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    2024(1):3-7, DOI: 10.4103/jad.jad_129_23
    Inflammation is a multifaceted cellular and molecular response triggered by injury, infection, or various pathological conditions. Serving as a protective defense mechanism, the inflammatory response involves clinical signs like redness, swelling, pain, and increased body temperature. Immune cells, notably neutrophils and macrophages, play key roles in orchestrating this response. The delicate balance between proinflammatory and anti-inflammatory mediators, including cytokines and chemokines, regulates the inflammatory cascade. While acute inflammation is crucial for tissue repair, chronic inflammation may indicate an imbalance, contributing to conditions like autoimmune diseases. Understanding these mechanisms is vital for developing therapeutic strategies and managing chronic diseases.
    2024(1):8-13, DOI: 10.4103/jad.jad_142_23
    Objective: To investigate cardiovascular risk factors affecting COVID-19 outcomes in a tertiary referral hospital.
    Methods: This prospective cohort study analyzed 269 participants with COVID-19. The primary outcomes were ICU admission, prolonged hospital stay duration, and in-hospital death. The secondary outcomes included death, chronic symptoms, and NYHA functional class during follow-up periods.
    Results: A total of 412 patients with COVID-19 symptoms were enrolled in the study, and out of which 269 patients had complete medical records and positive SARS-CoV-2 PCR test results, fulfilling the study criteria were analyzed. The patients were divided into two groups, with cardiovascular comorbidities (group A, n=122), such as established cardiovascular disease, diabetes mellitus, and hypertension, and without cardiovascular comorbidities (group B, n=147). Binary logistic regression analysis showed that patients with underlying hypertension, diabetes, and established cardiovascular disease had a 1.55 (95% CI: 1.28-2.26), 1.62 (95% CI: 1.34-2.13), and 1.63 (95% CI: 1.07-5.34)-fold risk of mortality, respectively in the adjusted model.
    Conclusions: Hospitalized COVID-19 patients with predisposing cardiovascular risk factors are more susceptible to develop worse outcomes. More attention should be paid to the management and follow-up of these patients.
    2024(1):14-19, DOI: 10.4103/jad.jad_139_23
    Objective: To explore correlation of neutrophil-to-lymphocyte ratio (NLR) to severity of coronary artery disease (CAD) and in-hospital clinical outcomes in patients with acute coronary syndrome (ACS).
    Methods: In this prospective and observational study, we recruited 500 patients with ACS. For all the eligible patients, demographic details were collected, and laboratory parameters were evaluated. The CAD severity was evaluated in terms of the number of involved vessels. The NLR was calculated based on neutrophils and lymphocytes and the correlation of various risk factors and severity and outcome of CAD was performed.
    Results: 77.2% of Patients was male, and 52% of the patients aged between 55-70 years. Based on the type of ACS, 396 out of 500 patients had ST-elevation myocardial infarction. An ascending trend in the white blood cell levels and NLR value was noted as the severity of the ACS increased and the highest white blood cell levels and NLR was noted among class Ⅳ patients. The mean NLR value among the non-survivors were higher compared to the survivors (9.52±5.72 vs. 4.76±2.36; P<0.01). Receiver operating curve showed that the cut-off NLR value was 5.76 with a sensitivity of 75.0% and a specificity of 77.3%.
    Conclusions: The NLR can be used as an independent prognostic marker in ACS. An elevated NLR value serves as a reliable predictor for short-term complications, notably in-hospital mortality.
    2024(1):20-25, DOI: 10.4103/jad.jad_115_23
    Objective: To determine the temporal trend and epidemiology of animal bite cases in Gerash City, Iran.
    Methods: This retrospective cross-sectional study analyzed 630 cases of people with animal bites between 2011 and 2021 in Gerash City. The collected data were analyzed using Chi-square test.
    Results: The mean age of victims was (30.9±17.5) years. 80.54% Of victims were male, 39.70% were self-employed, and 64.60% were adults (≥18 years). Most cases of bites occurred in 2019 (91 cases), 2020 (74 cases) and 2021 (87 cases), and most of the bites were related to the upper limbs (62.70%). Most of the wounds were superficial (78%), most of the biting animals were domestic animals (91.74%), and most of the victims had Iranian nationality (97.62%).
