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COVID-19 pandemic and the consequent online mode of education have challenged the national educational system and higher education. Thus, the present research aimed to explore students' experience of the advantages and disadvantages of online education at Bandar Abbas University of medical sciences during the pandemic. The present qualitative research conducted a content analysis of 26 nursing students' experiences. The sampling method was purposive. Unstructured face-to-face interviews were conducted with participants of the study to collect the required data. The interview protocol was followed. The required social distance was kept, and the ethical code was adhered to. The participants were interviewed as already arranged at a place of convenience. The interviews took between 40 and 60 minutes, depending on the immediate condition. The data collection continued until data saturation. The data analysis led to the extraction of 5 themes and 8 categories, including teacher-student miscommunication, student-student miscommunication, evaluation issues, anxiety, distancing from active learning, materials/sources, lack of physical attendance, non-educational activities, and 22 subcategories. The present findings could help professors and education authorities to better understand students' expected learning and the challenges of online education. They could, thus, be better aware of the existing barriers and could better plan to remove them.

Remdesivir, an antiviral medication, became an early promising therapeutic candidate for coronavirus disease 2019 (COVID-19) due to its ability to inhibit the virus in vitro. Current evidence about remdesivir treatment has been very controversial, so we aim to evaluate remdesivir to improve our knowledge about COVID-19 management and its long-term effects. In this retrospective cohort study using registered data derived from the Sina Hospital COVID-19 Registry with a 9-month follow-up, we enrolled patients receiving remdesivir and then matched a "control group" which did not receive remdesivir based on age, gender, and severity using propensity score matching. We used multivariant Cox regression to evaluate the remdesivir effect on patients' 9-month and in-hospital survival. We enrolled 227 patients, 116 in remdesivir and 111 in the control group. 213(93.8%) patients developed the severe disease, 88(38.8%) died during the 9-month follow-up, and 84(37.0%) died during hospitalization. In multivariate analysis, remdesivir did not affect the 9-month all-cause mortality and in-hospital mortality. Remdesivir was associated with increased in-hospital survival only in severe patients with diabetes (HR: 0.32; 95% CI: 0.14-0.75; P:0.008), and there was a trend for better 9-month survival in severe patients with diabetes (HR: 0.47; 95% CI: 0.20-1.09; P:0.080). We concluded that remdesivir treatment did not increase the 9-month survival rate either in patients with COVID-19 or patients with severe disease and underlying diseases. On the other hand, we found that remdesivir treatment could increase in-hospital survival only in patients with severe COVID-19 and a history of diabetes mellitus.

Phenobarbital is still one of the drugs of choice in managing patients with brain injury in the intensive care unit (ICU). However, the impact of acute physiological changes on phenobarbital pharmacokinetic parameters is not well studied. This study aimed to evaluate the pharmacokinetic parameters of parenteral phenobarbital in critically ill patients with brain injury. Patients with severe traumatic or non-traumatic brain injury at high risk of seizure were included and followed for seven days. All patients initially received phenobarbital as a loading dose of 15 mg/kg over 30-minutes infusion, followed by 2 mg/kg/day divided into three doses. Blood samples were obtained on the first and fourth day of study at 1, 2, 5, 8, and 10 hours after the end of the infusion. Serum concentrations of phenobarbital were measured by high-pressure liquid chromatography (HPLC) with an ultraviolet (UV) detector. Pharmacokinetic parameters, including the volume of distribution (Vd), half-life (t1/2), and the drug clearance (CL), were provided by MonolixSuite 2019R1 software using stochastic approximation expectation-maximization (SAEM) algorithm and compared with previously reported parameters in healthy volunteers. Data from seventeen patients were analyzed. The mean value±standard deviation of pharmacokinetic parameters was calculated as follows: Vd: 0.81±0.15 L/kg; t1/2: 6.16±2.66 days; CL: 4.23±1.51 ml/kg/h. CL and Vd were significantly lower and higher than the normal population with the value of 5.6 ml/kg/h (P=0.002) and 0.7 L/kg (P=0.01), respectively. Pharmacokinetic behavior of phenobarbital may change significantly in critically ill brain-injured patients. This study affirms the value of early phenobarbital therapeutic drug monitoring (TDM) to achieve therapeutic goals.

