فهرست مطالب hassan soleimanpour

 This scoping review study was conducted with the aim of identifying dimensions of trust in medical care, common trust subjects, and medical trust correlates among available instruments.

 We carried out a scoping review of literature through Medline, EMBASE, Scopus, Google Scholar engine, and various information sources of grey literature, to identify eligible studies up to 2023. We merely included psychometric studies in these areas. Non-psychometrics studies were excluded. Two assessors independently and carefully chose papers and abstracted records for qualitative exploration.

 Fifty-two studies (n=37228 participants) were included in the review. The majority of the participants 67 % (24943) were adults (≥18). One-dimensionality trust was found in 36 % (19) of trust in medical care studies, while multidimensionality was identified in 64 % (33) of the studies. Ten categories of trust in medicine correlates or associates were identified. In terms of trust scales subjects, about 71 % (37) of the scales measured trust in healthcare professions, 14 % (7) health care systems, and the rest were about emergency department, trauma care emergency department, health care team, technology, authorities, telemedicine, insurer, COVID-19 prevention policies, performance, and general trust.

 Various tools have been developed and validated in the field of trust in healthcare, and several domains have been identified. Trust in medicine is correlated by a variety of factors such as patient characteristics, healthcare provider factors, healthcare organization features, health conditions, and social influences. It is suggested that researchers pay more attention to the most commonly known dimensions in preparing tools.

 Non-alcoholic fatty liver disease (NAFLD) is diagnosed when≥5–10% of hepatocytes display macroscopic steatosis in the absence of other etiologies of liver disease. Consumption of coffee or tea or both may decrease the risk of NAFLD, as recommended by studies of liver enzymes.

 The required data was collected from different databases such as EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Web of Science as well as the database inception to July 2021. In addition, pooled mean difference and 95% confidence intervals (CIs) were considered in the random effects model.

 Of the total collected 218 articles, 8 met our inclusion criteria to be involved in the meta-analysis. Four studies assessed green tea and one study assessed sour tea consumption in NAFLD patients. Three studies assessed coffee use. All studies have shown an inverse correlation of coffee intake with elevated serum enzyme levels. Based on the meta-analysis outcome, the mean alanine aminotransferase (ALT) in the intervention group was measured as 12.50 points less than that of the control group. The mean aspartate aminotransferase (AST) of the intervention group was 9.23 points lower than that of the control group (P value<0.001).

 There is increasing evidence that steadily revealed an opposite relationship between the consumption amount of green tea and coffee and the risk of liver diseases. This meta-analysis supports the protective role of the mentioned beverages in patients suffering from NAFLD.

The World Health Organization (WHO) set six goals to maximize patient safety, with patient identification as the first goal. Today, at least two identifiers written on a paper wristband identify patients. If paper wristbands are used, the patient's identification information may not be available due to tearing or moisture, etc. Due to the fact that modern technology has not been used to solve the above problems, therefore, the intelligent wristband was designed in the educational and treatment center of Imam Reza Hospital in Tabriz in 2023

Smart wristband with QR code is specially designed for each patient. Doctors and nurses can scan the QR code from the patient's wristband and by entering their medical and nursing system number, they can access the demographic and clinical information of patients for safe identification.

The design of smart wristbands makes it possible to use waterproof electronic wristbands instead of using paper wristbands. Also, by scanning the assigned code for each patient, the treatment and care staff are connected to health information software that provides quick access to a summary of demographic information and the treatment history of the patient.

The use of Smart wristband through the provision of high-quality healthcare can have great potential to ensure patient safety, minimize medical errors, and improve the performance of healthcare professionals.

Vitamin C is a powerful antioxidant, which helps to improve the body's immune system. The antioxidant property of vitamin C reduces inflammation and improves the body's defense function against pathogens. In an interventional study, a total of 210 COVID-19 patients admitted to the intensive care units were randomly divided into two control and intervention groups. The intervention group received a treatment protocol including a high-dose vitamin C (12 g of vitamin C via a pump within four hours, which was repeated every 12 hours) for a week. About 60% of the patients in both groups died with no significant difference in the mortality rate between the two groups (p = 0.747). There was no improvement in the length of hospital stay, the degree of O2 saturation, and the mortality rate of the patients. No severe adverse effects were shown with this dose of vitamin C in ICU patients.