    Conclusions: Given the increasing trend of animal bites in Gerash City, health authorities should carry out basic measures such as education and awareness among the public, especially at-risk groups such as adult males. Additionally, since most cases of bites are due to dogs, it seems necessary to plan for vaccination of dogs, especially those with owners.
    2024(1):26-30, DOI: 10.4103/jad.jad_121_23
    Objective: To evaluate relationship between changes in the beneficial bacteria in intensive care unit (ICU) patients and nutritional therapy type.
    Methods: Ten patients aged ≥18 years admitted to the ICU between January and December 2020, were included. Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding. The ratio of beneficial bacteria at the first and second bowel movements after each patient’s admission was calculated and the patients were classified into the increase or decrease group. Among all patients, five each were in the increase and decrease groups. We investigated patient background, changes in sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scores, nutritional doses or methods, and clinical outcomes.
    Results: No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHE II scores at the time of admission. The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group (4/5 vs. 0/5, P=0.01).
    Conclusions: An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition. In the future, accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective.
    2024(1):31-35, DOI: 10.4103/jad.jad_109_23
    Objective: To investigate the clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to a neonatal intensive care unit in a tertiary care center.
    Methods: The prospective observational study was conducted in a tertiary care center in the Specialty Department of Pediatric. 196 Newborn babies with blood glucose levels < 45 mg/dL were examined with a simple random sampling method between December 2019 and November 2021. Maternal and neonatal risk factors and clinical signs were recorded and compared between symptomatic and asymptomatic cases.
    Results: The proportion of symptomatic hypoglycemia neonates born to gestational diabetes mellitus mothers was significantly higher (23.4% vs. 8.4%)(P<0.05). Small for gestational age, low birth weight, respiratory distress syndrome, hypothermia, and endocrine disorders were risk factors. The death rate in asymptomatic hypoglycemia neonates was significantly higher (58% vs. 39%) (P<0.05).
    Conclusions: The study indicates that maternal gestational diabetes mellitus is associated with symptomatic hypoglycemia and asymptomatic hypoglycemia is associated with neonatal mortality. It is important to take vigilance and timely interventions to address associated symptoms, particularly poor feeding, in the management of neonatal hypoglycemia.
    2024(1):36-39, DOI: 10.4103/jad.jad_142_22
    Rationale: Acute otitis media is a common disease in early childhood, and is usually caused by Streptococcus pneumoniae (S. pneumoniae). Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone (acute coalescent mastoiditis). In addition, the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells, leading to subperiosteal abscesses.
    Patient’s Concern: A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis (swelling and redness of the skin).
    Diagnosis: Bilateral acute coalescent mastoiditis caused by S. pneumoniae infection. The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.
    Interventions: The patient underwent intravenous antibiotic therapy and surgical treatment.
    Outcomes: The patient was discharged 14 days after hospitalization with an improved condition.
    Lessons: Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications, sometimes serious and even life-threatening. Complications are prevalent in children under 2 years, in whom the disease progresses more rapidly and severely. The vaccination with a 13-valent vaccine may not result in sufficient immunity against S. pneumoniae, a predominant pathogen in children affected by acute coalescent mastoiditis.
    2024(1):40-42, DOI: 10.4103/jad.jad_62_22
    Rationale: Multi-organ failure is a symptom of paraquat poisoning, resulting in high mortality and morbidity rates. Though paraquat is widely available, poisoning through inhalation is rare.
    Patient’s Concern: A 37-year-old male reported to the emergency department with complaints of vomiting after an alleged history of inhalation of paraquat while at work.
    Diagnosis: Paraquat poisoning.
    Interventions: Supportive management along with multiple sessions of hemodialysis.
    Outcomes: Renal complications caused by paraquat were improved after multiple sessions of hemodialysis. However, the patient developed respiratory complications and later due to persistent hypoxemia and non-responsive to supportive therapy, he succumbed to his illness.
    Lessons: Acute kidney injury is a complication of paraquat poisoning. However, kidney involvement with the inhalational mode is rare. It is caused by reduction and oxidation cycles, as well as the formation of reactive oxygen species, necessitating hemodialysis as the treatment. Without a clear history, a specific clinical trait, or a diagnostic test, diagnosis can be difficult. Our case thus highlights the inhaled paraquat poisoning, presenting with acute kidney injury with late respiratory impairment as a consequence.
