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Mizaj assessment and data analysis methods in Amirkola health and aging project (AHAP cohort)
Full text linkBackground: One of the principles of Persian medicine (PM) is the individualized approach that is presented with the concept of Mizaj. In this viewpoint, Mizaj is determined for every person based on 10 criteria, which is a result of the Mizaj of the main organs, including the brain, liver, and heart. There is no standard diagnostic tool for Mizaj assessment in the elderly. The purpose of this study is to explain the method of Mizaj assessment and data analysis in the elderly in the second phase of the Amirkola health and aging project (AHAP) in Iran. Methods: In this study, a novel Mizaj assessment method in two phases is presented. In the first phase, 1541 elderly were assessed by a PM expert and typical diagnoses were determined. At the second phase, an expert panel including 5 PM experts evaluated the cases. The paraclinical and metric data of the elderly whose Mizaj agreed in the expert panel was used to assess its correlation with Mizaj. Conclusion: In the lack of valid and reliable questionnaires to assess the personalized viewpoint of PM, a new expert-based method has been introduced that can be used in similar studies. The result of the Mizaj assessment in this way will be used to obtain objective values for the Mizaj assessment
COVID-19 and renal involvement in children: a retrospective study
Full text linkBackground: The New coronavirus (SARS COV-2) can cause acute respiratory disease and also multiorgan dysfunction. There is insufficient data about kidney involvement in children. So, this study was done on children with COVID-19 to evaluate nephrological involvement. Methods: All children with confirmed or suspected COVID-19 who were admitted in Children Hospital .were enrolled. They were admitted in hospital from March 2020 to July 2020. Serum Blood Urea Nitrogen (BUN), creatinine, sodium, potassium, calcium and urinalysis were evaluated. Also, glomerular filtration rate (GFR) was calculated by Schertz's formula. All patients were evaluated by chest x-ray and/or computerized tomography scanning (CTS). The data were analyzed by SPSS software and P value less than 0.05 was determined as significant. Results: Forty-seven children with confirmed or suspected COVID-19 were enrolled to this study. At admission, 23.4 and 27.7 of children with COVID-19 had abnormal increase in serum BUN and creatinine, respectively. Also 78.8 and 25.5 of children had GFR less than 90 and 60 ml/min /1.732, respectively. Additionally, 13/47 (27.7) of children had abnormal urine analysis (microscopic hematuria and/or proteinuria). There wasn’t a significant relationship between pulmonary lesions and abnormal reduction of GFR (P<0/05). Conclusion: In the study, the risk of AKI (acute kidney injury) and decrease of GFR and also abnormal urinalysis is high in children with COVID-19. So, more attention for detection of kidney involvement is necessary and more conservative management for prevention of AKI and decrease of GFR are recommended
One-year prevalence and the association between SARS-CoV-2 cycle threshold, comorbidity and outcomes in population of Babol, North of Iran (2020-2021).
Full text linkBackground: The present study aimed to investigate the one-year prevalence of SARS-CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran. Methods: This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran. Results: Out of the 19232 suspected to COVID-19 patients, 7251 (37.7) had a positive rRT-PCR result; 652 (9), 4599 (63.4) and 2000 (27.6) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8 cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5) (p<0.001). Conclusion: In summary, 37.7 of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9 were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate
Quality assessment of pathologic data in cancer registry centers based on ICD-O-3
Full text linkBackground: Prerequisite for achieving the goals of the registration program is the existence of valid and accurate data, and the usability of this data is possible if they are coded correctly. This study assets the quality of pathological data of the population-based cancer registration centers based on ICD-O-3. Methods: This applied study was performed descriptively and retrospectively. The study population included 20129 pathology reports sent to the population-based cancer registration center of Mazandaran Province during 2018-2020. A total of 2015 out of, 2050 samples of the received reports were examined according to stratified random sampling method. A researcher checklist was made to collect the data, and STATA 13 and Cohen's Kappa agreement coefficient were used to analyze the data. Results: Among the 2015 reports of pathology, 1114 (55.3) pathology reports were related to government centers, (42.9) 865 cases were registered with their topographic code, morphology and behavior. Based on the registration of the exact topographic code, the kappa coefficient and the total agreement were 0.266 and 27.70, respectively. Kappa coefficient in all received reports and reports with topographic code was 0.346 and 0.906, respectively. In the reports with topographic code, the most reports of cancers were related to cancers of the gastrointestinal organs (97.6) 246. Conclusion: The accuracy of the codes given in the pathology centers in terms of topographic, morphological, behavioral and grade codes based on the percentage of agreement with the coding was above average, which were higher in governmental centers and also in some cancers
