Ten-year Causes of Cerebral Venous Sinus Thrombosis in Patients Referred to Ghaem Hospital from 2009 to 2019.

Objective: Cerebral Venous Sinus Thrombosis (CVST), a complex and infrequent cerebrovascular disorder characterized by the formation of clots within the cerebral venous sinuses, occurs as a result of multiple risk factors and casualties, and its epidemiological picture should be investigated. Methods: This descriptive study was conducted retrospectively on patients with a final diagnosis of cerebral vein thrombosis, who were referred to the emergency room of Ghaem Hospital (Mashhad, Iran) between 2009 and 2019. The study included all patients with cerebral vein thrombosis who were older than 18 years. Clinical symptoms and causes were documented and contrasted according to demographics. Results: During the 10 years of this study, 749 cases of cerebral vein thrombosis were observed, with women accounting for the majority (72.8%). The most prevalent symptom was headache (554 cases; 74.0%), followed by seizures (23.1%), blurred vision (16.0%), nausea (7.5%), vomiting (6.9%), double nose (4.9%), and dizziness (3.3%). There was no significant difference in the frequency of symptoms between the two genders (p<0.05). The most commonly identified risk factors were OCP (110 cases; 14.7%), followed by infection (103 cases; 13.8%), malignancies (78 cases; 10.4%), and fasting (15 cases; 2.0%). There was no significant difference in risk factors between the two genders, with the exception that all cases of fasting were in women, and the differences were significant (p=0.015). The most common site of involvement according to Magnetic Resonance Venography (MRV) was the upper sagittal sinus (427 cases; 57.0%). There was no significant difference in terms of the site of the conflict between the two genders (p<0.05). Conclusion: The findings of the present study showed that deep vein thrombosis occurred mainly in women and manifested itself mostly as a headache. Moreover, the upper sagittal sinus was the most common site of involvement.

An Epidemiological Investigation on Patients with Non-traumatic Subarachnoid Hemorrhage from 2010 to 2020.

Objective: Subarachnoid hemorrhage (SAH) is still considered a life-threatening medical condition with a high mortality rate, particularly in developing countries. Thus, the present study aimed to investigate the angiographic findings of non-traumatic or spontaneous SAH. Methods: This retrospective cohort study included 642 health records of patients with non-traumatic SAH over a 10-year period, from 2010 to 2020. The required data, including demographic information, aneurysm type, size, location, disease severity classification, and secondary complications, were extracted. Results: The study included 642 patients, with 262 (40.8%) being male. The mean age of the participants was 54.72±13.51 years. The most prevalent type of aneurysm was saccular (89.1%), while serpentine (0.2%) and dissecting saccular (0.2%) aneurysms had the least prevalence. The most frequently involved arteries were the anterior communicating artery (ACoA; 38%), internal carotid artery (ICA; 27.6%), and middle cerebral artery (MCA; 13.4%). There was a significant correlation between sex and aneurysms occurring at ACoA and ICA (p< 0.0001), and ACoA - A1 (p=0.02). Patient age and sex were also significantly correlated with one another (p<0.0001). There was no statistically significant correlation between sex, aneurysm size, Glasgow coma scale (GCS), and modified Rankin scale (MRS). Conclusion: Based on our findings, the presence of aneurysms at ACoA, ACoA - A1, and ICA should be thoroughly ruled out in patients with severe headaches of sudden onset, particularly male patients of younger ages.

Dexmedetomidine vs Ketamine for Pediatric Procedural Sedation in the Emergency Department: A Randomized Clinical Trial.

Objective: To design and conduct the effectiveness of Ketamine vs Dexmedetomidine in children's sedation at emergency department (ED). Methods: This randomized clinical trial study was carried out at the two trauma centers in Mashhad, Iran. The patients were divided into two groups by means of a random numbers table to be treated with Ketamine (N=20) or Dexmedetomidine (N=20). Their demographic information and sedation times of drugs were collected and analyzed. Results: In general, sedation time was significantly higher in the ketamine group, 14.35 minutes (IQR:9.82-19) than in the dexmedetomidine group, 9.7 minutes (8.35-14.23) (p=0.023). Time of injection to complete anesthesia was 45.25 (IQR:30-58) and 72 (IQR:60.25-82) minutes in ketamine and dexmedetomidine groups, respectively (p<0.01). In the case of recovery, grade 4 of the Ramsey scale was statistically more prevalent in dexmedetomidine (45%) than in the ketamine group (p=0.0001). Conclusion: This study demonstrated that dexmedetomidine could be used in cases where a shorter sedation time is vital. Ketamine could be a better choice where full recovery time (from injection) matters most. Clinical Trial registration code: IR.MUMS.fm.REC.1396.534.

Aromatherapy with Isopropyl Alcohol versus Intravenous Ondansetron in Management of Mild Brain Trauma Nausea and Vomiting; a Randomized Clinical Trial.

