Evaluation of Intravenous Phenobarbital Pharmacokinetics in Critically Ill Patients With Brain Injury

Phenobarbital is still one of the drugs of choice in managing patients with brain injury in the intensive care unit (ICU). However, the impact of acute physiological changes on phenobarbital pharmacokinetic parameters is not well studied. This study aimed to evaluate the pharmacokinetic parameters of parenteral phenobarbital in critically ill patients with brain injury. Patients with severe traumatic or non-traumatic brain injury at high risk of seizure were included and followed for seven days. All patients initially received phenobarbital as a loading dose of 15 mg/kg over 30-minutes infusion, followed by 2 mg/kg/day divided into three doses. Blood samples were obtained on the first and fourth day of study at 1, 2, 5, 8, and 10 hours after the end of the infusion. Serum concentrations of phenobarbital were measured by high-pressure liquid chromatography (HPLC) with an ultraviolet (UV) detector. Pharmacokinetic parameters, including the volume of distribution (Vd), half-life (t1/2), and the drug clearance (CL), were provided by MonolixSuite 2019R1 software using stochastic approximation expectation-maximization (SAEM) algorithm and compared with previously reported parameters in healthy volunteers. Data from seventeen patients were analyzed. The mean value±standard deviation of pharmacokinetic parameters was calculated as follows: Vd: 0.81±0.15 L/kg; t1/2: 6.16±2.66 days; CL: 4.23±1.51 ml/kg/h. CL and Vd were significantly lower and higher than the normal population with the value of 5.6 ml/kg/h (P=0.002) and 0.7 L/kg (P=0.01), respectively. Pharmacokinetic behavior of phenobarbital may change significantly in critically ill brain-injured patients. This study affirms the value of early phenobarbital therapeutic drug monitoring (TDM) to achieve therapeutic goals.

COVID-19 in Single Kidney Patient

The COVID-19 pandemic has affected all people in the world, especially those at risk of kidney disorders. Early kidney damage in patients born with unilateral renal agenesis (URA) or solitary kidney can happen. These patients are at risk of chronic kidney disease (CKD), high blood pressure, and developing proteinuria. Unilateral renal agenesis is a cause of CKD. Therefore, it is very interesting that observe a unilateral renal Patient that Suffers from COVID-19. Hence, the management of these patients with COVID‐19 is an area of interest, and a unique approach is warranted. A 43-year-old male patient with unilateral renal presented to our hospital for corona disease. The case was discussed between the nephrologists, Infectious disease specialists, and nursing head nurses for a care plan daily. The patient had unilateral renal disease, and COVID-19 could have a detrimental effect on the renal, but renal tests were normal, and the patient recovered without acute renal complications. The treatment of such patients is the need for teamwork contain nephrologists, critical care nurses, and specialists in infectious and tropical diseases. This was a new experience in Iran.

Comparative Study of Deep Vein Thrombosis Recanalization Using Doppler Ultrasound in Different Post-Treatment Intervals in Traumatic Patients

Deep vein thrombosis (DVT) is a prevalent vascular disease characterized by pelvic and limb deep vein thrombophlebitis, and it has a high incidence in traumatic patients. Contrary to older studies, recent research has reported that recanalization in DVT is not a slow process. The present study aimed at the comparative examination of DVT recanalization with Doppler ultrasound in different intervals following treatment with heparin or enoxaparin. This prospective study was conducted on all traumatic patients hospitalized in Imam Reza Hospital of Kermanshah, Iran, with the clinical and sonographic diagnosis of DVT in limb veins. Doppler ultrasound was performed two weeks, one month, and three months following treatment in order to examine recanalization. Data were analyzed using statistical tests in SPSS16 at the significance level of <0.05. Based on Doppler ultrasound, a significant difference was found between the degree of recanalization in patients aged <45 years and those aged >45 years, between male and female patients, and between different DVT locations (P<0.05). After three months of treatment with heparin and enoxaparin, the degree of recanalization was increased in DVT. Moreover, it was found that Doppler ultrasound is a useful tool for the diagnosis of recanalization in patients with DVT.

