Ghaem Hospital Research Articles

The Flare-up of Rheumatic Autoimmune Diseases Following COVID-19 Vaccination

Background: Individuals with Autoimmune Rheumatic Disease (AIRD) are vulnerability to severe SARS-CoV-2 outcomes and vaccination. The present study aimed to determine the incidence of AIRDs flares following COVID-19 vaccination and its risk factors. Methods: The study was retrospective cross-sectional focused on patients with AIRD who experienced a flare-up at least during 30 days after receiving the COVID-19 vaccine. These patients were seen at Rheumatology Clinics at Imam Reza and Ghaem Hospitals, affiliated with Mashhad University of Medical Sciences, as well as private clinics in Mashhad, Iran, over a period of 1 years. Results: The rate of recurrence following COVID-19 vaccination was estimated to be 3.16%. Rheumatoid arthritis (18.9%), systemic lupus erythematosus (12.9%), and cutaneous vasculitis (10.6%) were the most frequent AIRDs among patients who experienced a flare-up following COVID-19 vaccination. More than 85% of patients who were vaccinated with AstraZeneca experienced a flare-up after the first dose of vaccination. In the majority of patients, the flare-up occurred after the first dosage of COVID-19 vaccination. Conclusion: In Mashhad, Iran, the incidence of flare-ups in autoimmune and inflammatory rheumatic diseases following COVID-19 vaccination is estimated to be a mere 3%. Despite their rarity, flare-ups in autoimmune and inflammatory rheumatic diseases post-COVID-19 vaccination can still pose a public health issue, potentially undermining public confidence in vaccinations.

A cross-sectional analysis of four common clinical decision rules for pulmonary embolism, Mashhad, Iran.

Pulmonary embolism (PE) is a potentially fatal condition. Several non-invasive clinical decision rules (CDRs) were developed for the safe exclusion of PE. All CDRs used to safely rule out PE have been created and tested within hospital or acute care environments. However, CDRs that are designed in one specific setting may not perform as effectively when used in a different setting. In this study, we aimed to compare the performance of four common CDRs; Wells Score, Simplified Wells Score, revised Geneva Score, and simplified revised Geneva Score. This was a cross-sectional study in which patients suspected of PE presenting to Imam Reza Hospital or Ghaem Hospital were recruited from September 23, 2013, to March 19, 2016 in Mashhad, Iran. The specificity, sensitivity, and accuracy were utilized as metrics to compare the CDRs in our region. Two hundred and forty patients were included in the study. The mean age of patients was 57.91±19.97 years, and 54.16% of them (n=130) were female. 120 patients were confirmed to have PE with CT angiography. Wells score showed the highest sensitivity (90.4%) and revised Geneva score represented the highest specificity (84.9%). The highest accuracy belongs to the simplified Wells score (62.3%). In this study, we demonstrated that the Wells criteria with its high sensitivity, can be used as a score for screening, and the revised Geneva score with its high specificity, can be used in the second stage for healthy people who have been diagnosed as unhealthy by the Wells score.

Comparison of prognosis between hyperbilirubinemic infants with and without hypernatremia.

Hypernatremia may facilitate the diffusion of bilirubin through the blood-brain barrier and increase the risk of bilirubin encephalopathy. This study was conducted to compare the prognosis of jaundice infants with those with jaundice and hypernatremia. A total of 615 term infants with idiopathic jaundice with or without hypernatremia were enrolled in this cohort study with 24-months follow-up at Ghaem Hospital, Mashhad, Iran, between 2010 and 2022. An in-house questionnaire including the laboratory evaluation and neonatal characteristics was used as the data collection tool. The follow-up of neonatal development status was performed using the Denver test II at 6, 12, 18, and 24 months after discharging from hospital. Normal outcomes were seen in 555 (90.2%) out of 615 studied infants, while 60 cases (9.8%) showed abnormal outcomes. Serum levels of sodium (P = 0.017), bilirubin (P = 0.001), urea (P = 0.024), and creatinine (P = 0.011) as well as hyperthermia (P = 0.046) and unconsciousness (P = 0.005) showed significant differences between the two groups. Approximately 16% of the newborns with both jaundice and hypernatremia, and 9% of those with only jaundice had unfavorable prognoses. Also, bilirubin level had the most predictive power (91.3%). Our results suggest that hypernatremia or jaundice alone, may affect the prognosis of infants aged 2 years; but jaundice and hypernatremia together, will intensify the developmental problems in jaundice infants. However, the role of hyperbilirubinemia in the incidence of complications is more than hypernatremia.