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    2018(3):99-102, DOI: 10.4103/2221-6189.236822
    Pulmonary embolism (PE), with the incidence of about 60 per 100 000 annually, can be a life-threatening disease if it is not treated promptly. It has been estimated that some 10% of PE patients die within the first hour of the event. Untreated PE has a mortality of about 30%. PE is a condition that is treatable if suspected and diagnosed early. The chest radiograph is still the first investigation that is ordered in patients presenting with cardiorespiratory symptoms or symptoms suggestive of PE. The CXR is also helpful in identifying or excluding other conditions or diagnoses. Thus, knowing and understanding some of the more specific CXR signs can be useful. We suggest that physicians to be aware of and utilize CXR findings such as Palla's sign, Westermark sign and Hamptons hump to help with the diagnosis of PE and to exclude other conditions that can mimic venous thrombo-embolism. Even if these signs are not common, their presence, even in an unsuspected patient without a high pretest probability of PE, should prompt further investigations such as a D-dimer test, lung scintigraphy or computed tomography pulmonary angiography as required.
    2018(3):93-98, DOI: 10.4103/2221-6189.236821
    Acupuncture is actually convoked for supporting Western Medicine. Its “Golden Points” can undoubtedly help patients during its neurological recovery. After almost thirty years of experience in saving patients at impending death situations and having made numerous contributions on the field, the author herein provides a reasoned survival bio-energetic circuit based on a detailed methodological and functional analysis of the Main Channels and the Wondrous Vessels (Qi jing ba mai) participating in it. K-1 Yongquan complementary resuscitation maneuver, systematized since 1987, has been consistently performed in sudden death and cardiac arrest conditions as a final resource in both basic and advanced CPR failure. Experimental analytical studies identify the prevention, control and assessment of treatments set up as well as the determination of their efficiency. Acupuncture K-1 Yongquan Resuscitation Maneuver is presented not only as a complementary CPR rescuer but as a protective aid for both traumatic and vascular acute brain injury. Current indications of KI-1 Yongquan are not limited to actuarial results in cardiac arrest resuscitations, but it functions as a brain protector in both traumatic and vascular brain injury situations should be included. Although many acupuncturists indicate only standard techniques for bio-energetic rehabilitation, it has not been noticed that they insist with greater emphasis in those specific points to stimulate the “Sea of Marrow” (encephalon). Divulgation of K-1 emergency therapeutic possibilities look for its inclusion into Critical Care Protocols, in order to upgrade survival rates in both cardiac arrest and stroke victims. Traditional Chinese Medical balancing effect principle can improve cognitive, intellectual and psycho-motor patterns after even severe brain injuries. Beyond the scientific methodology that supports it the efficiency of the maneuver derives mainly from the sustained increase in survival rates presented in the successive statistics published in renowned scientific journals since its application.
    2019(2):82-83, DOI: 10.4103/2221-6189.254433
    Distinguishing stroke mimics constitutes a considerable challenge for clinicians in emergency department. Here, we illustrate an extremely rare patient presenting with acute onset isolated dysarthria, who finally received diagnosis of tardive phenomenon associated with betahistine. Through the presentation of this case, we point out tardive phenomenon as an alternative differential diagnosis of stroke. Furthermore, this case adds substantial data presenting an interesting manifestation of isolated dysarthria as a tardive phenomenon, occurring due to betahistine usage which is extremely rare in literature.
    2018(2):90-92, DOI: 10.4103/2221-6189.233019
    Acute renal failure is an important acute renal disease. It is the totally acute impairment of the renal function and can be fatal if there is no proper and timely treatment. There are various causes of acute renal failure. The acute renal failure might be due to contact with nephrotoxic substance. The food borne acute renal failure is an important problem that is sporadically seen worldwide. Of several food borne acute renal failure disorders, the fish borne acute renal failure is an important problem. In this specific short review, the authors summarize and discuss the cases on important fish borne acute renal failure disorders.
