Mohammad Pishgahi; Seyed Mohammad Reza Nejatollahi; Fariba Ghorbani; Sadra Montazeri
Volume 25, Issue 9 , 2023
Abstract
Background: Although hypoalbuminemia is a well-known predictor of postoperative complications, including surgical site infection (SSI) and anastomotic leakage (AL) in gastrointestinal surgery patients, which requires necessary interventions before surgery, there is limited opportunity for preoperative ...
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Background: Although hypoalbuminemia is a well-known predictor of postoperative complications, including surgical site infection (SSI) and anastomotic leakage (AL) in gastrointestinal surgery patients, which requires necessary interventions before surgery, there is limited opportunity for preoperative optimization and intervention in emergency colorectal surgeries.Objectives: Therefore, this study aimed to assess the relationship between preoperative serum albumin levels and the development of SSI and AL in emergency colorectal surgery patients.Methods: In this cohort study, patients who underwent emergency colorectal surgery during 17 months, were assessed. Albumin level was measured before surgery, and patients were followed for 1 month after surgery to identify the development of SSI and AL.Results: In total, 173 patients were enrolled in the study, but data analysis was performed on 170 patients. They were divided into hypoalbuminemia group (n=98, 57.6%) and non-hypoalbuminemia group (n=72, 42.4%). The mean ages of patients in each group were 57.17±16.19 and 51.61±16.14 years old, respectively (P=0.028). The AL was observed in 4 (2.4 %) patients; 3 patients in the hypoalbuminemia group and one patient in the non-hypoalbuminemia group (P=0.205, relative risk=2.33, 95% CI: 0.42-12.82). The SSI was observed in 13 patients (7.6%) during the 1-month follow-up; 8 patients (5.1%) had superficial SSI and 5 (3.2%) had deep ones. Albumin level was significantly lower in patients with AL (2.9±0.48), compared to those without AL (3.6±0.7 g/dL). Moreover, albumin level was higher in patients with SSI (3.11±0.62), compared to patients without SSI (3.6±0.7 g/dL). The incidence of complications, either AL or SSI, was significantly higher in hypoalbuminemia patients, compared to non-hypoalbuminemia patients (P=0.017, Odds Ratio=4.24, 95% CI: 1.29-13.9). Adjusted OR for age was 3.82 (95% CI: 1.15-12.75, P=0.029); therefore, a 13.5% reduction in OR indicated that age is a confounding factor.Conclusion: Preoperative hypoalbuminemia was significantly associated with post-development of complications in emergency colorectal surgery and older age and lower preoperative albumin levels may serve as valuable indicators for the identification of patients at higher risk of complications.
Melika Esmaeili Nasab; Niusha Ansari; Sedigheh Galeshi; Fariba Ghorbani; Shadi Shafaghi; Masoud Shafaghi
Volume 25, Issue 2 , 2023
Abstract
Background: Interbody discs play a major role in maintaining the spine and skeleton structures which may undergo damage. If damage is so severe that the disc cannot be repaired, implants, known as "interbody cages", should be used.
Objectives: The present study aimed to propose a novel design with proper ...
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Background: Interbody discs play a major role in maintaining the spine and skeleton structures which may undergo damage. If damage is so severe that the disc cannot be repaired, implants, known as "interbody cages", should be used.
Objectives: The present study aimed to propose a novel design with proper strength and resistance against axial disc torques.
Methods: The design and analysis of innovative anatomical cages comprised two stages, namely, cage design according to three different models and finite element analysis (FEA). The designs were based on the spine of a 15-year-old teenager without lumbar disc disease. To model the vertebrae, computed tomography )CT( scans and Digital Imaging and Communications in Medicine (DICOM) files were entered into Mimics Version 10.01 (Materialise Inc., Leuven, Belgium); then, the L4 and L5 spinal segments were modeled.
Results: The implants were fixed to the bottom level and subjected to a net force of 1000 N. Additionally, a moment load of 7.5 Nm in flexion, extension, axial rotation, and lateral bending was applied in these three cage models. Considering the application of 1000-N force, maximum and minimum stress and strain distribution rates were presented in three honeycomb, Islamic architecture, and porous gyroid cages.
