Journal of Analytical Research in Clinical Medicine
Volume:6 Issue: 3, Summer 2018

Tuberculosis (TB) is a global emergency. This study was conducted to determine the status of TB in selected countries. This comparative study was conducted in 5 countries. The values for the indicators of each country were extracted from the World Health Organization (WHO) Profile and 2015 World Population Data Sheet. Among the selected countries, the highest and lowest incidence rates of TB were related to Malaysia and Germany, respectively. Regarding the improved index of patients undergoing treatment, Iran and Germany had the highest and lowest improvement rates, respectively. To achieve the End of Tuberculosis Epidemic (END-TB 2035), it is necessary to increase the number of activities aimed at increasing the detection, diagnosis, and effective treatment of disease by implementing strategies (Dots) in order to improve the success rate of treatment, as well as reduce the incidence of cases of resistance to treatment. Moreover, it is necessary to make interventions to improve living conditions and social welfare, support poor people in the community, and improve the status of prisons in the country.

As an essential part of antenatal care, pregnant women of all ages should be offered screening for chromosomal abnormalities before 20 weeks of gestation. This study was aimed to evaluate the type and frequency of chromosomal abnormalities following pregnancy screening tests, so that we can compare the actual pregnancy outcomes with test results, helping us in practical decision making. A cross-sectional study was conducted on 557 pregnant patients, presenting for prenatal diagnostic amniocentesis for chromosomal abnormalities, to Al-Zahra hospital, Tabriz, Iran, since 2012 to 2015. Amniocentesis was conducted by an expert obstetrician at second trimester between 16 and 22 weeks of gestation. An interview was set for pregnancy outcomes to assess the test results. Of 557 cases, the mean maternal age in amniocentesis was 31.84 ± 6.92 years (range: 15-47 years). Amniocentesis revealed the presence of chromosomal abnormalities in 32 cases (5.7%). The most common diagnosed chromosomal abnormality was Down syndrome (50.0%) followed by other chromosomal abnormalities. Following up the patients, 92.4% of newborns did not have any congenital abnormality, but the remaining (7.6%) had both chromosomal and non-chromosomal abnormalities. No fetal loss was reported in this study. Assessment of total costs revealed that $US100 had been spent for hospitalization, and about $US500 for genetic tests. There is still no consensus on the most cost-effective strategy that should be implemented to diagnose chromosomal anomalies. Therefore, we did not have an actual gold standard to compare with amniocentesis. More studies analyzing natural outcome after prenatal diagnosis of these chromosomal abnormalities are needed

There are different aspects of the presence of family members in cardiopulmonary resuscitation (CPR). The present study was carried out with the aim to determine the attitude of nurses and physicians towards the presence of family members during CPR in educational hospitals of Urmia University of Medical Sciences, Urmia, Iran. In this study, 190 nurses and emergency medical staff were asked to complete a questionnaire. The sampling method was as counting all the participants. Data collection tool was a pre-designed questionnaire. The questionnaire consisted of two parts: the first and the second parts were respectively related to demographic information and family presence during resuscitation (FPDR) issue and various factors influencing this attitude. After collecting the data, their analysis was performed using SPSS software. In this study, 62 (44.0%) and 101 (53.2%) of the participants respectively agreed and disagreed that during the CPR process, the relatives of the patients had the right to attend the resuscitation room. A significant number of participants in the study (64.2%) believed that the presence of the patient relatives during resuscitation violates the privacy of the patient, regardless of his/her prior consent. The findings of the study showed that many physicians and nurses opposed the presence of family members during the resuscitation process, and the number of individuals who agreed on this idea was much lower, however in some studies, physicians and nurses were agreed about the conditions. This can be due to cultural differences and conditions and also the place where resuscitation was performed.

Systemic lupus erythematosus (SLE) is a relatively common disease among the patients referred to the rheumatology clinics. Tumor necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK), as a cytokine, is a member of TNF family, and CD160 is an essential natural killer (NK) cell activator, both of which have been argued to be associated with SLE activity. Here, we aimed to evaluate the serum levels of sTWEAK and CD160 and their association with SLE activity. In a descriptive cross-sectional study, 48 patients with SLE, as the case group, and 40 healthy subjects, as controls, were enrolled. SLE activity was assessed using SLE Disease Activity Index (SLEDAI) in the case group. Moreover, the serum levels of sTWEAK and CD160 were determined using enzyme linked immunosorbent assays (ELISA) method in both groups. Mean serum level of sTWEAK was 19.09% lower in the control group compared to the case group (730.15 ± 170.21 pg/ml vs. 895.39 ± 451.25 pg/ml, respectively). Further, mean serum level of CD160 was 47.31% lower in the healthy subjects than that of SLE patients (206.16 ± 88.97 pg/ml vs 391.30 ± 283.46 pg/ml, respectively). The differences in both occasions were found to be significant (P = 0.013 and P =0.001, respectively). Mean SLEDAI in the patients was 8.68 ± 4.00. There was no significant correlation between serum levels of sTWEAK and CD160 with SLE activity. The serum levels of sTWEAK and CD160 markers in patients with SLE are significantly higher than those of healthy subjects. However, we found no correlation of these markers with the disease activity.

