The Clinical Efficacy of Prostate Cancer Screening in Worldwide and Iran: Narrative Review.

Prostate cancer (CaP) imposes a great health burden on men, while its incidence has significantly increased in recent years. The screening program for CaP is still controversial and recent large trials have failed to present a significant reduction in prostate-specific mortality and all-cause mortality. An entire body of data obtained from worldwide studies conducted on CaP screening is required to better evaluate health policy decisions and patient decision-making. In current review, the clinical efficacy of screening programs on CaP was discussed in numerous parts of the world, such as in the US, Europe, and Asia, to provide an updated screening recommendation. Finally, we discuss about CaP screening status in Iran and update the screening recommendation in Iran.

Comparison of Neurological Soft Signs between Psychotic and Non Psychotic Patients.

INTRODUCTION: Neurological Soft Signs (NSS) are a group of non-specific signs manifested in some psychiatric patients. Till date, most studies have focused on NSS in schizophrenic patients. AIM: In the current study, the mean NSS score was compared between psychotic and non psychotic patients. MATERIALS AND METHODS: This descriptive analytical study was conducted on 96 hospitalized patients having psychotic disorders. The patients were first examined by a psychiatrist and their axis I diagnoses (according to DSM-IV-TR) were made. Accordingly, the patients were divided into three groups of psychotic (schizophrenic and schizoaffective) and bipolar disorder patients with and without psychotic symptoms. Using a 28-item questionnaire, the patients were neurologically examined and their NNS scores were calculated. The mean scores were compared among the groups. RESULTS: Based on the results, the mean NSS score in psychotic patients (schizophrenic and schizoaffective) was higher as compared to that in non-psychotic patients (bipolar disorder patients without psychotic symptoms) and this difference was statistically significant (p<0.0001). CONCLUSION: It seems that calculation of NSS score in psychotic patients can help predict the response to pharmaceutical treatment, risk of drug reactions/side effects and prognosis of disease. Drawing a definite conclusion in this regard requires further investigations.

Clinical Information Transfer between EMS Staff and Emergency Medicine Assistants during Handover of Trauma Patients.

Introduction Clinical handover by Emergency Medical Services (EMS) staff, as the first people who have contact with trauma patients, in the emergency department (ED), is very important. Therefore, effective communication to transfer clinical information about patients in a concise, rational, clear, and time-bound manner is essential. In Iran, the transfer of necessary information in clinical handover in EDs was carried out orally and without following standard instructions. This study aimed to audit the current clinical handover according to the Identify, Situation, Background, Assessment, and Recommendation (ISBAR) tool and survey the effect of training the ISBAR tool to Emergency Medicine Assistants (EMAs) and EMS staff on improvement of the clinical handover of patients to the ED. METHODS: This is a clinical audit study in three phases in Imam Hossein Hospital (Tehran, Iran) during 2016. In the first phase, the clinical handover between EMS staff and EMAs for 178 trauma patients admitted to the ED using ISBAR was audited and information was recorded. In the second phase, the correct approach of clinical handover according to the ISBAR tool was taught to EMS staff and EMAs using pamphlets and lectures. In the third phase, again, the clinical handover between EMS staff and EMAs for 168 trauma patients admitted to the ED was audited using the ISBAR tool and information was recorded. At the end, clinical audit assessment indicators of handover were evaluated before and after training. RESULTS: Clinical audit of the current situation in the ED showed that the clinical handover process does not follow standard ISBAR (0.0%). However, after training, 65.3% of clinical handover processes were performed in accordance with ISBAR. In the current study, there was an increase in all parameters of the ISBAR tool after training, most of which increased significantly compared to the first phase of the study (before the intervention). CONCLUSIONS: Findings demonstrate that patient handover in the ED did not initially follow the ISBAR standard guideline. After providing education as pamphlets and lectures to EMS staff and EMAs, a high percentage of patient handovers were conducted in accordance with the ISBAR instructions. Fahim Yegane SA , Shahrami A , Hatamabadi HR , Hosseini-Zijoud SM . Clinical information transfer between EMS staff and Emergency Medicine Assistants during handover of trauma patients. Prehosp Disaster Med. 2017;32(5):541-547.

Accuracy of emergency transfusion score in prediction need for blood transfusion among multiple trauma patients: A cross-sectional study from Iran.

