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Background and purpose: Waiting time to receive appropriate services in emergency departments is considered as an important indicator for evaluating hospitals. Triage is the most important and the first stage of patient’s management at the time of arrival to hospital emergency department. This study aimed at determining the length of waiting time to receive treatment and diagnostic services and related factors within 5 level triage system in Imam Khomeini Hospital in Sari. Material and Methods: This cross-sectional study was done in Imam Khomeini Hospital of Sari in December 2012. The subjects included 365 individuals who were selected through Morgan table. Waiting time for receiving treatment and diagnostic services for each patient was calculated by researcher from medical records of the patients and the triage sheet and entered in data collection forms. These forms contained two sections. The first part included demographic data and the second part contained information on the emergency department service delivery. The statistical analysis was performed in SPSS V.16 Results: The mean time of first consultant by physician was 6.4 + 7.2 mins, the mean time to receive the first nursing service was 14.9 + 14.4 mins, and the mean time to determine the patients’ status was 136.6 + 143 mins. There was a significant relation between the working shift and the mean time of first consultant by doctor and determination of the patients’ status. The same relation was also found for triage level. Conclusion: This study indicated a good level of service provided by emergency department of Sari Imam Khomeini Hospital.

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Background and purpose: This research aimed at investigating the effect of kinesio tape on functional performance of lower extremity and pain severity in athletes with and without medial tibial stress syndrome (MTSS).

Materials and methods: The study was performed in 30 students of physical training course in Guilan University including 15 students with MTSS and 15 healthy students. At first, the function of lower extremity was compared between the two groups using shuttle run tests, figure 8 hop test, side to side hop test, and agility hop test. Pain severity was measured by visual analog scale. Then, taping was performed to evaluate the functional performance and pain severity in athletes before, immediately and 24 hr after continues use of the tape.

Results: Before the intervention the functional performance in those with MTSS was weaker in SR, FEH, and AH tests than that in healthy group (P≤ 0.05). The ANOVA test showed better scores in SR, FEH and AH tests and decrease in pain levels among individuals with MTSS syndrome after using kinesio tape (P≤05). But 24 hours after use of kinesio tape the functional performance and pain severity did not change (P≥0.05).

Conclusion: Trainers are recommended to plan special functional exercises and using Kinesio tape for its medicinal role (deep sense improvement and decrease of pain) to improve the functional performance of athletes with MTSS.

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Background and purpose: Head trauma is amongst the major causes of death and morbidity caused by traumatic injuries. Assessment of trauma patients is an active process which includes initial (triage) and secondary assessments. Various triage tools are designed and used, but, so far no specific and accurate tool has been introduced for triage of head trauma. This study compared the effectiveness of ESI triage tool and nursing triage approach based on Roy Adaptation Model to predict the need for ICU admission in patients with head trauma.
Materials and methods: A clinical trial was done in 400 patients with head trauma in Emergency Department, Mashhad Shahid Kamyab Hospital, 2016. Patients were selected using block randomization and based on the day of admission. They were allocated into receiving nursing care either through ESI triage or Roy Adaptation Model. Twelve hours after triage, patients' outcome were followed based on keeping them in ICU or ward admission. Finally, the margin of error was calculated and compared between the two instruments.
Results: Kappa test did not show any significant difference between the ESI and Roy Adaptation Model triage in prediction for ICU admission at first place (P= 0.123). But, the Roy Adaptation Model was associated with significantly less errors in keeping the patient in ICU or ward admission (P = 0.012 ).
Conclusion: Compared with ESI triage, Roy Adaptation Model could result in fewer errors in predicting the consequences of head trauma patients.
 
