A 41-Year-Old Woman with Seizure

The patient was a 41 year old woman that was brought to the emergency department (ED) by her husband following seizure. According to the relatives accompanying her, the seizure was of tonic-clonic type, had occurred one hour before presentation to ED, and had lasted 3 minutes. The patient had been drowsy for about 15 minutes after the end of the seizure. She had no history of head trauma and did not mention headache, nausea and vomiting, fever, vision problems or others. On presentation, amnesia regarding the things that happened was evident. In her history, she had a generalized tonic-clonic seizure 4 years back, regarding which she had not done proper follow up for taking necessary diagnostic measures and had not been treated with anti-epileptic medication. She had a history of surgery for removing cold thyroid nodule 20 years ago and was under calcium treatment for 15 years but she had decided to stop taking her medications since 5 year ago. She did not have a history of alcohol or drug abuse. The patient was conscious and awake on presentation and did not have any specific clinical complaints. Her vital signs on presentation were as follows:Blood Pressure = 120/70mmHg, Pulse Rate = 68/minute, Respiratory Rate = 16/minute, O2saturation= 98% at air room, Oral Temperature= 37°C, and bedside blood sugar in the normal range.In head and neck examination, the surgery scar was seen in the thyroid region. Examination of the thyroid also showed a nodular surface in palpation. Examination of the heart, lungs, abdomen and extremities did not have pathologic findings. Neurologic examinations including evaluation of cranial nerves, sense and power of the muscles, cerebellar examination and deep tendon reflexes were normal. Based on the opinion of the in-charge physician, anti-epileptic drugs were not prescribed at this stage. Laboratory tests including complete blood cell count, liver function tests (LFT), and level of blood sugar (BS), sodium, potassium, calcium, phosphorus, magnesium, urea and creatinine electrolytes were ordered. Considering the full consciousness of the patient and stability of vital signs and clinical examinations, by taking safety measures and accompanied by a nurse, the patient was referred to the radiology unit to undergo a brain computed tomography (CT) scan, the results of which are shown in figure 1

The Value of Serum NR2 Antibody in Prediction of Post-Cardiopulmonary Resuscitation Survival

Introduction: N-methyl-D-aspartate receptor subunits antibody (NR2-ab) is a sensitive marker of ischemic brain damage in clinical circumstances, such as cerebrovascular accidents. We aimed to assess the value of serum NR2-ab in predicting the post-cardiopulmonary resuscitation (CPR) survival. Methods: In this cohort study, we examined serum NR2-ab levels 1 hour after the return of spontaneous circulation (ROSC) in 49 successfully resuscitated patients. Patients with traumatic or asphyxic arrests, prior neurological insults, or major medical illnesses were excluded. Participants were followed until death or hospital discharge. Demographic data, coronary artery disease risk factors, time before initiation of CPR, and CPR duration were documented.  In addition, Glasgow coma scale (GCS), blood pressure, and survival status of patients were recorded at 1, 6, 24, and 72 hour(s) after ROSC. Descriptive analyses were performed, and the Cox proportional hazard model was applied to assess if NR2-ab level is an independent predictive factor of survival. Results: 49 successfully resuscitated patients were evaluated; 27 (55%) survived to hospital discharge, 4 (8.1%) were in vegetative state, 10 (20.4%) were physically disabled, and 13 (26.5%) were physically functional. Within 72 hours of ROSC all of the 12 NR2-ab positive patients died. In contrast, 31 (84%) of the NR2-ab negative patients survived. Sensitivity, specificity, positive and negative likelihood ratios of NR2-ab in prediction of survival were 54.5% (95%CI=32.7%-74.9%), 100% (95%CI=84.5%-100%), infinite, and 45.5% (95%CI=28.8%-71.8%), respectively. Subsequent analysis showed that both NR2-ab status and GCS were independent risk factors of death. Conclusions: A positive NR2-ab serum test 1 hour after ROSC correlated with lower 72-hour survival. Further studies are required to validate this finding and demonstrate the value of a quantitative NR2-ab assay and its optimal time of measurement

Traumatic Dissection of Carotid Artery in a 34-Year-Old Patient Presenting to Emergency Department; a Case Report

