Agreement of Cerebral State Index and Glasgow Coma Scale in Brain-Injured Patients

Background: Variables derived from electroencephalogram like cerebral state index (CSI) have been used to monitor the anesthesia depth during general anesthesia. Observed evidences show such variables have also been used as a detector of brain death or outcome predictor in traumatic brain-injured (TBI) patients. Objectives: The current study was designed to determine the correlation between Glasgow coma score (GCS) and CSI among TBI patients. Patients and Methods: In 60 brain-injured patients who did not need and receive sedatives, GCS and CSI were daily measured during the first ten days of their hospital stay. Correlation between GCS and CSI was studied using the Pearson's correlation test. The Gamma agreement coefficient was also calculated between the two variables for the first day of hospitalization. Results: A significant correlation coefficient of 0.611-0.796 was observed between CSI and GCS in a ten-day period of the study (P < 0.001). Gamma agreement coefficient was 0.79 ( P < 0.001) for CSI and GCS for the first day of hospitalization. An increased daily correlation was observed in both CSI and GCS values. However, this increase was less significant in CSI compared with the GCS. Conclusions: A statistically significant correlation and agreement was found between GCS and CSI in the brain-injured patients and GCS was also found to be more consistent and reliable compared with CSI

Types and Causalities in Dead Patients Due to Traumatic Injuries

Background: Trauma constitutes a major public health problem in our country and contributes significantly to unacceptably high morbidity and mortality. Objectives: This study aimed to evaluate the epidemiology of trauma in dead patients referred to Shahid Rajaee Trauma Hospital, Shiraz, Iran. Patients and Methods: In a cross-sectional study, all patients with trauma admitted to our center were enrolled between March 2011 and February 2012. Age, gender, months of referring, causalities, and injured body parts of the victims were extracted from the data registry and analyzed. Results: A total of 9113 patients, including 7163 (78.6%) males and 1950 (21.4%) females were evaluated. Among them, 479 patients (5.3%) had died. There was a significant difference between the age of alive and dead patients (35.70 ± 0.18 and 45.44 ± 1.01 years, respectively (P < 0.001)). In addition, dead men had significantly higher percentage than alive men (83.7% and 78.3%, respectively, P = 0.005). The highest percentages of men and women who referred to our center and died were in September. Crashing by car had the most frequency of dead (247 cases) in referred patients and motorcycle accident, stabbing, and falling related injuries with 67, 36 and 26 dead cases were in the next ranks. Thorax injury had the most frequency between dead patients (53.2% of all dead) and the intracranial injury and trauma to extremities altogether were in the next ranks, which constituted more than 18.8% of all dead. Conclusions: Our data demonstrated that car and motorcycle accidents are the most important cause of trauma and thorax trauma had the most frequency among dead patients. Epidemiological evaluations and preventive measures such as this study should be conducted to provide valuable data

Comparison of the CES-D and PHQ-9 depression scales in people with type 2 diabetes in Tehran, Iran

<p>Abstract</p> <p>Background</p> <p>The quality of life in patients with various chronic disorders, including diabetes has been directly affected by depression. Depression makes patients less likely to manage their self-care regimens. Accurate assessment of depression in diabetic populations is important to the treatment of depression in this group and may improve diabetes management. To our best knowledge, there are few studies that have looked for utilizing questionnaires in screening for depression among patients with diabetes in Iran. Therefore the aim of this study was to assess the efficacy and accuracy of the Center for Epidemiological Studies Depression (CES-D) scale and the Patient Health Questionnaire-9 (PHQ-9), in comparison with clinical interview in people with type 2 diabetes.</p> <p>Methods</p> <p>Outpatients who attended diabetes clinics at IEM were recruited on a consecutive basis between February 2009 and July 2009. Inclusion criteria included patients with type 2 diabetes who could fluently read and speak Persian, had no severe diabetes complications and no history of psychological disorders. The history of psychological disorders was ascertained through patients' medical files, taking history of any medications in this regard. The study design was explained to all patients and informed consent was obtained. Volunteer patients completed the Persian version of the questionnaires (CES-D and PHQ-9) and a psychiatrist interviewed them based on Structured Clinical Interview (SCID) for DSM-IV criteria.</p> <p>Results</p> <p>Of the 185 patients, 43.2% were diagnosed as having Major Depressive Disorder (MDD) based on the clinical interview, 47.6% with PHQ-9 and 61.62% with CES-D. The Area Under the Curve (AUC) for the total score of PHQ-9 was 0.829 ± 0.30. A cut-off score for PHQ-9 of ≥ 13 provided an optimal balance between sensitivity (73.80%) and specificity (76.20%). For CES-D the AUC for the total score was 0.861 ± 0.029. Optimal balance between sensitivity (78.80%) and specificity (77.1%) was provided at cut-off score of ≥ 23.</p> <p>Conclusions</p> <p>It could be concluded that the PHQ-9 and CES-D perform well as screening instruments, but in diagnosing major depressive disorder, a formal diagnostic process following the PHQ-9 and also the CES-D remains essential.</p