Association between Influenza vaccination and severity of lung involvement at CT images of the patients with COVID-19 infection: an Iranian retrospective case-control study
Full text linkBackground: Frequent waves of corona virus disease (COVID-19) and lack of specific drugs against that, warrant studies to reduce the morbidity and mortality of this pandemic disease. In this study, we investigated the association between influenza vaccination and the severity and outcome of COVID-19 disease in Iranian patients living in the North. Methods: This retrospective case-control study was performed on186 patients with COVID-19 infection between March and April, 2020. Patients with positive PCR were divided into two groups of case and control; Patients with moderate to severe and normal to mild lung involvement, respectively. The lung opacities in all of the 5 lobes were evaluated on chest CT images using a CT severity scoring system. The history of influenza vaccination during the fall of 2019-2020 was determined by a phone call. Statistical analysis was done using the chi-square test, student’s t-test, and logistic regression. The significance level was p<0.05. Results: The mean age of patients was 54.67±15.05years. Most patients had pulmonary manifestations including ground-glass opacity (57), consolidation (80) and pleural effusion (3.2). Adjusting for age, gender, and history of underlying disease, vaccination is an effective factor in the severity of pulmonary involvement (AOR=0.39; 95CI: (0.21, 0.73); P=0.003). Furthermore, the chance of ICU admission decreased via influenza vaccination (OR=0.21, P=0.001). Conclusion: The results showed that the severity of COVID-19 pulmonary involvement and outcome as ICU admission, and severe symptoms in patients with history of influenza vaccination were significantly lower than those without history of vaccination. This strategy can be used to prevent and reduce the complications of COVID-19
Can cytokines response play a role in the treatment of fatal leptospirosis?
Full text linkBackground: The northern coastal regions of Iran are endemic for leptospirosis which may range from a subclinical illness to a progressively fatal disease. There has been growing evidence that inflammatory markers play a significant role in the severity and prognosis of leptospirosis. This study aimed to investigate inflammatory cytokines in patients with leptospirosis. Methods: This descriptive-analytical prospective study was performed in 75 patients over 18 years old who had a positive microscopic agglutination test (MAT) titer from January to June 2019. SPSS software Version 20 was used for statistical analysis and the significance level was considered as p<0.05. Results: The patients’ age enrolled in this study are from 21 to 75 years with a mean and standard deviation of 48.6 ± 14.0. The male to female ratio in our participants was 54/21. Fever was the most common symptoms in 66 (88.0) patients, followed by myalgia in 62 (82.7) cases. The level of interleukin 10 was significantly higher in severe illness (P=0.003) and fatal cases (p<0.028) compared with recovered patients. The level of TNF-α level was also higher in the severe illness and Weil's syndrome compared with the mild kind (P=0.022). Conclusion: Our results showed that the levels of TNF-α and IL-10 significantly increased in severe leptospirosis. Also, IL-10 was significantly higher in fatal cases. The inhibition of IL-10 production might play an important role in decreasing the risk of fatal outcomes in leptospirosis
Specific pattern of bone scan as a Result of Unintentional-Intraarterial Injection Into the Ulnar Artery
Full text linkBackground: Bone scintigraphy with 99mTc labeled radiopharmaceuticals is a valuable method in nuclear medicine for assessing the bony structure. In clinical setting, bone scintigraphy is accomplished after the injection of 99mTc labeled diphosphonate complexes into a peripheral vein. Inadvertent intra-arterial injection on the antecubital region may cause a special form of artifacts leading to problems inaccurately interpreting these studies as functional images. Case Presentation: We present a 44-year-old man with history of chest wall pain for bone scintigraphy as part of a work-up for determining the pain source. The patient received an injection of 740MBq 99mTc-methylene diphosphonate (MDP) into a blood vessel at the right forearm. Two hours later, an increased uptake of activity was observed on the right forearm and ulnar half of the wrist-hand in the whole body and spot images. The scan findings were consistent with the anatomical and physiological expectations of the ulnar arterial perfusion range. This case displays that an incidental injection with a 99mTc labeled diphosphonate into the ulnar artery results in a hot ulnar half of the palm and ulnar-sided three digits, because these areas are directly exposed to radiopharmaceutical, therefore more radiopharmaceutical is deposited. Conclusion: It is important for the physician, and especially for the nuclear medicine technician, to know the specific appearance created in the bone scan due to such an event so that they do not make a diagnostic mistake.  
