Search

Ischemic stroke is a common disease worldwide and leads to a significant rate of mortality and disability in patients every year, and imposes high costs on the health care system. The aim of this study was to evaluate the efficacy of the invasive method of mechanical thrombectomy for rapid intervention in ischemic stroke patients with large vessel involvement. Patients suspected of having a stroke, who were referred to Imam Hossein Hospital, were examined, and the diagnosis of stroke was confirmed. In the next stage, patients' MRS index was measured and the possibility of emergency thrombectomy was evaluated in patients. Patients who underwent thrombectomy were considered as the case group and the other patients were contemplated as the control group; then, the cases of the two groups were evaluated and compared. The mean age of patients was 66.63 ± 12.26 years. the use of emergency thrombectomy in the study group significantly reduced the MRS index of patients after 90 days (p

Background: Migraine is a common disease with neurovascular nature, which is commonly prevalent in the general population. Due to the significant prevalence of migraine and its long-term complications, it is necessary to pay attention to its exacerbating factors. Therefore, the aim of this study was to evaluate the frequency distribution of dyslipidemia in patients with migraine compared with control group. Materials and Methods: This is a case–control study, in which 50 patients with migraine (with aura and without aura) were confirmed by the criteria of International Headache Society. Migraineurs and control group (n = 50) were selected from among patients who referred to the Neurology Clinic of Imam Hossein Hospital. The levels of total cholesterol, triglyceride, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol were measured in both the groups. SPSS software (version 21) was used to analyze the data. Results: The findings showed that among migraineurs, 21 patients (42%) revealed high levels of cholesterol and 22 revealed high levels of LDL (44%); whereas among subjects without migraine, 12 subjects (24%) exhibited high levels of cholesterol and 12 (24%) high levels of LDL, where a significant correlation between the two groups was achieved. Conclusion: The present results showed that migraine is associated with higher level of cholesterol and LDL when compared with the control group, where a significant relationship was found.

Seepage of water from beneath of built structures on permeable soils causes uplift force along the contact of structure with foundation. This uplift force reduces hydraulic structure stability. Typically, these instabilities occur due to under-pressure development (uplift force), gradual inner degradation of foundation material (piping) or sand boil phenomenon. Thus, it seems necessary to calculate the pressure applied to the contact surface of the dam. One method for preventing piping phenomenon, reduction in exit gradient as well as decrease of uplift force beneath diversion dams includes implementation of weep hole. This study aims to study the effect of radius, depth and location of pipe drains under stilling basin upon how much uplift force decreases. The benefit of this study in agricultural field for soil and water engineers is to have a safe design of lined canals, weirs or diversion dams. To do this, numerical simulation of Tabriz diversion dam with Geo-Studio software was carried out. Results showed that application of drain pipe under the structure reduced uplift force respect to without drain under the structure. Increasing of drain radius; caused reduction of uplift pressure more but increased of seepage flow slightly. Installation of drain in upper part of stilling basin had a tendency to decrease uplift pressure more. Existence of drain near the stilling basin bottom caused in more reducing of uplift pressure than of installation of it in deeper depth.

Introduction: Timely diagnosis and treatment of post-traumatic elevated intracranial pressure (EICP) could be reduced morbidity and mortality, and improved patients’ outcome. This study is trying to evaluate the diagnostic accuracy of sonographic optic nerve sheath diameter (ONSD) in detection of EICP. Methods: Sonographic ONSD of patients with head trauma or cerebrovascular accident suspicious for EICP were evaluated by a trained chief resident of emergency medicine, who was blind to the clinical and brain computed tomography scan (BCT) findings of patients. Immediately after ultrasonography, BCT was performed and reported by an expert radiologist without awareness from other results of the patients. Finally, ultrasonographic and BCT findings regarding EICP were compared. To evaluate the ability of sonographic ONSD in predicting the BCT findings and obtain best cut-off level, receiver operating characteristic (ROC) curve were used. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of sonographic ONSD in determining of EICP was calculated. P < 0.05 was considered as statistically significant. Results: There were 222 patients (65.3% male), with mean age of 42.2±19.5 years (range: 16-90 years). BCT showed signs of EICP, in 28 cases (12.6%). The means of the ONSD in the patients with EICP and normal ICP were 5.5 ± 0.56 and 3.93 ± 0.53 mm, respectively (P