Pathologic Response Rates in Patients with Gastric Cancer Following FLOT Neoadjuvant Chemotherapy

Background: Gastric adenocarcinoma is among the most prevalent cancers associated with a high mortality rate. The multidrug neoadjuvant chemotherapy administered before and after surgery has attracted attention as a beneficial standard of care for managing this malignancy. Objectives: This study assessed the pathologic response of patients with gastric cancer who were treated with fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT). Methods: Patients with pathologically confirmed gastric adenocarcinoma without distant metastases were enrolled in this retrospective cohort study conducted at Imam Reza and Ghaem hospitals in Mashhad. Data regarding demographics, tumor status, treatment toxicity, and pathology results were collected using a predesigned questionnaire after four cycles of FLOT neoadjuvant chemotherapy. SPSS-26.0 was utilized to analyze the data, and a significance level of P < 0.05 was applied. Results: We evaluated data from 53 cases with a mean age of 51.1 ± 9.7 years. Diffuse adenocarcinoma was the most common finding in histology (54.7%). Pathologic complete response was observed in 16 (30.2%) patients. Most (69.8%) patients received only 7 out of 8 planned cycles. Concerning surgical margin, 46 (86.8%) patients achieved R0 tumor resection. Pathologic complete response was not significantly linked with age (P = 0.91), sex (P = 0.65), performance status (P = 0.2), tumor histology (P = 0.14), tumor grading (P = 0.07), tumor location (P = 0.8), and the number of neoadjuvant chemotherapy cycles (P = 0.9). Conclusions: Our findings demonstrated the relative clinical efficacy of neoadjuvant chemotherapy with the FLOT regimen administered before and after surgery. However, due to chemotherapy-related side effects, patients may not adhere to all eight prescribed cycles of chemotherapy.

Investigating the synergic effects of the extracts of Camellia sinensis, Rosmarinus officinalis and Thymus with ampicillin against resistant Pseudomonas aeruginosa species

Introduction: The most common bacterium linked to the hospital and pneumonia-related infections is Pseudomonas aeroginosa, a known opportunistic pathogen. High mortality rates are brought on by this bacterium in hospitalized patients, immunocompromised individuals, and cystic fibrosis patients. The formation of biofilm structures has also made it more challenging to treat patients. Due to the severe side effects of the antibiotics, the lack of efficacy due to resistance, and the well-documented antibacterial effects of traditional plants, this study investigated the antibacterial properties of the combination of thyme, rosemary, and green tea. Therefore, the main purpose of the current study was to examine the antibacterial and anti-biofilm effects of the extracts of these three plants. Method: Pseudomonas arginosa strains were obtained from patients at Ghaem Hospital, Mashhad, Iran. The efficacy of various antibiotics on different strains was studied, and bacterial strains were classified into sensitive, semi-sensitive, and resistant. The minimum inhibitory concentration (MIC) of the combination of the three extracts, as well as the antibiotic of choice, was determined. The effect of the extract on the biofilm formation was also investigated. Results: The results indicated that the ternary composition has significant antibacterial and anti-biofilm effects; also, the combination of these three extracts has shown significant synergistic properties with each other. Further, the extracts inhibited the formation and growth of the biofilm. Conclusion: Results of this study indicated that the optimum combination of the three extracts possessed a remarkable antibacterial and anti-biofilm activity. Further, we have shown the synergistic antibacterial activity of the three extracts improved in the presence of the antibiotic of choice, resulting in a decrease in the MIC value of the antibiotic.

Evaluation of Mir-1290 as a Possible Diagnostic Factor in the Serum of Oral Squamous Cell Carcinoma Patients with Qualitative Real-Time Polymerase Chain Reaction.

