Can brain natriuretic peptide predict cardiovascular complications in severe preeclampsia? A case-control study

Background: Preeclampsia is one of the most common pregnancy complications, which is one of the major causes of fetal and maternal mortality. Objective: To compare the serum Brain Natriuretic Peptide (BNP) level in patients with severe preeclampsia and normal pregnancy and investigate associated cardiovascular complications. Materials and Methods: This case-control study was performed on 94 women with a singleton pregnancy (severe preeclampsia and normal pregnancy) at Imam Reza Hospital in Mashhad, Iran. The venous blood samples were collected to evaluate the serum BNP level. All patients were subjected to echocardiography performed by a single cardiologist. Results: The mean pro-BNP levels were 480.36 ± 754.52 and 67.46 ± 106.24 pg/dL in the severe preeclampsia and normal pregnancy patients, respectively (p < 0.001). However, adjusted BNP for maternal and gestational age was not different in the two groups (ANCOVA, p = 0.69). Furthermore, the two study groups showed no significant difference in terms of the cardiac parameters, including ejection fraction (EF), left ventricle end-diastolic and -systolic diameters (LVEDD and LVESD, respectively), tricuspid annular plane systolic excursion (TAPSE), and ratio of the early transmitral flow velocity to the early diastolic tissue velocity (E/Em). However, the serum BNP level showed a significant correlation with EF (r = -0.39, p = 0.008), TAPSE (r = -0.47, p = 0.001), and E/Em ratio (r = 0.48, p = 0.001) in patients with severe preeclampsia. Conclusion: It seems that BNP can be used as a predictor for some of the main cardiac functional indices (i.e., E/Em, EF, and TAPSE) in severe preeclampsia patients. Key words: Brain natriuretic peptide, Echocardiography, Stroke volume, Preeclampsia, Pregnancy

Comparing APACHE II, APACHE IV, SAPS II, and SOFA Predictive Power in Poisoned Patients Admitted to the Intensive Care Unit

Background: This study aimed to assess the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiologic Score (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores in predicting mortality rate in poisoning patients admitted to an intensive care unit (ICU).Methods: This cross-sectional study was performed on all admitted patients in the poisoning ICU of Imam Reza Hospital, Mashhad City, Iran. All patients were evaluated for three consecutive days since admission time and then every two days until discharge from ICU or death. The scoring systems mentioned above were calculated and analyzed by MedCalc statistical software version 18.9.1 and SPSS version 16.Results: Overall, 150 patients were studied, out of whom 67% (101) were male. Their mean±SD age was 41.6±18.9 years. In their whole hospitalization period, APACHE II (79.5%), SAPS II (78.7%), APACHE IV (78.4%), and SOFA (72.9%) were the most precise measures. On the first day of admission APACHE II (77.4%), on the second day, APACHE II (83.1%), on the third day, APACHE II (90.7%), and on the fifth day, SOFA (81.6%) were the most precise measures.Conclusion: All four systems have acceptable discriminatory power for poisoned patients. However, it seems that APACHE II can be used for mortality prediction, especially in the early days of admission.

The future of medical students; perspectives and expectations: a cross-sectional study in Mashhad University of Medical Sciences

Background: Health decision makers should be able to predict attitudes of medical students and factors influencing their tendency to allocate enough resources and university vacancy. These attitudes may not be always congruent with the actual and prominent health needs of society. The purpose of this study was to delineate medical students’ career prospects and general expectations. Methods: This cross-sectional study was conducted on 200 medical students who were selected through a multi-stage sampling method from all educational stages (basic science, physiopathology, clinical clerkship, internship) studying at Mashhad University of Medical Sciences in 2016-2017. The first five priorities for work after graduation and first five priorities for residency were studied and the Priority-Percentage Index (PPI), which considers the percentage and a reverse scoring for the priority of selecting an item, was calculated. Results: Principally, “pursuing one of the medical specialities” was the most desired career choice (3.73 PPI) followed by “employment in private practice” (2.08 PPI) regardless of gender, native status, and stage of education. Although the most preferred specialities were ophthalmology (1.99 PPI), cardiology (1.66 PPI) and radiology (1.44 PPI), the trend of interest varied by educational stage. Conclusion: Income and reputation have a significant influence on medical students’ attitude toward specialities. Therefore, it is crucial that policy-makers note preferences in specialities and consider the society’s demand in the field of healthcare

Work‐related respiratory symptoms and pulmonary function tests in northeast iranian (the city of Mashhad) carpenters