    2017(4):181, DOI: 10.12980/jad.6.20170406
    Objective: To determine the bacteriological profile and antimicrobial susceptibility patterns of burn wound isolates. Methods: Swabs were taken from burn wound of patients admitted to Ward D2C and Burns Intensive Care Unit (BICU) from December 2014 to November 2015. Samples were processed at the Microbiology Laboratory for identification and sensitivity. Bacteria isolated were identified using their morphological characteristics, Gram staining reaction and biochemical tests. The antimicrobial susceptibility testing was done using KirbyBauer disc diffusion method. Questionnaires were also administered to study participants to obtain information on demography, kind of first aid received, antibiotics received prior to culture and sensitivity. Results: A total of 86 patients comprising 45 patients from Ward D2C and 41 from BICU participated in the study. Males were 51(59.3%) and females 35 (40.7%). Age of participants ranged from 0–56+ years. Pseudomonas aeruginosa was the commonest pathogen isolated 26(30.2%), followed by Pseudomonas spp. 21(24.4%), Escherichia coli 17(19.8%), Klebsiella spp. 12(14.0%). Coagulase negative Staphylococcus accounted for 2(2.3%). Overall prevalence of infection in the study was 90.7%. Conclusions: Burn wound infection continues to be a major challenge in burn centers. Regular surveillance of commonly identified pathogens in the ward and their antimicrobial susceptibility will guide proper empiric selection of antibiotics for management of burn wounds.
    2018(3):103-107, DOI: 10.4103/2221-6189.236823
    Hyponatremia is a common electrolyte disturbance usually observed in neurosurgical patients undergoing surgical management of traumatic, as well as, nontraumatic intracranial pathology. The spinal cord trauma is also associated with occasional development of such hyponatremia; it usually occurs within the first two-weeks of the injury. Hyponatremia can lead to alterations of consciousness, convulsions, coma, cardiac arrhythmias and on rare occasions, death. Authors present a practical oriented review of the literature.
    2018(1):45-48, DOI: 10.4103/2221-6189.228878
    Hemoptysis is a common emergency symptom for pulmonary embolism. It's important to differential diagnosis for this symptom. This article reports a case of pulmonary vein stenosis. The patient was transferred to a number of hospitals for medical treatment, but was misdiagnosed for 7 months. This article aims to improve clinician's ability to differentially diagnose hemoptysis, and to deepen the knowledge of pulmonary vein stenosis.
    2019(5):179-184, DOI: 10.4103/2221-6189.268405
    Objective: To determine the effect of self-management program on the health status of elderly patients with heart failure. Methods: The present study was a single-blind, randomized clinical trial, and conducted on 90 patients with heart failure of stages II-III at one teaching hospital in eastern Iran in 2017. The participants were randomly assigned into two groups: the intervention group and the control groups, with 45 patients in each group. Self-management programs including awareness and recognition, problem-solving process, diet, exercise, and stress management were carried out. The participants were trained for six weeks and were followed for two months. Data of the health status were collected before, after and eight weeks after intervention by Kansas City Cardiomyopathy Questionnaire. Data analysis by chi-square, independent t-test, Fisher, ANOVA with repeated measures was conducted. Results: Patients in both groups were matched in terms of demographic characteristics before the intervention. There was no significant difference in the mean scores of health status between the two groups (P=0.1) before the intervention. However, the second measurement after intervention showed a significant difference in the mean scores between the two groups (P=0.001). Conclusions: Self-management program can improve the different dimensions of health (except in the subscale of sign and symptoms). Therefore, this supportive method can be used to improve the health of patients and manage problems caused by heart failure.
    2019(3):113-117, DOI: 10.4103/2221-6189.259110
    Objective: To investigate the frequency of integrase genes intI1, intI2 and intI3 of Escherichia coli strains, and their association with resistance to routinely used antibiotics. Methods: A total of 120 Escherichia coli strains were collected from patients with urinary tract infection in Ahvaz, Southwest of Iran. Antibiotic susceptibility testing was performed. The presence of intI1, intI2, andintI3 genes was determined by polymerase chain reaction. Results: Antibiotic susceptibility testing disclosed the highest resistance rate to ampicillin (91.7%) followed by trimethoprim/sulfamethoxazole (65.8%), and ceftazidime (56.7%). The imipenem susceptibility rate was 91.7%. IntI1 and intI2 were identified in 74 (61.6%) and 8 (6.6%) of Escherichia coli strains, respectively, but intI3 was not found in any isolates. The presence of integrons was significantly associated with resistance to ampicillin, trimethoprim/ sulfamethoxazole, ceftazidime, and ciprofloxacin antibiotics (P<0.05). Conclusions: The high resistant Escherichia coli isolates harboring class 1 integrons (intI1) were detected in patients with urinary tract infection in our region. Therefore, preventive strategies are necessary to restrict further dissemination of resistant strains.