استروک بخش قابل توجهی از علل مراجعات به بخش اورژانس را شامل می شود. این عارضه در صورت تشخیص سریع و مداخله درمانی مناسب می تواند با پیامد مطلوبی همراه باشد، ولی در صورت تاخیر در درمان با هزینه های فراوانی برای فرد، خانواده وی و همچنین سیستم بهداشت جامعه همراه خواهد بود. بنابراین تشخیص به موقع قدم اول و اساسی در برخورد با این بیماران در بخش اورژانس محسوب می شود و بعد از آن انتخاب روش درمانی مناسب در الویت خواهد بود. امروزه روش های درمانی مختلفی در برخورد با این بیماران، از اقدامات حمایتی تا ترومبولیتیک تراپی و مداخلات اندوواسکولار، در دسترس می باشند و یکی از سوالات اصلی در درمان سکته مغزی حاد در بخش اورژانس این است که کدام بیمار برای دریافت کدام درمان مناسب است؟ مداخلات اندوواسکولار روش درمانی نسبتا جدیدی است که می تواند لخته را از داخل عروق مغزی بیرون آورده و در مطالعات مختلف نشان داده شده است که یکی از موثرترین مداخلات درمانی در برخورد با سکته مغزی می باشد. مطالعات مختلفی در حمایت از فواید آن در سالهای اخیر منتشر شده اند که باعث تغییر گایدلاین های درمانی بیماران دچار استروک در امریکا و اروپا شده و نقش مداخلات اندوواسکولار پررنگ تر گردیده است. البته این مداخله درمان، روشی تهاجمی به شمار می رود که می تواند با عوارضی نیز همراه باشد و بنابراین برای دستیابی به حداکثر موفقیت در درمان با این روش باید تلاش شود تا بیمارانی که با احتمال بیشتری از این مداخله سود می برند به این منظور انتخاب شوند. گفته می شود اگر دلیل سکته مغزی انسداد یک رگ بزرگ باشد بهترین کاندید برای اینترونشن و درمان آندوواسکولار می باشد. در این شرایط مهمترین وظیفه پزشک بخش اورژانس، شناسایی عروق مسدود شده است. مهمترین روش تشخیصی که گایدلاینهای موجود در این زمینه پیشنهاد می دهند انجام سی تی آنژیوگرافی می باشد که وضعیت عروق بزرگ را از ابتدای شریان آئورت تا کوچکترین عروق داخل مغز نشان می دهد. بعضی از مراکز درمانی این اقدام را فقط برای موارد با احتمال سکته های وسیع مغزی انجام می دهند ولی پیشنهاد می شود که هم سی تی اسکن مغزی و هم سی تی آنژیوگرافی برای همه موارد استروک حتی موارد خفیف نیز انجام گیرد؛ چرا که ممکن است این بیماران در معرض بروز یک سکته وسیع قریب الوقوع باشند. در بعضی از مراکز تکنیک CT Perfusion را به دوگانه سی تی اسکن مغزی و سی تی آنژیوگرافی (CTA) اضافه می کنند. متاسفانه این تکنیک تقریبا در اغلب مراکز کشور ایران در دسترس نیست. ولی در مراکز پیشرفته دنیا در همان مقطعی که سی تی اسکن مغزی انجام می شود قابل انجام بوده و می تواند وضعیت دقیقی از حجم درگیری بافت مغزی و حتی برگشت پذیری بافت درگیر در استروک را نشان دهد. عروق مناسب برای ترومبکتومی شامل شاخه شریان مغزی میانی (MCA) کاروتید اینتراکرانیال، خصوصا قسمت افقی آن (M1) و در بعضی موارد بعد از دو شاخه شدن کاروتید (M2) می باشد. همچنین با پیشرفت های صورت گرفته، ترومبکتومی کاروتید اکستراکرانیال نیز امروزه قابل انجام است. ولی تقریبا هیچگاه شریان های مغزی قدامی (ACA) و شریان مغزی خلفی (PCA) در شرایط فعلی کاندید اینترونشن نیستند. مطالعات گسترده ای شامل IMS-3، MR-CLEN، ESCAPE، EXTEND-IA، SWIFTPRIME و PREVASCAT با هدف انتخاب عروق مناسب و کاندیداهای مداخله اندوواسکولار انجام گرفته اند که تقریبا هیچ یک امکان انجام ترومبکتومی شریان بازیلر را در مطالعه مربوطه بررسی نکرده اند. ولی مطالعه ای تحت عنوانBASICS در این زمین انجام گرفته است که در مجموع حتی زمان انجام ترومبکتومی برای شریان بازیلر و پروگنوز آن حتی بهتر از سایر عروق گزارش کرده است و بیشتر نورولوژیست های اینترونشنیست و استروک نسبت به انجام آن دید مثبتی پیدا کرده اند. در مجموع مطالعات فوق حدود 1700 بیمار تحت ترومبکتومی اورژانس قرار گرفتند که میزان موفقیت بدون انجام CTA حدود 40% و در صورت آگاهی از رگ درگیر در CTA میزان موفقیت حدود 70% گزارش شده است. در خصوص تحلیل شرایطی که امکانCTA وجود ندارد باید یادآوری شود که بعد از فراهم شدن امکان ترومبولیتیک تراپی، استفاده از ترومبکتومی حتی بدون اطلاع از وضعیت عروق درگیر با تکنیکی مانند CTA میزان موفقیت درمان بیماران دچار استروک از حدود 23% به حداقل40% افزایش یافته است. بنابراین به نظر می رسد که فراهم آوری امکانات انجام CTA قبل از ترومبکتومی اورژانسی باید حداقل در تمام بخش های اورژانس بیمارستانهای مرجع کشور مورد حمایت جدی قرار گیرد. همچنین از امکانات فعلی موجود نیز در کشور مثل دستگاه سی تی اسکن و بخشهای نورولوژی و آنژیوگرافی و متخصصین مربوطه به شکل مطلوبی بهره برداری شود. چنانچه بتوان دستگاه سی تی اسکن را به شکلی برنامه ریزی نمود که همزمان با انجام سی تی اسکن مغزی، همزمان سی تی آنژیوگرافی را هم انجام دهد، در نتیجه انتخاب بیمار کاندید انجام ترومبکتومی به نحوی مناسب تر انجام خواهد گرفت و با این تمهیدات ممکن است میزان بهبودی بیمار دچار سکته مغزی و در نتیجه رهایی از یک فلج و مشکل طولانی و ناتوان کننده را به 70% ارتقا داد.