Introduction: Nausea and vomiting are common complaints among patients who refer to the emergency department with head trauma. This study aimed to compare the effect of aromatherapy with isopropyl alcohol versus intravenous ondansetron in management of mild head trauma nausea and vomiting. Methods: This randomized clinical trial was conducted on patients with isolated mild head trauma complaining of nausea and vomiting who were referred to emergency department during a 6-month period. Patients were randomly divided into control (IV ondansetron + aromatherapy with saline) and intervention (IV saline + aromatherapy with isopropyl alcohol) groups. The frequency of vomiting and the severity of nausea (from 0 to 100 with the verbal scaling) were written before, and 10 and 30 minutes after intervention and compared between groups. Results: A total of 210 patients (105 patients in each group) with a median age of 38 years were included in the study, 112 (54.3%) of which were male. Ten minutes after aromatherapy, no significant difference was observed in nausea and vomiting between the two groups (p >0.05). Nausea score after 30 minutes (p = 0.015) was significantly lower in the intervention group compared to the control group, but vomiting after 30 minutes (p <0.001) was higher in the intervention group. Conclusion: Aromatherapy using isopropyl alcohol significantly reduced nausea of patients with mild isolate head trauma after 30 minutes. Regarding vomiting, no favorable result was observed in this study. However, the frequency of vomiting was reduced in both control and intervention groups.

Characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients: A systematic review and meta-analysis.

BACKGROUND: We aimed to determine the characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients. METHODS: PubMed, Embase, Web of Science, and Scopus databases were searched to retrieve articles on readmitted COVID-19 patients, available up to September 25, 2021. All studies comparing characteristics of readmitted and non-readmitted COVID-19 patients were included. We also included articles reporting the reasons for readmission in COVID-19 patients. Data were pooled and meta-analyzed using random or fixed-effect models, as appropriate. Subgroup analyses were conducted based on the place and duration of readmission. RESULTS: Our meta-analysis included 4823 readmitted and 63,413 non-readmitted COVID-19 patients. The re-hospitalization rate was calculated at 9.3% with 95% Confidence Interval (CI) [5.5%-15.4%], mostly associated with respiratory or cardiac complications (48% and 14%, respectively). Comorbidities including cerebrovascular disease (Odds Ratio (OR) = 1.812; 95% CI [1.547-2.121]), cardiovascular (2.173 [1.545-3.057]), hypertension (1.608 [1.319-1.960]), ischemic heart disease (1.998 [1.495-2.670]), heart failure (2.556 [1.980-3.300]), diabetes (1.588 [1.443-1.747]), cancer (1.817 [1.526-2.162]), kidney disease (2.083 [1.498-2.897]), chronic pulmonary disease (1.601 [1.438-1.783]), as well as older age (1.525 [1.175-1.978]), male sex (1.155 [1.041-1.282]), and white race (1.263 [1.044-1.528]) were significantly associated with higher readmission rates (P < 0.05 for all instances). The mortality rate was significantly lower in readmitted patients (OR = 0.530 [0.329-0.855], P = 0.009). CONCLUSIONS: Male sex, white race, comorbidities, and older age were associated with a higher risk of readmission among previously admitted COVID-19 patients. These factors can help clinicians and policy-makers predict, and conceivably reduce the risk of readmission in COVID-19 patients.

Increased age, neutrophil-to-lymphocyte ratio (NLR) and white blood cells count are associated with higher COVID-19 mortality.

OBJECTIVE: Coronavirus disease 19 (COVID-19) caused by the highly pathogenic SARS-CoV-2, was first reported from Wuhan, China, in December 2019. The present study assessed possible associations between one-month mortality and demographic data, SpO2, underlying diseases and laboratory findings, in COVID-19 patients. Also, since recent studies on COVID-19, have focused on Neutrophil-to-lymphocyte ratio (NLR) as an independent risk factor of the in-hospital death and a significant prognostic biomarker of outcomes in critically ill patients, in this study, we assessed predictive potential of this factor in terms of one-month mortality. METHODS: Patients admitted to Imam Reza hospital, affiliated to Mashhad University of Medical Sciences, Mashhad, Iran, from March to June 2020, with positive RT-PCR results for SARS-CoV-2, were included in this study. Kaplan-Meier survival analysis and Cox proportional hazard model were used to respectively estimate one-month mortality since admission and determine factors associated with one-month mortality. RESULTS: In this retrospective cohort study, 219 patients were included (137 men and 82 women (mean age 58.2 ± 16 and 57 ± 17.3 years old, respectively)). Hypertension, ischemic heart disease and diabetes were respectively the most common comorbidities. Among these patients, 63 patients were admitted to the ICU and 31 deaths occurred during one-month follow-up. With respect to mean peripheral capillary oxygen saturation (SpO2), 142 patients had SpO2 ≤ 90%. Based on our analysis, older age and increased Neutrophil-to-lymphocyte ratio (NLR), and White blood cells (WBC) count were associated with increased risk of one-month mortality. Patients with SpO2 ≤ 90% had a 3.8-fold increase in risk of one-month death compared to those with SpO2 > 90%, although the difference did not reach a significant level. CONCLUSION: Multivariate analysis introduced age, WBC count, and NLR as predictors of one-month mortality in COVID-19 patients.