During the unprecedented COVID-19 lockdowns, road traffic was limited, and a change in the traumatic emergency admission pattern was anticipated. We conducted the current systematic review and meta-analysis to assess the impact of the COVID-19 pandemic on hospital admissions due to road traffic crashes.

This systematic review and meta-analysis was conducted based on the Joanna Briggs Institute (JBI) instructions. The following databases were searched: PubMed, ISI Web of Knowledge, Scopus, ProQuest, and the Cochrane Library. Two independent reviewers screened articles based on the inclusion criteria for the review and assessed the methodological quality of the included studies using an appropriate appraisal checklist, introduced by the JBI, based on the study type. The metaanalysis was performed using Comprehensive meta-analysis (CMA) software. Considering the heterogeneity among studies, a random effect model was adopted to estimate the pooled effect with 95% confidence interval (CI) for binary outcomes.

A total of 13 studies were included in this systematic review, and all of them were considered for meta-analysis. According to the meta-analysis, differences in hospital admission rates during the COVID-19 pandemic and one year before this pandemic were statistically significant [RR: 0.685 CI 95% (0.578 -0.813) p<0.00001]. The heterogeneity assessment of the included studies in the meta-analysis showed high heterogeneity (I2=78%, p<0.00001).

The results of this systematic review showed that the COVID-19 pandemic dramatically reduced the number of hospital admissions related to road traffic crashes because of both quarantines and lifestyle changes. Health policymakers and top health managers might use the results of this systematic review in similar contexts in the future.

Introduction/

The COVID-19 pandemic caused by SARS-CoV-2 has been the major health concern in 2019 globally. Considering the severity and phase of the disease, various pharmacotherapy schedules were proposed. Here, we set out to provide close-up insights on the clinical utility of Tocilizumab (TCZ), a biologic monoclonal antibody in this regard.

In this comprehensive review, various databases, including Scopus, PubMed Central, Medline, Embase, Google Scholar, and preprint publishers (med/bioRxiv) were searched until January 30, 2024, according to the keywords and search criteria.

Besides the pros and cons, compelling evidence purported the safety and efficacy of TCZ and indicated that it exhibits great potential to reduce short-term and all-cause (28-30-day) mortality. TCZ significantly drops the adverse events if administered in the right time course (in the inflammatory phase) during critical/severe COVID-19 pneumonia. Despite contradictory results, the benefits of TCZ appear significant, especially in combination with add-on therapies, such as corticosteroids. Although the safety of TCZ is acceptable, solid data is lacking as to its benefits during pregnancy. There are limited data on TCZ combination therapies, such as hemoperfusion, intravenous immunoglobulin (IVIG), simple O2 therapy, vasopressor support, convalescent plasma therapy, and even in vaccinated patients and COVID-19 reinfection, especially in elderly persons. In addition, the impact of TCZ therapy on the long-lasting COVID-19 is unclear.

Personalized medicine based on individual characteristics and pertinent clinical conditions must be considered in the clinicians’ decision-making policy. Finally, to mitigate the risk-to-benefit ratio of TCZ, a treatment algorithm, based on available literature and updated national institute of health (NIH) and Infectious Diseases Society of America (IDSA) guidelines, is also proposed. 

Urolithiasis is responsible for the majority of urological emergencies. Although computed tomography (CT) scan can identify urinary obstruction caused by stones, there is a growing concern about exposure to radiation made by this method. Renal scintigraphy can provide valuable insights regarding the functional status of kidneys and can significantly reduce exposure to radiation. The goal of present study was to assess renal function through renal scintigraphy in patients with acute renal colic and it explores the association between renal scintigraphy performance and ultrasound in terms of detecting hydronephrosis. 

For this study, 20 patients with acute renal colic were chosen. Each patient underwent renal ultrasonography and subsequently received renal scintigraphy with Technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA). Cohen's Kappa coefficient and Cramer's V correlation were employed to demonstrate the extent of agreement between ultrasound and renal scintigraphy. 