OBJECTIVE: Prediction of blood transfusion requirement in trauma patients is a dilemma in most trauma centers. The aim of the current study was assessing the accuracy of emergency transfusion score (ETS) in detecting patients' need for blood transfusion in ED. METHODS: In this cross-sectional study, all multiple trauma patients referred to the emergency department (ED) of Imam Hossein Hospital, Tehran, Iran, from March to August 2014, were enrolled. ETS parameters including low blood pressure, free fluid on ultrasound, clinical instability of the pelvic ring, age, admission from the scene, and trauma mechanism were recorded for all patients. ETS was calculated for all patients and compared with patients who received blood transfusion to estimate the accuracy of ETS. RESULTS: Of the 793 patients included in the study, 54 (6%) received blood in the ED. The mean of ETS for all patients was 3.91 ± 0.93. There was a significant correlation between ETS more than 3 and amount of blood transfusion (P = 0.004). The sensitivity, specificity, positive, and negative predictive value of ETS was 98.1%, 13.8%, 7.7%, and 99%, respectively. CONCLUSION: ETS may be considered as a useful instrument for prioritizing multiple trauma patients' need for blood transfusion in Iran. Therefore, by implementing this score, it may be prevented from inappropriate requests for blood transfusion.

Successful Management of Two Cases of Placenta Accreta and a Literature Review: Use of the B-Lynch Suture and Bilateral Uterine Artery Ligation Procedures.

INTRODUCTION: Placenta accreta is an increasingly common complication of pregnancy that can result in massive hemorrhage. CASE PRESENTATION: We describe two cases of placenta accreta, with successful conservative management in a referral hospital in Tehran, Iran. In both cases, two procedures were performed: compression suture (B-Lynch) and a perfusion-decreasing procedure (bilateral uterine artery ligation). We also present the results of a narrative literature review. CONCLUSIONS: The double B-Lynch and uterine arterial ligation procedure in cases of abnormal placentation might be strongly considered in fertility preservation, coagulopathy, coexisting medical disease, blood access shortage, low surgical experience, distant local hospitals, and no help.

Evaluation of Ocular Side Effects in the Patients on Topiramate Therapy for Control of Migrainous Headache.

INTRODUCTION: Topiramate, a sulfa-derivative monosaccharide, is an antiepileptic drug which is administered in the control of migraine. It is reported to cause various ocular side effects such as visual field defect and myopic shift. To investigate the alterations in refractive error, properties of the cornea and changes in the anterior chamber in patients that receive Topiramate for migraine control. MATERIALS AND METHODS: This is a hospital-based, non-interventional, observational study that is conducted at Imam Hossein Hospital, affiliated to Shahid Beheshti University of Medical Sciences, Department of Neurology, in collaboration with the department of Ophthalmology. Thirty three consecutive patients with the diagnosis of migraine that were candidate for Topiramate therapy were recruited. Patients with history of ocular trauma or surgery, keratoconus, glaucoma, congenital ocular malformations and any history of unexplained visual loss were excluded. After thorough ophthalmic examination, all the patients underwent central corneal thickness (CCT) measurement, and Pentacam imaging (Scheimpflug camera) at the baseline. Various parameters were extracted and used for analysis. Anterior chamber volume (ACV), anterior chamber depth (ACD), and anterior chamber angle (ACA) measurement was performed. These measurements were repeated on day 30(th) and 90(th) after the initiation of Topiramate therapy. According to the normality tests, parameters with normal distribution were analysed using the repeated measures test and the remaining parameters (with non-normal distribution) were analysed using the non-parametric k-sample test. A p-value< 0.05 was considered statistically significant, according to Bonferroni post hoc correction. RESULTS: There were 66 eyes of 33 patients under the diagnosis of migrainous headache, that Topiramate was initiated for headache control, included in the study. The mean value of refractive error had a statistically significant myopic change, from -0.23 diopters (D) at the baseline to -0.61 D at the 90(th) day of follow-up period (p-value < 0.001). Mean CCT was 531.43 µm at the baseline and increased to 534.72 µm at the 30(th) day, and 537.51 µm at the 90(th) day after the administration of Topiramate (p-value=0.001). Mean value of other parameters, ACV, ACD, and ACA, did not reveal statistically significant change. CONCLUSION: Myopic shift and gradually increasing CCT in the patients after Topiramate administration should be considered before any refractive surgery. We found no gradual change in the anterior chamber and angle parameters in our patients in the 90 days of follow up. More studies with a longer duration of follow-up are needed to elucidate dose-dependent ocular manifestations.

