Journal of Analytical Research in Clinical Medicine
Volume:2 Issue: 4, Autumn 2014

Attention deficit hyperactivity disorder (ADHD) is complex in its etiology and ts manifestations. This systematic review will critically analyze the latest research regarding isk factors associated with ADHD such as environmental, including preterm birth, smoking, nd prenatal alcohol use. Furthermore reviewed, will be articles researching genetics, such as dopamine active transporter (DAT1), LPHN3, as well as enetic-environmental interaction for precursors of ADHD.
Current theories of ADHD show evidence supporting multiple genetic and nvironmental factors that interact during early developmental stages in the fetus to create a euro-biological susceptibility to ADHD. The DAT1 has been implicated in ADHD although he mechanism by which it exerts its effects remains unknown. Factors due to drinking, moking or stress while pregnant can affect the nervous system, which later may be linked to DHD symptoms because they may alter genes during development by causing a genetic ariation.
Future research could benefit from using prospective, longitudinal studies, with arge sample sizes. With contradictory results and many competing theories about precursors f ADHD, more research using advanced genetic technology will help researchers learn more bout ADHD’s complex risks, precursors, and symptoms.

Stroke is one of the important and common diseases, which can lead to permanent disability or even death to people. Intracranial hemorrhage (ICH) is a type of stroke that is associated with high mortality despite improved diagnostic and treatment methods, as well as the mortality rate remains high.
In the present review article, reputable internet databases since 2000 were analyzed. Studies that discussed the predicting mortality of ICH were included in this review.
For predicting the mortality rates in patients with primary ICH, physicians use several methods such as level of consciousness, bleeding volume and multiple rating systems. In this review, we introduce three scoring system of ICH in patients with ICH.
Perhaps its cut-off point of these three score systems were different in different societies according to conditions and facilities therefore it is needed to review these scores and record their results in different societies.

Human resources are one of the most important factors in developing of countries and have a considerable role in the developing status of countries. Hence, our aim in this study was to assess the relationship between health indicators and population indexes (population growth and composition).
The present study was conducted using panel data from 176 countries during 8 years from 2004 to 2011. Data were obtained from World Health Organization (WHO) and World Bank and analyzed with generalized linear square regression models using Stata version 10.
Our findings showed a significant association between health indicators (life expectancy at birth and infant mortality rate) and population indexes (sex ratio, residential status, and dependent population). Life expectancy was decreased by 0.35 with one unit increase in the dependent population. Furthermore, there was inequality in life expectancy among rural an urban subjects and was higher among urban subjects.
There is a significant association between health indicators with age, sex, and residential status of the population. Planning and need assessment for population structure should be done by managers and policy makers.

Among the various occupations, firefighters are exposed to stress due to the nature of their occupational. Hence, our aim in this study was to assess occupational stress and its correlates among Tehran’s firefighters, Iran.
A cross-sectional study was carried out among firefighters of Tehran in 2013. A total of 312 staff of firefighting organization selected from five operating region through a multistage sampling. Demographic and occupational stress questionnaires were filled by subjects. Finally, data were analyzed with the help of SPSS for Windows.
Prevalence of overall stress was 2.2%. Stress levels were 5.8% in demand area, 41.0% in control area, 12.5% in communication area, 1.5% in role area, 17.0% in change area, 14.1% in manager support area, and 5.4% in peer support. The significant association was found between married status (P = 0.006), lower education (P = 0.011), number of medical visit (P = 0.044), career history (P = 0.047) with occupational stress.
Prevalence of occupational stress in firefighters of Tehran is relatively low. It is suggested that stress-prone individuals should be identified and advised.