This study aimed to determine the incidence of microRNA (miRNA; miR-1290) in the serum of oral squamous cell carcinoma (OSCC) patients compared to a control group using the qualitative real-time polymerase chain reaction (PCR) method. Blood serum samples were obtained from patients diagnosed with OSCC and confirmed through biopsy. The samples were collected from patients referred to the Mashhad Dental Faculty and Ghaem Hospital. The OSCC group consisted of 17 patients, while the healthy group included 15 individuals. RNA was extracted from the patient samples, and samples with an A260/280 ratio between 1.8 and 2.0 (indicating acceptable RNA quality) were immediately converted into complementary DNA (cDNA) using albumin and cDNA reference genes. The SYBR green real-time reverse transcriptase PCR method was used to measure the presence of miR-1290 in the blood samples. A total of 32 patients were examined in this study, including 17 women (53.1%) and 15 men (46.9%). The mean age was 46.7 years in the healthy group and 54.6 years in the SCC group, indicating a significant difference (P<0.05). The expression level of the miR-1290 gene was higher in patients with SCC compared to the healthy group (P=0.000). While the expression level of miR-1290 was higher in grade 3 and advanced stage than in grades 2 and 1 and early stage, the differences were not statistically significant (P=0.173 and P=0.564 for grade and stage, respectively). The expression level of miR-1290 may increase in SCC patients compared to healthy individuals, making it a potential circulating biomarker. Further investigations for diagnostic utility would be warranted.

The association between vertebral artery hypoplasia and fetal-type variants of the posterior cerebral artery with imaging findings among patients with posterior circulation stroke: A single-center cross-sectional study.

The present study investigated the correlation between vertebral artery hypoplasia and fetal-type variations of posterior cerebral arteries with stroke patterns and imaging findings in individuals with posterior circulation ischemic stroke. In this cross-sectional study, patients with symptoms of acute ischemic stroke in the posterior circulation system referred to Ghaem Hospital in Mashhad between 2016 and 2022 were investigated. Demographic data, including age, gender, systemic diseases, history of previous stroke or transient ischemic attacks, and clinical manifestations of patients, were recorded using questionnaires and checklists from patient files. The results of imaging studies, including magnetic resonance imaging and computed tomography angiography, were also recorded. The obtained data were analyzed by SPSS statistical software. Among 974 patients suffering from posterior circulation ischemic stroke, 155 patients with an average age of 60.44 ± 13.95 years were included in the study, out of which 97 patients (62.6%) were male. Unilateral vertebral artery hypoplasia on the right, left, and bilateral hypoplasia was present in 67 (43.2%), 35 (22.6%), and 5 (3.2%) patients, respectively. There were complete unilateral fetal origin on the right in 38 (24.5%), complete unilateral on the left in 12 (7.7%), partial unilateral on the right in 12 (7.7%), partial unilateral on the left in 6 (3.9%), complete bilateral in 14 (9%), and partial bilateral in 8 (5.2%) patients. There was no significant relationship between vertebral artery hypoplasia and PCA fetal-type variants with different ischemia locations and infarct patterns (p > 0.05). Also, there was no significant relationship between the age and gender of patients with ischemia location and infarct pattern (p > 0.05). Despite previous evidence showing a relation between vertebral artery hypoplasia and PCA fetal-type variants as risk factors for PC stroke, the present study did not establish a significant correlation between these factors and the location of ischemia and infarct patterns.

Localization of Lupoid Leishmaniasis on the face: A case control study

AbstractBackgroundIn Lupoid Leishmaniasis, erythematous to brown papules often occur around a central old scar, which can expand over time. For unclear reasons, these lesions tend to develop on the facial area.ObjectivesThis study was conducted to study the distribution of Lupoid Leishmaniasis lesions on the face and compare them with those of acute leishmaniasis.MethodsThis case‐control study included 100 patients with the acute type of cutaneous leishmaniasis and Lupoid Leishmaniasis who were referred to the dermatology clinics of Ghaem and Emamreza hospitals. We recorded lesion morphology, demographic data and locations of lesions on the face.ResultsWe enrolled 55 patients with acute leishmaniasis and 45 patients with Lupoid Leishmaniasis, with a mean age of 21.30 ± 20.71 years. There were no significant differences in age (p = 0.78), gender (p = 0.48), and the distribution of lesions on different anatomical areas (p = 0.22) between the two groups. In both groups, the involvement of the zygoma was significantly higher than in other areas on the face (p = 0.001).ConclusionsOur study reveals that the anatomical location does not play a role in lesion evolving into Lupoid form.