Stroke makes up a significant part of causes for emergency department (ED) visits. This complication can be accompanied by a desirable outcome in case of rapid diagnosis and proper treatment intervention. However, in case of delay in treatment, it will bring about many costs for the individual, his or her family and the health care system. Therefore, timely diagnosis is the first and major step in managing these patients in ED and after that, choosing the proper treatment method is the priority. Currently, various treatment methods are available for managing these patients, from palliative care to thrombolytic therapy and endovascular interventions and one of the major questions in treatment of acute brain stroke in ED is which patient is suitable for receiving which treatment? Endovascular intervention is a relatively new treatment method that can extract the blood clot from the brain vessels and various studies have shown that it is one of the most effective treatment interventions in management of brain stroke. Various studies have been published in favor of its benefits in recent years, which have resulted in changes in treatment guidelines of stroke patients in America and Europe and highlighting the role of endovascular interventions in them. However, this interventional treatment is considered an invasive method that can be accompanied by side effects and thus, for reaching maximum success in this method, efforts should be made to select patients who have a higher probably to benefit from this intervention. It has been said that if obstruction of a big vessel is the reason for brain stroke, the patient is the best candidate for intervention and endovascular treatment. In this situation, the most important duty of the ED physician is to identify the obstructed arteries. The most important diagnostic method that existing guidelines suggest in this regard is performing computed tomography (CT) angiography that shows the status of big arteries from the beginning of Aorta to the smallest arteries inside the brain. Some treatment centers do this only for cases with the probability of extensive brain stroke, but it is suggested to perform both brain CT scan and CT angiography for all stroke cases including mild cases; because these patients might be at risk of an upcoming extensive stroke. Some centers add CT perfusion technique to the brain CT scan and CT angiography (CTA) duo. Unfortunately, this technique is not available in most centers in Iran. However, in the advanced centers around the world it can be performed at the same time as brain CT scan and can show an accurate picture regarding the extent of the brain tissue involved and even the reversibility of the tissue involved in the stroke. Proper arteries for thrombectomy are the middle cerebral artery (MCA) branch of intracranial carotid, especially its horizontal part (M1) and in some cases after branching of the carotid (M2). In addition, with the advances made, extracranial carotid thrombectomy can also be done today. But anterior and posterior cerebral arteries (ACA and PCA) are almost never intervention candidates. Extensive studies including IMS-3, MR-CLEN, ESCAPE, EXTEND-IA, SWIFTPRIME, and PREVASCAT have been done with the aim of selecting the proper vessels and candidates of endovascular interventions, almost none of which have evaluated the possibility of performing thrombectomy of basilar artery. However, a study called BASICS has been done in this regard that has even reported the time of thrombectomy for basilar artery and its prognosis even better than the other arteries and most interventionist and stroke neurologists have gained a positive view to performing it. Overall, in the above-mentioned studies about 1700 patients underwent emergency thrombectomy and the success rate without performing CTA was about 40% and if aware of the artery involved via CTA, the success rate has been reported to be about 70%. Regarding processing the situations in which CTA cannot be performed it should be noted that after enabling thrombolytic therapy, using thrombectomy even without knowing the status of the arteries involved with techniques such as CTA, the success rate of treating patients with stroke increased from about 23% to at least 40%. Therefore, it seems that preparing the equipment for performing CTA before emergency thrombectomy should be seriously supported, at least in major hospitals of Iran. In addition, the presently available equipment such as CT scan device and neurology and angiography departments and the specialists in these fields should be employed effectively. If the CT scan device can be programmed in a way that when performing brain CT scan, CT angiography can also be performed simultaneously, the candidate patients for undergoing thrombectomy can be selected more properly and by using these solutions the rate of improvement in patients with brain stroke and thus, being relieved from paralysis and long-term problems might increase to 70%.

