A cross-sectional study on adaptability and pertinence of the "Health Promoting Hospitals" (HPH) initiative in Iran: health professionals' perspectives.

BACKGROUND: Despite the expansion of the HPH approach and its application in several countries of the world, the conception is still not ascertained in Iran. The main purpose of this study was to investigate the Iranian health professionals' ideas on applicability of the HPH standards in day-to-day practices of the Iranian hospitals. STUDY DESIGN: A cross-sectional study. METHODS: The study respondents were 354 physicians, nurses and general managers working in the ten educational hospitals affiliated to the Tabriz University of Medical Sciences in Tabriz the capital city of the East Azarbaijan province, North West of Iran. A validated self-assessment tool was used for data collection about adaptability of the HPH standards i.e. management policy, patient assessment, patient information, healthy workplace promotion and inter-sectional cooperation from September to November 2016. RESULTS: The mean adaptability score of the HPH standards (60.0, SD: 13.0, range: 0- 136) represents ambivalent sentiment of the Iranian health professionals. The inter-sectoral cooperation and patient information standards were suggested to be the most and lest adaptable elements respectively. Only 32% of the study respondents endorsed the HPH standards' overall appositeness in the studied hospitals. Mean adaptability score of the HPH standards was significantly different between male and female health professionals, specialized and general hospitals, small oppose to the medium and large hospitals and those without prior knowledge and the knowledgeable respondents about the HPH standards (P< 0.05). CONCLUSIONS: This study gave an overall snapshot regarding the applicability of the HPH strategy in typical Iranian education hospitals through a wide range of health professionals' point of views. Understanding the limitations that constrain generalizability of the findings, the study results reflected a part of the gaps existing for application of the HPH strategy in the Iranian hospitals and challenges that might impede its successful conduct.

[Association between oral conditions and colorectal cancer: A literature review and synthesis]. / Association entre les affections buccodentaires et le cancer colorectal: une revue et synthèse de la littérature.

BACKGROUND: Chronic periodontitis and tooth loss are chronic oral conditions that, in recent decades, have been implicated in the occurrence of certain types of cancer. In this review, we address the question of whether colorectal cancer is associated with these oral conditions. RESULTS: Epidemiological studies evaluating a potential association between periodontitis, tooth loss and colorectal cancer are scarce. However, several mechanisms argue in favor of this association, notably inflammation, nutrition and possibly infection by specific bacteria, as suggested by this literature review.

Focal triphasic sharp waves and spikes in the electroencephalogram.

There is a plethora of data in the EEG literature on the characteristics of the most prominent component of interictal epileptiform discharges (IED), namely the negative (fast) phase. Surprisingly, however, little attention has been drawn to the after-coming slow wave (ASW), and its pathological as well as clinical significance. In this paper, we will address the significance of prominent (high amplitude) ASW, giving rise to a triphasic morphology of the IED (focal triphasic sharp waves and spikes­FTSW). We will discuss this EEG pattern with respect to its clinical, neurophysiological, and neuropathological significance. This investigation was conducted on a heterogeneous group of patients at KKH, Ha'il, KSA. Our data revealed that FTSW were rare EEG events occurring primarily in the first two decades of life. Ninety percent of the patients with FTSW had epilepsy, presenting clinically with generalized convulsive seizures, often without partial onset. The majority of these patients responded favorably to anticonvulsant monotherapy. We were surprised to find that half of the patients with FTSW had chronic and/or static CNS pathology, particularly congenital CNS anomalies. Even though more than one mechanism may be involved in the pathogenesis of FTSW, we believe a deeply seated pacemaker as the source of this EEG pattern is the most compelling theory. The presence of FTSW should alert clinicians to the possibility of an underlying chronic and/or static CNS pathology, in particular congenital CNS anomalies, underscoring the significance of neuroimaging in the work-up of this population. Moreover, it is conceivable that the prominent ASW may contribute to the interictal intellectual dysfunction of these patients, justifying aggressive anticonvulsant therapy.

Positive sharp waves in the EEG of children and adults.

