[Comparison of serum zinc level in the coronary artery disease patients with healthy volunteers]

Several studies have demonstrated that zinc plays an important role in the development of cardiovascular diseases in Western populations. But there are limited data for other racial groups. This study aimed to investigate the association between serum zinc and coronary artery disease [CAD] in Iranian population. This descriptive-analytical study was conducted on 81 individuals, aged 30 to 70 years, referred to Dr. Heshmat Hospital of Guilan, northern Iran, for routine coronary angiography. Based on the coronary angiogram results, the participants were assigned into 2 groups; 41 CAD patients in case group and 40 healthy ones in control group. Furthermore, data about smoking habit, physical activity and anthropometric indices were collected by questionnaire and using standard protocols. Serum zinc was measured by atomic absorption spectroscopy. The mean serum zinc concentration in the case and control group were 73.50 +/- 1.61microg/dl and 78.47 +/- 1.66microg/dl, respectively. The mean serum zinc concentrations were significantly lower in case group than that in the controls [p<0.05]. Zinc concentration had negative correlation with age [r= -0.23 p<0.05], and positive correlation with weight [r=0.26 p<0.05]. Participants living in rural areas had lower zinc concentration than those in urban [p<0.05]. Serum zinc concentration was significantly lower in Iranian patients with abnormal versus those with a normal angiogram. It seems Serum zinc concentration correlates with some risk factors for coronary artery disease

[ relationship between allergic rhinitis and chronic otitis media]

Allergic inflammation in upper airways can act as a predisposing factor for infectious ear diseases. There are some evidences about the role of allergic rhinitis [AR] in chronic otitis media with effusion, but its role in establishing Chronic Supportive Otitis Media [CSOM] has not been clearly shown. To assess the relationship between allergic rhinitis and CSOM in patients referring to Amiralmomenin hospital, Rasht, Iran. 61 adult patients with established CSOM were considered as case group and 58 patients with minor head and neck trauma as control group, they were evaluated for the presence of allergic rhinitis. All case and control group were over 15 years old and underwent skin prick test for 23 common regional aeroallergens. Allergic rhinitis was defined with positive symptoms and signs of AR and positive skin prick test. Allergic rhinitis was diagnosed in 15[26.20%] and 8 [13.80%] of patients and controls, respectively [P=0.065].By logistic regression equation after corroding the age factor and the difference between two groups became significant [x2=0.026, OR=3.27, CI=1.15 - 6.57]. Indoor allergens, especially mites and molds, were the most prevalent allergens among both groups, but Outdoor allergens like grass pollen have a low prevalence. The prevalence of AR in the CSOM patients is more than the controls

Dental status among urban and rural elderly of Talesh [2009]

The geriatric population is the most rapidly growing segment of the society regarding the evolution and improvement of health programs. To assess the oral health associated with oral health behavior in independent elderly outpatients referred to public dental health centers in Talesh [Guilan, Iran]. A cross -sectional study with total of 203 elderly patients [+65 years old] were investigated by means of interview and oral examination. Based on a simple cluster sampling, the demographic information, oral behavior, dental status, and systemic conditions were noted. Clinical examinations were conducted by a specialist in oral medicine on the basis of WHO criteria in urban and rural dental centers of Talesh. Statistical tests including the chi-square test, t-test, and the logistic regression were employed to analyze the data using the SPSS version 17. The mean age was 72 +/- 6.44 years with an age range from 65 to 79 years old. Of total patients, 125 [61.5%] were males and 78 [38.4%] females with 102 cases from urban and 101 from rural areas. Furthermore, 160 patients [more than two third of cases] were completely without teeth among those 95% with dentures and 10 without denture. The mean numbers of remaining teeth in partially dentate people were 7.34 +/- 4 and 95% found to have root caries vs. 18.5% with coronal caries. Oral hygiene practices such as times of tooth brushing, inter-dental cleaning, and toothpaste use were significantly higher in urban than the rural residents. Sixty seven percent had at least one general health problem and hypertension was more prominent among both the female and rural people [p<0.00l]. Moreover, diabetes mellitus was dramatically more prevalent among females [p<0.004] than males. On account of this study, more than two third of the population were edentulous. Under such circumstances, routine oral examination as part of health program with or without welfare services in elderly people is recommended

[Postoperative mortality and morbidity of carotid endarterectomy in patients with carotid stenosis]