Introduction: Factor VII deficiency is a rare congenital coagulopathy disorder. In most cases this disorder is diagnosed in childhood. Common symptoms of congenital factor VII deficiency are different and consist of mucosal cutaneous hemorrhage, gastrointestinal bleeding, and joint bleeding. CNS hemorrhage is a fatal and severe complication of congenital factor VII deficiency. The incidence of gross hematuria is a rare symptom of factor VII deficiency. Isolated presentation of hematuria is rarer and usually is accompanied by bleeding in other sites. Case Presentation: The patient reported here is a 6-month-old girl who was diagnosed with congenital Factor VII deficiency following episodes of isolated gross hematuria. We decided to report this case to demonstrate if there is no other organic cause in the investigation of a child with recurrent hematuria, we should also consider a coagulation factors deficiency. Conclusion: Since isolated hematuria is a rare symptom in the coagulation factors deficiency, the coagulation tests may be of less interest.

Background: late in 2019, the first case of COVID-19 was detected in China, and the disease caused pandemic state worldwide. Up to now, many studies investigated the impact of comorbid diseases, especially diabetes mellitus on COVID-19 outcomes. Objectives: In this study, we aimed to assess the para-clinic characteristics of COVID-19 patients with or without diabetes mellitus to identify factors indicative of poor prognoses. Methods: In this prospective study, 153 in-patients with COVID-19 were followed up from 1 March to 19 April. Paraclinical information of these patients was gathered from their medical records. Afterward, the association between these factors among both diabetic and non-diabetic patients were assessed in the correlation analyses. Results: discharge and expiration of 77.1% and 22.9% of the study participants resulted in a 1063 person-day follow up for patients who discharged healthily, and 384 person-day follow up for expired patients. 41.8% of the participants had diabetes mellitus. Lymphocytopenia and Neutrolhilia prevalences increased during hospitalization; comparing with their initial prevalences. Thirty-seven patients got acute respiratory distress syndrome; of those, 35 died. The mean of the initial C reactive protein level was 42.49 and serum creatinine of 1.39 Conclusion: The study showed that higher initial neutrophil count, increasing neutrophil count more than 15000 and decreasing lymphocyte count below 1000 during hospitalization; development of acute respiratory distress syndrome and being intubated; initial C reactive protein and serum creatinine level were associated with higher mortality rates in COVID-19 victims.

Personality disorders (PDs) would be associated with an unhealthy lifestyle. To date, however, there have not been sufficient studies on the relationship between them. This study aimed to investigate the association between personality disorders and an unhealthy lifestyle by using an analytical cross-sectional study. We selected 1538 married women based on the multistage cluster sampling method. We used the Millon Clinical Multiaxial Inventory (MCMI) and Lifestyle Questionnaire (LSQ). Apart from descriptive statistics, a one-sample t-test, multivariate analysis, and structural equation modeling were used. Analysis of the data suggested that negativistic (β= -0.321), schizotypal (β= -0.285), schizoid (β= -0.159), borderline (β= -0.136), melancholic (β= -0.079) PDs had a significant association with an unhealthy lifestyle, respectively. Cluster A personality disorders were prone to an unhealthy lifestyle more than the other two clusters.

Introduction: Platelets activation and aggregation play a major role in thrombosis formation of coronary arteries in patients with Acute Coronary Syndrome (ACS) and is responsible for most ischemic complications during PCI. There is little information on the benefits and side effects of intracoronary and intravenous injection of Eptifibatide ,a potent antiplatelet agent; therefore, this study was performed with aim to compare coronary blood flow velocity by measurement of TIMI frame count in intravenous versus intracoronary bolus administration of Eptifibatide during PCI in ACS patients. Methods: This non-randomized clinical trial study was performed on 103 patients with acute coronary syndromes who referred to the cardiac emergency ward of Ghaem hospital, Mashhad University of Medical Sciences, and were candidates for urgent coronary angiography and PCI. 48 cases received intracoronary bolus Eptifibatide and 55 intravenous Eptifibatide. TIMI Frame Count and Corrected TIMI Frame Count were used to compare the effect of these two methods on coronary blood flow velocity. Data were analyzed by SPSS software (version 22). To compare the quantitative variables in the two groups, according to the distribution of variables, the T test was used if it was normal or the Mann-Whitney test was used if it was not normal. Chi-square test was also used to compare qualitative variables in two groups. P

