The Value of Serum NR2 Antibody in Prediction of Post-Cardiopulmonary Resuscitation Survival

Introduction: N-methyl-D-aspartate receptor subunits antibody (NR2-ab) is a sensitive marker of ischemic brain damage in clinical circumstances, such as cerebrovascular accidents. We aimed to assess the value of serum NR2-ab in predicting the post-cardiopulmonary resuscitation (CPR) survival. Methods: In this cohort study, we examined serum NR2-ab levels 1 hour after the return of spontaneous circulation (ROSC) in 49 successfully resuscitated patients. Patients with traumatic or asphyxic arrests, prior neurological insults, or major medical illnesses were excluded. Participants were followed until death or hospital discharge. Demographic data, coronary artery disease risk factors, time before initiation of CPR, and CPR duration were documented.  In addition, Glasgow coma scale (GCS), blood pressure, and survival status of patients were recorded at 1, 6, 24, and 72 hour(s) after ROSC. Descriptive analyses were performed, and the Cox proportional hazard model was applied to assess if NR2-ab level is an independent predictive factor of survival. Results: 49 successfully resuscitated patients were evaluated; 27 (55%) survived to hospital discharge, 4 (8.1%) were in vegetative state, 10 (20.4%) were physically disabled, and 13 (26.5%) were physically functional. Within 72 hours of ROSC all of the 12 NR2-ab positive patients died. In contrast, 31 (84%) of the NR2-ab negative patients survived. Sensitivity, specificity, positive and negative likelihood ratios of NR2-ab in prediction of survival were 54.5% (95%CI=32.7%-74.9%), 100% (95%CI=84.5%-100%), infinite, and 45.5% (95%CI=28.8%-71.8%), respectively. Subsequent analysis showed that both NR2-ab status and GCS were independent risk factors of death. Conclusions: A positive NR2-ab serum test 1 hour after ROSC correlated with lower 72-hour survival. Further studies are required to validate this finding and demonstrate the value of a quantitative NR2-ab assay and its optimal time of measurement

Diagnostic accuracy of frozen section in Central nervous system lesions, a 10-year study.

How to Cite This Article: Khoddami M, Akbarzadeh A, Mordai A, Bidari Zerehpoush F, Alipour H, Samadzadeh S, Alipour B.Diagnostic Accuracy of Frozen Section of Central Nervous System Lesions: A 10-Year Study. Iran J Child Neurol. 2015 Winter;9(1):25-30. AbstractObjectiveDefinitive diagnosis of the central nervous system (CNS) lesions is unknown prior to histopathological examination. To determine the method and the endpoint for surgery, intraoperative evaluation of the lesion helps the surgeon.In this study, the diagnostic accuracy and pitfalls of using frozen section (FS) ofCNS lesions is determined.Materials & MethodsIn this retrospective study, we analyzed the results of FS and permanent diagnoses of all CNS lesions by reviewing reports from 3 general hospitals between March 2001 and March 2011.Results273 cases were reviewed and patients with an age range from 3 to 77 years of age were considered. 166 (60.4%) had complete concordance between FS and permanent section diagnosis, 83 (30.2%) had partial concordance, and 24 cases (9.5%) were discordant. Considering the concordant and partially concordant cases, the accuracy rate was 99.5%, sensitivity was 91.4%, specificity was 99.7%, and positive and negative predictive values were 88.4% and 99.8%, respectively.ConclusionOur results show high sensitivity and specificity of FS diagnosis in the evaluation of CNS lesions. A Kappa agreement score of 0.88 shows high concordance for FS results with permanent section. Pathologist’s misinterpretation, small biopsy samples (not representative of the entire tumor), suboptimal slides, and inadequate information about tumor location and radiologic findings appear to be the major causes for these discrepancies indicated from our study. ReferencesTaxy JB, Anthony G. Biopsy interpretation: the frozen section. 1st ed. China: Lippincott Williams & Wilkins; 2010. P.301-3.Somerset HL, Kleinschmidt-DeMasters BK. Approach to the intraoperative consultation for neurosurgical specimens. Adv Anat Pathol 2011; 18:446-9. doi: 10.1097/ PAP.0b013e3182169934.Regragui A, Amarti Riffi A, Maher M, El Khamlichi A, Saidi A. Accuracy of Intraoperative diagnosis in central nervous system tumors: report of 1315 cases. Neurochirurgie 2003; 49(2-3 Pt 1):67-72.Plesec TP, Prayson RA. Frozen section discrepancy in the evaluation of central nervous system tumors. Arch Pathol Lab Med 2007; 131:1532-40.Savargaonkar P, Farmer PM. Utility of intra-operative consultations for the diagnosis of central nervous system lesions. Ann Clin Lab Sci 2001; 31:133-9.Talan-Hraniloviæ J, Vuèiæ M, Ulamec M, Belicza M. Intraoperative frozen section analysis in of the central nervous system and pituitary gland pathology. Acta Clin Croat 2005; 44:217-21.Roessler K, Dietrich W, Kitz K. High diagnostic accuracy of cytologic smears of central nervous system tumors. A 15-year experience based on 4,172 patients. Acta Cytol 2002; 46:667-74.Ud Din N, Memon A, Idress R, Ahmad Z, Hasan S. Central Nervous System Lesions: Correlation of  Intraoperative and Final Diagnoses, Six Year Experience at a Referral Centre in a Developing Country, Pakistan. Asian Pac J Cancer Prev 2011; 12:1435-7.Burger PC, Scheithauer BW. Tumors of the Central Nervous System. In: AFIP Atlas of Tumor Pathology Series 4. Washington DC: American Registry of Pathology; 2007.Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO Classification of Tumours of the Central Nervous System. Acta Neuropathol. 2007; 114: 97–109. doi: 10.1007/s00401- 007-0243-

