and prognostic significance of three markers, CD8, CD68, and VISTA, in pancreatic ductal adenocarcinoma (PDAC), the most common subtype of pancreatic cancer.MethodsWe analyzed gene expression data from Gene Expression Omnibus (GEO) database using bioinformatics tools. We also utilized the STRING online tool and Funrich software to study the protein-protein interactions and transcription factors associated with CD8, CD68, and VISTA. In addition, tissue microarray (TMA) and immunohistochemistry (IHC) staining were performed on 228 samples of PDAC tissue and 10 samples of normal pancreatic tissue to assess the expression levels of the markers. We then correlated these expression levels with the clinicopathological characteristics of the patients and evaluated their survival rates.ResultsThe analysis of the GEO data revealed slightly elevated levels of VISTA in PDAC samples compared to normal tissues. However, there was a significant increase in CD68 expression and a notable reduction in CD8A expression in pancreatic cancer. Further investigation identified potential protein-protein interactions and transcription factors associated with these markers. The IHC staining of PDAC tissue samples showed an increased expression of VISTA, CD68, and CD8A in pancreatic cancer tissues. Moreover, we found correlations between the expression levels of these markers and certain clinicopathological features of the patients. Additionally, the survival analysis revealed that high expression of CD8 was associated with better disease-specific survival and progression-free survival in PDAC patients.ConclusionThese findings highlight the potential of CD8, CD68, and VISTA as diagnostic and prognostic indicators in PDAC.

Objective: Intoxication is among the most common causes of emergency department (ED) visits. Activated charcoal is one of the useful treatments preventing poison absorption. However, nausea caused by using charcoal has made this substance less acceptable among patients. This study aims at investigating the influence of using cold charcoal on reducing the nausea among poisoned patients. Methods: This clinical experimental trial study approved by the Medical Ethics Committee of Regional School of Medicine of Mashhad University of Medical Sciences with the code 930106. Randomization was provided by Sealed Envelope. Accordingly, the experimental group received cold charcoal (4ᵒC), while the control group received room temperature charcoal (23ᵒC). We used the coding method in order to double blind the study. After half and one hour, nausea was checked in patients by visual numeric scale (VNS). Data were described by using descriptive and analytic test indices including frequency, mean ± standard deviation and suitable charts and tables. Results: The average age of participants was 25.83±7.05. The severity of nausea half an hour after consuming charcoal in cold charcoal group and experimental group was 1.3 and 2.73, respectively (P < 0.001). One hour after consuming charcoal, the severity of nausea in cold charcoal group and experimental group was 0.39 and 1.38 (P < 0.001). As indicated by the results of the study and after investigating the changing trend of nausea severity, nausea severity decreased in both groups by passing time from half to one hour (P < 0.001). Conclusion: Cold charcoal can reduce the rate of nausea and make it more acceptable among patients.

Background and Objective: Due to the major role of emotional intelligence in the prevention of risky behavior and management of workplace stresses, the present study aimed to assess the relationship of emotional intelligence and job stress with safety behaviors among work permit issuers in one of the oil industries in Tehran in 2020. Materials and Methods: This descriptive-analytical cross-sectional study was performed on 300 employees of an oil refinery in Tehran. Demographic information questionnaire, Siberian Schering Emotional Intelligence Questionnaire, as well as Parker and Decotis Job Stress Questionnaire were used to collect data. Moreover, to examine safety behaviors, a 23-item behavioral questionnaire which was developed by Mehdi Nia et al. and assesses safety compliance and safety participation was used. To obtain the percentage of safe behavior on an observational basis, a behavioral checklist of five important behaviors of work permit issuers that are part of the work permit guidelines and have been measured in past events was used. Results: In this study, the percentage rates of safe behavior of work permit issuers, their stress levels, and emotional intelligence were reported as 40.57, 2.26, and 3.12, respectively. The assessment of the relationship between emotional intelligence and the percentage of safe behavior pointed to a statistically significant relationship (P=0.019) with a correlation coefficient of 0.161. Moreover, job stress with a correlation coefficient of -0.217 demonstrated a significant relationship with emotional intelligence (P=0.001). Anxiety with a correlation coefficient of -0.068 had a significant and inverse relationship with the percentage of safe behaviors (P=0.022). Conclusion: As evidenced by the results of this study, among the permit issuers in the refinery, people with higher emotional intelligence experienced lower levels of stress and perform more safety behavior.

