A 62-year-old Man with Acute Dizziness, Nausea and Vomiting

The patient was a 62-year-old man presenting to the emergency department 6 hours after the onset of dizziness, nausea and vomiting. The patient complained of numbness of the right side of her body and reported swallowing problems. The initial examination showed the patient was alert and stable. The left side of her face was sweating while the right side was completely dry. The neurological examination revealed the patient was alert, and the right pupil was about 2 mm smaller than the left eye pupil, and both pupils responded to light. A paresis was observed in the right side of the face, tongue and uvula. Uvula was slightly deviated to the right. Other signs included hoarseness and swallowing impairment. The muscle strength of all four limbs was 5/5. Babinski reflex was downward on both sides. The patient could not sit by herself, and leaned to the right. The patient had a history of primary coronary intervention (PCI) and stent placement four years ago. She had smoked a pack of cigarettes for 40 years. She used nitrocontin, pearl, lisinopril, carvedilol and furosemide. Laboratory tests were normal. The first CT scan in the emergency department was normal. As a brain stem infarction was suspected, MRI was performed and revealed an infarct (Figure 1). The patient received neurology consultation and was discharged with stable vital signs and the daily order of aspirin and atorvastatin after five days. The patient was asked to have weekly follow-up visits

A 62-year-old Man with Acute Dizziness, Nausea and Vomiting

The patient was a 62-year-old man presenting to the emergency department 6 hours after the onset of dizziness, nausea and vomiting. The patient complained of numbness of the right side of her body and reported swallowing problems. The initial examination showed the patient was alert and stable. The left side of her face was sweating while the right side was completely dry. The neurological examination revealed the patient was alert, and the right pupil was about 2 mm smaller than the left eye pupil, and both pupils responded to light. A paresis was observed in the right side of the face, tongue and uvula. Uvula was slightly deviated to the right. Other signs included hoarseness and swallowing impairment. The muscle strength of all four limbs was 5/5. Babinski reflex was downward on both sides. The patient could not sit by herself, and leaned to the right. The patient had a history of primary coronary intervention (PCI) and stent placement four years ago. She had smoked a pack of cigarettes for 40 years. She used nitrocontin, pearl, lisinopril, carvedilol and furosemide. Laboratory tests were normal. The first CT scan in the emergency department was normal. As a brain stem infarction was suspected, MRI was performed and revealed an infarct (Figure 1). The patient received neurology consultation and was discharged with stable vital signs and the daily order of aspirin and atorvastatin after five days. The patient was asked to have weekly follow-up visits

Occupational Burnout and Its Related Factors Among Iranian Nurses: A Cross-Sectional Study in Shahroud, Northeast of Iran

BACKGROUND: Good physical and mental health of employees is one of the major characteristics of a healthy organisation. AIM: Due to the importance of occupational burnout and its potentially negative consequences, the aim of this study was to assess occupational burnout and its related factors among Iranian nurses. METHODS: In this cross-sectional study, 205 nurses who were working in two educational hospitals affiliated with Shahroud University of Medical Sciences were included. Forty-two of the nurses were male, and 163 were female (mean age: 31 years). Maslach Occupational Burnout Inventory, demographic and job characteristics questionnaires were completed for each nurse. Questionnaires were then collected, and data were analysed statistically by SPSS, version 22. RESULTS: In the assessment of occupational burnout, the highest level was observed in emotional exhaustion and then in personal performance. There was a significant difference between the frequency of nurses' emotional exhaustion domain in terms of gender (P < 0.05), so that, women suffered more from emotional exhaustion. There was a significant difference between the frequencies of nurses' performance in terms of marital status (P < 0.05) so that married people had more personal performance disorder. CONCLUSION: The results of this study showed that nurses suffered from low occupational burnout. Female gender, sleeping disorders, awakening at night and employment in stressful wards such as the emergency ward was associated with a higher level of occupational burnout in nurses

Mucormycosis in Uncontrolled Diabetic: A Case Report

Background: Mucormycosis is an opportunistic infection produced by various fungi in the order Mucorales, which is most commonly seen in people with a defect, especially diabetics. Introduction of this infection can involve processes such as insulin injections and tooth extractions. Mucormycosis mortality is significantly high  even with surgical treatment and management of diabetes. In this paper, a case of 28-year-old female with a history of Type 1 Diabetes Mellitus referred to emergency ward 5 days after tooth extraction experiencing a progressive pain and swelling was reported. Patient's examinations showed left orifice edema, left 7th nerve paralysis, and ocular-paralysis of 3rd, 4th and 6th on the left side. The patient was deployed to a more equipped facility in Mashhad (Iran), and after several days she died

Mucormycosis in Uncontrolled Diabetic: A Case Report

Background: Mucormycosis is an opportunistic infection produced by various fungi in the order Mucorales, which is most commonly seen in people with a defect, especially diabetics. Introduction of this infection can involve processes such as insulin injections and tooth extractions. Mucormycosis mortality is significantly high  even with surgical treatment and management of diabetes. In this paper, a case of 28-year-old female with a history of Type 1 Diabetes Mellitus referred to emergency ward 5 days after tooth extraction experiencing a progressive pain and swelling was reported. Patient's examinations showed left orifice edema, left 7th nerve paralysis, and ocular-paralysis of 3rd, 4th and 6th on the left side. The patient was deployed to a more equipped facility in Mashhad (Iran), and after several days she died

A cross-sectional multicenter linkage study of hospital admissions and mortality due to methanol poisoning in Iranian adults during the COVID-19 pandemic

Abstract A methanol poisoning outbreak occurred in Iran during the initial months of coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the epidemiology of the outbreak in terms of hospitalizations and deaths. A cross-sectional linkage study was conducted based on the hospitalization data collected from thirteen referral toxicology centers throughout Iran as well as mortality data obtained from the Iranian Legal Medicine Organization (LMO). Patient data were extracted for all cases aged > 19 years with toxic alcohol poisoning during the study period from February until June 2020. A total of 795 patients were hospitalized due to methanol poisoning, of whom 84 died. Median [interquartile ratio; IQR] age was 32 [26, 40] years (range 19–91 years). Patients had generally ingested alcohol for recreational motives (653, 82.1%) while 3.1% (n = 25) had consumed alcohol-based hand sanitizers to prevent or cure COVID-19 infection. Age was significantly lower in survivors than in non-survivors (P < 0.001) and in patients without sequelae vs. with sequelae (P = 0.026). Twenty non-survivors presented with a Glasgow Coma Scale (GCS) score > 8, six of whom were completely alert on presentation to the emergency departments. The time from alcohol ingestion to hospital admission was not significantly different between provinces. In East Azerbaijan province, where hemodialysis was started within on average 60 min of admission, the rate of sequelae was 11.4% (compared to 19.6% average of other provinces)—equivalent to a reduction of the odds of sequelae by 2.1 times [95% CI 1.2, 3.7; p = 0.009]. Older patients were more prone to fatal outcome and sequelae, including visual disturbances. Early arrival at the hospital can facilitate timely diagnosis and treatment and may reduce long-term morbidity from methanol poisoning. Our data thus suggest the importance of raising public awareness of the risks and early symptoms of methanol intoxication