12 (60%) patients were male. Glomerular filtration rate (GFR) values were correlated with Cockcroft-Gault equation and the Gates method (P=0.002, r=0.642). There was a good agreement and a statistically significant relationship between ultrasound and renal scintigraphy in terms of detecting obstructive uropathy in both kidneys. 

To conclude, GFR values were correlated between Cockcroft-Gault equation and the Gates method in patients with acute renal colic. There was a good agreement and statistically significant relationship between ultrasound and obstructive renography results in both kidneys. However, we found no association between perfusion phase of renal scintigraphy and ultrasonography in terms of hydronephrosis detection.

 Older adults’ problems and needs may be ignored and not considered a priority matter during disasters due to their complexities and differences from other age groups. This content analysis study was conducted to explain the older adults’ experience of living in tents after the Mianeh county earthquake.

 In this research, we used a descriptive qualitative approach. The key elements of Standards for Reporting Qualitative Research (SRQR) were applied to design the research. Data were collected in-depth and semi-structured interviews were done with potential eligible participants. We used heterogeneous purposive sampling (with a maximum variety of 16 older adults with ages in the range of 60–81 years in Mianeh, East Azerbaijan, Iran. The data were analyzed using the conventional content analysis technique.

 Four main categories emerged, including failure to provide basic physiological needs, poor management of public support, distress and survival attempts, and loss of life authority. The main themes extracted included psychological quality of life and meeting the basic needs (disabilities and inefficiencies).

 It is beneficial to consider the specific needs of vulnerable groups, such as the elderly population, during the program designing by counties’ crisis management teams.

 The coronavirus disease 2019 (COVID-19) epidemic was confirmed as global pandemic by the World Health Organization (WHO) by 11 March 2020.

 Data was collected from all the emergency medicine staff working in two referral main centers for COVID-19 affiliated to Tabriz University of Medical Sciences, Iran. The participants were enrolled in the study six months after the first COVID-19 hospitalization and the COVID-19 Anxiety Scale (CDAS) was used.

 According to our results, while 46 (20.7%) participants had a moderate anxiety score, 26 (11.7%) had a severe anxiety score.

 The results of this study showed that emergency department staff are at risk of developing an Illness Anxiety Disorder (IAD). During the COVID-19 pandemic, more research should be done on these groups.

 This umbrella review presents comprehensive data on the evidence of the association between cerebral venous thrombosis (CVT) and COVID-19 vaccinations.

 We searched related databases to access issue-related systematic reviews both with meta‐analyses and without it that studied the connotation between COVID 19 vaccination and CVT in any languages on March 1, 2022. Two reviewers independently extracted the data using the JBI Form for Data Extraction in Systematic Reviews and Research Syntheses.

The primary search resulted in 886 titles, and finally, 48 full texts were selected, and of these, 12 qualitative systematic reviews or quantitative meta-analyses were eligible for the umbrella review. No study was excluded based on using the JBI checklist for critical appraisal. The results revealed that cerebral venous sinus thrombosis (CVST) from the COVID-19 vaccine could occur in any age group, in both sexes, and with all types of vaccine. However, young females were the predominantly affected cases. Although more common in adenovirus vaccine types, vaccines consisting of mRNA are not free from side effects. Headache was the most typical clinical symptom. Thrombocytopenia, PF4 IgG Assay, and d-Dimer evaluation were positive in many reported studies.

 The results showed that CVST from the COVID-19 vaccine can happen without age limitation for both sexes and all vaccine types. Although CVST is a life-threatening condition, early diagnosis and, most importantly, its management can be life-saving for patients. The overall balance of risk and benefit in favor of vaccination is positive in all of the included studies in the current umbrella review.

 Laryngospasm is a life-threatening condition caused due to involuntary contraction in laryngeal muscles. It can last seconds to minutes and may cause hypoxemia, loss of consciousness, and death.

 We report a case of laryngospasm in a patient with Coronavirus-2 infection who was admitted to the emergency department for the first time. Laryngospasm was revealed after treatment.

 The clinician should note that laryngospasm can be triggered by Coronavirus-2 infection.