Rapid and sensitive detection of SARS-CoV-2 virus in human saliva samples using glycan based nanozyme: a clinical study.

A highly sensitive colorimetric method (glycan-based nano(e)zyme) was developed for sensitive and rapid detection of the SARS-CoV-2 virus based on N-acetyl neuraminic acid (sialic acid)-functionalized gold nanoparticles (SA-Au NZs). A number of techniques were used to characterize the prepared nanomaterials including XRD, FT-IR, UV-vis, DLS, and TEM. DLS analysis indicates an average hydrodynamic size of 34nm, whereas TEM analysis indicates an average particle size of 15.78nm. This observation confirms that water interacts with nanoparticle surfaces, resulting in a large hydrodynamic diameter. The peroxidase-like activity of SA-Au NZs was examined with SARS-CoV-2 and influenza viruses (influenza A (H1N1), influenza A (H3N2), and influenza B). UV-visible spectroscopy was used to monitor and record the results, as well as naked eye detection (photographs). SA-Au NZs exhibit a change in color from light red to purple when SARS-CoV-2 is present, and they exhibit a redshift in their spectrum. N-acetyl neuraminic acid interacts with SARS-CoV-2 spike glycoprotein, confirming its ability to bind glycans. As a result, SA-Au NZs can detect COVID-19 with sensitivity and specificity of over 95% and 98%, respectively. This method was approved by testing saliva samples from 533 suspected individuals at Ghaem Hospital of Mashhad, Mashhad, Iran. Sensitivity and specificity were calculated by comparing the results with the definitive results. The positive results were accompanied by a color change from bright red to purple within five minutes. Statistical analysis was performed based on variables such as age, gender, smoking, diabetes, hypertension, and lung involvement. In clinical trials, it was demonstrated that this method can be used to diagnose SARS-CoV-2 in a variety of places, such as medical centers, hospitals, airports, universities, and schools.

Functional Outcome and Mortality Predictors in Patients with Cerebral Ischemic Infarction After Decompressive Craniectomy: Cross-Sectional Study

Surgeons commonly perform Decompressive craniectomy (DC) to manage patients with cerebral ischemic infarction. However, there are conflicting data on the long-term functional outcomes following DC. Therefore, this study aims to determine the functional outcome of patients with cerebral ischemic infarction after DC. This prospective and retrospective cross-sectional study included 148 patients with cerebral ischemic infarction who underwent DC at Ghaem Hospital, Mashhad, Iran, from March 2011 to March 2021. The Modified Rankin Scale (mRS) assesses disability in these patients and determines the recovery and degree of long-term functional outcomes. Demographic and clinical data were extracted and recorded in a researcher-made questionnaire. In summary, the follow-up revealed a survival rate of 39.2% among patients with ischemic stroke. The comparison of the mean infarct volume in patients with various mRS scores showed that the mean infarct volume was significantly higher in patients with unfavorable functional outcomes, based on mRS scores at discharge (P= 0.05), 3months mRS (P < 0.01), and mRS score at final follow-up (P= 0.01). Final mortality was higher in patients with higher mRS scores at discharge, after 3months, and final follow-up (P < 0.01). Older age and infarction volume can predict mRS and mortality in patients with ischemic stroke (P < 0.01). The present study showed that mortality and mRS scores at various times are associated with infarction volume and older age in patients with ischemic stroke.

Prevalence of IgA Anti-tissue Transglutaminase Antibody in a Cohort of Iranians Patients with Inflammatory Bowel Disease