    2018(2):88-89, DOI: 10.4103/2221-6189.233018
    Pox is an important infection that can cause the acute illness with dermatological manifestation. Apart from the well-known pox infections, the emerging zoonotic pox infections become interesting new issue in infectious medicine. In this short review, the acute illness which results from new important zoonotic pox infections such as monkeypox, cowpox, raccoon pox and buffalopox is discussed and summarized.
    2018(2):69-73, DOI: 10.4103/2221-6189.233014
    Objective: To study the effects of large doses of vitamin C and vitamin E on nerve injury, neurotrophic and oxidative stress in patients with acute craniocerebral injury. Methods: Patients with acute craniocerebral trauma who were admitted to the Third People's Hospital of Zigong from April 2014 to December 2016 were selected as the subjects and were randomly divided into two groups. The control group received conventional treatment, and the intervention group received large doses of vitamin C and vitamin E combined with conventional treatment. On the 3th day and 7th day after treatment, peripheral blood was collected and serum was isolated, then the contents of nerve injury index NSE, S100B, NGB, UCH-L1, Tf, Ft and neurotrophic indexes NTF-a, BDNF, NGF and IGF-I were determined by Enzyme-linked immunosorbent assay kit, and the contents of SOD, GPx, CAT, OH-, O2-, MDA and AOPP were measured by radioactive immunoprecipitation kit. Results: 3th day and 7th day after treatment, the contents of NSE, S100B, NGB, UCH-L1, Tf, Ft, NTF-a, BDNF, NGF, IGF-I, OH-, O2-, MDA and AOPP in the intervention group were all significantly lower than those in the control group. The content of SOD, GPx and CAT in serum in the intervention group was significantly higher than that in the control group. Conclusions: High-dose vitamin C and vitamin E treatment can alleviate nerve injury, oxidative stress response, and improve neurotrophic state in patients with acute craniocerebral injury.
    2019(2):45-52, DOI: 10.4103/2221-6189.254411
    Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P<0.001). The best combination of markers in predicting sepsis was NLCR and white blood cell (AUC: 0.801, 95% CI=0.724-0.878, P<0.001). Conclusions: The results of this small study showed that NLCR outperforms other markers in diagnosing sepsis in ED. It is readily available, cost efficient, non invasive and independent. It may be insufficient to rely on this single marker to diagnose sepsis, so some other diagnostic utilities should be taken into account as one part of the overall assessment. Our study also showed that combination of NLCR and white blood cell provides the highest diagnostic accuracy. More large scale studies across different population groups will be needed to confirm this finding.
    2019(6):221-232, DOI: 10.4103/2221-6189.272853
    Legionellosis is the generic term used to describe infections caused by different varieties of Legionella spp., including Legionnaires’ disease (LD), a severe and potentially fatal form of pneumonia, and Pontiac fever, a self-limited flu-like illness. Legionellosis is usually acquired through inhalation or aspiration of aerosols containing Legionella spp. These bacteria can cause acute consolidating pneumonia in susceptible patients who are at an advanced age, have underlying debilitating diseases, or are immunodeficient. The main natural reservoir for Legionella is water and this pathogen colonizes many different natural and man-made freshwater environments such as water networks, cooling towers, and water systems in buildings and hospitals. In recent years, various laboratory diagnostic tests for Legionella infections have changed significantly. Although the sequencing method is nowadays considered the fastest and most reliable method for differentiation and detection of different Legionella species, the isolation of these bacteria from clinical specimens is the golden standard for diagnosis of Legionnaires’ disease. Today the urinary antigen test as the most rapid and inexpensive method is routinely used for diagnosis of LD caused by Legionella pneumophila serogroup 1. The macrolides and fluoroquinolones are still the mainstays for the treatment of Legionella infections. For the prevention of spreading the contaminated water aerosols and controlling Legionella infections, an effective water treatment procedure is necessary. This review describs and summarizes the latest available information about all aspects of Legionella and Legionnaires’ disease.