Hybrid-Controlled Neurofuzzy Networks Analysis Resulting in Genetic Regulatory Networks Reconstruction

Reverse engineering of gene regulatory networks (GRNs) is the process of estimating genetic interactions of a cellular system from gene expression data. In this paper, we propose a novel hybrid systematic algorithm based on neurofuzzy network for reconstructing GRNs from observational gene expression data when only a medium-small number of measurements are available. The approach uses fuzzy logic to transform gene expression values into qualitative descriptors that can be evaluated by using a set of defined rules. The algorithm uses neurofuzzy network to model genes effects on other genes followed by four stages of decision making to extract gene interactions. One of the main features of the proposed algorithm is that an optimal number of fuzzy rules can be easily and rapidly extracted without overparameterizing. Data analysis and simulation are conducted on microarray expression profiles of S. cerevisiae cell cycle and demonstrate that the proposed algorithm not only selects the patterns of the time series gene expression data accurately, but also provides models with better reconstruction accuracy when compared with four published algorithms: DBNs, VBEM, time delay ARACNE, and PF subjected to LASSO. The accuracy of the proposed approach is evaluated in terms of recall and F-score for the network reconstruction task

طب اورژانس؛ گذری در گذشته و نگاهی به آینده

Before establishment of emergency medicine specialty around the world, emergency departments (ED) were deemed unimportant and long waiting time and misdiagnosis were common. However, the need for specialty in this regard was sensed during the 1960s and 1970s and it was established in the 80s and 90s. In Iran, establishment of emergency medicine in 2001 has revolutionized patient care. Although emergency physicians face some challenges, the most important thing is carrying out their responsibilities. An emergency physician should be responsible and reliable and people have a high expectation of them. In this letter, authors tried to briefly review the history of emergency medicine establishment in Iran and look into the future by discussing some challenges of this specialty. قبل از استقرار و توسعه رشته تخصصی طب اورژانس در جهان،‌ وضعیت ارائه خدمات در بخش های اورژانس بیمارستانی به شکلی دیگر بود. در آمریکا قبل از ایجاد بخش اورژانس به شکل تخصصی، آن را یک مکان دست دوم و بی اهمیت در نظر می گرفتند. جایی که در آن صف های طولانی انتظار و تشخیص های اشتباه امری طبیعی محسوب می شد. معمولاً این بخش توسط پرستاران اداره می شد و آنها بر اساس برآورد اولیه  شان از پزشکان درخواست کمک می کردند. تیم پزشکی اورژانس از یک بیمارستان تا بیمارستان دیگر تفاوت فاحش داشت. در بیمارستان های غیر دانشگاهی، معمولاً پزشکان اورژانس کسانی بودند که تازه شروع به کار کرده و یا سال-های آخر کار خود را می گذراندند و در بیمارستان های دانشگاهی بخش اورژانس منطقه كارورزان با کشیک های 24 ساعته  در نظر گرفته می شد و رزیدنت های سال های بالاتر در رشته های مختلف تخصصی تا حد امکان از بخش اورژانس دوری می کردند

Emergency Medicine; a Review of the Past and a Look to the Future

Before establishment of emergency medicine specialty around the world, emergency departments (ED) were deemed unimportant and long waiting time and misdiagnosis were common. However, the need for specialty in this regard was sensed during the 1960s and 1970s and it was established in the 80s and 90s. In Iran, establishment of emergency medicine in 2001 has revolutionized patient care. Although emergency physicians face some challenges, the most important thing is carrying out their responsibilities. An emergency physician should be responsible and reliable and people have a high expectation of them. In this letter, authors tried to briefly review the history of emergency medicine establishment in Iran and look into the future by discussing some challenges of this specialty