The immunosuppressive state after organ transplantation leads to infectious complications responsible for high mortality rate. Fungal infections account for 5% of all infections in Renal Transplantation (RT) recipients. A 53-year-old man was admitted with acute loss of consciousness. He had a history of renal transplantation 1 month before admission. Brain CT showed acute hydrocephalus with periventricular edema. A right frontal external ventricular drain was inserted urgently. One day later the consciousness further decreased, and CT scan showed unilateral left lateral ventricle dilatation and a hyperdense mass at the septum pellucidum. The patient was operated via endoscopic trans-middle frontal sulcus approach. The interventricular septum was pushed contralaterally, and a very adherent mesh-like thick layer covered the surface of lateral ventricle and foramen of Moro. The Monro foramen was opened, and septostomy was done. The mass inside the septum was found posterior to the foramen, punctured, and partially removed. Histopathological study revealed aspergillus infection of the lateral ventricles. CNS Aspergillosis should be considered in the differential diagnosis of altered consciousness among immunocompromised hosts. This report further implies that isolated ventricular involvement by aspergillus infection may be considered as the cause of hydrocephalus in immunocompromised patients. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):461-463.

Gestational hypertension or pregnancy-induced hypertension is the emergence of hypertension in a pregnant women after 20 weeks of gestation. This study aimed to evaluate the job-related factors associated with pregnancy-induced hypertension. This cross-sectional study was conducted on 560 pregnant women who referred to the Nursing Clinic of Imam Khomeini Hospital in 2017; of all studied cases, 210 pregnant women with pregnancy-induced hypertension were selected as cases and 350 women without pregnancy-induced hypertension were selected as controls. The data on demographic characteristics, occupational characteristics, and ergonomic dangers were collected by the researchers. Finally, the relationship between job variables and the probability of developing hypertension in pregnant women was measured. The results of the logistic regression analysis showed that the variables of body mass index, fertility, shift work, and service works had a significant relationship with pregnancy-induced hypertension. Women with service work were 2.32 times more likely to develop hypertension than women with other types of jobs (P=0.013). The people who had a shift work were 2.28 times more likely to develop pregnancy-induced hypertension than those who did not have shift work. Based on the results of this study, there was no relationship between ergonomic risks and pregnancy-induced hypertension. It seems that due to the higher frequency of pregnancy-induced hypertension in highly demanding jobs, it is necessary to pay more attention to the assessment of related risk factors, such as psychological variables. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):430-434.

Gastrointestinal Stromal Tumors (GISTs) are the most common gastrointestinal mesenchymal tumors and in 80% of the cases are associated with KIT activating mutations. The incidence of GISTs is generally 10-20 cases per million population, which turn out to be malignant in 20-30% of cases. GISTs can be large and present with dysphagia, even though they are usually small and asymptomatic. A 67-year-old woman was referred to the hospital complaining of pain and burning in epigastric area and left flank; the patient had experienced a weight loss within one month before the admission. Primary investigations upon upper endoscopy revealed a submucosal mass in distal part of esophagus, and nodularity and erythema in stomach. But through more examinations by MDCT of Abdomen and Pelvis, a mass measuring 20*33 mm in cardiac and lesser curvature submucosa, without lymphadenopathy was reported, that could suggest GIST. This mass was excised with normal margins via wide local excision, bilayer cardiplasty and funduplication. The patient was hospitalized for 10 days after surgery, and was discharged with good general condition. In follow-up, there wasn’t any sign of dysphagia and dyspepsia within 24 months. In the patients suffering from GIST, the tumor location appears to have the most important role on deciding whether to perform local excision or not. Treatment of GISTs locating near gastroesophageal junction (GE junction) is still challenging. Using an appropriate therapeutic method is crucial in improving the patient’s quality of life. Therefore, wide local excision followed by bilayer cardiplasty and funduplication, could be considered as the appropriate therapeutic protocol in such same situations due to elimination of post total gastrectomy adverse effects and the tumor relapse.

This article is an Editorial and does not include an Abstract.