Introduction: To identify the strengths and weaknesses of emergency medicine residency curriculum in Iran, and to benefit from the experiences of successful universities, comparative studies are crucial. This study compared the components of the national curriculum of emergency medicine in the United States, Canada, the European Union, Australia, and Saudi Arabia with Iran. Method: Data for this research was collected by searching the websites of different universities and also contacting them for requesting curriculums. The leading countries in emergency medicine and one of the countries in the Middle East region (Saudi Arabia) along with the World Federation of Emergency Medicine were selected as the sample. The model used in this field is a range model that identifies four stages of description, interpretation, proximity, and comparison in comparative studies. Results: In the curriculum of the United States, Canada, the European Union, Australia, and Saudi Arabia, there were lots of similarities in expressing the general characteristics of the curriculum, mission elements, vision, values, and ​beliefs of the discipline, educational strategy, techniques, expected competencies, rotation programs, and evaluation method, which were also similar to the Iranian curriculum. However, the duration of residency for emergency medicine in Iran is three years, which is shorter than other countries. As expected, the number and duration of rotations are less than other countries. Also, the process of entering into this field is different in Iran and is based on an exam for entrance, while most other countries use self-requested residency program. Conclusion: Considering the results of comparing the Iranian curriculum with the curriculums of the United States, Canada, the European Union, Australia, and Saudi Arabia, it seems that Iran's program is comprehensive and complete; but, a reappraisal of the course duration and entering options are necessary to eliminate or improve the inadequacies.

Introduction: Today, the use of new technologies has expanded in various fields. One of these cases is the use of smartphones and barcode reader software and two-dimensional barcodes. In this study, we tried to evaluate the influence of barcode utilization in the training of residents. Methods: This was a descriptive cross-sectional study conducted in the emergency department of Ghaem Hospital, in which the effect of using educational barcodes on 30 medical residents of the emergency, internal medicine, and neurology was investigated. A questionnaire recording the performance of residents in medical emergency procedures was used. Also, demographic variables of residents were recorded. Data analysis was performed using descriptive and inferential statistics in SPSS software.Results: A total of 30 residents completed the study questionnaire before installing the poster, and 29 of them completed the post-test questionnaire. Of these, 10 (33.3%) were emergency medicine residents, 13 (43.3%) Internal medicine and 7 subjects (23.3%) were neurology residents. All of them (100%) found the use of QR codes practical and easy. Analysis of data related to pre-test and post-test scores of residents shows that their average scores in the pre-test, 7 ±2.39, and their average scores in the test post 10.86 ±2.431, which indicates a significant increase after using the QR code poster (P-value = 0.000) Conclusion: The use of QR codes has been practical, easy, and user-friendly. Also, comparing the average scores of participants before and after the installation of these codes, shows that it has had a significant effect on training residents.

Background and purpose: Stroke is the most common and the most deadly neurological disease that is accompanied with many complications. The aim of this study was to compare the diagnostic value of hs-CRP and ABCD2 criteria in predicting the future incidence of acute cerebrovascular events during follow-up in patients with transient ischemic attack (TIA). Materials and methods: This cohort study was performed in TIA patients during the first 24 hours of onset of symptoms. Blood samples were taken and demographic information was obtained, then hs-CRP was measured in all patients. History of hypertension, atherosclerosis, and ABCD2 scores were also recorded. Results: The patients (n= 135) included 69 (51.11%) male and 66 (48.88%) female cases. Eight subjects had a stroke within three months. There was no significant relationship between hs-CRP level and stroke incidence (P= 0.303), but ABCD2 cut-off scores of >1.5 had the most sensitivity (87.5%) and specificity (81.9) that could significantly predict the occurrence of stroke (P= 0.011). Systolic blood pressure (OR=1.04) and ABCD2 score (OR=2.43) could predict the occurrence of stroke (P

