Journal of Iranian Medical Council
Volume:5 Issue: 2, Spring 2022

Several studies have aimed to discuss the Ultrasonographic (US) findings in the assessment of ulnar neuropathy at elbow; however, the current data are widely heterogeneous and it seems necessary to summarize the original studies to reach a consensus. The goal of this study was to conduct a systematic review on the ultrasound measurements of ulnar nerve cross-sectional area at the elbow among patients with definite diagnosis of ulnar neuropathy.

The global databases including Medline, Web of Science, Cochrane Library, Google Scholar, and Scopus were deeply evaluated for all eligible English studies. Among the 343 initially retrieved articles, 31 studies met the eligibility criteria and were published from 2000 April to 2019 December. After excluding the non-eligible articles, 18 manuscripts were systematically reviewed with the goal of assessing Cross-Sectional Area (CSA) at different levels regarding the elbow using different techniques and by various types of transducer ranged from 4-18 MHZ. Data extraction was independently performed by two reviewers on some structured data-collection forms.

The summary of following details were systematically reviewed for the included studies: technique of US measurement and type of transducer, as well as cut-off value and diagnostic capability of the ultrasonography. The collected data were analyzed in STATA software using random or fixed-effect models, as effect size measures such as raw or standardized mean differences (MD or SMD).

In the current meta-analysis, it was proved that ultrasound could be a suitable device to diagnose ulnar neuropathy at elbow, with acceptable sensitivity (72.0-76.1%) and specificity (76.1-81.8%) values.

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.

Nowadays, doing any activity at any level without having specialized knowledge in that special field is impossible. The practice and implementation of crisis management including reduction, preparedness, response, and reconstruction requires the knowledge compatible with any measure which puts into practice all the existing and accessible information in its best way. Based on these facts, the present research investigates the relationship between specialties of managers and crisis management function in hospitals in Tehran. The present study was conducted through survey method of research with a descriptive-analytical and correlational design. The statistical population included personnel working in hospitals in Tehran. For sampling procedure, randomized sampling was used. Based on Cochran formula, the size of samples was determined which included 80 hospital personnel encompassing 20 crisis management specialists.  Considering the results obtained, there was a significant relationship between managers’ expertise and crisis management performance (p<0.005, R = 0.24). According to the regression analysis, 6% of the changes in crisis management performance were associated with the managers’ expertise. Given the relationship between the managers’ expertise and the performance of crisis management in Tehran Hospitals, it seems that with more focus on the expertise of hospital managers and the importance of training and skills of managers in appointing them to managerial positions, crisis management in hospitals has been more successful.

While respiratory tract symptoms are the most frequent reasons for hospital admission in COVID-19 patients, renal involvement is common and is associated with worse outcomes. The aim of this study was to determine the incidence, risk factors and outcome of Acute Kidney Injury (AKI) in hospitalized COVID-19 patients in a referral center.  In a retrospective review, patients hospitalized for COVID-19 from February 2020 through April 2020 in a referral COVID center were studied. Demographic data, pre-existing comorbidities and drug history, along with laboratory data at presentation and during admission were recorded. AKI was diagnosed based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Data were analyzed to determine the incidence, risk factors and mortality of AKI.  Finally, 200 patients were included, with a mean age of 60.5 years. Of these, 126 (63%) developed AKI and this number was 73.5% among the ICU-admitted patients. Patients who developed AKI were 4.29 times more likely to die. Pre-existing CKD, treatment with immunosuppressant, ICU admission, and the need for hemodialysis, were significantly associated with mortality. Among the eleven renal transplant recipients in this study, we found that a prior renal transplant was not associated with a higher rate of AKI but was significantly associated with increased mortality after correcting for age and gender.   Our findings showed a high incidence of AKI in patients admitted due to COVID-19, with a higher risk in ICU patients and it was a significant predictor of mortality. Further research is encouraged to understand the etiology of AKI, along with the long-term outcomes in the patients.

The way one mourns varies across different cultures. As such in each society, the mourning rituals in accordance with the culture of that society can alleviate the grieving process. During the coronavirus (COVID-19) pandemic, in many parts of the world, restrictions have been imposed on hosting different ceremonies and events to control the spread of the virus. Since the enforced regulations have made changes to the way mourning is done in these times, an investigation of the experiences of people of different cultures in coping with loss during the current crisis seems to be of importance. The purpose of this study was to investigate the mourning experiences in north-east of Iran during COVID-19. This is a qualitative study which was conducted by using content analysis. The participants were 11 individuals who had lost a family member due to COVID-19 in Bojnurd in 2020. Sampling was purposive and continued until reaching data saturation. Semi-structured interviews and note-taking were utilized for data collection. The interviews were recorded and the notes were then evaluated. After analyzing the collected data and forming semantic units, three main categories and nine sub-categories of unexpressed grief were extracted. Unexpressed bereavement, effects on mental health, and dissatisfaction with services comprise the main categories while lack of farewell opportunity, the emotional burden of COVID-19, strange burial, fear and social stigma, lack of adequate psychological support, emotional trauma and shock, reducing the motivation for life, lack of professional principles in the death announcements, and finally lack of equipment and non-compliance with hygiene standards make up the 9 subcategories. The collected evidence concerning the unexpressed grieving experience ensuing from the COVID-19 induced death of a family member reveals such issue to be one of the most important mental health issues during the spread of the virus, which requires the necessary investigation and intervention of the experts in this field.