Interictal epileptiform discharges (IEDs) with negative polarity have been extensively studied in the EEG literature. However, little attention has been drawn to IED with positive polarity [positive sharp waves (PSWs)]. In this paper, we discuss pathophysiological, neuroimaging, and clinical correlates of this pattern in a heterogeneous group of children and adults who demonstrated PSW in their scalp EEG. We prospectively reviewed the EEGs of 1,250 patients from a heterogeneous population over a period of 1 year. Thirty-one patients had PSW in their EEG. We documented EEG parameters as well as demographic, clinical, and neuroimaging data. Statistical analysis was performed to correlate the aforementioned data. The analysis showed that PSW is an epileptogenic pattern with localizing significance, occurring primarily in the younger age groups. Furthermore, there was a strong association of PSW with chronic and/or static CNS pathology, in particular, congenital CNS anomalies, often accompanied by psychomotor retardation. Patients with "multifocal'' PSW invariably exhibited severe intellectual and motor deficits associated consistently with a variety of congenital CNS insults. PSW is a rare and under-reported EEG abnormality which, similar to negative IED, signifies focal epileptogenecity. The presence of PSW should prompt neuroimaging studies to investigate an associated chronic/static CNS pathology, in particular, congenital CNS anomalies. This association is particularly strong when PSW is multifocal in which case patients present with severe intellectual and motor deficits.

The effect of the COVID-19 pandemic on the diagnosis and progression of oral cancer.

The COVID-19 pandemic placed a significant burden on healthcare resources, limiting care to emergent and essential services only. The objective of this study was to describe the effect of the COVID-19 pandemic on the diagnosis and progression of oral cancer lesions in Montreal, Canada. A retrospective analysis of health records was performed. Patients presenting for a new oncology consultation for an oral lesion suspicious for cancer between March 2018 and March 2022, within the Department of Oral and Maxillofacial Surgery of the McGill University Health Center, were included. Data was collected on sociodemographic characteristics, oral cancer risk behaviors of study participants, oral cancer delays, tumor characteristics, and clinical management. A total of 190 patients were included, 91 patients from the pre-pandemic period and 99 from the pandemic period. The demographic characteristics of the patients in the two periods were comparable. There was no significant difference in the patient, professional, or treatment delay between the two periods. There was a non-significant increase in pathologic tumor size during the pandemic, but the pathologic staging and postoperative outcomes were comparable to those of the pre-pandemic cohort. The results indicate that emergent care pathways for oral cancer treatment were efficiently maintained despite the pandemic shutdown of services.

Atypical Interictal Epileptiform Discharges in Electroencephalography.

BACKGROUND AND PURPOSE: A great deal of attention has been focused on "typical" interictal epileptiform discharges (IEDs) in the electroencephalography (EEG) literature. However, there is a paucity of data on "atypical" IEDs, namely, positive sharp waves (PSWs), focal triphasic sharp waves and spikes (FTSWs), sharp slow waves (SSWs), bifid spikes, and "notched" delta. In this present study, we sought to address the pathophysiology, characteristics, and diagnostic significance of "atypical" IEDs in clinical neuroscience. METHODS: We prospectively reviewed the EEGs of 1,250 patients from a heterogeneous population over a period of 2 years. We also documented demographic, clinical, and neuroimaging data. RESULTS: Thirty-one patients had PSWs, 26 had FTSWs, 30 had SSWs, 24 had notched delta, and four had bifid spikes in their EEG data. Ninety-six percent of patients with PSWs had epilepsy whereas 100% of the FTSW and SSW groups had this diagnosis. In the ND group the rate of epilepsy was 95% and in the bifid spike group 75%. Accordingly, "atypical" IEDs are potentially epileptogenic patterns with localizing significance, occurring primarily in younger age groups. We also found that a significant number of these patients had congenital central nervous system anomalies. CONCLUSIONS: We conclude that "atypical" IEDs are rare and under-reported EEG patterns that potentially signify focal epileptogenicity. Our data also stresses the significance of neuroimaging in investigating the possibility of an underlying congenital central nervous system anomaly in this population.

Sharp Slow Waves in the EEG.