Detecting unilateral phrenic paralysis by acoustic respiratory analysis

The consequences of phrenic nerve paralysis vary from a considerable reduction in respiratory function to an apparently normal state. Acoustic analysis of lung sound intensity (LSI) could be an indirect non-invasive measurement of respiratory muscle function, comparing activity on the two sides of the thoracic cage. Lung sounds and airflow were recorded in ten males with unilateral phrenic paralysis and ten healthy subjects (5 men/5 women), during progressive increasing airflow maneuvers. Subjects were in sitting position and two acoustic sensors were placed on their back, on the left and right sides. LSI was determined from 1.2 to 2.4 L/s between 70 and 2000 Hz. LSI was significantly greater on the normal (19.3±4.0 dB) than the affected (5.7±3.5 dB) side in all patients (p = 0.0002), differences ranging from 9.9 to 21.3 dB (13.5±3.5 dB). In the healthy subjects, the LSI was similar on both left (15.1±6.3 dB) and right (17.4±5.7 dB) sides (p = 0.2730), differences ranging from 0.4 to 4.6 dB (2.3±1.6 dB). There was a positive linear relationship between the LSI and the airflow, with clear differences between the slope of patients (about 5 dB/L/s) and healthy subjects (about 10 dB/L/s). Furthermore, the LSI from the affected side of patients was close to the background noise level, at low airflows. As the airflow increases, the LSI from the affected side did also increase, but never reached the levels seen in healthy subjects. Moreover, the difference in LSI between healthy and paralyzed sides was higher in patients with lower FEV1 (%). The acoustic analysis of LSI is a relevant non-invasive technique to assess respiratory function. This method could reinforce the reliability of the diagnosis of unilateral phrenic paralysis, as well as the monitoring of these patients.Peer ReviewedPostprint (published version

Extracellular NAD and ATP: Partners in immune cell modulation

Extracellular NAD and ATP exert multiple, partially overlapping effects on immune cells. Catabolism of both nucleotides by extracellular enzymes keeps extracellular concentrations low under steady-state conditions and generates metabolites that are themselves signal transducers. ATP and its metabolites signal through purinergic P2 and P1 receptors, whereas extracellular NAD exerts its effects by serving as a substrate for ADP-ribosyltransferases (ARTs) and NAD glycohydrolases/ADPR cyclases like CD38 and CD157. Both nucleotides activate the P2X7 purinoceptor, although by different mechanisms and with different characteristics. While ATP activates P2X7 directly as a soluble ligand, activation via NAD occurs by ART-dependent ADP-ribosylation of cell surface proteins, providing an immobilised ligand. P2X7 activation by either route leads to phosphatidylserine exposure, shedding of CD62L, and ultimately to cell death. Activation by ATP requires high micromolar concentrations of nucleotide and is readily reversible, whereas NAD-dependent stimulation begins at low micromolar concentrations and is more stable. Under conditions of cell stress or inflammation, ATP and NAD are released into the extracellular space from intracellular stores by lytic and non-lytic mechanisms, and may serve as ‘danger signals–to alert the immune response to tissue damage. Since ART expression is limited to naïve/resting T cells, P2X7-mediated NAD-induced cell death (NICD) specifically targets this cell population. In inflamed tissue, NICD may inhibit bystander activation of unprimed T cells, reducing the risk of autoimmunity. In draining lymph nodes, NICD may eliminate regulatory T cells or provide space for the preferential expansion of primed cells, and thus help to augment an immune response