Conclusion: Novel designs for lumbar cages were considered to achieve damping capacity, light weight, and high resistance. Considering the characteristics of the honeycomb, Islamic architecture, and gyroid structures, optimal designs were proposed for lumbar cages to achieve adequate strength and resistance against axial disc torques under normal conditions.
Mojtaba Mokhber Dezfuli; Omid Mosafaeii Rad; Fariba Ghorbani; Behrooz Farzanegan; Elham Mir-Moeini; Mohammad Behgam Shadmehr
Volume 24, Issue 7 , 2022
Abstract
Background: Making decisions and planning about tracheostomy is not clear yet.
Objectives: This study aimed to report intensive care unit (ICU) admission, intubation, and tracheostomy rates among patients in different settings and compare the outcomes of surgical and Percutaneous dilational tracheostomy ...
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Background: Making decisions and planning about tracheostomy is not clear yet.
Objectives: This study aimed to report intensive care unit (ICU) admission, intubation, and tracheostomy rates among patients in different settings and compare the outcomes of surgical and Percutaneous dilational tracheostomy (PDT) techniques between COVID-19 and non-COVID patients.
Methods: Patients admitted to Masih Daneshvary hospital were assessed from February 2020 to May 2021 for intubation and tracheostomy rates. Different aspects and outcomes of two methods of tracheostomy, including surgical and PDT tracheostomy, were compared. Among non-COVID patients, 15 ICU admitted patients with different etiologies of pneumonia who required mechanical ventilation and tracheostomy were randomly selected and compared to COVID-19 patients.
Results: A total of 7,748 COVID-19 patients were admitted, with 12.7% admitted to ICU with an intubation rate of 5.13%. Tracheostomy was performed for a total of 36 patients (0.46%) for prolonged intubation with a trend of 0.1% to 1.45% in 16 months. Regarding the technique of tracheostomy, 24% and 33.3% of patients survived in surgical and PDT groups, respectively (P=0.44). Surgical tracheostomy and PDT were performed in 26.5% and 40% of non-COVID patients, respectively (P=0.5). The mortality rate was 72.2% and 20% in the surgical tracheostomy and PDT groups, respectively (P=0.003).
Conclusion: Given the study results, both surgical and percutaneous techniques are feasible for COVID-19 patients, and the decision about the optimal timing of intubation needs more inquiry.
Yazdan Abdolmohammadi; Mahla Nabi; Keihan Mostafavi; Mojtaba Mokhber Dezful; Seyed Mohammad Reza Nejatollahi; Fariba Ghorbani
Volume 24, Issue 3 , 2022
Abstract
Background: In our organ procurement unit, based on empirical evidence, the chance of turning a potential donor into an actual one is less than 30 percent and nursing plays a crucial role in this regard.
Objectives: We aimed to clarify nursing viewpoints and probe limitations that affect the organ donation ...
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Background: In our organ procurement unit, based on empirical evidence, the chance of turning a potential donor into an actual one is less than 30 percent and nursing plays a crucial role in this regard.
Objectives: We aimed to clarify nursing viewpoints and probe limitations that affect the organ donation process.
Methods: In this cross-sectional study, a self-constructed 28-item questionnaire including information regarding hospital characteristics, nursing attitudes, and level of knowledge was prepared. Our study population was all nurses who consented to fill in the questionnaire using the Quota sampling method.
After content validity, the questionnaire was circulated in cyberspace and the nursing society was invited to complete it. After one month, the response rate was 46 percent and the completed forms were analyzed.
Results: The majority of participants had not attended any organ donation training program (67%). Also, only 30% of nurses were aware of their crucial role in the donation process. In total, 61.7% of the participants had a high level of knowledge regarding brain death definition and donor maintenance. A positive attitude was observed in 59.1% of nurses with a significant difference in the high record of services (p=0.04). It was also, significantly higher in whom with the experience of working in private hospital (64% vs. 54%, p=0.05); hospitals with neurosurgery-ward (67.7% vs. 54.7%, p=0.01), transplant ward (67.4% vs. 54.9%, p=0.03). Attending training programs had a considerable impact (67.7% vs. 50.8%, p=0.03) but, being in ICU didn't affect nursing attitudes.
Conclusion: Hospital characteristics affect the nursing attitude toward organ donation and transplantation. It is recommended that all health staff obtain appropriate working experience in transplantation wards of the hospitals.