There exists a paucity of data in the EEG literature on characteristics of "atypical" interictal epileptiform discharges (IEDs), including sharp slow waves (SSWs). This article aims to address the clinical, neurophysiological, and neuropathological significance of SSW The EEGs of 920 patients at a tertiary-care facility were prospectively reviewed over a period of one year. Thirty-six patients had SSWs in their EEG. Of these, 6 patients were excluded because of inadequate clinical data. The clinical and neuroimaging data of the remaining 30 patients were then retrospectively collected and reviewed, and the findings were correlated. The data revealed that SSWs were rare and age-related EEG events occurring primarily in the first two decades of life. All patients with SSWs had documented epilepsy, presenting clinically with partial or generalized epilepsy. It is notable that one-third of the patients with SSWs had chronic or static central nervous system (CNS) pathology, particularly congenital CNS anomalies. Though more than one mechanism may be involved in the pathogenesis of SSWs, this research indicates that the most compelling theory is a deeply seated cortical generator giving rise to this EEG pattern. The presence of SSWs should alert clinicians to the presence of partial or generalized epilepsy or an underlying chronic or static CNS pathology, in particular congenital CNS anomalies, underscoring the significance of brain magnetic resonance imaging in the work-up of this population.

Investigation of relationship between quality of working life and organizational commitment of nurses in teaching hospitals in Tabriz in 2014.

The current research aimed to investigate the link between the quality of working life and the systematic commitment of nurses in the teaching hospitals in Tabriz. The methodology used was functional regarding the purpose and the proportional allocation as far as the stratified sampling method was concerned. The study population consisted of all the nurses in Tabriz. The instrument used in this study was a standard questionnaire, whose reliability was approved in national and international studies. Also data were collected and inserted into SPSS 20 software and a statistical analysis was performed. The results showed that the individuals' quality of working life had a direct effect on their action in the organization.

Nystagmus in laurence-moon-biedl syndrome.

Introduction. Laurence-Moon-Biedl (LMB) syndrome is a rare autosomal-recessive ciliopathy with manifold symptomatology. The cardinal clinical features include retinitis pigmentosa, obesity, intellectual delay, polydactyly/syndactyly, and hypogenitalism. In this paper, the authors report on three siblings with Laurence-Moon-Biedl syndrome associated with a probable pseudocycloid form of congenital nystagmus. Methods. This was a case study conducted at King Khaled Hospital. Results. The authors assert that the nystagmus in Laurence-Moon-Biedl syndrome is essentially similar to idiopathic motor-defect nystagmus and the nystagmus seen in optic nerve hypoplasia, ocular albinism, and bilateral opacities of the ocular media. Conclusion. The data support the previous hypothesis that there is a common brain stem motor abnormality in sensory-defect and motor-defect nystagmus.

Progressive supranuclear palsy: report of a case with torticollis, blepharospasm, and dysfluency.

A 76-year-old man is reported with advanced progressive supranuclear palsy (PSP) who developed a persistent, gradually progressive torticollis over a period of several months. Blepharospasm and dysfluency of the extrapyramidal type antedated the torticollis. This first report of torticollis in PSP reinforces previous notions that torticollis is related to pathologic changes in the striatum and brainstem. In addition, the combination of torticollis and blepharospasm in our patient supports the previous concept that these two "focal dystonias" have a common pathophysiologic mechanism. This also suggests that dysfluency in PSP may be an expression of a focal dystonia involving the muscles of articulation.

Spindle activity in the waking electroencephalogram: report of a case with hemispheric glioblastoma.

In this paper, we reported a patient with a hemispheric glioblastoma extending into the lateral thalamus and the posterior limb of the internal capsule. The waking electroencephalogram showed spindle activity on the side ipsilateral to the tumor. Based on the topography of the tumor in our patient, we speculate that a disruption of the synaptic pathways within the thalamus-cortex-thalamus circuit was primarily involved in the pathogenesis of abnormal spindling.

Coexisting alpha pattern coma, theta pattern coma and spindle coma.

Abnormal ectopic rhythms, such as alpha-theta activities and spindles, occur in comatose patients. A case is presented in which the EEG of a comatose patient showed coexisting alpha-theta pattern activities and spindles. It is concluded that the coexistence of these rhythmic patterns in the EEG of a comatose patient implies continued physiologic functioning of a thalamocortical system deafferented by brainstem dysfunction and a lesser degree of cortical dysfunction.

Unilateral alpha rhythm and Cheyne-Stokes respirations.

A case of unilateral basal ganglion hemorrhage with Cheyne-Stokes respirations is presented. During the hyperpneic periods there was rhythmic alpha activity in the hemisphere contralateral to the basal ganglion hemorrhage. We postulate that the hemorrhage interrupted the thalamocortical fibers on the involved side. The implications of this clinical evidence are discussed in the light of the theory of cerebral autorhythmicity.