Hepatitis A is the most common viral hepatitis during childhood especially in developing countries. It is, usually, self-limiting, but may be associated with severe complications in some patients particularly those with comorbidities. This study was aimed to determine the seroprevalence of hepatitis A in 2-16 years old children in Tabriz, Iran.
The study was a cross-sectional survey on all children who were referred to the clinic of Tabriz children hospital. For every subject, demographic data, including age, sex, method of sewage and waste disposal/type of water supply, history of blood transfusion and parent’s addiction were recorded. Immunoglobulin G (IgG) antibodies against hepatitis A virus (anti-HAV) were measured in sera by enzyme-linked immunosorbent assay. The association between seropositivity and demographic characteristics was studied.
This cross-sectional study was performed on 252 children aged 2-16 years in Tabriz city during 2012. Totally, 32.9% of children were seropositive for IgG antibody (anti-HAV) There was a significant difference in the history of blood product transfusion between two groups (P = 0.001). A total of 3% of case-patients had poor type of water supply. The discrepancy between two groups was statistically significant (P = 0.040). There was no significant statistic correlation in seroprevalence of hepatitis A relative to parent’s addiction (P = 0.480), age (P = 0.650) and sex (P = 0.890).
According to this study, hepatitis A is prevalent in the pediatric population, and it must be considered in the approach to all susceptible cases of acute hepatitis. Considering the difficulties for the control of environmental sources, we need to have a protocol for routine vaccination of children in our country.

Urinary stones are the third most common disease of the urinary. Renal stones may lead to some preventable complications. This study was designed to investigation and prediction of these complications.
In this cross-sectional study, 200 patients with kidney stones were enrolled. Kidney stone was confirmed and proven in all patients referred to Sina and Shaikh Al-Rais clinics. Their demographic characteristics like gender, age, stone number, stone type, renal failure and bio-chemistry data were evaluated.
Of 200 patients, 130 cases (65.0%) were male and 70 cases (35.0%) were female. The mean age of patients was 41.30 ± 16.06 years. Type of stone was (when evaluation was possible) was mixed (11.5%). However, the type of stone was not analyzed in 112 cases (56.0%). Among complications, recurrent infection was seen (16.0%), and staghorn stones were seen in 2.5% of patients. Dialysis was positive in 3 patients (1.5%). History of surgery was positive in 3 patients (1.5%). Extracorporeal shock wave lithotripsy (ESWL) history was positive in 8%. In evaluated patients, the mean level of calcium was 8.83 ± 0.27, phosphorus was 4.60 ± 0.33, parathyroid hormone (PTH) was 35.20 ± 14.22, uric acid was 4.98 ± 1.57, creatinine was 1.38 ± 1.02 and blood urea nitrogen level was 16.69 ± 11.54 mg/dl. Staghorn stones are significantly associated with progression to renal failure and subsequent complications such as hemodialysis (P = 0.001), surgery (P = 0.001). Recurrent infection was
more frequent in calcium-containing stones (P = 0.001) and ESWL undergoing patients
(P = 0.030). Stone numbers were more than 3 in hemodialyzed (HD) patients (P = 0.001). Uric acid stones were more seen in HD patients (P = 0.170).
According to results hemodialysis and recurrent infections are seen in patients with renal stones, and they may be detected in earlier with close periodic follow-up.

One of the causes of recurrent spontaneous abortions (RSA) is an infection by the toxoplasmosis Protozoa. In comparison, we present detailed results using real-time polymerase chain reaction (PCR) methods of detection. In this study, it was tried to detect Toxoplasma gondii (T. gondii) by real-time PCR methods in patients with RSA.
Amniotic fluid sampling was performed in the 16-20th weeks of gestation in 50 pregnant women with a history of RSA. The extracted deoxyribonucleic acid (DNA) samples were analyzed using quantitative real-time PCR.
In all the cases, the detection of T. gondii was negative in the peripheral blood, and amniotic fluid samples by using the molecular methods (real-time PCR). Using the serological detection methods, 6% of patients were diagnosed as positive for the immunoglobulin M (IgM) antibody. In addition, the IgG antibody was positive in 46% of the patients.
It can be concluded that the serological methods lack specificity.