 

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Background and purpose: Preeclampsia is a serious condition in pregnancy. Previous
studies have shown that NT-pro BNP level is higher in preeclamptic patients than that in pregnant women with normal blood pressure. Severity of preeclampsia is one of the critical factors in managing patients, so, this study aimed at investigating the relationship between the level of NT-pro BNP and severity of preeclampsia.
Materials and methods: In this descriptive study, three groups of pregnant women with normal blood pressure (n= 29), non-severe preeclampsia (n= 30), and severe preeclampsia (n=31) were included. Diagnostic criteria and classification of preeclampsia were based on the guideline for hypertension in pregnancy by the American College of Obstetricians and Gynecologists, 2013. The level of NT-pro BNP was measured by ELISA. Data analysis was done applying t-test, fisher test, Kruskal Wallis, and Mann Whitney.
Results: The levels of NT-pro BNP were 40±26, 55±33, and 74±37 pg/ml in pregnant women with normal blood pressure, non-severe preeclampsia, and severe preeclampsia, respectively. Significant differences were found between the cases with normal blood pressure and those with severe preeclampsia in the level of NT-pro BNP (P= 0.003).
Conclusion: The level of NT-pro BNP in preeclamptic women was higher than that of the pregnant women with normal blood pressure which was correlated with the severity of preeclampsia too. It seems that the level of NT-pro BNP could be used to differentiate severe preeclampsia from non-severe cases.
 

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Background and purpose: The Persian Diagnostic Aphasia Battery (P-DAB-1) is one of the tests available for screening and determining the severity of aphasia. The test classifies the patients in seven major diagnostic classes based on the extent of the impairment in different linguistic modalities. The present study aimed to describe the pattern of linguistic impairment in four aphasic patients according to the P-DAB-1 and compare that with the classical view of aphasia.
Materials and methods: The study was done in four Persian-speaking aphasic patients who were selected by convenience sampling. Inclusion criteria were being fluent in Persian and right-handed. Patients with severe untreated visual or hearing impairments and neurological diseases affecting cognition were excluded from the study. The P-DAB-1 test was used to determine the severity and type of aphasia.
Results: In this research, the participants had moderate aphasia quotient, of whom three had transcortical motor aphasia and one had conduction aphasia. The patients did not show some symptoms of a specific category according to the classical view.
Conclusion: This study proves the efficiency of P-DAB-1 test and also provides evidence for the deficiencies of the classical view in determining the types of aphasia.
 

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Background and purpose: Self-efficacy is central to behavior, especially preventive behaviors of Coronavirus Disease 2019 (Covid-19). Identifying the factors that lead to increased self-efficacy in individuals can pave the way for necessary decisions to change the behavior of the society. This study aimed at determining the relationship between people’s self-efficacy and perceived severity and sensitivity to preventive behaviors of Covid-19 in Sari, Iran.
Materials and methods: This descriptive-analytical study was performed in 268 patients attending certain health centers in Sari, 2020.The subjects were selected using convenience sampling. To collect the data, a researcher-made questionnaire was administered online consisting of three sections.
Results: The mean age of the study population was 36.81±8.6 years and 17.5% of the patients were confirmed cases of Covid-19. Among the people studied, 81.3% used soap and water to disinfect their hands. There were significant correlations between self-efficacy and perceived severity (B: 0.163, CI 95%: 0.068-0.257) and perceived sensitivity (B: 0.164, CI 95%: 0.060-0.267). Perceived sensitivity and severity also predicted 10% of the variance in self-efficacy.
Conclusion: Perceived severity and sensitivity to Covid-19 preventative behaviors could affect people’s self-efficacy.

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Background and purpose: Stress hyperglycemia is a neuroendocrine physiological response to medical stress, hyperglycemic stress increases the risk of mortality and morbidity in ill patients. This study aimed to investigate the frequency of hyperglycemic stress and its related factors, as well as the relationship between hyperglycemia and the severity and clinical outcomes of hospitalized patients with COVID-19.
Materials and methods: This cross-sectional study was conducted in Imam Khomeini Hospital in Sari in 2019. The patients were diagnosed based on clinical symptoms, CBC, CRP, ESR tests, RT-PCR test, and CT scan of the lungs and were hospitalized in the Covid ward. Data analysis was performed using SPSS Software.
Results: 312 COVID-19 patients were investigated, and 22 (7.1%) suffered from hyperglycemic stress. Hyperglycemic stress patients had more mortality, hospitalization in ICU, respiratory ventilation, and length of hospital stay compared to the normoglycemic subjects, but only in terms of mortality, there was a statistically significant difference between the two groups (P=0.46)
Conclusion: Considering the effect of hyperglycemia on the outcome of the disease and the death rate in ill and hospitalized patients compared to patients with normal blood sugar, it shows the importance of timely diagnosis and proper control of blood sugar in these patients.