OBJECTIVE: To assess the respiratory symptoms and pulmonary function of carpenters from the city of Mashhad (northeast Iran). METHODS: The frequency of respiratory symptoms was retrospectively estimated in a sample of 66 carpenters in the city of Mashhad in northeast Iran using a questionnaire including questions on work-related respiratory symptoms in the past year, allergy, type of irritant chemicals that induce respiratory symptoms, smoking habits, and working periods as a carpenter. PFT values were also measured in all participants, and the age and smoking habits matched those of a sample of men from the general population as a control group. RESULTS: Thirty-five carpenters (53%) reported work-related respiratory symptoms. Cough (34.4%) and sputum (33.3%) were the most common symptoms, and only 15.15% of carpenters reported wheezing during work. All respiratory symptoms were higher in carpenters than in controls, which was statistically significant for cough and sputum (p<0.001 in both cases). Most allergic symptoms were also significantly greater among the carpenters than in the control group (p<0.05 for both itchy eyes and sneezing). Most respiratory and allergic symptoms in the carpenters increased during work compared to rest period which was statistically significant only for cough (p<0.05). PFT values were significantly lower in the carpenters than in control subjects (p<0.05 to p<0.001). CONCLUSIONS: Carpentry work was associated with a high frequency of respiratory symptoms, particularly after exposure to irritating chemicals during work. PFT values were also significantly reduced among carpenters compared to controls

Rearrangement of Morning Report Sessions: An Action Research

Background: Morning report (MR) is one of the most common methods in medical education. It is effective for improvement of the communication skills, problem solving abilities, and clinical reasoning among learners. This study aimed to evaluate and rearrange the MR sessions in the department of obstetrics and gynecology of Imam Reza Hospital in Mashhad.Method: This study was an action research. The first step  included observation of current sessions, formation of focus groups, and conducting a training workshop regarding the principles of MR. Fourty-six individuals including 25 medical interns, 14 residents, and 7 faculties participated in the study within two months. Then , evaluation of the sessions was done and the effect of the intervention was evaluated.Results: Some of the significantly improved items are: the method of patient selection by selecting common diseases (P: 0.010), announcing the patient's file number (P: 0.000), the patient’s follow up  (P: 0.000) and declaring the person responsible for patient’s follow-up  (P: 0.000), writing the list of the patients on the board before the meeting (P: 0.042), proper management of the meeting (P: 0.000), referring to proper articles (P: 0.000), and managing the duration of the presentation (P: 0.000), documenting the summary of the history (P: 0.000), documenting the key points of history (P: 0.000), providing appropriate feedback to the provider (P: 0.010), and paying attention to complications (P: 0.001.Conclusion: The methods of holding MR differ from defined standards in many educational centers worldwide. Thus, various aspects of meetings, including structural principles of holding MR, timing, patient selection, attention to intern and resident training at different stages, and compliance with ethical issues still need to be reviewed

3D Printed Models for Teaching Orbital Anatomy, Anomalies and Fractures

Purpose: The aim of this study was to determine the efficacy of using 3D printing models in the learning process of orbital anatomy and pathology by ophthalmology residents. Methods: A quasi-experimental study was performed with 24 residents of ophthalmology at Mashhad University of Medical Sciences. Each stratum was randomized into two groups. The educational booklets were distributed, and various forms of orbital 3D models were printed from orbital computed tomography (CT) scans. Knowledge enhancement on the topics was measured by comparing pretest and posttest scores. Results: Thirteen residents who were trained using traditional methods were deemed the control group; while 11 residents who were trained using the 3D printed models were classed as the intervention group. The control group was younger than the intervention group (P = 0.047). The results showed that there was a statistically significant difference in the total posttest scores between the two groups. Based on the repeated measures of the analysis of variance (ANOVA), score variables were significant between the two groups (P = 0.008). Interestingly, the use of the 3D educational model was more effective and statistically significant with the year one residents as compared to the year two residents (P = 0.002). Conclusion: This study is the first one in Iran quantifying the effects of learning using 3D printed models in medical education. In fact, 3D modeling training is seemingly effective in teaching ophthalmic residents. As residents have never encountered such technology before, their experience using 3D models proved to be satisfactory and had a surprising positive effect on the learning process through visual training

Prevalence of Smoking in the Outskirts of Mashhad, Iran

Background:Globally, smoking is one of the main causes of morbidity and mortality. It is also an important social determinant of health and the largest contributor to health inequalities. While several prevalence studies are conducted on special groups such as physicians, less such studies have been focused on deprived areas (areas with lacking adequate food, shelter, education, etc). The aim of this study is to evaluate the prevalence of smoking in the outskirts of Mashhad, Iran. Methods:This analytical cross-sectional study was performed on 500 residents of sub-urban areas of Mashhad, Iran. Subjects were included and were interviewed using a multi-stage random sampling method.   Results:Composition of subjects, 40% (200) were male. Mean age was 35±11 years. Twenty-four percent (117) of subjects were smokers (18% women and 33% of men). Hookah was used twice as much as cigarettes (18% vs. 9%, respectively). Smoking was most prevalent between 25 and 34 years old for both genders. More than 75% of smokers had low grade education. Conclusion:Smoking is of high prevalence in suburban areas of Mashhad. Target oriented interventions are needed to effectively lower this major health risk factor