Matrix metalloproteinases (MMPs) are a group of zinc-dependent proteolytic enzymes that play a role in extracellular matrix (mainly collagen) degradation and remodeling. MMPs are not only causes of the increase rewarding effects of drugs, but also act as pro-addictive agents. In this research, 22 morphine and 20 methamphetamine-dependent patients included and their serum levels and activity of MMP2 and 9 were assessed by ELISA and gelatin zymography and compared with those of 23 healthy individuals as a control group. Our findings showed a significant increase in serum levels and activity of MMP-2 in opium and methamphetamine groups in comparison with the control group. Moreover, unlike MMP-2, serum levels and activity of MMP-9 in both case groups found to be decreased. This study showed that long-term abuse of opium and methamphetamine changes the activity and serum levels of MMP9 and MMP2. The effects of methamphetamines and opium are associated with an increase in extracellular dopamine levels in the brain, achieved by facilitating the release of dopamine from pre-synaptic nerves. Our findings showed that serum levels and activities of MMP-9 and MMP-2 could be considered as alternative valuable biomarkers from those investigated of pro-addictive or anti-addictive factors in dependent patients.

MYO7A is an unconventional myosin that is essential for ordinary hearing and vision; mutations in the MYO7A gene result in Usher syndrome type 1B and other disorders. In this manuscript, we reported a mutation (c.4705delA) in exon 35, causing the alteration of a Ser amino acid to Ala at codon 1569 (p.H2027del) located within the first FERMdomain of the human protein myosin VIIA. This mutation involved in the pathogenesis of hearing loss, congenital night blindness, muscular weakness, skin problem, and difficulty in keeping balance in the 13-year-old female. After checkup the patient’s DNA was extracted from peripheral blood and amplification was performed by PCR. Sequencing method was performed for identification of the mutation. The c.4705delA mutation in exon 35 was found in the patient in heterozygosis form; this means that her mother and father were carriers. This mutation is located on the tail of the myosinVIIA protein and is associated with several disorders.

Cystic fibrosis (CF) is a hereditary disease of mucous and sweat glands, which affects the respiratory and gastrointestinal systems. Herein, we describe a 3-month-old girl with a history of recurrent episodes of urinary tract infections that required hospitalization. She was referred to our center at the age of three months, with massive gastroesophageal variceal bleeding. In physical examination, she had clubbing, hepatosplenomegaly, and mild ascites. Laboratory studies revealed high serum levels of liver enzymes and low level of Albumin. As of suspicious to CF, sweat tests were performed twice which confirmed the diagnosis of CF. Gastrointestinal bleeding due to gastroesophageal varices is a rare complication of CF, which could result as a consequence of hepatobiliary involvement of disease. Early diagnosis of CF could prevent severe complications and even death in this group of patients.

Complications of hiatal hernia are potentially lethal, and surgical intervention is necessary. This matter is more important in cases that have ambiguous symptoms and are diagnosed with a delay. Such patients may experience life-threatening course and events. Accordingly, in this report, a 23-year-old male patient with unusual findings is presented. A 23-year-old male patient with acute dyspnea and fever was admitted in infectious disease ward with diagnosis of empyema according to chest radiography and CT-scan findings (Figures 1 and 2). On physical examinations the right lung sounds were normal, and the left lung sounds could not be heard. Then a gastrography was performed because of suspicion to hiatal hernia based on physical examination findings showing the presence of stomach in the thorax (Figure 3). In the surgery, the stomach and the transverse colon were released and reputed in the abdomen (Figure 4). The diaphragm was primarily repaired due to small defect, and the patient was discharged after 4-5 days with good general conditions. This case had a learning note that in the case of acute dyspnea with a positive history of stab wound to the chest, hiatal hernia should be considered as an important diagnosis and in these cases performing a gastrography would help physicians to make true and certain diagnosis and therapeutic decision.

