Acta Medica Iranica
Volume:60 Issue: 3, Mar 2022

An outbreak of atypical pneumonia termed coronavirus disease 2019 (COVID-19) has spread worldwide since the beginning of 2020. It poses a significant threat to the global health and the economy. Physicians face ambiguity in their decision-making for COVID-19 diagnosis and treatment. In this respect, designing an intelligent system for early diagnosis of the disease is critical for mitigating virus spread and resource optimization. This study aimed to establish an artificial neural network (ANNs)-based clinical model to diagnose COVID-19. The retrospective dataset used in this study consisted of 400 COVID-19 case records (250 positives vs. 150 negatives) and 18 columns for the diagnostic features. The backpropagation technique was used to train a neural network. After designing multiple neural network configurations, the area under the receiver-operating characteristic curve (AUC), accuracy, sensitivity, and specificity values were calculated to measure the model performance. The two nested loops architecture of 9-10-15-2 (10 and 15 neurons used in layer one and layer two, respectively) with the ROC of 98.2%, sensitivity of 96.4%, specificity of 90.6%, and accuracy of 94 % were introduced as the best configuration model for COVID-19 diagnosis. ANN is valuable as a decision-support tool for clinicians to improve the COVID-19 diagnosis. It is promising to implement the ANN model to improve the accuracy and speed of the COVID-19 diagnosis for timely screening, treatment, and careful monitoring. Further studies are warranted for verifying and improving the current ANN model.

Early administration of thrombolytic agents is standard for patients presenting with acute myocardial infarction (MI). Also, prolonged QT intervals indicate a higher risk for sudden death in patients with MI. This study was conducted to evaluate the door to needle time of streptokinase administration and the incidence of life-threatening arrhythmia in patients with anterior MI. This study was a prospective, single-center study on participants with anterior MI, who were divided into streptokinase and non-streptokinase groups. After administration of streptokinase, QTc was measured in hyper-acute, acute, and recent phases of anterior MI in the group and compared with acute and recent phases in the non-streptokinase group. The incidence of life-threatening arrhythmia was measured and compared in two groups. The data were analyzed by descriptive statistics method and variance analysis in the SPSS software, version 22. The level of significance was considered to be 0.05. Among 87 participants, there was a significant relationship between the door to needle time of 30 minutes and QTc interval in the hyperacute phase (P=0.005). Also, QTc in the streptokinase group was significantly lower than the non-streptokinase group in the acute phase (P=0.003 vs. P=0.205) and recent phase (P=0.007 vs. P=0.228). The incidence of fatal arrhythmias in the streptokinase group was lower than in the others. The relationship between the incidence of VT/VF and TIMI flow grade was insignificant (P=0.089). Reduction of the door to needle time after anterior MI has significant effects on QTc and incidence of threatening arrhythmia.

Epidural analgesia (EA) is one of the best pain relief for many pregnant women in labor. This study was conducted to evaluate the effect of epidural analgesia provided by a combination of bupivacaine plus meperidine or fentanyl on the mother, fetus, and labor process in term nulliparous women. A total of 558 nulliparous women were randomized into two groups of 279 subjects. The BF (Bupivacaine-Fentanyl) group received 16 ml bupivacaine 0.125% plus 50 mg fentanyl as a loading dose; then, an intermittent bolus of the same solution was administered once the patient requested analgesia. The BM (Bupivacaine-Meperidine) group received a loading dose of 16 ml bupivacaine 0.125% plus 20 mg meperidine followed by an intermittent bolus of the same solution if the patient requested analgesia. The time of labor phases 1 and 2 and the incidence of side effects were recorded. After the intervention, the pain score was significantly lower in the meperidine group compared to the fentanyl group during labor (P=0.006). The duration of the active phase of labor (P=0.04) and the rate of cesarean section (P=0.01) were significantly higher in the fentanyl group compared to the meperidine group. The duration of the second stage of labor was not significantly different between the two groups (P=0.24). Apgar score was significantly higher in the meperidine group. This study found that epidural meperidine could be a suitable alternative to fentanyl for improving pain relief and shortening the active phase of delivery without increasing the risk of the neonatal low Apgar score.

Organ failure, including; liver toxicity, renal failure, and neurotoxicity, are frequent complications following HSCT which can affect the transplant outcome, morbidity, and mortality of allo-HSCT recipients: A retrospective study of 206 allo-HSCT patients was conducted to determine the frequency of organ failure and overall survival in patients receiving allo-HSCT. Liver toxicity, renal failure, and neurotoxicity were diagnosed according to clinical and laboratory records pre and post-allo-HSCT. A total of 33 patients (16%) developed organ failure within 200 days after allo-HSCT. Liver toxicity was diagnosed in 12% of patients, and the median time of its occurrence was 22 days (range: 0-207 days) post-allo-HSCT. Two percent (6 of 206) of allo-HSCT recipients presented renal failure. Renal failure was developed within the median time of 33 days (range: 5-88 days). Neurological involvement occurred in 0.9% of patients. Among 206 patients, the frequency of complications such as veno-occlusive disease (VOD) and graft-versus-host disease (GVHD) was 1.4% and 16.01%, respectively. One-year overall survival of patients who had organ failure was 24%, and the mean survival determined 329±99.58 days. Three-month overall survival of patients who developed liver injury and renal failure were 78% and 33%, respectively. Organ failure remains a common complication in patients who received allo-HSCT. Patients with GVHD and two or multi-organ involvement seem to have lower overall survival.