Mastalgia as a chronic pain syndrome and its association with psychological disorders has not been fully addressed. All women with non-cyclic mastalgia attending to our center were screened for psychological disorders using General Health Questionaire-28 (GHQ 28) and those with score > 23 were referred to the psychiatry clinic.  60 patients were evaluated. Duration of mastalgia (month), days with pain in one month and duration of pain from onset to relief (minute) were 14.35±18.61, 13.01±7.36, and 79.23±180.82, respectively. Bilateral (43.33%), intermittent (58.33%), and radiating (58.34%) pain improved spontaneously (48.33%) was the most common characteristic of mastalgia. Mean GHQ score was 27.36± 12.7 and 50% of the patients had GHQ>23. Major depressive disorder (35%), mixed anxiety and depression disorder (26.66%) and general anxiety disorder (21.66%) were three leading diagnoses. It is required to respond to patient’s psychological disorder to reach sustain therapeutic results.

To tackle the 2019 coronavirus infection (COVID-19) disease pandemic, effective antiviral therapy is critical. We assessed the efficacy of sofosbuvir and daclatasvir for treating patients with COVID-19.  This was a randomized controlled trial in adults with moderate-to-severe COVID-19 disease admitted to Razi Teaching Hospital in Ahvaz, Khuzestan Province, Iran. Patients were randomly assigned to the sofosbuvir and daclatasvir group (n=35, intervention group) and control group (n=35, standard care). The primary endpoint of this study was the length of hospital stay, clinical improvement, mechanical ventilation, mortality, and side effect. We found that the combination of Daclatasvir and Sofosbuvir (DCV+SOF) did not make a statistically significant difference in terms of mortality. There was no significant difference in the duration of hospitalization between the two groups. The two groups did not differ significantly in terms of the frequency of side effects. There were 2 cases of intubation and death in both groups. The medications used in this study, i.e, the combination of daclatasvir and sofosbuvir, failed to show a significant effect in patients, and despite promising laboratory studies, there were no improvements observed in vital signs and the indicators studied, including clinical signs. Hospitalization days, ventilator requirements and mortality did not make a significant difference. To confirm the results of this study, conducting researches with a larger sample size are needed.

One of the main parts of the early treatment of Acute Ischemic Stroke (AIS) is the attitude and knowledge of Emergency Medicine (EM) specialists. This study aimed to investigate the knowledge and attitude of emergency physicians working in Iran about the prescription of tissue Plasminogen Activator (tPA) in AIS. This was a cross-sectional questionnaire-based study including EM physicians working in different cities of Iran in 2020. A previously used English questionnaire was translated into Persian. After face validity and reliability assessment, the final questionnaire was designed as a Google form and sent to 400 EM professionals. 128 physicians filled in the forms. 64.8% of participants had sufficient attitude and 68% had sufficient knowledge about tPA treatment in AIS. The knowledge regarding tPA treatment was higher in the age>40 years, male gender and physicians with up-to-date information (P<0.05), but no significant association was found for the attitude. Logistic regression analysis showed that the amount of information about tPA administration in AIS (OR=3.475, 95% CI =1.242-9.723, p=0.018) and age (OR=0.336, 95% CI = 0.130-0.865, p=0.024) had the greatest impact on the level of knowledge for tPA treatment. About two-thirds of EM professionals in Iran had sufficient knowledge and attitude about tPA administration in AIS. Having up-to-date information and age>40 years were the major predictors of higher knowledge of AIS treatment. Holding some training workshops together with strengthening infrastructures such as establishing intensive stroke units would help to increase the use of tPA in AIS in Iran.