 

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Background and purpose: The impaction of a third molar tooth poses a significant challenge for dental practitioners. It is a multifaceted issue with diverse pathological factors contributing to dental arch collapse and root resorption in adjacent teeth. The purpose of this study was to scrutinize the vegetative state of the mandibular wisdom tooth and the adjacent second molar`s external root resorption.
Materials and methods: In this cross-sectional and analytical epidemiological study, CBCT images of about 500 mandibular third molars were examined. Third molar teeth with mesioangular or horizontal impaction were included in the study. All images were prepared by CBCT CS9300 device (Carestream Dental LLC, Atlanta, Georgia) with the same exposure parameters. The images were evaluated by a final year dental student under the supervision of an oral, maxillofacial radiologist in a semi-dark room and LG monitor (LCD, 20 inch, 1600×900 pixel) in sagittal, axial and coronal planes. The images were classified based on the position of root external analysis as 1.3 apical, middle, and cervical root. The severity of external root erosion in the second molar tooth is also divided into three categories: Slight (A very small amount of dentin is involved), Moderate (Half of the dentin is involved), and Severe (Pulp cavity is involved). Also, its relationship with age and gender was determined and finally analyzed using SPSS software (version 22).
Results: In the present study, a total of 500 wisdom teeth were observed in CBCT images, of which 101 impacted wisdom teeth had a mesioangular or horizontal position. we found that the prevalence of impacted wisdom teeth with mesioangular (68 cases) and horizontal (33 cases) positions was about 20.2% and the prevalence of external analysis in the mandibular second molar root associated with impacted wisdom teeth was about 10.9%. The prevalence of external analysis was higher in women than in men (P=0.04). In determining the position of external resorption and its severity in the root of the second molar, it was also found that the highest position of external resorption of the root was related to the middle part of the tooth (63.7%) and the lowest was related to the apical part (9.2%). In examining the severity of external root resorption, we found that in 89.1% of the samples, root resorption of the second molar tooth was not observed. In the examination of the age group, it was found that the analysis was more common in the age group of 18-30 years (P=0.04). The only sample with moderate analysis was in the age group of 45-55 and male. The age group of 18-30 years and women have significantly more brief analysis than their corresponding groups. The relationship between the type of lower wisdom tooth impaction and the frequency of external analysis of the adjacent second molar root was statistically significant (P=0.03). the results of the relationship between the type of mandibular wisdom tooth impaction and the severity of external resorption of the adjacent second molar root, it was observed that there was a statistically significant relationship between the type of lower wisdom tooth impaction and the severity of external resorption of the adjacent second molar root (P=0.01). Moreover, the severity of the analysis was more intense in the horizontal position than in the mesioangular position.
Conclusion: Based on the results of this research, it can be concluded that the age group of the patient, gender, and position of the impacted third molar are the most influential factors regarding the external root resorption of the adjacent molar. There is a statistically significant relationship between the type of lower wisdom tooth impaction and the frequency and severity of external resorption of the adjacent second molar root.

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Background and purpose: The levels of serum ferritin increase with increasing disease severity, thereby suggesting a possible biomarker for the prediction of the cytokine storm. This study was carried out to evaluate the practical utility of ferritin as a serum biomarker in COVID-19.
Materials and methods: In this retrospective study, a total of 117 adult hospitalized patients with COVID-19 infection were included. The disease was diagnosed based on clinical signs and chest radiography, followed by real-time PCR. Patients were classified into mild-to-moderate (n= 47), severe (n = 46), and critical (n = 24) groups. Demographic and clinical information, as well as laboratory findings, were collected, and the concentrations of ferritin were compared among the different groups.
Results: The highest percentage of patients were in the critical group (76/29%). Overall, COVID-19 infection was more prevalent in females (66%) and the median age of patients in the critical group (76.29) was more than the other ones. The amount of ferritin was significantly higher in the critical (p< 0.001) group. The level of ferritin remarkably was higher in dead patients (620.88 ng/mL. Based on logistic regression analysis and ROC curve, ferritin can be a biomarker to predict high-risk patients. Furthermore, binary logistic regression showed ferritin to be a predictor of mortality supplemented.
Conclusion: Serum ferritin is a promising biomarker for anticipating cytokine storm, which may support clinical decision-making and contribute to the optimal management of patients with COVID-19.
 

