ali ashraf

Post-traumatic stress disorder (PTSD) is a psychological disorder resulting from a previous traumatic experience. The objective of the present study was to investigate the prevalence of PTSD and its related risk factors among Intensive Care Unit (ICU) survivors.

A total of 152 patients were followed up prospectively for one month. All included participants had Glasgow Coma Scale scores ranging from 12 to 15. PTSD was assessed using a Persian-translated version of the PTSD Checklist (PCL). Data were analyzed using SPSS 22.0 software.

Among the participants, seventy-two (47.4%) men and eighty (52.6%) women with a mean age of 54.5 ± 19.19 years responded to the questionnaire. The prevalence of post-discharge PTSD was 87.5%. There was a significant correlation between PTSD mean score and clinical factors such as hospitalization reason, self and familial history of psychological disorders, and Richmond Agitation Sedation Score (RASS) (p < 0.05).

Our findings suggest that, despite often being ignored, post-discharge PTSD is a significant psychological issue for ICU survivors. This highlights the importance of supportive care plans for patients with a history of mental disorders and agitation. The involvement of psychotherapists is crucial to improving postdischarge quality of life.

The ethnic crises of the first decade of the Islamic Revolution caused many effects on the national security of the Islamic Republic of Iran. The main question has been raised as follows: What effect did separatist movements have on the national security of the Islamic Republic of Iran in the first decade of the Islamic Revolution? In response to this hypothesis, it has been proposed that separatist movements in the first decade of the Islamic Revolution have become the basis for weakening the national security of the Islamic Republic of Iran. The findings of the article show that, in general, in the first decade of the Islamic Revolution, the existence of various crises in various dimensions contributed to endangering the national security of the Islamic Republic of Iran. In the meantime, the presence of separatist groups in Kurdistan, Sistan and Baluchistan, Gonbad, etc. caused the weakening of economic, political, military, etc. security. On the other hand, since the Islamic Republic of Iran was involved in the war with Iraq and also had recently established an Islamic Republic government with the overthrow of the Pahlavi government, the existence of separatist movements is more effective in jeopardizing the national security of the Islamic Republic of Iran. was The current research method is descriptive-analytical. Also, in order to theoretically support this research, national security theories have been used.

Nursing is a job with high physical activity; therefore nursed are at high risk of work-related musculoskeletal disorders, including neck pain. 

This study aims to investigate the prevalence and risk factors of neck pain in nurses working in intensive care units (ICUs) of teaching hospitals in Rasht, north of Iran.

In this cross-sectional study, 120 nurses working in the ICUs of seven educational therapeutic hospitals in Rasht in 2019 participated. Required data were collected using a two-part questionnaire. The first part surveyed sociodemographic information. The second part was the Persian version of the neck disability index. For statistical analysis, chi-square test, Fisher’s test, and logistic regression analyses were used.

The mean age of nurses was 35.7±5.8 years, and 97.5% of them were female. Their mean work experience was 11.1±5.6 years. The overall prevalence of neck pain was 82.5% (n=99). The frequency of neck pain among nurses with more than 15 years of work experience (P=0.019), age 30-39 years (P=0.031) and no sports activity (P=0.031) was more. The risk of neck pain in nurses who had a history of exercise was 3.277 times higher (95% CI; 1.030%, 10.43%, P=0.045) and in married nurses was 2.92 (95% CI; 0.920%, 9.274%, P=0.069) that was borderline significant.

There is a high prevalence of neck pain among nurses working in the ICUs of educational therapeutic hospitals in Rasht. Hence, it is necessary for hospital managers to take the necessary measures to reduce these complications in order to protect the health of nurses and improve the quality of patient care.

Changes in the body fluid and serum electrolyte status following major operations, such as brain tumor resection, are always expected. These changes can increase post-operation morbidity and mortality.

We aimed to evaluate the changes in serum electrolyte levels and renal function parameters in brain tumor patients after operation.

This cross-sectional study was performed on 168 patients with supratentorial tumors in Poursina Hospital, Rasht City, Iran, in 2020. The study parameters included patients’ demographics, hemodynamic stability, serum sodium, potassium, blood urea nitrogen (BUN) and creatinine levels, urine specific gravity, and urinary output, measured immediately and 12 hours after the operation.