Carotid stenosis is the most common cause of cerebrovascular accidents. If we select the patients appropriately, carotid endarterectomy would be acceptable regarding to mortality and morbidity for vascular complications. Since, carotid endarterectomy related complication is dependent on experience, equipment and facilities of surgical team, each surgical ward should be evaluated for complication separetely. Evaluating the postoperative mortality and morbidity and complication of carotid endarterectomy in patients with carotid stenosis in surgical wards of Razi Hospital in Rasht during September 2006 until end of February 2010. In this descriptive study, 51 patients undergoing carotid endarterectomy in surgical wards of Razi Hospital were recruited. Postoprative complications, mortality and morbidity of carotid endarterectomy were recorded during hospitalization and one month follow up period after discharge. The mean age of patients was 66.69 +/- 10.33. 35 subjects of patients were male and 16 subjects of patients were female. Mortality was reported in one case [%1.96], complication in asymptomatic patient was [%1.96], in symptomatic patient with Transient Ischemic Attack was [1.96%] and in Cerebro Vascular Accident patients was [0%]. Results of this study showed that the rate of mortality and morbidity is acceptable after endarterectomy surgery in Razi hospital in comparison with NASCET. So in order to elevation of quality of surgery in this center, results of surgery should be recorded and analysed every year

[Effect of donepezil on improvement of consciousness in patients with strock]

Strock is the common cause of death after cardiovascular diseases and cancer. Middle cerebral artery occlusion is the most common disease and because of its high extension in brain, the loss of consciousness is more. Donepezil protected neurologic cells. Effect of donepezil on improvement of consciousness in patients with strock. In this double blind clinical trial study 59 patients were selected according to inclusion criteria and filling out the consent form. They randomly divided to two groups: 28 patients who received donepezil 5mg daily till 4 weeks the 10 mg daily till 3 months [cases group] and 31 patients who received placebo [control group]. Patients' consciousnesses were registered before and after intervention. Change of consciousness was compared between two groups using spss 10. Improvement, no change and deterioration of consciousness was 26.9%, 46.2% and 26.9% in Donepezil group and 3.6%, 32.1% and 64.3% in placebo group, respectively. [p=0.008]. There was a significant difference between two groups, so Donepezil is significantly effective in improvement of consciousness, reduction of mortality and hospitalization in patients with strock

Tailoring of interventional procedures for HCC patients-review article

One of the most frequent primary malignant tumors in the world is hepatocellular carcinoma [HCC]. Currently, the optimal treatment methods for HCC are hepatic resection and liver transplantation. Unfortunately, surgical therapies are suitable for 20% of patients and those who are not eligible for surgery should undergo interventional therapies. In the past decade, a variety of interventional procedures have been employed for local control of hepatocellular carcinoma [HCC] including transcatheter arterial chemoembolization [TACE] and many tumor ablation techniques, such as percutaneous ethanol injection [PEI], radio-frequency ablation [RFA], percutaneous microwave coagulation therapy [PMC], laser-induced interstitial thermotherapy [LITT], cryoablation, and acetic acid injection. By development of new technologies in imaging and drug delivery, it is likely that in the future patients with HCC will be treated by combination therapies to improve patient survival. Computed tomography [CT] and magnetic resonance imaging [MRI] have a crucial role in diagnosis and also follow-up of HCC patients treated by interventional procedures, by which the treatment efficacy, recurrence of disease and certain complications are evaluated. In this review article, we discuss the imaging modalities and also tailoring of interventional procedures for HCC patients

CT cavernosography: a new method for evaluating venous incompetence in impotent patients

Cavernosography is traditionally recognized as an imaging modality for evaluation of venous leakage in impotent men. We introduce CT cavernosography as a novel method for demonstrating leaking veins. Sixty-seven patients diagnosed as venous incompetence by Doppler study, and eight normal subjects were enrolled into the study. After intracavernosal injection of papaverine, normal saline was injected into the corpora cavernosa and the injection rate was gradually increased and the penis was observed to obtain the injection rate causing erection. Then contrast media was injected into the corpus cavernosum with obtained injection rate followed by CT scan of the penis and pelvis. In the first group, 63 patients [94%] had venous leakage by CT cavernosography. In this group, full erection was observed at the rate of 36 ml/min of saline injection in three patients and 24 ml/min in one patient. In 46 patients [73%], erection was induced with saline injection at the rates of 48-120 ml/min, and in 17 patients [27%] no full erection was demonstrated even at the injection rate of 120 ml/min. In the 2nd group we observed full erection after saline injection at the rates of 36 ml/min and 24 ml/min in five and three patients, respectively. Beside the capability of CT source images in precise visualization of all leaking veins without superimposition of bony structures, different techniques of two- or three- dimensional reformation enable us to demonstrate the anatomy of the penis and the leaking veins elegantly for further surgical planning

