Comparative Study of Hearing Impairment among Healthy and Intensive Care unit Neonates in Mashhad, North East Iran.

INTRODUCTION According to World Health Organization (WHO) 2001 statistics, hearing disorders are the most common congenital disease, and the incidence rate among high-risk newborns is as much as ten times as high as that in healthy neonates. However, 78% of screening test failures are well-baby nursery babies. The Joint Committee on Infants' Hearing (JCIH) has emphasized the importance of early diagnosis and treatment in neonates with hearing impairments in order to preserve their maximum linguistic skills. The aim of our study was to compare the prevalence of hearing loss among babies in the neonatal intensive care unit (NICU) and the rooming-in unit (RIU). MATERIALS AND METHODS Neonates born in three hospitals in Mashhad between 2008 to 2010 were studied prospectively and screened for auditory disorders using the oto acoustic emission (OAE) test at the time of discharge and 3 weeks later. To confirm hearing loss, the auditory steady state response (ASSR) test was used among those participants who failed both OAE tests. RESULTS Two-thousand and sixty-three neonates from the NICU were screened and compared with a control group consisting of 8,724 neonates from the RIU or the well-baby nursery. At the end of the study, hearing impairment as confirmed by failure in the ASSR test was diagnosed in 31 neonates (26 in the control group [0.30%] and five in the NICU group [1.94%]). CONCLUSION In our study, the prevalence of hearing disorders among NICU neonates was 6.5-times greater than that among babies from the RIU or well-baby unit. This observation demonstrates the importance of universal screening programs particularly for high-risk population neonates

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Yield Comparison of Sesame Cultivars and Their Physiological Growth Indices Under Chemical and Biological Potassium Fertilizer Applications

To compare the yield and physiological growth indices of three Iranian sesame cultivars under the application of chemical and biological potassium fertilizers a pot experiment was conducted in the summer of 2015 in greenhouse. This study was performed as factorial arrangement based on a randomized complete block design with three replications. The potassium fertilizer application, based on soil test, was in four levels (K1:K2SO4 50%, K2: Bacillus circulans L., K3: Bacillus megatherium L. and K4: KSB1+KSB2 and three sesame cultivars used were Ultan, Yekta and Dashtestan 2. The plant samples were taken from 30 to 105 days after sowing with 15 days intervals. LAI, TDM, CGR, NAR and RGR were measured during the different growth stages. The results showed that the Yekta cultivar produced the highest seed yield (18.62 g.plant-1). Ultan produced highest growth rate as compared to the other cultivars. Furthermore, it responded differently to the application of biologic KSB1 fertilizer as compared to the other treatments and cultivars. KSB1 improved and accelerated plant growth rate at 90 days after sowing. While, the use of chemical potassium sulfate, KSB2 and combined application of Bacillus circulans L. with KSB1 and 2 improved growth 105 days after sowing

Assessment of Pain Management in Pediatric Emergency Department in Mashhad -Iran

Introduction: Pain may be described as a sensation of hurt or strong discomfort and is the body's way of sending message to the brain that an injury has occurred. Pain medicines block these messages or reduce their effect on the brain. Accurate administration of analgesia have a long –lasting effect on children whole experience of medical care and affects parents' and children's future reaction to pediatrics emergency departments. The purpose of this study was to evaluate pain management on children in our emergency department. Materials and Methods: In this study we evaluated the relief of pain and anxiety on 100 children who referred to our pediatric Emergency Department (ED) in Imam Reza Hospital- Mashhad .The patients were assessed based on the American Academy of Pediatrics (AAP) recommendations about pain.  Results: Patients were gone under IV Line 97%, Intubation 5% and Lumbar Puncture 28%. Training had been provided to 70% participants in the Emergency Department. Nonpharmacologic stress reduction was used in 35% of cases. Family presence was allowed only in 5%. Prehospital pain controlling was began on 20% of patients and continued in ED on 40%. At the time of discharge 40% prescribed analgesics. Sedation and pain prophylaxis was provided for 10% of patients undergoing painful procedures in ED.  Conclusion: According to results, pain management in our Pediatric Emergency Department was inadequate. Physicians and prehospital EMS providers should be justified about the importance of pain relieving and trained how to use all available analgesic and sedative options

Factors Related in Suicide Attempts in Admitted Poisoned Patients

Introduction Suicide is considered as a public health problem. Approximately 0.9% of all deaths worldwide are due to suicide. This study was performed to identify risk factors of suicide attempts among patients who admitted in a medical toxicology centre during three months. Materials and Methods: A cross sectional study was carried out; all admitted patients in our medical toxicology centre due to suicidal attempt who completed consent form were included from December to March 2013. A researcher designed questionnaire was prepared and its validity and reliability was confirmed; it was fulfilled by a psychologist via clinical interview. Data were analyzed by SPSS software 11.5 and results were discussed. Results:198 participants included; of whom 67.2% were female and 94.9% were less than 45 year old. Among the patients, approximately 48% of the patients were married; 27.77% were employed. More than 96% suffered from severe depression, 3.53% of the patients had psychotic symptoms. Personality disorders, previous suicidal attempt, unemployment, full stressed family, family history of suicidal attempt, moderate to severe depression and a history of dependence on antipsychotic drugs and lack of family support were identified as risk factors for suicide. Conclusion: Attention to personality trait  and family environment can be mainly effective in long-term prevention of suicide, treatment of physical illness in patients with chronic health conditions, evaluation and treatment of psychiatric issues in addition to family and social problems, and organizing educational courses  to families with suicide history can be helpful