COVID-19 has led to the demand for finding effective antiviral agents. Preliminary experiments showed Umifenovir inhibit replication in vivo. There is limited data on the clinical efficacy of COVID-19-infected pneumonia. Therefore, we aimed to evaluate this medication based on clinical findings. The present study was designed to investigate the advantages and disadvantages of Umifenovir and compared to empirical treatments. For this purpose, multi-stage sampling was considered. 56 people who had mild-to-moderate symptoms without signs of pneumonia, were selected by accidental non-random sampling method and divided into two groups [(group A with Hydroxychloroquine (HCQ) and group B in combination with Umifenovir] by randomized block sampling (1:1). During the study, three patients left the case group. Their clinical signs and symptoms were evaluated on 3rd, 7th, and 14th day after taking these medicines in the disease course. The SPSS software was used for data analysis and the significance level was considered to be p<0.05. On the seventh day after visiting the patients, there were statistically significant differences in recuperation dry cough (p=0.001), weakness (p=0.004), gastrointestinal symptoms (p=0.043) and shortness of breath (p=0.001) between the two groups so that group B patients (HCQ and Umifenovir) had a faster recovery. In patients treated with HCQ and Umifenovir compared to the control group, myalgia (p=0.03), gastrointestinal symptoms (p=0.047) and weakness (p=0.007) improved significantly earlier during the illness. Evaluation of the clinical findings in mild-to-moderate COVID-19 patients’ symptoms was performed and it was shown that recuperation was faster in the group who received both HCQ and Umifenovir.

Given the importance of the Intensive Care Unit (ICU), it is necessary to monitor the performance of this department to provide the urgent information required for clinical and managerial decision making. Its use can play an important role in improving the performance of the ICU. The aim of this study was to develop a clinical dashboard to monitor key performance indicators in ICU of Imam Khomeini Hospital affiliated to Urmia University of Medical Sciences.

The current study was carried out as a descriptive study in 4 main phases, in 2019. In the first phase, key performance indicators were determined through an electronic questionnaire. In the second phase, the dashboard was designed based on the user and technical requirements. In the third Phase, the dashboard was implemented in ICU of Imam Khomeini Hospital at Urmia. In the final phase, the dashboard usability was evaluated through the think aloud method.

A total of 28 key performance indicators in 3 categories were considered essential for the ICU dashboard from the perspective of intensive care professionals. The dashboard was created using the PHP programming language and MySQL database management system. The dashboard was implemented in the ICU, and information of 400 patients was entered online. Based on the data entered for each patient, the indicators were automatically calculated. After the physicians and nurses worked with different sections of the dashboard, their comments were used to improve visual features of the dashboard. 

The designed dashboard in the present study can be a useful tool for better understanding of the patients’ clinical conditions. It also enables managers to monitor the healthcare quality of the ICU department in real-time based on the key performance indicators.

Studying the prevalence of infertility as a common disease and its treatment have recently become an important issue. These treatments include drugs and surgery; and lasers have also been used complementarily. However, they affect the ovarian blood vessels number. Accordingly, the present study was conducted to investigate the photo-bio stimulation effect on near-infrared and red laser as of low-level lasers on the blood vessels in ovarian tissue, compared with the clomiphene’s effect. Twenty-eight female rats were randomly divided into four groups: Control (CT), Clomiphene Drug (D), Red Laser (RL) and Near-Infrared Laser (NIRL). Afterwards, the laser groups received irradiation (5 J/cm2 dose) and the rats in group D received clomiphene (1µg/kg). After the experiment, the animals were anesthetized and their ovaries were removed. Henceforth, the laser’s effect was investigated and compared with that of clomiphene.  The number of the blood vessels increased in NIRL (71.96%) and RL (67.070%) groups, compared with CT. It was also increased in NIRL (59.81%) and RL (14%) compared to D group. In addition, it increased in NIRL (53.27%) compared with RL. This increase was significant in the NIRL group indicating that NIRL increases ovarian activity to produce blood vessels that can be certainly used in future studies for finding a cure for ovarian negligence to produce more blood vessels and treat diseases caused by it. The results convinced us to introduce laser as a new method to increase the ovarian activation by increasing the blood vessels in a future study. Although the mechanism of low-level lasers action is not well known, it has been proved to be more effective than clomiphene.

Although the effect of Erythropoietin (EPO) in neonatal and animal model of hypoxic ischemic encephalopathy has been previously reported, its effect on comatose patients in adult human has yet to be investigated.

This study was designed to find the effect of intravenous administration of EPO on the recovery from coma in the adult patients with Cardiac Arrest (CA)-induced hypoxic ischemic encephalopathy. This randomized controlled trial study was performed on 60 CA patients who survived Cardiopulmonary Resuscitation (CPR) from April 2011 to Nov 2020. The patients were randomly divided into two equal groups including the control, received normal saline, and the EPO groups, and demographic data were recorded. The EEG and Glasgow Coma Scale (GCS) were recorded on hours 6, 12, 24, and 48 post-success CPR and interpreted by an expert neurologist. Magnetic Resonance Imaging (MRI) was done at 24 and 72 hr of post-CPR and interpreted by an expert radiologist. All patients were checked twice daily by an expert cardiologist.