Evidence-based Medicine versus the Conventional Approach to Journal Club Sessions: Which One Is More Successful in Teaching Critical Appraisal Skills?

This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.

Lipid Peroxidation and Antioxidant Status in Patients with Medullary Thyroid Carcinoma: A Case-Control Study.

INTRODUCTION: Oxidative stress or oxidant/antioxidant imbalance has a crucial role in the pathogenesis of some diseases like cancer. Medullary thyroid carcinoma (MTC) originates in the thyroid parafollicular cells and includes 3-4% of the malignant neoplasms that have an effect on this gland. The aetiology of MTC has not been clarified. However, oxidative stress may be one of the factors involved. AIM: The aim of the current study was to evaluate the antioxidant enzyme activity of catalase (CAT), Glutathione (GSH), total antioxidant capacity (TAC) and the levels of the lipid peroxidation product malondialdehyde (MDA) in blood samples of MTC patients as compared to healthy controls. MATERIALS AND METHODS: A case-control study was designed enrolling patients with confirmed MTC diagnosis and age-and sex group matched healthy volunteers referred to the clinic of the Research Institute for Endocrine Sciences, Tehran, Iran from April 2013 to July 2015. Fasting blood samples were taken for study. Catalase, GSH, MDA and TAC levels were measured by colorimetry using commercial kits (ZellBio GmbH, Germany). Data were analysed using SPSS 17 software, comparing mean±SD through t-test and difference between proportions through chi-square. RESULTS: No statistical difference was observed in the demographic characteristic between cases and controls. The final MTC group included 40 males and 45 females with a mean age of 30±12.9 year, and the control group 40 males and 47 females, with a mean age of 31.2±12.3 year. Anthropometric parameters, dietary and thyroid hormones levels (T3, T4 and TSH) were similar. Serum TAC (p=0.015), GSH (p=0.029) and CAT (p<0.001) levels were found to be significantly lower in the MTC patients, while serum MDA levels were significantly higher in MTC patients than controls (p<0.001). CONCLUSION: These preliminary findings suggest that oxidant/antioxidant imbalance may be associated with or possibly indicate an increased risk to medullary thyroid carcinoma. Further studies are needed to explore these findings.

The Effects of Air Pollution on Ischemic Stroke Admission Rate.

The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2±13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM10 (p<0.001) and PM2.5 (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department.

Comparing Zonisamide With Sodium Valproate in the Management of Migraine Headaches: Double-Blind Randomized Clinical Trial of Efficacy and Safety.

BACKGROUND: Migraine is one of the most debilitating medical conditions and has a high socioeconomic burden. As conventional therapeutic methods do not entirely alleviate the symptoms, new alternatives are being considered. OBJECTIVES: This study evaluates the efficacy and safety of zonisamide compared with sodium valproate in the management of migraine headaches. PATIENTS AND METHODS: In the current double-blind, parallel, randomized, controlled trial, 96 patients with a migraine diagnosis based on the international headache society (HIS) criteria were selected. They were divided randomly into two groups; the case group was given zonisamide, and sodium valproate was given to a control group. In addition to the side effects of the drugs, the severity, duration, and frequency of migraine attacks were evaluated at baseline and at three months. RESULTS: The 96 selected patients were divided randomly into two treatment groups (zonisamide n = 48, sodium valproate n = 48). Seven patients were excluded from analysis because of early dropout, leaving 89 (n = 45; n = 44) patients for analysis. While using zonisamide, six (13%) patients complained of fatigue, and two (4%) patients encountered noticeable appetite and weight loss. In the control group, five (11%) patients reported dizziness, and four (9%) patients faced obvious appetite and weight gain. Both drugs were considerably efficient in reducing further attacks. There was no statistically significant correlation between frequency or severity of migraine attacks and the drug used for treatment in three months of follow-up. CONCLUSIONS: Both medications are effective in reducing migraine attacks. It will be important to consider the drugs' adverse effects and availability and patients' medical and socioeconomic condition to select the appropriate treatment.