This study revealed statistically significant increases in serum sodium level (from 139.70±5.60 meq/L to 140.34±6.23 meq/L, P=0.002), urinary output (from 1043.70±455.00 mL to 1967.50±661.10 mL, P=0.008), urine specific gravity (from 1.010±0.007 to 1.012±0.008, P=0.011), and in serum BUN level (from 17.46±6.92 to 18.41±6.40, P=0.001), but significant decrease in serum potassium level (from 3.88±0.49 meq/L to 3.78±0.28 meq/L, P=0.017) during the first 12 hours after operation. However, the change in serum creatinine level was not significant (from 1.18±2.08 mg/dL to 1.17±2.08 mg/dL, P=0.787).

Significant changes in serum electrolytes (sodium and potassium) and renal function indicators (urine output, specific gravity, and serum BUN) are expected within the first 12 hours after brain tumor operation.

One of the common complications in craniotomy surgery is bleeding, which is associated with serious and sometimes life-threatening complications. It is essential to accurately estimate the amount of blood lost and compensate for it. This study was conducted to examine the relationship between suctioned blood volume, blood gauze volume, and hemoglobin (Hb) drop rate after craniotomy surgery and identify factors affecting it in hospitalized patients. The results of this research can help doctors accurately predict the amount of blood loss during the operation and avoid unnecessary blood transfusions.

Methods and Materials/Patients:

 Ninety-seven patients with a history of craniotomy surgery in the first 6 months of 2019 were included in the study. The information on the patients was recorded based on laboratory documentation. To calculate the volume of blood lost during the operation, the volume of blood suctioned from the operation description sheet and the volume of blood absorbed by gauzes were calculated and recorded by weighing them. Data were analyzed with SPSS software, version 22.

In this study, 32% of patients received blood during craniotomy. According to the obtained results, the blood volume obtained from blood gauze and suctioned blood and the total blood volume were significantly related to Hb drop, and their ability to predict Hb drop were 6.6%, 14.1%, and 11.2%, respectively. Based on Spearman’s correlation coefficient, the intensity of the correlation between the number of blood gauzes and the amount of blood obtained from blood gauzes was greater than the change in the volume of blood sucked and the amount of total bleeding.

This study showed that measuring the blood volume of gauze consumed in craniotomy surgery can be more effective in predicting the amount of blood loss and Hb drop of the patient after the operation even than the amount of suctioned blood.

Unwanted postoperative hypothermia is an unpleasant event that can cause various complications.

As this serious complication and its provoking causes have not been investigated sufficiently, this study was designed and conducted to determine the prevalence of hypothermia and its associated factors in the post-anesthesia care unit after elective surgery.

Four hundred patients undergoing elective surgeries were enrolled in the present cross-sectional research after termination of surgery and at the time of arrival at the post-anesthesia care unit of Poursina Public University Hospital. The tympanic membrane temperature was measured and recorded at the time of arrival at the post-anesthesia care unit and every 30 minutes after arrival. The required data were collected in a researcher-made checklist and analyzed after entering the SPSS software version 25.

Considering the 5% error, it can be said that the prevalence of hypothermia in patients undergoing elective surgery ranges from 20 to 28% at the time of arrival at the post-anesthesia care unit and 18.5 to 26% 30 minutes after arrival.

More than a quarter of patients experienced hypothermia following elective surgery. Therefore, appropriate treatment and control measures are necessary to manage this complication, particularly in patients with predisposing risk factors and comorbidities.

In the treatment process of hospitalized patients with COVID-19, one of the threatening complications is pulmonary complications such as barotrauma.

This study aims to investigate the prevalence of barotrauma in COVID-19 patients admitted to intensive care units (ICU) of two hospitals in Rasht, Iran.

This retrospective study was conducted on COVID-19 patients admitted to the ICUs of Razi and Poursina hospitals in Rasht in 2020. Their files were studied, and their demographic/clinical data and pulmonary complications were extracted using a checklist by an anesthesia resident. 

Out of 140 patients, 81(57.9%) received non-invasive mechanical ventilation and 59(42.1%) had invasive ventilation. Barotrauma was observed in 9 cases (6.4%), 8(88.9%) in the form of pneumothorax and one (11.1%) in the form of both pneumothorax and subcutaneous emphysema. The results showed that the incidence of barotrauma was significantly higher among patients who received invasive mechanical ventilation (P=0.003). No significant difference was observed among patients received non-invasive ventilation (P>0.05). 

The prevalence of barotrauma among COVID-19 patients in the study hospitals is low, which indicates the proper performance of the attending physicians and compliance with the standard guidelines.

The COVID-19 virus epidemic has caused a major physical and psychological burden on nurses in Iran and around the world.

