ABSTRACT
BACKGROUND: Hypertension (HTN), probably, is the most common public health problem among developed countries. Rapid diagnosis and effective treatment of HTN have not truly stopped the rapid rate of mortality and morbidity caused by HTN. Vascular wall changes are one of the most important and mortal complications of HTN. Ultrasonography was used for the evaluation of this vessel wall disorder by assessing the thickness of the intima and media layer. OBJECTIVE: The objective of this study was to compare the Carotid intima Media Thickness (CIMT) in hypertensive patients and the control group. METHODS: In a case-control study, 43 patients with documented primary HTN and 43 healthy subjects were assessed as control. Their HTN was controlled by the administration of drugs. The mean age was 53.9 years. The intima-media thickness (IMT) of internal and common carotid and outer vessel diameter were assessed by one radiologist. RESULTS: CAIMT in all carotid arteries in the case group was more than that of the controls (P < 0.05). It was found that there was no difference between the length of having HTN and mean CAIMT in the hypertensive, except the right internal carotid (P = 0.024). CONCLUSION: The present study found that the mean CAIMT of all carotid arteries in HTN was more than that of the controls. Moreover, the duration of the HTN can accelerate the atherosclerosis process in hypertensive patients.
ABSTRACT
BACKGROUND: Pneumonia is a common illness in all parts of the world and is considered as a major cause of death among all age groups. Nevertheless, only about 5% of patients referring to their primary care physicians with acute respiratory symptoms will develop pneumonia. OBJECTIVES: This study was performed to derive practical criteria for performing chest radiographs for the evaluation of community-acquired pneumonia (CAP). PATIENTS AND METHODS: A total of 420 patients with acute respiratory symptoms and positive findings on chest radiograph were evaluated from December 2008 to December 2009. The subjects were referred to outpatient clinics or emergency departments of Birjand's medical university hospitals, Iran, and were enrolled as positive cases. A checklist was completed for each patient including their demographic information, clinical signs and symptoms (cough, sputum production, dyspnea, chest pain, fever, tachycardia, and tachypnea), abnormal findings in pulmonary auscultation and laboratory findings (erythrocyte sedimentation rate, C-reactive protein levels, and white blood cell count). An equal number of age-matched individuals with acute respiratory symptoms, but insignificant findings on chest radiography, were included as the control group. Finally, the diagnostic values of different findings were compared. RESULTS: The data showed that vital signs and physical examination findings are useful screening parameters for predicting chest radiograph findings in outpatient settings. Therefore, by implementing a prediction rule, we would be able to determine which patients would benefit from a chest X-Ray (sensitivity, 94% and specificity, 57%). CONCLUSIONS: This study's findings suggest that requesting chest radiographs might not be necessary in patients with acute respiratory symptoms unless the vital signs and/or physical examination findings are abnormal. Considering the 94% sensitivity of this rule for predicting CAP, a chest radiograph is required for patients with unreliable follow-ups or moderate to high likelihood of morbidity if CAP is not initially detected.
ABSTRACT
BACKGROUND: The Alberta Stroke Program Early Computerized Tomography Score (ASPECTS) was used to detect significant early ischemic changes on brain CT of acute stroke patients. We designed the modified ASPECTS and compared it to the above system based on the inter-rater reliability. METHODS: A cross-sectional validation study was conducted based on the inter-rater reliability. The CT images were chosen from the stroke data bank of Ghaem hospital, Mashhad in 2010. The inclusion criteria were the presence of middle cerebral artery territory infarction and performance of CT within 6 hours after stroke onset. Axial CT scans were performed on a third-generation CT scanner (Siemens, ARTX, Germany). Section thickness above posterior fossa was 10 mm (130 kV, 150 mAs). Films were made at window level of 35 HU. The brain CTs were scored by four independent radiologists based on the ASPECTS and modified ASPECTS. The readers were blind to clinical information except symptom side. Cochrane Q and Kappa tests served for statistical analysis. RESULTS: 24 CT scans were available and of sufficient quality. Difference in distribution of dichotomized ≤7 and >7 ASPECT scores between four raters was significant (Q=13.071, df=3, p=0.04). Distribution of dichotomized <6 and ≥6 scores based on modified ASPECT system between 4 raters was not significantly different (Q=6.349, df=3, p=0.096). CONCLUSIONS: Modified ASPECT method is more reliable than ASPECTS in detecting major early ischemic changes in stroke patients candidated to tPA thrombolysis.