A Comparison of Verapamil and Digoxin for Heart Rate Control in Atrial Fibrillation

Purpose: Atrial fibrillation (AF) is one of the most common types of sustained dysrhythmia and there are some disagreements about its treatment. The goals of AF treatment include the control of ventricular rate, the establishment of sinus rhythm and the prevention of thromboembolic events. In this study, the effect of verapamil was compared to digoxin on heart rate control in patients with AF. Methods:This descriptive study was conducted in an emergency department (ED) in Iran. Sixty patients with a new onset AF and rapid ventricular response receiving digoxin or verapamil were included and observed. Results:Two thirty-patient groups receiving verapamil or digoxin were evaluated. The heart rate was significantly decreased in both groups (p = 0.002); however, the cardioversion was not noticed in both of them. The best rate control in verapamil and digoxin groups was observed after 5.9 mg (46.7%) and 0.6 mg (36.7%), respectively. Conclusion: Administration of verapamil in comparison with digoxin has no difference to control the heart rate in AF patients. It should be taken into consideration that prospective randomized studies should be conducted to identify the efficacy and select the best of these two drugs to treat AF patients

Comparison of Glasgow Coma Scale with Physiologic Scoring Scales in Prediction of In-Hospital Outcome of Trauma Patients; a Diagnostic Accuracy Study

Introduction: Limitations of Glasgow coma scale (GCS) led the researchers to designing new physiologic scoring systems such as revised trauma score (RTS), rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS), and worthing physiological scoring system (WPSS). However, it is not yet known whether these models have any advantage over GCS. Objective: The present study attempted to compare the values of 4 physiologic scoring systems including RTS, RAPS, REMS and WPSS with GCS in predicting in-hospital mortality of trauma patients. Methods: The present diagnostic accuracy study was performed on trauma patients presenting to emergency departments of 4 hospitals in Iran throughout 2017. Patients were clinically evaluated and were followed until discharge from hospital. Finally, the status of patients regarding mortality and poor outcome (death, vegetative status, severe disability, and moderate disability) was recorded and predictive value of GCS was compared with physiologic scales. Results: Area under the ROC curve of GCS in prediction of in-hospital mortality was not significantly different from that of REMS (0.89 vs. 0.91; p=0.298), RAPS (0.89 vs. 0.88; p=0.657), and WPSS (0.89 vs 0.91; p=0.168) but was significantly more than RTS (0.89 vs. 0.85; p=0.002). In addition, area under the ROC curves of GCS, REMS, RAPS, WPSS and RTS in prediction of poor outcome were 0.89, 0.88, 0.88, 0.91, and 0.81, respectively. Area under the ROC curve of GCS in prediction of poor outcome did not differ from area under the ROC curves of REMS (0.89 vs. 0.88; p=0.887), RAPS (0.89 vs. 0.88; p=0.601) and WPSS (0.89 vs. 0.91; p=0.113) but was significantly higher than RTS (0.89 vs. 0.81; p<0.0001). Conclusions: Findings of the present study indicated that GCS is still the best method for evaluating injury severity and trauma patients’ outcome in the emergency department; because it is easier to calculate and assess than many physiologic scales and it has a better performance in predicting in-hospital mortality and poor outcome compared to RTS

Formulation and Clinical Evaluation of A Topical Dosage Form of Alkanna orientalis Root Extract for Management of Pressure Lesions: A Pilot Cross-Sectional Clinical Trial

