Determination of the Predictive Value of Serum Bilirubin in Patients with Ischemic Stroke: A Prospective Descriptive Analytical Study

Purpose: In all types of ischemic stroke, especially in the acute phase, excessive oxidative stress causes structural and functional damage to the brain. This may play a major role in the pathophysiology of the brain damage. Higher serum levels of bilirubin have therapeutic effects in oxidative stress-induced stroke. Nevertheless, role of increased serum levels of bilirubin in the acute phase of ischemic stroke is controversial. Methods: This study was a cross-sectional prospective descriptive study conducted in the Emergency Department (ED) of Imam Reza hospital, Tabriz University of Medical Sciences, Tabriz, Iran, throughout six months. 275 ischemic stroke patients were evaluated based on their brain CT scan infarct size, NIHSS, MRS, and serum levels of bilirubin. Later, data were analyzed using SPSS software. Results: Total, direct and indirect bilirubin levels were significantly higher in expired patients (p< 0.0001). Total (p< 0.0001), direct (p< 0.0001) and indirect (p< 0.0001) bilirubin levels, NIHSS score (p< 0.0001), and ischemic area (p< 0.0001) significantly predicted the outcome in these patients. Conclusion: Total, direct and indirect bilirubin levels was significantly associated with mortality in the acute phase of ischemic stroke patients

Effectiveness of intravenous Dexamethasone versus Propofol for pain relief in the migraine headache: A prospective double blind randomized clinical trial

Abstract Background There are many drugs recommended for pain relief in patients with migraine headache. Methods In a prospective double blind randomized clinical trial, 90 patients (age ≥ 18) presenting to Emergency medicine Department with Migraine headache were enrolled in two equal groups. We used intravenous propofol (10 mg every 5–10 minutes to a maximum of 80 mg, slowly) and intravenous dexamethasone (0.15 mg/kg to a maximum of 16 mg, slowly), in group I and II, respectively. Pain explained by patients, based on VAS (Visual Analogue Scale) was recorded at the time of entrance to ED, and after injection. Data were analyzed by paired samples t test, using SPSS 16. P  Results The mean of reported pain (VAS) was 8 ± 1.52 in propofol group and 8.11 ± 1.31 in dexamethasone group at presenting time (P > 0.05). The VAS in propofol group was obviously decreased to 3.08 ± 1.7, 1.87 ± 1.28 and 1.44 ± 1.63 after 10, 20 and 30 minutes of drug injection, respectively. The VAS in dexamethasone group was 5.13 ± 1.47, 3.73 ± 1.81 and 3.06 ± 2 after 10, 20 and 30 minutes of drug injection, respectively. The mean of reported VAS in propofol group was less than dexamethasone group at the above mentioned times (P  Conclusions Intravenous propofol is an efficacious and safe treatment for patients presenting with Migraine headache to the emergency department. Trial registration Clinical Trials IRCT201008122496N4</p

Integrated modelling for mapping spatial sources of dust in central Asia-An important dust source in the global atmospheric system

Spatial mapping of dust sources in arid and semi-arid regions is necessary to mitigate on-site and off-site impacts. In this study, we apply a novel integrated modelling approach including leave one feature out (LOFO) - as a technique for feature selection -, deep learning (DL) models (gcForest and bidirectional long short-term memory (Bi-LSTM)), game theory (GT) and a Gaussian copula-based multivariate (GCBM) model for mapping dust sources in Central Asia (CA). Eight factors (precipitation, cation exchange capacity, bulk density, wind speed, slope, silt content, lithology and coarse fragment content) were selected by LOFO as effective for controlling dust emissions, and were used in the novel modelling process. Six statistical indicators were utilized to assess the performance of the two DL models and a hybrid copula-gcForest model, while a sensitivity analysis of the models was also carried out. The hybrid copula-gcForest model was identified as the most accurate, predicting that 16%, 7.1%, 9.5% and 67.4% of the study area is grouped at low, moderate, high and very high susceptibility classes for dust emissions, respectively. Based on permutation feature importance measure (PFIM) and Shapely Additive exPlanations (SHAP), bulk density, precipitation and coarse fragment content were evaluated as the three most important factors with the highest contributions to the predictive model output. The study area suffers from intense wind erosion and the generated spatial maps of dust sources may be helpful for mitigating and controlling dust phenomena in CA