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Abstract Background As acute myocardial infarction (AMI) prevalence is increasing because of lifestyle changes, the incidence of atypical symptoms in acute coronary syndrome (ACS) is rising and making misdiagnosing of this fatal event more probable. To better approach the patients with atypical symptoms, we tend to present a rare case of AMI with wrist pain. Case report A 41-year-old man presented to the emergency room (ER) with severe both-hand wrist pain and mild epigastric pain. His electrocardiogram (ECG) showed anterior ST-elevation myocardial infarction (MI) with an ejection fraction of 35–40%. His angiography showed severe left anterior descending artery (LAD), and first obtuse marginal artery (OM1) artery stenosis. He underwent Primary percutaneous coronary intervention (PCI). The patient recovered without serious complications and was discharged the day after PCI. Discussion In this rare case of AMI with wrist pain, it is important to know that atypical symptoms can be present at various levels of symptoms, which prevents future misdiagnosis.

Background and aims: To identify the pattern and causes of death and to deal with them are among the most appropriate strategies to increase human life expectancy. The pattern of death in society must be identified to cope with the causes of premature deaths. The aim of this study was to epidemiologically investigate the causes of death in people aged 5-14 years in northeastern Iran. Methods: Data on the deaths of people aged 5-14 years from Khorasan Razavi province during 2013- 2019, drawn from the Causes of Mortality Classification System of the Ministry of Health and Medical Education, were used to conduct the study. Results: Data on 2084 deaths were examined, of which 824 (40.04%) occurred in girls. The number of deaths was 976 (53.83%) and 1108 (46.17%) in the age group of 5-9 and 10-14, respectively. Traffic accidents, cancers, external causes (unexpected events), and circulatory system diseases were found as the main causes of death. Among the cancers, lymphoid leukemia, malignant brain tumors, and myeloid leukemia (18%, 12%, and 7%, respectively) were the most common cancers, leading to death. In rural areas, unexpected events (20%) were the leading cause of death, followed by traffic accidents and cancers (19% and 13%, respectively). Conclusion: Overall, the mortality rate in children aged 5-14 years due to traffic accidents and unexpected events (suffocation, burns, and the like) seems to be substantially higher in Iran compared to some developing countries and some neighboring countries such as Turkey. Given the possibility of taking preventive measures in this regard, it is necessary to develop policies to reduce the mortality rate in the age group.

Background: In recent years, in order to improve the quality of medical care, physicians have integrated their clinical expertise and best available research evidences to form evidence-based medicine. This study aims to assess the impact of training of evidence-based medicine on knowledge and attitude of medical students of Mashhad University of Medical Sciences.Methods: This experimental study had a before-after design and did not use a control group and was carried out among 244 medical externs in a course of an educational year. During the one-month course of family medicine, a three-day workshop consisting of seven two-hour sessions were held by faculty staff of community medicine department about definition, components, and how to clinically use EBM in practice. SPSS version 16 was used for data analysis.Results: The average attitude (total 5 points) improved from 2.2 before the workshop to 4.1, which was statistically significant (P = 0.001). The attitude regarding the positive effects of evidence-based medicine on patient outcome and its practicality and cost-effectiveness for the patient changed drastically. The knowledge of the participants regarding common concepts of EBM improved from 1.4 points to 2.4 points (total 3 points) after the workshop, which was statistically significant (P = 0.001).Conclusions: Considering negative attitude and inadequate knowledge of students regarding evidence-based medicine, and favorable impact of the workshops on the knowledge and attitude of the students, even in the short-term, necessitates more extensive programs to be designed by the educational staff of the university.

Backgrounds: Envenomation is common in Asia including Iran that induces morbidity and mortality. This study investigated the epidemiological characteristics of cases with snake, spider and scorpion bites. Methods: In this cross-sectional design, epidemiologic data of admitted cases to the Toxicology Department of Imam Reza Hospital of Mashhad, Iran were analyzed across a 7-yr period, from 2004 to 2011. SPSS was used for data analysis. Results: This study reports 686 admissions due to animal envenomation with an incidence rate of 2.9 per 100000. Mean (SD, min-max) age of admitted patients was 30 (19, 1-90) yr, and 471 (69%) were male. Snakebite (n, percentage, annual incidence) (299, 44%, 1.3 per 100000) and spider bite (188, 27%, 0.8 per 100000) and scorpion sting (126, 18.4%, 0.5 per 100000) were most frequent cases. Overall, case fatality rate was 0.09 per 100000 which were due to scorpion and unknown bite. No cases of snakebites died in this period. The highest age-specific incidence rate was 4.6 per 100000 and related to 10-20 yr of age. Conclusion: Animal envenomation is frequent in this area and a matter of health concern. While deaths related to snake bite are no longer reported-presumably due to using effective anti-venom - managing unknown and scorpion bites need to be addressed. Envenomation was not overtly an age-specific event in this province.