Comparison of doppler ultrasonographic findings in complicated and uncomplicated lower-limb varicose veins

Comparing anatomicopathologic findings in complicated and uncomplicated lower-limb varicose veins by ultrasonography. Totally, 231 consecutive patients [148 [64%] men; mean age, 46.8 +/- 14.3 years [range: 16-88 years]]; 155 [54%] left and 132 [46%] right variceal legs were evaluated by Doppler ultrasonography with color-flow imaging using a 7.5-10 MHZ linear probe. The lower extremity venous system [including perforators and valves] were evaluated in the supine and standing position, at rest and during Valsalva's maneuver. Chi square and Fischer's exact tests were used for statistical analysis. We also performed a logistic regression analysis considering presence of any type of complication as the dependent variable and anatomic pathologies as independent variables. Of the 287 limbs with varicose veins, 124 [43%] had at least one complication [ulceration, pigmentation or infection]. The highest complication rate was seen simultaneously with chronic deep vein thrombosis [DVT] with segmental obstruction [76.9] and the lowest complication rate in the incompetent valves was seen in patients with perforan vein reflux [50.4%]. Mostly, the complication rate was higher in patients with the pathology in comparison to patients without it [p values<0.005]. In a multivariate logistic regression model, presence of DVT and saphenofemoral incompetency were statistically significant in the model in comparison to other pathologies [OR=10.6 and 7, respectively, p values<0.02]. In 175 patients [75.8%] one of the legs were involved Presence of ulcer, pigmentation and infection are significantly associated with a higher incidence of DVT, deep vein, saphenofemoral and saphenopopliteal incompetency in patients with lower limb varices

Carotid doppler ultrasonography in preoperative assessment of coronary artery bypass graft surgery in an Iranian population: association between atherosclerosis risk factors and carotid stenosis

The aim of this study was to assess the frequency of significant carotid artery stenosis and its association with the cardiovascular risk factors in a group of Iranian candidates for CABG. Three hundred and one patients with critical coronary artery disease, who were candidates for coronary artery bypass graft [CABG] were evaluated by internal carotid Doppler study. The relations between age, gender, hypertension, diabetes mellitus, smoking, lipid profile, left main coronary stenosis greater than 50% by diameter and coronary artery disease with carotid stenosis were assessed. Significant carotid stenosis greater than 70% was detected in 13 patients [4.3%]. According to the meaningful relationship between significant carotid stenosis and low HDL serum level [lower than 45 in women and lower than 35 in men, p=0.028], hypertension [p=0.021], history of smoking [p=0.026] and left main coronary artery stenosis greater than 50% [p=0.035], they were identified as risk factors valuable enough to guide for selective screening. Among all cardiovascular risk factors. It seems that serum HDL, smoking, left main coronary stenosis and hypertension could be associated with significant carotid artery stenosis in CABG candidates

Evaluation of CT scan and MRI findings of pathologically proved gliomas in an Iranian population

The aim of this study was to report the main CT scan and MRI findings of gliomas in a group of Iranian patients. The MRI and CT scan of 96 pathologically proven patients of gliomas were retrospectively evaluated in a period of five years in our university affiliated hospital. We included all cases who had both CT scan and MRI in our study. Among our patients, 60 [62.5%] were male and 36 [37.5%] were female. The mean age of our patients was 41.8 +/- 19.3 [7-78]. The most common location of tumor was in the parietal lobes [54.2%] followed by the temporal lobes [52.1%], and the frontal lobes [39.6%]. The most common subtype was glioblastoma multiform in 42 patients [43.8%]. Edema, cystic formation, and hemorrhage were more frequently found in MRI in comparison with CT scan, while CT scan showed calcification better than MRI. In contrast to many other studies, the most common site of gliomas in our patients was parietal lobes

Prevalence of vitamin d deficiency among medical staff in shahid sadoughi hospital in Yazd, Iran