FPS-ZM1 Alleviates Circulating Indices of Liver Injury in Diet-Induced Type 2 Diabetic Mice

Despite dietary/lifestyle modifications as well as glycemic and lipid control, non-alcoholic fatty liver disease (NAFLD) imposes a considerable risk to the patients by advancing to non-alcoholic steatohepatitis (NASH). The present investigation aims to evaluate the protective potential of FPS-ZM1, a selective inhibitor for advanced glycation end products (RAGE), against circulating indices of liver injury in high fat diet-induced diabetic mice. FPS-ZM1 at 0.5. 1, and 2 mg/kg (orally) was administered for 2 months, starting 4 months after provision of the high-fat diet. Tests for glucose homeostasis, liver injury markers, and hepatic/plasma miR-21 expressions were performed. FPS-ZM1 attenuated diabetes-induced elevations in serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamate dehydrogenase (GLD), and alpha glutathione-S-transferase (α-GST) as well as alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT). It also decreased diabetes-associated elevations in serum ferritin and plasma cytokeratin 18 fragments. Additionally, FPS-ZM1 down-regulated elevated expressions of miR-21 in the liver and plasma of diabetic mice. These findings highlight the benefits of FPS-ZM in alleviating liver injury in mice evoked by high-fat diet-induced type 2 diabetes and suggest FPS-ZM1 as a new potential adjunct to the conventional diet/lifestyle modification and glycemic control in diabetics.

Is Percutaneous Endoscopic Gastrostomy Tube Feeding Beneficial for Improving Survival in Patients With Dementia? A Systematic Review and Meta-Analysis of Current Pieces of Evidence

Dementia is a progressive, disabling neurogenic disease that results in serious nutritional deficiencies included dysphagia, malnutrition, and weight loss. The Percutaneous Endoscopic Gastrostomy (PEG) is a long-term enteral feeding method that is routinely used in demented patients with poor food intake as a standard protocol. However, most of the pieces of evidence have not shown the beneficial effects of PEG feeding on complications or survival rates in these patients. Some studies have even reported an increase in mortality. The current systematic review and meta-analysis aimed to evaluate the mortality rate and survival in primary demented patients with PEG. A systematic search was conducted on Pubmed and Scopus databases up to Aug 2019. The data were reviewed according to the Cochrane handbook and preferred reporting items for systematic reviews and meta-analyses (PRISMA) and meta-analysis of observational studies in epidemiology (MOOSE). Based on the random-effects model, the mortality rate and median survival were expressed as risk ratio and weighted mean difference (WMD) and 95% CI, respectively. Among 13 included studies, PEG insertion in patients with primary dementia has no significant effect on 30-day, 90-day, 180-day, 1-year, and 2- year mortality rate or median survival (WMD: 9.77; 95% CI: -22.43 to 41.98; P=0.55). It seems that nasogastric tube (NGT) feeding in compared to PEG in this population is more effective. In conclusion, further prospective studies are needed for comprehensive evaluation of mortality or survival regarding comorbidities, underlying disease, cognitive and physical performance, and nutritional problems in demented patients.

The System of Awarding Degrees in Higher Education of Iran and United Kingdom: A Descriptive-Comparative Study With Focusing on the Internationalization of Health Education

The main indicators of higher education (HE) internationalization in the field of awarding degrees are the international development of disciplines and interdisciplinary sciences, new educational and learning methods, new and updated curricula, and their correct ways of sharing. This study aimed to examine the system of awarding degrees in health HE of Iran and the United Kingdom. This descriptive-comparative study focused on the field of medical sciences and its related disciplines. The vital information about the variables was collected by visiting the official websites of the UK universities and related or joint organizations. The related information to the Kerman University of Medical Sciences as a sample of Iran medical universities was obtained from the university’s Farabar system. All data extraction steps were performed manually. There were differences in the mechanism of setting up a new discipline and the process of students’ admission, diversity of degrees’ titles and curriculums, stability of disciplines over the time, creativity in creating competition between different disciplines, the reason for establishing a discipline and the requirements for certification and awarding of degrees in health sciences disciplines in Iran and the United Kingdom were described. Propelling of medical education in the health sciences area towards standard awarding degree systems can be responsible for the requirements of internationalization of higher education.

Universal Accreditation System (UAS): An Innovative Education and Research Credit Appraisal by USERN

The article's abstract is not available.

