Imam Hossein Hospital Research Articles

Treatment Costs of Traffic Accident Casualties in a Third-level Hospital in Iran; a Preliminary Study.

The costs of traffic accidents in low- and middle-income countries are estimated to add up to $65 billion annually, which is a little higher than the amount they receive as a final aid for development. The present retrospective study aims to evaluate the treatment costs of the hospitalized injured individuals in traffic accidents. The present study was carried out in Imam Hossein Hospital, Tehran, Iran. The study population consisted of all the individuals injured in traffic accidents, admitted to the hospital wards. Data were collected by a trained emergency physician. Demographic data, injury mechanism, the type of vehicle, the admission ward of the patient, and treatment costs were collected. 200 patient files were evaluated (males: 89%). The results showed that 54% of the patients were in the 18-40-year age group and collisions between cars and motorcycles were the most frequent accidents (47%). The mean hospitalization cost for each patient was estimated to be $1622.1. Statistical analyses showed that treatment costs in the neurosurgery ward was significantly higher than orthopedic and general surgery (df: 3; F=9.5, P=0.008). The results of the present study showed that the mean cost of each traffic accident victim in Tehran is approximately $1622.1 and these patients sustain significantly higher costs in neurosurgery ward.

Study of the neuroprotective effects of memantine in patients with mild to moderate ischemic stroke.

Ischemic stroke is amongst the top four causes of mortality and the leading cause of disability in the world. The aim of this study was to evaluate the efficacy of a high dose memantine on neurological function of patients with ischemic stroke. In a randomized, 2 armed, open-label study, patients with mild to moderate cerebral thromboembolic event (CTEE) who admitted to Imam Hossein Hospital, Tehran, Iran, during preceding 24 hours, entered the study. Patients allocated in two study groups of memantine (as add-on therapy) and control. All patients were managed based on the American Heart Association and American Stroke Association (AHA/ASA) guidelines. Patients in memantine group received conventional treatment plus memantine 20 mg TID. The National Institute of Health Stroke Scale (NIHSS) was determined and recorded daily. The primary objective was comparison of the changes in NIHSS in the study groups at day 1 and day 5 of intervention. Significance level of p<0.05 was considered for statistical analysis. Patients were randomly allocated in control (15 women and 14 men, age 70.78 ± 10.92 years) and memantine (16 women and 8 men, age 73.33 ± 9.35 years) groups. There were no significant differences in age and sex distribution of two study groups as well as in comorbidities and concurrent drugs. NIHSS changes were significantly different between control (1.24 ± 0.96) and memantine group (2.96 ± 0.1), (p < 0.0001). Our results reveal that memantine added to standard treatment of CTEE could result in a remarkable decrease in the NIHSS confirming improvement of the neurological function of the patients.

The effect of new emergency program on patient length of stay in a teaching hospital emergency department of Tehran.

Background and Aim:Ideally, the period of patients admitting in the Emergency Department (ED) should not exceed 6 hours. Prolonged of the patients admitting time affects the ED overcrowding, quality of patient care and patient satisfaction. To evaluate the efficacy of new programs and suggest new strategies to reduce the overcrowding in a typical overcrowded ED of general teaching hospital in Tehran city.Materials and Methods:In this descriptive case study, charts of patients held over 24 hours, in Imam Hossein Hospital affiliated to the Shaheed Beheshti Medical University, were reviewed from April 21rd on August 23rd, 2008.Results:Of 15,477 patients, 151 (1%) have been held in the ED over 24 hours. Reasons for this long-stay included:lack of available bed in Intensive Care Unit (ICU) (125 patients), lack of available bed in related wards (18 patients), poor final decision — making by physician (eight patient)Conclusion:Long-term stay of patients in ED of teaching hospital is a major problem. The most frequent cause is a limitation of inpatient beds. The long stay time had not been affected by paraclinic procedures, multispecialities involvement or the lack of obvious diagnosis. The following solution is proposed: (1) creation of a holding unit, (2) active inter-facility transfer and (3) governing admittance of patients who need ICU care to related wards.