Introduction: Timely diagnosis and treatment of post traumatic, elevated intracranial pressure (EICP), could reduce morbidity and mortality, as well as improve patients’ outcome. This study is trying to evaluate the diagnostic accuracy of sonographic optic nerve sheath diameter (ONSD) in detection of EICP. Methods: Sonographic ONSD of patients with head trauma or cerebrovascular accident suspicious for EICP were evaluated by a trained chief resident of emergency medicine, who was blind to the clinical and brain computed tomography scan (BCT) findings of patients. Immediately after ultrasonography, BCT was performed and reported by an expert radiologist without awareness from other results of the patients. Finally, ultrasonographic and BCT findings regarding EICP were compared. To evaluate the ability of sonographic ONSD in predicting the BCT findings and obtain best cut-off level, receiver operating characteristic (ROC) curve were used. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of sonographic ONSD in determining of EICP was calculated. P < 0.05 was considered to be statistically significant. Results: There were 222 patients (65.3% male), with mean age of 42.2±19.5 years (range: 16-90 years). BCT showed signs of EICP, in 28 cases (12.6%). The means of the ONSD in the patients with EICP and normal ICP were 5.5 ± 0.56 and 3.93 ± 0.53 mm, respectively (PConclusion: Sonographic diameter of optic nerve sheath could be considered as an available, accurate, and noninvasive screening tool in determining the elevated intracranial pressure in cases with head trauma or cerebrovascular accident.

Background and Objectives: Morning report is a long-standing method that its promotion has an important role in medical education. The present research was done with the aim of studying the structure of morning report sessions of the wards of type one educational hospitals and comparison with announced standards of the Ministry of Health and Medical Education.Methods: This study was performed in five main educational hospitals included wards of Obstetrics and Gynecology, Internal Medicine, Pediatrics, Surgery, Psychiatry, Neurology, Emergency Medicine, Orthopedic Surgery, Infectious Disease, and Intensive Care Unit wards were evaluated 8 approved standards 3 times for each one, and totally 73 cases. The studied standards consisted of the time of patient introduction, number of patients, duration of session, appropriateness of the session place, the venue, near ward place, Availability of teaching aids, number of sessions per week and a simple reception during the session.Results: Mean time for introduction of each patient was 4.4 minutes, mean number of introduced patients was 3.2 cases, mean duration of the session was 47.4 minutes, presentation in the ward (61.6%), appropriateness of place capacity 95.9%, and mean number of sessions per week was 4.2. No simple reception was seen in any sessions. Abundance of teaching aids was 79.5% for physical examination bed Negatoscope 89%, white board 93.2%, computer 87.7%, printer 19.2%, internet 17.8%, and video projector 83.6%.Conclusion: The results of this study showed that the general structure of morning report in the studied university was appropriate and fulfilled 6 out of 8 Standards. Also, the simple reception was not standard, and the standard of teaching aids was appropriate for 5 out of 7, and printer and internet were inappropriate.

Introduction: The role of diabetes mellitus in the pathogenesis of intracerebral hemorrhage (ICH) is controversial. Underlying comorbidities such as diabetes mellitus may increase the risk of intracerebral hemorrhage. In this study, we sought to assess the role of diabetes mellitus in the occurrence of intracerebral hemorrhage. Materials and Methods: In this case-control study, the prevalence of diabetes mellitus was evaluated in 120 patients presenting with intracerebral hemorrhage and in a control group of 135 patients with low back pain. All patients were treated at the Departments of Neurology and Neurosurgery, Shohadaye Tajrish University Hospital, Tehran, Iran between 2008 and 2012. T-test was applied for analysing the quantitative variables and chi-square and Fisher’s exact tests were used to analyse qualitative variables. Results: The mean age was 67.5±12.7 y in patients with intracerebral hemorrhage and 70.5±12.6 y in the control group (p=0.201). Diabetes mellitus was found in 39 patients with intracerebral hemorrhage (33.1%) and 30 (22.2%) control subjects (p=0.054). The prevalence of diabetes mellitus in patients younger than 60 y was 7.4% in the control group and 27.8% in the case group (p=0.042). Conclusion: In our study, no significant relationship was found between diabetes mellitus and intracerebral hemorrhage (except in patients younger than 60 years) and diabetes mellitus did not cause bleeding in certain brain areas. However, more studies are required on the correlation of diabetes mellitus and intracerebral hemorrhage in the same population to reach a definite conclusion.