    2020(2):61-66, DOI: 10.4103/2221-6189.281319
    Objective: To investigate the relationship between serum C-reactive protein (CRP) level and left ventricular function in patients with acute ST-elevation myocardial infarction. Methods: This study is a descriptive-analytic study and was conducted on patients with ST-elevation myocardial infarction, who were admitted to the Urmia Hospital in Seyed Alshohada Hospital, and underwent primary percutaneous coronary intervention from October to March 2018. Demographic, angiographic, echocardiographic data were evaluated based on the patients’ records. All patients were evaluated for 90 min and CRP levels were measured during the first 6 h after the primary percutaneous coronary intervention. Results: A total of 114 patients were studied, among whom 71.9% (82 patients) were male, and their mean age was (57.86±9.57) years old. The mean BMI was (26.1±3.8) kg/m2. Altogether 38.6% (44 patients) had a history of smoking, 17.5% (20 patients) of diabetes, 38.6% (44 patients) of hypertension, 5.3% (6 patients) of hyperlipidemia and 7.0% (8 patient) of coronary artery disease. The results showed a significantly negative correlation between ejection fraction and CRP, left atrial volume and CRP (P<0.05), and a significantly positive correlation between the global longitudinal strain level and CRP. The CRP level was significantly different at various diastolic grades (P=0.001). The level of CRP in patients with grade 2 diastolic dysfunction was higher than grade 1 diastolic dysfunction, while the level of CRP in diastolic grade 1 diastolic dysfunction was higher than the normal function. Conclusions: High CRP levels are associated with ejection fraction, global longitudinal strain loss and left atrial volume.
    2019(6):233-238, DOI: 10.4103/2221-6189.272854
    Objective: To determine the effect of rehabilitation education on pain, knee stiffness and performance difficulty in patients undergoing knee replacement surgery. Methods: This randomized clinical trial study was performed on 96 patients undergoing knee replacement surgery, who were randomly divided into two groups: the control group and the intervention group, with 48 patients in each group. In the intervention group, the patients received educational intervention in four stages (one day before surgery, 24 h and 48 h later, upon discharge from the hospital. In the control group, only the routine of the hospital was performed. Questionnaires were completed before and 6 weeks after the intervention. Results: The mean scores of pain, knee stiffness and performance difficulty were significantly decreased in the intervention group (P=0.01). Compared to the control group, the intervention group had a better outcome of the illness, including pain, knee stiffness and performance difficulty (P=0.001). Conclusion: Rehabilitation education could be a suitable way to improve the surgical outcomes of patients undergoing total knee replacement.
    2018(2):49-68, DOI: 10.4103/2221-6189.233013
    The I-Ching is one of the most significant texts in the literature of the world and embodies, as no other text does, the Chinese spirit and thought. Its perpetuation along millennia has exercised crucial influence on the development of Chinese philosophy and medicine. The hypotheses of its abstractions compose a “body of assumptions” that hierarchs concepts through a self-regulated process of reciprocal control, which allows the accurate prediction of specific sequences of events according to “fields of similarities”. This peculiarity enables this system of knowledge to make possible predictions based upon the Natural Laws with incredible accuracy, which is effective to process expectations and arguments or to affirm or reject its judgments. A detailed analysis of two consecutive hexagrams (N°23 & N°24) allows the understanding not only of the bases that consolidate the “Reconciliation vessel” but also of the specific determination of its function in the frame of Risk management that can be compared to present ISO standards.
    2018(6):225-233, DOI: 10.4103/2221-6189.248026
    The large amount of classifications about the concept of death from a medical-legal perspective leads us to think that there are still many aspects to accurately define that precise moment in which the end of our earthly existence is considered as a final and unalterable fact. An answer to such a question may come from a retrospective analysis of those victims of impending-death situations that have been rescued after both basic and advanced cardiac pulmonary resuscitation failure and their consequent medical-legal death declaration. The aim of the following work is to introduce a new phase within forensic thanatology, supported by a complementary resuscitation maneuver based upon millennial traditional Chinese medicine principles together with a detailed analysis of current global agreements on organ transplantation and an avant-garde perspective on actual knowledge about cell death. Those terms will then allow us to achieve a holistic view of said concept, still loosely defined at present. Such an innovative diagnostic-therapeutic resource can in turn enable us to evaluate and face the irreversibility of such extreme situation, analyzing the statistical feasibility of its promising results.