Iron overload may contribute to the pathogenesis of metabolic syndrome (MS). A growing body of evidence indicates that the oxidative stress that results from excess tissue iron can leads to insulin resistance, tissue damage, and other complications observed in MS. The objective of this study was to investigate indices of iron status including serum ferritin, iron, total iron binding capacity (TIBC) levels, and full blood cell count, together with demographic and anthropometric characteristics, lipid profile components, and other biochemical parameters in subjects with and with-out MS.
A total of, 385 individuals (176 with and 209 subjects without MS) according to the International Diabetes Federation’s (IDF) criteria were recruited. Indices of iron status and other clinical and biochemical parameters were determined in MS patients and healthy controls using standard methods.
Higher serum iron and ferritin values were observed in subjects with MS in compared to healthy controls (P 0.050). Among the other indices, only red blood cell (RBC) was associated considerably with the presence of MS (P Our data indicate that even in a country with a comparatively high prevalence of iron deficiency, serum iron and ferritin values in MS patients are higher than healthy controls. The reason why ferritin and iron are higher in MS patient may be related to dietary factors.

Nowadays chronic disease and number of elderly population climb in low and middle-income countries and need for high-quality hospice care services for them. The aim of this study was to review the experience of hospitalized end of life (EOL) patients and their family’s regarding hospice care.

In this qualitative study with the phenomenological approach, 20 patients and their families were chosen using purposive sampling to achieve data saturation from the Tabriz University of Medical Sciences Hospitals, Iran. The required data were collected using in deep semi-structured interviews and analyzed using Diekelmann method.

Patients and their family’s experiences included 7 main themes: lack of special education for healthcare providers, preferences, financial problems, health care quality, lack of providing information to patients and their families, limitation in life due to disease, burdens to EOL care for family.

Due to the lack of experience in hospice care in Iran, patients, families and health care provider not have adequate knowledge about hospice. The cost of this service is high, and qualities of these services are low. Furthermore provide educational courses for patients, families and health care provider and decrease of cost and improve of quality are necessary.

One of the most important causes of mortality and morbidity in burn wards is infection, and it is the major reason of death in burn injuries. There are several reasons that make burn victims predisposed to infection. The current study aimed to investigate the role of different factors that have an effect on bacteremia occurrence in burn patients and factors which are relevant to mortality in these patients.
This descriptive-analytic study conducted in a 1 year period in Sina Hospital, Tabriz University of Medical Sciences, Iran, and 81 burn were included. We collected patients’ data about their age, body weight, cause of burn, lesion color, place and percentage of burn by getting history and studying of their files. Then we documented all interventions. Blood tests and cultures and colonies criteria were recorded.
In this study, 39 patients were male (48.1%), and 42 was female (51.9%). Mean age was 32.06 ± 17.46 years. In patients without bacteremia, 57 patients did not need catheterization (89.1%), however in patients with bacteremia 9 patients demanded catheter insertion (52.9%). In patients with bacteremia 12 patients survived (70.9%), however in the without bacteremia group 56 patients survived (92.2%). Then, the relationship between type of burn, wound infection and bacterial species investigated, (P = 0.650, P = 0.210 and P = 0.110 respectively).
We concluded, invasive interventions increased bacteremia susceptibility in our studied burned patients. Mortality rate is directly related to bacteremia prevalence and increased by extent of burn area in these patients. The three most frequent microbial agents responsible for bacteremia were Pseudomona aeruginosa, Klebsiella and Staphylococcus aureus.

Secondary aortoenteric fistula (SAF) is an uncommon, but very important complication of abdominal aortic reconstruction. The complication often occurs months to years after aortic surgery. The clinical manifestation of the aortoenteric fistula is always upper gastrointestinal bleeding. Treatment of the disease is early surgical intervention. If operative treatment is not performed promptly, the mortality is high.
Case Report: A case of secondary aortoduodenal fistula found 6 years after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with SAF will present to the clinical physicians in the future. Hence, a high index of suspicion is necessary for prompt diagnosis and treatment of this lifethreatening event. The patient treated medically and finally expiration of the patient and review of the literature currently available in Medline.
The aim of this case report is to emphasize early diagnosis and management of all gastrointestinal bleeding in patients who have a history of aortic reconstructive surgery.