دیسکسیون شریان های ناحیه گردن از جمله شریان کاروتید از جمله آسیب های عروقی متعاقب ترومای بلانت ناحیه گردن به شمار می روند. تظاهرات این عارضه معمولا تاخیری بوده و به شکل تظاهرات نورولوژیک خود را نشان می دهد. این عارضه در مجموع عامل حدود 2 درصد موارد انفارکت های مغزی است ولی 20 درصد علل استروک مغزی افراد زیر 45 سال می باشد. با هدف بحث و تاکید بر اهمیت این عارضه، در این مقاله به معرفی یک مورد از بروز دایسکسیون کاروتید مراجعه کننده به بخش اورژانس پرداخته ایم. بیمار خانم 34 ساله ای است که متعاقب همی پارزی چپ و دیزارتری و سردرد که از چند ساعت قبل شروع شده به بخش اورژانس آورده شد که 10 روز قبل سابقه بستری بدلیل تصادف و واژگونی ماشین داشت که بعد از انجام بررسی های لازم، با حال عمومی خوب ترخیص شده بود. در سی تی اسکن مغز شواهد انفارکت ایسکمیک تحت حاد در محدوده شریان مغزی میانی رویت شد. با توجه به سن بیمار و شواهد ایسکمی وسیع و شرح حال ترومای اخیر، با شک به دیسکسیون عروق گردنی جهت بیمار آنژیوگرافی انجام شد و تشخیص دیسکسیون شریان کاروتید مسجل گردید.Dissection of neck arteries including carotid artery is among the vascular injuries following blunt neck trauma. Manifestations of this injury are usually delayed and present as neurological problems. This injury is accountable for about 2% of cerebral infarctions but causes 20% of brain strokes in patients less than 45 years old. Aiming to discuss and emphasize the importance of this injury, in this article a case of carotid dissection presenting to emergency department (ED) is presented. The patient was a 34 year-old woman that visited ED following left hemiparesis, dysartery and headache that had initiated a few hours back. She had a history of hospital admission 10 days before due to car accident and rollover, and had been discharged with good general health following required examinations. In brain computed tomography (CT) scan, there was evidence of sub-acute ischemic infarction around the middle cerebral artery. Considering the age of the patient, evidence of wide ischemia and history of recent trauma, neck artery dissection was suspected and angiography was performed, which confirmed the diagnosis of carotid artery dissection.

Acute Appendicitis in Pregnancy; a Case Study

درد شکم یکی از شایعترین شکایت های دوران بارداری است و بدلیل تشخیص های افتراقی متعددی که به همراه دارد همواره مورد بحث می باشد. هرچند در برخورد با این بیماران تشخیص های مرتبط با شرایط بارداری و پاتولوژی های فضای رحم و اطراف آن در اولویت قرار دارند، ولی هرگز نباید از سایر تشخیص های غیرمرتبط با بارداری که در این دوران تظاهرات متفاوتی از خود نشان می دهند، غافل بود. آپاندیسیت حاد شایعترین عارضه نیازمند جراحی در دوران بارداری است و شیوع آن یک مورد در هر 1500 مورد زن باردار گزارش شده است. به گواه مطالعات موجود آپاندیسیت حاد در دوران بارداری در 35-30 درصد موارد دیر تشخیص داده می شود. این کم توجهی می تواند عوارض وخیمی در پی داشته و موجب مرگ و میر مادر و جنین گردد. ظن بالینی قوی پزشک در کنار استفاده از اقدامات پاراکلینیک مناسب و پیشرفته می تواند از میزان بروز خطا در این زمینه بکاهد. به جهت تاکید بر اهمیت این موضوع به گزارش یک مورد آپاندیست در بارداری پرداخته ایم.Abdominal pain is one of the most common complaints during pregnancy, which is constantly debated due to its numerous differential diagnoses. Acute appendicitis is the most common problem requiring surgery during pregnancy and has a prevalence of 1 in 1500 pregnant women. Existing studies have declared that acute appendicitis during pregnancy is diagnosed with delay in 30 - 35% of cases. This can have severe side effects and may even lead to death of the mother or fetus. Strong clinical suspicion of the physician in addition to taking proper advanced paraclinical measures can reduce errors in this regard. To emphasize the importance of this subject, we have reported a case of appendicitis during pregnancy.

