mohammad mojtahed

Myxoma may cause systemic embolization and frequently presents as ischemic stroke. 

There have been debates about whether it is safe to use recombinant tissue plasminogen activator (rt-PA) in patients with cardiac myxoma who referred with ischemic stroke to the hospitalchr('39')s emergency. 

The patient was a young case of atrial myxoma with initial presentation of acute cerebral infarction symptoms who was treated with intravenous rt-PA with no complications.

The case provides an evidence of the efficacy and safety of intravenous rt-PA in cases of cardiac myxoma. However, we cannot always expect thrombolytic therapy to be effective, especially in tumor emboli.

Laboratory turnaround time (TAT) is an important determinant of patient stay and quality of care. Our objective is to evaluate laboratory TAT in our emergency department (ED) and to generate a simple model for identifying the primary causes for delay. We measured TATs of hemoglobin, potassium, and prothrombin time tests requested in the ED of a tertiary-care, metropolitan hospital during a consecutive one-week period. The time of different steps (physician order, nurse registration, blood-draw, specimen dispatch from the ED, specimen arrival at the laboratory, and result availability) in the test turnaround process were recorded and the intervals between these steps (order processing, specimen collection, ED waiting, transit, and within-laboratory time) and total TAT were calculated. Median TATs for hemoglobin and potassium were compared with those of the 1990 Q-Probes Study (25 min for hemoglobin and 36 min for potassium) and its recommended goals (45 min for 90% of tests). Intervals were compared according to the proportion of TAT they comprised. Median TATs (170 min for 132 hemoglobin tests, 225 min for 172 potassium tests, and 195.5 min for 128 prothrombin tests) were drastically longer than Q-Probes reported and recommended TATs. The longest intervals were ED waiting time and order processing. Laboratory TAT varies among institutions, and data are sparse in developing countries. In our ED, actions to reduce ED waiting time and order processing are top priorities. We recommend utilization of this model by other institutions in settings with limited resources to identify their own priorities for reducing laboratory TAT.

Carpal tunnel syndrome (CTS) is common in the industrial setting. However, there is a controversy about the sole role of occupational ergonomic hazards in CTS.

This study was conducted among assembling workers of a detergent factory and computer users with the aims of A) determination of CTS prevalence and B) evaluation of personal risk factors and level of exposure to occupational risk factors via Quick Exposure Check (QEC)).

In this descriptive cross-sectional study, 906 cases (332 assembling workers and 574 computer workers) were enrolled. CTS was assessed by symptoms on the Katz hand diagram and physical examination. QEC technique was applied to evaluate physical exposure to the risk factors.

According to this study, the prevalence of probable CTS was 14% in men and 8.9% in women; the rate of probable CTS was significantly higher in assembly workers than in computer users (P < 0.001). Mean age and work duration in the probable CTS group was statistically higher than in non-CTS group. But both groups were in the same range (fewer than 30, P = 0.024, 0.004); BMI in the probable CTS group was slightly lower than in non CTS group, but BMI in both groups were in the normal range. Wrist ratio > 0.7 correlated with increased risk of probable CTS (P < 0.001) Prevalence of probable CTS was significantly higher in third and fourth levels of QEC (P < 0.001).

Although this article had limitations, our findings suggest that the level of occupational exposure is an indicator of CTS development.