Intraventricularhemorrhage (IVH) is one of thecommon morbidities among preterm neonates. In thepresentstudy, we set out to evaluate the efficacy of two prophylactic modalities (ibuprofen and indomethacin prophylaxis) for prevention of IVH in our local setting. A prospective study was carried out in Akbar-Abadi Hospital, Tehran-Iran (2013-2014). Ninety-six preterm neonates who cared in closed incubator entered the study. Neonates randomly assigned into 3 groups; control, oral indomethacin (0.2 mg/kg indomethacin daily for 3 days) and oral ibuprofen (10,5,5 mg/kg ibuprofen every 24 hours during 3) administration. For all subjects brain sonography examination was performed in 3rd day, first, 2nd week of life and when infants reached to 36 and 42 weeks of postmenstrual age. The IVH prevalence and the effectiveness of the drugs among groups were statistically assessed. Of all 93 subjects; 14 cases had IVH (15.1%). IVH was significantly more frequent in the controls than in other groups (P=0.049). Prophylactic treatment could significantly decrease the incidence of grade 3 or 4 IVH in experimental groups (P=0.008). There were no significant differences between the three experimental groups with respect to theincidence of GI bleeding, Oliguria, renal dysfunction or NEC (P>0.05). This study demonstrates that low-dose prophylactic indomethacin and ibuprofen are equally associated with a reduction of IVH without any significant side effects like renal dysfunction, GI bleeding or NEC.

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychological disorders of childhood. Methylphenidate is highly effective in the treatment of ADHD. This study aimed to determine the effectiveness of combined Parent behavioral management training (PBMT) and medication treatment (Methylphenidate) in reducing ADHD symptoms in 6-12-year-old children, using randomized sampling. A total of 50 children with ADHD were assigned into two groups: an experimental group of PBMT and a control group of medication treatment (Methylphenidate) without other interventions. Conners’ Parent Rating Scale (CPRS-48) was employed before and after interventions to determine the effects. Descriptive Statistics method (consisting of Mean and Standard deviation) and Statistical inference method, (including t-test and Levene's Test) were used for data analysis. Findings revealed that the combined behavioral intervention of PBMT and methylphenidate treatment is more effective in reduction of ADHD in children. The difference of means between pre-test and post-test of CPRS in the experimental group was equal to 10.77, and it was equal to 1.88 in the control group. In addition, PBMT was more effective in the case of younger parents (P

Gum tragacanth is a natural complex mixture of polysaccharides and alkaline minerals extracted from species of Astragalus plant, which is found widely in arid regions of the Middle East. In a pilot experimental study we examined the effects of its topical application on wound healing in ten albino adult male rats. Two similar parasagittal elliptical full-thickness wounds (control vs. test samples) were created on the dorsum of each animal. Test group samples were fully covered by a thin layer of gum tragacanth daily. The extent of wound healing was evaluated by planimetric analysis on multiple occasions during the 10-day study period. On the 7th day of the study, the percent of wound closure was significantly higher in gum tragacanth-treated specimens compared to the control samples (87%±2% vs. 70%±4%, P

Nanotechnology is a most promising field for generating new applications in medicine, although, only few nano products are currently in use for medical purposes. A most prominent nanoproduct is nanosilver. Nano-silver has biological properties which are significant for consumer products, food technology, textiles, and medical applications (e.g. wound care products, implantable medical devices, in diagnosis, drug delivery, and imaging). For their antibacterial activity, silver nanoparticles (Ag NPs) are largely used in various commercially available products. The use of nano-silver is becoming more and more widespread in medicine and related applications, and due to its increasing exposure, toxicological and environmental issues need to be raised. Cytotoxicity induced by silver nanoparticles (AgNPs) and the role that oxidative stress plays in this process were demonstrated in human hepatoma cells AgNPs agglomerated in the cytoplasm and nuclei of treated cells, and they induced intracellular oxidative stress. AgNP reduced ATP content of the cell and caused damage to mitochondria and increased production of reactive oxygen species (ROS) in a dose-dependent manner. Silymarin was known as a hepatoprotective agent that is used in the treatment of hepatic diseases including viral hepatitis, alcoholic liver diseases, Amanita mushroom poisoning, liver cirrhosis, toxic and drug-induced liver diseases. It promotes protein synthesis, helps in regenerating liver tissue, controls inflammation, enhances glucuronidation, and protects against glutathione depletion. Vitamin E is a well-known antioxidant and has hepatoprotective effect in liver diseases. In this study, we investigated the cytotoxic effects of Ag NPs on primary liver cells of mice. Cell viability (cytotoxicity) was examined with MTT assay after primary liver cells of mice exposure to AgNPs at 1, 10, 50, 100, 150, 200, 400 ppm for 24h. AgNPs caused a concentration- dependent decrease of cell viability (IC50 value = 121.7 ppm or µg/ml). Then the hepatoprotective effect of silymarin and vitamin E were experimented on silver nanoparticle toxicity on mice liver primary cell culture. The results showed that silymarin at 600 µg/ml and vitamin E at 2500 µmol/l have protective effects on silver nanoparticle toxicity on mice liver primary cell culture. Viability percentage of the primary liver cell of the mouse were exposed to silver nanoparticles at 121.7 ppm and co-treatment of silymarin, and vitamin E is more than viability percentage of the primary liver cell of the mouse were exposed to silver nanoparticles and silymarin or silver nanoparticles and vitamin E.