Ruptured Abdominal Aortic Aneurism with Atypical Manifestations; a Case Report

پارگی آنوریسم آئورت شکمی عارضه ای با میزان مورتالیتی بالا در مراجعه کنندگان به بخش اورژانس می باشد. علائم شایع آن شامل درد شکم، پشت و پهلوها بوده و هیپوتانسیون و سنکوپ از سایر تظاهرات آن می باشد. ولی گاها این بیماران با تظاهرات نامعمول مراجعه می کنند که با توجه به این مهم، در این گزارش به معرفی بیماری با تظاهرات آتیپیک پرداختیم. تشخیص اولیه این عارضه بر مبنای ظن بالینی بالا و انجام سونوگرافی شکمی بر بالین است. استاندارد تشخیصی سی تی اسکن شکمی در بیماران پایدار از نظر علائم حیاتی است. درمان انجام جراحی باز یا اندوواسکولار است و تاخیر در درمان با مرگ و میر بسیار بالایی همراه خواهد بود.Abdominal aortic aneurysm is a condition with a high mortality rate among those presenting to the emergency department. Its common symptoms include abdominal, back, and flank pain and hypotension and syncope are among its other manifestations. However, sometimes these patients present with uncommon manifestations. Considering this important point, we have introduced a patient with atypical manifestations in the present report. Initial diagnosis of this condition is based on high clinical suspicion and performing bedside abdominal ultrasonography. Diagnostic standard is abdominal computed tomography (CT) scan in patients with stable vital signs. The treatment is performing endovascular or open surgery and delay in treatment is accompanied with a high rate of mortality.

Présence de Frambocythere COLIN, 1980, (ostracode limnique) dans le Maastrich-tien des Monts du Zagros, Iran : un nouveau relais entre l'Europe méridionale et l'Extrême-Orient

L'ostracode limnique Frambocythere tumiensis zagrosensis nov. subsp. (Limnocytheridae, Timiriaseviinae) a été trouvé pour la première fois en Iran. Les niveaux contenant cette espèce pro-viennent de la partie inférieure de la Formation de Tarbur dans les Fars intérieurs des Monts Zagros. L'âge maastrichtien est donné par les rudistes, les grands foraminifères (Omphalocyclus macroporus, Loftusia spp.) et les foraminifères planctoniques (Zone à Contusotruncana contusa-Racemiguembelina fructicosa) dans les niveaux de la partie supérieure de la Formation de Tarbur. L'âge maastrichtien est aussi conforté par la présence dans les mêmes niveaux des charophytes Platychara shanii, Peckichara cristellata et Stephanochara cf. producta. Le genre Frambocythere COLIN, 1980, n'était jusqu'à présent connu que du Maastrichtien supérieur à l'Éocène moyen en Europe méridionale, Inde et Chine, ainsi que dans l'Albien de la République Démocratique du Congo. La présence de Frambocythere gr. tumiensis en Iran est donc un nouveau relais entre l'Europe méridionale et l'Extrême-Orient (Chine).The limnic ostracode Frambocythere tumiensis zagrosensis subsp. nov. (Limnocytheridae, Timiriaseviinae), has been found for the first time in Iran. The strata containing this species are in the lower part of the Tarbur Formation in the interior Fars of the Zagros Mountains. The Late Maastrichtian age is indicated by rudists, larger foraminifers (Omphalocyclus macroporus, Loftusia spp.) and plank-tonic foraminifers(Contusotruncana contusa-Racemiguembelina fructicosa Zone) present in the upper part of the Tarbur Formation. The Maastrichtian age is confirmed by the occurrence in the same strata of the charophytes Platychara shanii, Peckichara cristellata and Stephanochara cf. producta. The genus Frambocythere COLIN, 1980, was until now known mostly from the Upper Maastrichtian to Middle Eoce-ne of southern Europe, India and China, as well as the Albian of the Democratic Republic of Congo. The presence of Frambocythere gr. tumiensis in Iran is therefore a newly recognized link between southern Europe and the Far East (China)

Preparation and Characterization of Undecylenoyl Phenylalanine Loaded-Nanostructure Lipid Carriers (NLCs) as a New α-MSH Antagonist and Antityrosinase Agent