مقدمه: نیازسنجی آموزشی نخستین گام در تدوین و توسعه برنامه های آموزشی ارتقا دهنده مهارت ها و دانش نیروی انسانی قلمداد می شود و می تواند عامل ایجاد و تضمین اثربخشی کارکرد آموزش و بهسازی سازمانی و نیز توانمندسازی نیروهای انسانی ماهر و متخصص محسوب شود که در نظام سلامت از اهمیت بسزایی برخوردار است. یکی از بخش های مهم ارائه دهنده خدمات سلامت بخش اورژانس است که به دلیل فشردگی اطلاعات، پیچیدگی مسائل و نیاز به سرعت عمل بالا در این واحدها، ارتقای آموزش ها و مهارت ها در این بخش بسیار مهم و ضروری است. لذا در مقاله حاضر نیازهای آموزشی پزشکان و پرستاران بخش اورژانس؛ بر اساس مطالعات انجام شده؛ مورد کنکاش قرار گرفته است. روش کار: این پژوهش مبتنی بر یک مرور نظام‌مند می باشد که ارزیابی کیفیت مقاله ها با استفاده از چک لیست استاندارد STROBE، صورت گرفته است. مطالعات اولیۀ انجام شده، از طریق مقاله هایی که در زمینه ارتقای آموزشی طب اورژانس و تربیت حرفه مندان بخش اورژانس و فوریت های پزشکی؛ در پایگاه‌های اطلاعاتی فارسی زبان؛ SID ،Iranmedex ،Magiran و پایگاه‌های انگلیسی زبان؛ Science Direct، PubMed، ProQuest،Cochrane Library،Embase ،Scopus و موتور جستجوگر Google Scholar در بازه زمانی سالهای 2010 تا 2022 منتشر شده است، انجام گرفت. کلید واژه‌های فارسی؛ اورژانس، فوریت های پزشکی، آموزش، آموزش مداوم، نیازهای آموزشی، مهارت های مورد نیاز و عبارات مرتبط با اورژانس به صورت ترکیب واژگان و لغات انگلیسی Emergency, Education, Continuing Education, Educational Needs, Needs Assessment با کمک روش های جستجوی بولین و عملگرهای And و OR مورد توجه بوده است. یافته ها: در این مطالعه مرور سیستماتیک نیازهای آموزشی حرفه مندان بخش اورژانس بررسی گردید که پس از جستجو در پایگاه های اطلاعاتی با کلیدواژه های متناسب، 21 مقاله که شرایط لازم را بر اساس معیارهای ورود داشتند، آنالیز شد. از میان مطالعه های مورد بررسی، بیشترین تعداد مطالعات استخراج شده در آمریکا(9مقاله) و ایران(8مقاله) انجام شده است. روش تحقیق بکار رفته در 18 مقاله، توصیفی-مقطعی بود و روشهای دلفی، مطالعه کیفی با انجام مصاحبه و تحلیل محتوا نیز بین مطالعات وجود داشت. 9 پژوهش در حوزه های اختصاصی و مابقی به طور کلی به نیاز سنجی پرداخته بودند. به لحاظ جمعیت هدف نیز پرستاران، پزشکان، دانشجویان و کارورزان، دستیاران، اعضای هیات علمی، کارکنان و مدیران؛ در این مطالعات، مشارکت داشته اند. نتیجه گیری: آنالیز نتایج مطالعات از نیاز آموزشی به مهارتهای لازم در زمینه تشخیص صحیح و سریع، آموزش های لازم برای انجام اقدامات درمانی فوری، ارائه صحیح و استاندارد خدمات مراقبتی، مدیریت شرایط و موقعیت های بحرانی و مهارت های ارتباطی؛ حکایت دارد. اگرچه در طول یک دهه گذشته محققان پژوهش در آموزش تلاش زیادی برای شناسایی نیازهای آموزشی بخش اورژانس داشته اند با این حال به نظر می رسد علیرغم مطالعات بسیار بر روی بخش اورژانس، مطالعات نیازسنجی از انسجام لازم برای ارائه راهبردهای آموزشی کارآمد برخوردار نیست.