To evaluate and compare posterior corneal elevation data and anterior segment parameters in different grades of keratoconus by Pentacam. 114 eyes of 114 keratoconic patients (85 men and 56 women) with a mean age of 31.6±4.7 years were evaluated with a Pentacam Scheimpflug camera. Keratoconic eyes were divided into 3 groups or grades according to the maximum keratometry reading: mild or grade I (K=50 or less than 50 diopters [D]), moderate or grade II (K=50.0 to 55.0 D), and severe or grade III (K=55.0 D or higher). The posterior corneal parameters were obtained posterior. There were no statistically significant differences between keratoconus grades in terms of sex (P=0.661). Also, there were no statistically significant differences between 3 grades in terms of age (P=0.214). There were statistically significant differences in anterior keratometry readings (K), anterior chamber depth (ACD), anterior chamber angle (ACA), and all pachymetric corneal measurements between all groups. With the progression of the disease, posterior K readings and all posterior elevation measurements were statistically different between the three grades. However, there were no significant differences in pupil diameter, anterior chamber volume (ACV), and corneal volume (CV) between the three grades of keratoconus. According to the results of this study, height data of posterior elevation, when combined with corneal anterior segment parameter, could provide a useful keratoconus severity classification tool.

Patient safety is a major health concern throughout the world, and medical errors are the most important factor threatening patient safety, especially in the Intensive Care Unit (ICU). To prevent errors and improve patient safety, it is necessary to identify the underlying causes of error from the perspective of nurses working in ICUs. This study aimed to explore nurses’ experiences of factors contributing to medical errors in the Intensive Care Unit. The present qualitative study was conducted using conventional content analysis. The participants included 17 nurses working in ICUs in two educational hospitals affiliated with the Iran University of Medical Sciences in Tehran. Data were collected using in-depth semi-structured interviews and were analyzed through the conventional content analysis approach based on Graneheim and Lundman's model. Four main categories (a) extra-organizational challenges; (b) Organizational position; (c) The specificity of the care environment, (d) Individual reason and nine subcategories: (accreditation problems, non-native care standards, organizational management, organizational Features, critical condition of patients, physical structure of unit, neglect in the process of care, lack of clinical knowledge and experience, and physical and psychological problems) were identified. From the nurses' perspective, a series of factors associated with the health system, the organization, the ICUs, and the individual play a role in the occurrence of errors; therefore, it is necessary for planners, policy-makers, nursing managers to think about these underlying factors and with in-service training, and a positive, supportive atmosphere; lead nurses to support the patient and improve patient safety.

Stature is one of the important variables to identify an individual, and the previous reports show that intact femur has the highest correlation with stature. But the femur is usually damaged in forensic cases. Hence in the present study, the femur length is estimated from proximal and distal femoral fragments in the Iranian population. Sixty-four dry femora (32 from each side) without sex determination were studied. The variables were measured by using the osteometric board and digital vernier caliper. The bones with visible abnormalities were excluded from the study. The measured values were analyzed by SPSS 25 software. The linear regression is used for estimating maximum femur length from the other measurements of femoral fragments. The result of this study showed that the value of segmental measurements was different between the right and left sides, but it was not statistically significant. All segmental measurements were positively correlated and found to have a linear relationship with the maximum femoral length (P<0.05) except for femoral neck circumference, which was not significantly different. The regression equation suggested that the intertrochanteric crest length is the best estimator of maximum femur length. The data of this study showed that the femoral length could be estimated from proximal and distal femoral fragments with the help of a regression equation. Then femoral length can be used to estimate the stature. The result of this study can be used in the analysis of forensic bone remains.

Bone involvement in sarcoidosis is rare; its estimated prevalence ranges between 3 and 13%. Osseous lesions usually occur in the phalanges of the hands and feet. Involvement of the axial skeleton is more uncommon. Osseous involvement may be asymptomatic. It is often incidentally discovered on imaging modalities. Radiological techniques can reveal sclerotic and/or destructive lesions. We present a case of a 61-year-old woman in whom osseous sarcoidosis of the sacrum was revealed by back pain and sciatica. To our knowledge, only one isolated case of sacral sarcoidosis has been reported in the literature. Sarcoid bone lesions can be present at disease onset without pulmonary involvement. A biopsy is often required in order to eliminate other conditions, especially malignancy. Treatment is not specific and also not needed in a significant number of cases.

Coronavirus Disease 2019 was initially identified as an infection of the lower respiratory tract but has so far manifested itself with very different symptoms. One of these symptoms is skin lesions associated with an active viral infection that can occur from the onset of infection until treatment. Therefore, observing these skin manifestations can be helpful in diagnosing and managing the disease. Our case is a 56-year-old man who came to the infectious clinic with a chief complaint of skin rashes. The patient was in good general condition on arrival and had no evidence of systemic symptoms of infection, such as fever, body aches, and cough. However, the PCR test for COVID-19 was positive. Although many dermatological findings have been reported with Coronavirus Disease, this case has reported with no symptoms other than skin manifestations that describe a viral infection. It seems that this disease can cause unexpected symptoms, even in mild cases. Therefore, it is better to have the COVID-19 in the corner of your mind when examining people with these symptoms.

Cerebral dysgenesis, neuropathy, ichthyosis, and keratoderma (CEDNIK) syndrome is an autosomal recessive neuro-cutaneous disorder characterized by a collection of clinical manifestations, including microcephaly, cerebral dysgenesis, palmoplantar keratoderma, facial dysmorphism, and ichthyosis. The etiology of this condition has been proved to be a homozygous mutation in the SNAP29 gene, which has an essential role in dermatological and neurological manifestations of this syndrome. In this report, we present the first documented Iranian patient with CEDNIK syndrome. So far, only 14 cases of this condition have been reported globally.