Incidence and risk factors for infantile colic in Iranian infants

AIM: To assess the incidence of infantile colic and its association with variable predictors in infants born in a community maternity hospital, Tehran, Iran. METHODS: In this prospective cohort study, mothers who gave birth to live newborns between February 21 and March 20, 2003 at the hospital were invited to join to the study. For every infant-mother dyad data were collected on infant gender, type of delivery, gestational age at birth, birth weight, birth order, and mother’s reproductive history. Then mothers were given a diary to document the duration of crying/fussiness behaviors of their infants for the next 12 wk. We scheduled home visits at the time the infants were 3 mo of age to collect the completed diaries and obtain additional information on infants’ nutritional sources and identify if medications were used for colic relief. Cases of colic were identified by applying Wessel criteria to recorded data. Chi-square and Mann-whitney U tests were used to compare proportions for non-parametric and parametric variables, respectively. RESULTS: From 413 infants, follow-up was completed for 321 infants. In total, 65 infants (20.24%) satisfied the Wessel criteria for infantile colic. No statistical significance was found between colicky and non-colicky infants according to gender, gestational age at birth, birth weight, type of delivery, and, infant’s feeding pattern. However, firstborn infants had higher rate for developing colic (P = 0.03). CONCLUSION: Colic incidence was 20% in this population of Iranian infants. Except for birth order status, no other variable was significantly associated with infantile colic

Serum Cortisol Levels as a Predictor of Neurologic Survival inSuccessfully Resuscitated Victims of Cardiopulmonary Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is the most stressful lifetime event for the victims and an important issue for the emergency physicians. The status of the hypothalamic pituitary- adrenal axis (HPA) function in successfully resuscitated victims of cardiopulmonary arrest has been recently of an interest for the researchers. Methods: In a prospective cohort study, 50 successfully resuscitated OHCA victims’ serum cortisol levels were measured 5 minutes and 1 hour after return of spontaneous circulation (ROSC). The data were analyzed comparing the one-week neurologic survival. Results: Fifty blood samples were obtained for serum cortisol levels after 5 minutes of ROSC. Fourteen patients (28%) pronounced death during one hour after CPR. Blood sample from living 36 patients after one hour post-CPR were obtained for second cortisol assay. Eleven patients (22%) were neurologically survived after one week. Seven patients (14%) were discharged finally from hospital with good neurologic recovery. The serum cortisol levels in both the neurologically surviving and the non-surviving after 5 minutes of ROSC patients were 63.4 ±13.6 and 43.2±25.5(microg/ml), (mean±S.D., respectively) and after 1 hour of ROSC patients’ serum cortisol levels were 64.9±13.1 and 47.3±27.1(microg/ml), (mean±S.D., respectively). The difference was significantly higher in neurologically survived group in both 5 minutes and 1 hour after ROSC (P= 0.015 and 0.013 respectively). Conclusion: serum cortisol levels after 5 minutes and one hour of ROSC in victims of cardiopulmonary arrest are significantly higher in neurologically survived than non-survived patients

Effect of Queue Management System on Patient Satisfaction in Emergency Department; a Randomized Controlled Trial

Background: Patients’ experience in hospitals affects their satisfaction. Aim: The purpose of the present study was to assess the effect of applying a queue management system on patient satisfaction in emergency department waiting rooms.Methods: The present prospective randomized single-blinded interventional study was performed from July to August 2020 and involved 236 patients that were divided into one intervention group and one control group, each consisting of 118 patients. The mentioned patients’ perception of the waiting time and satisfaction before being visited by an emergency medicine doctor was evaluated with and without applying the queue management system.Results: The mean actual waiting time (15.5 ± 7.5 minutes) as well as the mean perceived waiting time (11.9 ± 7.4 minutes) for the intervention group were significantly lower than those of the control group with the values of 27.03 ± 8.5 and 32.8 ± 8.7 minutes, respectively (p < 0.001). The mean perceived waiting time was significantly less than the mean actual waiting time (11.9 min vs 15.5 minutes) for the intervention group (p < 0.001). The level of satisfaction in the intervention group was significantly higher than that of the control group (p < 0.001).Conclusion: It can be proposed that the application of a queue management system in the emergency department waiting rooms can reduce the actual and perceived waiting times and increase the patient satisfaction