Episodic anterior drowsy theta in adults.

The present study included 1300 adults with various clinical problems. We prospectively studied the EEG's of this population over an 18-month period. Ninety-two patients showed episodic generalized or frontal-central bursts of theta activity, occurring synchronously over both hemispheres in drowsiness (episodic anterior drowsy theta or EADT). We found no interaction between the parameters involving the above theta rhythms (amplitude, rhythmicity, topography and presence or absence in the waking EEG), demographic variables (age, sex), and clinical presentation. Our data, however, did suggest that the incidence of the EADT may be higher in young females. We also found a tendency for the EADT in otherwise abnormal EEGs to be rhythmic and present awake. Our data indicated that the presence of EADT is non-specific as to etiology.

Coexistence of ectopic rhythms and periodic EEG pattern in anoxic encephalopathy.

In this paper, we reported unique EEG patterns in two patients with anoxic encephalopathy. In the patient with a longer survival, the early EEG showed: suppression-burst pattern and theta pattern coma during quiet states; and quasi-periodic, generalized, epileptiform discharges associated with alpha-theta pattern coma during periods of arousal. A second EEG showed a disappearance of suppression-burst pattern and alpha coma. A third EEG demonstrated a disappearance of quasi-periodic epileptiform discharges. Such distinct evolution of the electroencephalogram was associated clinically with increased responsiveness despite a fatal course of illness. The second patient who had a more dramatic course, had an EEG immediately preceding death, which showed a combination of periodic pattern and theta pattern coma.

Periodic lateralized epileptiform discharges (PLEDs): a possible role for metabolic factors in pathogenesis.

Periodic, lateralized, epileptiform discharges (PLEDs) in the electroencephalogram have been reported in association with a variety of structural lesions of the brain. Although a great deal of attention has been directed to the neuropathological basis of PLEDs, little emphasis has been placed on the functional basis of this EEG syndrome. In this paper, we reported a patient with multiple systemic problems whose EEG showed PLEDs. However, radiological and pathological studies revealed no neuropathological basis for the occurrence of this EEG syndrome. Thus, we presented evidence that metabolic factors may play a part in the pathogenesis of PLEDs.

Positive temporal sharp waves in neonatal EEG.

The clinical correlates and EEG characteristics of rolandic positive sharp waves in neonatal EEG have been studied systematically. Morphologically similar positive sharp waves have been reported to occur in the temporal areas (PTS). Their significance is, however, unclear. We reviewed fifty-two EEGs on patients from the Neonatal Intensive Care Unit of the University of Arkansas for Medical Sciences. Twenty-one of the EEGs which were reviewed had PTS. We correlated the PTS with the results of ultrasound of the head and with clinical evaluations. PTS are more strongly correlated with the occurrence of non-hemorrhagic than of hemorrhagic intracranial pathology.

A comparative study of electroencephalography and computed axial tomography in recent cerebral infarction.

In order to re-assess the present role of electroencephalography in the investigation of cerebral infarct, we prospectively studied 50 adults with recent supratentorial cerebral infarction over a ten-month period. All 50 patients had EEG's and CT scans within the first two weeks of the apoplectic event. The time span between the two procedures was one week or less in all patients. We monitored the following EEG parameters: characteristics of alpha rhythm (depressed, unchanged, or enhanced); prevalence, type, rhythmicity, and topography of focal slowing; and presence or absence of FIRDA. We grouped the patients on the basis of CT findings as follows: depth of the infarct (cortical-subcortical, deep white matter, or lacunar); size of the infarct (large, medium, or small); and presence or absence of mass effect. Statistical analysis revealed no differences with regard to the EEG parameters between the groups. However, when patients were categorized according to topography of the infarct, the group with parietal infarct showed a significantly higher incidence of depressed alpha rhythm compared with the groups with frontal or occipital infarct. Of the 50 patients, four patients whose history and clinical presentation suggested infarct had normal CT scans despite the presence of EEG abnormality. On the contrary, in two patients, the EEG was normal, whereas the CT confirmed the infarct. Our data suggested that physiological factors may play a major role in the pathogenesis of EEG abnormalities in cerebral infarct, thus accounting for the discrepancies between the EEG parameters and CT findings observed in our population. It was also suggested that EEG's be included routinely in the investigation of cerebral infarct.