Vitamin D deficiency is one of the major health problems and has a high unexpected prevalence in sunny countries ie, Middle East. In this study we determined the prevalence of vitamin D deficiency in medical staff in Shahid Sadoughi hospital affiliated to Yazd University of Medical Sciences. Our study emphasized the awareness of the medical staff on their own deficiency which is the first step to combat it. In a cross-sectional study, 82 medical personnel of Shahid sadughi hospital [August-September, 2005] were studied. The data were collected by questionnaire and blood sampling was done to measure serum 25 [OH] vitamin D by ELIZA method. Vitamin D deficiency was determined at the level of 25 [OH] D < 20 ng/ml. The prevalence of vitamin D deficiency according to the above definition was 78%.We observed a high prevalence of vitamin D deficiency among medical staff that is a health problem in this sunny city and has significant public health implications

[Survey the ratio of random urine protein to creatinine and 24 hours urine protein as a alternative method for diagnosis of preeclampsia]

Abstract Introduction: Preeclampsia is the most common complication of pregnancies and one of the three major causes of maternal mortality. So diagnosis of disease and minimizing the complications on mother and newborn is very important

Objective: Determine the association between the ratio of random urine protein to creatinine and 24-hour urine protein in women with suspected preeclapmsia who referred to Alzahra hospital

Materials and Methods: Sixty women with suspected preeclampsia at>20 weeks of gestation were studied prospectively. The ratio of protein to creatinine and 24-hour urine protein was obtained. Data were analyzed by t-test, Pearson correlation and ROC curve

Results: Thirty five percent of the studied population had significant proteinuria. There was a significant moderate correlation between the ratio of protein to creatinine and 24-hour total protein [r=0.511, p-value< 0.0001]. The area under the curve was 82% [%95 CI, 0.72-0.93]. The data suggest that a cut-off equal or more than 0.22 has the most sensitivity, specifity, and predictive value

Conclusion: According to the results, the ratio of random protein to creatinine was not moderately correlated with the standard test of 24-hour urine protein and can not be performed as the alternative method for diagnosis of preeclampsia

[Determine the attitude about community based participatory research in people residing in Ali Abad]

Introduction: Participatory research as performing research by involving all people, need to public participation, so determining the attitude of people toward this topic is important

Objective: Determine the attitude about Community Based Participatory Research in People Residing in Ali Abad

Materials and Methods: This descriptive cross sectional study was performed on 178 people residing in Aliabad with a convenient sampling method. A structured questionnaire comprised of attitude statement and demographic characteristics was used for data collection and completed self administered by participants. The validity of attitude statements was determined by faculty members and reliability was measured by Cronbach's alpha greater than 0.7. T-test was applied for data analysis using SPSS program

Results: The mean attitude score was 45.56 [95% CI: 44.74-46.38]. Furthermore the mean attitude in empowering category with 20 maximum score was 10.77 [95% CI: 10.77-11.48], removing community problem with 15 maximum score was 9.11 [95% CI; 8.84-9.38], community participation with 25 maximum score was 16.12 [95% CI; 15.74-14.49] and community confidence with 15 maximum score was 9.0[8.64-9.37]. Participant attitude toward community based participatory research was statistical significantly associated with respondents membership in population research center [P<0.05]

Conclusion: The most important factor in successfully administrating community base programs is the community participation. The findings of this study indicate the importance of community based participatory research for community

[Effects of zinc supplementation on the physical growth of 2-5 years old children]