Context:

 There is a link between proton pump inhibitors (PPIs) use and the occurrence of spontaneous bacterial peritonitis (SBP) in cirrhotic patients in some studies; however, in other studies, such a link does not exist.

 The aim of the current systematic review and meta-analysis was to evaluate the association between PPI and the occurrence of SBP or hepatic encephalopathy (HE) in cirrhotic patients.

Data Sources: 

A systematic search of sources was conducted in order to evaluate for any relationship between PPI and the risk of SBP in patients with liver diseases. Medline, Scopus, Ovid, ProQuest, Google Scholar, and Web of Science were searched to find any evidence in this regard from 1980 to November of 2021.

Study Selection:

 The articles were evaluated by two independent reviewers according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). After deleting the duplicates, first, the titles of the studies were evaluated, and then the full texts were evaluated. Any disagreement between the two researchers was solved by discussion or a third reviewer.

Data Extraction: 

Appropriate Critical Appraisal Checklists of Joanna Briggs Institute (JBI) were used for the quality assessment of eligible studies. Statistical analysis was performed by CMA software (version 2.0), and a P-value of less than 0.05 was considered a significant level.

 In the systematic search of sources, 3705 articles were identified. Finally, 33 studies were included in this meta-analysis study. A total of 6370 PPI users and 8037 patients in the control group experienced at least one of the complications of liver cirrhosis, including SBP or HE. According to meta-analysis, the risk of SBP or HE in the intervention group was 1.95 times higher than in the control group (RR = 1.95; 95% confidence interval [CI]: 1.53 - 2.48, P < 0.001).

 The use of PPIs is associated with a higher risk of SBP and HE in cirrhotic patients. However, the quality of included studies in the current systematic review and meta-analysis was moderate, and high-quality studies with a larger sample size are required.

Context: 

Migraine is one of the most common causes of disability worldwide and the sixth cause of loss of life years due to disability. Migraine is reported mainly in young and middle-aged people, so it can cause a person to face many problems in doing daily tasks. The emergency department annually accepts 1.2 million patients with migraine. Therefore, timely diagnosis of the disease, knowledge of valuable drugs in an emergency, knowing how to use them, and finally, early treatment can play an essential and decisive role in improving patients’ symptoms and reducing the disability caused by the disease. An essential and valuable drug category in the emergency department to manage pain is non-opioid intravenous (IV) drugs. Therefore, this study aimed to evaluate non-opioid IV drugs to manage pain in patients with acute migraines in the emergency department.

 This study conducted a comprehensive literature review to access the latest scientific studies and documents using keywords (acute migraine, non-opioid IV drugs, pain management) in reliable databases such as PubMed, Scopus, Web of Science, Cochrane, and Google Scholar. We reviewed 87 articles, 53 of which were evaluated and compared.

 A review study considers intravenous acetaminophen as a suitable option for the first-line treatment of acute migraine in the emergency department if the patient does not tolerate aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). Various studies have obtained positive effects of NSAIDs and dihydroergotamine (DHE) in treating acute migraine. Prescribing anti-dopaminergic drugs can effectively reduce associated symptoms such as nausea and vomiting. Dexamethasone and magnesium sulfate are effective in preventing migraine and severe attacks. Intravenous sodium valproate is effective in moderate to severe migraine attacks or treatment-resistant migraines. In the emergency department, prescribing intravenous haloperidol, lidocaine, and propofol can help manage migraine and improve other associated symptoms, such as nausea or vomiting.

 Non-opioid IV drugs are essential to manage pain and improve other migraine symptoms in the emergency setting. Knowing the above drugs and their optimal use has a decisive role in managing patients with acute migraine in the emergency department.

 One of the complications of laryngoscopy is cardiac dysrhythmia due to an increased QT interval.

 This study aimed to compare the effect of fentanyl and remifentanil on QTc interval in patients undergoing intubation by the rapid method in 2020.