Objective: The purpose of this study is to investigate the presence of under-reaction or over-reaction in Tehran Stock Exchange after extreme market events. Regarding the vast number of these events, finding how investors trade in these conditions is crucial for timely decision making and portfolio management. Regulations also can be wisely made to control investors. Methods: Using daily TEDPIX and daily prices of all stocks from 2009 – 2018, we identify extreme market events by comparing daily market returns with the 500- days moving Value at Risk (VaR) of returns. Winner and loser portfolios are formed in the second stage and Then, we investigate the presence or absence of under-reaction or over-reaction by comparing momentum and reversal strategies' excess return. Positive values of momentum strategy excess returns lead us to under-reaction and positive values of reversal strategy lead us to an over-reaction. Results: According to the results from the present study, from 67 extreme events in the research period, we have 30 positive and 37 negative extreme events. The momentum strategy yields a positive and significant excess return on average. Consequently, we find that stocks tend to under-react after both positive and negative events. But this behavior is more intense after negative events. Thus, the momentum strategy can make excess returns. Also, we didn't find the persistence of over-reaction within the study criteria. Conclusion: Short-term under-reaction in the Tehran Stock Exchange may be due to the daily price limit of this market. Disregarding of the cause, investors can make a profit by taking advantage of the opportunity in the days following an extreme event. In other words, investors that prefer a momentum strategy can have notable excess returns in the days following an extreme event.

Poetry, a literary and artistic creation, is a combination of different elements. Imagination and illustration are significant aspects of poetry. Imaginary elements in this genre of literature play an important role in its beauty and permanence. Among these, lyrical poems are among literary forms in which illustration is prominently visible. Lyrical poetry is a reflection of the poet's personal feelings and emotions. Some literary works such as Khamseh Nezami, which were copied during the Safavid period, are also a reflection of pictorial and imaginative elements. The study of the reflection of illustration in the poems of lyrical poems with the five paintings of Shah Tahmasebi can illuminate the deep connection between poetry and painting. This descriptive and analytical method seeks to study the forms of imagination and illustration in systems such as Nasrin and Firooz, Salim and Salmi, Nel and Daman, Naz and Niaz. The research findings indicate the deep presence of illustration and imagination in such poetic artworks. The use of rhetorical industry, style and innovation of illustration is almost the same in all systems, but the style of illustration of the story of "Nel and Deman" has changed outlook midway. The most common criteria used in the imagination and illustration of these few systems are on such axes as emotion, communication and information, social class, the position of the beloved, speech and conversation, carpentry, planets and natural elements. In Khamseh Shah Tahmasebi's paintings, the element of imagination and illustration such as mourning, beloved, speech and natural elements can be evidently seen. Research aims: 1. The place of illustration and imagination in four systems: Salim and Salmi, Firooz and Nasrin, Nel and Daman, Naz and Niaz. 2. A comparative study of pictorial and imaginative elements in the lyrical poetry with the paintings of Khamseh Shah Tahmasebi. Research questions: 1. What effect and role does imagery and imagination have on the poetry of Salim and Salmi, Firooz and Nasrin, Nel and Daman, Naz and Niaz? 2. What are the similarities between the pictorial and imaginative elements in lyrical poems such as Salim and Salmi, Firooz and Nasrin, Nel and Daman, Naz and Niaz with the five paintings of Shah Tahmasebi?

