Cut off Value for Parathormone Level in Children with Vitamin D Deficiency

Background: When serum level of 25-hydroxy vitamin D [25(OH) D] decreases, intact Parathormone (iPTH) level increases compensatory. This study aimed to determine the cut off value for iPTH level in 2-14-year-old children with vitamin D (VD) deficiency. Methods: This cross-sectional study was performed on 153 children aged 2-14 years old who referred to the endocrinology clinic of Amirkola Children's Hospital for growth assessment. Census sampling was conducted from January 2016 to June 2017 according to the eligibility criteria including height and weight above the percentile of 3% of growth charts and normal serum of calcium level (>8.5 mg/dl). Laboratory parameters such as serum calcium, 25(OH) D and iPTH levels were assessed. The children were divided into three groups based on serum levels of 25(OH) D as mild, moderate and severe VD deficiency. The Receiver Operating Characteristic (ROC) curve was used to analyze the cut-off point of iPTH and 25(OH) D. P-Value< 0.05 was considered significant. Results: The mean VD and iPTH levels in children were 11.8 ± 4.59 ng/ml and 28.3 ± 13.3 pg/ml, respectively. At the iPTH serum level of 23.5 pg/ml, with a sensitivity of 66.1%, there was a possibility of moderate to severe VD deficiency. In the severe deficiency group, at the iPTH serum level of 23.5 pg/ml and above, with a sensitivity of 78.9%, there was a possibility of severe VD deficiency. The cut-off point of 25(OH) D and iPTH, at the serum VD level ≤10 ng/ml were determined. Conclusions: The results of the present study showed that the cut-off value for iPTH in children with VD deficiency is serum level of 25OHD≤10ng/ml

Shiraz Azodi hospital and its role in Advancing medical knowledge

زمینه و هدف: با قدرت‌گيري آل‌بويه و دستيابي این خاندان بر بخش‌هاي مرکزی و غربي جهان اسلام به خصوص بغداد و شيراز، كه اصلي‌ترين مراكز تحت حكومت آل‌بويه بودند، روند فعاليت‌های پزشكي و بهداشتي ازجمله ساخت و تجهيز بيمارستان شتاب بيشتري یافت. ازجمله این مراکز، بیمارستان عضدی شیراز بود که در سال 360 ق. و به دستور عضدالدوله دیلمی بنا شد و بنیان‌گذار حوزه طبی شیراز گردید. علیرغم اهمیت این بیمارستان، اطلاعات مدون محدودی پیرامون آن وجود دارد که ضرورت انجام پژوهشی گسترده را آشکار می‌سازد. بر همين اساس شناخت جايگاه پزشكي این بیمارستان به عنوان حلقه استمرار پيوند دانش پزشكي جندی‌شاپوری به دوران اسلامي از اهميت به سزايي برخوردار است. از اين رو هدف از اين مطالعه ترسيم وضعيت اين بیمارستان بر اساس منابع موجود تاریخی است. مواد و روش‌ها: در اين پژوهش با روش توصيفى تحليلى، بیمارستان عضدی شیراز از جنبه‌هاي ساختاری و تشکیلاتی چون كاركردهاى درمانى و آموزشى بررسی شد. یافته‌ها: نتايج اين بررسی نشان مى‌دهد كه بیمارستان عضدی شیراز به سبک بیمارستان جندی‌شاپور اداره می‌شد و در امور داخلي و تشكيلات سازماني خود داراي سلسله مراتب و بخش‌هاي مختلفي بود که به مرور زمان و با بهره‌مندي از دستاوردهاي پزشكي حاصل شده بود. این بیمارستان با برخوردارى از پشتوانه مالی دولتی و حمایت خیرین سال‌ها پابرجا بود و در طول دوران فعالیت خود به واسطه‌ کتابخانه‌ بزرگ آن مطرح می‌شد. نيز اين بیمارستان در انتقال دستاوردهاى علمى و پژوهشى و تربیت پزشکان برجسته‌ای چون ابوماهر شیرازی و علی بن عباس اهوازی مؤثر بود. نتیجه‌گیری: نتايج تحقيق بيانگر آن است كه حمايت‌هاي عضدالدوله دیلمی موجبات ارتقای سطح بهداشت و درمان طی دوران حکومت آل‌بویه در شیراز را به همراه داشت که پیامد آن جذب دانشمندان و پزشكان برجسته و انتقال اطلاعات طبي آنان از طريق کتب طبی و حفظ آن‌ها به صورت تأليف و ترجمه بود.Background and Aim: With the Buyid dynasty day to day powering and conquering central and western regions of the Islamic world, especially Baghdad and Shiraz, health-related activities including building and equipping the hospital accelerated. One of these centers was Shiraz Azodi hospital, which was built under the order of Azod od-Dowleh Panah (Fana) Khusraw in 971-973 AD. This interest in medical sciences resulted in founding Shiraz Medical Field. Despite the importance of this hospital, there is limited published information about it, which reveals the need for more extensive research. Accordingly, recognizing the role of this hospital in linking Jundishapuri’s medical knowledge and the Islamic era is of great importance. Therefore, the purpose of this study is to explain this hospital status in the Buyid dynasty based on historical sources that are available. Materials and Methods: In this study by descriptive-analytical method, Shiraz Azodi hospital was studied from structural and organizational aspects such as therapeutic and educational functions. Findings: The results of this study showed that Shiraz Azodi hospital was managed like Jundishapur Hospital. Azodi hospital had its specific organizational structure and departments, which were developed over time and as a result of medical achievements. This hospital was established and managed with the financial support of the government and the receiving charity for many years and was known mainly because of its great library. This hospital was also active in transferring research achievements and training physicians such as Abu Maher Shirazi and Ali Ebn Al-Abbas-al-Majusi (Haly Abbas). Conclusion: The results of the study indicate that the support of Azod od-Dowleh led to the improvement of the health system in Shiraz over four centuries, which resulted in attracting prominent scientists and physicians and transmitting their medical information through the preparation of books and educating other students. Amiri Ardakani E, Nikpour SH, Zare F. Shiraz Azodi hospital and in Advancing medical knowledge. Medical History Journal 2021; 13(46): e14