A scientometric study of Iran and the world countries\' contribution to internal medicine (1996-2019)
Full text linkBackground: Considering the importance of internal medicine and the lack of sufficient scientometric data on the research status of the field in Iran, the study aimed at investigating the state of scientific output in the country compared to the countries in the world. Methods: This applied research used a scientometric approach. The related MeSH-driven terms in "internal medicine" were selected as search phrases and searched in the SCImago database. SPSS and Excel software packages were used for statistical analysis. Geographical mapping was done with Google Maps for depicting country geographical distribution. Results: Out of all 4,972,258 papers published by 230 countries worldwide in the field, about 60 belonged to the USA and Western European countries. These countries were at top of citation and self-citation counts as well as the h-index indicator. The citations per paper indicator were 27.1 and about 25.1 of total citations were self-citations. A significant positive correlation was found between the number of papers, citation count, and self-citation rate, and h-index in the field (p<0.001). Conclusion: The research status of internal medicine in developed regions and countries was quantitatively and qualitatively better than that of developing countries, including Iran
The Role of GIS Mapping Program in Evaluating the Geographical Distribution of Patients with COVID-19 during the First Wave of the Epidemic in Babol
Full text linkBackground and Objective: One of the first cities that announced the outbreak of COVID-19 in Iran was Babol, in the north of Iran. Geographic Information System (GIS) is an important tool in tracking and dealing with the spread of diseases. The aim of this study is to investigate the effect of the weekly GIS reports on the spread of the disease in controlling COVID-19.
Methods: This cross-sectional study was conducted for two months, from the third week of the beginning of the epidemic till the end of the first wave of COVID-19. The geographic address of hospitalized patients was extracted and pinned on the map of Babol. Coding was done in the Python program (python 3.7.6) and the information was placed in an online map that can be enlarged and separated to show the alleys and houses. Moreover, the information was entered into the GIS software and the weekly output was obtained in HTML and PNG formats. The output results of the maps were used as the basis for follow-up in the deputy health department, and after the creation of operational teams, the follow-up of points with high prevalence was done on a weekly basis until the end of the first peak of the COVID-19 epidemics.
Findings: The number of hospitalized patients in hospitals of Babol had an upward trend from the beginning of the disease until March 12, 2020. After that, according to the measures taken (including the preparation of patient distribution maps), at first a steady trend and after ten days, a downward trend was observed. A total of 174 pollution points were found in Babol city and Babol county, of which 60 pollution points were related to Babol city.
Conclusion: Based on the results of this study, the preparation of distribution maps of COVID-19 patients in Babol and targeted follow-ups helped to control the first peak of this outbreak within 10 days
The Association of Clinical Symptoms and Coexistent Clinical Conditions with Ophthalmic Manifesting in COVID-19 Patients
Full text linkBackground: The ocular symptoms are common manifestations in coronavirus infectious disease 2019 (COVID-19), which faces secondary complications and therapeutic challenges. Underlying diseases actuate the body to infectious diseases and their related manifestations through the aberration of metabolism and suppressing the immune system. This study aimed to investigate the correlation of underlying diseases and ocular manifestations in COVID-19 patients. Methods: This cross-sectional study was held on 108 hospitalized COVID-19 patients (confirmed by molecular detection) admitted to Rouhani hospital, Babol, Iran. Upon hospitalization, all clinical symptoms and underlying diseases were registered. Detailed clinical examinations regarding ophthalmological protocols were used to investigate the ocular symptoms. All analyses were performed by SPSS, version 25. Results: Our results showed that 26.67 of patients with at least one ocular symptom had hyperlipidemia, while 10.42 of patients without any ocular symptoms had hyperlipidemia (P=0.049). In this study, 97.81 of COVID-19 patients without epiphora had no thyroid disorders (hyper-/hypo-thyroidism), while 82.35 of COVID-19 patients with epiphora had not any thyroid disorders (P=0.012). Also, 75.00 of patients with blurred vision had diabetes mellitus, while 35.00 of patients without blurred vision suffered from diabetes mellitus. This difference was borderline significant (P=0.051). Other results showed that 13.04 of COVID-19 patients with eye redness suffer from myalgia, while 35.29 of patients without eye redness had myalgia (P=0.044). Also, 35.11 of COVID-19 patients without photophobia had myalgia, while no one none of the patients with photophobia had myalgia (P=0.005). Finally, 70.00 of patients with respiratory distress had at least one ocular symptom, while 43.10 of patients without respiratory distress had at least one ocular symptom (P=0.007). Conclusion: Some underlying diseases, e.g., hyperlipidemia, diabetes mellitus, and thyroid disorders, and some clinical symptoms in hospitalized patients, e.g., myalgia and respiratory distress, are correlated with ocular manifestations in COVID-19 patients