Background: Pressure lesions are chronic wounds causing the development of infection and inflammation into deeper structures and finally necrosis. In Persian medicine, Alkanna orientalis (Boraginaceae) has been used for centuries as a naturally derived remedy for managing lesions. A cross-sectional pilot clinical trial was conducted to assess the wound healing effect of an ointment made of chloroform extract of roots of A. orientalis (CERAO). Methods: Sixty patients (36 men and 24 women) diagnosed with bedsore staging 1-2 entered the study for one year. They were divided into two groups of control and treatment with equal proportions. The control group received conventional treatment from the hospital, including irrigation serum, mupirocin, phenytoin ointments, and gauze dressing. After rinsing and cleansing with normal saline, in the intervention group, patients received a thin layer of CERAO once daily for four weeks. Clinical outcomes were measured at weeks 2 and 4. Results: Recovery assessment was carried out by measuring wound area, days of epithelia formation, and complete wound closure. The difference between the two groups was statistically significant (P-value <0.05) in terms of the mentioned criteria. The recovery percentage was 26.7% and 60% for the control and treatment groups, respectively. In the control group, 16.7% of the study population experienced the development of wounds, while in the intervention group, wound progression was not observed. Conclusion: The results of this pilot study indicated that the clinical efficacy of CERAO could be promising and a replacement for conventional treatment of pressure ulcers

Value of CA-125 Glycoprotein in Predicting Acute Appendicitis; a Diagnostic Accuracy Study

Introduction: Carcinogen antigen 125 (CA-125) is a glycoprotein antigen, which has shown potentials in predicting peritoneal inflammation. The aim of this study is to determine the value of CA-125 in predicting acute appendicitis (AA). Methods: This prospective diagnostic accuracy study was conducted on 15 – 70 year-old patients with acute abdominal pain, suspected to AA, referred to emergency department. The serum level of CA-125 was measured for all patients before appendectomy and its screening characteristics in detection of AA case (confirmed by histology findings) were calculated and reported with 95% confidence interval (CI). Results: 95 patients with the mean age of 31.65 ± 12.9 (15-75) years were studied (54.3% male). Based on the histologic findings, 72 (75.8%) cases were categorized as AA (23 cases as severe). AA and non-AA (NAA) groups were similar regarding the mean age (p = 0.59), mean duration of symptoms (p = 0.08), mean white blood cell (WBC) count (p = 0.37), and mean PMN percentage (p = 0.55).  Mean CA-125 level was 16.5 ± 20.0 U/mL in the AA group and 30.5 ± 6.1 U/mL in the NAA group (p = 0.001). Adjustment of analysis based on gender revealed a significant correlation between CA-125 level and diagnosis of AA only in females (34.23 ± 39 U/mL in NAA versus 20.7 ± 26.7 U/mL in AA, p = 0.012). The area under the ROC curve of CA-125 was 0.62 (95%CI: 0.51 to 0.72). Sensitivity, specificity, NPV, PPV, NLR, and PLR of CA-125 in 16.4 U/mL cut off (best point) were 77.8% (95%CI: 66.4 - 86.7), 50.0% (95%CI: 28.2 - 71.8), 83.6% (95%CI: 76.7 - 88.7), and 40.7% (95%CI: 27.4 - 55.6), 0.44 (95%CI 0.2 - 0.8), and 1.56 (95%CI: 1.0 - 2.4), respectively. Conclusion: Considering the lower levels of CA-125 in patients with AA compared with NAA cases and also weak screening performance characteristics, it seems that it could not be considered as an accurate screening tool in this regard

Cadaver Donation and Bequeathment in Medical Education

Background & Objective: Anatomy is the basis of medical education and is conducted by the dissection of the cadaver. The cadaver is a book which can provide great educational grounds for medical and paramedical students. However, cadaver shortage is one of the most important problems of medical schools in Iran; a subject that, despite high levels of theoretical training of the anatomy, has created problems for the practical training of this science. Methods: In this study, scientific references, articles, and reports have been analyzed to determine the role of cadaver donation and its obstacles and the effect of bequeathment in the elimination of these obstacles. Results: Findings have shown that experiences gained through dissecting cadaver are better and more effective than knowledge obtained from books or models. For more effective education, cadavers are constantly required. Cadaver shortage has been the topic of discussions and complaints of anatomy professors and medical students for consecutive years. Providing cadavers or dissection is a complicated subject which requires cultural training. The provision of unidentified cadavers by morgues can result in both remuneration for the deceased and steps towards the acquiring of knowledge. Conclusion: The field of anatomy can only survive through cadaver donation. Cadaver donation is an actual and effective way to support medical development and facilitate life of future generations. Legal, religious, and cultural obstacles impede cadaver bequest. The elimination of these obstacles is possible through the establishment of cadaver donation institutes, cultural promotion, and creation of motive and awareness in the society. Key Words: Medical education, Cadaver devotion, Educational cadave