Regarding mental disorders, one of the important factors in the validity of clinical diagnosis is its consistency in consecutive evaluations. This varies from 29% in personality disorders to 70% in schizophrenia. This survey was conducted to study clinical diagnosis stability among readmitted patients in referral psychiatric university hospital. In this study, 1000 records were evaluated retrospectively. Data were gathered by educated clinical psychologist with a prepared checklist. The checklist consisted of demographic data, clinical interview data, primary and final diagnosis, and process of care. The collected data were analyzed using SPSS software and presented as descriptive and proportion measures. The mean age of patients in the first hospitalization was 31.23 years. Since the first admission, 26.6% of patients’ life time was spent in hospitals. The clinical diagnosis of cases at discharge was bipolar mood disorder I (BMD I) and schizophrenia in 49.5 and 40.4 percent of cases, respectively. Generally, concordance between admission and discharge diagnosis was 94.9 and 84.4 percent among the women and men, respectively. 66.0% of patients with BMD I and 71.4% of patients schizophrenia received the same diagnosis in at least 75% of their next hospital admissions. Furthermore, the prospective consistency was 80 and 60 percent in schizophrenia and BMD I, respectively. The findings of the present study showed that in psychiatric studies, clinical diagnosis can be challenging especially in short term evaluations.

Traffic accidents are of the most common causes for emergency ward admissions with variable outcomes ranging from full recovery to death. In order to have an accurate policy setting, the information regarding the accidents should be unraveled. The present study was carried out aiming to describe traffic accidents causing trauma in one of Iran’s major municipalities. In this cross-sectional study, 757 patients admitted to the emergency wards with the background of traffic accidents were included in the study. All patients had signed informed consent before participating in the study. Data regarding these patients were extracted from the hospital information system (HIS) and then analyzed. The mean age of the patients was 33.09 ± 17.19. Most of the patients (70.7%) were men. Almost two third of the patients were injured inside the cities. Accidents happening on the inter-city roads were significantly related to the car collisions. Emergency medical services (EMS) were the most common route of admission and referral. The head trauma had the highest incidence rate among all traumas based on location. Accidents on the inter-city roads were related to the injury to the neck, thorax, and upper limbs. Based on various factors effecting trauma caused in traffic accidents, the clinical picture was variable. It is important to have an understanding of the situation regarding traffic accidents in order to further enhance the quality of care for these patients

Iran's hazard level against disasters is estimated to be 8 out of 10. The Farsi version of Hospital Safety Index (FHSI) has been designed by the World Health Organization (WHO) to simply scan the hospital safety standards for disasters. This study was designed to investigate the uncertainty about the safety level of hospitals in Tabriz, Iran, against disasters and the importance of the issue. In this study, 21 hospitals in Tabriz City were evaluated. The items in the hospital safety index (HSI) were provided with a checklist. The collected data were entered into the SPSS statistical software. Finally, the safety levels of the hospitals were determined and compared with one another. The average hospital safety score was 6.70 ± 1.16. Only 6 hospitals were in good condition, with the 4 cases being non-academic hospitals. The functional safety of the hospitals was acceptable, and the structural and non-structural safety levels were modest. The highest and lowest scores were related to functional safety and structural safety, respectively. The rate of safety of general hospitals was significantly higher than that of the specialized hospitals with rates 7.07 ± 1.03 and 5.75 ± 0.88, respectively. There was no significant correlation between the number of hospital beds with the level of safety score. The results of this study indicated the weak safety of Tabriz hospitals against disasters, especially in structural aspect. However, the probability of occurrence of various disasters in this area including earthquakes, extreme cold weather, etc. is very high. So, it seems to be necessary to attract attention to change policies about hospital management.

Rhabdomyolysis is the clinicopathologic presentation that is caused by striated muscle damage with leaking of toxic pigments into the blood. Clinical findings of rhabdomyolysis ranges from asymptomatic increase of muscle enzymes to the fatal forms of acute renal failure (ARF) and electrolyte disturbance. The causes of rhabdomyolysis can be classified under several groups: (a) direct injury from trauma, (b) overuse of muscle, (c) congenital muscle enzyme errors, and (d) uncommon pathogens like drugs and toxins, ischemia of muscle, metabolic and endocrine disorders, and finally infections. The diagnosis of rhabdomyolysis is based on myalgia and weakness, tea-colored urine (myoglobinuria), an increase in muscle enzymes that is not caused by myocardial infarction (MI) or polymyositis (PM). The most important goal of treatment is to diagnose and cure complications like electrolyte disturbances and acute tubular necrosis (ATN). Case Report: The case in the present study was a young man who was admitted with fever and chill and generalized myalgia with tea-colored urine. Finally, he died because of acute adult respiratory distress syndrome (RDS), acute renal tubular necrosis, and hyperkalemia. Among congenital muscle enzyme disorders, the most common type is the carnitine-palmitotransferase defect (CPT), and after that, the second most common is myophosphorylase deficiency. Among muscle carbohydrate metabolism defects, McArdle disease (MD), or glycogenosis type V (GSD-V), is the most prevalent, which is caused by a deficiency in glycogen-phosphorylase enzyme. In this disorder, only striated muscles are affected, which leads to rhabdomyolysis in the primary steps, and exercise intolerance, muscle cramps, and myoglobinuria, when reaches more developed levels. This predisposition to rhabdomyolysis in patients with MD prevents us from administrating certain drugs in these cases. Rhabdomyolysis may develop among individuals with abnormal muscles as in congenital diseases of glycogenolysis, glycolysis, purine, and lipid metabolism. Considering the rare causes of rhabdomyolysis like MD permits physicians to diagnose and treat this potentially fatal occult causes.