Wandering spleen is an uncommon entity in adults and has been described only rarely with sigmoid volvulus, that rarely affects children and adolescents. It is usually described in adults.Wandering spleen characterized by the abnormal location of the spleen, caused by incomplete fusion of the four primary splenic ligaments, allowing the spleen to be mobile within the abdomen.The wandering spleen can lead to torsion and subsequent splenic infarction or rupture. Clinical suspicion plus urgent investigation and intervention are important. We present a rare clinical case of acute abdomen due to torsion of wandering spleen and volvulus of sigmoid in a 14-year-old girl presented with painful periumbilical mass. Detorsion of sigmoid occurred while undergoing exploratory laparotomy and splenectomy was performed. The possibility of torsion and its complication like gastric, pancreas tail and colon volvulus should be kept in mind in the differential diagnosis of the acute abdomen to avoid serious complications.

Macintosh direct laryngoscope has been the most widely used device for tracheal intubation. GlideScope video laryngoscope (GVL) has been recently introduced as an alternative device for performing intubation; however, its validity in emergency settings has not been thoroughly evaluated. The aim of this study was to compare Macintosh direct laryngoscope versus GVL for emergency endotracheal intubation. This quasi-randomized clinical trial was performed on 97 patients referred to Imam Reza Hospital whom all needed emergency intubation in 2011. Patients were divided into two groups of the easy airway and difficult airway; intubation was performed for patients with direct laryngoscopy or GVL. Then, the patients were evaluated in terms of demographic characteristics, successful intubation rate and intubation time. Data was analyzed by SPSS software 16. There was no significant difference in demographic characteristics of the patients in both easy airway and difficult airway groups who intubated with direct laryngoscopy and GVL methods (P>0.05). In difficult airway group, a significant difference was found in successful intubation at the first attempt (60.9% vs. 87.5%; P=0.036), overall intubation time (32.7 ± 14.58 vs. 22.5±7.88; P

DNA sequencing is the most conclusive method for emm (M protein gene) typing of Streptococcus pyogenes. This method is not a feasible approach in developing countries where streptococcal infection is widespread among adults and children. Alternatively the PCR-RFLP has the potential for rapid screening of different types of S. pyogenes. To document the emm type distribution of S. pyogenes in a group of patients suffering from pharyngitis, the restriction fragment length polymorphism (RFLP) profile of 50 isolates were analyzed. By using Hae III+ HincII (double digestion) and Dde I restriction enzymes and based on RFLP, the profile patterns of the isolates were compared. The analysis of data identified 15 distinct RFLP patterns for Hae III+ Hinc II and 13 patterns for Dde I. They differ from each other by at least one band. Although the number of isolates was not sufficient to make any epidemiological conclusion, but the finding demonstrated that the S. pyogenes population among pateints was heterogeneous. Regarding the PCR method, we managed to improve the results by modification of CDC protocol in three different ways. This study was conducted in normal circumstances when pharyngitis was at the peak seasonal incident. However emm amplicon restriction digest analysis is a valuable tool for rapid analysis of S. pyogenes infection in more important situation like outbreaks and in selected type of study like consideration of nosocomial infection.