Abstract Background and Aims Some studies have reported the coexistence of inflammatory bowel disease (IBD) and celiac disease (CD). However, the prevalence of anti-tissue transglutaminase antibodies (IgA and IgG) and their screening value in patients with IBD is not yet clear. This study aimed to assess the prevalence of IgA anti-tTG and its potential correlation with disease status in patients with IBD. Materials and Methods This cross-sectional study was conducted on 110 patients with confirmed IBD diagnosis at Ghaem Hospital, Mashhad, Iran. For each patient, all demographic and clinical data including age, extra intestinal manifestations, underlying diseases, types of diseases, and surgical history were collected. IgA anti-tissue transglutaminase titers were assessed by enzyme-linked immunosorbent assay. Results None of the patients with IBD were positive for IgA anti-tTG antibodies, with a mean titer of 3.31 ± 1.3 AU/mL. Also, the mean titers were not associated with age, gender and various disease clinical features including the disease history, underlying disease, diagnosis type, extraintestinal manifestations, and surgery history. Conclusion No significant prevalence pattern of IgA anti-tTG antibody was observed in patients with IBD. Accordingly, serological screening for CeD is not recommended in IBD patients, unless in a relevant clinical CeD suspicion.

The efficacy of phase I cardiac rehabilitation training based on augmented reality on the self-efficacy of patients undergoing coronary artery bypass graft surgery: A randomized clinical trial

BackgroundOpen-heart surgery is considered one of the primary treatments for severe coronary artery stenosis, but it comes with its own set of complications. However, these complications can be reduced through the implementation of proper cardiac rehabilitation during phase I. This study aimed to examine the impact of phase I cardiac rehabilitation training, using augmented reality, on the self-efficacy of cardiac management in patients undergoing coronary artery bypass grafting.MethodologyThis randomized clinical trial study involved 60 patients who were admitted to the Cardiac Surgery Intensive Care Unit at Ghaem Hospital in Mashhad. The software used in this study consisted of various videos and educational images demonstrating physical exercises for cardiac rehabilitation. The software was developed to train the patients in the intervention group on the rehabilitation program, starting from their admission to the Intensive Care Unit until their discharge from the hospital. The collected data were analyzed using statistical tests such as independent t-test, Mann-Whitney test, paired t-test, chi-square test, as well as descriptive indicators. Cohen’s d was also used to evaluate the magnitude of the effect size.ResultsThe findings of this study revealed that the total mean score for cardiovascular management self-efficacy significantly increased during the transfer to the Intensive Care Unit and at the time of discharge. Notably, the increase observed in the intervention group was significantly greater than that of the control group (P < 0.001).ConclusionThe results of this study indicated that implementing early rehabilitation programs, using innovative educational technology like augmented reality, enhanced the self-efficacy of patients undergoing coronary artery bypass grafting. These findings suggest that such programs can be effectively employed as educational tools throughout different stages of cardiac rehabilitation.Trial RegistrationThis study was registered in the Iranian Registry of Clinical Trials (no. IRCT20200203046361N1) on 16/02/2020.

Correlation between Diagnostic Magnetic Resonance Imaging Criteria and Cerebrospinal Fluid Pressure in Pediatric Idiopathic Intracranial Hypertension

Purpose: Idiopathic intracranial hypertension (IIH) is a clinical syndrome that mimics brain tumors with increased intracranial pressure. The present study is designed to investigate the diagnostic criteria of magnetic resonance imaging (MRI) and the severity of cerebrospinal fluid (CSF) pressure to understand the relationship and frequency of these criteria with the level of CSF pressure.Methods: The present cross-sectional study was conducted on children diagnosed with IIH between the years 2011 and 2020, who were admitted to the pediatric neurology department of Ghaem Hospital, Mashhad, Iran. Clinical manifestations and imaging findings of the patients were recorded through a checklist. Results: Forty-nine patients were included in the study; 27 (55.1%) were male, and 22 (44.9%) were female. The average CSF pressure was 40.64±20.63 cmH&lt;sub&gt;2&lt;/sub&gt;O. The mean diameter distension of the perioptic subarachnoid space was 6.02±1.21 mm. Six (10.8%) patients had unilateral transverse sinus stenosis with an average CSF pressure of 20.47±36.80 cmH&lt;sub&gt;2&lt;/sub&gt;O and 11 (21.4%) patients had bilateral transverse sinus stenosis with an average pressure of 48.22±21.04 cmH&lt;sub&gt;2&lt;/sub&gt;O. In 22 (44.89%) patients, flattening of the posterior globe with the CSF pressure of 48.80±17.94 cmH&lt;sub&gt;2&lt;/sub&gt;O was reported. Twenty-four (49%) patients had optic nerve tortuosity, with an average CSF pressure of 46.52±20.33 cmH&lt;sub&gt;2&lt;/sub&gt;O. Among the diagnostic criteria, the pressure had a significant relationship with the flattening of the posterior globe (&lt;i&gt;P&lt;/i&gt;&lt;0.022).Conclusion: Since MRI is a non-invasive method for examining IIH, the findings of this study may aid in diagnosing and monitoring these patients.