The purpose of this study was to investigate the role of anxiety and resilience in predicting occupational fatigue in nurses during the COVID ‐ 19 virus epidemic in Iran.

This cross-sectional online survey was conducted on the nurses of Razi and Porsina public hospitals in Rasht, north of Iran. A total of 160 nurses of were selected using simple random sampling method. Data were collected using the Swedish occupational fatigue inventory (SOFI), the corona disease anxiety scale (CDAS) and the Connor-Davidson resilience scale (CD-RISC).

Participation rate was 87.5%. The score level of most nurses in CDAS was low to moderate. The CDAS score was higher in women and those who work in the COVID units than those who work in both the COVID and non-COVID units. The CD-RISC score was higher in married people than singles and in people with permanent employment status than in contract and temporary employment status. SOFI was positively correlated with CDAS and negatively correlated with CD-RISC; But CDAS and CD-RISC were not significantly related (p<0.05). In multivariate linear regression model. Anxiety was the only significant independent predictor of occupational fatigue (B=1.16, P<0.001).

Despite the COVID-19 epidemic crisis in the fourth wave and high mortality, anxiety level in nurses was low and moderate, which can be attributed to the COVID-19 vaccine. But the anxiety score still played an important role in occupational fatigue. It is suggested that appropriate interventions be developed and implemented to improve nurses' anxiety to stressful epidemic conditions of Covid-19 and thereafter.

 Patients who undergo major orthopedic surgery are at risk of acute kidney injury (AKI) due to blood loss, electrolyte disorders, infection, and other co-morbidities. In this study, we aim to investigate the frequency of AKI and its risk factors in patients undergoing major orthopedic surgery in Rasht, Iran.

 This is an analytical cross-sectional study on 180 patients undergoing major orthopedic surgery. Those with a history of chronic kidney disease and dialysis were excluded. 

 The data including patients’ age, gender, drug history, history of underlying diseases, duration of surgery, mean arterial pressure during and after surgery, and use of inotrope during and after surgery, and creatinine level before and after the surgery. 

 The mean age of patients was 47.3±22.8 years. The incidence of AKI was 11.11%. The use of some drugs, duration of surgery, MAP, and inotrope use had no significant relationship. The occurrence of AKI had a significant relationship with the history of heart disease, diabetes, and kidney disease. Multiple linear regression analysis results showed that with the increase of one unit in preoperative creatinine level, the postoperative creatinine level increased by 0.3.

 The incidence of AKI after major orthopedic surgery in Rasht city is relatively high. Careful monitoring of kidney function before, during, and after major orthopedic surgery is important; it can prevent the occurrence of postoperative AKI.

 Physicians whether during training years or working years are involved with the shift work system. Night shifts and the sleep deprivation that ensues have many adverse effects both physical and mental. Hence any decrease in doctors’ mental capacities will potentially put his and his patients’ health at risk, we decided to conduct a study to check medical interns’ Visual Short-Term Memory (VSTM) and Response Inhibition Functions changes after a night shift compared to the day before.

 In this study, 32 medical interns from the Guilan University of Medical Sciences were recruited by random sampling. Each participant completed a Pittsburgh Sleep Quality Index questionnaire and was asked about his/her smoking habit and prior night's sleep. Each examinee then was tested in the morning before and after the night shift for VSTM by forward Corsi Block Tapping Test (CBTT) and for Response Inhibition by Stroop Word/Color Test implemented in the PEBL software version 2beta6. The data were coded and analyzed in SPSS v21.

 There was no significant change in the intern's CBTT and Stroop Test results after a night shift and their VSTM and Response Inhibition Functions remained fairly intact. According to their PSQI results, 29 interns had poor sleep quality and only two had an acceptable PSQI score (5 or less).

 We argued that the consistent results of the CBTT and the Stroop Color Test could be due to many causes from small sample size to overall lower function under chronic sleep deprivation.

