ABSTRACT
Objective: To perform a diagnostic accuracy of the rapid ultrasound in shock [RUSH] to diagnose the etiology of undifferentiated shock in patients presenting to the emergency department [ED]
Methods: We searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till July 2017. Two independent reviewers screened studies for eligibility. Our study analysis is planned in accordance with the guidelines for metaanalysis of diagnostic studies. In the systematic search, of 397 references, 295 were excluded on the basis of the title and abstract. For the remaining 102 articles, the full text was retrieved and critically reviewed. After the selection process, five papers were included
Results: The pooled estimate of all data showed that the RUSH protocol exhibited high sensitivity [0.87, 95% Confidence Interval [CI]: 0.80-0.92, I[2]=46.7%] and specificity [0.98, 95% C. I.: 0.96-0.99, [I]2=30.8%]. The AUC for SROC, a global measure of the RUSH protocol performance, was 0.98+/-0.01, indicates the high accuracy of the test. Positive and negative likelihood ratios reported from the studies ranged from 9.83 to 51.32 and 0.04 to 0.33, respectively. The pooled estimate of all data showed that the RUSH protocol exhibited high positive likelihood ratio [19.19, 95% C. I.: 11.49-32.06, I[2]=14.1%] and low negative likelihood ratio [0.23, 95% C. I.: 0.15-0.34, I[2]=18.4%]
Conclusion: This meta-analysis suggests that RUSH protocol has generally good role to distinguish the states of shock in patients with undifferentiated shock referred to the emergency department
ABSTRACT
This study aims to assess the relationship of serum Mg and vitamin D levels in a nationally-representative sample of Iranian adolescents. The study participants consisted of 330 students, aged range from 10 to 18 years, consisting of an equal number of individuals with and without hypovitaminosis D. The correlation between serum 25 hydroxy vitamin D [25[OH] D] and magnesium [Mg] concentrations was determined. The mean age of participants was 14.74 +/- 2.587 years, without significant difference between those with hypovitaminosis D and those without it. The mean 25[OH] D level was 6.34 +/- 1.47 ng/ml in the group with hypovitaminosis D and 39.27 +/- 6.42 ng/ml in the group without it. The mean Mg level was 0.80 +/- 0.23 mg/dl with lower level in the group with hypovitaminosis D than in others [0.73 +/- 0.22 mg/dl vs. 0.87 +/- 0.22mg/dl, respectively] and according to t-test analysis, significant lower levels in the deficient group was observed [P = 0.0001]. The linear regression analysis showed the meaningful relationship between Mg and 25[OH] D serum levels [P = 0.0001]. Our study revealed significant associations between serum Mg and 25[OH] D levels. This finding may be of use for further studies on the prevention and management of hypovitaminosis D in children and adolescents. Further longitudinal studies shall evaluate the underlying mechanisms and the clinical significance of the current findings
ABSTRACT
This study aims to assess the frequency of some hygienic behaviors that is, tooth brushing and hand-washing, in Iranian school students at national level. This nationwide study was conducted in 2011-2012 among 14,880 elementary, secondary and high school students who were selected by random cluster stratified multistage sampling from 30 provinces in Iran. We used the global school-based health survey questionnaire of the World Health Organization. The population of this survey consisted of 13,486 children and adolescents [participation rate of 90.6%] including 49.2% girls and 75.6% urban inhabitants. The mean age of participants was 12.5 years [12.3-12.6, 95% confidence interval] According to the self-report of students, 26.9% of them [20.2% of boys and 33.9% of girls] brushed their teeth more than once a day, 37.8% of boys and 42.1% of girls brushed their teeth once a day. In general, girls brushed their teeth more than boys. The frequency of those students who never brushed their teeth was twice in rural than in urban students [11.4% vs. 6.2%, respectively]. In total, 3.4% of the students stated that their school had not an appropriate place for washing hands after toilet, with three-fold higher frequency in rural than in urban schools [6.8% vs. 2.3%, respectively]. 85% of students [87% of girls vs. 83% of boys] reported that they had always washed their hands after toilet, 10.1% did it occasionally and 4.1% did not. This nationwide survey revealed that Iranian students have an acceptable level of hygienic behaviors both in urban and rural areas; however, still it is necessary to improve school health facilities and hygienic habits in Iranian students
ABSTRACT
Pulmonary valve stenosis [PS] is one of the most common congenital heart disease in children. Isolated pulmonary stenosis is the most common form of pulmonary stenosis. Isolated Pulmonary stenosis is responsible for 8 to 10 percent of congenital heart disease. Balloon valvuloplasty is the choice of treatment for this cardiac disease. One of the most important complications of this disease is pulmonary regurgitation in follow-up. The purpose of this study was to characterize the status of pulmonary regurgitation on follow-up after pulmonary valvuloplasty by balloon. We studied pulmonary regurgitation after balloon valvuloplasty retrospectively in children less than 14 years old age and isolated pulmonary stenosis. These patients had not complex congenital heart disease and admitted for balloon valvuloplasty during period of September 2001 to September 2011 in Shahid Rajaee Cardiovascular Research Center. The mean time of follow-up was 7+/-2.5 years. Four hundred and fifty-eight patients with mean age of 10.3+/-8.6 months were studied. Two hundred and fifty-five patients were male and 230 were female. Right ventricular pressure was decreased from 82.3+/-42.2 mmHg before procedure to 45.2+/-22.4 mmHg after procedure [P= 0.043]. Pressure gradient between right ventricle and pulmonary artery was decreased from 75.4+/-18.2 mmHg to 25.7+/-15.13 mmHg during procedure [P= 0.032]. The day after procedure, 180 [37.1%] patients had no pulmonary regurgitation echocardiographic evaluation, 175 [36.08%] had mild, and 118 [24.3%] had moderate pulmonary regurgitation. In patients with moderate pulmonary regurgitation, 7 [0.14%] of those improve to severe pulmonary regurgitation. In echocardiographic exam, 12 [2.4%] patients had severe regurgitation the day after balloon valvuloplasty. During long-term follow-up [7+/-2.5 years] for 3 patient pulmonary valve replacement were performed. In our study, balloon to annulus ratio in three groups of pulmonary regurgitation [mild, moderate and sever] had significant correlation [P=0.012]. Pulmonary regurgitation was seen after balloon valvuloplasty in some patients.In most patients it had no symptoms and long-term follow-up is necessary