Comparison of the level of vitamin D in preterm infected and uninfected infants

Introduction. Despite the substantial progress in intensive cares, sepsis is still an important cause of neonatal mortality. Given the role of vitamin D in infection control, this study was conducted to compare vitamin D level in infected and uninfected preterm infants. Materials and methods. This cross-sectional study was carried out on 87 preterm infants (45 infected infants and 42 uninfected infants) hospitalized in Mashhad Ghaem Hospital, Iran, during 20152017. The subjects were selected by using convenience sampling. The infected infants (n = 45) included babies with clinical and laboratory findings compatible with infection and/or positive blood or cerebrospinal fluid cultures. The serum levels vitamin D were measured in all infants. A researcher-made questionnaire containing demographic, clinical and laboratory features of infants was used. In addition, independent t-test and chi-square test were applied. SPSS was used to perform the statistical data analysis. Results. 83% of infants had vitamin D deficiency 34.5%, 26.4%, and 21.8% of whom exhibited severe (less than 10 ng/ml), moderate (10.120 ng/ml), mild deficiency (20.130 ng/ml), respectively. The mean vitamin D level of infants was 23.319.40 ng/ml in the control group and 11.028.64 ng/ml in the case group (p = 0.000). In the case group, the mean vitamin D was 8.145.53 ng/ml in early sepsis and 12.629.75 ng/ml in late-onset sepsis (p = 0.121). 95% of infected infants and 71% of uninfected infants had vitamin D less than 30 ng/ml (p = 0.003). Conclusion. Vitamin D deficiency is very common in preterm infants. Serum vitamin D levels in infants with sepsis were lower than those in uninfected infants. Therefore, the correction of vitamin D deficiency may contribute to better control of neonatal infection.

Evaluation of Viral Respiratory Pathogens Among Patients Initially Tested Negative for SARS-CoV-2

Background: A number of ribonucleic acid (RNA) and deoxyribonucleic acid (DNA) viruses commonly circulating among vertebrates, such as influenza H1N1, respiratory syncytial virus (RSV), adenoviruses, and human coronavirus (HCoV)-229E, cause symptoms similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These viruses are important causes of cold, pneumonia, and shortness of breath in humans, which have been overlooked during the coronavirus disease 2019 (COVID-19) pandemic. Furthermore, the diagnosis of infection with these viruses mostly relies on physical examination and clinical history, despite the fact that accurate molecular diagnosis is available. Objectives: This study aimed to evaluate the presence of respiratory viruses in patients who were suspected to be infected with COVID-19 yet initially tested negative for SARS-CoV-2, as it could be beneficial in developing effective control measures and more reliable testing and surveillance of such viruses. Methods: In this study, laboratory samples of 123 patients referred to Ghaem Hospital of Mashhad, Iran, were evaluated that tested negative for SARS-CoV-2 in the initial assessment while showing the clinical symptoms of COVID-19. Initial testing for SARS-CoV-2 was carried out by the TaqMan real-time polymerase chain reaction (PCR) method using a kit approved by the Ministry of Health (Pishtaz Teb, Iran). Further analysis for the presence of 17 respiratory viruses was carried out using Genova kits based on the virus genome conserved sequences of influenza H1N1, influenza B, influenza A, SARS-CoV-2, HCoV-HKU1, HCoV-OC43, HCoV-NL63, HCoV-229E, metapneumovirus, RSV, human bocavirus 1, 2, 3, parainfluenza 1, 2, 3, and adenovirus. Results: According to the results of the present evaluations, out of 123 samples that were acquired using nasal and throat swabs and that initially tested negative for SARS-CoV-2, 8 cases of influenza A (47.1%), 1 case of parainfluenza (5.9%), 1 case of HKU1/OC-43 (5.9%), 4 cases of RSV (23.5%), 1 case of HCoV-NL63/HCoV-229-E (5.9%), and 2 cases of SARS-CoV-2 (11.8%) were detected. Conclusions: Based on the results of real-time PCR tests obtained from patients who had clinical symptoms of SARS-CoV-2 infections, it can be mentioned that due to the similar symptoms of patients with respiratory viral infections, individuals with respiratory symptoms could be examined for other viral infections in addition to SARS-CoV-2 infection, and a suitable basis for their prevalence in the community could be provided.