Physical growth disorder in children, aged under 5-years, is a common health problem in developing countries, including Iran, where national studies have shown that the prevalence of stunted growth disorder is approximately 15 percent. The aim of this study was to determine effects of supplemental zinc on physical growth in children with retarded growth. The study was a 12-month community-based RCT which incorporated 6 months of zinc supplementation to 2-5-year-old children with height-for-age index less than the 25th percentile of NCHS [n=90]; children were assigned randomly into either the Zinc Group receiving 5 ml of a solution containing 5 mg of zinc as zinc sulfate [ZG, n=40] or the Placebo Group who received placebo [PG, n=45] daily [7d/wk] for 6 months. The children's weight, height, mid-upper arm, Z-score for height for age, weight for age and weight for height were measured at baseline and monthly for 12 months. Data were analyzed by the SPSS statistical package. Student-t test was used for comparing the means and chi-square and Fisher's exact test were performed to compare categorical variables. Eighty-five children completed [55.3% girls, 44.7% boys] the study supplementation; compliance with supplement consumption was 95-100% and the two groups were not significantly different. The means of total weight increments [Kg] among girls in the PG and ZG groups were 2 +/- 0.9 and 2.6 +/- 1.1 [PV=0.05], respectively and for boys were 2.1 +/- 0.8 and 2.7 +/- 0.8 [PV=0.04], respectively. The mean of total mid arm circumference increments [Cm] among girls in the PG and ZG groups were 1.23 +/- 0.46 and 1.7 +/- 0.51 [PV=0.8], respectively; these figures for boys were 1.43 +/- 0.51 and 1.19 +/- 0.39 [PV=0.1], respectively. The means of total height increment [Cm] among girls, in the PG and ZG groups were 8.28 +/- 2.23 and 9.64 +/- 1.7 [PV=0.02], respectively; these figures for boys were 8.34 +/- 3.14 and 11.7 +/- 1.96 [PV=0.001], respectively. At baseline, stunted rates in the ZG and PG groups were 26.7% and 15% respectively [NS]. However, these rates in the 6th month of intervention in ZG and PG were 2.5 and 20%, respectively [PV= 0.01]. The results of this study showed that administration of 5 mg zinc daily to young children have significant effects on growth, particularly if the interventions are focused on stunted children

effect of EMLA cream on reducing pain due to vaccination in children

One of the medical procedures causing pain is vaccination. It is associated with increased anxiety, restlessness, and increased parent distress and angry. Therefore, recognition and application of pain control strategies by health care worker is necessary. The aim of the current study was to examine the effect of EMLA cream in reducing pain due to DPT vaccination. A randomized controlled trial, double-blind design was selected to conduct the study. One hundred and two infants with age 4 months undergoing DPT vaccination were selected by convenient sampling and randomly allocated to either experimental or control group. Infants in experimental group received EMLA on the skin and those in control group received placebo [Vit A+D] on the skin. Symptoms associated with pain while DPT vaccination measured by [MPBS] and crying time. The results showed that the MPBS scores were significantly lower in the EMLA group [2.08 +/- 1.02] compared with the placebo group [4056 +/- 1.05] [P=0.03]. The duration of crying was significantly lower in the EMLA group [6.00 +/- 5.01sec] than in placebo group [10.42 +/- 4.34] [P=0.04]. There was no statistically significant difference in side effect of intervention between two groups. This study showed that EMLA cream could be effective in reducing pain due to vaccination in infants. Health care workers are recommended to use EMLA cream for relieving pain, facilitating acceptance of parents to multiple injections and Promoting of quality health care

diagnostic accuracy of digitized mammography

Digitized mammography has several advantages over screen-film radiography in data storage and retrieval, making it a useful alternative to screen-film mammography in screening programs. The purpose of this study was to determine the diagnostic accuracy of digitized mammography in detecting breast cancer. 185 women [845 Images] were digitized at 600 dpi. All images were reviewed by an expert radiologist. The mammograms were scored on a scale of breast imaging reporting and data system [BIRADS]. The definite diagnosis was made either on the pathologic results of breast biopsy, or upon the follow-up of at least one year. The overall diagnostic accuracy of digitized mammography was calculated by the area under receiver operating characteristic curve. 242 sets of mammograms had no lesions. The total counts of masses, microcalcifications or both in one breast were 39 [11%], 42 [12%], and 25 [7%], respectively. There were 321 [92%] benign and 27 [8%] definite malignant lesions. The diagnostic accuracy of digitized images was 96.34% [95% CI: 94%-98%]. The diagnostic accuracy of digitized mammography is comparably good or even better than the published results. The digitized mammography is a good substitute modality for screen-film mammography in screening programs

Acute pulmonary embolism due to rupture of pulmonary valve hydatid cyst

Cardiac hydatid cyst is rare comprising 0.5-2% of all cases. A 20-year-old man was admitted for acute pulmonary embolism. Echocardiography and magnetic resonance imaging revealed hydatid cyst of pulmonary valve annulus. The cyst was drained surgically, and the patient was discharged with oral albendazole. For fatal complications of cardiac hydatid cyst, surgery is recommended in all patients

Prevalence of incidental thyroid nodules diagnosed by ultrasound in an Iranian population