 In this study, 50 patients without a history of heart disease and without a history of drug use who were candidates for rapid intubation in the emergency department were selected and divided into two groups. Before the injection of intubation drugs, a baseline ECG was obtained from the patient and then randomly assigned to one group of patients with 2 μg/kg fentanyl and the other group with 1 μg/kg remifentanil. Other intubation drugs, including lidocaine, etomidate, and succinylcholine, were fixed in both groups. Immediately after drug injection and immediately after laryngoscopy, ECG was prepared from patients, and the QT interval was calculated.

 In group comparison, changes in QT values during the studied time were statistically significant (P = 0.004). However, in the comparison between groups, there was no statistically significant difference between the two groups receiving fentanyl and remifentanil (P = 0.235). The results showed that the rate of QT interval changes during three different measurements increased in both groups of patients receiving fentanyl and remifentanil.

 In the present study, in comparing the QT interval, there was a statistically significant difference between the two groups receiving fentanyl and remifentanil at any of the studied times. Therefore, fentanyl and remifentanil during endotracheal intubation did not have a statistically and clinically significant effect on the QT distance of patients' ECG, and the administration of the above two drugs during intubation was safe.

There is limited data about the short-term stroke mortality rates for patients in treatment
settings.

This study aimed to estimate the short-term stroke (in hospital, one month, one year) mortality rates in Iran through a systematic review and meta-analysis.

We searched electronic databases, including three national (IranDoc, Megiran, SID) and four international (Scopus, PubMed, Web of Science, Google Scholar), from January 1990 to March 2020. We considered all observational studies on stroke mortality, such as cohort and crosssectional studies. Furthermore, the sub-group analyses were performed based on each province and metaregression analysis based on the study’s year and patients’ mean age.

Among 143 studies, 28 were eligible (11 cohort and 17 cross-sectional studies). Based on the random model, the mortality rates for in-hospital, 1-month, and 1-year mortality were reported as 18.71% (95% CI: 15.09%-22.34%), 23.43% (95% CI: 20.08%-26.78%), and 34.44% (95% CI: 32.02%- 36.85%), respectively. The results also revealed that mortality rates were neither related to the year studies conducted nor to the patient’s age.

Approximately one-fifth of stroke patients in Iran die in the hospital after admission. The mortality rate increased in the one-month and one-year period, and about one-third of the patients died in the first year. Therefore, it is cardinal to focus on programs and solutions in which we can ameliorate mortality in the short-term period after stroke by performing primary specific treatments on patients.

The most common cause of death and serious disability in cyclist’s crashes is traumatic brain injury. The The present study aimed to provide accurate statistics and information on traffic accidents based on epidemiologic characteristics and outcomes of cyclists’ injuries in East Azerbaijan province‑Iran, based on International Classification of Diseases ICD-10 and International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) guidelines.

This cross‑sectional study was conducted in Tabriz, Iran, on 317 cyclists who sustained an injury through road traffic accidents. Multivariable Cox regression, reported as hazard ratios (95% confidence interval), quantified the association between explanatory variables such as age, gender, and anatomical regions with mortality.

The present study included 317 trauma patients with an average age of 34.72 (SD= 24.14) years old; 89.6% of the patients were male. Collision with truck or van, pick‑up, and automobiles collisions (42.9%) were the most common counterpart vehicle used [V13]. The most common anatomical regions affected by the cyclists were head injuries (72.2%) (S00–S09). The highest proportion of injuries incurred by cyclists was superficial (46%) [S00-T00]. Closure of skin and subcutaneous tissue of other sites were the most clinical modification provided for the patients(54.1%) (86.59). The obtained regression coefficient showed that age increased the odds ratio of mortality by 0.02.

Men were the most injured group. Head injuries were the most common injuries. Skin and subcutaneous tissue sutures commonly require surgery. Also, the chance of mortality increases with age. All cyclists need to wear a helmet to reduce head‐impairing injuries.

This systematic review evaluated the studies conducted on Guillain-Barré syndrome (GBS) due to COVID-19 vaccination to clarify any possible connections and the type of vaccines causing GBS.

A comprehensive search was performed on July 2021 through MEDLINE (via PubMed), Scopus, Cochrane, and Web of Science databases to detect published and unpublished papers. Our PICO was all COVID-19 vaccinated individuals as the population, COVID-19 vaccines as the intervention, and patients experiencing GBS following COVID-19 vaccination as the outcome. Critical appraisal instruments from the Joanna Briggs Institute case series or case report were used to evaluate the quality of included studies.