Hyperglycemia, in trauma patient, is commonly associated with a hyper metabolic stress response. Our objective is to determine the effects of hyperglycemia on the overall outcome of head trauma patients. In this descriptive study data were collected from head trauma patients' admitted to Intensive Care Unit (ICU) of Poursina University Hospital in a one-year period (Jan 2004-Jan 2005), retrospectively. All patients had stayed in the ICU for more than 48 hours post-injuries. They were divided into two groups according to their serum glucose levels at the time of admission (200mg/dl), age, gender and Injury Severity Score (ISS). Patients with diabetes mellitus were excluded .We determined the outcome according to duration of hospitalization and ICU stay as well as mortality rates. Variables were analyzed with t-test and chi square test. Out of 115 patients, 89.6% were men. About 36 % of patients had serum glucose levels ≥ 200 mg/dl over the study period and this group had significantly greater mortality rate but without necessarily longer ICU or hospital stay. In this study we have shown that admission hyperglycemia has significant effect on patient's mortality but it is still unclear whether it can be a cause for longer ICU/hospital stay."n© 2009 Tehran University of Medical Sciences. All rights reserved.

Concomitant coronary artery bypass surgery (CABG) in patients undergoing mitral valve replacement (MVR) has been shown to be an important risk factor for hospital mortality. We evaluated preoperative characteristics, postoperative complications, in-hospital mortality rate, and length of stay in hospital for patients undergoing concurrent CABG with MVR. Preoperative and postoperative clinical data from 175 patients undergoing concurrent CABG with MVR operation at Tehran Heart Center from 2002 through 2006 were collected and entered into a database. Information was obtained by clinical and case note review as well as detailed questionnaires to physicians and patients. Mean age of patients was 57.95 ± 10.54 years and 51.4% were male. Mean New York Heart Association (NYHA) score was 2.46 ± 0.84. Among studied patients, 18.3% and 2.9% underwent aortic and tricuspid valve replacement, respectively. In-hospital mortality was 6.9% and 96.0% of patients were hospitalized ≥14 days. History of congestive heart failure (P = 0.027) and postoperative brain stroke (P = 0.004) were independent predictors for in-hospital mortality. Exact considering of congestive heart failure and postoperative brain stroke related to in-hospital mortality in concurrent CABG with MVR operation are necessary.

In this study we evaluated the incidence and severity of obstructive sleep apnea and Obstructive sleep apnea syndrome in patients with thromboangiitis obliterans for reduction of crisis. In 40 patients with Buerger's disease daily sleepiness and risk of Obstructive sleep apnea were evaluated using the Epworth sleeping scale (ESS) and the Stop-Bang score. An Apnea-link device was used for evaluation of chest motion, peripheral oxygenation, and nasal airflow during night-time sleep. The apnea/hypopnea index (AHI) and respiratory tdisurbance index were used for Obstructive sleep apnea syndrome diagnosis. All subjects were cigarette smokers and 80% were opium addicted. The prevalence of Obstructive sleep apnea (AHI>5) was 80%, but incidence of Obstructive sleep apnea syndrome (AHI>5 + ESS≥10) was 5% (2/40). There was no association between duration or frequency of hospitalization and Obstructive sleep apnea syndrome (P=0.74 and 0.86, respectively). In addition, no correlation between ESS and Stop-Bang scores and AHI was observed (P=0.58 and 0.41, respectively). There was an inverse correlation between smoking rate and AHI (P=0.032, r = −0.48). We did not find an association between Buerger's disease and Obstructive sleep apnea syndrome. Although the AHI was high (80%) and daily sleepiness was low. The negative correlation of smoking with AHI and on the other hand daily napping in addiction may be caused by the absence of a clear relationship between Obstructive sleep apnea syndrome and Buerger's disease.

Zellweger syndrome (ZS) is a peroxisomal disorder with a multiple congenital anomalies, characterized by stereotypical facies, profound hypotonia, organ involvement including cerebral, retinal, hepatic, and renal. Herein, a 3-month-old female with ZS is presented who was referred because of increased liver enzymes (subclinical hepatitis), which was detected in work-up of her neck cyst, severe hypotonia, and abnormal facies. An increased concentration of very long chain fatty acid in lipid profile was detected. ZS should be considered in the list of differential diagnosis in infants with stereotypical phenotype, neurodevelopmental delay, and severe hypotonia in association with liver and other organs involvement.