Investigation of Psen1&2 Genes in Early Onset Alzheimer’s Disease Patients

Investigation of Psen1&2 Genes in Early Onset Alzheimer’s Disease Patients

Late Pregnancy Outcomes in Women with Vaginal Bleeding in Their First Trimester

First trimester vaginal bleeding (FTVB) does not usually terminate the pregnancy. However, its outcome is a matter of debate. This study sought to assess the outcomes of pregnancies, complicated by FTVB. In this cohort study, 236 gravida 1 and 2 FTVB patients with delivery after 28weeks of gestational age, admitted to Imam Hossein Hospital during 2009-2010, were evaluated. The control group consisted of 944 gravida 1 and 2 women without any history of vaginal bleeding. Late pregnancy outcomes such as gestational hypertension, preeclampsia, placental abruption, preterm delivery, and premature rupture of membranes in the mothers and low birth weight (LBW), intrauterine growth restriction(IUGR), Apgar score at 5min <7, and NICU admission in the infants were evaluated. Logistic regression was used for estimation of odds ratios (OR) and 95% confidence interval. Compared to controls, the FTVB cases had more premature rupture of membranes (OR=10), gestational hypertension (OR=5.3), and placental abruption (OR=4.7), while their infants had higher odds of LBW, IUGR, Apgar score at 5min <7, and admission to NICU too. The incidence of premature rupture of membranes was 3.6% in the controls and 27.1% in the cases (RR=10, P<0.001). The incidence of gestational hypertension and LBW was 1.5 and 7.2% (P<0.001) in the controls and 6.6 and 12.3% (P<0.001) in the cases. The other outcomes were similar in both groups. FTVB may play a role in the development of late pregnancy outcomes in mothers and infants. Thus, it is recommended to evaluate some interventions on FTVB cases to prevent complications.

Utilization of Failure Mode and Effects Analysis (FMEA) Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study.

The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED) are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA) method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided into one main system and six subsystems, based on FMEA. The study was divided into two phases. In the first phase, the problems leading to the loss of revenue in each subsystem were identified and weighted into four groups using risk priority number (RPN), and the solutions for fixing them were planned. Then, in the second phase, discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after intervention using the repeated measure ANOVA test. 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousand US dollars/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousand US dollars/month after solving first, second, third, and fourth priority problems, respectively (337.75% increase in two years) (p<0.001). 111.0% increase in the ED revenue after solving of first priority problems revealed that they were extremely indispensable in decreasing the revenue (p<0.0001). The findings of the present study revealed that FMEA could be considered as an efficient model for increasing the revenue of emergency department. According to this model, not recording the services by the nursing unit, and lack of specific identifying code for the patients moving from ED to any other department, were the two first priority problems in decreasing our ED revenue.

Salivary high‐sensitivity cardiac troponin T levels in patients with acute myocardial infarction

Accurate and rapid diagnosis of acute myocardial infarction (MI) is of major medical and economic importance. The objective of this study was to identify whole saliva high-sensitivity cardiac troponin T (hs-cTnT) in patients with acute MI. A case-control study was carried out in 30 normal healthy individuals, and 30 patients with acute MI were hospitalized in CCU of Imam Hossein hospital, Tehran, Iran. The hs-cTnT levels were assayed in serum and whole saliva in the first and second morning following the MI by ELISA method. Statistical analysis of the Student's t-test and Pearson correlation coefficient was performed. The mean stimulated and unstimulated saliva and serum levels of hs-cTnT at both the first and the second morning following the acute MI were significantly higher in patients with acute MI compared with healthy individuals. Furthermore, stimulated and unstimulated saliva hs-TnT levels correlated significantly with serum hs-TnT level (r = 0.415, P < 0.023; r = 0.466, P < 0.021, respectively). Results suggest that salivary hs-cTnT can be used as an alternative to serum hs-cTnT for diagnosis and monitoring of myocardial infarction.