The COVID-19 pandemic has had unpleasant consequences for health care providers, including medical stagers and intern students; due to the importance of this issue, this study was conducted to evaluate anxiety, resilience and burnout. This cross-sectional analytical study was performed on stager and intern medical students of Guilan University of Medical Sciences in Rasht, Iran. Data were collected using a list containing Student Demographic Information, Maslach Burnout Inventory-Student Survey (MBISS), Academic Resilience Inventory (ARI) and Corona Disease Anxiety Scale (CDAS). Data analysis was performed using SPSS v.19 at the level of significance 0.05. High levels of burnout and anxiety were calculated to be 21.1 and 7%, respectively. Burnout score was higher in people with grade point average less than 17 (p=0.014); burnout score was also higher in males (p=0.009). Other results showed that COVID-19 anxiety score was significantly higher in females (p=0.029). The results of multivariate linear regression indicated that the variables including academic resilience (β=0.330) and COVID-19 anxiety (β=0.218) significantly explain 20% of the variance of burnout in students. Also, with the introduction of demographic variables, it was increased to 31% in which the share of gender variable (β=0.283) was significant in this model. Academic resilience, anxiety and gender had an effective role on the rate of student burnout. Accordingly, it is suggested that health care providers and psychologists pay attention to student empowerment by providing appropriate therapeutic interventions during and after the COVID-19 epidemic.

COVID-19 is a systemic infection with a significant impact on the hematopoietic system and hemostasis. Infected subjects are at high risk for coagulation diseases such as venous thromboembolism. The aim of the present study was to investigate the consequences of delayed referral of patients with COVID-19 in Ilam. In this investigation, a present prospective study was performed in 2020 on the registry data of patients with COVID-19 disease in the infectious ward of Shahid Mostafa Khomeini Hospital in Ilam. In this study, the effect of delay in hospitalization from the onset of the first symptom of the disease on death and intubation of patients in special and general wards in 2350 patients with COVID-19 was investigated. The statistical software of SPSS 16 was used for analyzing data. The results of univariate logistic regression analysis for the main causes of death due to COVID-19 disease according to hospitalization in ICU and general ward showed that the variables of age, sex, marital status, heart disease, blood pressure, diabetes, chronic lung disease, chronic disease Kidney, neurological disease, cancer, and delayed referral were statistically significant which were associated with death at the 5% error level. The chance of death for delayed referral in ICU patients is equal (OR ICU ADMISSION = 1.06; 95% CI, 1.01-1.12; P value=0.01) and in normal ward patients (OR =0.88; 95% CI, 0.79-0.97), the P-value=0.01 was obtained. The final regression model which was adjusted to the other variables, in hospitalized patients, each day of delay in hospitalization meant a 0.08% increase in the odds of mortality rate and a 0.05% increase in the odds of intubation.

 In December 2019, a new type of Coronavirus (SARS-CoV-2) pneumonia (COVID-19) was reported in Wuhan and quickly spread worldwide. This study was designed to investigate the clinical symptoms of the COVID-19 patients.

 In this retrospective study, we collected data of 132 COVID-19 dead patients. Demographic, epidemiological, and clinical data and laboratory test results were analyzed on days 1, 3, and 6 of admission.

Most cases were in the 66-75 age group, 64.39% of which were males. Three days after admission, 55.3% of patients died. The most frequent clinical manifestations were dry cough (70.45%) and fever (54.54%), which increased during hospitalization. Diabetes and blood pressure were reported as the most prevalent underlying diseases. Lymphopenia and an increase in leucocyte number were observed in most patients. ESR (92.5%) and LDH (94.64%) levels were above normal. Furthermore, 42.85% and 44.73% of patients had elevated ALT and AST levels, respectively.

 The results of this study revealed that males are more likely to be infected with SARS-CoV-19. Underlying diseases were common among patients and clinical and laboratory symptoms aggravated with a rise in hospitalization time.

 Hypothermia is often present in trauma patients at the time of arrival to the hospital. Moderate hypothermia can be associated with an increased patient mortality rate. Early diagnosis and treatment can be effective in better patient outcomes.

 In this analytic cross-sectional study, 325 trauma patients admitted to the emergency room (ER) of Poursina hospital were evaluated. The initial temperature was recorded as the tympanic temperature of the first 15 minutes of patients' arrival to the ER department by the infrared thermometer TM 80 manufactured by Healer Company. Other variables included: age, sex, IV fluid injected volume, method of patient transport, systolic blood pressure, and heart rate. After collecting data, analysis was done using SPSS software version 25.

 According to the findings of our study, 56 trauma patients out of 325 patients were hypothermic (17.2%). The average systolic blood pressure was lower in hypothermic patients and the average IV fluids volume injected into hypothermic trauma patients was higher than in other patients. 

 Trauma patients are prone to hypothermia, although this complication does not have a high prevalence due to its harmful effects such as decreased systolic blood pressure, increased injected IV fluid volume, and increased hospitalization time, trauma patients should be monitored regularly for body temperature and necessary measures should be considered to eliminate hypothermia in trauma patients.