The Pattern of Motorcyclists' Death Due to Accidents and a Three-year Forecast in East Azerbaijan Province, Iran

Introduction: In low- and middle-income countries, a large proportion of road users include pedestrians, cyclists, and motorcyclists, and nearly half of road traffic fatalities occur among motorcyclists. This study aimed to examine the pattern of motorcyclists' death due to accidents in East Azerbaijan, Iran between 2006 and 2021 and present a forecast. Methods: We used death data due to motorcycle accidents of Legal Medicine Department between 2006 and 2021. For time series analysis, the Box-Jenkins model was used and three stages of identification, estimation, and diagnosis were successively performed and repeated several times to achieve the best prediction model. The Box-cox transformation method was used to stabilize the variance, and the first-order seasonal differential method with a period of 12 was used to control the seasonality. Due to seasonal variations, the Seasonality Auto-Regressive Integrated Moving Average model: SARIMA (p, d, q) (P, D, Q)s was employed and the death trend was predicted for 36 months. The candidate models were compared based on Log-likelihood, AIC, and BIC indices. STATA 17 was used for data analysis. Results: About 18.6% of all accident deaths are attributed to motorcycle accidents. The death rate for all causes of accidents and motorcycle accidents were 23.13 and 4.30 per 100,000 population, respectively. Seven models were considered as candidates. The SARIMA (0, 0, 0) (1, 1, 1)12 model was selected as the best model due to better fit and used to predict the number and trend of motorcycle accident deaths. Motorcycle accident deaths are predicted to decrease gradually in the next 36 months, from June 2021 to May 2024, affected by seasonal changes. Conclusion: The trend of death due to motorcycle accidents from 2006 to 2021 in East Azerbaijan was declining, and it is predicted to decrease slightly in the next three years as well. As this reduction may be attributed to many factors, it is recommended to investigate effective factors in future studies

Cosmetic Breast Implants and the Risk of Suicide: A Systematic Review and Meta-Analysis

Objective: Having cosmetic breast implants increases a woman's chance of suicide, which is now a global challenge. This systematic review evaluated the possible risk of suicide among women who undergo cosmetic breast implants. Method: This meta-analysis was done based on Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). In the current systematic review and meta-analysis, we systematically searched for all articles written in both English or Persian that estimated the prevalence of suicidal ideation in women who had cosmetic breast implants. We systematically searched different databases, including MEDLINE (PubMed), Web of Science, Embase, Cochrane, Library ProQuest, Scopus, and Google Scholar, from inception to March 2021. There was also a search for references. Suicidal ideation, a suicide plan, or suicide attempts were the outcomes. In order to determine the total pooled prevalence of suicidal ideation, we utilized a random-effects model. To examine the risks of bias in each study, we applied the Joanna Briggs Institute Critical Appraisal method. Results: We identified 218 citations in our initial search. After omitting duplicated citations and excluding irrelevant studies according to the title and abstract selection, 42 studies were chosen for the full text analysis. Finally, 11 research, examining a total of 324,332 women were incorporated into the systematic review and critical appraisal assessment. Eight of these studies were found to be eligible for meta-analysis. The frequency of suicide in women with cosmetic breast implant was 0.2% (95% CI: 0.1% to 0.4%; P < 0.001) (Q-value: 168.143, I2:95.83). Most of the included studies had moderate quality. Conclusion: There might be a correlation between cosmetic breast implants and suicide risk, which could be stronger in the presence of a history of mental illnesses. The evidence about the possible effects of breast implants on the risk of suicide is still inconclusive, and there is a need for future well-designed studies on this topic