Purpose: The aim of this study was to characterize the undecylenoyl phenylalanine (Sepiwhite (SEPI))-loaded nanostructured lipid carriers (NLCs) as a new antimelanogenesis compound. Methods: In this study, an optimized SEPI-NLC formulation was prepared and characterized for particle size, zeta potential, stability, and encapsulation efficiency. Then, in vitro drug loading capacity and the release profile of SEPI, and its cytotoxicity were investigated. The ex vivo skin permeation and the anti-tyrosinase activity of SEPI-NLCs were also evaluated. Results: The optimized SEPI-NLC formulation showed the size of 180.1±5.01 nm, a spherical morphology under TEM, entrapment efficiency of 90.81±3.75%, and stability for 9 months at room temperature. The differential scanning calorimetry (DSC) analysis exhibited an amorphous state of SEPI in NLCs. In addition, the release study demonstrated that SEPI-NLCs had a biphasic release outline with an initial burst release compared to SEPI-EMULSION. About 65% of SEPI was released from SEPI-NLC within 72 h, while in SEPI-EMULSION, this value was 23%. The ex vivo permeation profiles revealed that the higher SEPI accumulation in the skin following application of SEPI-NLC (up to 88.8%) compared to SEPI-EMULSION (65%) and SEPI-ETHANOL (74.8%) formulations (P<0.01). An inhibition rate of 72% and 65% was obtained for mushroom and cellular tyrosinase activity of SEPI, respectively. Moreover, results of in vitro cytotoxicity assay confirmed SEPI-NLCs to be non-toxic and safe for topical use. Conclusion: The results of this study demonstrate that NLC can efficiently deliver SEPI into the skin, which has a promise for topical treatment of hyperpigmentation

Global prevalence of suicide in patients living with HIV/AIDS: a systematic review and meta-analysis

Background: In fact, people living with HIV are at a greater risk of mental health disorders. Based on lack of necessary information in this area the present systematic review and meta-analysis study was conducted to determine the magnitude of committed suicides among HIV/AIDS people as well as their associated factors in a global setting. Method: Firstly we registered the protocol of study in PROSPRO. Then the publications were searched in the 4 main databases from January 2000 to April 2022. After removing duplication and inappropriate studies we applied inclusion and exclusion criteria. Finally 60 studies were included for analysis. Comprehensive meta-analysis software were used for analyzing. Results: After reviewing 60 articles published from January 2000 to April 2021 in 24 countries, the total prevalence rate of suicide among 61,904 patients was estimated at 0.249 (95 % CI, 0.2–0.306). Findings indicated that the highest suicide prevalence was related to single patients estimated at 0.257 (95 % CI, 0.184–0.347). A gender-based meta-analysis depicted that the prevalence of suicide/ suicidal ideation was higher among females estimated at 0.22 (95 % CI, 0.15–0.29) compared with men at 0.17 (95 % CI, 0.11–0.23). Conclusion: Health planners and policymakers should develop suicide-prevention strategies aimed at female patients in younger age groups who live alone and are deprived of social support to effectively promote their self-efficacy in successful management of the disease. Integrating mental health services into anti-retroviral therapy for HIV/AIDS patients is also suggested in order to effectively design integrated programs for the management of individuals living with HIV/AIDS

Global depression in Breast Cancer patients: systematic review and meta-analysis

Background: Breast cancer is known as one of the most common diseases among women, the psychological consequences of which are common in women and affect various aspects of their lives, so this study aims to investigate the prevalence of depression among women with breast cancer globally. Method: The present meta-analysis was performed by searching for keywords related to breast cancer and depression in 4 main databases: PubMed, Embase, Web of Sciences and Scopus in the period of January 2000 to November 2021 and the results of the study using R and CMA software were analyzed. Results: A total of 71 studies were selected in English and the results of the analysis showed that the prevalence of depression in women with breast cancer is 30.2%, with Pakistan having the highest (83%) prevalence of depression and Taiwan having the lowest (8.3%). And in the WHO regions, EMRO region had the highest (49.7%) rate and SEARO region had the lowest (23%) prevalence of depression. Also, with increasing age, the prevalence of depression among women with breast cancer increases. Conclusion: Community and family support for women with breast cancer, holding psychology and psychotherapy courses, lifestyle modifications and training in this area can be effective in preventing the reduction of the prevalence of depression, and given the pivotal role of women in family affairs, this This can be in line with the work of health system policymakers