    2019(6):239-244, DOI: 10.4103/2221-6189.272855
    Objective: To assess the preparedness for handling injuries by female primary school teachers based on their knowledge, attitude, practice and their willingness to learn first aid. Methods: A cross-sectional questionnaire on first aid was provided to female primary school teachers, and the knowledge, attitude, practice and their willingness to learn first aid were investigated. Data were analyzed using SPSS version 23. Quantitative data were analyzed by one-way ANOVA, categorical variables were analyzed by the Chi-square test. The level of significance was set at P<0.05. Results: In total, 464 teachers of different age groups and education responded. The mean knowledge score was low but the mean attitude score was high. Parental consent was sought by one-fourth of the teachers, and 25.6% of teachers documented the health status of children. Most of the teachers desired to have a first aider, and they were keen on training (62.3%) and educating children (88.1%) on first aid. Knowledge scores were significantly impacted by age (P<0.05) and experience (P<0.01), while specialization impacted mean practice scores (P<0.001). Teachers’ qualification (P<0.05), first action to be taken at the accident site (P<0.05), and frequency of training (P<0.05), were significantly associated with the need of a first aider. Conclusions: Based on the paucity of awareness and expertise, on priority basis, it is important to strengthen teachers’ skills. Child safety is an important public health issue and can be improved by educating and training teachers.
    2019(5):215-220, DOI: 10.4103/2221-6189.268412
    Rationale: Acute myocardial infarction in the presence of right bundle branch block. Patient concerns: A 70-year-old, male heavy smoker presented with angina and hypertension. Interventions: Electrocardiography, intravenous nitroglycerin infusion, intravenous streptokinase infusion. Diagnosis: Acute myocardial infarction in the presence of with changeable trifascicular heart block. Outcomes: Dramatic clinical improvement with electrocardiographic ST-segment (whether elevation or reciprocal ST-depression) resolution. Lessons: Acute myocardial infarction may be associated right bundle branch block. Accompanied trifascicular heart block had pre-streptokinase left anterior fascicular block with left axis deviation and post-streptokinase left posterior fascicular block with right axis deviation.
    2019(5):185-190, DOI: 10.4103/2221-6189.268406
    Objectives: To study the rate of survival to discharge after in-hospital cardiac arrest and its associated factors in an emergency department of a tertiary care hospital, South India. Methods: This prospective observational study was conducted between December 2016 and May 2017 among all patients above 12 years old, who suffered witnessed cardiac arrest, after arrival in the emergency department. A semi-structured questionnaire was used to collect data (socio demographic details, chief complaints, comorbidities). Initial documented rhythm, duration of CPR, use of defibrillator, and presumed cause of cardiac arrest and others were collected from the case records. Results: The study cohort contained 252 participants. The age was (50.0+17.2) years and male patients accounted for 54.4%. The most common complaint was breathlessness (29%), followed by chest pain (20.2%) and trauma (17.5%). The proportion of non-shockable rhythm (77.4 %) was higher than shockable rhythm (22.6%). Pulseless electrical activity (53.9%) was the most common initially documented rhythm. The predominant presumed cause of arrest was cardiac origin (29.7%). The overall rate of survival to discharge was 17.5%. Logistic regression analysis showed age >60 years [odds ratio (OR): 3.4, 95% confidence interval (CI): 1.03-11.22, P=0.04], males (OR: 3.45, 95% CI: 1.00-11.44; P=0.04), presumed respiratory cause (OR: 11.8, 95% CI: 1.0-160.0, P=0.05), initial rhythm ventricular fibrillation (OR: 9.1, 95% CI: 1.0- 92.0, P=0.05) as individual predictors of survival rate to discharge after in-hospital cardiac arrest. Conclusions: Our study shows that less than one-fifth of patients survive to discharge after inhospital cardiac arrest. This signifies the need to identify and to make the necessary changes at all levels of organization, service delivery and patient care, so as to improve the overall survival rate following cardiac arrest.

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