Complete Labial Adhesion in a Post-Pubertal Girl: A Case Report

Labial adhesion usually occurs in the infancy period and in prepubertal girls. It is a rare entity in reproductive age without any hypoestrogenism condition. Voiding dysfunction is a rare manifestation of these conditions. Here, we report a 19-year-old girl with complete labial adhesion presented with urinary retention. A 19-year-old virgin girl was referred to the obstetrics and gynecology department of Ghaem Hospital. She complained of urinary retention. Physical examination was normal except that was moderate hypogastric tenderness and a huge vesical globe. Genital examination revealed complete fusion of the labia minora in the midline, extended from the posterior fourchette to the region of the clitoris covering the entire vaginal introitus, urethral meatus, and clitoris. Despite the use of topical estrogen cream and surgical labial separation, re-adhesion occurred for the third time. Vulvar biopsy confirmed severe inflammation. Finally, topical anti-inflammatory medication improved the symptoms. Although labial adhesion is very rare in the post-pubertal period, it can successfully be managed by medical and surgical treatment.

Comparison Between ASCVD Versus WHO Risk Score in Predicting of 10-Year Cardiovascular Risk in an Iranian Adult: A Hospital-Based Cross-Sectional Study

Cardiovascular disease (CVD) mortality has increased in the Iranian population. Word Health Organization (WHO) risk score was recently used in Iranian prevention and control of non-communicable disease programs for risk assessment. The purpose of the study was to compare the 10-year cardiovascular risk using atherosclerotic cardiovascular disease (ASCVD) and WHO risk score. In a cross-sectional study, data from patients with cardiac symptoms without any documents related to CVD were collected from the outpatient clinic. The proportion of subjects with high CVD risk according to ASCVD and WHO risk score and also agreement between two scores was presented. The sensitivity and specificity of ASCVD according to the WHO risk score as a national risk assessment tool were calculated. The study included 284 subjects with a mean age of 53.80 (8.78) years and 68 % of women. The frequency of subjects with high CVD risk based on ASCVD and WHO was 35% and 6%, respectively. The agreement between the two scores was moderate (κ=0.45), with the most agreement in identifying low-risk subjects. The sensitivity and specificity of ASCVD according to the WHO risk score was 95.3% and 75.1%, respectively. The present finding showed that Agreement between two risk scores was moderated, especially in stratifying low-risk subjects. But, the ASCVD risk score categorized more people as a high risk rather than the WHO tool. Assessment of the accuracy of the WHO risk score with comparing predicted risk with observed risk in a cohort study for the Iranian population is necessary.

Neutrophil-to-Lymphocyte Ratio Cut-Off Point for COVID-19 Mortality: A Retrospective Study

Several months have passed since the onset of the COVID-19 pandemic. Multiple characteristics have been proposed as prognostic factors so far. This study aims to provide evidence on the association of neutrophil-to-lymphocyte ratio (NLR) at the hospitalization time and three desired outcomes (mortality, prolonged hospitalization, and intensive care unit [ICU] admission). We designed a single-centre retrospective observational study in Baharloo Hospital (Tehran, Iran) from 20 February to 19 April 2020. Patients with confirmed COVID-19 diagnosis via rt-PCR or chest CT imaging were included. Demographic and clinical data were obtained. The sample was divided into three groups, using tertile boundaries of initial NLR. The differences in mortality, comorbidities, hospitalization duration, drug administration, and ICU admission between these three groups were investigated. The identified confounding factors were adjusted to calculate the odds ratio of death, ICU admission, and prolonged hospitalization. Nine hundred sixty-three patients were included. In total, 151 and 212 participants experienced mortality and ICU admission, respectively. In multivariate logistic regression models, the adjusted odds ratio for mortality event in the second and third tertile of initial NLR after full adjustment were 1.89 (95% CI:1.07-3.32) and 2.57 (95% CI:1.48-4.43) and for ICU admission were 1.85 (95% CI:1.14-3.01) and 2.88 (95% CI:1.79-4.61), respectively. The optimal cut-off value of the initial NLR for predicting mortality was 4.27. Initial NLR can predict mortality and ICU admission in COVID-19 patients. Further investigations for curating the calculated cut-off can propose initial NLR as an indicator of poor prognosis for COVID-19 patients.