Comparing the Effect of Conventional and Team Triage Methods on Emergency Department Performance Indicators

Background. Effective triage is a viable solution to improve performance indicators in the emergency department. This study aimed to compare the effect of conventional triage and team triage methods on the performance indicators of emergency department. Methods. In this descriptive cross-sectional research, all 749 patients referred to the emergency department of Tabriz Sina Hospital were triaged using conventional and team methods for two consecutive weeks in July 2020. A researcher-made checklist was used to collect emergency performance indicators. The data were extracted from patient records and recorded in the checklist. Data analysis was performed using descriptive statistics, Chi-square and Mann-Whitney tests in the SPSS.19 software. Results. Among the patients, 86.9% in the triage group using the conventional method (52.7% female) and 86.7% in the group using the team method (52% female) were older than 40 years. The results showed that in the team triage group, the number of temporarily hospitalized patients was significantly higher and the frequency of self-responsible exit was lower compared to the conventional method. In addition, the waiting time for patients triaged with the team method was shorter, and the difference in values was significant for all three triage levels. Conclusion. According to our results, team triage had a more positive effect on improving emergency performance indicators compared to the conventional method. Therefore, it is recommended to consider this method in hospital emergency departments to provide better services and increase patient satisfaction

Reliability of Platelet Indices for Diagnosing Pulmonary Embolism; a Brief Report

Introduction: Early diagnosis of pulmonary thromboembolism (PTE) is crucial in clinical medicine. Many para-clinical measurements are used to diagnose PTE. Objective: The present study was conducted to evaluate platelet indices in terms of diagnosing PTE. Methods: The present case-control study was conducted between September 2015 and September 2016 with 173 patients suspected of PTE in the emergency wards of Shahid Madani Hospital and Imam Reza Hospital affiliated to Tabriz University of Medical Sciences, Iran. The patients’ platelet indices were checked upon admission and they were evaluated in terms of diagnosing PTE. Platelet indices included mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PL-CR). PTE was diagnosed in 125 out of the 173 patients. Platelet indices were also compared between two groups. Results: No statistically significant differences were observed between the two groups in term of demographic variables (P>0.05). MPV was found to be 10.38±8.59 in the case group and 9.46±1.11 in the controls (P˃0.05). PDW was also found to be 12.86±5.57 in the case group and 12.32±2.48 in the controls (P>0.05). Moreover, PL-CR was found to be 22.59±7.32 in the case group and 21.97±8.16 in the controls (P>0.05). Conclusion: According to the obtained results, platelet indices do not increase in PTE. They cannot be therefore used to diagnose PTE in suspected patients

Epidemiological and clinical status of patients with scorpion sting: emergency department of Sina hospital in Tabriz-Iran

Objective: Scorpion is one of the world’s most venomous arthropods and every year many people are bitten by it. In Iran, scorpion sting is a common health issue. The aim of this study was to evaluate the epidemiological and clinical status of patients with scorpion sting in the emergency department of Sina hospital in 2014. Methods: In this descriptive cross-sectional study, all patients with a history of scorpion sting during 2014 in the emergency department of Sina hospital in Tabriz entered the study. Required information such as sex, age, location and time of the sting, the patient’s symptoms, etc were extracted from the medical records. These findings were analyzed using SPSS version 15. Results: Based on our results, 47.2% of patients were male. The mean ± SD of their age was 35.63 ± 18.87. Of 176 patients, 83% lived in urban areas, 87% of scorpion sting cases occurred in houses, and 81.3% of stings were done by yellow scorpion. Most of the bites were in upper extremities (47.2%). In evaluation of symptoms and signs of patients, 89.8% had pain, 48.8% had local erythema and redness, 21% had inflation of sting position and 0.6% had pulmonary symptoms. Conclusion: Scorpion stings are more common in young people as they are more active. Scorpion stings occur more frequently during the night and in the summer. In our study, most of scorpion stings occurred in houses