60 patients were included in this study. There was no significant difference between two groups in terms of demographic data. There was also no significant difference between two groups in terms of GCS and EEG at all post-CPR interval times. No significant difference was observed between both groups with respect to the frequency of pre-existing and metabolic acid-base disorders. 

The intravenous administration of EPO has no effect on the recovery from coma in the adult patients with CA-induced hypoxic ischemic encephalopathy.

Medical errors are an important concern in medical practice and may occur throughout the processes of diagnosis, treatment, prevention, and rehabilitation. Despite the use of modern technology in health care, these errors remain one of the most challenging issues that medical management seeks to minimize.

The recent rise of Invasive Fungal Infections (IFI), especially mucormycosis in COVID-19 patients, is further complicating the outcomes. Here, we present a case of concomitant rhino-orbital and breast mucormycosis after COVID-19. To the best of our knowledge, this is the first case of breast mucormycosis after COVID-19.

COVID-19 has several different presentations including cutaneous manifestations. In this report, we introduce a case of generalized herpes zoster in a COVID-19 patient. No sign of upper or lower respiratory tract involvement was detected, but due to unexpected dissemination of the lesions, COVID-19 Polymerase Chain Reaction (PCR) was tested and revealed positive. Although the incidence of herpes zoster during COVID-19 infection has been reported previously, none of them was disseminated. Therefore, we recommend that during the pandemic of COVID-19, any unexpected disseminated herpes zoster be considered as a possible case of this disease and be quarantined until the PCR is negative.

Dear EditorChronic psychiatric disorders, not only causes symptoms and psychological problems in patients but it also causes significant limitations and disabilities in the individual and social functioning of these people (1).The main goal of psychosocial rehabilitation is to help patients with chronic psychiatric disorders for the most use of their potential. After replacing community-based services with clinical and hospital services in mental health systems, Rehabilitation Day Centers played a very important role in rehabilitating people with chronic psychiatric disorders and bridging the gap between public and social health services (2).“ABR Rehabilitation Day Center” is one of the few centers in Iran that has covered patients with chronic psychiatric disorders since 2017. During its four years of continuous activity, according to the reports of physicians and clients’ families, this center has been able to reduce a great extent of the recurrence rate of the disease and increase the participation and independence of clients in daily individual and social activities.

Coronavirus disease 2019 (COVID-19) is an infectious disease that was declared a global pandemic on March 11, 2019, by the World Health Organization. The COVID-19 pandemic has made very rapid and profound changes in our daily lives and society (1). This pandemic will have irreversible effects on children with neurodevelopmental disorders. Neurodevelopmental disorders are a group of disorders that begin in the period of development. These disorders’ symptoms usually appear early in a child’s development and often before entering school, leading to impairments in personal, academic, occupational, and social functioning. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies the following disorders as neurodevelopmental disorders: Autism Spectrum Disorder (ASD), Intellectual Disabilities (ID), Attention-Deficit/Hyperactivity Disorder (ADHD), motor disorders, Specific Learning Disorder (SLD), communication disorders, and other neurodevelopmental disorders (2).To prevent the spread of the COVID-19, many governments have enacted restrictive laws and regulations, and one of the main actions of parents and children is to stay at home. In these situations, it is very difficult for families and caregivers to care for children with neurodevelopmental disorders who have special needs. The spread of this virus can lead to severe psychological distress in people who have previous mental health problems (3,4). Children with neurodevelopmental disorders are at risk due to increased vulnerability to complex and unpredictable changes. This disease increases stress and anxiety in children with neurodevelopmental disorders and their families. The daily routine of children with neurodevelopmental disorders is affected by the frequent observance of health tips and advice, as well as social isolation and distancing, and causes them discomfort (5).

Organoids are a miniature, simplified version of a human organ that are produced in three dimensions in the laboratory and show the true anatomical array. These organelles originate from one or more cells - embryonic stem cells or induced multipotent stem cells - that can organize themselves in three-dimensional culture media. The use of stem cells due to the unlimited capacity of tissue division and regeneration is a great promise as a therapeutic tool. These three-dimensional models of human tissue can be used to test drugs before they are tested on humans. Lung organoids are one of the different types of organoids that, like other organoids, can be formed through a process of self-organizing stem cells or specific parts of an organ. These organoids can also be utilized as a useful tool for screening drugs and vaccines for infections such as the novel SARS-COV-2 infection. The aim of this study was to investigate the potential of lung organoids in the treatment of pulmonary diseases.