Introduction: Upper gastrointestinal bleeding is one of the major and emergent causes of mortality and morbidity around the world. The tranexamic acid has been raised since years ago as a therapeutic intervention. Therefore, prize of exact and timely treatment of upper gastrointestinal bleeding, the present study aimed to evaluate the effects of systemic tranexamic acid on the possible consequences of upper gastrointestinal bleeding such as need for blood transfusion, admission in intensive care unit (ICU), surgery to control bleeding or eventually short-term mortality. Materials and Methods: This double-blind randomized clinical trial included 88 patients with upper gastrointestinal bleeding in a referral academic gastrointestinal center. Patients with symptoms of upper gastrointestinal bleeding referred to the emergency department were randomly divided into two groups: intervention group (n=45) who treated with tranexamic acid in addition to receive standard therapy for upper gastrointestinal bleeding, and control group (n=43) treated with standard therapy for upper gastrointestinal bleeding and placebo (distilled water). Results: Administration of tranexamic acid along with the standard therapy for upper gastrointestinal bleeding in the intervention group caused reduction in mortality and recurrent bleeding compared to the control group. There is no difference between two groups in need for surgery, hemotransfusion and ICU admission. Conclusion: Due to the beneficial effects of tranexamic acid administration on reducing mortality and bleeding recurrence in patients with upper gastrointestinal bleeding, added this drug to the standard therapy may have a favorable potential for upper gastrointestinal bleeding.

Orotracheal intubation is one of the sure ways to manage airways in critical patients (1, 2). Failed intubation (Failure to properly place the endotracheal tube (ETT) in trachea) is a rather common event (3). There have been many techniques to confirm proper intubation, but none of them are applicable in all conditions. Methods such as capnography, tracheal sonography and chest-X-ray, were introduced for verification of proper tracheal intubation but they have their own limitations (4, 5). Given the significance of proper airway management, the authors focused on a secondary method of verifying proper intubation using tracheal tactile method and compared it to existing methods.

Objective: Septic shock is a response to infection and tissue hypoperfusion which does not respond to fluid therapy and eventually leads to organ dysfunction. Aggressive treatment of a broad-spectrum antimicrobial and supportive measures are the cornerstones of successful treatment. In addition to the main treatment, there are adjunctive therapies. Steroids are one of the treatments which have been studied in the management of refractory septic shock. Despite numerous studies on the role of steroids in the mortality of severe sepsis and septic shock, still lots of controversies exist. These conflicts are often about the steroid dose and duration of administration. Methods: This was a prospective, randomized-controlled, two-group assignment study. Patients referred to Imam Reza (AS) hospital in Mashhad who had refractory septic shock criteria were randomly divided into two groups: 80 patients were included in each group. After obtaining the baseline cortisol level and cosyntropin test, one group was treated with intravenous hydrocortisone, and the other group was treated with placebo. The response to hydrocortisone, the return of shock duration, and mortality at 28 days were investigated. The data were analyzed using SPSS version 16. For the normally distributed variables, a t test was used for comparisons. Concerning qualitative variables, the chi-square test or Fisher exact test were applied accordingly. Results: The return of shock duration and mortality in intervention group patients was more than control group, but it was not statistically significant. Conclusion: Despite numerous studies in this field, there are various outcomes (mortality rate, rate of return of shock, time of return of shock). These differences can be attributed to high degree of heterogeneity. Perhaps considering the underlying disease and more differentiation could change the return of shock and mortality rate.