Guillain-Barré Syndrome (GBS) is an autoimmune disease that may occur after infections. As Coronavirus Disease 2019 (COVID-19) may bring about GBS, it is important to assess the effect of the COVID-19 pandemic on this disease

This study aimed to compare the distribution and characteristics of GBS during and before the COVID-19 pandemic in an academic referral hospital in the north of Iran.

This retrospective study assessed GBS distribution and characteristics during the COVID-19 pandemic period (from March 2020 to the end of February 2021) and before the pandemic (from March 2019 to the end of February 2020) on 5340 patients referred to the Neurology Ward of Poursina Hospital of Guilan Province, in Iran.

There was no significant difference between GBS distribution during (0.03%) and before (0.04%) the COVID-19 pandemic (P=0.413). There were also no differences between the two periods regarding the gender (P=0.659) and age (P=0.417) of the patients. The most common subtype of GBS during the COVID-19 pandemic was Acute Motor and Sensory Axonal Neuropathy (AMSAN) (71.4%). In both periods, the most common type of treatment was intravenous administration of immune globulin. There was no significant difference between the two periods (P=0.838) regarding the patients’ treatment response.

The distribution of GBS, its subtypes, type of treatment, and response to treatment were not different between the two study periods.

Colorectal cancer is the third most common cancer in Iran. Some studies have shown that age and sex are associated with the course and prognosis of colorectal cancer. Due to the fact that recognizing the factors affecting colorectal cancer improves the screening system and selects better treatment modalities, and due to the lack of such studies in Iran, in this study, the relationship between the degree and stage of malignancy with environmental factors, gender and age of patients was examined for colorectal cancer.

This is a descriptive cross-sectional study and the pathology report of samples of patients with colorectal cancer admitted during 1393-1397 in Poursina Hospital in Rasht (Iran) in terms of age, sex, tumor location and pathological stage of patients undergoing was evaluated.

From 94 pathology reports, the number of men was more than women and the highest number of patients were reported in the age group of 50-60 years. Abdominal pain was the most common clinical symptom at diagnosis. Most tumors were located in the rectum. Stage III had the highest frequency. Higher stages were statistically significantly associated with being a woman. There was no significant relationship between age and smoking and alcohol consumption with colorectal tumor stage. Also, the degree of tumor was not related to age and sex and history of smoking and alcohol consumption of patients.

In this study, a significant relationship was found between the female gender and the higher stages of cancer. But there was no association between age and sex and smoking and alcohol consumption with the degree of cancer. Also, no relationship was found between age and smoking and alcohol consumption with the stage of cancer.

Medical students, as part of the healthcare team, are directly exposed to challenging conditions during the COVID-19 epidemic. This study investigated COVID-19 anxiety, burnout, and academic achievement in stagers and interns of Guilan University of Medical Sciences.

The present analytical cross-sectional study was conducted on medical students and interns studying at Guilan University of Medical Sciences in the 2020-2021 academic year. Of whom, 150 students participated in this study. Corona Disease Anxiety Scale (CDAS) and Maslach Burnout Inventory-Student Survey (MBI-SS) were used to measure anxiety and academic burnout of the students, respectively. Measuring students’ academic achievement was based on Grade Point Average (GPA). Data analysis was performed using chi-square, Mann-Whitney U test, and partial Spearman correlation Coefficient.

The participation rate in this study was 92%. The results showed that 6.5% of students had high anxiety, 18.8% reported high academic burnout, and 79% reported the average level of burnout score. Also, the participants’ GPA was 16.76±1.30. The academic burnout score was significantly higher in male students than female ones (t=-2.01; P=0.04). The GPA was significantly higher in students under 24 years old than in older students (t=4.71; P=0.01). The partial correlation coefficient adjusted for sex showed a positive and significant correlation between CDAS and MBI-SS (r=0.346; P<0.001).

The present study results showed that medical stagers and intern students had high academic burnout during the COVID-19 epidemic, and there was a weak and direct correlation between academic burnout and COVID-19 anxiety. Accordingly, to reduce the consequences of the COVID-19 epidemic, appropriate therapeutic and educational interventions should be provided to empower stagers and intern students.

The recommended position for measuring Intra-Abdominal Pressure (IAP) is the supine position.However, patients put in this position are prone to Ventilator-associated pneumonia. This study was done toevaluate the relationship between bed head angle and IAP measurements of intubated patients in the intensivecare unit.