Comparison of oral dydrogesterone with vaginal progesteronefor luteal support in IUI cycles: a randomized clinical trial.

BACKGROUND: The aim of this study, we have compared the advantages of oral dydrogestrone with vaginal progesterone (cyclogest) for luteal support in intrauterine insemination (IUI) cycles. Progesterone supplementation is the first line treatment when luteal phase deficiency (LPD) can reasonably be assumed. OBJECTIVE: This study was conduct to compare the effect of oral dydrogestrone with vaginal Cyclogest on luteal phase support in the IUI cycles. MATERIALS AND METHODS: This prospective, randomized, double blind study was performed in a local infertility center from May 2013 to May 2014. It consisted of 150 infertile women younger than35years old undergoing ovarian stimulation for IUI cycles. They underwent ovarian stimulation with oral dydrogesterone (20 mg) as group A and vaginal cyclogest (400 mg) as group B in preparation for the IUI cycles. Clinical pregnancy and abortion rates, mid luteal progesterone (7daysafter IUI) and patient satisfaction were compared between two groups. RESULTS: The mean serum progesterone levels was significantly higher in group A in comparison with group B (p=0.001). Pregnancy rates in group A was not statistically different in comparison with group B (p =0.58). Abortion rate in two groups was not statistically different (p =0.056) although rate of abortion was higher in group B in comparison with A group. Satisfaction rates were significantly higher in group A compared to group B (p<0.001). CONCLUSION: We concluded that oral dydrogestrone is effective as vaginal progesterone for luteal-phase support in woman undergoing IUI cycles. Moreover, the mean serum progesterone levels and satisfaction rates in dydrogestrone group were higher than cyclogest group.

The Role of Antiepileptic Treatment in the Recurrence Rate of Seizures After First Attack: A Randomized Clinical Trial.

OBJECTIVE: Epilepsy is a serious, potentially life-shortening brain disorder that occurs in patients of all ages and races. A total of 2-4% of people have experienced seizures at least once in their lifetime. Although treatment usually begins after a seizure, it is an important question whether the first cases of seizure do need to be treated by antiepileptic drugs. In this manner, we compare the recurrence rates of epilepsy in first seizure patients treated with sodium valproic acid as an antiepileptic drug versus a placebo. MATERIAL & METHODS: In a randomized clinical trial study, 101 first seizure patients were randomly divided into two groups: one group was treated with antiepileptic drugs (sodium valproate 200mg, three times a day) and the other group was given a placebo. The recurrence rate of seizures was evaluated and compared between the groups after 6 months of follow up. RESULTS: Eight recurrence cases were detected. All recurrence cases came from the placebo group, with four patients suffering an additional seizure after four months and between 4-6 month follow up. A comparison of recurrence rate detected a statistically significant difference between the drug group and placebo group. CONCLUSION: Our data shows that the recurrences occurred only in the placebo group with the difference between the recurrence rates in the placebo versus drug-treated was significant. Our results suggest that drug therapy for people after their first seizure attack might reduce the probability of seizure recurrence.

The effect of premenstrual syndrome and menstrual phase on postoperative pain.

BACKGROUND: Premenstrual syndrome (PMS) is a common finding in luteal phase of menstrual cycle resulting in several changes in woman life including pain sensation. OBJECTIVES: This study evaluated the alterations of postoperative pain sensation in those with and without a history of PMS. PATIENTS AND METHODS: A total of 140 women in in postoperative period were assigned to four groups regarding luteal or follicular phase of menstrual cycle and the history of PMS and were evaluated regarding scale of pain sensation and morphine demand in recovery room. To evaluate the difference among the groups, Mann Whitney U, Kruskal-Wallis, and Bonferroni tests were used. RESULTS: Patients with PMS presented higher pain sensation and analgesia request (P = 0.003). Patients in luteal phase showed less pain and analgesia request in two out of five studied outcomes (P = 0.075). CONCLUSIONS: The most comfortable postoperative women were those in luteal phase without history of PMS group.

Ovarian Malignancy Probability Score (OMPS) for appropriate referral of adnexal masses.