Background & aim: Maternal mortality is defined as the death during pregnancy or up to 42 days postpartum. This study sought to determine the trend of maternal mortality ratio (MMR) and its associated factors in Khorasan Razavi province, Iran. Methods: This retrospective cross-sectional study was conducted in Khorasan Razavi Province, North East of Iran, during 2010 to 2014. Data was collected from the reports of Maternal Mortality Committee of Mashhad University of Medical Sciences, Mashhad, Iran. The MMR was calculated for each period, and its trend was estimated. Chi-square test was used to find the relationship between mode of delivery and direct or indirect causes of maternal death. Results: According to the results, 94 maternal deaths occurred during 2010 to 2014. The total MMR was 17.68 (95%CI: 13.59-21.77) per 100,000 live births. The mean maternal age was 30.7±6.1 years old. Most of the deaths (75.6%) occurred during postpartum period, from which 81% happened following a high-risk pregnancy. In addition, 50% of the mothers had proper numbers of visits during pregnancy. The most direct and indirect causes of maternal death were maternal hemorrhage (24.5%) and cardiovascular diseases (12.8%), respectively. The relative risk of maternal mortality associated with cesarean section was 1.3 in comparison to normal vaginal delivery. Conclusion: The estimation of MMR is essential for decision-making and resource allocation. To reach this goal, a good registration system is needed to register all deaths and their exact causes.

Background: Approximately 25% of the residents’ time in each shift is allocated to educating lower-level assistants and interns. Assistants have played a major role in interns’ education. Aim: To assess the teaching abilities of emergency medicine assistants in the training and monitoring of medical interns and undergraduate students. Methods: This cross-sectional study was performed in 2015 at the emergency center of Imam Reza hospital in Mashhad University of Medical Sciences. We employed a researcher-made questionnaire to search the capability of emergency medicine residents to assess the teaching capabilities of emergency medicine residents to interns. This questionnaire was completed by 106 interns. The Validity of the questionnaire was confirmed by three specialist experts and reliability of the questionnaire was confirmed by Cronbach's alpha (0.94). This questionnaire consists of 24 questions in six areas. The analysis was performed by descriptive statistics using SPSS 16. Result: The study showed that the least favorable score was related to “residents get feedback on each shift” and the highest score was given to “a friendly relationship with the Interns and residents”. Conclusion: Considering the key role of residents in the education and training of future healthcare specialists, training interventions and allocating sufficient time to the proper education of different members of healthcare teams and medical students could largely contribute to the development of clinical training systems.

In order to quality service improvement, digital video broadcasting terrestrial should increase both channel capacity and also data rate. The system should be stable against fading. To achieve this aim, using multiple input multiple output which is equipped by dual polar antennas with low correlation is practical. However, using polar antennas lead to interference creation caused by cross polarization. This issue bring the decrease of both data rate and transmit capacity. To decrease the influence of depolarization, applying successive interference cancellation (SIC) is very effective. In this paper, a new detection algorithm based on SIC detection is proposed. The main characteristics of this algorithm is changing in the SIC detection nulling. This article also shows that, in environmental with high fading, in contrast to other detection method like ZF-SIC and MMSE-SIC, bit error ratio performance versus SNR is improved in new proposed detection method.

Objective: Road traffic injuries (RTIs) are the second leading causes of death in Iran. One of the most important steps in the prevention of traffic-related trauma and its consequences is gaining insight into the epidemiology of injuries. We conducted this study to describe the characteristics of RTIs and to find strategies for its prevention. Methods: This was a prospective cross-sectional study on consecutive road traffic trauma patients admitted to the emergency department (ED) of the second largest trauma center in the northeast of Iran, during July to September 2013. Demographic characteristics, type of vehicle, and injured area of the body were documented for each patient. Results: Of 666 included patients, 562 (84.4%) were male and 104 (15.6%) were female, with a mean age of 28.89 ± 16.62 years. Most of the patients were uneducated. The highest frequency of RTIs was related to motorcyclists with an attributed risk of RTIs for motorcycles at 75.8%. The most common traumatized area was head, face, and lower extremities. Conclusion: The largest number of traumatized patients was among motorcyclists and uneducated population underscores the importance of public training about motorcycle usage and security and increase social awareness about reasons behind traffic law.