Serum Evaluation of Helicobacter pylori in Patients with Multiple Sclerosis

Background: Multiple sclerosis (MS) is an autoimmune inflammatory disorder of the central nervous system of unknown etiology, which is believed to be caused by immune dysregulation triggered by genetic and environmental factors, leading to demyelination and axonal loss. Researchers consider infectious agents, like Helicobacter pylori, as these environmental factors. H. pylori can permanently infect someone’s stomach and cause an acute or chronic inflammatory response, in which inflammatory mediators affect the brain and cause a pathologic disease. Methods: In this cross-sectional study, 38 patients with multiple sclerosis who were referred to the Neurology Clinic of Ghaem Hospital were included, and their serum samples were analyzed for IgM, IgA, and IgG antibodies against H. pylori by using enzyme-linked immunosorbent assay (ELISA). Results were compared with the samples of 41 sex- and age-matched controls admitted to other wards of Ghaem Hospital &amp; had no symptoms of MS. In the end, we analyzed the data with SPSS v.20. Results: In this study, 79 patients, including 38 patients with MS disease in the case group and 41 healthy individuals in the control group, were studied. These two groups had no significant differences in demographic characteristics, including age, gender, and occupation. H. pylori seropositivity was significantly higher in patients with MS than in controls (68.4% vs 39%) (P = 0.009). In addition, comparing H. pylori seropositivity in 20 of 30 patients with relapsing-remitting MS versus 6 of 8 patients with progressive MS suggested a significant difference between these two groups (P = 0.030). Also, H. pylori seropositivity had no significant difference between males and females (39.1% vs 58.9%). Conclusions: The prevalence of H. pylori seropositivity was significantly higher in patients with MS than in control, besides this seems more frequent in a progressive type of MS than in a relapsing-remitting one, suggesting that H. pylori might be a causal factor for developing &amp; progressing MS and this may have an adverse impact on the prognosis and course of the disease.

Predicting neurodevelopmental outcomes in preterm infants: A comprehensive evaluation of neonatal and maternal risk factors

ObjectiveThis retrospective cohort study aimed to evaluate neurodevelopmental outcomes of preterm infants (≤ 34 weeks gestational age) in the NICU. MethodsThis retrospective cohort study included 89 preterm infants admitted to the NICU of Ghaem hospital, Mashhad, between 2016 and 2020. Data on neonatal and maternal factors were collected. By recalling the mentioned infants in 2021, the neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development. Data analysis included descriptive statistics, non-parametric tests, and binary logistic regression conducted with SPSS V.26 and R program software. ResultsThe sample comprised 48.3 % males with a mean gestational age of 32.10 weeks. Bayley Scale analysis revealed significant associations of Intrauterine Growth Restriction, Pneumothorax, and Bronchopulmonary Dysplasia with impairments in all domains. Diabetes in Pregnancy, Surfactant use, and Necrotizing Enterocolitis were also significantly linked to various impairments. Lower Apgar scores, gestational age, birth weight, and extended hospitalization and oxygen therapy durations correlated with several domain impairments. Logistic regression showed hospitalization duration impacted the coarse motor domain (OR = 0.92, p = 0.019), oxygen therapy duration influenced cognitive, perceptual, and fine motor domains. ConclusionThis study underscores the importance of considering neonatal and maternal factors when assessing developmental outcomes in preterm infant. Long hospital stays and increase duration of oxygen therapy associated with negative developmental outcomes in different domains of Bayley scales.Early identification of these risk factors and targeted interventions may improve long-term outcomes for preterm children.

Effect of support based on family centered empowerment model on care burden in family caregivers of patients with multiple sclerosis.