In this clinical trial, seventy-six critically ill patients under mechanical ventilation were en-rolled. IAP measurement was performed every 8 hours for 24 hours using the KORN method in three differentdegrees of the head of bed (HOB) elevation (0◦, 15◦, and 30◦). Bland-Altman analysis was performed to identifythe bias and limits of agreement among the three HOBs. According to World Society of the Abdominal Com-partment Syndrome (WSACS), we can consider two IAP techniques equivalent if a bias of <1 mmHg and limitsof agreement of - 4 to +4 were found between them. Data were analyzed using SPSS statistical software (v. 19),and the significance level was considered as 0.05.

The prevalence of intra-abdominal hypertension was18.42%. Mean ± standard deviation (SD) of IAP were 8.44 ± 4.02 mmHg for HOB angle 0◦, 9.58 ± 4.52 for HOBangle 15◦, and 11.10 ± 4.73 for HOB angle 30o (p = 0.0001). The IAP measurement bias between HOB angle 0◦andHOB angle 15◦was 1.13 mmHg. This bias was 2.66 mmHg between HOB angle 0◦and HOB angle 30◦.

Conclusion:

 Elevation of HOB angle from 0 to 30 degree significantly increases IAP. It seems that the measurement ofIAP at HOB angle 15◦was more reliable than 30◦.

 Coronavirus disease 2019 (COVID-19) as an alarming attack broke out in China and spread rapidly worldwide.

 Based on a theory indicating the correlation between some viral diseases and blood types, we investigated the relationship between blood groups and coronavirus infection risk in Guilan Province, Iran.

 Retrospectively, all the files of the admitted patients with suspected COVID-19, in peak conditions of the disease between March 1 and May 30, 2020, were reviewed using the Census method. The required data, including epidemiological and clinical information and outcomes, were obtained from electronic records.

 A total of 249 cases were analyzed, of whom 109 were collected from governmental centers, and the rest were collected from private hospitals. The most common co-morbidity was diabetes with 71 (37.6%) cases and the main symptom at the admission time was dyspnea with 170 (24.5%) cases. Of the total patients, 155 (62.2%) were discharged, and the rest died. The most common blood group among our patients was O Rh-positive with 91 (36.5%) cases. No meaningful correlation was found between outcomes and blood groups in terms of ABO types (P = 0.89) or Rh factor (P = 0.456). The Rh-positive proportion was significantly higher in the COVID-19 cases than in the general population (P = 0.038).

 We found that the Rh-positive proportion was significantly higher in the COVID-19 cases than in the healthy individuals. However, no correlation was observed between the groups regarding ABO typing.

Currently, the most available treatment for acute ischemic stroke (AIS) is thrombolytic therapy with recombinant tissue plasminogen activator (r-TPA). A challenge in r-TPA therapy is the prediction of recovery in each case.

The aim was to find a possible relationship between the cerebral oximetry indexes and the clinical outcome of r-TPA therapy to assess the cerebral oximetry as a non-invasive monitoring agent for therapy.

The inclusion criteria were all patients with AIS who received r-TPA. The neurologic status was evaluated based on the national institutes of health stroke scale (NIHSS) score at arrival, and after a period of 24 hours. In addition, the levels of brain oxygenation in both hemispheres were measured before and continuously over the first 24 hours after r-TPA injection, using an oximetric sensor in the frontal lobes. The clinical success was defined as a 4-point improvement from the baseline NIHSS.

Total 44 patients with the mean age of 58.2 ± 2.18 years were enrolled, of whom 68.18% were male. Twenty-eight patients remained clinically unimproved and 16 patients were improved. A significant difference was found in the mean surface area under the brain oximetric curve in the 24 hour, in the affected hemisphere in the improved group, compared to the unimproved group (P = 0.007). There was a significant difference between the mean increase in brain oxygenation within 24 hours in the improved and unimproved groups (P = 0.002).

It is likely that, The cerebral oximetry could contribute to predict the likelihood of r-TPA prognosis in patients with AIS.