Cerebrolysin effects on neurological outcomes and cerebral blood flow in acute ischemic stroke

Mohammad Reza Amiri-Nikpour,1 Surena Nazarbaghi,1 Babak Ahmadi-Salmasi,1 Tayebeh Mokari,2 Urya Tahamtan,2 Yousef Rezaei3 1Department of Neurology, Imam Khomeini Hospital, 2School of Medicine, 3Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran Background: Cerebrolysin, a brain-derived neuropeptide, has been shown to improve the neurological outcomes of stroke, but no study has demonstrated its effect on cerebral blood flow. This study aimed to determine the cerebrolysin impact on the neurological outcomes and cerebral blood flow. Methods: In a randomized, double-blinded, placebo-controlled trial, 46 patients who had acute focal ischemic stroke were randomly assigned into two groups to receive intravenously either 30&nbsp;mL of cerebrolysin diluted in normal saline daily for 10&nbsp;days (n=23) or normal saline alone (n=23) adjunct to 100&nbsp;mg of aspirin daily. All patients were examined using the National Institutes of Health Stroke Scale and transcranial Doppler to measure the mean flow velocity and pulsatility index (PI) of their cerebral arteries at baseline as well as on days 30, 60, and 90. Results: The patients&rsquo; mean age was 60&plusmn;9.7&nbsp;years, and 51.2% of patients were male. The National Institutes of Health Stroke Scale was significantly lower in the cerebrolysin group compared with the placebo group on day 60 (median 10, interquartile range 9&ndash;11, P=0.008) and day 90 (median 11, interquartile range 10&ndash;13.5, P=0.001). The median of PI in the right middle cerebral artery was significantly lower in the cerebrolysin group compared with the placebo group on days 30, 60, and 90 (P&lt;0.05). One patient in the cerebrolysin group and two patients in the placebo group died before day 30 (4.3% versus 8.7%). Conclusion: Cerebrolysin can be useful to improve the neurological outcomes and the PI of middle cerebral artery in patients with acute focal ischemic stroke. Keywords: ischemic stroke, cerebrolysin, neuroprotection, NIHSS, mean flow velocity, pulsatility inde

Outcome after Neuro-interventional Treatment of Intracranial Aneurysm (as a First Treatment Modality)

Endovascular treatment is widely applied as the first-line treatment for intracranial aneurysms and includes simple coiling (SC), stent-assisted coiling (SAC), flow diversion stent, and flow disruption stent. The present study is a retrospective cohort study performed in Imam Khomeini Hospital, Department of Neurovascular Intervention, between March 2016 and March 2021. A total number of 229 patients with intracranial aneurysms who underwent therapeutic intravascular interventions were enrolled, of which 89 were treated with SC, 111 with SAC, 25 with flow diversion stent, and 4 with flow disruption stent. The mean age of the subjects was 51.8±12.6 years, and 51.1% were male. Modified Raymond-Roy classification (MRRC) was used to define the occlusion outcome. The success rate, considered as Class I and Class II of MRRC at treatment time was 89% (94.4% in SC, and 84.7% in SAC), which was increased to 90.9% (94% in SC, 93% in SAC, 69.6% in flow diversion stenting, 100% in flow disruption) at 6-month follow-up, and 84.6% (80.8% in SC, 87.8% in SAC, 78.3% in flow diversion stenting, and 100% in flow disruption) at 12-month follow-up. The mean modified Rankin Scale (mRS) before the procedure was 0.05±0.26 which was increased to 0.22±0.76 after the procedure, 0.22±0.76 at 6 months, and 0.30±0.95 at 12 months (P<0.001). Similar to previous studies, the present study demonstrates that neurovascular intervention can treat ruptured aneurysms as the first therapeutic modality with favourable outcomes. A double-blind, randomized clinical trial is needed to eliminate the confounding factors and better demonstrate the outcome