Clinimetrics of the Freezing of Gait Questionnaire for Parkinson Disease During the "off" State.

INTRODUCTION: Freezing of gait, a common PD motor symptom, could increase the risk of falling. This study aimed to investigate the clinimetric attributes of the Freezing of Gait Questionnaire (FOGQ) for people with Parkinson disease in the "off" state. METHODS: A total of 115 patients with Parkinson disease (PD; mean age, 60.25 years) were included. Acceptability, internal consistency (by the Cronbach alpha, and test-retest by Intraclass Correlation [ICC]), and reliability of the Persian-translated version of the FOGQ were examined. Dimensionality was estimated by Exploratory Factor Analysis (EFA). Fall efficacy scale-international, unified Parkinson disease rating scale-II, Berg balance scale, functional reach test, and Parkinson disease questionnaire-39 were applied to determine the convergent validity. Diagnostic accuracy for obtaining optimal cutoff point, separating faller and non-faller groups, was analyzed by Receiver Operating Characteristics (ROC) curve analysis and Area Under the Curve (AUC). All tests were carried out in an "off" state. RESULTS: The Cronbach alpha was high (α=0.92). The test-retest showed high reliability (ICC=0.89). The FOGQ was unidimensional according to the EFA and had acceptable convergent validity with moderate to high correlation with other clinical scales. The optimal cutoff point to discriminate fallers from non-fallers during the "off" state was 9/10, with an AUC of 0.92. CONCLUSION: Our results suggest that the FOGQ has appropriate reliability, validity, and discriminative ability for measuring FOG in patients with PD during the "off" state.

Fatigue in Children with Cancer: Reliability and Validity of the Persian Version of Child, Parent, and Staff Fatigue Scale.

CONTEXT: The fatigue is reported as the most common and annoying symptom in patients with cancer, timely diagnosis, and treatment can significantly influence the treatment and rehabilitation. It is crucial to have an appropriate tool to accurately assess fatigue status. OBJECTIVES: Our purpose was to assess psychometric properties of the Persian versions of fatigue scale by Original Scales from the viewpoint of children with cancer (Child Fatigue Scale [CFS]-24 h), their parents (Parent Fatigue Scale [PFS]-24 h), and staff (Staff Fatigue Scale FSF-24 h). METHODS: Convenience sampling of the participants was conducted 100, including children with cancer within the age range of 7-12 years, their parents, and caregivers in medical staff. Test-retest reliability and internal consistency were evaluated using intraclass correlation (ICC) and Cronbach's alpha coefficient. Dimensionality was determined by factor analysis. The patients' fatigue was also assessed through visual analog scale-fatigue (VAS-F). RESULTS: Test-retest (ICCCFS = 0.71, ICCPSF = 0.82, and ICCSFS = 0.78) was acceptable with a high level of internal consistency (αCFS = 0.80, αPFS = 0.83, and αSFS = 0.84). Factor analysis identified three, five, and two components for the CFS, PFS, and Staff Fatigue Scale (SFS), respectively. There was moderate correlation between CFS and VAS-F. CONCLUSIONS: Results of the current study indicated that CFS in children with cancer, PFS in their parents, and SFS in medical staff were valid and reliable instruments to assess fatigue from the viewpoint of children with cancer along with their parents and medical staff.

Post-Traumatic Pulmonary Pseudocyst following Blunt Chest Trauma; a Case Report.

Traumatic pulmonary pseudocyst is a rare complication of chest trauma that has been poorly documented and usually resolves without specific treatment. Here, we present a case of pulmonary pseudocyst in a child with chest trauma without obvious symptoms. It is important to consider this diagnosis in patients with chest trauma to avoid unnecessary invasive procedures.

Concurrent Hand and Penile Gangrene following Prolonged Warfarin Use; a Case Report.

Warfarin induced skin necrosis (WISN) is a rare but important side effect of warfarin. Early diagnosis may lessen the amount of permanent tissue damage and can prevent progression to full thickness skin necrosis. So, physicians should be aware of such a complication. Screening for protein C or S or anti-thrombin deficiencies, or presence of anti-phospholipid antibodies before beginning warfarin therapy, could be helpful to avoid high levels of international normalized ratio (INR). Here, we report a 54-year-old man who presented to the emergency department with acral and penile gangrene following prolonged use of warfarin.

Performance of physiology scoring systems in prediction of in-hospital mortality of traumatic children: A prospective observational study.