The aim of this research was to examine the effect of consumer innovativeness (emotion and cognitive) on shopping styles. This is a descriptive - survey and statistical society type of study. The participants were students of Razi University in Kermanshah. The statistical sample of the research was chosen according to the random-stratified sampling method. The field method was chosen for data collection. On the basis of optimal allocation, 325 questionnaires were distributed among the students and a total of 301 questionnaires were returned correctly and were chosen as the sample. The validity of the questionnaires was confirmed by 15 experts in the field of sports management and their reliability was calculated using the Cronbach's alpha. The value of the questionnaires such as the modernization questionnaire (α = 0.84) and the shopping style questionnaire   (α = 0.80) were calculated. These values showed the reliability of the scales. For data analysis, structural equation modeling was done using the LISREL software.Finally, the results of the research showed that fitting of the model with the data was appropriate. Also, the coefficient of influence of the two factors of cognitive innovativeness on purchasing styles: "quality awareness (0.63), cost awareness (0.67) and confusion (0.60)" and emotional innovativeness on purchasing styles, "fashion-oriented (0.79), habit-oriented (0.78), brand awareness (0.76), inurement (0.73), disorganization (0.64) and entertainment (0.63)" was meaningful. The results showed that innovativeness was effective on nine shopping styles. These findings enable sports marketers to adopt a more effective approach to targeting a particular group of users.

Myocardial dysfunction is frequently described as an underlying cause of mortality in traumatic brain injury (TBI) known as brain-cardiac link. However the impact on prognosis of a disease remains uncertain. The current study aimed at investigating the correlation between TBI and cardiac troponin I (cTnI) rise and in-hospital mortality rate among patients with TBI. In the current prospective study TBI patients with abbreviated injury scale score (AIS) > 3 and Glasgow coma scale (GCS) score ≤ 8 with cTnI measurement within the first 24 hours of admission were evaluated. Chi-square, Kruskal-Wallis, Mann-Whitney U and Logistic Regression tests were used for data analysis. A total of 166 eligible patients were studied .The mean age of the cases was 37.64 ± 17.21 years, largely under 65 (93.4%) and male (86.7%).The most common injuries were cerebral contusion (35.1%), while motor vehicle crash (MVC) was the most common cause of injuries (83.73%); 59 % of the patients showed detectable cTnI concentrations within 24 hours of admission; 65.7% of the patients expired; they showed higher levels of cTnI compared to survivors that showed lower levels, 0.148 ± 0.074 vs 0.057 ± 0.055, respectively (P < 0.001). Moreover, a significant association was observed between mortality rate and lower admission GCS 3.49 ± 1.08 vs 6.79 ± 1.66, respectively (P < 0.001). Increased cTnI levels could be a predictor of mortality among patients with TBI. Its measurement and investigation for therapeutic strategies could lead to better management of these cases.

The drought and its effect are the most important and common environmental stress that has limited agricultural production in the world. One of the useful strategies of crop breeding for drought resistance is maintaining and exploiting the diversity of their germplasms. To identify drought tolerant sources, 125 Aegilops tauschii genotypes in an augmented designwith three replications under twocontrol (supplementary irrigation in three stages of jointing, flowering and seed filling) and drought stress (without supplementary irrigation) conditions were cultivated and evaluated based on tolerance indices. Correlation coefficients between yield and tolerance indices showed that the indices ofmean productivity (MP), geometric mean productivity(GMP), stress tolerance index(STI) and tolerance index (TOL) were suitable for identifying high yielding genotypes under both stress and non-stress conditions. Based on these indices, genotypes 50, 55, 58 and 65 were identified as the most tolerant genotypes and genotypes 45, 34, 3 and 9 as the most sensitive genotypes. Cluster analysis based on tolerance indices using between-group average method (UPGMA) classified the studied genotypes into seven different groups. Genotypes number 50, 55, 58, and 65, with the highest values for above mentioned indices, were placed in two groups three and five. Finally, according to the results of different analyzes, genotypes number 50 and 55 were identified as the most tolerant genotypes, which could be considered as suitable genetic sources in wheat breeding programs for drought tolerance.

Pain is an experience often caused by tissue damage and is proportional to the severity of the injury. The role of underlying factors in severity of the pain such as prehospital factors have been discussed in some investigations. The current study aimed to assess the effect of different parameters on pain severity in patients with trauma. Methods and Materials/Patients: The current descriptive, cross-sectional study was conducted fully conscious 270 fully patients with trauma admitted to Poursina Hospital in Rast, Guilan, Iran, in 2016. They were assessed in terms of demographic and pre-hospital factors as well as mechanism and severity of trauma based on verbal rating scale. Linear regression analysis demonstrated that among various factors like age, sex, level of education, opium dependence, vehicle type, ventilation, blood pressure, pulse rate, mechanism of trauma, and type of trauma, the highest severity of pain was pertaining to the type of trauma such as multiple trauma and large bone fracture with mean scores of 9.26 and 9.13, respectively. It also revealed that among these parameters, mechanism of trauma, type of trauma, transfer time, type of vehicle, and pulse rate were significantly associated with the severity of the pain. The current study showed that increasing the quality of vehicle, decreasing the transfer time, and paying more attention to hemodynamic factors such as pulse rate, blood pressure, use of analgesic agents, and immobilization of damaged tissue can diminish the severity of pain in patients with trauma.