M-Guard Stent in Stemi Patients with High Thrombus Burden Lesions: A Prospective, Single Arm Study

Introduction: Primary PCI is the preferred modality to restore blood perfusion in STEMI patients, but myocardial reperfusion is sometimes lower than optimal. Distal embolization seems to play the leading role. There is rare evidence suggestive of M-Guard stents; a recent innovation which protects against distal embolization may be beneficial in this circumstance. Materials and Methods:This was a prospective single arm study. Patients with acute STEMI admitted at the Cardiac Emergency Unit of Imam Reza Hospital from July 2011 to November  2012 who had a large bulk of thrombus in their angiogram, underwent M-Guard stenting and were followed up for six months for chest pain and secondary revascularization. Results: The 23 patients, aged between 34 and 84; 65.2%, were male and had undergone primary PCI, mechanical thrombus aspiration, and M-Guard stenting. Left Anterior Descending (LAD) (63.9%) and Right Coronary Artery (RCA) (39.1%) were most commonly involved. 78.2%, 13.1%, and 8.9% of patients had primary Thrombolysis in Myocardial Infarction (TIMI) Thrombus grade five, four, and three. Among them, 86.9% achieved TIMI Flow grade three and 13.04% TIMI Flow grade two. The rate of transient "no-reflow" phenomenon was 21%. One patient died after stenting in the setting of cardiogenic shock. There was one case of in-stent restenosis five months after the procedure. Of the other 15 accessible patients, after six months, none experienced a second angioplasty or any ischemic symptoms. Conclusion: Using M-Guard stents in acute STEMI patients having undergone primary PCI with high thrombus burden is probably associated with lower rates of the "no-reflow" phenomenon and improved vessel reperfusion.

Comparative Study of Hearing Impairment among Healthy and Intensive Care unit Neonates in Mashhad, North East Iran

Introduction: According to World Health Organization (WHO) 2001 statistics, hearing disorders are the most common congenital disease, and the incidence rate among high-risk newborns is as much as ten times as high as that in healthy neonates. However, 78% of screening test failures are well-baby nursery babies. The Joint Committee on Infants’ Hearing (JCIH) has emphasized the importance of early diagnosis and treatment in neonates with hearing impairments in order to preserve their maximum linguistic skills. The aim of our study was to compare the prevalence of hearing loss among babies in the neonatal intensive care unit (NICU) and the rooming-in unit (RIU), and study their risk factors.   Materials and Methods: Neonates born in three hospitals in Mashhad between 2008 to 2010 were studied prospectively and screened for auditory disorders using the oto acoustic emission (OAE) test at the time of discharge and 3 weeks later. To confirm hearing loss, the auditory steady state response (ASSR) test was used among those participants who failed both OAE tests.   Results: Two-thousand and sixty-three neonates from the NICU were screened and compared with a control group consisting of 8,724 neonates from the RIU or the well-baby nursery. At the end of the study, hearing impairment as confirmed by failure in the ASSR test was diagnosed in 31 neonates (26 in the control group [0.30%] and five in the NICU group [1.94%]).   Conclusion:  In our study, the prevalence of hearing disorders among NICU neonates was 6.5-times greater than that among babies from the RIU or well-baby unit. This observation demonstrates the importance of universal screening programs particularly for high-risk population neonates

Clinical and Laboratory Findings of Lead Hepatotoxicity in the Workers of a Car Battery Manufacturing Factory

Background: Occupational lead poisoning is common in workers of some industries, but lead hepatotoxicity has rarely been reported. Several animal studies have revealed lead induced liver damage but clinical studies concerning the manifestations of lead induced liver toxicity in humans are scares. This study was designed to investigate the clinical manifestations and pathological parameters of hepatic dysfunction and its relationship with blood and urine lead concentrations in a car battery-manufacturing workers. Methods: This cross sectional study was carried out in Mashhad, Iran, during April-June 2011. One hundred and twelve workers underwent blood and urine sampling for determination of lead concentrations and liver function tests. Clinical signs and symptoms of possible lead hepatotoxicity were investigated. Results: Mean (±SD) age of the workers was 28.78 (±5.17) yr with a daytime work of 8.67 (±1.41) h and mean work duration of 3.89 (±2.40) yr. Mean blood lead concentration (BLC) and urine lead concentration (ULC) were 398.95 (±177.41) µg/l and 83.67(±50) μg/l, respectively. We found no correlation between the clinical findings and BLC or ULC. A weak correlation (R: 0.27, P=0.087) between serum alkaline phosphatase concentration and BLC was obtained. No significant relationship was found between other liver function tests and BLC or ULC. Conclusion: We found no specific clinical and laboratory abnormalities of liver in the workers of car battery manufacturer who had chronic lead toxicity. Further investigations with more specific laboratory tests such as LDH5 and gamma glutamyl transferase (GGT) as well as novel biomarkers of metal induced hepatotoxicity might be helpful in evaluating lead hepatotoxicity