A Headache Misunderstood for a Grief Reaction: An Unusual Cerebral Venous Thrombosis Presentation

This is a report of a 24-year-old woman who presented to the emergency department (ED) at Imam Hossein Hospital in Tehran, Iran with a one-week history of headache and agitation following her father's death. Before presenting to our ED, a diagnosis of conversion reaction was suggested by three physicians in different outpatient clinics. Cerebral venous thrombosis (CVT) was confirmed in this case on the basis of brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). In this report, current knowledge regarding cerebral venous thrombosis and its related clinical features are discussed.

Toxic and Essential Trace Metals in First Baby Haircuts and Mother Hair from Imam Hossein Hospital Tehran, Iran

Hair metal level in newborn and mother pairs from Iran is reported. Toxic metals including cadmium (157 vs. 87.5 μg/kg), mercury (246 vs. 198 μg/kg), copper (14,313 vs. 11,776 μg/kg) and aluminum (52,022 vs. 408,207 μg/kg) were higher in newborn hair when compared to their mothers; suggesting that metals maybe discarded in the fetus as a detoxification method. Comparison with available data from Germany and Poland, and Iraq suggests overall similarities and significant differences in the case of the Iraqi subjects. Public protection from mixture toxicity of metals will be facilitated by studies such as ours.

P01-217 - Change of cliinical features of bipolar i disorder on a year-over-year basis in patients hospitalized in Imam Hossein Hospital during years of 1991 to 2006

IntroductionBipolar I Disorder (BID) might be diagnosed primarily as schizophrenia or major depressive disorder in children and adolescents due to unstable or vague symptoms. The depressive phase not yet followed by a manic or mixed episode in either adults or adolescents may lead to an early misdiagnosis. The concept of mixed episode as a manic episode intruding on previous depressive traits puts emphasis on early managements that may lead to a mixed episode.ObjectivesAssess of changes in clinical features of BID.AimsTo determine the frequency of mixed and manic phase of BID and assess change in rate of mixed versus manic episode on a year-over-year basis.MethodsStudy is a cross sectional study performed on 322 patients diagnosed with BID hospitalized in the psychiatric ward of Imam Hossein Hospital during the years of 1991 to 2006. Each episode was considered as an individual case. A single psychiatrist used DSM IV-TR criteria to differentiate a mixed episode from a manic one.ResultsAmong 322 patients, 117 were cases of mixed episode and 205 patients were diagnosed as manic episode. Year-over-year comparisons showed an increasing rate of the diagnosis of mixed episode during the course of the study.ConclusionsThe increased rate of the diagnosis of the mixed episode during the period of the study drives attention to all the probable factors that might have a role on the subsequent changes of the clinical feature of BID toward mixed episode.

P01-541 - Qualitative evaluation of archived files of pasychiatric ward of Imam Hossein Hospital during years of 2007 to 2008

IntroductionMedical records include information about the status and the hospital course of a patient and the instructions given to the patient. The accurate, accessible and up to date information can be used for further evaluation of the patient and also probable research projects.ObjectivesQualitative study of the archived patients’ files.AimsEvaluating the quality of the medical records at the psychiatric ward.MethodThe study was an observational descriptive study in which 400 archived files at the psychiatric ward of Imam Hossein Hospital during the years of 2007 and 2008 were qualitatively studied. The data was gathered by a data sheet and was analyzed using SPSS v. 15.0.ResultsAmong patient's demographic information, place of birth was not recorded in 82% of the files followed by birth date that was missing in 38% of the files. Case history, psychiatric formulations and progressive notes of patients were not appropriately recorded in 2.5% of the patients’ files. Finally, the summary sheets did not clarify the main complaint in 11.7% of the files and 7.5% of them lacked information to indicate dates of admission and discharge. Only 21.25% of the summaries defined initial and final diagnosis.ConclusionWith regards to the results and since there were incomplete data; the information could not be properly used as the raw material for researches. It seems that more supervision is needed to completely fill the files.