Assessing the Relationship between Leadership Styles and Organizational Health in Ilam's Teaching Hospitals in 2018

Background: leadership style is one of the factors affecting organizational health. Therefore, it has been considered as one of the clearest indicators of organizational effectiveness. Leadership is a part of nursing skills that plays an essential role in providing good health services. Aim: This study aimed to determine the relationship between leadership styles and organizational health in Nurses of Teaching Hospitals affiliated to Ilam University of Medical Sciences. Methods: This descriptive-correlational study was conducted on 110 nurses from Teaching Hospitals in Ilam, 2018. To collect data, an assessment battery including Bass and Avolio's Multifactor Leadership Questionnaire (2004) consisting of 45 items and Hoy and Tarter's Organizational Health Inventory (1997) consisting of 44 items were used. The data analysis was performed using descriptive statistics and analytical tests ( Pearson's and Spearman's correlation coefficients). Results: The findings demonstrated that the prevailing leadership style in the teaching hospitals was the transactional leadership style (2.95 +/- 0.72) and the organizational health level (97.38 +/- 21.89) was at an optimum level. Also, Pearson's correlation coefficient indicated a significant relationship between leadership styles and organizational health (p <0.005, r = 0.29). Regarding the direct relationship between leadership style and organizational health based on the results of this study, it can be suggested that nursing managers choose transactional leadership style and take steps toward its implementation in order to increase organizational health in their managed centers

Effects of Ascorbic Acid on Growth and Photosynthetic Pigments of Basil under Arsenic Toxicity

This study was conducted to investigate the effects of different concentrations of ascorbic acid (0, 10 and 20 mM) on growth, fresh and dry weight of basil under different levels of arsenic (0, 40, 80 and 120 mg.kg-1 of soil) in pots. The experiment was factorial based on a randomized complete block design with three replications. It was carried out in greenhouse at the Faculty of Agriculture, University of Zabol. All growth characteristics, fresh and dry weight of shoots and roots and photosynthetic pigments of plants treated with arsenic decreased. Application of ascorbic acid, especially at concentration of 20 mM, could increase the amount and activity of photosynthetic pigments in basil which resulted, in reducing the negative effects of arsenic and an increase on leaf area, fresh and dry weight of shoot as compared with those of control (non-application of ascorbic acid). Foliar application of ascorbic acid did not have significant effect on plant height, fresh and dry weight of roots and leaves as compared with those of the control

How properties of cellulose acetate films are affected by conditions of iodine-catalyzed acetylation and type of pulp

The present study has been carried out to consider the effect of acetylation conditions and type of bleached pulps [Kraft and SO2–ethanol–water (SEW) pulps] on the properties of obtained cellulose acetates (CA) and their films. The acetylation reaction in the absence of solvent was performed by using acetic anhydride and iodine as a catalyst. The efficiency of acetylation and the degree of substitution, crystallinity, transparency, tensile strength, young modulus, differential scanning calorimetry, water vapor permeability (WVP), scanning electron microscope and atomic force microscopy images were studied. The results showed that the while the Young’s modulus and transparency increased by up to 8% of the catalyst due to the increase in iodine charge; higher iodine levels led to embrittlement of the film. The increase in the ratio of acetic anhydride to pulp (A:P) from 10:1 to 20:1 with 4% catalyst led to a reduction of the DS by 8–10%, the crystallinity by 25%, the Young’s modulus by 13–25%, and transparency by 1–34% of a CA obtained from SEW and Kraft pulp, respectively. With the use of higher amounts of the catalyst (8%) and a ratio of A:P equal to 20:1, all properties of CA were suitable for film preparation. WVP of films from Kraft pulp and SEW pulp showed a decrease of about 8.5% and 18% respectively when increasing the iodine amount from 4 to 8% in acetylation. The tensile strength of CA films was initially increased by enhancing the amount of iodine, but then reduced in a similar way to other properties. The condition of acetylation can be adjusted to produce a high-quality CA film according to the characteristics of the pulp used as raw material.Peer reviewe