Since Iran is an endemic region for iodine deficiency, we conducted this study to determine the prevalence of incidental thyroid nodules in our university-affiliated hospitals. Four hundred and ten consecutive patients who attended our center for color Doppler ultrasound of carotid or other sites of the neck-other than the thyroid gland-from September 2005 to May 2006 were included in this study. All patients underwent dedicated thyroid ultrasound for detection of thyroid nodules. We found one or more nodules in 210 [51.2%] of our patients. The mean [ +/- SD] age of patients with incidental thyroid nodules was 62.9 +/- B.1 [range: 14-100] years. The nodules were unilateral in 56.5% and bilateral in 43.5% of the patients. Incidental thyroid nodules were detected in 46.9% of men and 58.8% of women [P=0.017]. Among our patients, 61% had only one nodule. The mean [ +/- SD] largest diameter of nodules among those with only one nodule was 10.6 7.9 mm while it was 14.2 11 mm among those with more than one nodule [P=0.03]. The prevalence of thyroid incidentalomas in the population we studied was higher than many other studies. This may be due to iodine deficiency in our country

[Incidental sinus abnormalities in 256 patients referred for brain MRI]

Imaging abnormalities in the paranasal sinuses are regularly noted as incidental findings on MRI, however, little is known about their prevalence in the Iranian population. The purpose of this study was to classify these findings in the paranasal sinuses as seen on MRI and to investigate the prevalence, according to site and type of paranasal abnormality. In this cross-sectional study, the T2-weighted axial MRI of 256 patients with diseases unrelated to their paranasal sinuses were reviewed between May 2002 and June 2003. The findings were categorized according to the anatomic location and the imaging characteristics of the abnormality. The abnormalities recorded included total sinus opacification, mucoperiosteal thickening >/= 5mm, air fluid levels and retention cysts or polyps. Unilateral or bilateral involvement and septal deviation were also noted. A sinus was considered normal if it was fully aerated and no soft-tissue density was apparent within the cavity. Among our cases, 111 [43.5%] were male and 145 [56.5%] were female. Of these patients, abnormalities in one or more of the sinus groups were found in 110 subjects [42.9%], 55.5% of which were male and 44.5% were female [P=0.001]. Maxillary sinus abnormalities were observed in 66.4% of the patients, while ethmoid sinus abnormalities were found in 63.6%. Of the ethmoid abnormalities, 21% were found in the anterior section, 9% in the middle ethmoid, and 8% in the posterior ethmoid. The most common abnormality found was mucosal thickening. Among our cases, 23.4% had septal deviation, which was significantly higher among those with sinusitis [29% versus 19.1%; P<0.01]. Of those patients with sinus involvement, 16% were involved in the sphenoid sinus and 5% in the frontal sinus. The results obtained from the patients with sinus abnormality revealed that 85% suffered from cough, nasal obstruction, runny nose, facial pain and post nasal discharge and 24% had been diagnosed with chronic sinusitis by physician. Our results showed that there was a high rate of incidental abnormalities in the paranasal sinuses that are unrelated to the patient's presenting problems

Computed tomography findings in patients with mild head trauma

To determine the frequency of computed tomography [CT] findings in patients with mild head trauma. In this cross-sectional study conducted between September 2005 and April 2006, 708 patients with mild head trauma as defined by a Glasgow Coma Score [GCS] of 13-15, were underwent standard clinical examination and cranial CT. The mean +/- SD age of our patients was 26.8 +/- 19.03 years [range: 1 month to 89 years]. 489 [68.9%] patients were male and 219 [30.8%] were female. GSC was 13 in 1%, 14 in 4.6% and 15 in 94.4% of patients. The most common mechanism of trauma was car accident and falling down, each of which happened for 132 patients [18.6%].The most common findings on CT were subgaleal hematomas in 213[30%] and intracranial lesions were seen in 41 patients[5.8%] ;among them 37 were male. Among intracranial lesions, the most common finding was epidural hematoma in 18 patients followed by hemorrhagic contusion in 13 patients. Intracranial lesions were observed in 28.6% of patients with GCS of 13; in 15.2% with GCS of 14 and in 5.1% with GCS of 15 [P=0.002]. Many of patients with GCS equal to 15 after head trauma have considerable intracranial lesions and minor focal neurologic signs revealed by careful physical examination could be a good marker of these lesions