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Background and purpose: Given that many diabetic and non-diabetic patients experience hyperglycemia during the course of COVID-19, which may influence the severity of the disease, this study aimed to examine the patterns of blood glucose variation and their association with clinical manifestations and disease severity in diabetic and non-diabetic COVID-19 patients hospitalized at Sari Imam Khomeini Hospital.
Materials and methods: This case–control study was conducted on 130 COVID-19 patients, including 66 individuals with diabetes as the case group and 64 non-diabetic individuals as the control group. Data on demographics, medical history, symptoms, CT findings, laboratory results, and disease progression were collected via questionnaire. Subsequently, the severity of the disease, blood glucose fluctuations, and their associations with disease severity were compared between diabetic and non-diabetic individuals. Analyses were conducted using SPSS version 20, with statistical significance set at P<0.05.
Results: Diabetic COVID-19 patients were significantly older (61.77 ± 1.61 vs. 49.45 ± 2.06 years; P < 0.001) and had a higher BMI (P= 0.028) than non-diabetic patients, but hospitalization and ICU stay durations did not differ significantly (P> 0.05). Diabetic patients exhibited more severe disease compared with non-diabetic patients (P= 0.008). A significant correlation was observed between random blood glucose (BS) at admission (P= 0.048) and discharge (p = 0.004), as well as fasting blood glucose (FBS) at discharge (P= 0.004), and disease severity. However, no significant correlation was found between BS (P= 0.34) or FBS (P = 0.48) measured during hospitalization and disease severity. Neither BS nor FBS trajectories over time showed a significant association with disease severity (P= 0.21 and P= 0.70, respectively).
Conclusion: Hyperglycemia in diabetic COVID-19 patients may be linked to greater disease severity compared with non-diabetic patients. Fasting blood glucose levels, particularly at discharge, and random blood glucose at both admission and discharge, are significantly associated with severity, underscoring the need for clinicians to closely monitor blood glucose at these critical time points.

 

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Background and purpose: Urinary incontinence is a common health problem in women that affects their quality of life. The aim of the present study was to compare the quality of life in different types of urinary incontinence in women.
Materials and methods: This descriptive cross-sectional study was conducted in 2023 AH on women with urinary incontinence presenting to the Sari Women's Clinic. Women with urinary incontinence, diagnosed by a certified gynecologist, were included in the study and divided into three groups based on the type of incontinence: stress, urgency, and mixed. 30 people from each group were randomly included in the study. The severity of urinary incontinence was determined using the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF), and quality of life was determined using the Incontinence Impact Questionnaire (IIQ-7). SPSS version 22 software and Chi-square test and Fisher's exact test were used for analysis.
Results: The results showed that the frequency of women with severe incontinence in the stress, urgency, and mixed groups was 43.3%, 83.3%, and 53.0%, respectively. In the study of quality of life, 83.3% of women with stress incontinence, 80% of those with mixed incontinence, and 86.7% of women with urgency had an unsatisfactory quality of life (P=0.787). There was no relationship between the decrease in quality of life and the increase in the severity of urinary incontinence in women with mixed and stress urinary incontinence (P<0.050). However, in women with urgency urinary incontinence, quality of life decreased significantly, increasing severity of incontinence (P-0.034).
Conclusion: In women with urgency urinary incontinence, quality of life decreases significantly as the severity of incontinence increases, compared to mixed and stress urinary incontinence.  The significant impact of urinary incontinence on women's quality of life makes it imperative to recognize and treat it.