Pain is the most common complaint in emergency department and there are several methods for its control. Among them, pharmaceutical methods are the most effective. Although intravenous morphine has been the most common choice for several years, it has some adverse effects. There are many researches about intravenous acetaminophen as an analgesic agent and it appears that it has good analgesic effects for various types of pain. We searched some electronic resources for clinical trials comparing analgesic effects of intravenous acetaminophen vs. intravenous morphine for acute pain treatment in emergency setting.In two clinical trials, the analgesic effect of intravenous acetaminophen has been compared with intravenous morphine for renal colic. The results revealed no significant difference between analgesic effects of two medications. Another clinical trial revealed that intravenous acetaminophen has acceptable analgesic effects on the post-cesarean section pain when combined with other analgesic medications. One study revealed that administration of intravenous acetaminophen compared to placebo before hysterectomy decreased consumption of morphine via patient-controlled analgesia pump and decreased the side effects. Similarly, another study revealed that the infusion of intravenous acetaminophen vs. placebo after orthopedic surgery decreased the consumption of morphine after the surgery. A clinical trial revealed intravenous acetaminophen provided a level of analgesia comparable to intravenous morphine in isolated limb trauma, while causing less side effects than morphine.It appears that intravenous acetaminophen has good analgesic effects for visceral, traumatic and postoperative pains compare with intravenous morphine.

Introduction: Patient satisfaction is an accurate assessment factor for evaluating the performance of health policies in the community. The purpose of this study is to assess patients' satisfaction with emergency department of Imam Reza hospital of Mashhad Iran. Materials and Methods: In this cross-sectional study, during six months period from April to October 2012, 420 patients were entered to study in morning, evening and night shifts before being discharged or transferred from emergency department. The Press Ganey questionnaire of patient satisfaction was completed. Results: 420[daneshgar1] patients in three work shifts of morning (140 patients) evening (140 patients) and night (140 patients) participated in our research. 226 (53.8%) of participants were male and 194(46.2%) were female. The average of patients’ time waiting for doctors' visit was 10.7±6.1 minutes. The mean score of satisfaction during attendance in Emergency Department (ED), during physicians' visit and overall satisfaction was 25.24±5.04, 25.32±5.42, 8.52±1.91 respectively. The highest level of satisfaction is related to speed of admission (81%), medical treatment (76%), nursing skills for doing medical orders (71.4%) and lowest level of satisfaction is related to comfort and pleasantness of the waiting area (45.9%), time the physician spent with the patient (56.5%) and length of wait before going to an exam room (62.8%). Conclusion: Attempt for reducing waiting time, providing comfort environment, increasing the time of visit with emergency physicians and enhance service quality based on patient needs can reduce the patient dissatisfaction.

Introduction: Confirmation of proper endotracheal tube placement is one of the most important and lifesaving issues of tracheal intubation. The present study was aimed to evaluate the accuracy of tracheal ultrasonography by emergency residents in this regard. Method: This was a prospective, cross sectional study for evaluating the diagnostic accuracy of ultrasonography in endotracheal tube placement confirmation compared to a combination of 4 clinical confirmation methods of chest and epigastric auscultation, direct laryngoscopy, aspiration of the tube, and pulse oximetry (as reference test).Results: 150 patients with the mean age of 58.52 ± 1.73 years were included (56.6% male). Sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio of tracheal ultrasonography in endotracheal tube confirmation were 96 (95% CI: 92-99), 88 (95% CI: 62-97), 98 (95% CI: 94-99), 78 (95% CI: 53-93), 64 (95% CI: 16-255), and 0.2 (95% CI: 0.1-0.6), respectively.Conclusion: The present study showed that tracheal ultrasonography by trained emergency medicine residents had excellent sensitivity (>90%) and good specificity (80-90) for confirming endotracheal tube placement. Therefore, it seems that ultrasonography is a proper screening tool in determining endotracheal tube placement.

