Background:Little is known about biomarkers which are used to classification of patients in order to diagnosis severity of sepsis among clients of emergency units. It seems that Lactate’s clearance can be used in this regard. This study aimed to determine the relationship between Lactate’s clearance, mortality and organ’s dysfunction with severe sepsis.Materials and methods:In this study 90 patients with severe sepsis, were visited and examined exactly. Para clinical tests, serum venous lactate, organ’s dysfunction scores, Acute Physiology and Chronic Health Evaluation II (APACHE-II) and Sequential Organ Failure Assessment (SOFA) were applied upon admission and 6 hours after it. According to clinical and laboratory criteria, dysfunction in main organs were examined and Lactate’s Clearance was accounted. All the patients were cured according to early goal-directed therapy protocol.Results:Among the participants 49 and 41 were male and female respectively. The mean age of the group was 49.37±1.41. The patients were classified to groups, less or more than 10% lactate’s clearance. Mortality rate of the patients was 18.9% (17 people). Mean age of the dead group was 49.71±13.33. The mean of dysfunctional organs which is assessed in terms of clinical, laboratory and SOFA criteria was significantly higher among the dead group than other. The Lactate’s clearance in the dead group was significantly lower than the other group (p<.05).Conclusion:It was concluded that patients with severe sepsis is a marker which is related to tissue hypoxia, also lactate’s clearance increasing is related to drastic reduction in biomarkers, mortality, and incidence of organ’s dysfunction. Overall, patients with lower lactate’s clearance are counted a high risk group for mortality and organs’ dysfunction.

and talebia@modares.ac.ir; * Corresponding author During a study on insect-associated heterostigmatic mites (Acari: Prostigmata) in southern Isfahan Province, Central Iran, two colonies of mites were found on Scarabaeus pius (Illiger, 1803) (Coleoptera: Scarabaeidae): Pavania lanceolata sp. n. Bahramian et Hajiqanbar (Dolichocybidae) that is easily discernible by some modified foliate setae on tarsi I-III; and Tarsopolipus massai Husband, 1989 (Podapolipidae) for which Scarabaeus pius is a new host record.

The aim of this study was to evaluate the effect of prescribing vitamin D on improving the symptoms of patients diagnosed with urosepsis. The participants were randomly divided into two equal groups (each consisting of 50 patients). The patients in the first group received standard treatment with 300 000 units of injected vitamin with a volume of 1 cc. As for the patients in the second group, they received standard treatment along with 1 cc normal saline injected to them as placebo. Vital signs of the patients were checked every 6 h, while their CBC, EXR, CRP, creatinine, urea, and uric acid were checked 0, 24, 48, and 72 h following the interventions. Calcium, phosphorus, and vitamin D levels were measured 72 h following injection of the medicine. A significant difference was observed between the two groups in terms of the number of WBC's in 24th, 48th, and 72nd hours. A similarly significant difference was reported between the case and control group in terms of the average BUN within 24th, 48th, and 72nd hours. The difference observed between the two groups in terms of average Cr within the 0th, 24th, 48th, and 72nd hours and in terms of days of hospitalization was also significant. Considering these results and keeping in mind the fact that no particular side effects were reported as a result of utilizing muscular injections of vitamin D and the easy and cheap use of this medicine, it can be used in auxiliary treatment of patients with urosepsis.

Myocardial infarction (MI) (i.e., heart attack) is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia) which accounts for a large number of deaths in the hospital. Diagnosis of myocardial infarction is confirmed based on clinical manifestations and electrocardiographic changes along with increased cardiac enzymes. Electrocardiogram (ECG) is one of the safest and easiest methods in the first place. Therefore, this study aimed to investigate the diagnostic value of standard electrocardiogram in the diagnosis of acute right ventricular infarction following lower cardiac infarction. This research was carried out at a time interval of one and a half years to diagnose acute primary infarction. In this method, the diagnostic value of ST↓ in lead I, ST↓ in lead aVL and I ST↓ + aVL, compared with ST↑ in lead V4R was investigated for diagnosis of right ventricular infarction. ST↑ in the lead V4R is a gold standard for the detection of right ventricular MI. All the patients who had the inclusion criteria were allowed to participate in the study. A total of 66 patients participated in the study. Accordingly, 58 (87%) were male and 8 (13%) were female. The mean age of the population was 54.9 ± 11.41. According to the ST↑ standard in lead V4R, 26 patients (39%) had right ventricular myocardial infarction. There was no significant relationship between angina pectoris and premature infarction (P-Value = 0.869). In this study, the right ventricular was most commonly involved in right coronary artery (RCA) (78%). There was no significant relationship between the occlusion of right coronary artery and right ventricular infarction in 60 patients (P-Value = 0.94). The results showed that electrocardiogram manifestations help determine the occlusion site and the area at risk (ST↓ in lead aVL and aVL + I, sensitivity = 96%). In myocardial infarction, symptoms such as the ST-Segment elevation in lead aVR and ST-Segment depression in the lower leads are possible. Accordingly, in the lower infarction, ST changes in the leads V1-V6 are helpful in detecting patients at risk. Thus, the use of electrocardiogram in acute myocardial infarction (AMI) helps detect more invasive patients and prevents extensive myocardial damage and other complications.

Chest pain is one of the most common reasons for admitting patients to the emergency room. The focus of the diagnostic process in chest pain patients at the emergency department is to identify both low and high risk patients for an acute coronary syndrome (ACS). Numerous risk prediction scores have been developed for fast and accurate risk stratification of chest pain in ED, like HEART score that a new ED Chest Pain risk stratification score. In this prospective cohort study, we aimed to evaluate efficacy of HEART score in prediction of 30 days major advanced cardiac events (MACE) in acute chest pain patients. A total of 100 unselected patients presented with acute chest pain at the cardiac emergency department of Emam Reza Hospital in Mashhad, from September 2015 until February 2016. The HEART score was assessed as soon as the first lab results and ECG were obtained. Endpoint was the occurrence of major adverse cardiac events (MACE) within 30 days. After 30-day follow-up, a total of 24 patients (24 %) reached one or more endpoints, AMI was diagnosed in 18 patients (18%), 2 patients (2%) underwent percutaneous coronary intervention (PCI), One (1%) had coronary artery bypass graft (CABG) surgery and 3 (3%) died. Independent predictors of MACE included age (P= 0.001). Hypertension was independent predictor of the combined end point only in female (P= 0.006). Age and troponin were independent predictors of the combined end point in both gender (Age P= 0.032 and Tpi P= 0.000). The average HEART score in the no end point group was 5.42 and in the patients with at least one end point was 7.42 (P=0.000). In low HEART scores (points 0-3), risk of MACE was 0%. In patients with HEART scores 4-6, MACE was diagnosed in 14.58%. In patients with high HEART scores (7-10), MACE occurred in 41.46%. In our study with increasing point of HEART score: sensitivity decreased, specifity increased and Positive predictive value increased.The HEART score helps in making accurate decisions at the emergency room without the use of invasive procedure. The HEART score is an easy, quick and reliable predictor of outcome in acute chest pain patients. It facilitates communication between doctors, especially when discussing the use of limited resources for chest pain patients. In this conditions who have higher HEART score points, choices may appear clear. This analysis suggests that HEART score can identify ED patients with acute chest pain for early discharge, as attention to high risk patients for admission for clinical observation, appropriate treatment including noninvasive testing and/or invasive strategies.