Correlation between sacral ratio and bowel function as well as fecal continence has been well documented in patients with anorectal malformations (ARMs). One hundred and twenty children with ARMs were investigated in this study. Sacral ratio (SR) was measured from pelvic X-rays of patients. Among these, 52 patients (43%) had no pelvic X-ray and were excluded from this study. SR was measured by drawing three horizontal lines, through iliac crests (A), tip of coccyx (B) and inferior point of sacroiliac joints (C). The SR was determined by dividing the distance between lines B and C to the distance between lines A and B. In the normal and well developed children, the average ratio is ≥0.74. The SR was higher than 0.70 in 12 (17.7%) children and less than 0.69 in 56 children (82.3%). Among children with ARMs and abnormal SR, 38 cases (68%) had SR of 0.50-0.69; 12 cases (21.5%)had SR of 0.40-0.49 and 6 cases (10.5%) had SR of 0-0.39. In children with ARMs and normal SR, the fecal incontinence was observed in 2 cases (16%). In contrast, 16 cases (29%) with ARMs and abnormal SR had functional disturbance, either fecal incontinence or soiling (P < 0.12). When the patients had an absent sacrum, they had zero possibility for bowel control and frequently had major urinary problems. The sacral feature and SR appear to have a direct influence on the final functional outcome in ARMs. The abnormal SR < 0.7 correlates with poor bowel function. In patients with ARMs, sacral segment and SR are important factors in post operative bowel function disturbance.

Valproic acid is one of the main antiepileptic drugs. There is an increased risk of neural tube defects and axial skeletal malformations among infants born to women who had received valproic acid. There is a hypothesis that one biochemical abnormality underlying the teratogenicity of valproic acid is a drug-induced reduction in maternal plasma zinc .In the present experimental study mated rats were divided into four groups of 8 animals each [control, valproic acid (VPA), valproic acid + zinc (VPA+ Zn) and zinc (Zn) groups]. The VPA group received 300 mg/kg valproic acid, daily.The control group received an equal volume of 0.9% NaCl. The VPA+ Zn group received 300 mg/kg VPA and 30 mg/kg zinc sulfate and the Zn group received 30 mg/kg zinc sulfate, daily. Valproic acid, NaCl, and Zn were administered intraperitonealy from day 6 through day 15 of gestation. On day 16, six rats of each group were authanized and the other rats were scarified on gestational day (GD) 20 to evaluate the skeletal system among the elder fetuses. Blood was drawn to determine plasma zinc. The data were analyzed by using analysis of variance (Kruskal -Wallis test). The zinc concentration in the plasma of rats treated with valproic acid was significantly lower than those of the other groups on 16 GD (P=0.004). Some anomalies such as hydrocephaly, spina bifida, hemivertebrate, and rib malformations were seen in VPA treated group. Low percentage of rib anomalies and spina bifida were observed in the VPA+ Zn treated group while no skeletal anomalies were seen in Zn and control groups. The results from the present experiment support the hypothesis that one of the biochemical abnormalities causing the teratogenicity of VPA is a drug–induced maternal plasma zinc deficiency, and possibly, it may also result in reduction of embryonic Zn.

Problematic use of the Internet by children and adolescents is a newly emerging disorder that has alerted health authorities throughout the world. In Iran, despite the very high speed rate of Internet spread, there is not enough data on the rate of Internet addiction among the adolescents. This study is the first nationwide study that addresses this issue. Overall 4500 students of high school or pre-college schools were recruited from 13/31 provinces of Iran by a cluster sampling method and 4342 (96%) participated. Two self-rated questionnaires (one demographics and one Young's Internet addiction scale) were filled b the participants. Data were analyzed by SPSS software. 962 (22.2%) of the study participants were labeled as having "internet addiction." Males were significantly more likely to be an internet addict (P

Wegener’s Granulomatosis is a necrotizing granulomatous vasculitis involving small and medium sized vessels. The syndrome is classically defined as having involvement of kidney, lungs and upper respiratory tract (i.e. sinuses). Wegener’s Granulomatosis may be present in other autoimmune or inflammatory diseases, particulary systemic lupus erythematosis (SLE), but most frequently has been associated with polyarteritis and glumerulonephritis.We present a case of wegener’s Granulomatosis (WG) in a middle age lady with Rheumatiod Arthritis (RA); and discuss the implications of these two conditions co-existing in one patient. As for as we are aware, through medline and interent research, this is probably the fourth case with such as association of WG and RA and the fist one in Iran.Presentation of new uncontrollable sing and symptoms, in a previously well controlled RA patient, might suggest a new overlapping syndrome like Wegener’s Granulomatosis besides to flare up of previous disease as differential diagnosis