P01-245-Substance related disorder among bipolar patients

IntroductionBipolar disorder (BPD) is a common, severe, and persistent psychiatric illness affecting 1.3% to 1.7% of the population. Substance use disorders (SUDs) are also common. A community-based study found a lifetime prevalence of 17% for alcohol abuse or dependence and 6% for other substances. BPD and SUDs occur together more frequently than would be expected by chance alone.ObjectivesThis study was conducted to determine the pattern of substance abuse among Iranian bipolar disorder inpatients.AimsWe reviewed the history of patients who admitted with bipolar diagnosis in any phase to determine types of substance usage.Methods and materialsThis descriptive-analytical cross-sectional study on existing data, conducted among 322 patients with bipolar disorder attending to Imam-Hossein Hospital. The clinical records of each patient was assessed for any type of substance or alcohol related disorders.Results84 patients (26.1%) had substance use disorders. 40.5% were using opioids, 6% mood-elevators, 7.1% alcohol, and 46.4% were using multiple substances. The mean duration of substance abuse was 104 months plus 23 days.ConclusionsTotally, it may be concluded that substance abuse frequency among patients with bipolar disorder is high and may lead to deteriorated prognosis. Substances can also distort the clinical feature and course of the disorder and may create difficulties in correct diagnosis

Effect of timing of umbilical cord clamp on newborns' iron status and its relation to delivery type.

This study was conducted to evaluate the hematological effects of umbilical cord clamp timing and delivery type in term infants 48 hours after birth in Imam Hossein Hospital, Tehran, Iran. From Oct 2007 - March 2008, 100 mother-infant eligible pairs were selected and divided by cord clamp timing (< or =15 s and >15 s) for hematologic value determination between the two groups. Data analysis was performed with SPSS for Windows statistical package (version 13). Maternal hematological status was assessed upon admission to the delivery room. A total of 100 mother-infant pairs were divided into two groups: delayed cord clamp time within 15 s (n=70) or early cord clamp time [15 s after delivery (n=30)]. The groups had similar demographic and biomedical characteristics at baseline. Forty-eight hours after delivery the mean infant hemoglobin (Hgb; 16.08 gm/dL vs. 14.5 gm/dL; P<0.001) and hematocrit (Hct 47.6 vs. 42.8; P<0.001) levels were significantly higher in the delayed clamping group. There was no significant difference in ferritin levels (214.7 vs. 173.6 ng/dL; P=0.08). Fifty infants were born vaginally and 50 were delivered by cesarean section. Infants delivered vaginally had significantly more delayed cord clamp times (>15 s; P<0.001). Delaying cord clamping increases the red cell mass in term infants. It is a safe, simple and low cost delivery procedure that should be incorporated in integrated programs that are aimed at reducing iron deficiency anemia in infants in developing countries. Vaginal delivery facilitates this action.

Evaluation of serum PSA after cyproterone compound treatment compared with oral contraceptive pill in hirsute polycystic ovary syndrome patients

To evaluate the effect of oral contraceptive on the serum free prostatic specific antigen (PSA) in women with polycystic ovary syndrome (PCOD) compared with cyproterone compound. In this randomized clinical trial, 60 hirsute PCOD patients that referred to Imam Hossein hospital were enrolled. Baseline Ferriman–Gallway score (FG), body mass index (BMI), free PSA, 17-hydroxy progesterone (17-OHP), free testosterone, and dehydroepiandrestandione sulfate (DHEAS) were measured. Then patients were divided randomly into two groups. One group received oral contraceptive pill (OCP) and the other one ate cyproterone compound (Diane). Hormonal profile and Ferriman–Gallway scores were evaluated again after 3months. Baseline FG score was 10.78±2.4 vs. 11.5±2.3 in OCP and cyproterone compound group, respectively. FG score was reduced after 3months to 8.06±2.5 vs. 9.2±2.3, respectively ( P value=0.000). There was no significant difference in FG score reduction after the treatment between two groups ( r >0.05). Baseline PSA was 0.201±0.3 in OCP group and 0.097±0.12ng/ml in cyproterone compound group and after the treatment was decreased in both groups significantly 0.135±0.24 vs. 0.059±0.05ng/ml, respectively, but the mean reduction of score was the same for both groups ( r >0.5). Free testosterone reduced more in OCP group (2.48±1.3ng/ml to 2.24±1.0ng/ml, P value=0.03) than cyproterone compound (2.00±1.2 to 1.64±0.9ng/ml, P value=0.1). There was no statistical differences observed in 17-OHP and DHEAS after the treatment in both groups ( P value >0.5). Serum free PSA and free testosterone and FG score were decreased after treatment with OCP and cyproterone compound but there was no preference between the two groups of anti-androgen treatment.