Delirium is the most common neurological diagnosis among patients in intensive care units. The prevalence of delirium in the ICU patients is high and this is associated with many complications. Thus, by assessment and identifying predictive factors of delirium, its incidence can largely be prevented in intensive care units.
This study aims to determine predictive factors of delirium incidence in patients hospitalized in intensive care units.
This study is a descriptive-analytic study which included all patients admitted to intensive care units (neurology, general and trauma) in one of the training centers, Rasht for three months in 2013 without any symptoms and signs of delirium before hospitalization. There was no age limit for selection of samples. At least 24 hours after admission to ICU, with and without mechanical ventilation, ability to see and hear, Persian language, conscious or semi-conscious, not receiving neuromuscular blockers, coma, history of severe nerve damage (such as acute stroke, dementia, aphasia), chronic renal failure, alcohol abuse and drug abuse were the study inclusion criteria. Patients who used painkiller and sedatives during the study were excluded. Thus, samples were selected gradually considering the inclusion criteria. Based on the preliminary results with 20 samples, the study sample size was estimated 81. The tools used in this study were Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). RASS is the standard tool to assess the level of restlessness and sedation in ICU patients. CAM-ICU examines four main characteristics of delirium; acute change or fluctuations in mental status, lack of concentration, disturbance of consciousness and unorganized thinking.
The first part consisted of demographic characteristics including age, sex, Charleson comorbidity index, Acute Physiology Score (APS) in three ranges of 0-9, 10-14-and ≥15, white blood cell count, serum total bilirubin, days of mechanical ventilation, and days of ICU stay and hospitalization. Charlson comorbidity index had 19 conditions in which the patient is scored based on its potential impact on mortality rate. APS is the biggest part of APATCH (Acute Physiology and Chronic Health Evaluation), obtained from 13 clinical evaluations performed 24 hours after ICU admission in which higher scores is indicative of worsening patient's physical condition. The second part consisted of examining the incidence of delirium in which patients were assessed by RASS in terms of level of consciousness. This tool consisted of 10 items, each representing one level of consciousness (of Combative to Unarousable). To determine RASS, without any interaction, the patient was only observed and if conscious, she was scored 0 to . If the patient was unconscious, his/her name was called loudly and asked to look at the researcher. If the patient responded to call, appropriate score (1-3) was assigned. If there was no response, the patient's shoulder was shaken. If no response was observed, his/her sternum was strongly squeezed and appropriate score (4-5) was given. In case of no consciousness level disorder based on RASS, the subjects were assessed by CAM-ICU for examining delirium which took about 3-5 minutes.
The collected data were analyzed using descriptive and analytical statistics (Fisher and chi-square). For multivariate analysis of the associated factors with delirium, Backward Logistic Regression model was used. P 64.2% of the subjects were male and most of them (48.1%) were hospitalized in the general ward. The majority of samples (49.4%) scored 0-9 in terms of APS. Charlson comorbidity index also showed most cases (29.6%) with 1-2 scores. The mean and SD of patients were 50.95 ± 21.33 years, the maximum tracheal intubation days was 146 days. The maximum duration of ICU stay was 147 days and 150 days in the hospital. Furthermore, the maximum total bilirubin was 4.2 mg dl and the highest number of white blood cells was 29.2000 mg dl. Delirium was observed in 27.2% of samples using CAM-ICU. Delirium distribution was not significant based on qualitative variables; sex, ward and Charlson score whereas APS score which was significant (p=0.048). Distribution of delirium was significant in terms of age (P=0.06). However, it was not statistically significant in terms of the number of mechanical ventilation days, hospitalization and ICU stay, total bilirubin and white blood cell count.
Based on logistic regression model, age, sex, days of tracheal intubation, ICU and hospitalization days, total bilirubin, white blood cell count, and Charlson index were not predictors of delirium. Only APS (considering the range of 0-9 scores as the reference) in two ranges of 10-14 (P Patients with APS points higher than those with lower scores are more likely to develop delirium.