Silent osteonecrosis of the femoral head following high-dose corticosteroids in patients with systemic rheumatic diseases

Background: Osteonecrosis (ON) is known to be one of the most disabling complications following corticosteroid (CS) medications. However, evidence regarding risk of asymptomatic prevalence of ON among different diseases and the impact of variable steroid regimens are conflicting. We aimed to determine the prevalence of ON of femoral head in asymptomatic patients with systemic rheumatic diseases who received high-dose CS and also clarify its relationship with different dosages and regimens. Methods: In this cross-sectional study, 50 consecutive patients receiving high-dose CS for rheumatic diseases who have no pelvic pain were recruited. MRI of both hips was performed on all patients using a 1.5 Tesla to diagnose ON. Results: Of 50 subjects, 18 (36) developed ON of the femoral head. Groups with and without ON were comparable in terms of sex, age and mean starting CS dose. There was no statistical difference in the type of CS regimen including daily dose, peak dose and cumulative dose between the two groups. However, silent ON was associated with both the cumulative CS dose and the duration of CS therapy. Conclusion: According to high prevalence of ON in our selected patients with no other identifiable risk factor for ON, monitoring of high risk patients with periodic hip MRI would help diagnose necrosis in early stage

The attitudes of team members towards family presence during hospital-based CPR: A study based in the Muslim setting of four Iranian teaching hospitals

Background: Contrary to international guidelines recommending family presence during cardiopulmonary resuscitation (CPR), allowing family members to be present remains a matter of debate in many countries. The purpose of this study was to determine the opinions of healthcare providers from a Muslim setting concerning family-witnessed resuscitation (FWR). Methods: The sample population consisted of CPR responders in four teaching hospitals in Tehran. These centres have no policy regarding the presence of family members during resuscitation. We developed and circulated a questionnaire gathering opinions, and collated their comments. Results: From 200 respondents, 77 opposed FWR. We found that gender, age, experience, previous exposure to FWR or specialty (except for emergency physicians) did not predict opinion towards family presence during CPR. The most common reasons given for opposition to family presence were fear of psychological trauma to family members, possible interference with patient care/ decision-making, and a perceived increase in staff stress. Conclusion: In a largely Muslim community, and contrary to general guidelines, our survey suggested that the majority of CPR responders do not favour the presence of relatives during cardiopulmonary resuscitation. Any counter to this opinion would need to be based on educating team members about the possible benefits of relatives being present during resuscitation. Public education surrounding CPR would also be a fundamental element for implementing any formal programme encouraging family-witnessed CPR in hospitals such as ours. © 2010 Royal College of Physicians of Edinburgh

8H-Chromeno[2′,3′:4,5]imidazo[2,1-a]isoquinoline

The title compound, C18H12N2O, comprises two aromatic fragments, viz., imidazo[2,1-a]isoquinoline and benzene, linked by oxygen and methyl­ene bridges. Despite the absence of a common conjugative system within the mol­ecule, it adopts an essentially planar conformation with an r.m.s. deviation of 0. 036 Å. In the crystal, due to this structure, mol­ecules form stacks along the b axis by π⋯π stacking inter­actions, with shortest C⋯C distances in the range 3.340 (4)–3.510 (4) Å. The mol­ecules are bound by inter­molecular C—H⋯O inter­actions within the stacks and C—H⋯π inter­actions between the stacks

Use of Diagnostic Tests in Patients with non Traumatic Acute Abdominal Pain Referred to the Emergency Department

<p><strong>Background and Objectives</strong></p><p> Non-traumatic acute abdominal pain is one of the most common complaints in patients referred to emergency department. To make diagnosis decision several diagnostic tests such as WBC count, urine analysis, and abdominal sonography are usually ordered which disturb emergency department, staff and force significant cost to patient and are time consuming. This study was done for determining the tests frequency for diagnosis of patients presenting in ED of Hazrat e rasoul hospital with non traumatic acute abdominal pain that had been dismissed from hospital in comparison to previous studies to find whether we can omit some unnecessary tests. </p><p> </p><p><strong>Methods</strong></p><p>Study method was descriptive-cross sectional. By sequential sampling, the data of 400 dismissed patients with non-traumatic acute abdominal pain were gathered and interpreted by statistical descriptive methods.</p><p> </p><p><strong>Results</strong></p><p>Participants were 29-22 years old, 40.8% male and 59.2% female. WBC had been ordered in 92% of cases. Urine analysis and abdominal sonography had been ordered 91.7% and 95.5% respectively. Frequency of CBC ordering was similar to previous studies while was 2 and 4 fold more for UA and abdominal sonography in comparison to previous studies.</p><p> </p><p><strong>Conclusion</strong></p><p>These results necessitate revising the diagnostic tests for non-traumatic acute abdominal pain to omit unnecessary tests.</p><p> </p&gt

Assessment of Emergency Medical Education on Knowledge Alterations of Medical Students in Rasoul Akram Hospital (2005-2006)

Background and objectives: Education and management are considered two integrated and non-separable requirements of an emergency department (ED). Despite the emphasis on teaching of essentials of approaching and management of critical patients, medical students do not acquire the necessary knowledge to handle these patients during their rotation in different specialties other than emergency medicine (EM). This study aims to evaluate the changes in EM knowledge of interns during their one month rotation in ED of Rasoul Akram Hospital. Methods: In a 15-month period, 226 interns were entered into this study. A pretest was taken at the beginning of their one-month internship period. Then, the interns were provided with a handbook, which was prepared and revised according to the approved curriculum of Ministry of Health and Medical Education of Iran and latest emergency medicine textbooks. The interns were taught by several lecture and practical sessions. At the end of their EM internship period, a post-test was taken and the change of their emergency medical knowledge was assessed by comparison of pre-and post-test results. Results: The results showed a significant increase of mean post-test scores compared with the pretest scores. Also, there was a significant difference between the scores obtained by males and those obtained by females (P < 0.001). Conclusion: The one-month EM training significantly improved the level of interns’ knowledge. Keywords: Student, Medical; Curriculum; Education; Emergency Medicin

Medical student and patient perspectives on bedside teaching

Objectives: To evaluate the perspectives of medical students and patients on bedside teaching (BST). Methods: A cross-sectional study was undertaken to elicit patients and learners opinions on BST in Hazrat Rasool Hospital, a university teaching hospital in Tehran, Iran. From June 2008 to September 2008, 100 fourth-year medical students and 100 adult patients admitted to the general medical service of a teaching hospital were chosen randomly. Patients who stayed for a minimum of 48 hours and had at least 2 case presentations in 2 consecutive mornings were included in the study. Patients under 18 years of age, non-Persian speakers, and cognitively impaired were excluded from the study. Their perspectives on BST were assessed with 2 separate questionnaires. Results: The mean age of medical students was 25.2±2.2 (22-36) years and 35 were male. The mean age of patients was 46.3±18.7 (17-85) years and 50 were male. Most of medical students believed that BST is an effective way for learning principle of history taking, physical examination, practical skills, data registry, communicating skills, evidence based medicine, and interpretation of para-clinical findings. Fifty-three percent of them believed that the time of BST is not enough, while 40 thought BST is the most effective way of learning clinical skills. Sixty percent of patients were comfortable with BST and 80 of them preferred that case presentation be performed in front of them. Conclusion: Our study suggests that teaching in the presence of patients provides unique and valuable opportunities to integrate the knowledge and skills of medicine for the direct benefit of the patient