Objective(s): Incidence of neurocognitive and psychological disorders may be related to serum homocystein (Hcy), cobalamin (vitamin B12 ) and folate levels in old people. The aim of this study was to assess the relation between Hcy, cobalamin, folate and neurocognitive and/or psychological disorders in the elderly. Materials and Methods: In this cross-sectional study, 280 subjects with ≥ 65 years old, were evaluated. The subjects were selected from 12 regions of Mashhad, Iran, over March to October 2009. After blood sampling, data were collected by questionnaire, face to face interview and performing neurocognitive and psychological tests. The sera of 250 persons were analyzed for cobalamin and folate by RIA method. Amongst the aforementioned samples, 78 cases with cobalamin Results: Amongst the people, 126 (45%) were male and 154 (55%) were female. The prevalence of hyperhomocysteinemia (HHcy) was 59.5% and 37.1% in male and female respectively (P -value =0.049). Hcy inversely correlated to cobalamin (r=-0.282, P=0.014) and to folate (r=-0.203, P=0.014). Hcy, cobalamin and folate correlations to neurocognitive and psychological impairments were not statically significant. Conclusion: Hyper Hcy or low cobalamin and folate in the elderly, are prevalent but their relationships with neurocognitive and psychological impairments is controversial. If these relationships had been confirmed, performing a single serum Hcy or cobalamin test would have been enough to diagnose and prevent neurocognitive impairments and inversely, neurocognitive-psychological sign and symptoms could have meant probable tissue vitamin deficiencies. However methods of assessing neurocognitive and psychological markers with validity and reliability of clinical and laboratory tests for finding aforementioned relationships should be revised.

Introduction: Today, the use of new technologies has expanded in various fields. One of these cases is the use of smartphones and barcode reader software and twodimensional barcodes. In this study, we tried to evaluate the influence of barcode utilization in the training of residents. Method: This descriptive cross-sectional study was conducted in the Emergency Department of Ghaem Hospital, Mashhad, Iran in which the effect of using educational barcodes versus conventional posters on 30 medical residents of the Emergency, Internal Medicine, and Neurology Departments was investigated. A questionnaire was used to record the performance of residents in terms of medical emergency procedures. Moreover, demographic variables of residents were recorded. Data analysis was performed using descriptive and inferential statistics in SPSS software. Result: In total, 30 residents completed the study questionnaire before installing the poster, and 29 of them completed the questionnaire post-test. It should be mentioned that 10 (33.3%), 13 (43.3%), and 7 (23.3%) subjects were Emergency Medicine, Internal Medicine, and Neurology residents, respectively. All of them (100%) found the use of QR codes practical and easy. Analysis of data related to pre-test and posttest scores of residents showed that their mean scores in the pre-test and post-test stages were 7±2.39 and 10.86 ±2.431, respectively, which indicated a significant increase after using the QR code poster (p-value=0.000). Conclusion: The use of QR codes has been practical, easy, and user-friendly. In addition, comparing the mean scores of participants before and after the installation of these codes showed that it had a significant effect on training residents. [ABSTRACT FROM AUTHOR]

Abstract We present two robust and well‐dated paleomagnetic poles from upper Eocene and Oligocene volcanics in the Urumieh‐Dokhtar magmatic arc, Central Iran. These two poles place Iran ∼3.7°–3° of latitude south of its present position between ca. 40 and 23 Ma. Our new paleomagnetic declination data indicate that the Central Iran block may have experienced a ∼11.6° clockwise rotation since the Late Eocene. We integrated our new data with the retrodeformed margins of the Zagros collision zone and contemporaneous Arabia positions to better constrain the age and configuration of the Arabia and Eurasia assembly process. In our model, the Arabia‐Eurasia collision occurred first in the western Main Zagros suture between ca. 35 and 30 Ma and then diachronously spread eastwards. Our paleogeographic reconstruction and initial continental collision timing supports the Arabia‐Eurasia collision as a first‐order driver of global cooling, Red Sea rifting, and Mediterranean extension.