HYPERTENSIVE ENCEPHALOPATHY INDUCED BY MERCURY POISONING; A REPORT OF 3 CASES (IN AN IRANIAN FAMILY)

Objective Mercury poisoning is one of the important recent causes of mortality and mortality in children worldwide, particularly in industrial environments; mercury is a poisonous metal, especially harmful to the nervous and immune systems and the kidneys and can even be fatal. Elemental mercury is present in thermometers, barometer batteries, sphygmomanometers and latex paints. Inorganic mercury salts are found in antiseptics, pesticides, pigments and explosives and are used as preservatives in medicine. Mercury was once used to stop fever, and this worked because the immune system was so weakened that it could no longer sustain the attack for which the fever was created. Some medical drugs still contain mercury chloride and mercurous chloride and certain forms of mercury are still used in some laxatives. Mercury toxicity of the nervous system causes anorexia, ataxia, lack of ability to coordinate voluntary muscle movements, dementia, depression, dizziness, emotional instability, erethism (abnormal irritability in response to stimulation), incoordination, insomnia, irritability, loss of ability to speak, memory impairment, numbness, saresthesias (sensation of prickling, tingling or creeping on the skin), psychosis, tremors, drowsiness, fatigue and weakness. Other organ damages include kidney failure, headaches, hearing impairment, visual impairment, hypertension, dermatitis, digestive tract problems, colitis, diarrhea, stomatitis and excessive salivation, loss of teeth, metallic taste, chromosomal damage, birth defects and ensuing organ failure. Chronic mercury poisoning can cause Acrodynia (Pink disease). Mercury poisoning is a rare cause of hypertension in children. Herein we report 3 cases, the first a child with hypertensive encephalopathy due to severe mercury poisoning and his two siblings with moderate symptoms. Case report A 10 year old boy was admitted in psychiatric ward of Imam Hossein Hospital with behavioral disorder, irritability, mood change and convulsion. Because of his blood pressure which was 160/120 he was referred and admitted to the Pediatric Nephrology department. On arrival, for his hypotonia and the pink discoloration of his fingers a diagnosis of Acrodynia (Pink disease) was considered; his history showed that he has played with a ball of mercury, taken from a laboratory. He and his 2 siblings received British Anti Lewisite(BAL) and D-penicillamin; at follow-up all symptoms had gradually disappeared and they are well now. Keywords: Mercury poisoning, Children, Renal complications, Hypertensive encephalopathy

Relationship between pregnancy outcome and maternal BMI and weight gain

Background: Previous studies have suggested the effects of maternal BMI and weight gain on pregnancy outcomes, thus, the present study was conducted over 106 parturients referring to Imam Hossein Hospital to determine the maternal BMI and weight gain and its relationship with pregnancy outcomes. Materials and methods: One hundred and six parturients had entered this longitudinal study. Initial data including weight, height, and previous deliveries were all recorded. Perinatal care was achieved. Maternal weight gain was determined and the relationship between pregnancy outcomes and maternal BMI and weight gain was assessed. Results: Of a total of 106 parturients, 101 (95.3%) aged 18–35 years. Most of the candidates (47.2%) had BMI of 19.8–26. Thirty-seven percent had weight gain below the standard level, whereas 35% had weight gain above the standard level. BMI was revealed to be correlated with weight gain. Preterm delivery was noted in 33.3% of the females with BMI between 26 and 29; however, normal candidates have experienced preterm delivery in 24%. Conclusion: Abnormal weight gain and BMI were revealed to be associated with severe maternal and neonatal complications that are associated with extra expenses for the society and the family. Maternal education and consultation seems to be helpful.