In the present systematic review, 12 case reports and case series including 21 patients were assessed. More than half of the patients were male, and the mean age of male patients was lower than females. In terms of vaccine type, the most common kind of vaccine injected was Oxford/AstraZeneca, and all the cases except one patient had received only one dose of the vaccine. Regarding the interval between receiving the vaccine and the onset of GBS symptoms, the mean duration was 14 days. The lowest mean time interval between receiving the vaccine and the onset of symptoms of GBS was related to the unnamed vector-based COVID-19 vaccine, and the highest was associated with Oxford/AstraZeneca.

Through this systematic review of case reports, we neither attempt to establish nor rule out a causal link between the COVID-19 vaccine and GBS, because such a link requires extensive case-control studies. However, we must highlight any events that may occur following the injection of existing vaccines. Practical Implications. The most common symptoms seen in patients experiencing GBS after vaccination included progressive bilateral lower limb weakness, paresthesia, numbness of limbs, generalized body aches, and back pain.

A 47-year-old female with a history of antiphospholipid syndrome and ischemic stroke was presented to the emergency department due to abdominal pain and bloody vomiting. Ultrasonography showed double inferior vena cava and bilateral mild hydronephrosis. Furthermore, the abdominal computed tomography (CT) scan did not show any evidence of urolithiasis. The ultrasound images of distinctive developmental variations of inferior vena cava and other veins are important to be known. Vascular anomalies, although rare, should be taken into account in the differential diagnosis of focal lesions within the abdominal cavity. Double IVC might have been the cause of hydronephrosis in our patient.

Iodinated contrast agents are commonly used in diagnostic radiography techniques along with therapeutic interventions. Contrast-Induced Acute Kidney Injury (CI-AKI) is a significant problem of all angiographic procedures, triggered by the use of Iodinated Contrast Media (ICM). There are conflicting data concerning the prevention and treatment of CIAKI. Numerous approaches have been studied to prevent CI-AKI, but the therapy of choice remains undetermined. The cornerstones of CI-AKI prevention include low-osmolar ICM and intravenous hydration. The recommended hydration must be achieved by means of an isotonic solution of saline. Statins were tested against AKI due to their anti-inflammatory action and antioxidant effect on endothelial function. Novel approaches are required to investigate the short-term effects of high dosage atorvastatin versus sodium bicarbonate on CI-AKI prevention. The objective of this review is to compare the findings of various studies that had applied different doses of statins, sodium bicarbonate, and other agents for preventing CI-AKI.

Procedural sedation (PS) plays an important role in facilitating emergency procedures. Dexmedetomidine is an alpha-adrenergic agonist which can play a role in this issue. This study aimed to systematically review the literature about the role of dexmedetomidine in PS in the emergency department (ED).

In this study, several databases, namely PubMed, Embase, Ovid, ProQuest, Scopus, Web of Science, and Cochrane Library, were searched since 1999 up to November 30, 2020. The inclusion criteria in this study were randomized clinical trials performed on ED patients using dexmedetomidine for PS and articles only in the English language. The exclusion criteria were the studies that were not clinical trials or were not performed in the ED, low-quality studies or animal studies.

A total of 473 articles were identified in this study. Five studies fulfilled the inclusion and exclusion criteria. Three articles studied the adult population. One study used dexmedetomidine in an intranasal way, and one study used an intramuscular route for drug administration.

Although the reviewed studies reported dexmedetomidine as a safe and effective agent for PS, there are not sufficient data on this issue. Therefore, it is required to perform further studies to a draw firmer conclusion.

Many of the known coronaviruses cause a wide range of respiratory infections in humans, and the novel coronavirus is no exception to this rule. Although no drug has yet been discovered to prevent or treat this disease, chloroquine (CQ) and hydroxychloroquine (HCQ) have been widely used in studies showing different results.