BACKGROUND: Ovarian cancer is the most common cancer cause of gynecologic cancer deaths. In order to increase the likelihood of patient survival through primary operation by gyneco-oncologists, an appropriate algorithm for referral is considered here. MATERIALS AND METHODS: Suspicious adnexal mass cases including ovarian malignancy probability score-1 (OMPS1) scores between 2.3-3.65 are re-evaluated by OMPS2. Sensitivity and specificity of each score were determined. RESULTS: Sensitivity and specificity with a 3.82 score of OMPS2 in the studied subgroup (OMPS1 scores between 2.3-3.65) were 64% and 76.9% respectively. CONCLUSIONS: Management of OMPS1 scores of below 2.3 with sensitivity of 100% and above 3.65 with specificity of 72.9% is clear. In the subgroup of cases with OMPS1 score between 2.3-3.65, OMPS2 is helpful for triage with a cutoff score of 3.82.

Blood Transfusion Practice before and after Implementation of Type and Screen Protocol in Emergency Department of a University Affiliated Hospital in Iran.

Background. Blood transfusion is the cornerstone of therapy for many serious and common diseases. This study was performed to assess blood transfusion practice before and after implementation of type and screen protocol in emergency department of a university affiliated hospital in Iran, 2012-2013. Methods. An audit was studied before and after the implementation of type and screen protocol. The number of blood transfusions, time interval between blood order and transfusion, cross-match to transfusion ratio (C/T ratio), and transfusion index (TI) were checked. C/T ratio was used as a measure of the efficiency of blood ordering practice. We compared our results before and after implementation of type and screen protocol. Results. In present study after implementation of type and screen protocol, the time interval between requesting blood transfusion and transfusion of blood has decreased significantly (P < 0.001). The number of blood transfusions required by actual patients increased significantly from 1/2 to 2 (P < 0.001). The average cross-match to transfusion (C/T) ratio got near 1.13 from 1.41 and TI got near 0.91 from 0.58 (P < 0.001). Conclusion. The implementation of T&S protocol has been proven to be safe, efficient, and beneficial to the transfusion practice of our hospital from the current study.

Attenuation of cisplathin-induced toxic oxidative stress by propofol.

BACKGROUND: Antioxidant effects of propofol (2, 6-diisopropylphenol) were evaluated against cisplatin-i nduced oxidative stress in rat. OBJECTIVES: In this experimental study, 20 male rats were equally divided into 4 groups (5 rats each), and were treated by propofol (10 mg/kg/day, IP), or cisplatin (7 mg /kg/day, IP), or both. MATERIALS AND METHODS: G roup one was control, while group 2 was given cisplatin (7 mg /kg/day, IP). Animals of the third group received only propofol (10 mg/kg/day, IP). Group 4 was given propofol with cisplatin once per day for 7 days. After treatment, blood urea nitrogen, creatinine levels, and oxidative stress m arkers such as total thiol groups (TTG), lipid peroxidation (LPO), and total antioxidant capacity (TAC) were measured. RESULTS: Oxidative stress induced by cisplatin, was evident by a significant increase in LPO and decrease in TTG and TAC. Propofol recovered cisplatin -induced changes in TAC, TTG and LPO in blood. CONCLUSIONS: It is concluded that oxidative damage is the mechanism of cisplatin toxicity, which can be recovered by propofol.

Plasma levels of CXCL1 (GRO-alpha) and CXCL10 (IP-10) are elevated in type 2 diabetic patients: evidence for the involvement of inflammation and angiogenesis/angiostasis in this disease state.

BACKGROUND: Recent evidence has demonstrated that environment and genetic factors play pivotal roles in diabetes and its related complications. The significant contributory role of cytokines in pathogenesis of type 2 diabetes is also well documented. This study was aimed to examine and compare both CXCL1 (GRO-alpha) and CXCL10 (IP-10) circulating levels in type 2 diabetic patients and healthy controls. METHODS: Peripheral blood samples were collected from 100 type 2 diabetic patients and 150 healthy controls. Circulating CXCL1 and CXCL10 levels were measured by ELISA. RESULTS: Elevated serum levels of both CXCL1 and CXCL10 were found in type 2 diabetic patients in comparison to controls. CONCLUSIONS: Elevated levels of CXCL1 and CXCL10 could possibly be used as a marker of inflammation and angiogenesis/angiostasis in type 2 diabetes.