BACKGROUND: This study is designed to compare the value of four physiologic scoring systems of rapid acute physiology score (RAPS), rapid emergency medicine score (REMS), Worthing physiology scoring system (WPSS) and revised trauma score (RTS) in predicting the in-hospital mortality of traumatic children brought to the emergency department. METHOD: We used the data gathered from six healthcare centers across Iran between the April-October 2016. Included patients were all children with trauma. Patients were assessed and followed until discharge. Moreover, patients were divided to two groups of died and alive, and discriminatory power and general calibration of models in prediction of in-hospital mortality were compared. RESULTS: Data was gathered from 814 children (average age of 11.65 ± 5.36 years, 74.32% boys). Highest measured area under the curve was for RAPS and REMS with 0.986 and 0.986, respectively. Areas under the curve of WPSS and RTS were 0.920 and 0.949, respectively (p = 0.02). Sensitivity and specificity of RAPS were 100.0 and 95.05, respectively. These amounts for REMS were 100.0 and 94.04, respectively. Two models of RTS and WPSS had the same sensitivity of 84.62. Specificity of these two was 98.22 and 96.95, respectively. Three models of RAPS, REMS and RTS had proper calibrations in predicting mortality; however, it seems that WPSS overestimates the mortality in high risk patients. CONCLUSION: As calculations of RAPS is easier than REMS and their proper calibrations, it seems that RAPS is the best physiologic model in predicting in-hospital mortality and classifying in traumatic children based on severity of injury. However, further validation of the recommended score is essential before implementing them into routine clinical practice.

Worthing Physiological Score vs Revised Trauma Score in Outcome Prediction of Trauma patients; a Comparative Study.

INTRODUCTION: Awareness about the outcome of trauma patients in the emergency department (ED) has become a topic of interest. Accordingly, the present study aimed to compare the rapid trauma score (RTS) and worthing physiological scoring system (WPSS) in predicting in-hospital mortality and poor outcome of trauma patients. METHODS: In this comparative study trauma patients brought to five EDs in different cities of Iran during the year 2016 were included. After data collection, discriminatory power and calibration of the models were assessed and compared using STATA 11. RESULTS: 2148 patients with the mean age of 39.50±17.27 years were included (75.56% males). The AUC of RTS and WPSS models for prediction of mortality were 0.86 (95% CI: 0.82-0.90) and 0.91 (95% CI: 0.87-0.94), respectively (p=0.006). RTS had a sensitivity of 71.54 (95% CI: 62.59-79.13) and a specificity of 97.38 (95% CI: 96.56-98.01) in prediction of mortality. These measures for the WPSS were 87.80 (95% CI: 80.38-92.78) and 83.45 (95% CI: 81.75-85.04), respectively. The AUC of RTS and WPSS in predicting poor outcome were 0.81 (95% CI: 0.77-0.85) and 0.89 (95% CI: 0.85-0.92), respectively (p<0.0001). CONCLUSION: The findings showed a higher prognostic value for the WPSS model in predicting mortality and severe disabilities in trauma patients compared to the RTS model. Both models had good overall performance in prediction of mortality and poor outcome.

Correlation of Homocysteine with Cerebral Hemodynamic Abnormality, Endothelial Dysfunction Markers, and Cognition Impairment in Patients with Traumatic Brain Injury.

OBJECTIVE: This study aimed to assess any correlation between serum levels of homocysteine (Hcy) and markers of cerebral hemodynamics, endothelial dysfunction, and cognition impairment in patients with traumatic brain injury (TBI). METHODS: By a cross-sectional study, all clinical data and serum levels of homocysteine of 85 TBI patients were collected. The pulsatility indices (PIs) of the middle cerebral artery were recorded by transcranial color-coded Doppler ultrasonography and cerebrovascular reactivity was measured by the increase in middle cerebral artery flow velocity in response to 5% inhaled CO2. Serum levels of intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion molecule-1 (VCAM-1), cognition status by Montreal Cognitive Assessment, and Mini-Mental State Examination were measured in all participants. RESULTS: Totally, 85 patients including 51.76% male and the mean age of 54.48 years were studied. The level of Hcy in patients who died in the hospital or during 6 months after TBI was significantly higher than in survivors (P = 0.045, P = 0.020, respectively). Also, the levels of ICAM-1, VCAM-1, and PI in deceased patients were higher than their figures in survivors in both hospital and 6-month follow-ups (P = 0.450, P = 0.000; P = 0.072, P = 0.000, P = 0.090, and P = 0.000, respectively). Cerebrovascular reactivity in deceased patients was significantly lower than that in alive individuals (P = 0.008 and P = 0.000, respectively). A significant correlation was found between Hcy with cognition impairment according to Montreal Cognitive Assessment, Mini-Mental State Examination, and cerebral hemodynamic status according to PI (P = 0.000 for all). Also, this correlation was shown between Hcy with ICAM-1 and VCAM-1 in hospital and 6-month follow-ups (P = 0.000 for both). CONCLUSION: Hcy has a significant correlation with markers of cerebrovascular, endothelial, and cognition abnormality in TBI patients.