The present study is an umbrella study. The search was conducted for the articles published from January 2020 to November 2020 using the keywords (“COVID-19” OR “SARS- CoV-2” AND “Hydroxychloroquine“ OR “Chloroquine” AND “Systematic Review” OR “Metanalysis”). This study was limited to human samples and systematic reviews with or without meta-analysis. The quality of the articles was also evaluated independently by two researchers.

To evaluate the clinical efficacy of HCQ and CQ, a total of 176 papers and 643569 cases ranging from patients with mild pneumonia to intubated critically ill patients were evaluated. Finally, 8 studies were included.

There are conflicting results regarding HCQ or CQ efficacy and safety in the systematic reviews. More evidence is needed to confirm whether these drugs are useful in COVID-19 infection, and their usage as the standard care cannot be recommended based on the majority of the studies included in this umbrella review.

Animal bites are of the major health threats. Delayed post-exposure prophylaxis (PEP), especially in frail older people, may lead to mortal risks in this age group. The aim of this study was to investigate the pattern of delayed PEP in animal-bites injuries and to identify its contributing factors in older people of Tabriz city, Iran.

In this cross-sectional study, the census method was used to obtain data from health records of older adults who were referred to Tabriz's Rabies Treatment Center between March 2013 and March 2018. The delay was defined as starting PEP longer than 24 hours after a suspected rabies virus exposure. The relations between delayed PEP and each of the predictors were investigated using the chi-square test in univariate analysis. The decision tree model was applied to predict the delay time of PEP.

A total of 322 older people with a mean age of 67.62 ± 7.18 were studied. In all, 31.7 % of the older persons victims who were bitten by an animal had a delayed PEP. Urban victims (34.1%) compared to rural (16.3 %), stray animal victims (42.0 %) compared to an owned animal-bite victim 24.6 %, all other animal bite-related victims (39.9 %) compared to dog-bite injuries (23.8%) experienced a higher frequency of delayed PEP. The decision tree revealed that animal ownership status, animal status, and animal species were the most important factors for predicting delayed PEP (p < 0.001).

The possibility of delayed PEP in older adults bites victims, increased if the animal was ownerless and escaped. A reasonable approach to tackle this issue might be to conduct larger population studies in the future.

To the best of our knowledge, aspirin (ASA) is known as a commonly used medication worldwide. Although the cardiovascular aspects of ASA are well-established, recently, it has been identified that ASA can yield multiple extra-cardiovascular therapeutic potencies in facing neurodegenerative disorders, various cancers, inflammatory responses, and the COVID-19 pandemic. In this review, we aimed to highlight the proven role of ASA administration in the variety of non-cardiovascular diseases, particularly in the field of anesthesiology.

Burns is one of the most common and potentially dangerous public health problems. Burn patients' hospitalization facilitates the provision of medical services. However, prolonging the length of hospital stay can not only impose an economic burden, but also cause various infections in patients. The aim of this study was to evaluate the factors affecting hospitalization length in burn patients admitted to Sina Hospital as burn referral hospital in Northwest of Iran.

In this cross-sectional study, the medical records of burn patients, who were admitted to Sina Hospital in Tabriz during 2018, were included. Data collection was performed, using a goalbased researcher checklist. Data were analyzed, using Stata 16 software and through quantile regression modeling.

The total number of hospitalized burn patients was 1586 of whom 998 (62.3%) were male. The mean age of the patients was 25.5 ± 22.9 years. Burns occurred more often in summer (30.5%) and at home (n=1246, 78.6%). The median length of hospitalization was 8 days (95% CI: 7.34- 8.57). Single (P = 0.010) and illiterate patients (P = 0.022) had a longer hospitalization length. The lower the Glasgow coma score at the beginning of hospitalization, the longer hospital stay seemed to grow (P = 0.034). Patients with burns on face (P = 0.037), head and neck (P <0.001) and back of the trunk (P = 0.031) had longer hospital stays, respectively.

Glasgow coma score, burns on the face, neck and back were identified as effective clinical signs on hospitalization length of stay amongst burn patients. Considering these symptoms in the triage of burn patients, providing quality treatment and care services to manage these symptoms can reduce the length of hospital stay and ultimately lead to a reduction in social and economic costs for patients and society.