Family caregivers of patients with multiple sclerosis (MS) are at risk of care burden that may lead to a detrimental effect on their quality of life (QoL), physical and mental well-being. This study aimed to determine the effect of the family-centered empowerment model (FCEM) on the care burden of caregivers of patients with MS. This quasi-experimental study was conducted using convenience sampling on 60 caregivers of patients referring to the Multiple Sclerosis Clinic in Ghaem Hospital, Mashhad, Iran. The participants were assigned to FCEM and control groups based on the days they were referred to the MS clinic. Data collection tools included the Zarit Caregiver Burden Inventory (CBI), completed in the intervention and control groups before and 1 month after the intervention. The support based on FCEM was provided during eight 45-60-min sessions, and the control group received the medical center's routine training. Data were analyzed by Chi-square, independent t-test, analysis of covariance, and repeated measure tests. The results of the present study showed that all demographic characteristics were homogeneous at the baseline. Before the intervention, no significant difference was observed between the two groups regarding mean scores of care burden. Based on the repeated measure test, there was no significant treatment and time interaction in changes in care burden. The FCEM has no significant effect in alleviating the care burden. It is recommended to observe the necessary considerations regarding the context of this type of intervention and to carry out further investigations in different intervals.

Bacterial Microorganisms in Definitive Neonatal Sepsis

Background The proper diagnosis and treatment of neonatal sepsis is done depends on the understanding of its causative organisms. Objective The present study aimed to investigate the types of microorganisms in definitive neonatal sepsis. Methods Neonatal sepsis is a serious infectious disease with high mortality. And its diagnosed by blood culture. It includes early (appearance of clinical symptoms from birth to the third-seventh day) and late (from the third day to the twenty-eighth day) types with specific and sometimes common clinical symptoms. This cross-sectional study was performed on 266 neonates hospitalized with definitive sepsis in Ghaem Hospital in Mashhad from 2010 to 2020 using available sampling method. Infants suspected of bacterial infection who had positive blood cultures were included in the study. Type of bacterial organism, time of sepsis, main causes of death and need for mechanical ventilation were evaluated. Results Eighty eight neonates had early sepsis and 197 neonates had late sepsis. The bacterial organism of early sepsis was gram negative as 70.1% and in late sepsis was gram negative as 77.1%. The most common causes of early sepsis were Klebsiella pneumonia 21 cases (23.9%), Staphylococcus epidermis 16 cases (18.2%) and 10 cases (11.4%) E. coli . And the most common causes of late sepsis were K. pneumonia 35 cases (25.4%), Enterobacter aeroginosa 25(18.1%), S. epidermis 12(8.7%) and E. coli 11(8%). Conclusion K. pneumonia, S. epidermis and E. coli were three most common organisms in early neonatal sepsis and K. pneumonia, S. epidermis and Enterobacter were the most common organisms in late neonatal sepsis.

A Spatial Variation Analysis of In-Hospital Stroke Mortality Based on Integrated Pre-Hospital and Hospital Data in Mashhad, Iran.

Despite significant advances in the quality and delivery of specialized stroke care, there still persist remarkable spatial variations in emergency medical services (EMS) transport delays, stroke incidence, and its outcomes. Therefore, it is very important to investigate the possible geographical variations of in-hospital stroke mortality and to identify its associated factors. This historical cohort study included suspected stroke cases transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 to March 2019. Using emergency mission IDs, the pre-hospital emergency data were integrated with the patient medical records in the hospital. We used the Bayesian approach for estimating the model parameters. Out of 301 patients (142 (47.2%) females vs. 159 (52.8%) males) with a final diagnosis of stroke, 61 (20.3%) cases had in-hospital mortality. Results from Bayesian spatial log-logistic proportional odds (PO) model showed that age (PO=1.07), access rate to EMS (PO=0.78), arrival time (evening shift vs. day shift, PO=0.09), and sequelae variables (PO=9.20) had a significant association with the odds of in-hospital stroke mortality (P<0.05). Furthermore, the odds of in-hospital stroke mortality were higher in central urban areas compared to suburban areas. Marked regional variations were found in the odds of in-hospital stroke mortality in Mashhad. There was a direct association between age and odds of in-hospital stroke mortality. Hence, the prognosis of in-hospital stroke mortality could be improved by better control of hypertension, prevention of the occurrence of sequelae, increasing the access rate to EMS, and optimizing shift work schedule.