Predictors of Stages of Change in Fruit/Vegetable Consumption based on Trans-Theoretical Model: A Population-based Study

Background and Objectives: Low Fruit/Vegetable (FV) diet seems to be a global public health problem. The&nbsp;trans-theoretical&nbsp;stages of change&nbsp;model&nbsp;have long been considered a useful interventional approach in lifestyle modification programs. The aim of this study was to find the most important intermediating factors of FV consumption in Mashhad, Iran. Materials and Methods: In this cross-sectional design, 777 participants were included with a convenient method from the general population in public places all around the Mashhad City, Iran in 2014. A standardized checklist about socio-demographic characteristics and possible related factors and stages of change questionnaire (6 stages: pre-contemplation, contemplation, preparing, action, maintenance, and termination) were used for data collection. Data were analyzed by SPSS 11.5 software using Chi-square test, Mann-Whitney U test, and Multiple Logistic Regression. Results: Totally, 254 (47.7%) and 299 (59.8%) of participants were in pre-action stages of FV, respectively. Smoking (OR=3.2, p=0.02) and believing that this is good for the body (OR=0.12, p=0.001) were predictors of the pre-contemplation stage for fruits. Being physically active (OR=2, p=0.008), low agreement with health benefits of vegetables (OR=8, p<0.001) and low agreement with &ldquo;vegetables make more diet variability&rdquo; (OR=4, p<0.005) were predictors of pre-contemplation stage for vegetables. Conclusions: Understanding the pros and cons of changing lifestyle can help public health specialists to perform targeted interventions. Keywords: Behavior, Fruit, Vegetable, Trans-Theoretical Model, Urban populatio

A Review of Writing Patterns of Authors\' Participation in Research Articles and Presenting a Practical Pattern: Color-Coded Contributions

Introduction: In this era, with the increase in research, the issue of ignoring the basic principles of research ethics, including determining the share of authors, is raised more than before. Different models for writing this section have been presented in reputable journals and the study endeavors to compare them to provide a practical model for writing participation in the guidelines of Persian language journals. Methods: This review article uses English and Persian keywords: Writing Instructions, Authors' Participation Guide, Authors' Collaboration Statement, to review and compare how to write the Authors' Participation section on the website of medical publishers and instructions of reputable Persian and English journals in the databaseses such as Iranmedex, Google Scholar. Results: After reviewing websites and magazines and removing duplicates, twelve writing patterns were identified and compared in terms of different aspects. Finally, combining different patterns and taking the strengths of each, in compliance with ICMJE and COPE criteria, the use of visual patterns to facilitate its completion, the possibility of accurate monitoring of the order of names, and ease of understanding by readers, a pattern was offered. In this template, while providing definitions of ICMJE criteria, the authors' contribution in the predefined Excel file is determined and finally, the amount of participation is presented in a table with a color spectrum called "Color-Coded Contributions" with the ability to be included in the article. Conclusion: The proposed model in this study, based on the strengths of previous models, has provided a simple application framework. Therefore, its use in journals to comply with authors' criteria, which is one of the important indicators in the field of research ethics, could be useful

Tramadol Overdose Induced Transient Paresthesia and Decreased Muscle Strength: A Case Series

Background: Tramadol overdose is relatively common in Iran. A series of tramadol poisoned patients with paresthesia and decreased muscle strength are described. Methods: In this prospective cross-sectional study, all referred cases to Mashhad Medical Toxicology Center with suspected tramadol poisoning between 1st July 2010 and 1st September 2012 were included. Patients with mixed overdose, history of neurologic and musculoskeletal disorders including primary seizure, and history of addiction were excluded. Patients were visited on admission, 6 and 12 hours later. All cases underwent complete neurologic examination. Muscle strength was assessed with manual muscle testing. Results: Tramadol overdose accounted for 1026 cases during the study period. Eight hundred eighty nine cases were excluded and finally 137 cases were tramadol only overdose. Most patients (92%) were men. Mean (SD, min-max) age was 24.5 (6.9, 10-42) years. The strength of upper and lower limbs symmetrically declined in the first visit and increased gradually in 6 and 12 hours post-admission, but the strength of lower limbs was more significantly affected on admission and after 6 hours (P < 0.001) compared to upper limbs. Paresthesia happened in 64%, 9% and 0% in upper limbs and 86%, 35% and 3% in lower limbs on admission, and after 6 and 12 hours. No spasticity and flaccidity were observed. On admission, pupils were symmetrically reactive and 6.7 (2.3, 1-11) mm wide. Pupil size significantly declined to 5.6 (2.1, 1.3-9.0) mm 6 hours later (P < 0.001).                  Conclusion: Transient paresthesia and transient symmetrical decline in muscle strength of upper and lower limbs are potential neurologic complications following tramadol abuse and overdose. Further studies are needed to fully clarify the pathogenesis and mechanism of these complications following tramadol overdose