The Frequency of Constipation and It's Causes in Iranian Children

Background:Childhood constipation is a common problem, accounting for 3% of visits to pediatric clinics and up to 25% of visits to ediatric gastroenterologists.However,little is known about the prevalence of childhood constipation in developing countries and the frequency of its causes.We proposed to determine the frequency and causes of constipation in children presented to a gastroenterology clinic of a teaching pediatric hospital located in Tehran, Iran.Methods: All five hundred and fifty six children referred to a pediatric gastroenterology clinic were evaluated for gastrointestinal problems including difficulties in defecation.   After the detection of constipated children, a questionnare was completed including baseline characteristics, physical examination, paraclinic laboratory data and determination of the cause of constipation (organic or non-organic). Results:Out of all 556 children,constipation was diagnosed in 87 individuals (15.64%).Among children with constipation, 53% were girls and 47% were boys and only in 13% organ problems was the main cause.Urinary incontinence and encopresis were detected in 16.2% and 27% of constipated children,respectively. The prevalence of urinary tract infection in children with constipation was significantly higher in girls than boys(P<0.05).Conclusion: The results of our study show that the prevalence of constipation among Iranian children is high enough to emphasize it's importance

بررسی علل مراجعه مکرر به اورژانس بیمارستان های دانشگاه علوم پزشکی ایران؛ یک مطالعه توصیفی- مقطعی

Introduction:&nbsp;Readmission is among the causes of overcrowding in hospital emergency departments. Identifying the characteristics of patients with readmission helps healthcare administrators propose more effective strategies to reduce the frequency of their readmission to the emergency department. This study was designed to investigate the characteristics of readmitted patients in emergency departments of hospitals affiliated with Iran University of Medical Sciences.&nbsp;Methods:&nbsp;Patients with more than 5 times admissions to emergency wards of Rasoul-e-Akram, 7 Tir martyrs, and Firoozgar Hospitals from March 2017 to March 2018 were selected using Health information system (HIS), which recorded computerized patient information. Frequency of referrals and patient complaints during readmission to emergency departments were extracted from patient records.&nbsp;Results:&nbsp;Out of all referrals to hospitals (around 20 thousand patients), 208 patients were readmitted to emergency departments of the mentioned hospitals more than five times (minimum 5 and maximum 10 times). Mean readmission frequency was 6.40 ± 1.26 times and mean patient age was 52.53±17.02 years. Most frequent underlying illnesses were cancer, asthma and chronic obstructive pulmonary disease (COPD), and heart ischemic; and the least frequent were schizophrenia, aplastic anemia, and drug addiction. &nbsp;Conclusion:&nbsp;There was a significant correlation between age and readmission (p-value=0.001). Cancer, COPD, and ischemic heart diseases were the most common causes of readmission to the emergency department. Shortness of breath, chest pain and weakness were the most common complaints at the time of readmission in this study.مقدمه: مراجعات مکرر از علل اصلی ایجاد ازدحام در بخش های اورژانس بیمارستان ها می باشد. شناسایی ویژگی های مراجعین مکرر به مدیران سیستم ارائه خدمات درمانی کمک می کند تا راهکار های موثرتری برای کاهش تعداد دفعات مراجعه آنها به بخش اورژانس ارائه دهند. این مطالعه با هدف بررسی ویژگی های مراجعین مکرر بخش های اورژانس بیمارستان های دانشگاه علوم پزشکی ایران طراحی شد. روش کار: بیمارانی که طی سال 1396 بیش از 5 بار به بخش های اورژانس بیمارستان های حضرت رسول اکرم (ص)، شهدای 7 تیر و فیروزگر دانشگاه علوم پزشکی ایران مراجعه کرده بودند با استفاده از سیستم های رایانه ای ثبت اطلاعات بیماران Health information system (HIS) ، تعداد مراجعات و شکایات بیمار در زمان مراجعات مکرر به بخش های اورژانس از پرونده های بیماران استخراج شدند. يافته ها: از بین مراجعات به اورژانس بیمارستان ها (حدود 200 هزار بیمار)، 208 بیمار بیش از 5 بار (حداقل 5 و حداکثر 10 بار) به بخش های اورژانس بیمارستان های مورد بررسی مراجعه کرده بودند. میانگین تعداد دفعات مراجعه کنندگان بیش از 5 بار، 40/6 بار با انحراف معیار 26/1 بار بود. میانگین سنی بیماران 52/53 سال با انحراف معیار 02/17 سال بود. شایع ترین بیماری های زمینه ای در بیماران شامل سرطان، آسم و بیماری های مزمن ریوی و پس از آن بیماری های ایسکمیک قلب بودند. کمترین شیوع را بیماری های اسکیزوفرنی، آنمی آپلاستیک و مسمومیت با مواد مخدر تشکیل می دادند. بین سن و تعداد مراجعات مکرر رابطه آماری معنی دار وجود داشت (P= 0.001). نتيجه گيری: نتایج نشان داد که سن یک پیش بینی کننده بسیار مهم در بررسی تعداد دفعات مراجعه بیمار به بخش اورژانس می باشد. سرطان، بیماری های انسدادی ریه و بیماری های ایسکمیک قلبی رایج ترین علل مراجعه مکرر بیماران به بخش اورژانس بودند. تنگی نفس، درد سینه و ضعف رایج ترین شکایات در بیماران با مراجعه مکرر بودند